Its been a little over one month since I started residency... Since then, I've learned a lot about nephrology, but not nearly enough to be considered confident/competent in the field, and not nearly enough to where I feel like I know enough for general pediatrics. I find myself constantly double guessing myself and questioning my knowledge base... Because lately, it seems minuscule.
I was reading another bloggy by a current medical student who talks about the difficulties of med school in real talk. None of the flowery garbage about how somethings are so inspiring, but she talks about it in a way that's realistic. I know what she is going through and although I could never eloquently describe how med school was affecting me, she's been doing that.
Basically, med school and medicine makes you question everything about yourself. I'm no different. I'm not sure if my pessimism is from constantly being beat down by exams or from breakups prior. I love medicine, but I don't like the feeling that I know nothing... When will this feeling go away? We are starting board review quizzes that are required every two weeks, and this week is on growth and development. They are requiring everyone to participate, from interns to seniors, and adding in a $100 prize for each resident per PGY year who scores the highest total score at the end of the year. I'm glad and mad because I've already given up and I've already assumed that it won't be me from the interns. Its a great tool to have since it requires us to start reading and preparing for boards early on. But, the incentive just makes me feel dumb.
I graduated top %5 of my high school class, somewhere at the top of my college class though I'm not certain where since they did not rank us, and I was used to making As and a few Bs. I cried if I ever made any Cs (I made 3 in my life prior to med school). Then came med school, and with all the smarter people in my class, I had to finally swallow the bitter pill that I'm just average. I've gotten pretty good evals from other people I've worked with like other residents and attendings, but I can't seem to shake off the feeling like I'm inadequate. I feel the same in residency. That I'm just an average intern. I want to "exceed expectations" and have people thinking wow, she's good. I kind of feel like I'm just trying to survive at this point.
And its only been one month.
Until the next one then.
Sunday, July 29, 2012
Wednesday, July 18, 2012
Difficult
Peds is hard. Not to mention hardcore. My head is spinning with everything that has happened to patients both medically and socially. I can't really say anything here for HIPPA and legal reasons, but man. I need a hug. Or maybe just my two days off this weekend. After Friday, I will have worked 12 days straight.
Tired!!
Until the next one then.
Tired!!
Until the next one then.
Wednesday, July 11, 2012
Drowning
I. am. drowning. with. work.
Not just actual work, but I just moved into my apartment closer to work and half of everything is still in boxes!! I am so tired when I get off work so all I end up doing is just eating and watching mindless television... Hells kitchen, Masterchef, sytycd, and whatever else I can find that's entertaining. I need to search for and read articles to actually learn something but I don't have Internet yet, and I forget to do it at work lol. My list of things that I want to learn and read about is steadily growing. But, I have been pretty good about keeping up with my work at work though. I hope I didn't just jinx myself!! :-/ My entire kitchen is in boxes. My living room has bags everywhere. My bedroom has clothes everywhere but I just hung up a lot of my clothes so hopefully I'm almost done with that room. I just need my dresser, sofa, and desk (that I'm going to use as a dining table since its huge). I just have a memory foam pad/mattress topper sitting in my living room that has served as my sofa and my bed this past few days. My bed is here and it's ready and I'm going to sleep on it and I'm super excited about sleeping on it since its actually a bed!!
But for realz, man, I have so much to do!!
And I start my continuity clinic tomorrow where I'm the PCP for the patients. Me. Woah. O_o
Until the next one then.
Not just actual work, but I just moved into my apartment closer to work and half of everything is still in boxes!! I am so tired when I get off work so all I end up doing is just eating and watching mindless television... Hells kitchen, Masterchef, sytycd, and whatever else I can find that's entertaining. I need to search for and read articles to actually learn something but I don't have Internet yet, and I forget to do it at work lol. My list of things that I want to learn and read about is steadily growing. But, I have been pretty good about keeping up with my work at work though. I hope I didn't just jinx myself!! :-/ My entire kitchen is in boxes. My living room has bags everywhere. My bedroom has clothes everywhere but I just hung up a lot of my clothes so hopefully I'm almost done with that room. I just need my dresser, sofa, and desk (that I'm going to use as a dining table since its huge). I just have a memory foam pad/mattress topper sitting in my living room that has served as my sofa and my bed this past few days. My bed is here and it's ready and I'm going to sleep on it and I'm super excited about sleeping on it since its actually a bed!!
But for realz, man, I have so much to do!!
And I start my continuity clinic tomorrow where I'm the PCP for the patients. Me. Woah. O_o
Until the next one then.
Tuesday, July 03, 2012
Tired...
One day off is like nothing... I don't feel like I had any time off. Fortunately, since tomorrow is July 4th and I'm on subspecialty service, I'll actually get to go home after a half day. I still have work to do tonight, like I have had every night. I'm sitting in the lounge waiting to checkout to the night resident but whoever is checking out right now is. taking. forever.
My mom is convinced that we can't find a boy for me because they all think I might be too smart for them since I'm a doctor working in the med center... Ohh lol, if they only knew what kind of idiot I really am. But it works for me actually... I have absolutely no time to maintain a relationship, much less start one from scratch. In a way, I guess *someone* did me a favor by making me so jaded and ending things when we did. I won't have time for anyone but my patients and myself for the next three years... At least thats the situation as I'm seeing it based on the past week...
Until the next one then.
My mom is convinced that we can't find a boy for me because they all think I might be too smart for them since I'm a doctor working in the med center... Ohh lol, if they only knew what kind of idiot I really am. But it works for me actually... I have absolutely no time to maintain a relationship, much less start one from scratch. In a way, I guess *someone* did me a favor by making me so jaded and ending things when we did. I won't have time for anyone but my patients and myself for the next three years... At least thats the situation as I'm seeing it based on the past week...
Until the next one then.
Sunday, July 01, 2012
One week!
So I've officially finished my first week of residency!! I still feel really stupid though... Hopefully that will change soon. I guess I just have to get used to all the protocols in place at the hospital and when reporting certain things...
What I learned in the past couple of days:
How to calculate fluid balance I'm a kid who's getting peritoneal dialysis
What day x of y antibiotics really means
The labs are sometimes forgets to update the culture results on our patients
If I drink iced tea at lunch, I'm energized enough for the afternoon
I'm a little more efficient than the ther intern. I think the difference between us is that he writes everything in paragraphs and I write a short assessment paragraph and bullet thr plan list. This seems more efficient and much easier to read instead of having to sift through all that text to figure put what we were planning on doing for that patient that day.
We are getting a senior resident to work with us starting tomorrow! I'm not sure whether or not that's a good or bad thing. We don't have many patients on our service and adding another res takes away from the learning side. But, it will help tremendously in clinic. Last week, we had so many patients in clinic that I was there until 7pm, and I didn't even get a chance to write my notes. So we will see tomorrow how that goes.
Let's go! Week 2!
Hopefully I can learn some medicine this week lol...
Until the next one then.
What I learned in the past couple of days:
How to calculate fluid balance I'm a kid who's getting peritoneal dialysis
What day x of y antibiotics really means
The labs are sometimes forgets to update the culture results on our patients
If I drink iced tea at lunch, I'm energized enough for the afternoon
I'm a little more efficient than the ther intern. I think the difference between us is that he writes everything in paragraphs and I write a short assessment paragraph and bullet thr plan list. This seems more efficient and much easier to read instead of having to sift through all that text to figure put what we were planning on doing for that patient that day.
We are getting a senior resident to work with us starting tomorrow! I'm not sure whether or not that's a good or bad thing. We don't have many patients on our service and adding another res takes away from the learning side. But, it will help tremendously in clinic. Last week, we had so many patients in clinic that I was there until 7pm, and I didn't even get a chance to write my notes. So we will see tomorrow how that goes.
Let's go! Week 2!
Hopefully I can learn some medicine this week lol...
Until the next one then.
Friday, June 29, 2012
Day 6
Its been almost a full week of residency... Kinda wild.
