A Lost Opportunity

The student had met her earlier last week. During that time she had been quite charming, quick minded, snarky, but with a compassion beyond belief. She had insisted that the doctor come to her home, once she was discharged, and sample some of her homemade jam recipes. She proudly recalled that she grew her own ingredients and her jars of jams and other treats were the talk of the neighborhood. Her daughter smiled lovingly at her. She was decisively independent in action and thought, but euphoric about her improvement. Traits that endeared her to the student and he hoped that he'd see her again when he returned the next week.

Upon the student’s return he found her in an opposing condition. That Friday she had been planning to go home, doing well and feeling optimistic about her time left, but now she was besieged like a cornered animal, clinging to an oxygen mask as life sustaining gas was pumped through at more than 7 liters a minute. Her eyes were screaming at him: “Help. I can’t breathe. Help!” and he recalled seeing that her oxygen saturations had dropped over the weekend to precariously low levels. The room, once full of euphoria, was now transformed into a dark, humorless, shadow full of dispair and exhaustion. The student felt a unique sense of vertigo, as if his entire world was being lost along with her's.

With this remarkable uneasiness that assailed him from every corner of the room, he examined her. He instantly recongnized the revulsion that had grown up in him and stood as a palpable lump in his throat. He found it hard to talk, even when just telling her what he was doing.

As the student arrived at the abdomen he discovered that the once soft, obese stomach was now a massively enlarged, rock hard, mound with discernible peaks and valleys. He could not appreciate any bowel sounds – an ominous sign. She had stopped producing urine and her eyes were no longer white, but were markedly yellow. His horror magnified as he examined these eyes, noting the distinct despair and cries that were manifested there within.

He knew from last week that she had undergone a major surgery to remove cancerous tissues. They had hoped that there hadn’t been any spread, but clearly the truth was here for the student to behold: The tumor had survived and was assaulting the woman from within; taking control of her body, plaguing her kidneys and liver, and making breathing an incredibly laborious effort. She was drenched with sweat from the effort of living. The student felt the sudden need to leave. He did not know what to do.

The morning rounds consisted of lengthy discussions between the doctor and her residents as well as with the family and the patient. The main topic focused on her sudden and clearly unexpected change. He found somewhere during this time that a party had been for her return and the banners still hung in her living room. "I doubt she'll see them" he had thought.

Radiographic films were viewed with the family in the physician’s lounge and the doctor explained the findings. The student already knew – large amounts of a homogenous, grey material obscured large amounts of the normal anatomy, interspersed with tumor. Her abdominal wall was caked in oppressive and magnificent abnormal cellular reproduction that constricted her diaphragm and reduced the patient's ability to move air.

“Metastasis. Outcome looks bad. Kidneys have begun to stop working”.

The family received these messages with stunned silence; then the daughter, the loving woman whom had been at the patient’s side when he initially met her, began to cry. The student looked away. He was surprised to find that he was fighting back tears as well – tears for a patient he’d only met once. Yet he knew what all of this meant.

In the span of 3 days she had fallen down the potential abyss that many patients navigate unscathed. She had “decompensated” and he knew there was nothing more to be done. She was going to die and he felt the acutely ironic scenarios play out before him.

****

She died later that week - a full code despite the attempts to obtain a DNR. He had avoided talking with the family or seeing the patient since that day unless he absolutely must. The situation was uncomfortable and the interrogations he received or perceived frustrated and confused the student. He didn’t know what to do, nor what to say. The doctor should be doing that. He was angry at the situation and the distinct perception that he was absolutely and completely ignorant of how to proceed. "How is it that after all this time I have no idea what to do"? he would often find himself asking aloud. His mind swam with guilt.

Now, as the student surveyed her lifeless body, tracheal tube still in place, eyes fixed and staring, chest exposed with the disproportions of her abdomen starkly evident, he was disgusted. A sudden and uncontrollable compulsion welled up within him. “I must get out of here!” he thought and he looked longingly at the door and the sanctuary of the nurses station. There he would be safe from the woman’s gaze, from his guilt.

