Dr. Neely would not be proud

ME

Hello sir, my name is Dr. Wu, and I'm with the neurology team.

PATIENT

[looking me over, then starting to freak out]

Oh my god oh my god oh my god. I'm going to die.

ME

Sir, I'm going to take really good care of you.

PATIENT

What's wrong with me? Just lay it on the line. Just tell me. TELL ME. Give it to me straight.

ME

Well, sir, we took some images of your brain --

PATIENT

[now hyperventilating]

Oh my god oh my god. I'm too young. I'm too young for this. Oh my god. Why?? Oh my god oh my god.

ME

[not knowing what to do, so continuing to plow through my spiel]

..and your CT scan looks as though you might have had a small stroke. That said, it's in the part of the brain that we think will recover very well. So the weakness you have will gradually improve. But of course, we'll have our therapists come work with you too to help you regain your strength.

PATIENT

I already know all that. They told me in the ER.

ME

Oh okay. So yeah, I'm going to continue your stroke workup, which means we're going to look at the blood vessels in your neck and legs, and we're going to do an ultrasound of your heart ---

PATIENT

[interrupting me]

But what about the bad news!

ME

What do you mean?

PATIENT

Your name tag says you're a psychiatrist! 

ME

Oh, I am.

PATIENT

So tell me! I have a brain tumor right? I'm going to die? And you're here to talk to me to make sure I don't go jump off a bridge right?

ME

...

You don't have a brain tumor to the best of my knowledge.

PATIENT

Then why did they send a psychiatrist to come talk to me?!?!

Without fail

It always happens, doesn't it? The moment your eyes start to close and you actually believe you might be able to get a few minutes of sleep, your pager goes off.

I've been on night float for the last five days. I'm probably giving myself acute kidney injury, because I now refuse to go to the bathroom. Because the moment I sit down on the toilet, my pager will go off. Every time. Every single time. And then I have to fumble to throw my pants back on and rush over to my adjoining call room to turn off my pager before I wake up the other 4 residents sleeping in the neighboring rooms. I finally got smart and just started taking my pager with me, but yesterday, I almost dropped my pager into the toilet, because it freaked me out when it started ringing mid-pee. Gross, but true.

Most of the time, the pages are pretty legitimate. A patient needs to be admitted, another patient had a sudden drop in her potassium level, someone needs benadryl to sleep, and so on and so forth.

Yesterday, I got paged about one of the rocks on our service. He had a stroke and he's currently waiting for a spot at our rehab hospital. And at two o'clock in the morning, his nurse paged me urgently to tell me that my patient had a sudden change in his exam.

I freaked out.

Sudden change in exam usually means progression of stroke, or worse yet, a brand new one. As I pulled up his most recent labs and imaging, I asked the nurse what had changed.

NURSE

He spilled water all over himself!

ME

What? How?

NURSE

I put the cup in his hand and he spilled it! 

ME

That might be because his stroke affects his left side. He has 0/5 strength in his left arm and hand.

NURSE

Oh. But doctor! He also very unsteady on his feet.

ME

...

NURSE

When we did walking trial just now, he almost fall over. Very dangerous.

ME

Yes. That's why he's on strict bed rest. He has no strength on his left side at all.

NURSE

Well, he also very sleepy.

I didn't tell her that he's probably sleepy because normal people sleep in the middle of the night instead of participating in walking trials. Instead, I went and saw the patient, assessed that he was exactly the same as he has been, and then I went back to my call room.

And just as I took off my glasses to get some sleep, my pager went off yet again.

The boy who lived

I finally did it. I finally one-upped Martin. Sure, he might be in surgeries every day, doing procedures, removing blood clots, relieving intracranial pressure, and saving lives and all that jazz, but today, I did him one better.

Today, my patient came back from the dead.

True story.

He was legally dead in the morning, and alive that afternoon. And no, I didn't even need to pound on his chest.

He was brought in to the ED after being found in the morning by his family, not moving and unresponsive. A quick CT scan showed that he had suffered a devastating hemorrhagic stroke at his brainstem. There was nothing that could be done for him. He had no reflexes, no response to noxious stimuli, and worst of all, he was starting to show signs of herniation. My attending and my senior resident each performed brain death exams, six hours apart, with apnea tests and everything, and declared him to be dead. They filled out all the legal paperwork, the death certificate, and wrote up a discharge summary.

My co-intern was on call, but we were hanging out in the call room, finishing up notes and tying up loose ends, when we got a call on our emergency phone.

NURSE

Doctor, you need to come see your patient right away.

CO-INTERN

Why, what's going on?

NURSE

He's ALIVE!

We stared at each other blankly, not believing, and then we sprinted to the ICU.