I've learned a lot of how to do things on the computer systems and how to discharge patients. I haven't done an admission yet so that will be another challenge.
I wake up everyday at 5:30am and I've been getting to the hospital just before 7am. It's not too terrible I guess, since I have 3 hours to do all my work before we round. Today I found out that we are rounding at 11 so I had an extra hour. I'm already done with all my notes and I've seen the patients and even assessed a low BP and bolused him and I discharged another patient all before 10:30. I shouldn't be too boastful since I only have two patients today lol. I'm kind of glad I'm starting out on a service like this one instead of something so much more intense. But at the same time, these patients are really sick and it's hard to figure out exactly what they need. I guess that's why we have a fellow to watch over everyone.
I can't say that I feel different though. I kind of feel like a med student at times who is only watching from the sidelines. Maybe it's because we don't get sign out in the morning for how our patients did overnight, and I have to guess based on what is in the computer or if the nurses are on top of it (and most of them are), then they'll tell me. I was really thankful when the might resident text paged me about what happened overnight with my patient. I wasn't completely in the dark that morning and I was able to get to him quicker than I normally would have. But I still feel really useless and like I'm not needed on this service. The fellows are really self sufficient and the nurses only call them. The night resident only calls them. Sometimes i think that it wouldn't matter if I actually came to work... I felt that way a LOT during med school and thought it would have gotten better in residency. But maybe it will, in the ER or inpatient ward months, where we would be responsible for a lot more, but who knows? For now, I'll just keep going and hope that I get better at this doctor thing.
Until the next one then.
I've learned a lot of how to do things on the computer systems and how to discharge patients. I haven't done an admission yet so that will be another challenge.
I wake up everyday at 5:30am and I've been getting to the hospital just before 7am. It's not too terrible I guess, since I have 3 hours to do all my work before we round. Today I found out that we are rounding at 11 so I had an extra hour. I'm already done with all my notes and I've seen the patients and even assessed a low BP and bolused him and I discharged another patient all before 10:30. I shouldn't be too boastful since I only have two patients today lol. I'm kind of glad I'm starting out on a service like this one instead of something so much more intense. But at the same time, these patients are really sick and it's hard to figure out exactly what they need. I guess that's why we have a fellow to watch over everyone.
I can't say that I feel different though. I kind of feel like a med student at times who is only watching from the sidelines. Maybe it's because we don't get sign out in the morning for how our patients did overnight, and I have to guess based on what is in the computer or if the nurses are on top of it (and most of them are), then they'll tell me. I was really thankful when the might resident text paged me about what happened overnight with my patient. I wasn't completely in the dark that morning and I was able to get to him quicker than I normally would have. But I still feel really useless and like I'm not needed on this service. The fellows are really self sufficient and the nurses only call them. The night resident only calls them. Sometimes i think that it wouldn't matter if I actually came to work... I felt that way a LOT during med school and thought it would have gotten better in residency. But maybe it will, in the ER or inpatient ward months, where we would be responsible for a lot more, but who knows? For now, I'll just keep going and hope that I get better at this doctor thing.
Until the next one then.
Tuesday, June 26, 2012
First few days...
So today is my third day of residency. I've already been sleep deprived for over a week, meaning that I haven't woken up past 7am in what feels like forever. Yesterday was a particularly brutal day, and it was what I was expecting an average day to be like. Sunday, my first day was nearly nothing. It just took me a long time to figure out how things are done here and what the computer system is like. Yesterday, I woke up at 5ish, got to the hospital around 6:30ish... I had to prepare for round and write my notes on my 2 patients, and I allotted an hour for each patient. Getting used to the EMR has been quite a challenge. Then after I finished preparing, we had a renal conference at 8:30 until 9:30. Rounds started at 10am so I still had 30 mins to get everything together. Then rounds were over at 11:30, and I had to go to noon conference and eat lunch at the same time... After that was done, we went to the renal clinic, where I worked until 6:30. Then i had to go sign out my patients to the ngt resident and tell them what to watch out for, and I had to write two orders for a patient after that. Whew, I didn't get home until 7:15.
Just writing about it makes me tired haha. I really liked clinic and writing notes and staying busy. I'm technically done for the day today but I can't leave until my attending does this teaching thing he suggested after rounds today, and he said we should meet at 3:30. Le boo. So I'm just hanging out waiting for something to happen lol. I'm going to go check on both my patients in a few minutes though even though I know one is fine and the other is probably still under anesthesia and probably in the PACU, and even though I really want to take a nap dice I just ate lunch.
Today, luckily I got to the hospital around 7 and was able to do some work before we got a page to go to Grand Rounds. What?! I had forgotten and almost freaked out bc I didn't think I'd be ready for rounds by 10. I'm glad I didnt just sleep in to aim to be at work at 8. Sad right? Sleeping in long enough to be here by 8? I'm so sleepy. I think I need to start drinking coffee again despite the fact that I've been getting 6-7 hours of sleep every night. Clearly, it's not enough... Totally going to bed at 9-9:30 again tonight.
Other than that, I'm taking it day by day and everyday I'm realizing how little I actually know. It's both humbling and anxiety provoking. I've been pimped more times these past three days than I have been in the past 10 months.
Things I've learned:
VACTERL Syndrome
Hypercalciuria causes micro stones that can lead to micro trauma of the ureters and persistent hematuria
The three organs involved in ARPKD and why they do bilateral nephrectomies in some patients
That renal patients have really bad bleeding problems bc of problems with their platelets and can be treated by DDAVP like in vWF disease.
Heel sticks are terrible for potassium levels.
Giving maintenance IV fluids in dialysis patients
How dialysis works
Calculating ins and outs in dialysis patients
Being scared about septic shock
What to do when NO ONE can get an IV in a dehydrated kid (in emergencies do an IO, but if non emergent then can do it through interventional radiology.
Hmm what else... I'm sure there was plenty lol.
Well I should go walk around a little and get my blood pumping a little bit before I pass out on the desk here.
I knew this app would be handy :)
Until the next one then
Just writing about it makes me tired haha. I really liked clinic and writing notes and staying busy. I'm technically done for the day today but I can't leave until my attending does this teaching thing he suggested after rounds today, and he said we should meet at 3:30. Le boo. So I'm just hanging out waiting for something to happen lol. I'm going to go check on both my patients in a few minutes though even though I know one is fine and the other is probably still under anesthesia and probably in the PACU, and even though I really want to take a nap dice I just ate lunch.
Today, luckily I got to the hospital around 7 and was able to do some work before we got a page to go to Grand Rounds. What?! I had forgotten and almost freaked out bc I didn't think I'd be ready for rounds by 10. I'm glad I didnt just sleep in to aim to be at work at 8. Sad right? Sleeping in long enough to be here by 8? I'm so sleepy. I think I need to start drinking coffee again despite the fact that I've been getting 6-7 hours of sleep every night. Clearly, it's not enough... Totally going to bed at 9-9:30 again tonight.
Other than that, I'm taking it day by day and everyday I'm realizing how little I actually know. It's both humbling and anxiety provoking. I've been pimped more times these past three days than I have been in the past 10 months.
Things I've learned:
VACTERL Syndrome
Hypercalciuria causes micro stones that can lead to micro trauma of the ureters and persistent hematuria
The three organs involved in ARPKD and why they do bilateral nephrectomies in some patients
That renal patients have really bad bleeding problems bc of problems with their platelets and can be treated by DDAVP like in vWF disease.
Heel sticks are terrible for potassium levels.
Giving maintenance IV fluids in dialysis patients
How dialysis works
Calculating ins and outs in dialysis patients
Being scared about septic shock
What to do when NO ONE can get an IV in a dehydrated kid (in emergencies do an IO, but if non emergent then can do it through interventional radiology.
Hmm what else... I'm sure there was plenty lol.
Well I should go walk around a little and get my blood pumping a little bit before I pass out on the desk here.
I knew this app would be handy :)
Until the next one then
Saturday, June 23, 2012
Shadowing...
