You Know You're a 4th Year Medical Student When...
You know you're a 4th year when you decide that you're cool enough to pimp your resident. And yes, folks, that's precisely what I did on my 1st day of OB-Gyn, while on the intake service. There were two residents in that particular area, that serves as a sort of OB emergency room. One was an OB-Gyn intern, the other a family practice resident. The family practice resident was very impressive to me. He was doing a lot of teaching and explaining, which is always well appreciated. And then... he started pimping me.
For those of you who are non-medical people, "pimping" refers to when someone above your level tests your fund of knowledge by asking you questions. This can range from "draw me the carbon skeleton of the neuromuscular blocker, succinylcholine" (this happened to me on anesthesia... i'm not kidding) to "which side of the heart is the right atrium on?" (this did not happen to me, but i think it would be amusing if it did... especially if i got it wrong).
Anyways, he was pimping me on UTI's - urinary tract infections. What do you see on the urine dipstick, what would you look for on the urine culture. Then, he started asking me about vaginosis... what's the treatment?
Metronidazole I say.
Why wouldn't you give this medication to an alcoholic? he asks.
Cuz it causes a disulfiram reaction, I say.
Then, I start to get irritated, for no particular reason. I began to develop an unnecessary mentality that kind of went like this: How dare you ask such menial questions to a fourth year medical student? Don't you know who I am, and how superior I am? Leave me alone!!
And then, it happened, before I figured out that it was coming.
Do you know the mechanism of action of metronidazole? I ask.
He pauses for a minute. Leans his elbow on the counter. Ummmmmmm... lemme see. Does it work on a protein?
Nope, try again, I say.
I dunno. What is it? he asks me.
Forms toxic metabolites in the bacteria, I say, withdrawing this very miniscule piece of information that was somehow acquired during the process of studying for the Step One.
Ohhh! That's really good! Thanks for letting me know, He says.
Dammit. He actually was happy to learn. He had a much better attitude at getting pimped by a medical student, than I would have. In retrospect, I think this may have been a dangerous thing to do, to pimp my resident, especially since I was asking him a question that I was almost 100% sure that he wouldn't get correct, but I really do feel it was an accident. Maybe...
Thursday, October 27, 2005
Monday, October 24, 2005
Sutures and Shoes
The first day of my OB-Gyn rotation was precious, not because I delivered my first baby, not because I found myself in a position where I was the most qualified medical personnel to perform an emergency C-section, but because I taught Anu how to tie his shoelaces.
We formed our teacher-student bond during the "suture workshop" portion of our OB-Gyn orientation day. I was first showing Anu how to tie the one-handed and two-handed surgical knot.
"Yeah if they want me to tie in the OR," Anu said to me, "I'll just do it like I was gonna tie my shoelaces." I laughed.
He then demonstrated on the practice suture model, making two loops with the two sides of the string, and tying them together. And that's when I realized... Anu ties his shoelaces like a FOB.
"What do you expect? My parents taught me how to tie my shoelaces," Anu said, when I told him that he was a FOB, "and I never learned the whole 'round the tree trunk' thing."
I told him that I would teach him. First, we needed some shoelaces! I looked at Anu's shiny black Kenneth Coles, and I reached down to untie his shoelaces.
"It's quite simple Anu," I began, "You make a loop with one side of the string, bring the other strand around, and pull it through the little loop, and tighten."
"Like this?" Anu.
"No, no... like this..."
He got it after two tries. I guess the first day of orientation of OB-Gyn is useful after all:)
The first day of my OB-Gyn rotation was precious, not because I delivered my first baby, not because I found myself in a position where I was the most qualified medical personnel to perform an emergency C-section, but because I taught Anu how to tie his shoelaces.
We formed our teacher-student bond during the "suture workshop" portion of our OB-Gyn orientation day. I was first showing Anu how to tie the one-handed and two-handed surgical knot.
"Yeah if they want me to tie in the OR," Anu said to me, "I'll just do it like I was gonna tie my shoelaces." I laughed.
