Underneath your clothes (there's an endless story)

I've seen my fair share of naked patients.

I'm always very aware of how uncomfortable and unnerving it must be to the patient, but it's necessary for us to perform a thorough exam - to fully be able to palpate lymph nodes and feel for pulses. And so we ask patients to change into a hospital gown, with the ties in the back. Granted, most times the patients are never completely naked. We try to give them as much of their decency as we can allow - so underwear is allowed. Sometimes bras or undergarments. But essentially, if the patient doesn't take off all their clothes, we just work around it. I remember one patient who wore five sets of underwear. He had his briefs on over an ACE bandage, and then three - count them - three different pairs of boxers. By the way, he was in the hospital for viral gastroenteritis (in other words, something completely unrelated to his genitalia). And so, when it came time to examine his abdomen, which was being completely obscured by yards of fabric, we just peeled back enough of it so that we could listen and palpate.

Anyways, the point I'm trying to make is this. No patient ever has to go completely naked. Because we know that it's awkward and weird, and makes the patient feel totally self-conscious.

Yesterday night, I was sitting in the hospital lobby, next to the Starbucks, waiting for Martin to finish his shift so that we could go home and have dinner.

As I was sitting there studying, I heard a man's voice singing as he came down the escalator. And his song got louder as he headed towards Starbucks. So I looked up. And there was a patient. In a hospital gown. And then as he breezed by me, I realized that that was ALL that he was wearing. Just the hospital gown. Just a tent-like piece of fabric barely long enough to cover his naughty bits.

Our gowns come in only one size, and you can adjust how tightly you tie it in the back. The man was slightly obese. And so the ties were pretty loose.

So yeah, as he breezed by me, I also realized he wasn't wearing any underwear. And everything his momma had given him, was hanging out. His big beautiful and saggy butt was on full display.

Best part? He came and sat down on the couch across from mine while he was waiting for his coffee to finish brewing. So to my fellow students - avoid the couch facing the window next to the entrance. After all, no one knows how well or how often they sanitize the lobby furniture.

I would say it was awesome, but I'm still flabbergasted just thinking about it.

With love

It's been one week exactly. Let's not lose that lovin' feeling. No, let's stick together and make our nation great and truly indivisible. Let's pledge our allegiance to the flag and one another. Even amidst all of our economic woes and world troubles, it really is a great time to be an American. Because there's promise of a better tomorrow.

(For more awesome love letters, go to from52to48withlove.)

Up up and away

Because sometimes, you just wanna get away - away from the world and the terribleness that sometimes comes with it - without changing out of your pajamas.

...
I really wish I had some fifty million balloons right about now, too.

If the youtube link isn't working, the HD (ie, pretty! clear! reach out and touch it!) version is here.

Stuttering

My preceptor used to really like me.

Let's back up. So I've met with my preceptor five times now. The first time we met over coffee with her other med student, and then she showed me around the hospital. She asked me what I wanted to be when I grew up, and not being a total kiss-ass like the other student on my team (whom responded that he too wanted to be a hospitalist, just like her), I truthfully answered that I wanted to go into pediatrics. Her face changed slightly, and she kinda ignored me for the rest of the visit. But after that initial visit, I met with her on my own and I think I was starting to win her over. She told me my oral presentations were fantastic, and I had really good bedside manner. In fact, I know I was doing better, because for our last two visits, she bought me coffee. Starbucks coffee.

And then, I had to go and ruin all of that.

So today at preceptor, I had to perform a complete history and physical on a patient. My patient turned out to by a very opinionated, but very sweet old woman (who used to be a nun!). I asked my questions and did my little exams (observe, percuss, palpate, auscultate), and went back upstairs to see my preceptor so I could give my oral presentation.

I was all over the place.

"Miss McEntire is 72 years old female with a past medical history of diabetes, presenting today with abdominal pain and lots of vomiting and nausea - five episodes max. Oh and transient ischemic attacks - four of them in May 2004, September 2006, and August 2008 - oh sorry, that was part of her pertinent past medical history. Anyways, um, this started two days ago when she, um, woke up to sharp pain radiating down to all three lower quadrants. She claims no alleviating factors, but says that lying on her left side is aggravating. Oh and position and movement. And a hot - no, warm! - water bottle. Because that's what she used to self-treat, but it ended up hurting..."

Yeah, that look on your face right now? That what the heck is she talking about face?

