The Biggest Scut Monkey Roaming JPS

Last night was my first Medicine call night. Before I delve into how call night played out, I'm going to fill you in on the dynamics of my team. I am on team Medicine team C. I am paired with a notorious attending who is is from Eastern Europe and thinks women's place in society is barefoot and pregnant wearing an apron much less a doctor. So it doesn't sound like a good start. Well first of all I have a ob-gyn intern and psych intern and senior family resident on my team. Its quite a bunch. On the first day I was told to stay away and do not listen to the ob-gyn intern b/c he is known to be a slacker. The other two residents are nice and helpful. On my first day of rounds still in my nice business clothes, I listen to glimpses of my attending's bedside manner. This a conversation to a patient: " You have a arteriovenous malformation" you will need to see neurosurgery. The patients eyes just ballooned three times bigger and my attending walked out the door. So as you can see he doesn't have the best bedside manner.

Lets move on to call night. Ok call starts at 3:00pm at JPS and patients trickle in for admission. While all the other med students I talked to on Medicine already have their own patient load to follow, I have ZERO. I hoped and hoped that I would get a patient on call night so that I can follow, but my senior resident insisted that he and the other residents do everything themselves. So no patients for me, and I spent the rest of the night shadowing interns. This was such a bummer especially since I was so excited about doing medicine and hoping to really force me to think of good A/P. I am like excesses baggage that constantly runs around JPS hunting down VS, xrays, doppler, and echo reports. I'm on call again Sunday with new resident's on my team I hope they will let me have a patient.

Its also really disappointing to see how jaded JPS residents act. They are really pessimistic labeling all pts some name or another "drug seeking", "hispanic panic"-[chest pain in a hispanic woman who is not having an MI], and others. Another problem around JPS is getting help around here. Can you believe JPS does not weight pts as part of their intake vitals, it has to be specially ordered. On the bright side, my senior resident says my attending likes me so I should not have a problem on this rotation. Haha the irony , how could someone like me I haven't done a single thing that is worth evaluating.

About time for a New Entry!

Well I took a long blogging vacation. I think I should get back to this thing. Like any first day. It starts out with orientation:all the necessary information, phone numbers, books, preceptors. I like my assignment. Preceptors are laid back, teach alot, and I get a lot of time off---> what more can I ask for? I saw lot of colds, and good variety of stuff I have never seen before.

time to sleep: I 'll write a better entry next time.

Cook's Children's is the Best!!!

I finished 2 wks of inpatient service at Cooks. It was the best time I have had my entire time here during Peds. The new hospital wing has a Castle Theme, the lobby and the pt rooms look like castle walls. When I walked into the lobby I felt like I walked into a fairy tale , everything is so shiny, the glass and windows and when I looked up from the lobby to the ceiling there were bright sky lights. Everything at Cooks is so efficient and all the Peds Dr.s & nurses are super nice. I saw some of the cutest kids there. Cook's is where I also actually Learned. I mean I gave formal presentations of my patients, followed their labs, care, orders, ect. I got to interview my patients in the ER. I saw a CT of cysticercosis- Pork tape worm cyst.

O but now back to PCC- where slowness, inefficiency, and no learning occurs. After my enjoyable experience at Cook's, I tried talking myself into liking Peds. The more I thought about it, the more I believe that I can't endure a 3 year residency in Peds. Ah well :)

Just for laughs check out this website: specifically : "medical hierarchy" and "12 types of medical speciality sterotypes" comics from the same person who came up with "12 types of med students" This site always gives me the chuckles. ;)

http://theunderweardrawer.blogspot.com/

Kids are Like Puppies : )

Kids are like puppies in a pet store, they are really cute and fun to play with at the store but I wouldn't want to take one home with me.

In the mist of the mundane activities of outpatient clinic, cute- well behaved kids just bring a big fat smile to me. Lately kids are coming in droves to squeeze in their school physical & shots before the start of school this Monday. There were all sorts of cute puppies, I mean kids this week. We had quiet ones who read books while waiting for me & the Dr., 4th grade girls who dressed like their moms, who dressed like they were 18, and then we had the kids who are completely nuts and can't sit still for a second for me to examine them ie ADHD kids. Trying to examine ADHD kids is like trying examine a kid at the jungle gym all the while chasing after them with with your otoscope and stethoscope. I would have one ADHD kid sitting on the table and 1 s later that get distracted by their parents or other siblings and are just bouncing from wall to wall. Mom later explained to me that during vacation, the kids are off the ADHD medicine. In the mist of this playground aka Peds clinic I also saw some sick babies. Yea babies are cute too but man they are just big fat petri dishes.

