Reason number 542 NOT to bring your kid to the ER...

I'm at the ER again today.  I think I just have the worst luck, because once again not a single kid has actually qualified for a study--don't get me wrong, we've had TONS of kids with abdominal pain and whatnot, but none who are being tested for appendicitis--mostly just constipated.  Woot.  It's a poopy kind of day.  Only kid who might have qualified for my other study had x-rays with him when he arrived, which ruled him out.  (ETA:  Finally had a qualifying kid come in at 15 minutes til my shift was up...ended up staying almost an hour late but it was worth it because I got to help run the ultrasound for his broken clavicle!)

Best chief complaint of the day: kid who was brought to the ER (yes, folks, the emergency room) because he had cotton from the end of a Q-tip stuck in his ear.  The US medical system at work, folks, right here in front of our eyes.  

I'm thinking of talking to one of the doctors here about finding someone who's doing a case review study that I could help out with and get published.  All the cool kids are doing it, apparently...and God knows I have to keep up with the crowd.  In all honesty, though, it would definitely be a boost to the CV if I had a publication, even if peds doesn't necessarily require it. 

We had our lottery for the student-run clinics that we can run in our second year.  Basically, the school has four clinics throughout the city that are essentially run by second year med students (reporting to legitimate physicians, don't worry), and we can get two elective credits for working once a week for seven weeks at one of them.  Obviously, lots of people want to do this, so to make it fair in terms of who gets to do it (and which clinic they get to work at) we have a lottery.  Everybody's name got randomly assigned a number and then today at the lotto session when they called your number you picked which clinic and which session you wanted to work.  Unfortunately, I had a pretty high number so I didn't get my first choice clinic, but I did get one that I think will be a fun one to work.  I'll be working for seven weeks next spring (at the end of the year, when I might actually know something and when things will stick the most for third year, I'm hoping) in a clinic that serves mostly women, some children, and a few men, most of whom are involved with a local half-way house.  I'm super excited and can't wait to get some more clinical experience under my belt.  

Only two more weeks of class, study week, then two weeks off before my externship starts!

Not waiting any more...

HE GOT THE JOB!!!!!!!!   :-D

So excited. Both of us are.  YAY!!!!!!!!!

Waiting

I'm playing hooky today because we only had two hours of lecture this afternoon, and my alternate option was staying home all day with D, who's off work.  I'll catch up with the lecture recordings later.  These last three weeks of actual class/lecture prior to our final set of exams are going to be fabulous--this week we are essentially done already, because I'm skipping class today, tomorrow we have a small group but no new material lecture, and all we have Friday is a Sim Lab (get to play with the dummies some more--no new material here either).  Next week is a short week with no school on Friday and a quiz on Thursday, so no new material there either.  The week after that we have PBL (problem based learning) modules, which means we sit around and pretend to be doctors for a while but don't have to actually attend lecture.  Then study week.  I'll take that, thanks very much.  

Today we are waiting on pins and needles to hear back from D's employer--he interviewed for a promotion within his company yesterday and we are hoping to hear back today.  This is the third such promotion he's interviewed for since February, and the past two times he has been told outright that he had the best interview, the best qualifications, but was not given the job.  Needless to say, things have been exceedingly frustrating.  He's taken it all extremely well, given the circumstances, and has kept improving his performance, so we're hoping for good results on this one--but things have been extremely political in the past, so it's hard to say what will happen.  Cross your fingers for us...

Baby Day at the Zoo

D and I took advantage of the absolutely gorgeous weather this afternoon and went to the zoo.  We got a membership last year and haven't been able to use it all that much, so it was really nice to spend the day enjoying the sun and hanging out (and getting some exercise to boot).  We actually sort of assumed no one would be there, because today's the day of a huge festival in our hometown and we figured everyone and their mother would be busy with that.  Unfortunately, we must have missed the memo that when all the single adult and older family types are out celebrating, everyone with a child under the age of 5 goes to the zoo.  The place was literally crawling with strollers.  I have never in my life seen so many in one place--except maybe Disney World.  It was crazy.  Luckily, though, little kids tend to be pretty into the zoo and it actually made for a really fun time, because not only did we get to enjoy for our own sake, but we got the additional hilarity of hearing three year old lisps proclaiming the virtues of meerkats.  