The family had agreed to organ donation, and now the organ donation team was there to start the process. However, as they started putting in IVs and various other things, our patient started moving.

And now here we were, my co-intern and me, watching our patient withdraw to our trapezius pinches and sternal rubs, and coughing quite vigorously as we stuffed a probe down his endotracheal tube.

Holy cow.

We have no idea what happened, or how it happened. But we ended up writing a brand new admission history and physical for our patient, with brand new admit orders, with a brand new status of FULL CODE. Chief complaint? Rose from the dead.

I'm pretty sure he's never going to come out of his vegetative state, but who knows now? He might just end up walking out of our ICU doing calculus.

I mean, when exactly is the Christmas season over?

After seeing Christmas tree needles all over the elevator floor, hearing three snarky comments about Christmas, and a Glee reference about Christmas trees still being up in the middle of January, I finally did it.

I took my tree down.

And now I feel as though my living room is incomplete.

Best consult ever. EVER.

ME

Hello, this is neurology -- you paged?

UNIDENTIFIED RESIDENT

Hi, yeah, we have a consult for you.

ME

Okay, what's the consult for?

UNIDENTIFIED RESIDENT

Diarrhea.

ME

Um. And you wanted neurology?

UNIDENTIFIED RESIDENT

Yeah, I mean, he had bowel incontinence, and diarrhea came out. So, we wanted you guys to come assess him.

ME

Hm. Did he have a seizure? Did you notice anything else? Any other symptoms?

UNIDENTIFIED RESIDENT

Yeah, weakness in his legs. He can't move them.

ME

Oh, that's pretty concerning! When did that start??

UNIDENTIFIED RESIDENT

Um, fourteen years ago when he got shot in the back.

ME

...

Too early for Valentine's?

A bowtie might be worse than an ascot

My co-intern is an insufferable prat.

He's constantly on his iPhone, playing Words With Friends, and gives off this aloof air of "I'm too smart and awesome to be involved in this cerebral neuro crap." When we round on patients, he never goes into the room with the rest of the team, but rather stays at the nursing station, pretending to write orders, even on patients that aren't even his. He never comes to morning signout, and always arrives ten minutes late to rounds.

And he wears a bowtie.

Every day.

Every single freaking day.

Seriously.

But I can deal with all that.

Except today, I came by to find my senior resident because the radiology resident wouldn't approve one of the imaging tests that we wanted, and I wanted to give him an update.

My co-intern was playing Words With Friends next to him and overheard our conversation.

CO-INTERN

What do you mean he won't do it? Did you tell him the whole family history?

ME

Yes. And I told him about all the crazy symptoms that she's been having too.

CO-INTERN

You don't know how to talk to these people. You have to give them the facts and only the facts. 

ME

Um, I know. And I did.

CO-INTERN

[loud audible sigh] 

Let me show you how it's done.

ME

...

CO-INTERN

[on the phone]

Hi, this is Dr. [name redacted], my patient needs that test and she needs it yesterday. [pause] Yes, I know you spoke with my intern already, but she's psych so she doesn't really understand what's going on...

My jaw dropped.

I'm sorry. We're both interns. I belong to no one. And I am definitely not his intern. And secondly, sure, I'm psych, but I went to med school, and you know what? I actually pay attention in rounds. I probably know more about my patient than he think he does.

Ugh, hate.

I was so happy that the neurorads fellow wouldn't approve the exam for him, either. Sure, it wasn't great for our patient, but it made me feel so vindicated. I do know what I'm doing. And no one can bring me down.

Especially someone who wears a clip-on bowtie.

Beverly Hills cop

Maybe I've gotten a little too comfortable with driving. Because I'm starting to break the rules a little bit.

I was driving on the freeway, in the third lane over, cruising merrily at 75mph, singing along to Katy Perry, when I looked in my mirror and saw a motorcycle curiously close on my tail.

Before I even had time to react, the cyclist had swerved into the left lane, and pulled up alongside me.

It was a cop, complete with helmet, dark shades, handlebar mustache, and every other stereotypical cop-like accessory.

And as I turned my head to look at him, he pointed his index finger at me, and started yelling/mouthing:

SLOW.


DOWN.

I don't know if I slowed to a 55mph crawl because of his warning or because I was just so freaked out I took my foot off the gas.

I don't know why he decided not to turn on his siren and pull me over. Maybe it was my Northwestern Wildcats license plate and he had seen how terribly we lost our bowl game just a few days ago. Maybe it's because he saw my USC parking sticker. Maybe it's because he realized I would be that Asian girl who cries when she gets a ticket.

Whatever the reason, I'm super glad I'm not paying off a $250 fine and attending traffic school.