He then demonstrated on the practice suture model, making two loops with the two sides of the string, and tying them together. And that's when I realized... Anu ties his shoelaces like a FOB.
"What do you expect? My parents taught me how to tie my shoelaces," Anu said, when I told him that he was a FOB, "and I never learned the whole 'round the tree trunk' thing."
I told him that I would teach him. First, we needed some shoelaces! I looked at Anu's shiny black Kenneth Coles, and I reached down to untie his shoelaces.
"It's quite simple Anu," I began, "You make a loop with one side of the string, bring the other strand around, and pull it through the little loop, and tighten."
"Like this?" Anu.
"No, no... like this..."
He got it after two tries. I guess the first day of orientation of OB-Gyn is useful after all:)
Thursday, October 20, 2005
Versed for laughs
I got to place an IV in a real live comic today - a comic who travels the country touring and putting on shows.
I had a lot of questions for him such as, "Can you tell me a funny joke?"
He told me he gets that question a lot and says it's hard to deliver on the spot. How bout that for a comic? Maybe it's similar to when you pimp a brilliant medical student, "How many chambers in the heart?" and you only get a blank stare...
He did say that because he was getting his toe amputated, he considered himself a "toe-away zone." Ba-doom ching!
I was putting an IV in him. He had this gorgeous vein popping out above his wrist that was the size of a tree trunk, and the resident said, "We're gonna put in a 16 gauge in this baby! I'll have my star medical student put in the IV." Now, this is one reason why I'm actually looking forward to intern year, so that patients won't actually fear getting treatment from you, and because residents don't have to treat you like a two year-old. I only worked with this particular resident one day... star med student? Gimme a break...
It's not like I wasn't capable of putting in the IV or something like that - by now I had gotten real comfortable with this minor procedure, having had two weeks of experience. Place the tourniquet, patient pumps their wrist, swab area with alcohol, then inject some lidocaine, swab area with more alcohol, then place the IV catheder, advance the catheder, connect to the tubing, let the IV run... But I think the combination of the patient'thick skin, and an annoying resident looking over my shoulder led to me blowing his vein. I had failed to put place an IV in a tree trunk.
I tried again... this time in his hand, and I got it very easily. I think maybe cuz the resident wasn't hovering over me as I did it. Then, I saw someone in scrubs pumping his fists in a very Home Alone sort-of-way out of the corner of my eye. It was the resident. It's almost like he wouldn't have been happier if the Astros made the World Series or something...
Anyhoo, it was at this point that I began to talk to the patient more, while I was securing the IV in place with tape.
"I want to look at my hand. Feels like a mummy down there." he said. I smiled.
"Just trying to tape it up real good," I said.
He held up his hand. "What's that?" he said, referring to a blood stain on his index finger.
"Ahhh... that's just... uhhh" I said, trying to think of something to make the comic laugh. Something witty, on the spot, something that would reveal that this medical student had hidden stand-up comedy talent. But all I could think of was the word "lipstick." Lipstick???!!!#@$
"You hesitated too long there," he said, interrupting my stuttering, "You're about to lie. I know... I play poker."
Of course he knows, he's a comic! "What would you have said?" I asked.
"Iodine," he replied, "It's just some iodine there..." He was trying to sound like a doctor.
"Iodine? ! But iodine doesn't even look like that!" I said, appealing to my logical medical knowledge, "It's more orange in color!"
"Most of us don't know that. We're stupid."
"I guess." He got me there.
We talked some more. He told me about various jobs he had and told me about some of the other comics that were his friends. He said he knew some Indian comics.
Then I noticed some blood trickling from his IV. Crap. It was leaking. I tightened the tubing on the IV a bit tighter and the leaking resolved, but there was another, much larger blood stain on his hand. He held up his hand to see how bad it looked.
"Nothing but some iodine there," I said, "The alcohol swab'll do that to ya too."
He laughed. "You learn fast."
I accepted the compliment.