Fighting off this instinct, the student stayed. He stayed when the doctor and residents lefts, he stayed when they cleaned up the woman. He even stayed when the family came in and burst forth in tremendous sobs. He persisted, in spite of himself. He had not been there for them before, but he wanted to be there now. Not so much for them, but for himself. If the student ran from this, then he had utterly failed in his duty.

The day culminated in a total of 20 hours. He had not needed to stay and had been released earlier. Yet he persisted. Wanting to stay and learn from his mistakes he remained and accompanied her to the morgue. He had avoided Death, but clearly it could not be brushed aside. It must be faced, and he had not performed admirably during the patient’s transition.

Though he desired to view her autopsy, he knew that this was an intrusion he could not perform. He had not been there with her during life, surely he should not be there when she was dissected and the tense abdomen exposed - it felt too intimate. He heard the next day that when the pathologist intially began she gushed liters of fluid. Metastatic ovarian cancer with mets all over her body.

At least she’s at peace, he thought. If there is a heaven, then surely she’s making her famous jams. The student smiled, and went about the rest of his day.

Enough Already

I’ve noticed something that has developed within me towards the end of 3rd year. My tolerance, as little as I have, has been almost completely eliminated. Mostly my intolerance of members of my class has begun to become far more evident the closer I get to being away from them. I look forward to 4th year for this reason - a long vacation from the laziness and abject stupidity that multiple people have evidenced throughout this year and the 2 previous.

I’m done with them. Thankfully I’ve had very little contact with Worst Medical Student Ever and have only interacted with him for a short duration during morning rounds (when he’d actually show up that is) and the one day a week class. During that time I’ve told him to shut up, grow the fuck up, damn near turned around and bitch-smacked him for comments he was making during lectures, and developed a very fun game with some friends related to Chewbaca. I can’t really explain it because you just won’t get how hilarious it is to mimic his “Ohhhs” with a Chewy purrrr. Hey, I already warned you about not getting it.

I’m not the only one who has just had it with our peers. A friend of mine told me recently of being bullied by another poor student. Unfortunately I’ve not had a rotation with her and have only received this information from the few and far between contacts we have. Mostly I get updates from her blog (which I will not share here as it’s not anon and would only help to out me as well as her) as to the recent insult received by this ass. She’s close to taking it to a physical level with the punk and I whole-heartedly agree with this line of action. No reason for that type of behavior.

So as this week comes to a close I believe that I’ll take a long and much needed breather from classmates. I plan on studying for Step 2 CK which I'll take in August, but I’ll steer clear of the various forums where classmates may be found.

******
On another note, I think I’m becoming an alcoholic. Daughter saw a beer bottle under the stairs of our apartment last week and told Wife “Daddy’s home! There’s daddy’s drink!” I think that says something - like perhaps it’s time to stop having a beer with every dinner (OK 2 or 3 beers, sheesh).

3...2...1

So, with one week left in OB/GYN and no more clinical or floor work required (fuck yeah) I thought I’d capture the craziest and just plain bigoted statements I’ve heard on this rotation. With that being said, enjoy:

“You have to have a vagina to do that. You can’t do that without a vagina.” (nurse telling me I can’t perform a certain procedure on a patient)

“The uterus and vagina are incredible. Amazing. Truly God knew what She was doing.” (attending discussing the changes made during pregnancy and afterwards)

“The womb is sacred and should be worshipped. Bow down!” (resident screwing with me)

“I hate fat people. Can’t see shit and it smells.” (ARMY doc after speculum exam that took a little too long with a rather ripe patient)

“Anesthesia? Really? But you can’t do cool shit...like cutting people up.” (ARMY doc during a hysterectomy)

“My mom usually goes to a male OB/GYN because back in her home country most of them are males. She’s seeing one now and told me: He’s gay, but a good doctor anyway.” (friend telling me about the differences between American women wanting to see mostly female OB/GYNs and his home country)

“I had my hand deep inside her vaginal orifice” (worst medical student ever discussing his examination during morning rounds - I truly hate this jackass)

