This is what not-racism looks like

Thanksgiving vacation was great, except for the traveling parts. On the way to California, I missed my flight because of ridiculous near-misses on public transportation (the Staten Island ferry, then the subway). Actually, I didn’t even miss my flight; I got to the airport at 6:02 for a 6:30 flight. Had I been able to check in online and print out my boarding pass from the hospital, I probably could have edged my way through security and onto the plane, especially since I had only carry-on luggage. But, the hospital has recently shut down Internet access at all the computers I could find, even in the library. I found one computer that had access, but no printer. I even had a flash drive and saved my boarding pass as a jpg, meaning to print it from a different computer, but literally could not find a computer that would recognize my flash drive. When I asked the librarian what was going on, all she said was, “Oh, that’s been happening.” And that was it.

Sometimes I wonder what would happen if I acted in a similar way to my patients. You say that you’re passing out all the time? Well, that happens. You say you’re throwing up blood? Oh, I’ve heard of that. I love that other people are allowed to not care about things not working, but doctors are not allowed to not care about things not working in people. I mean, that’s the whole basis of medicine: things don’t work and somebody’s supposed to fix them. Actually, now it just feels like customer service, albeit customer service with 16-hour workdays and, you know, actual solving of problems.

Anyway, public transportation is not as awesome as people like to pretend it is, things don’t work at hospitals, and I missed my flight. Luckily, there was another flight 2 hours later, and I was able to get a seat on it for the low, punishing rate of $50. Whatever. At that point, I went to the airport bar to get chicken fingers and lots of beer.

On the trip back to the Big City, my mom packed my carry-on luggage with a lot of food. A LOT of food. The idea was that I would eat some of it over the next few days, and the rest would keep well in the freezer. But, since I was taking it all as a carry-on, I had to go through security. When my bag went through the scanner, they called for a bag check. Fine, whatever. I had 30 minutes before boarding began on my flight, so I wasn’t too worried. The TSA bag check guy, however, took his sweet time going through every container of food, and asking me what was in each container. It was taking forever, but I was still nice about it, since I was pretty sure nothing was over 4 ounces of liquid, and also, it was FOOD, and I was about to take out a plastic fork and encourage him to taste test everything if it meant he would stop pawing through my stuff.

The kicker came, though, when he kept saying, “I’m just doing my job, ma’am. I have to do this.” I was like, “I know, it’s fine, just please hurry because my flight is boarding soon.” Then he goes, “I promise you, this isn’t discrimination against you because of your race, and I’m not judging you for the food you eat.” And I said, “I didn’t even think of that until you said it.” And you know what? It’s true. I live in a privileged world where I don’t usually encounter racism or prejudice in the bad way. The worst that happens is that people assume I play musical instruments (which I do) and that I’m good at math (which I’m not). Nobody is actually outright racist, so I generally don’t assume people are being racist. (There is much more to say about latent sort-of prejudice, like when people ask me if I “eat Chinese food every night,” to which I reply, “Yes, but at home, we just call it ‘food,’ [you dumbass].”)

The TSA guy was so awkward, too. He kept putting containers to the side and telling me I could start to repack them in their plastic bags. Then when I would reach for the containers, he would suddenly decide I couldn’t touch anything yet until he was done. This happened twice. The TSA guy decided that one of the containers that had a meat sauce was “too much liquid” and was suspiciously cold for food. When I explained that it was frozen because a 5-hour flight with frozen meat sauce makes it less likely to spoil, he very patiently told me that “when frozen things melt, they turn into liquid.” GENIUS. He wanted to throw it away, but I asked if I could leave security to hand it over to my parents, who were on their way back to the airport after they called wondering if I was at the gate yet. By the way, when they called me, I asked if I could pick up my phone while he was still searching my bag. His response was something like, “Of course. Why wouldn’t you be able to?” Oh, I don’t know, maybe because you freak out anytime I do something besides sit in the chair with my hands in my lap.

