Splice

Happy Halloween!

Hate my life

Wow, I had forgotten how much I absolutely hated my third year surgery rotation.

Except, it feels like I'm right back on it again. I'm on my ICU month, and the 8-ball rolled against me, and I got placed in the SURGICAL ICU.

I didn't think it would be that bad. But I forgot that I'm working with surgeons. Who don't smile. Who think that students are merely there for scutwork, not teaching. Who think that students merely get in the way.

And I had gotten used to nice medicine residents. Nice medicine attendings. Residents and attendings who want to help the students. Teach us.

Adding surgeons to my fear of ICU machines? I'm bound to fail.

My ICU attending (or should I call her my trauma surgeon attending?) makes us prepare presentations. And we gave our first presentations this morning. I dunno about you, but when I think of presentations, I think of handouts and imparting clinical pearls and key facts about the topic to the group at hand in a tidy 3-5 minute presentation. Apparently, per my attending, presentations mean that we read about the topic, and she grills us until she's satisfied that we did enough research and reading. So really, today was just a giant pimp fest. And I still have no idea about any anything my fellow students presented -- or rather, were supposed to present. Wow, I learned so much today.

My chief resident just likes to tsk tsk at us. The list wasn't updated? Tsk tsk. But sir, we updated the information on our patients. How about everyone else? ...But we don't know what's new with them. Tsk tsk. I especially loved how he rolled his eyes at us when we told him we had to go to class. A mandatory one at that.

I just spent a month being a sub-intern. I'm used to being in charge, getting to make decisions, learning, and feeling like an integral part of the team. But it looks like I need to brush off my yes'sirs and do as I'm told and regrow that tough thicker skin that I somehow acquired. I'm back to feeling like I'm just constantly in the way.

Damn, I hate surgery.

Raise your glass

The Guggenheim and YouTube got together to find the top 25 most unique, most ground-breaking, and in my opinion, the most artistic and AMAZING self-created videos, to create a new kind of art exhibit - YouTube Play.

This one's my favorite - probably because I have a love affair with food and bright beautiful colors. That said, I think they're ALL amazing. Go to youtube.com/play to see all of the jury selections.

Kinda spectacular, right?

True colors

ME

I'm not chic enough for New York.

LEE-ARNG

You're pretty hip though.

ME

Am I?

LEE-ARNG

Totally.

ME

I think you haven't seen me in a while - I am the total antithesis of hip.

LEE-ARNG

Maybe you're hiphop.

ME

Maybe I'm hip to the not.

LEE-ARNG

Well, dress to impress. I suggest suspenders. Makes you look scholarly.

ME

Mmmm, I always did like the Larry King look.

Doppelganger

So in December, I'm going to be walking through these doors for an interview.

Yes.

For reals.

I am interviewing at Seattle Grace...or rather, the hospital that pretends to be Seattle Grace every Thursday night on ABC.

I'm kinda excited.

You're looking at me

After 15 months of being on the wards, I think I've become rather good at schmoozing. I know how to be a team player. I know how to keep rounds serious, but fun. And I know how to make my residents and attendings like me.*

Until now.

I swear my attending hates me. He doesn't smile when I crack jokes during my presentations. He doesn't give me any feedback whatsoever. But every time I look up, he's staring at me. Disapprovingly.

I dunno if any of you read Sister Carrie in high school or beyond, but she gets her big breakout role as an actress for standing in the back of the play, looking on in consternation. Disapprovement.

And that is the look my attending gives me. Without fail. Every second of every moment of every minute of rounds. It's uncomfortable. And it's intimidating. I almost want to stop in the middle of my presentation to ask him to please stop, but I can't imagine that could possibly go over well.

It doesn't make any sense at all. My attending's young (and supposedly hip) - and we should be having a grand ol' time on rounds. He used to be a resident just 3 months ago. And a med student just three years before that. So why the dour faces? Why the stoic expressions? Why does he hate me?!!?

Two more weeks. Two more weeks.

*True there was that one terrible month of surgery, but I like to pretend that whole month was just a really bad dream.