Now we're home and being domestic--I mowed the front yard, he's currently mowing the back and I'm studying the endocrinology of the reproductive system.  Because, you know, that's how we work.  

The continuing saga of the Mr. Hackencough.

We finished our sim lab experience yesterday--I presented the story of the guy I had interviewed (and, though we didn't give as much feedback as we had before with other people, it seemed to go over really well) and we discussed what we knew about acid/base levels and their relation to respiratory problems.  We also discussed/learned how we can adjust these kinds of problems with ventilator settings. We then got to troop ourselves into the Sim lab, where Mr. Hackencough was replaced with a simulator dummy hooked up to a ventilator.  Our sim dummies are pretty cool--basically, they look like CPR dummies, but they're computerized to the point that they breathe in oxygen and out carbon dioxide, they bleed, they have heart and lung sounds and pulses in the right places, and when we give them drugs, they react appropriately.  They also tend to be hooked up to monitors so that we can follow their vitals (heart rate, blood pressure, pulse-ox, etc.).  

The guy I had to "intubate" last week was presented to us with respiratory acidosis, and we basically went through the actions of fixing his vent, then watching him go nuts again (he developed further acidosis and uremia), fixed that, then he got better, and then he got worse again.  We "fixed" him a total of I think three or four times.  I love things like this, mainly because the doctors that work with my group did a really good job of letting us make the decisions and talking us through them, rather than essentially telling us what to do and letting us fake our way through the procedure.  I can't say that I feel like I would be able to handle a ventilator patient all on my own now, but I do feel confident that if I walked onto the wards tomorrow, I would at least have a basic idea of how it works and what to adjust to effect certain changes.  I also managed to remember all of the causes of anion gap metabolic acidosis (of which there are many--the mnemonic we were given to help remember was A CAT MUDPILES, with each letter representing a different possible cause, and some letters representing two), which pretty much made me feel like a badass in front of the attendings who were helping us.  

As I told D this morning, days like this are so incredibly re-affirming.  I am deeply, deeply satisfied with choosing medicine as a career, and things like this just reinforce that.  I'm sure I would probably be a bumbling idiot if you suddenly threw me into third year right now, but I feel confident about my abilities to take a history, present the pertinent information, and answer questions about the basics of the problem.  Of course, this should (hopefully) only improve next year with path and pharm.  We shall see. 

Crash

Last Friday, I was the representative from my clinical cases group that had to go up to our "standardized patient" lab to get a history for our next case.  For those not in the know, the SPs, as we call them, are trained actors whose job it is to act sick and give a history like a real patient would--essentially giving us a chance to practice doing doctor-ly things on people we cannot possibly harm.  They also usually give us feedback on things that were good or bad about us--questions we should have asked, procedures that were done well or left out, etc.  I've had several of these encounters before, interviewing "patients" for everything from back pain to depression to gout and learning to do a physical exam.  This time, I was one of twelve people who got lucky enough to have to interview a patient who was having trouble breathing, and who we could expect to completely decompensate before our very eyes during the interview.  