The TSA guy then called over his supervisor, and he says this to him right in front of me: “She says all this food is just for her, but I don’t believe her. This is way too much food for just one person.” The mind reels with snappy comebacks and questions in response to that statement. 1) Really, it’s all just for me. I’m just a total foodie and a fatty, seriously. 2) There is this much food because my parents really, really love me. 3) Who else could it be for? The tiny kitten hiding in my pockets? 4) What awful things could I do to the other passengers? Feed them delicious homemade Chinese food? That would be a new breed of terrorist. 4) You’re just jealous.

In order to give my parents the “unsafe” food, I had to leave security and would have to go through the screening again. And when I said that I hoped it didn’t take too long, the TSA guy said, “You could throw the food away. I have people throw away stuff all the time,” as though that would make matters better. As I was finally allowed to repack my things, I was saying that I hoped I didn’t miss my flight because this TSA search had taken a good 30 minutes, and it was now 8:55 and my flight was at 9:25. This dipshit’s response? “Well, you were already late.” UM, NO. Showing up at 8:30 for a 9:25 flight when you have no luggage and have a boarding pass is not late, it is on time. AND YOU KNOW WHAT, you are not helping.

I repacked my bag, and he says, “Follow me out — I can’t touch your bag once you’ve repacked it.” I haul my suitcase off the table, and stand there waiting for him. He then says, “GO! You need to walk in front of me!” SERIOUSLY, WHAT THE HELL? It’s not that I can’t follow directions, it’s that I can’t follow directions that are exactly opposite of each other. Repack your bag, don’t touch your stuff; follow me, walk in front of me; you’re on time, you’re already late.

I don’t hate security measures. I don’t begrudge TSA for trying to make flying safer. I like that they screen bags and scan people. But I cannot countenance incompetence that is made to seem like my fault.

In the end, my parents met me curbside and I handed over the “unsafe” food. I went through security again, went to a different line, and that bag checker did not even stop my suitcase this time. She didn’t even blink. I boarded my plane as the last person on board, crawled into my seat, and passed out for 4 hours before landing in New York. The only good travel-related encounter I had happened at 6 AM at JFK, when the guy behind the ground transportation counter saw my reaction to the $55 flat rate for taxis to Manhattan, and came out to the curb to find me and tell me about $21 SuperShuttle rides, then escorted me back inside the airport, called the shuttle for me, and kept an eye out for the shuttle driver when she arrived. It was amazing: in that busy of an airport at that inhumane a time with my people skills completely depleted and brain cells nearly all comatose, something efficient happened. That guy totally deserves a gold star. I think I thanked him, like, 5 times.

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Psychiatry summary

I meant to write more last month when I was on my psychiatry rotation, so here’s a summary of those 6 weeks. Psychiatry felt a lot like being a camp counselor. It didn’t help that I didn’t wear my white coat, and instead had a long lanyard with my hospital ID, keys to the ward (it was a locked ward, you know), a pen, and a flash drive clipped onto it, and everything would jangle as I walked around on the psych unit. Oh, and I had a clipboard with notes in it, and one of my patients drew me pictures during an art therapy session, and I stuck the pictures in the outer window. Between the art groups, the recreational walks, and then interpersonal drama between patients, it was like camp for adults. Involuntary camp. With ID bracelets and big security guards watching your every move. But still, kind of like camp.

I had a patient who told me that the tv talked to him directly, that newscasters could see him through the tv, and then he confessed his masturbatory habits to me (it made me so uncomfortable that he, even through his social awkwardness and um, psychiatric psychosis, actually said to me, “I can tell I’ve made you uncomfortable, sorry,” and I was like, “UM… Yeah, okay, you’ve made me really uncomfortable, um… yeah.”). It was actually a hopeful story, because he responded really well to medications and psychotherapy, and was committed to continuing therapy, and had a family that was supportive, which are not things that other patients tend to have going for them. So, anyway, even though I had to sit through a really weird conversation about marijuana and masturbation, he ended up being one of my favorite patients on the rotation.