Mirrored on my preceptor's.

It was pretty terrible. I seriously don't know what happened. I even wrote things out in an orderly manner. I particularly like how I mentioned there were four TIAs, but only gave dates for three. Oh, and you know how I said that they were part of her pertinent past medical history? They weren't pertinent at all.

Anyways, you'd think it couldn't get any worse, but it did. At the end of my convoluted mess, my preceptor asked me what I thought it was.

"Um...."

And there was silence. For a good thirty seconds. Uncomfortable, squirm in my seat, awkward silence.

"Um...well...um..."

Here, my preceptor tried to help me out and point me in the right direction: "She had abdominal tenderness. And what did her CT show?"

"Inflammation." Right on cue.

"Right, so now what's on your differential diagnosis?"

"...um....um....malabsorption syndrome?"

"..."

I said malabsorption syndrome! Which, to my credit, does present with inflammation. But if I were just to ask a random person, what causes extreme pain on your right abdominal side that could cause you to wake up in the middle of night and needs to be taken care of right away? you'd probably get the answer my preceptor was looking for.

Because that would be appendicitis.

Or even, just something simple like 'what causes stomach pain and vomiting?' would yield a better answer than malabsorption syndrome.

Cause that would be food poisoning.

But okay, so I'm a little slow when it comes to medical diagnoses. I know I'm not going to be the next Dr. House. That's fine. The thing that broke my heart was the way my preceptor looked at me. Like she suddenly realized that I was not the mentee she was hoping for. I didn't have the smarts or natural mental acuity to be the next her. I was suddenly, just another medical student, and she was disappointed in me. She snapped out of it quickly, stepped back into her teaching role, and took me down to see the patient. And elicited all the information she needed and performed a better physical exam in less than ten minutes, whereas I was with the patient for a little over two hours. And then, I was dismissed to go home. But instead of the "good job today" that I've come to expect, I merely got a cursory "see you in two weeks."

So since then, I've been a little crushed and a lot disappointed at myself today. Because I should have done better. I know I definitely could have done better.

She didn't buy me coffee today.

God bless the USA

Yes we can! Yes we can! And we DID.

America, we made history tonight, and I couldn't be prouder. Tonight is a truly amazing, truly historical, truly wonderful night.

I came home from the library at 7pm sharp, so I could watch all the poll results come rolling in. And since I hadn't scored a Golden Ticket for the Obama rally and the Boy was on call, I was glued to the TV. I switched between Anderson Cooper on CNN (they had cool fancy graphics, although I still don't know what to think of those holograms) and the regular networks all night. No commercials for me!

And let me tell you, I was nervous all night. I tried to eat dinner, but more food ended up in my lap than in my mouth. I gnawed a hole in my sleeve when the first poll results came in, and McCain was ahead. But as the night progressed, states slowly started to flip. Obama was painting the nation blue. And at 10PM Chicago-time, history was declared. America elected its very first African-American president.

But it goes so much farther than the color of his skin. This is a man who has truly energized the nation. He's inspiring and inspired, promising to unite our divided country and restore the American Dream, and I sincerely do believe that a change is going to come.

Yesterday - even just earlier today - I was glad that today was the end of the election. After all the fact checking and articles written by political pundits, I would finally be able to get back to my studies and not troll CNN.com's Political Ticker every five seconds. But as Obama said in his speech tonight, tonight is not the end. No, tonight is just the beginning.

Tonight, Obama pledged to be our president... the president for the "young and old, rich and poor, Democrat and Republican, black, white, Latino, Asian, Native American, gay, straight, disabled and not disabled." We voted for change, but now we must all start our quest to make change happen. And while he said "the road will be long, and the climb will be steep," that is a journey I can't wait to take. That is a journey that leads us to a better American future.

Call me cynical, but I never thought I would see a black man become the President of the United States. And to have such history happen at my relatively young age, makes me wonder at the history that is bound to occur throughout the rest of my life. It's going to be an amazing. These next four years will be amazing. And I cannot wait to see all that we can accomplish. Because it's going to be extraordinary. It's going to be exciting. It's going to be historical.

A change is gonna come

I woke up today feeling giddy. Kind of like a five-year-old waking up on the day of their birthday party - excited and ready to rip open presents. My heart was pounding, and there was a huge grin on my face.

Today is election day!