And I decided not to tell him that I had what I considered to be a "stupid med student morning." I had to transfer some Vanc from a bottle to a bag of normal saline for a patient's IV using a 10 cc syringe, and while doing so, I punctured the bag of normal saline, leaking the liquid onto the floor of the OR. The resident (different from the one earlier in the story) looked at me like I was a moron. And I agreed with him. I thought about apologizing, but decided against it, based on principle. Why should I have to apologize for being a moron? I'm sure back in the day, that resident had many moronic moments. I hope...
The point is, that I had a great conversation with this particular patient. I didn't really have any life-altering epiphonies, or signficantly impact the rest of this patient's life, but I got to learn about a lifestyle I knew nothing about, and did counsel him a bit on how to take care of himself better. Despite my moronic moments, it was a morning that made me glad I was going into medicine, glad that I was going to be able to touch many lives in ways that are more meaningful than they may seem.
*********
Note: Versed, pronounced "Ver-SAID", is a drug (benzodiazapine) used for pre-operative sedation. Anesthesiologists refer to Versed as their margherita, their cocktail. When you give it to kids, it can make them pretty giggly.
I got to place an IV in a real live comic today - a comic who travels the country touring and putting on shows.
I had a lot of questions for him such as, "Can you tell me a funny joke?"
He told me he gets that question a lot and says it's hard to deliver on the spot. How bout that for a comic? Maybe it's similar to when you pimp a brilliant medical student, "How many chambers in the heart?" and you only get a blank stare...
He did say that because he was getting his toe amputated, he considered himself a "toe-away zone." Ba-doom ching!
I was putting an IV in him. He had this gorgeous vein popping out above his wrist that was the size of a tree trunk, and the resident said, "We're gonna put in a 16 gauge in this baby! I'll have my star medical student put in the IV." Now, this is one reason why I'm actually looking forward to intern year, so that patients won't actually fear getting treatment from you, and because residents don't have to treat you like a two year-old. I only worked with this particular resident one day... star med student? Gimme a break...
It's not like I wasn't capable of putting in the IV or something like that - by now I had gotten real comfortable with this minor procedure, having had two weeks of experience. Place the tourniquet, patient pumps their wrist, swab area with alcohol, then inject some lidocaine, swab area with more alcohol, then place the IV catheder, advance the catheder, connect to the tubing, let the IV run... But I think the combination of the patient'thick skin, and an annoying resident looking over my shoulder led to me blowing his vein. I had failed to put place an IV in a tree trunk.
I tried again... this time in his hand, and I got it very easily. I think maybe cuz the resident wasn't hovering over me as I did it. Then, I saw someone in scrubs pumping his fists in a very Home Alone sort-of-way out of the corner of my eye. It was the resident. It's almost like he wouldn't have been happier if the Astros made the World Series or something...
Anyhoo, it was at this point that I began to talk to the patient more, while I was securing the IV in place with tape.
"I want to look at my hand. Feels like a mummy down there." he said. I smiled.
"Just trying to tape it up real good," I said.
He held up his hand. "What's that?" he said, referring to a blood stain on his index finger.
"Ahhh... that's just... uhhh" I said, trying to think of something to make the comic laugh. Something witty, on the spot, something that would reveal that this medical student had hidden stand-up comedy talent. But all I could think of was the word "lipstick." Lipstick???!!!#@$
"You hesitated too long there," he said, interrupting my stuttering, "You're about to lie. I know... I play poker."
Of course he knows, he's a comic! "What would you have said?" I asked.
"Iodine," he replied, "It's just some iodine there..." He was trying to sound like a doctor.
"Iodine? ! But iodine doesn't even look like that!" I said, appealing to my logical medical knowledge, "It's more orange in color!"
"Most of us don't know that. We're stupid."
"I guess." He got me there.
We talked some more. He told me about various jobs he had and told me about some of the other comics that were his friends. He said he knew some Indian comics.
Then I noticed some blood trickling from his IV. Crap. It was leaking. I tightened the tubing on the IV a bit tighter and the leaking resolved, but there was another, much larger blood stain on his hand. He held up his hand to see how bad it looked.