I examined 2 babies with URI [upper respiratory tract infections] using a tongue blade and they just laid a big cough right in my face. I felt like was just sprayed with 10^14 colonies of bacteria all on me. Well to no surprise I woke up the next day with a big headache and a sore throat. OH NO! I was getting sick. Luckily I take my vitamins regularly, supplemented with Extra Vitamin C when I feel like I coming down with some cold. So my minor cold lasted 2 days, but during those days I just felt dizzy and weak and massively sleepy--those darn cytokines & TNF were kicking in.

Kids also are super excited about stickers they get at the Dr.'s office. I mean I would be too. You guys should see these cool looking stickers the Dr.'s got. There's Shrek, Dora, Ratioulle, Spiderman, Barbie, Sponge Bob, I mean they're pretty big and some are really shiny and glittery,and even 2D looking. So a neat trick I like to use when I examine kids, is that I tell them if they don't behave they won't get stickers. Yea so some of you may think that's mean, but its really an empty threat, but really all Kids get stickers before they leave.

Another thing to be careful of when you examine them, is too be careful not to drop the "S-bomb." I mean "Shots" they totally freak out and some start crying even before the needles arrive if you even mention the word in front of them.

Well I'm heading to Costco this weekend to stock up on some more Vitamin C. It really works!!! Hope you guys who just took the shelf have a good weekend. :)

Suspicions Confirmed- R/O Pediatrics

So begins the Pediatric rotation on Monday. Hmm the past few days at PCC have been uneventful albeit kinda inching towards boredom. The most interesting part of Peds is visiting the specialty clinics at Cook Children's. Yesterday I saw sick little ones in the Ped Pulmonology Clinic with varieties of Asthma, Cystic Fibrosis, and some other breathing problems. I like the specialty clinic the mostly because the kids are way sick and that keeps them sitting still, laying in mom's lap, they don't run, open and slam doors, demand for stickers like the healthier kids at PCC.

Today I confirmed what I always suspected I hate Peds. Hmm you can say its a combination of the parents, the noisiness, the coughing in your face, the incessant crying, the I' can't tell what's wrong with me because I can't talk, when you exam them. To me it seems like all kids have ADHD despite if they are actually diagnosed. Today was a busy day we're running behind and parents complain b/c of the long wait. I'm sorry, I don't recall at time when I visit my doctor I did not have to wait. News Flash: Its a fact of medicine, going to the doctor means waiting. Well this mother was a little irritated and decides to lay it on the little innocent med student -ME.

Mother: My appt was at 4:00pm , its now 5:00pm, this is the last time I'm coming here. [in a huff]
Med-student: I apologize for the wait we've been hit with a lot very sick kids today.
Mother: [in a very annoyed tone] Yea you guys are getting too busy, I can't get my child in for well child visit until October and its past his birthday ( by like 1 mo.)

Onto the exam:
S: MOM: son has rashes with pus oozing out.
O: Afebrile, VS stable:
PE: Her son has these erythematous (red) , pruitic (itchy), infected lesions on his legs that he scratches and salivates on. He looks dirty and and boogers hanging out. [These pts are my favorite :) ]
A: Son: dirty- infected excoriations
Mother: Over reacting, and angry,
P: Recommend bathing your son regularly + abtx for the infection
Mother: needs a chill pill

Well for starters mom lets bathe your kid and stop him from licking those scratches. Then possibly those scratches won't get infected and subsequently you won't have to come to the Dr. and most importantly you won't to take your anger and frustration on the innocent med student who already hates PEDS, and finally the med student can go home a happy camper.

Not to say its all bad: the fun people are the nice parents and the chubby kids. I can't resist poking at chubby kids' cheeks, and tickling them to make them laugh like the Pillsbury Dough Boy.

Tomorrow: genetics clinic.
Shout out: I saw a DE at the library today with books and computer in stow, looking all cool with her Sunglasses at top her head and getting in some serious studying. Its cool to know people actually read this blog.

Last Night of Ob Call~~~the Most fun Call Night Ever.

Sat. was my last Ob call night for the rest the rotation. It was the best call night I have had the entire rotation. Oh Let me count the ways:

1. My senior and junior resident let me stay in the call room after morning report finished & rounding finished at 10am until pretty much 7:30pm!! This left me ample time to surf the internet and finish so some uncompleted reading. Although it was a lot of time, I never could really settle down and read with concentration b/c I felt like at some point there were going to page me soon like previous call nights where I only sat in the room for 1 or 2hr. Why did I get called back at 7:30 ~~~ have you guys heard of NIGHT ROUNDS~~~ well only with a certain Dr. here we do morning and night rounds. We review our pts that we have on L&D [labor and delivery] and those on the floor recovering after delivery, then we go by and visit them. After night rounding we sat around while the attending with nothing better to do than to begin pimping. Pimping was actually fun, b/c he made it very educational and unintimidating.