Today, I went to the hospital to shadow the current renal team to try to get a feel of what the rotation will actually be like during rounds. The resident (now officially a second year), was sooooo helpful and told us how everything would be run. I'm a little les nervous now since I navigated to the children's hospital just fine. Let me tell you though, the med center is huge and the hospital is huge and I'm not very good with directions. Anyways, I think I'm most nervous about being able to write notes on the EMR since it's a system for notes that I'm not too familiar with. I guess I'm a little nervous about charting in general, and I hope I figure out how to get access to the EMR at home. That will e really helpful.
Well, let's see how tomorrow goes. It's officially my first day of work. Ever. My first real job. Eep.
Until the next one then.
Well, let's see how tomorrow goes. It's officially my first day of work. Ever. My first real job. Eep.
Until the next one then.
Friday, June 22, 2012
Testing the app
So I finally got around to downloading the app for blogger on my phone so I can post whenever, wherever and if I ever have time. I read a lot of reviews about the app, and they weren't very positive... I guess I'm not expecting much as long as its functional.
I'm attaching a picture of my new work out shoes to see where the pics get inserted in the post. But I love my work out shoes. They're so bright and colorful!
Until the next one then.
--//--Edit--//--
So clearly my pics get inserted at the bottom of the post. I guess I won't be putting pics up via phone then lol.
I'm attaching a picture of my new work out shoes to see where the pics get inserted in the post. But I love my work out shoes. They're so bright and colorful!
Until the next one then.
--//--Edit--//--
So clearly my pics get inserted at the bottom of the post. I guess I won't be putting pics up via phone then lol.
Testing
Typing on my iPhone... Just checking to see if this works. I'm about to download the app to see how it works too... If it works lol...
Im just sitting here at the main hospital orientation getting lectured about documentation, and I am being bored to tears. I know this is important but it's still boring and frustrating. The good news is that today is the last day of orientation!! However, that just means I will be starting work sooner :-/ and I'm starting on renal, a subject that I remember little about. I'm planning on reading my step 1 and step 2 books quickly this weekend just to refresh my memory.
You can call me Doctor, but I still don't know what I'm doing.
Maybe one day I'll figure it out, but for now, I'm starting to get more and more nervous...
Until the next one then.
Im just sitting here at the main hospital orientation getting lectured about documentation, and I am being bored to tears. I know this is important but it's still boring and frustrating. The good news is that today is the last day of orientation!! However, that just means I will be starting work sooner :-/ and I'm starting on renal, a subject that I remember little about. I'm planning on reading my step 1 and step 2 books quickly this weekend just to refresh my memory.
You can call me Doctor, but I still don't know what I'm doing.
Maybe one day I'll figure it out, but for now, I'm starting to get more and more nervous...
Until the next one then.
Wednesday, June 20, 2012
Gift basket!
Today's residency orientation to one of the hospitals I will be working at completely sucked the life out of me. So boring. So useless. I don't even think I remember anything that was told, and they lied to us and made us get there super early. I'm about to pass out on top of my laptop. I have the university orientation tomorrow, and I'm praying that its not nearly as boring. I think there will be a lot of down time though since we will have to be in line to set up our direct deposit/payroll stuff with the university so we can get paid... Money! Finally! But, not until the end of July... *headdesk*
So several weeks ago (maybe a month or two ago?), I posted about my new vanity basket and I promised that I would post pics of the basket I made for the high school graduate as a gift. Here it is:
My post is ultra short today because its time for me to sleep. I have to wake up tomorrow at 5am to be in the med school building at 7. Boooooo!!! On the plus side, I finally got information about what my first rotation will be like, but I'm still pretty nervous about starting as an intern on Sunday!! AhHhhHhhHhhh!! :-/
I think its finally starting to hit me now. I'm starting residency. I have an M.D. after my name. Woah.
Until the next one then.
So several weeks ago (maybe a month or two ago?), I posted about my new vanity basket and I promised that I would post pics of the basket I made for the high school graduate as a gift. Here it is:
 |
| Lots of sparkle! |
 |
| Bathroom survival kit for living in the dorms with community bathrooms at college! |
 |
| How I finally wrapped it |
I think its finally starting to hit me now. I'm starting residency. I have an M.D. after my name. Woah.
Until the next one then.
Tuesday, June 19, 2012
Sleepless Zombie
So even though I haven't officially started residency, I'm turning into a sleep deprived zombie that needs coffee in the mornings to wake up.
Oh noes! :(
I had given up coffee after my pediatrics rotation in third year, promising myself that I would sleep enough so I wouldn't need it. I was good until this week... I had coffee yesterday and today during my PALS training. Needless to say, I'm super caffeine sensitive now, and I felt likeI was tachycardic my heart was beating too fast all morning even though I knew to sip the coffee slowly. I'll have to work on figuring out how much coffee I really need in the mornings. Tonight, I will be going to sleep at 9 since I have to be at my next orientation event at 7am, which means I have to wake up at around 5am to get ready. Yikes.
But, I am now NRP and PALS certified! If there's a preemie being born that needs to be intubated, I'm your girl. If there's a kid in cardiac arrest, well, I'll probably panic first and then hopefully remember the protocol for resuscitation. I only did CPR practice for BLS training for a few minutes yesterday yet my hand feels like its completely bruised. Weaksauce. We'll see what happens if I ever have to do it for real.
Sooooooo I'm a zombie also because I don't think I've felt anything for like the past several months. Not happy, not sad, not angry about absolutely anything. And I really mean that I haven't felt anything about anything... including match day, graduation, starting residency, weddings, etc. The only thing I've felt was pride for a high school graduate who I consider to be my little sister, but is pride really considered an emotion? I've just been floating through everyday, keeping myself occupied with stupid things (facebook, tv shows, puzzles on my iPad, etc), or even just staring into space doing absolutely nothing. It comes off as being sleepy though, maybe just because I'm quieter than usual. I've been starting to think that there was something really wrong with me, until today. Unfortunately, as I was drivingto work to the hospital for today's orientation events, I saw a dog get hit by a car that was about 100 feet in front of me and something had snapped off the dog, but I'm not sure what it was though. I had to swerve to avoid running over the already injured dog. As I passed by, I could hear the dog whelping in pain. Geez, I felt something then. But it wasn't pretty.
Maybe I'm not an emotionless zombie afterall.
Until the next one then.
Oh noes! :(
I had given up coffee after my pediatrics rotation in third year, promising myself that I would sleep enough so I wouldn't need it. I was good until this week... I had coffee yesterday and today during my PALS training. Needless to say, I'm super caffeine sensitive now, and I felt like
But, I am now NRP and PALS certified! If there's a preemie being born that needs to be intubated, I'm your girl. If there's a kid in cardiac arrest, well, I'll probably panic first and then hopefully remember the protocol for resuscitation. I only did CPR practice for BLS training for a few minutes yesterday yet my hand feels like its completely bruised. Weaksauce. We'll see what happens if I ever have to do it for real.
Sooooooo I'm a zombie also because I don't think I've felt anything for like the past several months. Not happy, not sad, not angry about absolutely anything. And I really mean that I haven't felt anything about anything... including match day, graduation, starting residency, weddings, etc. The only thing I've felt was pride for a high school graduate who I consider to be my little sister, but is pride really considered an emotion? I've just been floating through everyday, keeping myself occupied with stupid things (facebook, tv shows, puzzles on my iPad, etc), or even just staring into space doing absolutely nothing. It comes off as being sleepy though, maybe just because I'm quieter than usual. I've been starting to think that there was something really wrong with me, until today. Unfortunately, as I was driving
Maybe I'm not an emotionless zombie afterall.
Until the next one then.
Thursday, June 14, 2012
Dr. Nads!
Graduation was about two weeks ago... Two weeks already!! I've been a doctor for two weeks!! And, I've been swamped since two days before graduation... There is just so much for me to do for orientation and the beginning of residency. Plus, my parents gave me a new toy for graduation so that has been keeping me occupied as well.