Only on a psych rotation can your patient tell you that he’s with the CIA and the Israeli government. Or, a patient can freak out on you and tell you she’s bisexual and wants you to hit on her. (That conversation, by the way, really did make me freak out until I told one of the nurses, and the nurse was like, “Oh honey, that’s just Janie* — she asks everybody that.” That was… oddly comforting.) I ended up liking psychiatry a lot more than I thought I would, as much as I feared I would, and now it’s on the short list of specialties that I would consider doing my residency in. Yikes. I have some issues with becoming a psychiatrist (mainly: the total lack of medical respect that other doctors give psychiatrists, and the idea of going to med school to become “just” a psychiatrist), even though pharmacological treatment of psychiatric diseases is a lot more medical/science based than I would have suspected AND treatment often involves the psychological and social aspects of patients and overlaps a lot with public health and public policy, and even law.

Psychiatry is just very exhausting, and moreso than in Internal Medicine or Ob/Gyn, you can’t always hold your patients accountable for their actions. Psychiatry can be even more paternalistic than Internal Medicine, given that the physician always has to maintain the therapeutic relationship and basically rise above any immature stunts or behavioral issues in order to preserve a good treatment relationship. And whatever the patient expresses is supposed to be encouraged so that we have an idea of what’s going on in their lives. And you know what, maybe I’m not a big enough person to rise above it and listen to some of my patients who cannot let shit go or stop being such whiners, and one day I would give in to the urge to yell, “OHMYGOD, WHATEVER, OKAY?” Maybe that’s one point for medicine — you don’t have to be exceedingly patient with people who just don’t get it, over and over. In Ob/Gyn, if your patient refuses to come in for pre-natal care, you don’t go find them and drag them into the hospital, and a lot of the time, the baby turns out okay anyway. In Internal Medicine, you try your best and at some point you can wash your hands of a competent adult patient, but in psychiatry, part of the reason these patients are in the hospital is because they literally are not allowed to make decisions for themselves and need people who won’t give up on them. So maybe what I’m saying is that I’d like to be a quitter. But then I think about how fun it was every day to go to work, to play mental chess with the overtly hostile patients, to talk with the cooperative patients who understood that psychiatric help is a type of healthcare need, to hang out with nurses who have seen and heard the craziest things, and I think maybe it’s worth it. And you know, the hours can’t be beat.

*Names changed to protect patients… and me.

Excuse me, your issues are showing

The things that people say or the way people react can give you little clues about what their lives are like. Sure, it’s possible that our conclusions are totally untrue and come from baseless extrapolation, but I prefer to think of it as secret peepholes into other people’s issues. Here, have some vignettes:

1. In our pharmacology lecture one day, Professor P started talking about the mechanism of action of Viagra. This was probably our 2nd or 3rd time learning the mechanism of action of Viagra, since starting med school. For some “unknown” [sacasti-quotes] reason, the professors in med school really love talking about how Viagra works and why it’s awesome. But Professor P’s quote during lecture really was the best of the bunch. Paraphrased, he basically said something like [you have to think of this being said in a Tennesseean, Al Gore-esque accent]: “Now, as men get older, the reproductive equipment doesn’t work as well as it used to. And it’s not anybody’s fault, it just happens, and it’s perfectly natural and Viagra really gives those people that function back.” Of course, those of us sitting in the audience (well, those of us who are awake) are a bit taken aback, and kind of looking down at our notebooks thinking, Um, awk-ward…

2. Last week in a lecture on psychotherapy, Dr. D started telling us about what couples therapy is. He says, “You would not believe the number of couples who do not have sex.” We’re nodding our heads in understanding and writing notes. He continues, “You would. not. believe. They are in committed relationships and they are partners, but when the lights go out at night, [sound effect that basically means, “nothing”].” We’re still nodding our heads, and he says one last time, “So many people. So many.” Gotcha, Dr. D. A lot of people, even the people we would least suspect. Ahem.

