No more call shifts!!!!!!!

OK, so I'm pretty freakin excited! Not only did I finish my last call shift last night, but there are only 2 more sleeps until I finish 3rd year. After that, I'll officially be a 'senior medical student' and be 3/4 of the way to getting an MD degree!

In thinking back to what I've done and seen over the past year, I know I've changed. My classmates don't see it, but we see eachother everyday, so they wouldn't notice it. Something inside has changed. I feel more capeable of handling tense situations and am more comfortable with relying on my abilities to take a patients history and doing physical exams to make diagnoses. But I've also become more cynical and non-shallant about pretty serious stuff.

For instance, on my second to last shift, I was doing a consult in emergency (on a little 19 day old girl with pyloric stenosis...i.e. projectile vomiting!) and I was writing it up when I noticed that the emerg docs rolled in a trauma patient. I looked up from my notes to see the trauma team doing their thing...controlled chaos. Putting in IV lines, assessing the patient's ABC's (airway, breathing, circulation), doing CPR. There was a man on top of the patient doing chest compressions while other people were trying to draw blood, intubating the patient, and getting the report from the paramedics. I went back to finishing my notes. After I was done, I looked over my shoulder just as the team pronounced the patients death and put a sheet over his head and rolled him away. I thought to myself "Hmmmm that's too bad." Normal people would react like: "Wholly shit a man just lost his life here...does anyone care?!??!?!?" Medical people aren't normal people. I don't want to become a person who is insensitive to things like that.

But then something happened last night on my call shift to change my thinking.

Since I am with Pediatrics, we are called to C-section births (as well as forceps and vacuum deliveries). I was paged at 11:30 at night for a C-section on a 26 week old fetus. Anyone can tell you that this is WAY too early (normal babies=term=40weeks). The limit of viability is 24weeks. In any case, the team was called to help the baby after it was born. The pediatrician I was on designated me to 'catch' the baby. The obstetrician who delivers the baby with give it to me to carry over to the incubator. So I am ready. Towel draped across the front of me, hands gloved, heart racing. "Don't drop the baby," I am thinking. The baby girl is born at 12:23am. All 620 grams of her (1.3lbs). Her whole hand was as big as my thumbnail and most of her body fit in one palm. And she tried to cry in her squacking sort of way! The pediatrician had to put a tube down her throat to help her breathe, but she is otherwise in pretty good shape, considering. She did well overnight. It'll be a long road ahead for her and her parents, but it amazes me that babies this small can survive. It made me appreciate the life of each and every patient I come across and made me think that I have to work to keep this in mind.

On a funny note: As the doctor was securing some equipment with sutures, he didn't want to open up another package of sutures "We'll try to save money on sutures," he said. I thought that was funny becausese it costs THOUSANDS of dollars to keep these tiny patients in the NICU every day...what difference will a couple-a-bucks do????

10 more sleeps until 3rd year is over!!!!!!!!

I've been trying to do a bit of studying lately. Not working out so well, but I have done a lot of school work. I had to do a 30 min presentation on Hamburger Disease (because of the case last week) and I had to write an essay. It's about using CT scans (aka cat scans) on kids with minor head injuries. I saw a couple cases when I was in pediatric emergency. One kid had a skull fracture! Ouch!

I was on call 2 nights ago. I actually started out at another hospital at an Urgent Care Clinic and I saw a case of Scarlet Fever. I always thought it was an "olden days" thing, but apparently it's quite common. It's just a very specific skin reaction that happens when kids have Strep throat. I thought that was cool. Afterwards, I went to the other hospital where I was on call. We had one consult in emerg. A probably viral meningitis. Sent her home. Nothing we can do, but she'll be fine. Bacterial meningitis, on the other hand...different story altogether!

We were called to 3 vaginal deliveries. The first 2 went fine, but the last one the baby came out blue and floppy (ie NOT what we want to see) because it may have inhaled meconium. I intubated the baby twice!!! The pediatrician I was working with was like "Here you go...give'r" I jumped at the chance, but in my head I was thinking: Oh shit...I was supposed to watch that neonatal recuscitation video!!! Everything turned out fine though. Baby perked up after I shoved tubes down it's trachea. That'll do it!

