Jan 25, 2014

Dream Office #1

I'm in love with family medicine, most likely because I want to have my own little clinic. Which means I spend a lot of time fantasizing what my future clinic will look like. And how I can differentiate myself from other doctor's offices. Because I don't want to just be a competent doctor. I WANT TO BE THE COOLEST PHYSICIAN IN AMERICA.

Okay. Idea. My favorite part of life is essentially educating patients. But I can't talk to everyone about everything. WHAT IF....

I designed a website with patient education materials specific to whatever city/town/region I was working in... like, if we still haven't gotten a handle on pharmaceutical costs, where you can get the cheapest diabetic supplies without a prescription. But then it would also have a lot of information about the disease (e.g. diabetes), and then specifically it would be handled by one of my "uber patients." A well informed patient who agreed to help others with their disease. They'd update the disease page as if it was their own blog, and maybe they'd even stay uptodate... lol, with current management and disease breakthroughs. And then they could chat with my other patients who had been recently diagnosed. Maybe even form a support group that could meet IRL occasionally. And if they had any questions about management that they couldn't answer, they could e-mail me and I could respond back.

That would be... super fun. Also, super empowering. I wish I had a support group for my diabetes. We could have contests to see who could have the lowest A1c. We could talk about the best ways to make sure you always have sugar on you. I could find out more about insulin pumps. I mean, seriously. This could be awesome.

Jan 18, 2014

You win this time, baby.

"Syncopal Event" So a couple of nights ago I ended up unconscious, on the floor, dreaming about a duck and a witch debating over who should mow their lawn. Incredibly unprofessional. But apparently these things are common on Ob-Gyn rotations. But I don't understand why these things have to be common for me. Here's my track record so far: In a week of working pure shifts I observed a c-section and helped out with a normal spontaneous vaginal delivery (NSVD). I nearly passed out in one, and definitively passed out in the other--I was on the floor dreaming about ducks. That means right now the score is: seven pound neonates 2, Elora 0.

When the scrub nurse told me I needed to leave the table during the c-section because I was leaning on the patient and I was passively crossing my eyes, I gave my retractor up and I had at the time told myself my blood sugar was probably low. Type 1 Diabetes fail! I sulked out of the room--very slowly so that I wouldn't fall onto any of the nurses standing cautiously around me. And then I had found my way to a patient fridge which are really just stock piles of assorted milks, jellos, and juice cups. One chocolate milk and one orange juice down, I found a dark, quiet unused part of the family waiting room and slowly collected the sweat pooling off of my face onto the collar of my oversized, hospital recycled scrubs. Excellent example of an acute hypoglycemic event--so perfect I didn't even think about checking my blood sugar. And then I actually passed out for real during a NSVD and upon regaining consciousness enough to check my blood glucose, I was perfectly normal--better than normal… 176 mg/dl. So now everything is in question!

DID I REALLY ALMOST PASS OUT DURING THAT C-SECTION? Even my potential as a future family practitioner should be questioned. If I can't handle pregnant people and kids, then I will have to become a… oh god… an internist? I would rather die than do something that boring. I HAD SUCH HIGH HOPES FOR OB-GYN. I've more or less "mastered" (for a third year medical student) the pelvic exam (I can find your cervix! If you have one). Vaginas don't creep me out at all! Vaginal products don't really creep me out either. Senior year of high school, as a swim team captain, I had picked up, with my bare hands, a bloodied feminine napkin that some noob had left on our locker room floor. This merited me a great gag gift at the end of the season. But it also kind of made me think that I could handle a large amount of grossness associated with the female reproductive tract. I still don't think vaginas or uteruses are my problem.

Which is why I think my real problem is… babies. When I had returned to the floor station after passing out during the NSVD, and the nurse wheeled the less than one hour old baby past me, I pointed at it and declared: "You made me pass out, baby!" What the hell is wrong with me? THEY BARELY MOVE! They are pathetic. Me and a baby in an actual fight? I would probably win, right? Gah. Maybe not.

This is the bruise left from my syncopal event.