3. This week, one of my patients slapped another patient in annoyance and anger. My patient is a 30-year-old, autistic and mildly mentally retarded man who doesn’t actually have a mental illness, just difficulty coping with his emotions and expressing his feelings. In a sequence of events that feels like gentle irony, I ended up being assigned to this patient to work with him on verbally expressing himself, and helping him deal with feeling emotions in a healthy manner. I KNOW, you guys are totally laughing at the idea of me doing that, right? It’s like the blind leading the blind, you guys. Anyway, we were doing just fine, until I started talking to him about the difference between an “acceptable touch” and an “unacceptable touch,” meaning that hitting people in unacceptable, but shaking hands or high fiving is acceptable. And my patient says that hugging is also an acceptable touch. My response was, “Sometimes we have to ask permission to hug, before we just give a hug.” He didn’t understand and kept asking, “But WHY?” Without really thinking (but definitely in mild tones, because this guy is so sensitive I have to be really careful), I said, “Well, not everybody likes being hugged.” And he gave me this sideline look and said, “I am gonna hug you one day.” I’m a dead woman walking, you guys.

I know kung-fu

This is my favorite story from my Internal Medicine rotation, and it didn’t even happen to me. But, the hilarity and the moral of the story make it worthwhile to pass around.

The paramedics and EMTs often drive around our parts of the city, responding to calls or just looking out for people in trouble. One very hot mid-morning in July, they brought in an 80-something-year-old Korean man who we will call Mr. Kim (I never actually knew his real name). The EMTs found Mr. Kim looking unkempt and disheveled, diaphoretic (sweating), and leaning against a really fancy-looking apartment building. They brought him into the hospital, thinking he had dementia and heat stroke or dehydration. He had no ID or wallet, just a pair of keys. He spoke no English, only Korean. While in the ER, he kept trying to get off his bed and leave the hospital, and all he could say in English was, “I teach kung-fu!” All the doctors and nurses and ER techs were like, “Whatever, silly demented Asian dude who keeps trying to leave the hospital and doesn’t know what’s good for him,” and slapped on some arm restraints to keep him stuck to the bed. So, all afternoon he was sitting cross-legged and strapped to his ER bed, telling anybody who would listen that he taught kung-fu, and pantomiming random kung-fu movements at passers-by.

Finally, one of the interns on a different team was down in the ER to pick up his own new patient, and looked over and said, “Hey! That’s Master Kim! He taught me kung-fu when I was a kid!” Everyone went, “FOR REAL?!” And the intern said, “Oh yeah, he’s really famous — he teaches at West Point and stuff like that. His kung-fu studio is nearby. And actually, I think his apartment is close to here, too, because I went there once as a kid when he had a big party for our class.” So, of course, everybody is freaking out because maybe he’s not so demented and not so silly and didn’t need to be rescued.

Cut to a few hours later, when Mr. Kim’s daughter comes into the ER in search of him. She’d been looking all over town for him when he didn’t show up for his afternoon class at the kung-fu studio. She had called our hospital’s ER, but we didn’t have him listed as a patient because we’d spelled his name in some ridiculous way (this is the same hospital that misspelled my nametag two different ways, so it is not so surprising). She came in anyway, because she figured a name difficulty might have come up.

And the truth? The truth was, he had been disheveled and sweaty because he had just finished teaching his morning kung-fu class. That really nice building he’d been leaning against was his own apartment building. He couldn’t tell us any addresses because he just walked every day from his apartment building to his kung-fu studio and back. He had been trying to leave because he knew he had an afternoon class to teach.

The only thing that made it slightly less embarrassing for us and the profession of medicine was that he really was dehydrated on a disgustingly hot and humid day, and really did have some dementia that had gotten him in some trouble before. His daughter was very understanding and nice and our ER department was really apologetic, but still.