Other than that, I am trying to organized and pack my stuff so I can move out of my apartment at the end of the month. No electives next year in this fair city. I'll save $800 a month instead! Anyone want to buy furniture?

I love summer...and BBQs.

I'm pretty much livin' the high life right now. I'm in the middle of my Peds rotation during a time of year when kids generally aren't sick. Clinics are cancelled, docs are on holidays, kids are enjoying thier summer. I'm at a peripheral hospital where all the residents, nurses, and docs are super nice and do good teaching. The call rooms here are pretty sweet with real beds and real bedding (unlike the 50 year old hospital beds and sketchy sheets you normally get). The lounge has a fully stocked kitchen (fruit, cheese, bread, bagels, yogurt, juice, milk, cereal, coffee, tea, condiments, icecream). We have a new gym complete with treadmill, eliptical, rowing machine, free weights, and plasma TV. A large screen TV sits in another lounge with 4 couches. Even better than home. And I'm extra lucky because, the NICU is full so no more sick babies can come here and the maternity ward has no laboring moms on it right now. What shall I do?!??! Hmmm study or sleep???

I was called to the ward earlier to evaluate a patient who had some abnormal lab results. He was admitted a few days ago with abdo pain, vomiting and diarrhea. We thought he had some sort of stomach flu, but he wasn't getting better with any of our treatments like IV fluids. We redid his bloodwork...hence me being called to the ward:
Nurse: His hemoglobin dropped from 153 to 102!
Me: I know he had some blood in his stool, but not enough to drop his hemoglobin. Let me see the other labs...
Nurse: His platelets are down to 44 too.
Me: What were they before?
Nurse: 280.
Me: What does his urine look like?
Nurse: It's funny looking...like tea.
Me: What's his creatinine? (Marker of kidney function)
Nurse: 340, up from 80 before!
Me: Call in Dr. X. He has to go to the children's hospital. He has HUS. I'll be up in a sec.

For those of you who don't know, HUS is hemolytic-uremic syndrome AKA Hamburger Disease. Some patients (especially kids) go into renal failure after a bout of E. coli O157:H7 food poisoning. You've read about it in the news.

Yea me! Maybe I have learned something this year!!!!!!!!!!!

I didn't die!

I did the coolest thing yesterday!!! My friend in my class got his pilot licence this year and he was going for a mountain certification flight. Apparently a basic pilot's licence doen't allow you to go over any mountians...boring So he invited me to go along with him and his instructor. I jumped at the chance!

He had to go early to plan out the flight so I just slept and read in the car. Then he oriented me to the 4 person plane. Tiny thing compared to the commercial jets that I'm used to! We took off and flew through the mountains to a small town where he had to do a particularly challenging landing. He had to abort the landing once because there wasn't enough runway! I'm pretty sure my blood pressure was in the roof for that part, but I felt OK because there was an instructor on board that would take over if anything happened. Then we promptly took off again and flew over a major ski resort and circled back around to the airport. What amazing views!! We flew right over glaciers, glacial lakes and waterfalls, awesome cliffs and quite rugged terrain that you can't see by driving there.

We made it back safe and sound after an uneventful landing. So cool!
Then I came home and made dinner for a couple of my girlfriends. What a pleasant day.

I'm still alive!

A little birdy told me that there were actually people out there waiting for me post a new blog. Sorry it's been so long, but I just haven't had much to write about. I am in the middle of my pediatrics rotation. I've started doing outpatient clinics. I did 2 weeks of emergency which I enjoyed. I had to shake my head a few times at anxious parents who brought their kids in for a variety of combos of fever, cough, runny nose, stuffiness, vomiting, diarrhea, and 'lethargy'. What parents call lethargy and what docs do, are two totally different things! I examined a kid who was running around the office and seemed totally well and the mother had just finished telling me that he was lethargic. Hmmm lady, if this is lethargic, what is normal in your world?!?!?!?

My favorite case was one that I origninally saw on the wipeboard first. It read: "fishhook in forehead". Yup, you guessed it! The child was fishing with her brother who was casting into the water and managed to catch her in the forehead! Cute.

