We go together

MARTIN

Hey, can I store some of my more valuable stuff at your place while I'm away?

ME

Like what?

MARTIN

Oh, like my camera stuff. And my DS. And ipod.

ME

Oh that stuff. Sure!

MARTIN

Oh........... and Teddy too?

ME

Hahahaha, what would your subletters possibly do to Teddy?

MARTIN

I don't know! Who knows what crazy things they might do to him if I leave him here!! Or worse! They might STEAL him. [sad pouty face]

---

I know I gave him a hard time about it, but I'm glad that Teddy's back. Bunny missed her buddy.

You send me

[Disclaimer for Ankur and all tweens: This video stars Miley, Demi, Selena, and the Jonas Brothers. You've been forewarned. Please don't have a heart attack.]

Look! All the Disney stars in one place! And in a music video they claim is about environmentalism! Too cute. And I must say, Nick Jonas is growing on me. Miley, not so much.

(UPDATE: video has been reposted!)

Brand new day

I love this - probably because I genuinely feel as though I can do anything after watching it. Fabulous song, awesome dancers - and it's not even the best dance of the season!

Brand new day, indeed. I'm feeling it.

Fire burning

I miss watching fireworks with the boy on Wednesday nights.

Poker face

PATIENT

So, your whole team...what's the hierarchy?

ME

Well, there's the attending, the senior resident, the intern, and then there's me, the medical student. And we're your general medicine care team.

PATIENT

Hm, can you put that in Grey's Anatomy terms?

ME

Sure! So Dave, the resident, is like Meredith Grey. Or Cristina Yang. Izzie Stevens. That group of people.

PATIENT

Got it.

ME

And Jami - the intern, is like Lexie Grey. You know, the people on the show who were performing appendectomies on each other.

PATIENT

I'm assuming they don't do that in real life.

ME

Haha, no. And our attending Dr. Peters* is like...Dr. Shepherd.

PATIENT

Oh, McDreamy.

ME

Yes, though unfortunately, not as attractive.

PATIENT

Hahaha! I agree! Wait, so who does that make you?

ME

Well, clearly, I'm the Chief.

*Name changed to protect my grade.

Show me what I'm looking for

You know how in the last post I was ranting about how the worst part of being a third year medical student was the getting yelled at for no reason part?

I take it back. I take it all back.

The worst part of being a third year med student is realizing that you can't do anything for your sweet middle-aged patient who doesn't know her pancreatic cancer has spread.

She was accompanied by her husband of forty years. They were high school sweethearts, but it was obvious by the way he looked at her that the plan was to be old-aged sweethearts too.

She came in to the hospital because of a bacterial infection that was so terrible, she had no idea who or where she was. She couldn't tell us who the president was or what the date was. She only answered one question correctly, and that was her husband's name.

As part of the workup, we found that her cancer had grown so much that it was now constricting her duodonum - which was why she was only eating clear soups and smoothies for the past two weeks. The site of her bacterial infection turned out to be a liver abscess. But there were three other masses on her liver that turned out to be cancerous. And she was accumulating abdominal fluid because of omental metastases.

My attending isn't an oncologist. But looking at the scans and pathology reports, she sighed and remarked that our patient probably only had three months or so. The chemo didn't seem to be having any kind of effect at stopping the cancer.

But there must be something that we can do, right?

Unfortunately, no. All we can do is treat her bacteremia, and get her out of the hospital so she can spend as much of her life out there, instead of in here.

Two days later, my patient was smiling and joking around with her husband, her infection now under control. She was ready to go home.

It was time, according to my attending.

I nodded, grabbed my white coat, and followed her to the patient's room, where we sat down and tried to explain all the new lab findings to our patient. Since my attending was doing all the talking, I took the opportunity to just watch the patient and her husband's reactions.

They didn't cry or even become distraught. She simply nodded and said that she understood what we were telling her. Her husband told us that he'd make an appointment with the oncologist right away. They were a team, and they were going to attack this cancer together.

She was discharged later that afternoon, with our best wishes.

Yesterday night, on my way home, I passed by the the local Starbucks and saw my patient's husband sitting next to the window. He looked at me, as though wondering if I remembered who he was, so I smiled and waved. He waved back, and I walked in to say hi.

His wife had come back to the hospital for her outpatient procedure to open up her duodenum so that she could go back to eating solid foods. She'd have to come back in a couple of days to switch out her biliary stents. Yes, she was hanging in there.

And in the midst of this very matter-of-fact conversation about his wife, he suddenly broke down. They were planning on going on a cruise in December, he told me, asking if I thought that she'd still be strong enough to go. And their daughter just found out that she was pregnant again. Would his wife be able to help her through labor? Would she still be with us?

I didn't know what to say, as I silently sat there and handed him pieces of tissue from my white coat.

At that moment, his cell phone rang. The procedure was finished, and his wife would be waking up from sedation within the next 30 minutes, if he wanted to go sit in her room so that he'd be there when she woke up. He did, and so after I wished him good luck and sent all my love to his wife, he got up to go back to the hospital.

As a third year med student, I spend a lot of time with my patients. I'm often the first person they see in the morning, and I make sure to say goodbye before I head home at night. I get to know my patients rather well, and I often find myself holding their hands. Sometimes it's when they're getting blood drawn and they need someone's hand to squeeze through the pain. Othertimes, it's as they're getting wheeled down for some procedure, and they want a familiar face with them, especially since the family can't go. My job is to hold hands and reassure my patients that things will be okay. That of course they were going to recover from their pneumonia! That yes, while the pain is bad, they were definitely not going to die in the hospital - at least, not on my watch.