2. Both residents let me stay in my room and said not to sweat the small stuff, and if there was a delivery they would let me primary deliverer. Awesome huh, other times I followed the intern around doing orders and reading them over her shoulder.

3. I found Bomb-sticks at the hospital cafeteria!!~~ I realize I only like the banana part and I scraped the chocolate away. I haven't had one since College ~3 yrs ago.

So after a slow start, all the sudden BAM !! everyone decides to do a drive-by the L&D. First a 13yo who is about 36/40 wks pregnant. Whose mother just recently found out that she was pregnant at 7mo [28wks], came in for early contractions and pain. She was going into the 8th grade mind you.

Second, 21yo deaf pt 21 wks GA [gestational age] comes in for abdominal pain and UTI.

Third, a 23 yo G3P1011 at 39 wks for suprapubic pain and contractions after intercourse. So what is the mechanism of intercourse and contractions? Well sperm carries prostaglandins and intercourse causes deposition of prostaglandins around the cervix and causes uterine contractions like actually giving pitocin. So we frequently see pts come in after intercourse with CC of Vaginal bleeding. We went ahead and did a C-section on her but Oh no her:
Hgb: 7.o
HCT: 29
Platelets 33K
She was at sever risk of bleeding and she had suprapubic pain right over her previous uterine scar~~ Risk of rupture high!!! So C-section was a must even though she may be a bleeder
The plan:
1. give her general anesthesia. No epidural in fear of bleeding complications of hematoma
2. Do the C/s in a max of 20 mins and the get the baby out quick~ b/c if mom is not breathing under gen. anesthesia neither is baby.
3. Minimize bleeding as much as possible by cauterizing everything us see bloody.

Plan in action
1. Total C/s time 1hr 30mins.
2. Everyone is double gloved~ a specific requirment by on Dr. for all residents and students.
3. Incision is made, cutting is started,baby delivered pretty fast Oh maybe 15 mins into the action.
4. Confirmed~ uterus had a whole in it she was leaking amniotic fluid with meconium.
5. next 1hr and 15mins is spent A) removing 1st pair of gloves. B) attending being nit picky about how the Senior resident should suture and making extra sure he cauterizes every leaky BV.
Attending to Chief resident: not enough myometrium, ok too much myometrium, now be sure to get enough serosa, ok make sure its very tight... this went on for another hour.
6. Junior resident contaminates his gown by rubbing it against the attendings head--> he gets a new arm shield. --> Junior resident making faces at me b/c Dr. going into a 1hr procedure that normally takes 30mins from skin open to skin closure.
7. Finally she is sewed up and post op-lab shows lab mistake:
Hbg 10.1
HCT 36
Platelets 231 K !!!

We also take phone calls when pts call at night for the outpt clinic. So a pt calls cc of vaginal bleeding and contractions. Here is the phone call conv from what I could hear the junior resident over the phone:
R: So you are having contractions morning, afternoon, and at night.
R: Any bleeding, Leakage of fluids, and pain?
R: Have you been drinking enough water, or doing any vigorous activity, or have intercourse

PT: well now come to think of it: I had sex after breakfast, in the afternoon, and at night.

R: Uncontrolled Bursts of laughter while on the phone.
R: Please excuse me, I have a cough here. Handset is placed on the desk where he starts laughing some more.
R: Ok' I'm back I just have some allergies here.
R: Well now Ms. X maybe you should take a break from Sex tonight and tomorrow night.
R: If you have any more bleeding or its getting more painful let us know~~
End of conversation.

Basically we were all in the call room listening to his converation and everyone was laughing.

Fun night!!! Bye Bye Pregnant ladies.

Nifty Tips I have learned so Far.

This post was idea I got from Year3clerckship blog. It was such a good Idea I decided to make a post. I'll try to post what I learn along the way.
Tips and tricks I have learned so far:

Presentations:
1. Pick a common topic that you can easily look up (ie more information = less researching time).
2. Use "UptoDate" make it makes Px so much easier ~ less researching time. It has everything you want to know, stats, pathophys, management, risk factors ~ everything.
3. Compare your research and check the facts with the textbook the residents are using
4. Double & triple check for grammar and spelling~ you lose credibility if you can't spell!!
5. Make enough handouts for everyone so they don't have to squint and read the screen.