What I love most about this story is that he didn’t need us at all, but that health care people, in an act of hubris, patronizingly took him to the hospital to “protect” him and dismissed his talking as rambling crazy talk. This will forever be known as the time we kidnapped a patient from in front of his own apartment building, then restrained him when he rightly kept trying to leave. Whoops.

Psych out!

This post comes to you from scenic suburbia. For my 6-week rotation in psychiatry, I have temporarily relocated and I’m living in a sublet at a friend’s apartment, about 10 minutes away from the psych hospital.

The psych hospital is a separate building from the main hospital. It has its own ER, and 3 floors with 1-2 units each (for a total of 5 units). Since each adult unit can hold about 22 people, and each child & adolescent unit can hold about 16 people, that means the capacity of the hospital is approximately 98 people (not counting the ER, where people can supposedly languish for up to 3 days while waiting for a bed). That’s a pretty impressive number of people.

I am on unit B2, which is an adult unit. For good or bad, we do not rotate through different floors or units during our 6 weeks. Instead, the unit you get assigned to is the unit you stay with the entire team. Similarly, the two attending physicians you get at the beginning are the same ones for all 6 weeks. One of my attending physicians is Dr. D, the same person who ran the Behavioral Science course from my first year, and he’s now the clerkship director for the psychiatry rotation. This is… a mixed bag. On the one hand, I specifically chose this hospital to do my rotation because I’d learned so much during my first year. On the other hand, I really didn’t want to actually be on Dr. D’s unit — he expects a lot from his students. I didn’t want to directly work on his team — I just wanted to be adjacent to the team, and reap the benefits by being at his lectures. I mean, on the first day, Dr. D asked us what the definitions of psychosis and delusion were! The nerve! I don’t remember things I learned over a year and a half ago! I barely remember Internal Medicine, and that was 3 weeks ago! And now he expects us to read and learn and answer questions, God, I am so put upon. (Ha, now you all are hoping I don’t become your doctor in the future.)

So, obviously, the bad parts of being on Dr. D’s team have to do with being forced to learn and work, which is anathema to other students’ experiences on other psychiatry teams. The good part is that I will learn a lot of psychiatry. Dr. D truly loves his job, and basically spends those 6 weeks trying to convert people to psychiatry. Dr. D himself started out at an obstetrician/gynecologist, and then realized that he’d rather do psychiatry.

One point in favor of psychiatry? On Friday morning, we went to court! We had some patients who took us to court, to petition for release because they were being held involuntarily in the psych ward. Not to be mean, but some of the best times come from when patients prepare statements or speak out of turn, because then the judge gets to see just how RIDICULOUSLY CRAZY they are. For real, one of our patients prepared a long statement that started off with, “I am with the Israeli government. I am also with the CIA. I am a lawyer, and I taught special education for [redacted] County for 7 years.” The judge interrupted and said, “Wait a minute… the Israeli government and the CIA?” The patient said, “Yes.” And the judge, bless his heart, replied, “Okay.” The patient’s request to be released was, thankfully, not granted. Court was really, really interesting. It’s not so much that I love lawyers or confusing law-speak (sorry, Erika, but I do not), but rather that this specialty of health care interacts so much with other parts of the world. You have judges and lawyers and social workers and doctors and patients and their families and the police who maybe were called to the scene, all working together to try to help the patient. It’s enormously gratifying to be part of this overall plan, and not just work in a vacuum of the hospital, where we release our patients after they are mostly better and hope they continue to heal. I suspect, though, that the recidivism (is that even the right term? probably not) of our sicker patients is very high, and that this chronicity of mental illness would start to bring me down over the years.

Liar liar, pants on… Oh wait, nevermind.

