Friday, July 22, 2011

The Google

I've just discovered this Stats application on Blogger. Who knew that it kept a record of all the Google searches that have lead people to my blog. The best one?

"Who let me into medical school?"

I don't know, but I think the same thing at least once a day.

Completely not okay

Seriously. It is way too hot. Although I totally deserve this because the Midwest has been having this kind of heat for the last couple of weeks while I've been going on about how nice it's been here with the 80 degree weather and the lack of humidity. 

Now it's so hot that staying outside one more second that I possibly have to makes me feel like killing anyone standing in the way of my air conditioned apartment, which is basically every stupid driver within a three mile radius. 

On a more medically related note, I had a patient yesterday who had a probable yeast infection. It didn't sound like it to me, but she was adamant that it was. The problem was she doesn't want him to do a swab, nor does she want him to even look down there. My attending tells her that the standard practice is to take a vaginal swab and culture it to confirm the diagnosis. The patient decides she wants the medication that treats a yeast infection instead. He tells her that he could prescribe it to her, but if it gets worse and she ends up in the ER, then they're going to do one there, and they're going to be pissed at him for not doing a culture. 

So she turns and looks at me and asks if I can do the swab since I'm female. Obviously I'm a much better actress than I give myself credit for because this woman must not realize that I have no idea what I'm doing! I want to tell her that somedays I can't even get the little plastic covers to stay on the otoscope when I'm trying to look into people's ears. I refrain imparting this bit of information

I, of course, am all for it because that'll be the closest I will get to anything even remotely resembling a procedure all month, but, alas, in the end she decided to just go with empirical antibiotic therapy.

Not that this is even a remotely complicated or dangerous procedure, but still. Two months ago I was sitting on my couch memorizing all the components of MEN syndrome and now the nurse keeps introducing me as "the doctor student," which makes me sound more competent than I truly am.

I think somebody needs to reexamine her priorities if she'd rather have the medical student do anything to her instead of the real doctor. Some guy in an ER once let me suture his face back together after I informed both him and the attending that I had never sutured anything before. I guess I should be glad that these people have some kind of inordinate faith in me because I sure as hell wouldn't. But to each his/her own, I guess.

Tuesday, July 19, 2011

The Doctor Is In

     I'm two weeks into my very first rotation. Family Medicine. Among the myriad of medical-ish things I've learned thus far, mostly I have learned that I'm not cut out for general medicine. Don't get me wrong, I'm loving this rotation, but I suspect that a good portion of that is due to the fact that I am no longer sitting in class (or sitting on my couch, as the case may be) and instead am finally seeing patients and practicing my doctor skillz. Really, proctology is better than the first two years of medical school.

    I enjoy talking to patients and listening to their stories, actually much more than I would have thought, given my misanthropic tendencies. I regret not being able to follow up on their progress, partially because I'm curious to know how the story ends medically, but mostly because I want to know how it turns out for them. Was this patient's fatigue caused by chronic Lyme? Was this kids unexplained weight loss just a simple parasitic infection, or something more worrisome? Will my patient every get his crippling anxiety under control so she get back to making her art? I guess the not knowing how the story ends is all part of being a medical student, even a resident. At the end of the month we move up and out, onto something new.

    I also like that 90% of the patients are more than happy to extend their visit by 10 minutes to allow the bumbling medical student a chance to see them before the real doctor comes in. I love when they wish me good luck in my journey of becoming a doctor. I get the sense that it's not a bother when I ask them a hundred questions only to have my attending ask them again five minutes later. There's almost a sense of pride that they were able to contribute to my education and to the future of the medical community.

    Here's what I don't enjoy: sore throats, ear pain, high blood pressure, and tick bites. These things are boring. Even the tick bites, which at least hold the promise of some kind of cool infectious disease (but rarely do). I cannot imagine spending the rest of my medical career treating these things. Thank goodness there are people that love treating these medical problems, because general practitioners are sorely needed. I don't want medicine to ever become boring, I want to wake up every day excited to go to work. I figure that's the least I can ask out of medicine after paying with my blood, sweat, tears, and about $200,000. If I'm already bored by the prospect of seeing another inflamed pharynx two weeks in, I won't be able to hack it for the rest of my natural life.

     So Family Medicine is looking like a no. But who knows, I still have another 6 weeks of it to change my mind. Maybe I'll get to diagnose someone with Ebola this week. Or at least get somebody with a positive strep test so I can put them on antibiotics.

     Best part of the rotation so far? (Besides having lunch provided by the drug reps every day) I saw a college student last week who came in complaining of a sore throat, a runny nose, and a cough. I did an H&P (history and physical) and was just about to leave the room to present to my attending when the patient asked me, "In your professional opinion, what's wrong with me?"

     Ha! My professional opinion! That is so cute. I wanted to say, "Can't you tell I've only been doing this  2 weeks and I have no professional opinion?" The only thing I've become professional at is saying "I don't know, but I'll look it up" whenever I'm asked a question. But half of being a medical student, I think, is pretending that you know what you're doing even when you have less than no clue, so I told her that I thought it was a virus, but that I was on my way to get the real professional.

Sunday, July 3, 2011

NYC take II

I've been trying to find a church around here, but the general impression that I'm getting of New Jersey is that they don't really like Protestantism. Or English speaking Protestants, at any rate. I was hoping that I'd be able to find a church within walking distance of my apartment, because walking to church sounds so quaint, and it means that I don't have to move my car.

Unfortunately the churches within walking distance are all 1) Catholic or 2) Protestant in Spanish or Arabic  or something equally as un-English (unhelpful, considering that I took French for 5 years and seemed to have retained only the ability to say my name and ask where the library is).