 The midwife, the residents, and a ton of nurses have been very supportive of the fact that I am not, in fact, a very imposing six foot tall woman, but rather a pathetic, spineless, inexperienced medical student. Every one has stories of passing out and watching other people pass out. It makes me feel better to know that this isn't rare. But I don't want to feel normal. I want to actually be good at maintaining consciousness in unpleasant situations.

Talking with my friend, Cindy, who was also on shift with me, who had also watched this baby emerge into the world, who had also, like me, held the mom's legs back to flatten the pelvic floor and increase the size of the pelvic outlet, and who is a very small five feet tall, but who had NOT passed out, suggested something like, maybe it's not the actual sight of a baby entering the world--because they are pretty ugly looking in an adorable way--but maybe it's the smells of deliveries that really knock me out. Possible. The c-section lady had smelled pretty gross before the operation, and during it, she hadn't smelled that much better. And during the NSVD, I was literally holding up a thigh as the woman kept exhaling directly into my face. I shouldn't say anything. If I had been in labor for the last thirteen hours, yea… I probably wouldn't have spent time brushing my teeth, either. But then it was all I could smell and I felt like vomiting. And when the baby came out I kind of stepped out into the corner, leaning against the window sill. I was thinking to myself "hypoacousis: the thing that happens to me when I'm really happy/manic when driving and I have to turn up the radio all the way because everything sounds so quiet" because that's what was happening to me at the time. Everything was incredibly muffled. There was no longer blood in my ears, apparently. Nor was their blood in the rest of my body, because my arms and legs were moving very slowly. I managed to make it to the window sill and was just kind of waiting for the aura to subside. But it was a prodrome. And the next time I opened my eyes, I was staring at the ground and a nurse was propping me up against the wall with a blanket, and another was going out to get me orange juice. "I don't know what just happened," was my response to "Are you alright?" And Cindy was giving me a pity smile. The patient's family members were mildly freaking out, and I wondered if when the kid asked about her birth they'd tell her that she made a medical student pass out.

Later I would have to fill out an employee injury report, and although I had a small, 1-2 cm laceration ion the lateral aspect of my forearm, and my hand was really sore, I was tempted to write "ego" in the head of the anatomical model of the human body, and circle it to show where I was in fact, most hurt.

Jan 15, 2014

Laziness? or the best medical student ever?

"In a recent study, Johns Hopkins researchers followed two groups of medical interns for a month and found they sat down at the bedside only 9 percent of the time.

Sitting down, which would seem like one of the simplest things to do, is the least practiced of five communication skills for doctors that Lenore would have endorsed and that research has shown can make a big difference in patient satisfaction."

I smiled when I read this. One: it harkens back to the thesis I wrote in undergrad about how important body language can be in patient-doctor communication. Two: I am the laziest person I know.

I will sit on anything. I have, on occasion, left a patient's room to grab a chair so I could sit down while talking to them. Standing? I don't have time for that. If I get five minutes off my feet, I am going to take those five minutes.

A lot of the times I feel like I get lucky a lot when I'm interacting with patients. I've had very few bad patient encounters, and a lot of times I get patients personally thanking me for being so kind. I wonder how much of this has to do with me being "lazy", not trying to be overly professional.

Anyway, you can read the rest of the article "5 Simple Habits Can Help Doctors Connect with Patients" at http://www.capradio.org/news/npr/story?storyid=261398048

Jan 9, 2014

Baby Blues

I realized earlier this week that I was getting very upset at my patients. And I didn't know why. OBGYN is only women, and almost all of them were very nice (or however nice anyone who's contracting can be.)

It was only when I saw a newly created father staring at his neonate that I realized why I was so upset. I was jealous. You keep telling yourself you want to be a doctor. I think it's something that I  really want to do. But most people my age are.... And there are a lot of things I do on my downtime that aren't medical school related. But being a mom isn't one of them. And it isn't in my foreseeable future or even my actual future. Being pregnant sounds miserable. Being in a stable relationship with a significant other sounds worse. So this whole family thing is impossible.