“I thought the hater-nation was over after 2nd year ended” (worst medical student again trying to fight back tears as all the medical students on service turned against him and his incessant laziness before morning rounds)

“So you put it against the os-hole?” (Another ARMY doc discussing a tool with a rep)

"I'm taking that for my Bipolar Disorder. Oh yeah (stares blankly at ceiling and then head slowly turns back towards physician) I also take it for my multiple personalities." (various patient encounters where a history was being taken)

One more week and then it’s all over. This week’s going to be fucking hard as hell - at least 5 or 6 exams, reports, presentations, etc. Just breath and get through it. It’s almost over. I had a friend tell me that she thought I'd enjoy it because there's a lot of procedures. I did like the OR, but everything else just was painful. I truly had the easiest out of most of the students and am thankful for that. God I hate OB/GYN.

BMI Discussion and AWOL

OK. In response to the comments about the last post related to the “patient” I must admit something: that was me. Way to go Liz...you nailed it.

That’s right. I had you guessing about what kind of shape I’m in, what I might look like, and what you, my avid and voracious readers, thought MSG's fitness level is based on numbers because I'm an incredibly vain person. Happy?

The result? Well, basically most of you had me fairly well described: slightly overweight with a muscular build, often mistaken for weighing far less than I actually do (usually 40 pounds or so). I do not, regrettably, have legs of steel or “guns of nazarone”. Yet. So thanks for playing.

I was thinking about using this as a BMI discussion since I honestly feel I'm not "close to being obese" as the BMI suggests, but I think I’ll hold off on it. Afterall, most of us understand that this particular tool is useful but is clearly subject to interpretation.

******

Yesterday Stepson had his elementary school graduation. I was given a reprieve for the morning, but was supposed to return to the Army base afterwards. Instead I just didn’t go. I was essentially AWOL.

What's interesting to me is the fact that I’ve never done this before – completely forgoing my responsibilities because I despise a rotation. But here it is…I missed a day for no real reason. I just didn’t want to drive that far to deal with that crap.

Do I feel guilty? In some ways, yes, I do feel guilty. But in an abundance of others I feel completely OK. I had a great day with my family and enjoyed a picnic with his classmates. I spent some quality time celebrating Stepson's accomplishments and this movement into a new phase of his life. Hell, in one year we might be moving several thousand miles from him and his asshole dad, so taking time to enjoy these moments is even more important.

The only issue is whether I'll receive a reprimand on Tuesday for not returning. Either way - whatever. I really don't care anymore. I've got a couple more weeks and then 3rd year's over.

Stupid, stupid, stupid...

I did an incredibly stupid and completely embarassing thing this week. To say that it was negligent is a little far, but I'm sure if this goes to a trial it would be found that way.


Yeah, you read that right. This event could, if the patient wanted to, go to trial. I'm not going to discuss what the infraction was that I committed, but needless to say it was not done with malice of forethought. Rather I was just trying to be proactive and fucked up royally. My ability to think ahead was apparently impaired and I went about the task without considering the magnitude of the undertaking at hand. When I informed the nurses of my findings their looks and gasps were enough for me to understand how truly screwed I was.


I was talked to at least 4 times yesterday by increasingly higher levels of power within the OB/GYN program. Just grateful that they were understanding to a degree, but I could sense how concerned they actually were. When you're scrubbing into a C-section and get pulled out, already gowned up, you begin to understand how big a deal this is. When they use the terms: "You could go to jail for something like this" (well actually the nurse said that, but still) you're apprehension heightens.


And all of this after I hated this rotation so much, but have begun to get a feel for it, feel like I can accomplish some tasks without being completely deflated and demoralized, and was not dreading everyday as I had the first couple weeks. But now...

Stupid, stupid, stupid.

Lovey-Dovey

Patient on the table, after have a spinal for anesthesia, looked up at the CRNA (RN who does anesthesia) and said in a very hilariously drunk and lovey-dovey voice:

"I love you!"

Apparently the patient was quite satisfied with her pain control.