Residency will officially start in about 1.5 weeks, and I still have so much to take care of before Monday... There is just so many online training modules, resuscitation training (one day of neonatal and two days of pediatric) and pretests to be taken before the class, and in class EMR training. We had the departmental pediatric orientation on Tuesday and I think all I took away from it is that Blackboard is important and has everything that we will need on it. But we don't have access yet. I still have yet to find out what my exact schedule will look like for my first rotation, but all I know is that I'm on nephrology. Hopefully, I'll be free the weekend of the 30th and the 7th...
Crap. My six month long hiatus from anything medicine related makes me ask the question... What are the kidneys again??
I think I havea lot some quite a bit of reading and reviewing to do before I start :-/
Until the next one then.
Residency will officially start in about 1.5 weeks, and I still have so much to take care of before Monday... There is just so many online training modules, resuscitation training (one day of neonatal and two days of pediatric) and pretests to be taken before the class, and in class EMR training. We had the departmental pediatric orientation on Tuesday and I think all I took away from it is that Blackboard is important and has everything that we will need on it. But we don't have access yet. I still have yet to find out what my exact schedule will look like for my first rotation, but all I know is that I'm on nephrology. Hopefully, I'll be free the weekend of the 30th and the 7th...
Crap. My six month long hiatus from anything medicine related makes me ask the question... What are the kidneys again??
I think I have
Until the next one then.
Wednesday, May 30, 2012
Male or Female?
So going along with the post two days ago, here is a chest xray (from a google search) a lot worse than what I found... Seriously, this person's xray is making me cringe. I see at least 5 fractures on the left side of the picture (which is the right side of the patient), and all that cloudiness is probably fluid (blood) or contused lung parenchyma from a severe blunt trauma to the right side of the chest. No bueno.
Here's a normal chest xray of someone that I found on google images.
Now here's a question for you that my radiology professors asked us from my first year of medical school in anatomy class...
What sex is the patient in the second xray? And how can you tell?
Its actually really prominent and obvious in this picture, but I'll wait for someone to guess! :)
~~~~~~~~~~~~~~~~~~~~
COUNTDOWN TO GRADUATION: 3 DAYS!!
Here's a normal chest xray of someone that I found on google images.
Now here's a question for you that my radiology professors asked us from my first year of medical school in anatomy class...
What sex is the patient in the second xray? And how can you tell?
Its actually really prominent and obvious in this picture, but I'll wait for someone to guess! :)
~~~~~~~~~~~~~~~~~~~~
COUNTDOWN TO GRADUATION: 3 DAYS!!
Tuesday, May 29, 2012
Expiration Dates
I had a great weekend... Started off Friday night with catching up with really close friends. It was even more fun since we all haven't been in the same city at the same time with nothing to do in a while. Then Saturday afternoon/evening/night was my high school friend's wedding. They really knew how to throw a party, and I had soooo much fun even though I ended up getting a speeding ticket on my way to the wedding (ugh!). I needed all day Sunday to recover from the wedding. I finally have a new phone, and I jumped the iphone bandwagon. I got the white 32 Gb iphone 4s, and I actually like it a lot. It really easy to use and figure out, and I'm loving the battery. I got really fed up with my Android phone that wouldn't last the whole day even if I didn't use it. Now, I'm just waiting on my case to get here before I can breathe easy haha. I've been treating it like its a fragile egg.
Anyways, at the wedding, my friends from high school and I were *finally* shocked to realize that someone who was so close to us got married when so many of us still don't feel like we're 26/27. I know don't feel that way. I think it hit a lot of them that woah, when did we grow up?? We're not teenagers anymore! I know several of my high school friends have no interest in settling down until they reach 30. I don't think I have a certain age where a switch is suddenly turned on where I'd settle for anyone. But, I'm pretty sure I don't think I want to settle down for at least a while... Whether that's a year or three years, I don't know. All I know is that I want to focus on residency instead of looking for someone to get married to. I wish everyone would respect and understand that.
I love being South Asian, but I also hate our culture sometimes. I hate the fact that my entire life I've been taught that education is the key to everything and boys/boyfriends are frivolous (and bad/sinful) while growing up. So I never once let boys distract me from my path to my career. Sure, I liked guys and gushed over who was hot and who was not and who was sweet or what my dream "type" of guy would be, but I never made acting upon all that a priority, and I never pursued anyone. When I was graduating high school, I thought that I would meet someone and everything would just magically fall into place and I'd be married by age 25. Things haven't happened the way I've wanted them to, and 25 seemed old to the 17 year old me. I bumped into the four relationships (only one serious one though) that I've been in on accident. I really believed that *someone* and I were meant to be... But he didn't feel the same way about me at all. I know this because he wouldn't have run away when the parents gave him an ultimatum (commit to get engaged or else), and he wouldn't have suddenly, magically remembered his life long dream of pursuing medicine after years of being in the business world at around the same time, which also happened to be the ultimate deal-breaker for me. But my point was that I've never actively pursued anyone. I've only been pursued... and then dumped. If I could go back in time and talk to the 17 year old me, oh the things I would tell her and warn her about. I'd tell her to focus on school and career like my parents emphasized, but my reasoning would be that she can only ever count on herself and to never become emotionally dependent on a boy.
Once I became of "acceptable marrying age," which to my parents seemed to be 23ish after my first year of med school, they asked me to flip the switch and find someone to get married to. asap. I hate the entire half-arranged marriage process that we're supposed to go through if we can't find and bring someone acceptable to them. It was not that bad in the beginning just because I was so busy studying that I didn't care, but slowly, its gotten worse and worse. Before it was just asking around friends of friends about anyone they knew who would be looking and exchanging pictures... When that failed, it became the damn matrimonial website, which my parents put me on without my permission... That hasn't produced any results either, and now its some random lady who has a matrimonial service for the area we live in. Ugh.
Through all of that, I basically feel like I'm being pimped out and being put on sale by my parents. I feel like I have no value as a person through these processes, and no one cares. The mothers who are looking for someone for their sons only have a checklist that says, "young, tall, slim, beautiful" with an occasional "professional degree" thrown in the mix. I'm so tired of it. My parents are having a harder and harder time trying to find a guy (any guy!) for me, and I'm losing interest in the idea of settling down. I'm almost 27, which in our culture is almost the end of my "viable shelf life"... Meaning that I'm about to "expire"... Meaning that I'm only a few years away from being too old to be suitable for marriage anymore. And as my age keeps creeping up, my parents are getting more and more desperate.
But honestly, I'd much rather just focus on something that I know will be happening for me, like residency. I don't want to waste time focusing on or thinking about something so abstract, fickle, and unreliable as love, relationships, or marriage. Its not worth it, and eff it, I'm almost a doctor.
Until the next one then.
~~~~~~~~~~~~~~~~~~~~
COUNTDOWN TO GRADUATION: 4 DAYS!!
Anyways, at the wedding, my friends from high school and I were *finally* shocked to realize that someone who was so close to us got married when so many of us still don't feel like we're 26/27. I know don't feel that way. I think it hit a lot of them that woah, when did we grow up?? We're not teenagers anymore! I know several of my high school friends have no interest in settling down until they reach 30. I don't think I have a certain age where a switch is suddenly turned on where I'd settle for anyone. But, I'm pretty sure I don't think I want to settle down for at least a while... Whether that's a year or three years, I don't know. All I know is that I want to focus on residency instead of looking for someone to get married to. I wish everyone would respect and understand that.