During my Internal Medicine rotation, I had a patient who was picked up by EMS after he fell down and couldn’t get back up. He was pretty bruised and incoherent, so the ER people went through his bags and found discharge papers from a different hospital in New York, dated 2 days prior. The point of discharge papers from the hospital is to summarize why the patient was hospitalized, what was done (test, imaging, surgeries), what was found, and medications that the patient has to continue taking (and for how long). The patient gets a copy of their discharge summary and is supposed to bring it to their primary care doctor. (There are, of course, plenty of patients who don’t have the means to have primary care doctors or who have to use the ER as their primary care doctor, but that is a rant for another time.) The listing of the “admitting diagnosis” is generally listed in order of importance, and can contain other existing medical conditions. For example, if a patient came in for a heart attack, but also had pre-existing hypertension and then was found to have early type II diabetes mellitus and high cholesterol, all of those would be listed in the discharge summary after the diagnosis of a heart attack. My point is, other medical professionals (oooh, I just got a tiny thrill when I realized I am part of that group) read the discharge papers and depend on them as a succinct and honest summary of what happened.

So anyway, we read the discharge summary from the other hospital, and the leading diagnoses were “ethanol intoxication” and “mechanical fall,” which is just a fancy way of saying he was drunk and fell down. Well, that would explain the falling down and incoherence, right? It would be consistent with his liver function enzyme tests, which basically said that he had alcoholic liver disease and some liver failure. Because alcohol withdrawal can cause seizures, the ER is pretty aggressive about medicating any signs of alcohol withdrawal. So, they started this guy on a higher dose of medications, but it meant that he was even more out of it, and more incoherent. After a lot of time, we finally figured out what he was trying to say, which was that he was visiting New York from Scotland, and was trying to get in touch with old friends and family members he hadn’t seen in a long time. Further, he didn’t know where they were, or where he had been in the 2 days between when he was discharged from the other hospital and when he was brought to our hospital. Some of the details that he gave sounded pretty incredible, like how he used to be a musician in a band, and in the British Royal Navy after that as a longshoreman, and that he hadn’t seen these family members in over 30 years, and that he was friends with some kind of famous people. We asked if he had had any alcohol to drink, and he said no. But, given the discharge papers and his liver enzyme profile, we were kind of like, “Yeah, right,” and kept medicating like he would go into alcohol withdrawal.

A few days of treatment later, we tapered him off the medications and his speech cleared up. Once it cleared up, the patient was really able to give more details about where he’d been while in the US, and then gave us phone numbers so that we could check out his story with friends and family in Scotland. He also swore that he hadn’t had alcohol in two years, but did say that he used to drink “a lot,” which, in Scottish terms, must mean a LOT a lot. Anyway, I also called the other New York hospital and got in touch with the physician whose name was signed at the bottom of all the discharge papers. When I got him on the phone, I asked about the course of the hospital stay. The last question I wanted to ask was if the patient had actually come in with “ethanol intoxication” as the cause of his falls. And the physician was like, “Um. No.” I said, “Oh, really?” And he said, “Actually, we did a urine toxicology screen, and he was clean for everything; no alcohol, no drugs.” Understand that the discharge summary is not written until the day the patient leaves the hospital. So I said, “Well, then why did you write that the primary diagnosis was ethanol intoxication?,” which came out a bit rude, but I think a fair question, given that he flat-out said that they’d written a diagnosis that the patient didn’t have, and which also led us think that the patient had been lying to us for days.

We also finally got in touch with the patient’s friends, who told us the patient’s stage name from his days in the band. And lo, Google search turned up plenty of proof, including photos and interviews and discographies of the band. So, in the end, here was the tally:
1. Patient says he was in a band: true.
2. Patient says he hasn’t had anything to drink: true.
3. Patient says he is in town to see family and friends he has not seen in years: also true.
4. Patient says he is childhood friends with semi-famous actor: true, and they were raised in the same town.
5. Patient says he was a longshoreman: well, I stopped checking facts at this point, because he was up 4 points to our 0 points, and there was no way we were going to make up this deficit.