"Nothing but some iodine there," I said, "The alcohol swab'll do that to ya too."
He laughed. "You learn fast."
I accepted the compliment.
And I decided not to tell him that I had what I considered to be a "stupid med student morning." I had to transfer some Vanc from a bottle to a bag of normal saline for a patient's IV using a 10 cc syringe, and while doing so, I punctured the bag of normal saline, leaking the liquid onto the floor of the OR. The resident (different from the one earlier in the story) looked at me like I was a moron. And I agreed with him. I thought about apologizing, but decided against it, based on principle. Why should I have to apologize for being a moron? I'm sure back in the day, that resident had many moronic moments. I hope...
The point is, that I had a great conversation with this particular patient. I didn't really have any life-altering epiphonies, or signficantly impact the rest of this patient's life, but I got to learn about a lifestyle I knew nothing about, and did counsel him a bit on how to take care of himself better. Despite my moronic moments, it was a morning that made me glad I was going into medicine, glad that I was going to be able to touch many lives in ways that are more meaningful than they may seem.
*********
Note: Versed, pronounced "Ver-SAID", is a drug (benzodiazapine) used for pre-operative sedation. Anesthesiologists refer to Versed as their margherita, their cocktail. When you give it to kids, it can make them pretty giggly.
Tuesday, October 18, 2005
The 6 A.M. Wire
The darkness envelops my sense of urgency to arrive promptly at the Ben Taub OR at 6:30 A.M so I can have the best pick among the patients needing intubation. My steps are soft on the concrete, but the synthetic fibers of my scrubs swooshing and my ID badge colliding with the head of my stethoscope serve as familiar music on the short journey from my car on "Lanesborough Street" to the Smithlands Metrorail station.
I check for cars twice before making a potentially fatal crossing that would otherwise be safe if only a luminous walking man signal were present. I'm well aware that I awakened from my dreams only thirty minutes earlier. I arrive at the rail stop and fill an empty seat that lies between an African American lady and a balding Asian man engaged in conversation. I lean back against the glass, trying to give them space to communicate. The lady is showing many of her teeth in her laughter, and she seems to be saying to the other man, "... much better job. You just don't work as much." It doesn't make sense, but I admire that she is animated while knowing that a med student sits beside her in that pre-dawn state in between slumber and wakefulness. It's similar to the "in-between" state in anesthesiology where it's dangerous to extubate patients: you want to make sure the patient has regained all their airway reflexes before you take the endotracheal tube out.
The conversation continues, and the lady's voice is the only one I can hear on the metrorail station. It's an anomaly, and I enjoy that at least two people around me know eachother. Suddenly the man turns away, the lady still speaking, now looking in another direction, "I don't know what he wants. But this is what he should have done..." What's going on? Who is she talking to ? Is the man mad at her? Or does she have schizophrenia? I want to know more, I want to ask her, but I've learnt that people don't always like that. Just like in the 2nd grade one time when I saw Casey and Shannon sitting on the monkey bars talking to each other about something that I wanted to know about. I yell out from down below,"Who are you talking about?" "Mind your own beeswax!" Casey yells back. I walk away thinking "Yeah, well I'm never gonna tell you anything again." Not that I had ever told her any of my juicy secrets prior to that moment... Not that I had any juicy secrets. I was eight.
The lady was still talking, still laughing, and the Asian man was now looking in the opposite distance, presumably for the train to arrive. And then, I see the wire, highlighted by the red background of her blouse. A wire that connects a cell phone I can't see to a small silver earpiece. Ahh, I should have known. It was the all-pervasive cell-phone conversation, with an apparently crazy woman and a wire as clues. Now I'm sad - no one on the rail station knows eachother, and maybe the lady and the balding man would have begun conversing, maybe about the Astros losing last night, if she hadn't had her cell phone. Or maybe she and I would have talked. Or maybe I would have talked to the Asian man. I still could say hi... but I decide I'm too sleepy, too tired, not interesting enough. I sigh, wondering how long it'll take for me to awaken, just as the train arrives and opens its doors, allowing me to enter.