I found a church about 10 minutes away that looked decent so I went this morning. Or I tried to go. I swear. There wasn't a parking lot, so I spent 20 minutes trying to find street parking, but all the non-resident-only parking was full (of course).

So I apologized to God and decided that I'd go worship at the Church of American Consumerism instead, otherwise known as Wal-Mart. I plugged the address into my GPS and took off. I got about a mile down this highway-ish road that suddenly split off into two roads, but Judy the GPS didn't really think it was necessary to warn me that I needed to be in the far left lane on this 6 lane interchange thing. Needless to say, I was not in the left lane, or anywhere near it, and I ended up in the toll lane for the Lincoln Tunnel into NYC.

I sat in the stupid toll lane traffic trying to decide whether or not I was going to cry. The problem with not knowing where you're going in New Jersey, is that making mistakes is expensive. So I got to pay $8 for the privilege of driving under the Hudson River for two miles and ending up in Manhattan. I sat in traffic (at noon on a Sunday, seriously?) for 15 minutes until I could get myself back to the Lincoln Tunnel and back to Jersey. But, hey, I can now say that I drove in NYC and I didn't die, in fact, I mostly just sat at a complete stop and looked at all the really tall buildings.

And I won't be skipping church next week, that's for sure.

Toto, I don't think we're in Kansas any more...

I went into New York city today and walked around. I've never been before, and NYC looms so large in my mind as the biggest, brightest city on earth that it was almost a letdown to realize it is basically like every other big city I've visited. Almost...

Right out of the subway tunnel, there was a huge farmer's market and tons of people milling around in the amazing weather. Little old men were challenging passersby to play them in chess. A woman was sitting on the ground telling fortunes and reading tarot cards.

I walked around Greenwich Village, which has some of the most beautiful, old architecture. I love taking photos of old buildings, and I would have, had I not forgotten my camera. I'm clearly awesome at being a tourist. The camera on my phone had to be sacrificed in order to conserve the pathetic battery, because Judy the GPS needs a lot of energy to live and I never know where I am.

I also went to the Strand, the home to 18 miles of books, which made my inner nerd happy. And my outer nerd.

I met up with a couple of other Kirksville survivors and a couple of their friends for dinner and drinks. Everyone at the table, excluding myself and my roommate, graduated from KU, which meant the night quickly dissolved into arguments over whose state was responsible for the border skirmishes during the Civil War. Again with the nerdiness. There was also a lot of Rock Chalk Jayhawk chanting going on. I threw in an MIZ-ZOU chant, but really I have no school spirit, I was just feeling outnumbered.

So that is how the only picture I took on my first excursion into NYC ended up representing the Midwest...

The Enemy
I made it to New Jersey alive. My parents and I drove all my stuff here in a two day trip that was exactly like The Griswald Family Vacation if the Griswalds drove 16 hours in one day and were only allowed to stop 4 times.
When we made it to my apartment, my dad took one look around and immediately started campaigning for residencies as far away from the East Coast as possible. Well not quite, because that would mean the West coast, which is almost as bad.

I think the thing I was most worried about was going to be the driving. My roommate told me about the unofficial motto of New Jersey drivers, which is: one foot on the break, the other foot on the gas, one hand on the wheel, and the other hand flipping of the other drivers. I can safely say that this is a pretty accurate description.

New Jersey drivers (and I'm assuming most East Coast drivers) are like dogs: they can smell your fear. If you hesitate for even a fraction of a second and they'll start biting your heels  honking and using the shoulder to speed around you because your license plate says Missouri and obviously you are completely inept at life.

This works out well seeing as how I have no idea where I'm going. Other than attempting to drive in a large city while missing the gene that carries directional skills, driving here isn't too bad (granted I haven't actually been out during rush hour, so I'm holding judgement). People here are good drivers and they just kind of go, which in some ways makes it easier to drive here than St. Louis, where everybody must own stock in break pads given how much they enjoy using them.

The real problem here is parking. I park on the street outside my apartment and the street sweeper comes through four times a week and everyone has to go out and move their car from 10 to Noon . It sounds easy enough except I keep forgetting which side of the street has to move.

Yesterday I went out to check on my car only to see that it was the only one left on its side of the street. Not a good sign. So I run in and get my keys. When I went back out to move my car the meter maid that drives in front of the street sweeper, like the harbinger of death, was heading down the street. I made it to my car and drove off just as she pulled up to give me a ticket! Take that New Jersey Transit Authority. The good news is that this won't be an issue when I finally start working. The bad news is the first day I'm post call and I'm trying to sleep during the day I'm going to get a ticket.

Here's the other problem related to parking. I cannot parallel park. The only time I have successfully parallel parked was in the Drivers Ed car in high school. And that was only because there was a football player in the passenger seat telling me exactly what to do. I even failed that section of the driving test and the crazy DMV lady still passed me!

The people here are like parallel parking wizards. They can park in spaces that leave about 6 inches between each bumper. I don't even understand how they can pull out of spaces like that. I mostly just drive around until I can find a place where I can just pull straight in. I went to the library the other day, and after 10 minutes of driving around, it became very apparent that if I ever wanted to stop driving I was going to have to parallel park. So I drove around until there wasn't anyone driving up behind me because I did not need the extra pressure of some impatient person behind me (it's like vehicular performance anxiety). It took me 5 minutes and a 60-point turn to get into the space, but I finally made it.

Pictoral Evidence
I was still about 18 inches away from the curb. I got out of my car and there was this guy sitting on his porch laughing at me. Glad I could provide some entertainment for your smoke break, dude.

Do you think there are driving schools that offer remedial parallel parking?