Anyway, the moral of this story is, people might lie about the little things, but I think they don’t tend to make up hugely untrue stories about who they are, and what they’ve been doing for the last 2 weeks. Maybe this way, I won’t get jaded about how “all patients lie” and will listen to their stories, no matter how outlandish the stories seem. But then again, my next rotation is in psychiatry, so perhaps not for this next set of patients who say they are Batman or psychically connected to Oprah.

My hypochrondriasis is incredibly prescient

Hey, remember when I told everybody that an insulinoma would explain my Insta-Bitch? Well, all that self-awareness made me actually pay attention to insulinoma as a disease, even though it is very rare. It paid off, though, because it was the answer on my exam last week! The question was a case presentation of a woman brought in by her friend, because the woman had been eating tons and gaining weight suddenly, acting generally irritated and anxious, and had a headache lasting weeks. I was reading it and not understanding what the question was trying to hint at, and thought, “Huh, that sounds like me when I’m hungry…. OH HEYYYY, insulinoma is an answer choice!” Very exciting. Good job, unfounded paranoia!

For the record, though, I did not see an insulinoma while on my Internal Medicine rotation. So really, the exam was not representative of my actual Internal Medicine rotation at a certain Big City Hospital. Had the test been truly representative, the patient in the question would have been a 50-something-year-old male, probably homeless, with hypertension or high cholesterol or poorly-controlled diabetes (or all three), current or former smoker/drinker, coming in for shortness of breath or chest pain after drinking all weekend/doing cocaine/losing his medications (all things that happened). It’s like a really tedious and frustrating game of Mad Libs.

It’s the end of medicine!

[This post goes out to Grace, who I probably scared when I simply messaged her, “NO MORE MEDICINE, WOOHOO!” on gchat, and then disappeared. I later got a message from her that said, “WAIT, are you quitting med school?!” No, I am not. I think this story illustrates a growing difference in our vocabularies. Med school is tearing me apart from real life and real English!]

This past weekend was the end of my Internal Medicine rotation, which was my first rotation in 3rd year. If you’re thinking, “Wow, I didn’t realize she was on the same rotation since July; that seems really long,” you’d be right. It’s friggin’ long. Internal Medicine is a 10-week rotation in 3rd year, and it’s the longest rotation we do as students (3rd or 4th year). In fact, it used to be a 12-week rotation (meaning three whole months, ack), but this year, the school shortened the rotation to 10 weeks, because students in the past had asked to have extra time to explore other specialties as 3rd year students. Our choices were really wide-ranging and exciting, but instead of seeing something that I probably wouldn’t end up choosing as a career (ie, radiation oncology or dermatology or preventive medicine (I didn’t even know what this was when we were ranking our choices, but NOW I find out it would have meant working with the New York Department of Health on outbreak investigations(!) and Adolescent STD Education, maaaaan that would have been SO COOL dang it)), I decided to really take a look at a field I have been interested in since 1st year: I’m doing my elective in radiology! It’s funny because I came into med school thinking I could do anything except radiology because I didn’t think I would be able to stand sitting in a dark room all day. Imagine my surprise during 1st year when I realized I really liked looking at films, and was clearly a visual learner. Radiology keeps jumping in and out of my Short List of Possible Specialties (it has always lived on the Medium List), so much that I’ve now nicknamed it “The Siren Song of Radiology,” because while the specialty appeals to me so much, but the competitiveness of the field and the very real possibility of having to move to some really faraway place (such as a Dakota!) for residency makes it seem like a pipe dream. Anyway, we will see how the next 2 weeks go. One point for radiology: I don’t have to start until 9 AM every day! That seems luxuriously late, after 10 weeks of getting to the hospital before 7 AM.

In any case, when I say that I’m done with medicine, I don’t mean that I’m dropping out of medical school. Within the medical field, the word “medicine” has a very different meaning. To the New Me, “medicine” and “medical” mean having to do with Internal Medicine, internists, and basically anything that doesn’t have a procedure involved with it. Think pills, not scalpels.