But friends, I was only going 75mph.

I'm pseudo-fluent in medical speak too

You know what scares me most about starting my non-psych months?

How absolutely miserable the interns seem on the other side.

Today, I got signout from the current intern on the neuro service, and not only did I not understand a single acronym coming out of her mouth, she didn't smile or reassure me once!

I suppose I should be glad I did a SICU rotation, and I can still hear Dr. Corbridge's crazy voice in my head when it comes to vent settings, but it did me no good today.

CURRENT INTERN

So yeah, this guy is a 45 year old DS patient with DM, HTN, EDS, HL, [more abbreviations], and is here for a [abbreviation]. He also needs an [abbreviation] and [acronym] and you should perform [mnemonic] daily. Tomorrow, be sure to check his [acronym]. Oh, and he's Spanish speaking and his family would like to be updated. You'll have to call them in Mexico City. Anyhow, we expect that by the weekend, he'll be ready to transfer to [abbreviation] unless his [abbreviation] comes back abnormal, in which case you should send him to [abbreviation]. Questions?

ME

Haha, of course not. That was such a clear signout.

CURRENT INTERN.

Yes. Do you want to know his vent settings?

ME

Should I know them?

CURRENT INTERN

Well. You are a doctor aren't you?

ME

Haha, I meant, doesn't the respiratory therapist decide weaning parameters?

CURRENT INTERN

Yes, but you're the one who approves it. You went to medical school. You do know vent settings right?

ME

Well, I'm a little rusty, but yeah, I'm sure it'll come back eventually. So lay it on me. Is the patient on SIMV or AC settings? Square shape? What's his PS? Peep? FiO2?

CURRENT INTERN

[blinks] 

He's on CRVC. 

ME

Oh that one!

I had no idea what she was talking about. I just started throwing out all the abbreviations I remembered from  my SICU days, just to pretend I could speak the medical language too.

Yet, for some odd reason, I think it backfired, because now I have a list of 22 critically ill patients, no idea how to manage any of them, and I'm the poor resident responsible for the entire unit (and then some!) starting at 7am tomorrow morning.

Help.

There's an elephant sitting on my chest

I feel like I'm in med school all over again. I'm having trouble breathing and I constantly feel like I want to vomit. I'm having so much anxiety about starting my neuro/medicine/pediatrics months, it's almost as though Dr. Meanie Bikini is standing over my shoulder barking pimp questions at me.

And I'm getting them all wrong.

Because for all my bravado and outward self-confidence, I'm freaking out. I don't remember anything non-psych. I'm been joking that I'm just going to give all my patients Haldol and that'll solve all their problems, but the truth is, I don't even remember how to order maintenance IV fluids.

ME

I should probably review some neuro, huh?

MARTIN

Sure, why not?

ME

I'm so not looking forward to five hour rounds and "let's play Localize The Stroke!!" Man, I hate that game.

MARTIN

I'm sure you'll be fine. You'll remember more than you think.

ME

Hm, how many cranial nerves are there again?

MARTIN

[stares in disbelief]

ME

No seriously, crap, what's the first one? It's the nose one. Occulonasal? Oronasal? Oh shoot, what's the name! I remember it, I do! It comes out the cribriform plate and is associated with Kallman's syndrome...but shoot! What's the name??

MARTIN

You're hurting me.

---
P.S. The answer's olfactory. And there are twelve cranial nerves. Bottom line: I'm going to die on my non-psych months. Seriously, I need some Xanax.

When I say I'm competitive, I mean it

ME

Sigh, I can't believe it. How did I gain SO much weight in just six months? It's disgusting.

CO-INTERN

I don't believe it. Did you really gain twenty pounds?

ME

Well, seventeen pounds to be exact. But still, that's disgusting.

CO-INTERN

Have you been working out? Eating salads?

ME

Yeah, but I'm just not motivated to actually go to the gym, you know?

CO-INTERN

Let's start up a Biggest Loser for our class.

ME

OH MY GOD, yes please! I love competition!!

CO-INTERN

Yeah, and we can have weekly weigh-ins during class on Tuesday.

ME

Yes! And we can have punishments for those people who have the fewest pounds lost! Like, no elevator privileges for one week! Or, no specialty coffee for one week! You can only have your coffee BLACK. Or, forced parking on the rooftop!

CO-INTERN

Whoa there. I was thinking of you know, rewarding the person who lost the most weight at the end with a nice dinner or something.

ME

Oh, what's the fun in that?

New year, new resolutions

I'm keeping it simple.

1. No soda.
2. No donuts. (Do not donut.)
3. No meat on MWF.  *Seafood not included.

Let's do this!

[Friends, please help keep me accountable. Thanks!]