I'm a little ashamed to admit it, but this is the first election where I've felt personally invested. This is the first election where I've actually cared. Bush and Gore? Why bother - clearly Gore was going to win. And Bush vs. Kerry? Sorry, I had midterms to take.

But this election year is a whole 'nother story. Because the next four years are going to be important for me. I am no longer going to be the perpetual student, shielded from the economy and wars by the three walls of my library cubicle desk. No, this election is going to affect my life, my work, my family. And best of all - after all these days of complaining about my health insurance, or rather, lack thereof, we are finally having an election where that was a major talking point. There's finally talk about withdrawing our troops, and I hope that there will soon be an end to the CNN articles that tell us about the daily Iraq death toll.

So yeah, I'm invested. Tonight I'll watch the poll results come in and be excited, instead of years past where I've always been disappointed that House was preempted for this presidential crap. No, I'll be excited, because today, America rewrites history. Today, we will find out who our next president will be. The first African American? The oldest president ever? Regardless, today America will decide a new path - a new destiny - for our truly wonderful nation.

And with the largest voter turnout ever predicted, today is guaranteed to be exciting. Historical. Nerve-wracking. And hopefully joyful.

See you on the other side.

Give us clean hands, give us pure hearts

Medical students just might have a superhero complex.

After all, for the most part, we all came to med school to save lives. We want to care for patients and make them feel better. Lessen pain. Even those who came for the fast cars and the easy money snapped to reality very quickly and either left or realized that they actually do want to help people.

And so we start school bright-eyed and excited. Hungry to be getting out there to make an impact in the world. I mean, most students can tell you everything about their first patient. First and last name, age, date of birth, what they presented with in the ER, the complete differential, and possibly even how many dogs and cats they have. It's because we're hungry to help, hungry to finally be able to touch someone's life. And so that first patient is super special, because it's validating. This is, after all, why we came to medical school. To care for patients.

What they don’t tell you is how absolutely and completely scared they are.

Yes, I remember the very first patient I saw. He had a foot infection secondary to lower extremity neuropathy, was fifty-seven years old, and a successful interior designer. And he has three cats named Fluffy, Mops, and Piglet.

I could rattle off his differential diagnosis (there were really only two possibilities), and impressed my preceptor with my detailed assessment and plan. We should start him on antibiotics and antifungals – perhaps a cephalosporin and nystatin? Oh, and let’s order a CBC to make sure his white blood count is okay so he can fight off this infection.

I might have sounded confident, but in reality, I was shaking in my Crocs when I walked in the door. After wanting to come to medical school for all the right reasons, I was now convinced that somehow or another I might accidentally kill the patient. What if I tripped over his IV line? What if he coded? I had no idea how to do anything, much less save a life. I was terrified - irrationally so, considering I was merely going to ask him a couple of questions, and while my mother always complained of it, I don’t think I could actually talk someone to death.

As medical students, we are obsessed with death. Our Type A personalities might have drawn us to medicine, but that same personality is what makes us equate death with failure. Yet, death is a very tangible thing in medicine. Medicine is a profession that constantly straddles the line between life and death, and the relationship between the two is pervasive and ever-present. A simple mistake or a wrong decision can have devastating results.

I am just starting to realize the amount of medical knowledge that exists out there, and how little I know of it. I am starting to realize that no matter how hard I try, I will inevitably kill someone. Sure, it’ll be accidental, due to an oversight, maybe because of a lack of knowledge. But I also know that I will be devastated. I will be devastated, because causing harm to a patient is to go against the very thing I came to medical school for.

But I will learn from it. Apologize to the family. Face the consequences. Figure out what went wrong, how it went wrong, and then move on. Patient deaths are part of the learning process, and in medicine, physicians are the perpetual student. We can never stop learning - not just because our field is ever-evolving, but also because that is what will ensure that we are the best possible physicians we can be.

In the end, I know what will carry me through such an experience is the fact that I am a good doctor. I’ve been trained well. In all the stories I’ve read about medical mistakes, there was always a very specific point where the doctor made a poor judgment call. A bad decision. But we are all human, which means we’re prone to make mistakes. We don’t have any control over that. What we do have control over is our relationships with our patients. How we treat them as patients – as people – will make a huge difference in their medical treatment. That is what will help us make the right judgment call. The right choice.

It's about having heart. And at the end of the day, I know that I have a good one. I care. That is ultimately what will make me a good doctor. And even good doctors can make mistakes.