Smell like a monster

Man, I don't remember Sesame Street being so hip and current back in my kindergarten days.

This is too awesome.

Gonna get this

My pager went off. Riva's BP is 70/40. Please advise.

I called up the nurse and held her antihypertensives.

My pager went off an hour later. Riva's BP on recheck is 68/38. Please advise.

I stared at my patient's LVEF of 35% and then told the nurse to give a 500cc bolus, and reassess as soon as it was done.

BP 64/38.

Miss Riva stared at me in bewilderment every time I came in. I feel fine, she kept insisting. But the rapid response nurse kept taking her blood pressure. And I kept staring at her med list and her EKGs, chest xrays, CTs, and echos, trying to figure out what I was missing.

After six hours of continuous vitals monitoring and 3L of fluids, my senior resident finally decided that we just didn't know what to do, and sent Ms. Riva down to the medicine ICU.

I feel like a failure. I just can't figure out what we could have possibly missed.

Me against the music

THIRD YEAR MED STUDENT

Happy Birthday Michelle!

ME

Thanks!

M3

So, how old are you now?

ME

Twenty-six!

M3

Oohhh, are you bummed about getting older?

ME

Nah. It is what it is.

M3

Well, you know, now you're closer to thirty than you are to twenty!

ME

... thanks.

So real

On my junior medicine OSCE, for one of the standardized patient stations, we were instructed to go in, interview the patient, get some labs halfway through the encounter, interpret them for the patient, and then tell them what the next steps in management would be.

I knocked, introduced myself, and got the HPI. The patient had classic symptoms of unstable angina. Chest pain? Check. Shortness of breath? Check. High cholesterol? Check. Family history? Check and check.

This was going to be so easy, I told myself. I'd probably have to look at an EKG and tell the patient he likely needed to get an echocardiogram, with the possibility of a reflex cath, if it were abnormal. This I could do. So I started going through the motions. Finished the interview. And then set the stage. "Well sir, it looks like we did some tests and labs. Let me get those results, and we can figure out what the next step should be."

I opened the door and grabbed the lab tests that were sitting in the folder outside. Oh your physical exam was unremarkable and your EKG was normal - so good news, you're not having a heart attack! And your chest xray shows ... oh...a 3.4 cm lung mass... indicating...ummmm, cancer.

My fake patient went into hysterics.

And I agree. That was probably the worst way ever to tell someone they have cancer. True, I should have read the results outside before coming in. True, I should have gone through the 6 step protocol on "how to deliver bad news." And true, I should have done all sorts of things that I didn't do. Instead, I essentially said, good news! you're not having a heart attack! Bad news! You have lung cancer! I'm sure the way I said it - hesitantly and all drawn out - only made the situation inherently more awkward.

Fast forward to my sub-i, and I have a 40 year old guy who comes in with what seems like indigestion, only to find out that he actually has metastatic cancer of unknown origin. Someone in the ED had told him, but had not gone about it properly. "Hello sir, well it doesn't look like you have gallstones, but we need to admit you to find out where your cancer is coming from." "My what???"

It was a rough morning that day, as he became a part of my team's census, and I was assigned to his case. It was rough seeing his wife and father jump on the first plane out so that they could be by his side. And it was rough seeing him break down, every time he thought about how he should have spent more time with his family when he had a chance.

They teach us how to deliver bad news in med school, and they even have us practice it. But the truth is, reality is so different from those structured exercises. How are we supposed to set the stage and determine how much the patient wants to know? What are you supposed to say? "Sir, your CT results are back...but first, why don't you tell me what you want to know?" Honestly, what is a patient going to say to that?

I dunno what I'm gonna do or say when it comes time for me to personally break bad news to a patient first. Heaven knows I completely botched it for a fake patient, what will happen when it happens to a real person? With real feelings and real families and real everything?

Burning out (running on emptiness)

During one month of junior medicine, I wrote 8 H&Ps.

It's now been one week of senior medicine, and I've already written 6 H&Ps, 4 discharge summaries, and 8 discharge instructions.

I can't believe I still have over 3 weeks to go.

Help.