Though I’m finished with the rotation, I have so many stories that I have been meaning to write about. (To blog about? That phrase just seems so wrong for me to be saying about myself. Would that make me a… blogger? Uh, I just threw up in my mouth a little at the idea.) I’m thinking that I’ll take advantage of these next 2 weeks of easy-peasy 9-to-5 working to catch up on storytelling. Here’s a good one to end with for today: at the end of each rotation, we have to fill out evaluations. One of the questions asked how many hours we worked per week, not counting the hours we stayed VOLUNTARILY (the word was in all caps). This was problematic because we are often told that we can leave, but it’s not like I’m going to take off at 2 PM simply because my interns don’t know what to do with me. Similarly, I have been on call and told that I could leave if I wanted to, even though technically we are supposed to stay for the duration of call. It’s a sticky situation because I don’t want to appear as though I don’t care, but I am sure that if I played it right, I could have been out of the hospital by 4 PM most weekdays (which is the absolute minimum we are expected to stay, as dictated by the school, not by our residents or interns). Does that mean that any time I’ve spent after 4 PM is considered “voluntary”? Of course not. But it wasn’t all against my will, either. I ended up splitting the difference and estimating that I spent 10 hours a day on non-call days plus 14 hours a day on call days, plus 6 hours on Saturdays, which came out to a rough estimate of 65 hours a week. 65. That is bananas, you guys. I will now proceed to scoff at anybody who complains about a 40-hour workweek (including the Old Me from 2004-2006).

Self-diagnosis

Wow, I thought the paranoid self-diagnosing would stop after Boards, but that turned out to be false. I’m just using different books, now.

Things I’ve diagnosed myself with, using Step Up to Medicine
From the week of August 3, 2008.

Diffuse Esophageal Spasm
What: Uncoordinated spontaneous contraction of the esophagus, preventing or causing painful swallowing of food.
Why I totally had it: Sometimes when I swallow, food feels like it’s getting stuck, and then I get chest pain between the clavicle down to the sternum.
But actually: I really need to chew my food more thoroughly, and not inhale my food all at once.

Home is where the heart is (not really)

Today was a Sunday spent on call, which meant that I had a full day of work, plus on call duties (haha, I said “duties” — this will get funnier as I tell my story) until 8:30 PM. Whew. I came home so tired and hungry that I bought dinner at the first restaurant I saw after getting off the bus and ate it in 10 minutes at home.

One of my patients came in with anemia that had never been investigated, and the anemia was severe enough that they were thinking of transfusing her. One of the things to check when someone has anemia is to see if they are bleeding from the stomach or intestines. To test this, we do a stool guaiac test. To get stool guaiac, you either have to wait for the patient to have a bowel movement and go after the stools with a swab, or you do a digital rectal exam on the patient and then smear the gloved finger on the stool guaiac test paper. And by “you,” I mean the medical student; and by “the medical student,” I mean me. (Man, you guys are really wishing you’d never asked how med school was going, huh?)

I was reading the directions on the stool guaiac test kit, and noticed that the test kit was manufactured by Beckman Coulter, with an address in F——–, CA! How weird is that? This stool guaiac test kit came from the same enormous office building that I drove past twice a day, every day, on the way to and from high school for four years. I can totally picture the building now, in my mind. I think it’s now across the street from an Albertsons/Sav-on distribution center.

Awww. I guess this just means that no matter how far I go or how weird my life gets, my past homes are always right there with me. Sometimes covered in stool.

(By the way, gathering the necessary items for the stool guaiac test made my front left coat pocket home to a seriously weird collection of items: 4 vinyl gloves (I double-gloved for this), 2 packets of lubricant, 1 stool guaiac test kit, 1 reagent bottle, and stickers with the patient’s name and date of birth printed on them. Sometimes I feel like MacGyver. But with lube.)

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