I love being South Asian, but I also hate our culture sometimes. I hate the fact that my entire life I've been taught that education is the key to everything and boys/boyfriends are frivolous (and bad/sinful) while growing up. So I never once let boys distract me from my path to my career. Sure, I liked guys and gushed over who was hot and who was not and who was sweet or what my dream "type" of guy would be, but I never made acting upon all that a priority, and I never pursued anyone. When I was graduating high school, I thought that I would meet someone and everything would just magically fall into place and I'd be married by age 25. Things haven't happened the way I've wanted them to, and 25 seemed old to the 17 year old me. I bumped into the four relationships (only one serious one though) that I've been in on accident. I really believed that *someone* and I were meant to be... But he didn't feel the same way about me at all. I know this because he wouldn't have run away when the parents gave him an ultimatum (commit to get engaged or else), and he wouldn't have suddenly, magically remembered his life long dream of pursuing medicine after years of being in the business world at around the same time, which also happened to be the ultimate deal-breaker for me. But my point was that I've never actively pursued anyone. I've only been pursued... and then dumped. If I could go back in time and talk to the 17 year old me, oh the things I would tell her and warn her about. I'd tell her to focus on school and career like my parents emphasized, but my reasoning would be that she can only ever count on herself and to never become emotionally dependent on a boy.
Once I became of "acceptable marrying age," which to my parents seemed to be 23ish after my first year of med school, they asked me to flip the switch and find someone to get married to. asap. I hate the entire half-arranged marriage process that we're supposed to go through if we can't find and bring someone acceptable to them. It was not that bad in the beginning just because I was so busy studying that I didn't care, but slowly, its gotten worse and worse. Before it was just asking around friends of friends about anyone they knew who would be looking and exchanging pictures... When that failed, it became the damn matrimonial website, which my parents put me on without my permission... That hasn't produced any results either, and now its some random lady who has a matrimonial service for the area we live in. Ugh.
Through all of that, I basically feel like I'm being pimped out and being put on sale by my parents. I feel like I have no value as a person through these processes, and no one cares. The mothers who are looking for someone for their sons only have a checklist that says, "young, tall, slim, beautiful" with an occasional "professional degree" thrown in the mix. I'm so tired of it. My parents are having a harder and harder time trying to find a guy (any guy!) for me, and I'm losing interest in the idea of settling down. I'm almost 27, which in our culture is almost the end of my "viable shelf life"... Meaning that I'm about to "expire"... Meaning that I'm only a few years away from being too old to be suitable for marriage anymore. And as my age keeps creeping up, my parents are getting more and more desperate.
But honestly, I'd much rather just focus on something that I know will be happening for me, like residency. I don't want to waste time focusing on or thinking about something so abstract, fickle, and unreliable as love, relationships, or marriage. Its not worth it, and eff it, I'm almost a doctor.
Until the next one then.
~~~~~~~~~~~~~~~~~~~~
COUNTDOWN TO GRADUATION: 4 DAYS!!
Saturday, May 26, 2012
Chest X-Ray ABCs
If you haven't noticed by now, I've been trying to do a post-a-day thing with my graduation countdown at the bottom. Its been kind of hard keeping up with it sometimes.
I leave you with the following story from the night shift on my ER rotation during the first half of my fourth year.
Night shifts were always rough for me. I didn't really have a problem going on nights after working days since I'm naturally a night owl, and I'm able to stay up until about 2am before I really crash. To prepare for those long night shifts, however, I'd sleep a lot during the day. Like until 4pm when staying in bed any longer made me feel pretty gross about myself. Shifts were 12 hours long for both days and nights (duh!), but day shifts just flew by. The ER would be slammed with patients all day, and there was never a shortage of things that needed to be done or patients to be seen. The beginning of the night shift would start out really busy but the incoming patients would taper off around 2 or 3am, and stay relatively slow until the shift was over at 7am. It could get really really boring. I would read books, read articles that were homework, and text *someone* nonstop during the night. The slow ER is what bored me to tears. Sometimes even reading my book was boring...
One patient who came in was a supposedly drunk middle aged lady, who also supposedly had some mental handicaps. The specifics of what that might have been was unclear. She came in reeking of alcohol, and complaining about pain on the left side of her chest. All she was able to tell us was that she had fallen... When or where or how was a mystery. She didn't have the capacity to accurately answer our questions. On exam, she was extremely tender on the left side of her chest. She screamed and nearly jumped off the stretcher when we tried to palpate the area. I felt really bad for this lady though. Instead of only having one or two sets of hands pushing around in the painful area, she had like four people examine here -- the nurse, me the med student, the medicine resident, and the ER faculty. Because she was such a poor historian, everyone else was inclined to think that she was either faking or just wanted to have a safe place to sleep for a few hours. I wasn't so sure. I thought she had a rib fracture, but the intern disagreed only because of her poor history giving skills.
However, since a lot of medicine is all about covering your butt, they still ordered a chest xray (which is what I was pushing for too). There is a separate radiology department for the ER where there is an upper level resident or maybe even faculty who reads all of the imaging studies that have been ordered for the entire ER. There is also a special computer in the ER physicians' office where all of the imaging studies can be pulled up for review by the physicians and students in the office. We got the official report as dictated by the radiologist, who read the chest xray as normal. The ER attending barely glanced at the chest xray itself and nearly discharged the patient with orders to take ibuprofen for the pain. Now, since I had a strong suspicion of a rib fracture and because I like looking at xrays (and CTs and MRIs lol), I went over the xray very systematically and very slowly.
They teach the ABC method of looking at xrays:
A - airways (midline, patent?)
B - bones (fractures or lytic lesions?)
C - cardiac silhouette (normal? appx half of the chest width?)
D - diaphragm (flattened or elevated? symmetric? air under it?)
E - edges of the heart (well defined or not to rule out any fluid in the lungs)
F - fields (lung fields well inflated? any effusions, infiltrates or nodules?)
G - gastric bubble (present?)
H - hilum (nodes or masses?)
I - presence of any instruments? (ET tubes, central lines, NG tubes, etc)
[I had to look up each letter and what it meant. I'm usually good with A-D and F]
I didn't have to go through it very far. I was checking her bones, and I followed each rib on the left side from the vertebrae until it disappeared (this is where the bony part of the ribs are attached to the cartilage of the ribs which is then attached to the sternum). And guess what I found?
Two rib fractures in ribs 6 and 7 on the left side... That both the radiologist and my ER attending missed. I stopped my attending from discharging the patient so fast by saying, "Dr so and so, I think she has two rib fractures here!" He double checked what I found, told me I was correct, and then called the radiologist to change his note. That conversation went something like... "Dr radiologist, this is Dr So and So, I'm calling in regards to Ms Chest Pain. My medical student pointed out that she has two rib fractures on the left side..." [it would have been much cooler if he called me his "astute medical student" though.]
I don't want to sound cocky, but I was really proud of myself that day. I figured out a differential diagnosis based on her history and exam, and it happened to be what was on the top of my list. More importantly, I helped a lady be diagnosed correctly and get discharged with actual pain medications instead of just ibuprofen. Unfortunately though, there's not much that can be done for rib fractures other than to let them heal on their own and to provide pain relief in the mean time.
My concern is that the ER attending, radiologist, and the medicine resident who were working that night all missed it. They all have many many years of more experience in both treating patients and reading xrays than me. How did this happen?! I want to give them the benefit of the doubt and say that they were tired and in a rush, and the rib fractures were really subtle. So if someone were to glance at it quickly, then they would probably overlook it. I was actually looking for rib fractures because I really believed that's what had to be wrong. However, even then, I think someone should have seen the fracture first. If you're working the night shift, I feel like you should be prepared and awake... The med student shouldn't be catching their mistakes. Thoughts?
Until the next one then.
~~~~~~~~~~~~~~~~~~~~
COUNTDOWN TO GRADUATION: 7 DAYS!!
I leave you with the following story from the night shift on my ER rotation during the first half of my fourth year.
Night shifts were always rough for me. I didn't really have a problem going on nights after working days since I'm naturally a night owl, and I'm able to stay up until about 2am before I really crash. To prepare for those long night shifts, however, I'd sleep a lot during the day. Like until 4pm when staying in bed any longer made me feel pretty gross about myself. Shifts were 12 hours long for both days and nights (duh!), but day shifts just flew by. The ER would be slammed with patients all day, and there was never a shortage of things that needed to be done or patients to be seen. The beginning of the night shift would start out really busy but the incoming patients would taper off around 2 or 3am, and stay relatively slow until the shift was over at 7am. It could get really really boring. I would read books, read articles that were homework, and text *someone* nonstop during the night. The slow ER is what bored me to tears. Sometimes even reading my book was boring...