Obviously, I was rather nervous going in, but the lab leaders prepped us--just take a history, no physical, keep an eye on vitals.  He'll probably pass out and need to be intubated before you're done.  Ok--no biggie.  When the guy stops talking I'll go ahead and ask for the intubation kit (oh, and for those wondering who in the world these SPs are that would let us intubate them needlessly--the procedures are all performed on mannequin dummies).   I walked in, introduced myself, and took the history--pretty darn well, I'd say.  All the pertinent information was there:  What's going on, how long has it been happening, what makes it better/worse, other symptoms, past medical history, family history, even some social history.  Pretty much everything you could ask a patient who's hacking up a lung right in front of you.  And so I finish asking pretty much every question I know to ask--and he's still just coughing away.  There was no one in the room with me, no one to turn and show the vitals, no one to offer me labs or other information.  So I stuck my head out of the room and asked for labs.  "There are none."  Ok...   Sickly dude is telling me how frightened he is and wants to know when his wife will arrive.  "I'm sure she'll be here soon, sir, don't worry, we'll take good care of you and get you feeling better."  Finally, someone random comes in the room.  "Have you done your history?  Did you ask (X) question?  What about (X)?"  Done, done, and done.  I read him the entire history.  "Well have you done a physical?"  They told us not to, but whatever, so I listen to the guy's lungs (which, obviously, sound FINE since this guy is in fact not sick, but whatever).  Turn back to the helpful guy--"So what's going on with your patient?"   Well, he's sick.  He's having trouble breathing, started a few days ago, can't get up today.  His O2 sats are dropping, along with his blood pressure.  "No, I mean, what's going on with him RIGHT NOW?"  He's resting.  "Are you SURE?"  Crap.  

After ascertaining that Mr. Actor Guy was, indeed, no longer responding to my shaking him and asking him if he was ok, I turned to Mr. Helpful Guy (or, not so helpful at this point) and inform him that Mr. Actor seems to have passed out.  At this point, I got to intubate the dummy, which was in all rights pretty neat.  

My only question is, for this whole experience, could we make things a little a) more realistic or b) more timely.  If the guy was supposed to pass out on me before the end of the physical, then he should have.  If he didn't, then there should have been another doctor there because as a med student who has NO background in either pathology or pharmacology, I have no clue what to do for this guy other than watch him cough until he passes out and I can "intubate."   It would have been an awesome experience, were it not for the disorganization.  Ah, well.  Now I get to present him to my group and our resident/attendings who help out, so hopefully they won't bash me too much. 

Exam Week and Car Issues

Last week was possibly the most exhausting week ever.  I have never been physically tired after an exam, but I was on Friday evening.  I don't think I necessarily worked harder than I normally do for an exam week, but the sheer mountain of material that was covered on this exam--easily twice what we had on our last one--made for a daunting mental experience.  Then, on test day, we have six one-hour long exams, with a fifteen minute break between each and an hour for lunch in the middle.  This is supposed to get us ready for the boards next year, which follow roughly the same format, but the difference is that when you take the boards, you are not required to take the allotted amount of time for each section.  If you finish early, you can take your ten minute break and then start the next section at will.  For our exams, if I finish half an hour early on each section, I am simply treated to a forty-five minute break between each exam, which makes for a very long, very tiring day.  I came home, plopped straight down on the couch, and fell asleep for an hour afterward.  

The nice thing was, D and I got to go to the med school "Spring Fling" dance Friday evening, which turned out to be pretty fun.  Any excuse to wear a fun dress is ok by me.  The rest of the weekend was equally nice because I went shopping and rounded out a little more of my professional wardrobe for the externship this summer.  

This morning, I was all up and ready to go to class at 8 when I walked outside, threw my stuff in my car, turned the key, and...nothing.  Not a sound.  Not a click, whirr, or a light.  Nada.  I thought maybe it just needed time to warm up a bit since it's been unseasonably cold lately, but no dice.  Luckily, when I called my extended warranty people to see if there was any chance in hell that it was still active, it turned out that the car was still covered under warranty until June 11 (2009) or 75,000 miles, whichever came first.  My car has (literally) 74,800 + miles.  Thank God.  Triple A is coming sometime (supposedly) here within the next fifteen minutes to tow my car to the shop and I think I get a free rental car out of the deal.  Hopefully the whole business won't take too long, since I have to go to school and pretend to talk to patients about not smoking by three.