Yesterday, I couldn't answer the husband's questions the way he wanted me to. I couldn't reassure him that they were gonna kick this cancer, and she'd be with him until they were old and gray.

I could have told him reassuring lies, but I didn't - because that wouldn't have been honest. I only wish that I would have told him the one truth I did know, just from spending three days with them - that they were lucky to have each other.

Cancer sucks. Especially when you all you want to do is punch it in its face, and you can't.

Then I woke up

The verdict is in. The worst part of being a third year med student is the getting yelled at part.

Let me rephrase. The worst part of being at the absolute bottom of the totem pole is getting a whole bunch of crap crapped on you, and having to sit there, smile, and take the abuse.

Especially when you totally don't deserve it, because you didn't do anything wrong.

Yeah. If you couldn't tell, today was not a good day at the hospital.

I have a patient who gets her blood drawn every morning at 4am. Yes, she gets woken up every morning at 4am for her blood to be drawn so that by the time the medical team gets to the hospital, results will be waiting. That way, we can figure out our plan of attack for the day.

For the past two weeks, those results have always been there. And my patient is a very smart lady, so every morning when I go see her, I bring in her daily results, and we sit there and add another data point to her growing graph.

Today, there were no results at 6:30am. There were still no results at 7:03am when my intern walked in the door, no results at 7:29am when I left for morning report, no results at 8:35am when I came back from morning report, and no results at 9:15am when we were standing outside her door as I updated the team on her condition before we went in to examine her.

ME

Good morning Ms. Prince!

PATIENT

Hey there Michelle - is my bloodwork in yet?

ME

No, it doesn't seem like it..but don't you worry - I'll be in and let you know what they are as soon as they pop up on my chart!

PATIENT

Okay...just as long as I don't need that biopsy.

ME

Nope, I think you're good for now...but we'll wait for those results to make a definite plan.

At 11:30am, when rounds finally ended, some of her other lab work started to trickle in. A sputum culture had grown out some stuff, antibodies for a couple of bugs were negative, and some cancer markers had come back negative. But her bloodwork was still missing. So I worked on my notes and waited for stuff to come back. Except it never did. And at noon, I had to go to class.

And at 2:45pm, right before class ended, my pager started buzzing.

Patient's husband found blood tubes in room - apparently never sent to lab. Btw, family very angry with care team. - Nurse

Oh shit.

So there was lots of yelling over that. Even though I had absolutely nothing to do with blood draws and making sure those things got to the lab. Apparently I should be checking under beds and in bedpans for vials of blood. Who knew?

Then, later that evening, because the aforementioned patient had fired her Infectious Disease team, I had to call and arrange for the other ID team to come see her.

ME

Hi, I'm calling regarding a consult for Ms. Prince.

MEAN RESIDENT

This better not be about treatment, because you know you can look that stuff up right? Don't waste my time.

ME

Oh no sir --

MEAN RESIDENT

Sigh. What's the one liner on her?

ME

She's a 55 year old female with a past medical history of leukemia presenting with fever of unknown origin.

MEAN RESIDENT

She had leukemia?

ME

Diagnosed in 2000.

MEAN RESIDENT

IF SHE HAD LEUKEMIA, YOU CONTACT THE OTHER TEAM, NOT ME.

ME

Oh, see, the thing is, she fired --

MEAN RESIDENT

[dial tone]

Fabulous. So then I went back to my team room to finish up my notes, and my intern - as he was leaving - remarked slyly about how the recycling bin was getting awfully high and that it ought to be taken out...by a med student.

So knowing my cue, I got up to go empty it out.

Only, the new interns had thrown their lunch and gum and other sticky things into the bin.

So I stood there, throwing away the papers coated in cottage cheese into the trash, and feeding the others into the Shred-N-Recycle bin.

SOMEONE IN CHARGE OF SOMETHING

Are those patient files?

ME

Yeah.

SOMEONE IN CHARGE OF SOMETHING

Why are you throwing those into the trash? They need to be shredded. Privacy rules, you know.

ME

Yeah, but they have food on them and I didn't want to mess up the shredder.

SOMEONE IN CHARGE OF SOMETHING

So you'd rather have patient information be leaked?

ME

Well no...I'm sorry, I'll put them in the shredder bin.

SOMEONE IN CHARGE OF SOMETHING

Ah, finally a smart idea! Maybe your first!

Then I stand there trying to rip just the piece of the paper with gum on it off, and feed the rest into the shredder. And he finally walks away.

SOMEONE ELSE WHO THINKS THEY'RE ALL THAT

WHAT are you doing?!?! There's FOOD on that!

ME

I know I know...but I'm trying to rip off just that section...

SOMEONE ELSE WHO THINKS THEY'RE ALL THAT

You're going to ruin the machine. Sigh. Please. Stop. Just step away please.

There was no winning this battle. I ended up shredding it myself with a pair of scissors and I scattered them among 3 trash bins. Hopefully that was enough to appease the higher-ups.

Ugh.

Like I said, it wasn't a good day at the hospital.

The thing is, I had been loving it up until today. I get lectured at every day, but it's typically about stuff that I can be doing to improve patient care. Constructive criticism. Slow down when you're talking. They still have a PIC line in? Uh...that's high risk for bacteremia. You probably shouldn't give a patient a whole bucket of ice chips if they're NPO.

But today? Today's lectures were unnecessary. I didn't need to be lectured at as though I were a five year old - [sing-song voice] So then, after blood work is drawn, what do you do? Yes, you put the label on it...good girl.

Especially when I don't even do that stuff.

I keep waiting for someone to pinch me and tell me that today was just a big bad dream.