Another one that baffled me was this baby who was brought in for seizures. He had a seizure a week previous, but the parents thought it was just a febrile seizure (which are VERY common in kids who have fevers) They had a neice who had a febrile seizure so they've seen one before and weren't worried at that time. Me: Did he have a fever then? Parents: No. They finally brought him in because he had had 2 more the morning I saw him. Me: Did he have a fever? Parents: We took his temp when he was seizing and it was normal. It's weird isn't it? Me: Ummm...yes it is. (Logic would tell me this wasn't a febrile seizure becasue he didn't have a fever! I didn't need 3 years of med school to tell me this.)

I go on to ask the parents more about the child. He was 10 months old and couldn't roll over or sit by himself. He wasn't able to lift his head up he would just lie there. He only recently just started smiling and wasn't able to follow objects. The parents out there may recall this is VERY abnormal for a baby that old. When I examined him, the baby was very floppy and developmentally he was like a 2 month old. I told the doctor I was working with (he agreed with my assessment) and we claled in the neurology team to admit and assess him. I'm not sure what the outcome was but it doesn't look good. I was most amazed that even though the family were all telling the parents that thier baby was't normal, they didn't listen. I'm even more disappointed that they hadn't taken the baby to a GP for well baby checks, which surely would have caught this earlier on.

This past week I was in an outpatient Peds clinic. I saw 10 patients all week. Not good for learning, but a nice rest. I guess summer is good for kids because they don't get sick!

Next week, I start my inpatient block at another hospital. I hope I see some interesting things, but I'm aiming for the 'bread and butter' of Peds to use in my future GP clinic. Till then!

What I did on my summer vacation

Sorry. A little tounge-in-cheek humor. I had a whopping 2 days off in between my surgery and peds rotations and I definately made the most of it!

My surgery oral exams went good. My board exams...well, we'll just see in a month or so. After writing those, I travelled with some classmates to a big lake many hours away to go on a classmates houseboat! It slept 15 anf came complete with a gas fireplace, dishwasher, hot tub and a slide off the top deck! It was a short but sweet trip and we got lucky with a day of sunshine. So much fun!

Now, it's back to the grind and my final rotation in pediatrics. Yesterday was orientation and I swear I may just poke my eyes out with a fork. After being relatively independent for internal medicine and surgery, the peds people want us to hold their hands like kids. We were getting a tour of the (very confusing) hospital and our tour guide (who is also one of our instructors) actually said to us: "OK, listen up students. Students? Are you listening?" And she would stare at us until every single one of us was looking at her and silent. Get over yourself.

I'll be doing my first 2 weeks in the childrens emergency department. Today was S-L-O-W. I saw a total of 6 cases in an 8 hour shift. Ahhhh...sweet, sweet, summer!

Surgery...check.

Well, OK. I haven't OFFICIALLY completed my surgery rotation, but close enough. Yesterday was my last clinical day and the surgeons and residents were nice and let us go early so we could study!

This morning was the oral exams. Basically, we sit down with 2 surgeons who grill us for half an hour on 2 topics and then we switch rooms and do it again with 2 other surgeons. For my surgery rotation, I did 2 weeks of plastic surgery, 2 weeks of peds general surgery, and 4 weeks of adult general surgery. However, for this exam, we're required to know some basics from all the surgical disciplines: neurosurgery, ENT, thoracic surgery, urology, plastics, peds, radiation oncology, vascular, and cardiovascular surgery. For the oral exams, they try to make it so you get a general surgery station, plus at least one station from a rotation you did.

For instance, my stations consisted of cases from:
1)general surgery (rectal cancer and bowel obstruction cases)
2)plastics (tendon laceration, burn injury, and scalp avulsion cases)
3)vascular (abdominal aortic aneurysm, peripheral vascular disease, and DVT cases)
4)neurosurgery (subarachnoid hemorrhage, malignant headache, and spinal cord compression cases).

I think I did fine. Now I just have to write the 2.5 hr standardized exam tomorrow morning and then I'm done surgery!!! I'm taking it easy tonight and not studying. These standardized exams are a joke and don't really test your knowledge or your experience during the rotation. I've written a few; studied hard for a couple and barely studied at all for a couple. Got the same marks for both of them, so I figure it doesn't really matter if I study anyways. I might as well have a relaxing evening!

Tomorrow evening...I'm going houseboating for the weekend!!!!