The darkness envelops my sense of urgency to arrive promptly at the Ben Taub OR at 6:30 A.M so I can have the best pick among the patients needing intubation. My steps are soft on the concrete, but the synthetic fibers of my scrubs swooshing and my ID badge colliding with the head of my stethoscope serve as familiar music on the short journey from my car on "Lanesborough Street" to the Smithlands Metrorail station.
I check for cars twice before making a potentially fatal crossing that would otherwise be safe if only a luminous walking man signal were present. I'm well aware that I awakened from my dreams only thirty minutes earlier. I arrive at the rail stop and fill an empty seat that lies between an African American lady and a balding Asian man engaged in conversation. I lean back against the glass, trying to give them space to communicate. The lady is showing many of her teeth in her laughter, and she seems to be saying to the other man, "... much better job. You just don't work as much." It doesn't make sense, but I admire that she is animated while knowing that a med student sits beside her in that pre-dawn state in between slumber and wakefulness. It's similar to the "in-between" state in anesthesiology where it's dangerous to extubate patients: you want to make sure the patient has regained all their airway reflexes before you take the endotracheal tube out.
The conversation continues, and the lady's voice is the only one I can hear on the metrorail station. It's an anomaly, and I enjoy that at least two people around me know eachother. Suddenly the man turns away, the lady still speaking, now looking in another direction, "I don't know what he wants. But this is what he should have done..." What's going on? Who is she talking to ? Is the man mad at her? Or does she have schizophrenia? I want to know more, I want to ask her, but I've learnt that people don't always like that. Just like in the 2nd grade one time when I saw Casey and Shannon sitting on the monkey bars talking to each other about something that I wanted to know about. I yell out from down below,"Who are you talking about?" "Mind your own beeswax!" Casey yells back. I walk away thinking "Yeah, well I'm never gonna tell you anything again." Not that I had ever told her any of my juicy secrets prior to that moment... Not that I had any juicy secrets. I was eight.
The lady was still talking, still laughing, and the Asian man was now looking in the opposite distance, presumably for the train to arrive. And then, I see the wire, highlighted by the red background of her blouse. A wire that connects a cell phone I can't see to a small silver earpiece. Ahh, I should have known. It was the all-pervasive cell-phone conversation, with an apparently crazy woman and a wire as clues. Now I'm sad - no one on the rail station knows eachother, and maybe the lady and the balding man would have begun conversing, maybe about the Astros losing last night, if she hadn't had her cell phone. Or maybe she and I would have talked. Or maybe I would have talked to the Asian man. I still could say hi... but I decide I'm too sleepy, too tired, not interesting enough. I sigh, wondering how long it'll take for me to awaken, just as the train arrives and opens its doors, allowing me to enter.
Wednesday, October 12, 2005
Ode to Intubation
I started a two week anesthesia selective this past Monday, and I felt the urge to dedicate a poem to the intubation:
I started a two week anesthesia selective this past Monday, and I felt the urge to dedicate a poem to the intubation:
Ode to the Intubation
I was hangin’ in the pre-op area one day
And a surgery patient came my way
My resident says, “It’s a thyroidectomy!
She’ll need to be intubated, so follow me!”
We wheel the patient into OR number five
Where blue sterile towels are happy and alive
And on a tray right next to me
A gleaming Mac blade is what I see
We put the patient to sleep, she never fought us
I then insert the Mac blade to see the epiglottis
The plastic tube went through the vocal cords
A job I felt deserved accolades and awards
I listened to her lungs for equal breath sounds
Alas! For a minute I began to frown
What if I intubated the right main stem bronchus?
And the tube went way past the glottis?
But as I listened more clearly to her lungs
They were equal, and my heart gleefully rung
with joy at completing my intubation well
To you, dear reader, this tale I wish to tell.