One patient who came in was a supposedly drunk middle aged lady, who also supposedly had some mental handicaps. The specifics of what that might have been was unclear. She came in reeking of alcohol, and complaining about pain on the left side of her chest. All she was able to tell us was that she had fallen... When or where or how was a mystery. She didn't have the capacity to accurately answer our questions. On exam, she was extremely tender on the left side of her chest. She screamed and nearly jumped off the stretcher when we tried to palpate the area. I felt really bad for this lady though. Instead of only having one or two sets of hands pushing around in the painful area, she had like four people examine here -- the nurse, me the med student, the medicine resident, and the ER faculty. Because she was such a poor historian, everyone else was inclined to think that she was either faking or just wanted to have a safe place to sleep for a few hours. I wasn't so sure. I thought she had a rib fracture, but the intern disagreed only because of her poor history giving skills.
However, since a lot of medicine is all about covering your butt, they still ordered a chest xray (which is what I was pushing for too). There is a separate radiology department for the ER where there is an upper level resident or maybe even faculty who reads all of the imaging studies that have been ordered for the entire ER. There is also a special computer in the ER physicians' office where all of the imaging studies can be pulled up for review by the physicians and students in the office. We got the official report as dictated by the radiologist, who read the chest xray as normal. The ER attending barely glanced at the chest xray itself and nearly discharged the patient with orders to take ibuprofen for the pain. Now, since I had a strong suspicion of a rib fracture and because I like looking at xrays (and CTs and MRIs lol), I went over the xray very systematically and very slowly.
They teach the ABC method of looking at xrays:
A - airways (midline, patent?)
B - bones (fractures or lytic lesions?)
C - cardiac silhouette (normal? appx half of the chest width?)
D - diaphragm (flattened or elevated? symmetric? air under it?)
E - edges of the heart (well defined or not to rule out any fluid in the lungs)
F - fields (lung fields well inflated? any effusions, infiltrates or nodules?)
G - gastric bubble (present?)
H - hilum (nodes or masses?)
I - presence of any instruments? (ET tubes, central lines, NG tubes, etc)
[I had to look up each letter and what it meant. I'm usually good with A-D and F]
I didn't have to go through it very far. I was checking her bones, and I followed each rib on the left side from the vertebrae until it disappeared (this is where the bony part of the ribs are attached to the cartilage of the ribs which is then attached to the sternum). And guess what I found?
Two rib fractures in ribs 6 and 7 on the left side... That both the radiologist and my ER attending missed. I stopped my attending from discharging the patient so fast by saying, "Dr so and so, I think she has two rib fractures here!" He double checked what I found, told me I was correct, and then called the radiologist to change his note. That conversation went something like... "Dr radiologist, this is Dr So and So, I'm calling in regards to Ms Chest Pain. My medical student pointed out that she has two rib fractures on the left side..." [it would have been much cooler if he called me his "astute medical student" though.]
I don't want to sound cocky, but I was really proud of myself that day. I figured out a differential diagnosis based on her history and exam, and it happened to be what was on the top of my list. More importantly, I helped a lady be diagnosed correctly and get discharged with actual pain medications instead of just ibuprofen. Unfortunately though, there's not much that can be done for rib fractures other than to let them heal on their own and to provide pain relief in the mean time.
My concern is that the ER attending, radiologist, and the medicine resident who were working that night all missed it. They all have many many years of more experience in both treating patients and reading xrays than me. How did this happen?! I want to give them the benefit of the doubt and say that they were tired and in a rush, and the rib fractures were really subtle. So if someone were to glance at it quickly, then they would probably overlook it. I was actually looking for rib fractures because I really believed that's what had to be wrong. However, even then, I think someone should have seen the fracture first. If you're working the night shift, I feel like you should be prepared and awake... The med student shouldn't be catching their mistakes. Thoughts?
Until the next one then.
~~~~~~~~~~~~~~~~~~~~
COUNTDOWN TO GRADUATION: 7 DAYS!!
Thursday, May 24, 2012
Why Breakups* Suck.
*especially the ones that end in heartbreak!
Going along with my last post which was the more rational medicaly/doctory side of me, is this post which is the less-rational-girl-who's-recently-been-dumped-again side of me.
- Pain. To say that it hurts would be putting it lightly. When you really think you're meant to end up with someone, only to have them walk out on you, it completely shocks and then it crushes you and rips you apart. Ugly crying is a distinct possibility here, and for some people, its a certainty.
- Self pity. Everyone has a phase of crying/being sad/moping around the house feeling sorry for themselves. Its probably the ugliest stage, even more hideous than the ugly crying. This is when people let themselves go completely for any given time, refuse to shave, rarely shower, etc as seen on tv. Its when you don't want to look nice for anyone. You want to stay in your nastiest pair of sweats all day listening to sad break up songs and watching romantic comedies and wondering why those happy endings are never seem to happen to you.
- Declining self esteem. A lot of it is based on not understanding what happened or how things went wrong, only to assume that it was your fault even if in reality, it wasn't. You start to think that there's something terribly wrong with you, that you're not pretty enough, not skinny enough, not smart enough, not desirable enough, not lovable or wantable enough. That list can go on and on. And that sort of thinking damages you. Its not healthy, but its inevitable. It doesn't matter how much your friends try to cheer you up or try to convince you other wise, in your head, you know best. And you think you're right and will always be right. You think that no one will ever want to be with you ever again, and you shut out everyone else who tries to help you.
- Then after all that, you reach a certain calm level of sadness. You've accepted that the two of you aren't meant to be, but you're also feeling your lowest about yourself, and you've convinced yourself that he/she has probably moved on by now since there's no possible way they'd be feeling this bad. They were the dump-er (no poop jokes please!), and you were the dump-ee. They must be happier without you since this is what they wanted. Its a resignation of well, life keeps going on, work keeps going on, family continues to need you, etc. The pain is dull here, but still deep and fresh enough to where you occasionally cry yourself to sleep at night. It might have been something you saw, perhaps driving by the place you first spent a whole weekend together, or something you remember, perhaps the first time you told them how you felt with the L word, or it might just be that time of the month and your hormones are kicking your emotional side into overdrive. You're still able to socialize like a normal person and smile, laugh, and joke around, but that pain is still in there. You feel it, but no one else can see it.
- Occasionally there's anger towards the other person and all happy couples. I think the anger towards the other person is self-explanatory and makes complete sense. When you've been snubbed, your knee jerk reaction might be to push the other person away even farther. Or revenge. It just depends on they type of person you are. But every one of your non-single friends will keep spouting the same garbage about how "everything happens for a reason" and "he wasn't the one" and "it just wasn't meant to be for the two of you" and "stop whining and get over it already" and "you'll find your soul-mate soon, look how quickly I found mine!" Seriously? Dear friends in happy relationships, don't give advice to your newly single friends even if they are your best friends. They do not want to hear it. Its not helpful right after a breakup. You should ease into it a little while later. All your heartbroken friend needs is comfortable silence, a shoulder to cry on, and an open environment so if he/she says, "I miss him/her, and I want him/her back," you won't interject with a giant, "ITS OKAY. HE WASN'T THE ONE. EVERYTHING HAPPENS FOR A REASON, AND I KNOW YOU'LL MEET THE GUY/GIRL OF YOUR DREAMS ONE DAY." Its not helpful. Trust me.
- Faith in love is destroyed. You (the dump-ee) start believing that love doesn't exist. That its a delusion shared by two people (also known as a shared psychotic disorder in psychiatry, fyi). You stop thinking that everyone ends up marrying their soul-mates. You start to question whether or not soul-mates even exist. You promise yourself you won't ever be fooled again. That you won't let a smile or a hug or a kiss melt your heart even a little ever again. Its too risky to become vulnerable. Then finally you convince yourself you're better off alone than ever risking your heart like that ever again. Because pain like that shouldn't ever happen to anyone more than once.