Team Player

***Warning: severe bitching and whining in this post.***

A couple weeks ago I had a student moment. I lost it on some of my “colleagues” because they’d not been on time to round on patients for a week and we had a patient that wasn’t seen. 15 minutes before rounds my friend and I quickly obtained the information and saw the patient for rounds, but did not write a note. During rounds I explained this, telling the other students (in the presence of the resident) that I would not write the note. There were enough students to see at least one patient and these 3 students had not seen anyone in a week.

This week I was taken aside by the resident who was present during my tirade. She explained that she understood me being upset, but that I was in the wrong for not writing a note on a patient I’d seen. My job was not to monitor other students. I was supposed to ensure that I was seeing patients and covering where it needs to be done. In essence, be a team player.

I find it extremely absurd that when people who have been victimized by parasites and suffer from it are expected to remain stoic. Apparently my expression of frustration showed “weakness” to this resident and showed her that I was a potential “problem student”. Hmmm, what about those who don’t even do their damn work? Aren’t they more of a concern? What about the fact that they’re going to get a very similar evaluation because no one has paid attention to the fact that they aren’t presenting during rounds? Am I just supposed to accept this chronic and habitual laziness while I work longer and harder? And if so, why?

I’ve heard of people talking about letting “gunners” do the work while they slack. I joked about letting other students who were interested in OB/GYN perform all the deliveries, but when it comes down to it I have a work ethic. I’m in no way a gunner on this rotation (perhaps on surgery I was, but certainly not here), but I still feel that when there is a requirement for students to see postpartum patients then everyone needs to be getting here on time and getting their notes written. If there’s a paucity of patients for a couple days and not everyone gets a chance to present at rounds then you can read. Not showing up till morning rounds start is not an option.

It’s just shows a general character flaw in some people who feel they’ll get away with as much as they can whenever they can. It shows a general lack of concern for patients and poor medicine in general. My problem is that I’ll get the same evaluation they do when they clearly don’t deserve it.

Grin and Bear It

OB/GYN. Week 2. Kill me now.

Terrible is a brief enough adjective to describe my experience in OB thus far. I am on an elective week block right now where we tour various fields of the profession. However, since the instruction and directions are patchy at best my colleague and I have no idea what we’re expected to do. To add to this confusion the residents and attendings don’t know either. To further add to this farce is the fact that this is the end of the year. This is not a new bolt thrown in to jam up the works. So why doesn’t anyone know what the fuck to do with us? Yesterday, before rounding with the Gyn/Onc team we were suddenly asked to get a patient presentation ready in 15 minutes. Not fun and pretty much worthless.

My schedule, despite not being part of the labor and delivery team, requires me to arrive at the hospital by 5:30am every morning (except weekends – the one blessed thing about this hell) to round on completely non-English speaking patients. Thankfully I know enough Spanish to get a quick SOAP note and avoid continuously asking the only medical student who speaks fluent Spanish how I would ask: “Do you have blood in you vagina?”

After morning rounds have completed my day varies. I have no idea what to expect nor can I schedule anything around my day. It’s chaos. Absolute chaos. Then, once everything is finalized with whatever I’m imprisoned with that specific day (ironically one day a week we do go the prison) I have to re-round on patients in the afternoon and get all their discharge paperwork ready for the morning (if they need it).

Gyn surgeries are interesting, but when I’m trying to help close I don’t enjoy being told that everything I learned on surgery was wrong. Yesterday I told the resident he was upsetting me after his constant castigations caused me to lose the needle in subcutaneous fat. He proceeded to tell me that grabbing the needle with pickups is incorrect and he was teaching me the correct way. Fine. Your way caused me to lose the damn needle, but whatever. Just get me the fuck outta here.

14-hour days are the norm. Depsite this norm I often find myself standing around with nothing to do yet mandated to remain. Something will come up if we wait long enough.

My wife hates me right now. She’s a single mother again trying to get both kids ready, get them to school, and get to work before 6:15 am every morning. She then has to pick them up, get them fed, bathed, homework done, and in to bed all by herself. I rarely get home before 8pm. I come home stressed and all hell breaks loose because I'm not "helping out". I hate this rotation and the worst is still to come. This is the “easy” portion.