Vera and her fibrous pineapple
My friend who is also in medical school - we'll call her Vera - attended what she called a very engaging Psychiatry lecture given by the queen of psychiatry(and of the Step 1 apparently), Dr. Kristin Kassaw. Dr. Kassaw covered many topics regarding physician burnout, one of which involved the tendency of many physicians to be "perfectionists." Now, I know that I definitely have this trait as a part of my personality, and I felt that this term nicely describes Vera. Vera, however, profusely denied this particular label.
She then told me an unrelated story, which I will attempt to recreate here, and you'll see my point when I'm done:
"So I had a really funny morning. You're gonna think I'm crazy when I tell you this. This morning, I decided to go to *Anonymous medical specialty* Grand Rounds because I had to talk to *insert famous faculty name here*. So I get there, and walk in to the room with my little plate of food and coffee and sit down. And as soon as I set my coffee down, I tell myself, Vera, don't spill your coffee! *laugh* So right after this, a grape rolls right off my plate onto the floor. I check to see if anyone's looking at me, and then I pick up the grape and I tried to throw it into the garbage, but I missed and it ricocheted off the side of the garbage can and landed behind the damn garbage can. I panicked. I looked to see if anyone was watching - thankfully no one was! Then, another grape rollls off the other side of the plate! And my coffee spills! But I tried to keep my cool, so I picked up the cup and started drinking the rest of my coffee like nothing happened. I didn't even clean up the coffee that had spilled! *laugh* So then I was eating my pineapple, cutting it with my fork. The chief resident was sitting right next to me, and so I trying to do my best in cutting my pineapple, so he wouldn't think that my surgical skills were terrible. *pause due to outburst of laughter from Devi* And then I realized that it's poor etiquette to cut your food with a fork, but I didn't have a knife. I was doing a good job cutting my pineapple, but there was this little strand of pineapple that I couldn't cut! I was getting nervous that the chief resident was watching me, and finally I managed to cut the strand. I didn't even bother with the rest of the pineapple on my plate."
Hmmmm Vera... ya think you're NOT a perfectionist?
My friend who is also in medical school - we'll call her Vera - attended what she called a very engaging Psychiatry lecture given by the queen of psychiatry(and of the Step 1 apparently), Dr. Kristin Kassaw. Dr. Kassaw covered many topics regarding physician burnout, one of which involved the tendency of many physicians to be "perfectionists." Now, I know that I definitely have this trait as a part of my personality, and I felt that this term nicely describes Vera. Vera, however, profusely denied this particular label.
She then told me an unrelated story, which I will attempt to recreate here, and you'll see my point when I'm done:
"So I had a really funny morning. You're gonna think I'm crazy when I tell you this. This morning, I decided to go to *Anonymous medical specialty* Grand Rounds because I had to talk to *insert famous faculty name here*. So I get there, and walk in to the room with my little plate of food and coffee and sit down. And as soon as I set my coffee down, I tell myself, Vera, don't spill your coffee! *laugh* So right after this, a grape rolls right off my plate onto the floor. I check to see if anyone's looking at me, and then I pick up the grape and I tried to throw it into the garbage, but I missed and it ricocheted off the side of the garbage can and landed behind the damn garbage can. I panicked. I looked to see if anyone was watching - thankfully no one was! Then, another grape rollls off the other side of the plate! And my coffee spills! But I tried to keep my cool, so I picked up the cup and started drinking the rest of my coffee like nothing happened. I didn't even clean up the coffee that had spilled! *laugh* So then I was eating my pineapple, cutting it with my fork. The chief resident was sitting right next to me, and so I trying to do my best in cutting my pineapple, so he wouldn't think that my surgical skills were terrible. *pause due to outburst of laughter from Devi* And then I realized that it's poor etiquette to cut your food with a fork, but I didn't have a knife. I was doing a good job cutting my pineapple, but there was this little strand of pineapple that I couldn't cut! I was getting nervous that the chief resident was watching me, and finally I managed to cut the strand. I didn't even bother with the rest of the pineapple on my plate."
Hmmmm Vera... ya think you're NOT a perfectionist?
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