Until the next one then.
~~~~~~~~~~~~~~~~~~~~
COUNTDOWN TO GRADUATION: 9 DAYS!!
Going along with my last post which was the more rational medicaly/doctory side of me, is this post which is the less-rational-girl-who's-recently-been-dumped-again side of me.
- Pain. To say that it hurts would be putting it lightly. When you really think you're meant to end up with someone, only to have them walk out on you, it completely shocks and then it crushes you and rips you apart. Ugly crying is a distinct possibility here, and for some people, its a certainty.
- Self pity. Everyone has a phase of crying/being sad/moping around the house feeling sorry for themselves. Its probably the ugliest stage, even more hideous than the ugly crying. This is when people let themselves go completely for any given time, refuse to shave, rarely shower, etc as seen on tv. Its when you don't want to look nice for anyone. You want to stay in your nastiest pair of sweats all day listening to sad break up songs and watching romantic comedies and wondering why those happy endings are never seem to happen to you.
- Declining self esteem. A lot of it is based on not understanding what happened or how things went wrong, only to assume that it was your fault even if in reality, it wasn't. You start to think that there's something terribly wrong with you, that you're not pretty enough, not skinny enough, not smart enough, not desirable enough, not lovable or wantable enough. That list can go on and on. And that sort of thinking damages you. Its not healthy, but its inevitable. It doesn't matter how much your friends try to cheer you up or try to convince you other wise, in your head, you know best. And you think you're right and will always be right. You think that no one will ever want to be with you ever again, and you shut out everyone else who tries to help you.
- Then after all that, you reach a certain calm level of sadness. You've accepted that the two of you aren't meant to be, but you're also feeling your lowest about yourself, and you've convinced yourself that he/she has probably moved on by now since there's no possible way they'd be feeling this bad. They were the dump-er (no poop jokes please!), and you were the dump-ee. They must be happier without you since this is what they wanted. Its a resignation of well, life keeps going on, work keeps going on, family continues to need you, etc. The pain is dull here, but still deep and fresh enough to where you occasionally cry yourself to sleep at night. It might have been something you saw, perhaps driving by the place you first spent a whole weekend together, or something you remember, perhaps the first time you told them how you felt with the L word, or it might just be that time of the month and your hormones are kicking your emotional side into overdrive. You're still able to socialize like a normal person and smile, laugh, and joke around, but that pain is still in there. You feel it, but no one else can see it.
- Occasionally there's anger towards the other person and all happy couples. I think the anger towards the other person is self-explanatory and makes complete sense. When you've been snubbed, your knee jerk reaction might be to push the other person away even farther. Or revenge. It just depends on they type of person you are. But every one of your non-single friends will keep spouting the same garbage about how "everything happens for a reason" and "he wasn't the one" and "it just wasn't meant to be for the two of you" and "stop whining and get over it already" and "you'll find your soul-mate soon, look how quickly I found mine!" Seriously? Dear friends in happy relationships, don't give advice to your newly single friends even if they are your best friends. They do not want to hear it. Its not helpful right after a breakup. You should ease into it a little while later. All your heartbroken friend needs is comfortable silence, a shoulder to cry on, and an open environment so if he/she says, "I miss him/her, and I want him/her back," you won't interject with a giant, "ITS OKAY. HE WASN'T THE ONE. EVERYTHING HAPPENS FOR A REASON, AND I KNOW YOU'LL MEET THE GUY/GIRL OF YOUR DREAMS ONE DAY." Its not helpful. Trust me.
- Faith in love is destroyed. You (the dump-ee) start believing that love doesn't exist. That its a delusion shared by two people (also known as a shared psychotic disorder in psychiatry, fyi). You stop thinking that everyone ends up marrying their soul-mates. You start to question whether or not soul-mates even exist. You promise yourself you won't ever be fooled again. That you won't let a smile or a hug or a kiss melt your heart even a little ever again. Its too risky to become vulnerable. Then finally you convince yourself you're better off alone than ever risking your heart like that ever again. Because pain like that shouldn't ever happen to anyone more than once.
Until the next one then.
~~~~~~~~~~~~~~~~~~~~
COUNTDOWN TO GRADUATION: 9 DAYS!!
Wednesday, May 23, 2012
Bereavement vs Heartbreak
While I was on my psychiatry rotation, I had a lot of difficulty discerning the difference between normal bereavement (grieving from a death) and adjustment disorder caused by a heartbreak. Everyone laughed at me and only gave me the explanation that death is so much worse. Umm, yeah I understood that, but my point was that patients suffering from both will have similar symptoms, and I also argued that in both, there's a loss of someone in your life and you still go through all the stages of grief to get over it.
Denial - "This can't be really happening."
Anger - "Why did this have to happen to me?! Its not fair!"
Bargaining - "I'll do anything to have more time with you. Just come back to me."
Depression - "What's the point to life without that person? Who cares?"
Acceptance - "I guess I'll be okay, and there are things to look forward to without that person here."
Maybe it all just seemed too similar for me for my exams. I'm sure DSM-IV (the psych book of diagnostic criteria for every disorder) probably is more specific, and I honestly don't remember what it said. Those books are still sitting in my med school apt. However, all I remember is being really really confused since almost everything going on in a person's head is the same in both.
Maybe this is why I'm not cut out for psych. Too many shades of gray when it comes to people and their psychiatric well being. Who's to say going through the bereavement like states isn't normal for a person who had their heart crushed? There's just so much overlap. I guess I like a lot of things with clear cut answers. History of alcohol abuse and LFTs elevated over 500? Acute alcoholic hepatitis. Done. TSH has sky rocketed through the roof and you're cold, constipated, and balding? Hypothyroidism. Done. Right lower quadrant belly pain, nausea, vomiting, fever, constipation? Appendicitis, let's get you into CT and then surgery. Done. Everything in psych is so fluid and even the criteria can be bent a little. Differential diagnoses are often listed as "rule out _____ disorder," and often times, there's not really a test that can be done other than watching and waiting to see how long these symptoms continue. I didn't like that. So I decided no psychiatry for me even though it was really interesting.
Until the next one then.
~~~~~~~~~~~~~~~~~~~~
COUNTDOWN TO GRADUATION: 10 DAYS!!
Denial - "This can't be really happening."
Anger - "Why did this have to happen to me?! Its not fair!"
Bargaining - "I'll do anything to have more time with you. Just come back to me."
Depression - "What's the point to life without that person? Who cares?"
Acceptance - "I guess I'll be okay, and there are things to look forward to without that person here."
Maybe it all just seemed too similar for me for my exams. I'm sure DSM-IV (the psych book of diagnostic criteria for every disorder) probably is more specific, and I honestly don't remember what it said. Those books are still sitting in my med school apt. However, all I remember is being really really confused since almost everything going on in a person's head is the same in both.
Maybe this is why I'm not cut out for psych. Too many shades of gray when it comes to people and their psychiatric well being. Who's to say going through the bereavement like states isn't normal for a person who had their heart crushed? There's just so much overlap. I guess I like a lot of things with clear cut answers. History of alcohol abuse and LFTs elevated over 500? Acute alcoholic hepatitis. Done. TSH has sky rocketed through the roof and you're cold, constipated, and balding? Hypothyroidism. Done. Right lower quadrant belly pain, nausea, vomiting, fever, constipation? Appendicitis, let's get you into CT and then surgery. Done. Everything in psych is so fluid and even the criteria can be bent a little. Differential diagnoses are often listed as "rule out _____ disorder," and often times, there's not really a test that can be done other than watching and waiting to see how long these symptoms continue. I didn't like that. So I decided no psychiatry for me even though it was really interesting.
Until the next one then.
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COUNTDOWN TO GRADUATION: 10 DAYS!!
Tuesday, May 22, 2012
My New Vanity Basket
So I'm tired of all the cheap-o bathroom stuff I've had for the past 4 years. My set was a $10 one from Ikea that I don't even like very much. I only bought it because it was cheap. I want to change things up for my new apartment. The great thing about my new bathroom is that the tub has a sliding glass door, so I don't need a shower curtain! This is so exciting to me since I hate when the water leaks out from around my shower curtain, onto the floor, soaking whatever bathroom mats I might have. The other great thing about my new apartment's bathroom is that there is sooo much counter space! The sink is connected to the counter, but it forms an "L" shape to the right of the sink. Essentially, one entire wall of the bathroom is counterspace! There's even space under the counter to put a little vanity chair/stool. I'm super excited about the bathroom. Since I don't need a shower curtain, all I really need is the bathroom accessories set...
I started off with all of those items that I found for less than $10 at the craft store. The big satin rose was on clearance for $1, and the fancy sequined ribbon was for 50% off for $2, so I saved maybe $4. With my hot glue gun from 7th grade and a small tube of super glue in hand, I turned all of that into this:
 |
| Picture taken with basket on the back surface with the rose on the front surface facing the light |
And like this (from another angle):
It looked pretty great without the rhinestones, but I wanted to give it some element that would make it look like it matched the bathroom set. I found some really nice bath rugs that are the same shade of blue as my basket this past weekend, and now all I need are matching blue towels. Now everything matches!
By the way, this is NOT the bathroom that my new vanity basket is going to live in. I won't be moving there until the first week of July.
This entire project took me about two hours from start to finish. I have absolutely nothing to do, so this provided me with some distraction from everything going on in my head and around me. Loved doing it. What do you think?
Since I have an additional purple basket that I'm making into a gift basket for someone for graduation, I'm thinking of doing a similar, simpler, an even more girly design (read: lots of hot pink and flowers) for her since she's still a teenager. I don't have supplies for it yet, but it will give me something to do! I'll post a pic once I'm done with that one.
Until the next one then.
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COUNTDOWN TO GRADUATION: 11 DAYS!!
Monday, May 21, 2012
Always Wash Your Hands
In medicine, they teach you to become germophobes and be aware of handwashing techniques. Its for a good reason too. Not only will you be preventing the spread of certain diseases and bacteria/viruses, but most importantly, you'll be protecting yourself against being exposed to things that you shouldn't be. The simplest way they teach to to do that is by washing your hands. Before you see a patient. After you see a patient. Before procedures. After procedures. After you blow your nose. After you watch a patient cough into their hand and then proceed to shake your hand. After touching questionable doorknobs in clinics. The list goes on and on.
In the real world, every clinic I have worked at has had antibacterial hand gel sanitizer dispensers outside of every patient room. So before entering, I'd gel it up, and after I'd leave, I'd gel it up again. It became a habit. I'd only wash my hands in the room with the patient after examining diabetic feet (ewwwwww, its one of the reasons I'm not going into adult medicine), examining someone sweaty (eww again), or doing a procedure of some sort. Anyways, I use hand sanitizers all the freakin time. Even when I'm not in clinic or at the hospital, I'll feel better after I've cleaned my hands.
Sometimes, I'm acutely aware of which part of my hands have touched something "dirty" that now has to be sanitized. I think that hyperacuity comes with being trained in working with the sterile technique, where everything blue (or green depending on the hospital) can't be touched by anything unsterile. I learned to watch myself and all parts of myself to prevent contaminating any sterile field. Plus, I got yelled at by the scrub techs a couple of times while I was on surgery. All of those things together made me hyperaware of what I've touched and what needs to be washed.
In the exam environment, usually with the med school's OSCEs (Objective Structured Clinical Examinations) and even the USMLE Step 2 CS (Clinical Skills), washing your hands is usually the last thing on your mind, but its the easiest way to gain points (or lose points depending on which way you look at it). I know for a fact during my 3.5 years of med school when we had OSCEs, I'd always have to consciously remember to walk into the SP's room and wash my hands at the sink first. (SPs are standardized patients, basically actors hired by the school to memorize a script and only answer to what we students ask.) It made introductions really awkward, but it was the only way that evaluators could see that yes, we actually wash our hands before every patient we see. The CS exam is the OSCE of all OSCEs, and it counts as one of our board exams that we absolutely have to pass to be licensed. There are 11 patient encounters for 20 minutes each (I think?) and then 10 minutes between each encounter to either answer questions or write a clinic note. That was a really high pressure exam, and it moved very very quickly. Even as a germophobe and all the hand cleaning habits I formed, I forgot to wash my hands before THREE patient encounters. Oh. My. Gosh. I nearly panicked once I realized what I forgot and I prayed that I wouldn't fail just because of that. Thankfully, I remembered to wash my hands inside each room for each encounter after that, and thankfully I managed to pass! :)
I realized later why I kept forgetting........ I hadn't taken an OSCE in over 9 months, and there were no hand sanitizer dispensers outside the rooms, and that's where my habit bit me in the butt. These exams are really not representative of what we do normally, but they need a standardized exam to put us all somewhere on some vague scale. All that matters is that I passed.
Until the next one then.
~~~~~~~~~~~~~~~~~~~~
COUNTDOWN TO GRADUATION: 12 DAYS!!
In the real world, every clinic I have worked at has had antibacterial hand gel sanitizer dispensers outside of every patient room. So before entering, I'd gel it up, and after I'd leave, I'd gel it up again. It became a habit. I'd only wash my hands in the room with the patient after examining diabetic feet (ewwwwww, its one of the reasons I'm not going into adult medicine), examining someone sweaty (eww again), or doing a procedure of some sort. Anyways, I use hand sanitizers all the freakin time. Even when I'm not in clinic or at the hospital, I'll feel better after I've cleaned my hands.
Sometimes, I'm acutely aware of which part of my hands have touched something "dirty" that now has to be sanitized. I think that hyperacuity comes with being trained in working with the sterile technique, where everything blue (or green depending on the hospital) can't be touched by anything unsterile. I learned to watch myself and all parts of myself to prevent contaminating any sterile field. Plus, I got yelled at by the scrub techs a couple of times while I was on surgery. All of those things together made me hyperaware of what I've touched and what needs to be washed.
In the exam environment, usually with the med school's OSCEs (Objective Structured Clinical Examinations) and even the USMLE Step 2 CS (Clinical Skills), washing your hands is usually the last thing on your mind, but its the easiest way to gain points (or lose points depending on which way you look at it). I know for a fact during my 3.5 years of med school when we had OSCEs, I'd always have to consciously remember to walk into the SP's room and wash my hands at the sink first. (SPs are standardized patients, basically actors hired by the school to memorize a script and only answer to what we students ask.) It made introductions really awkward, but it was the only way that evaluators could see that yes, we actually wash our hands before every patient we see. The CS exam is the OSCE of all OSCEs, and it counts as one of our board exams that we absolutely have to pass to be licensed. There are 11 patient encounters for 20 minutes each (I think?) and then 10 minutes between each encounter to either answer questions or write a clinic note. That was a really high pressure exam, and it moved very very quickly. Even as a germophobe and all the hand cleaning habits I formed, I forgot to wash my hands before THREE patient encounters. Oh. My. Gosh. I nearly panicked once I realized what I forgot and I prayed that I wouldn't fail just because of that. Thankfully, I remembered to wash my hands inside each room for each encounter after that, and thankfully I managed to pass! :)
I realized later why I kept forgetting........ I hadn't taken an OSCE in over 9 months, and there were no hand sanitizer dispensers outside the rooms, and that's where my habit bit me in the butt. These exams are really not representative of what we do normally, but they need a standardized exam to put us all somewhere on some vague scale. All that matters is that I passed.
Until the next one then.
~~~~~~~~~~~~~~~~~~~~
COUNTDOWN TO GRADUATION: 12 DAYS!!
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