all grownz up

On June 19, 2008, Dr. French Fry was born.

Well, not really, but I was one year into medical school and decided that medical school was an incredible, wonderful, soul-crushing and terrifying experience and that I needed an outlet.  That day, on that first post, I wrote about three promises I made to myself: 1)stay normal, 2) do not become a crazy bitch, and 3) do not turn into a goblin.

Three years have passed, Dr. French Fry is all grownz up.

Tomorrow I start my residency. Tomorrow I  become an intern.  FuckShitFuckCrap.

On the eve of this horrifying day I am going to amend these promises:

1) Stay normal.  Sometimes I think of medical school as a dark brown smelly slop of quick sand.  If you are not watching where you walk you will take one big giant step into a pile of shit that will straight up swallow you.  You will either never emerge, or if you do you will return to the world entirely unrecognizable.  Since complete avoidance is impossible, I spent four years of my life trying to make sure I didn’t blindly fall in. I tried to keep my ties to the real world and when I got about waist deep I was usually able to tug on them to bring me back.  The verdict is still out on whether or not this was a wise decision, but I managed to get the residency I wanted while continuing to lead a somewhat “normal” life.  I fear this will be harder to do in residency, but I’m gonna give it a shot.

2) Do not become a crazy bitch.  Well, I am going to do us all a favor and combine this with #3, do not turn into a goblin.  I will not turn into a goblin if I am able to sleep.  Likewise, I will not become a crazy bitch if I am able to sleep.  I am going to, against all odds, get some goddamn sleep this year*.

3) Write.  I am going to need an outlet. I am going to have some good stories.  I am going to make an effort to document my experience.

* I should probably apologize in advance for turning into a giant crazy goblin bitch.

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medical personnel

Thank fucking god, I thought to myself, it doesn’t sound cardiac, pulmonary, or neurologic.  I think this guy is going to be okay. The nurse next to me asked what I thought.  I looked at her and tried to sound confident but the increase in pitch at the end of my sentence likely gave away my doubt, “a panic attack?” She concurred and suggested aspirin just in case.  Good thinking, I thought, I am so glad you are here.  Aspirin is the first step in cardiac care and has proven benefit.  So I said outloud to the patient and those listening, “Though we don’t think this is cardiac in origin we are going to give you some aspirin.  It’s only precautionary and won’t hurt you.”  So the flight attendant got the aspirin and the nurse gave it to him.

Deep breath.

It all started with the innocent little ding of the seatbelt noise on the airplane.  “Any medical personnel on board, please ring the call bell, your help is needed at the back of the plane.”  Before I had time to decide whether or not I was actually the medical personnel of whom they spoke, my friend in the seat next to me had already rang our call bell, forcefully, four or five times.  Well, I am sure there’s a doctor on the plane, I’ll just go back and see if I can help.

I trail a woman who says she is a nurse to the back of the plane.  When we reach the galley at the back I notice three things: 1) there is a sweaty man lying on the floor; 2) the only two people who have responded to the request for help are me and this nurse; and 3) I am sweating and after that long walk to the back of the plane my face is certainly bright red.

The flight attendant looked at me, are you a physician?  No, I am a fourth year medical student (yes, I emphasized those words), can you tell me what’s going on?

I crouch down on the ground next to the man, ask him his name, and introduce myself as a fourth year medical student.  “Bruce,” he responded.  Okay good, I thought, airway intact.  I did a quick survey, breathing is fast but unlabored, radial pulse is 110 and strong.  Determining what appears to be immediate stability I continue with questions.

And so this, organized as a medical HPI (history of present illness) as I might present to an attending, is what we were able to gather:

50 year old man with a past medical history of asthma and high blood pressure is presenting with shortness of breath. The shortness of breath started about five minutes prior to presentation while sitting in his seat on an airplane, shortly after the initial symptom he felt as if there was mucous stuck in his throat.  This made him aware of his breathing, which subsequently made him extremely anxious with associated feelings of imminent death.  He was diaphoretic, lightheaded, and noted a tingling in his fingers.  He denies chest pain, back pain, nausea, vomiting, loss of consciousness, or numbness anywhere in his body.  He has no history of diabetes, his last meal was breakfast, he had only water on the flight, and took his daily hypertensive medication this morning as scheduled.  His asthma is well controlled, he uses his rescue inhaler one every 3-4 months.  He had one panic attack, one year prior, that felt similar but not identical.

The nurse mentions that she has a prescription for clonazepam, an anti-anxiety medication.  She asks me if she should get it.  Umm, why are you asking me?  I’m a med student.  And why is everyone is looking at me?  Oh. Okay I get it. I am making this decision. I racked my brain for any contraindications.  If this is cardiac clonazepam won’t hurt.  If this is neurologic clonazepam won’t hurt.  If it is a panic attack it will help, shit, even if it’s not a panic attack it will help.  There are no contraindications with asthma, and in this situation with such a low dose I’m really not worried about respiratory depression.  Is there anything else I should worry about?  Fuck Shit Fuck. “Okay, go get it,” I respond. She returns and shows me the bottle.  I nod.

Twenty or thirty minutes have gone by and I crouch back down by the man lying on the floor.  “How’re you feeling, Bruce? Any changes?” “No, feeling a bit better,” he responds. But he looks terrified and his legs are trembling. I tell him that it doesn’t appear that anything acutely dangerous is going on and that I think he is going to be okay.  Most likely this is a panic attack, but with the resources we have there is no way to know for sure and that I want him to go to the doctor when he gets home.  “I am so embarrassed.” Don’t be, I tell him.  I had a panic attack before and I felt like I was going to die, it’s a real and seriously scary feeling. I explain to him that if anything changes, if he starts having chest pain, if he starts having more difficulty breathing, if he feels numb anywhere, I want him to tell me or the flight attendant immediately.

We all stand around for another while, watching Bruce, checking his vitals, trying to think of things to talk to each other about. His pulse is down, his BP is down, he is looking much better. The nurse heads back to her seat. Slowly I start feeling like my old self again. I am left with Bruce and the flight attendant who asks me for help with the paperwork.  I help her fill out the presenting symptoms and vital signs and I see there is a spot to write down the name of the medical personnel.  I remind her, “You know, I’m just a medical student. I am not sure that counts as medical personnel?”

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this is med school

If you have ever wondered what med school is like, this sums it up exquisitely.

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lazylazylazy

On a lighter note, allow me direct your attention to this: compliments.

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busybusybusy

Since I’m too busy (or lazy) to post, I suggest you read this:

Agraphia: a modest proposal

One of my favorite bloggers covering an issue I am forced to confront in one way or another every single day I spend in the hospital.

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triage

The average triage note:

35 yo  F 10 weeks pregnancy had seizure, similar to szs in past.

68 yo M with cardiac history here with chest pain, started this morning.

25 yo M sore throat.

Yes, boring. But today things took a turn toward crazy:

48 yo M felt the need to direct traffic today to keep the city safe, given orders by the dept of justice to direct traffic on a different corner.

24 yo F needs to get pregnant.

33 yo F has a painful rectum and can’t stop eating.

Really.  How can you not love this job? In other news, today instead of asking my patient if she has diabetes or hypertension in her past medical history I instead asked her if she has diapertension.  Yes, diapertension.



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mr. bossman

I met my patient when he was boarded and collared, on a stretcher in the hallway.  He is a hispanic man who was recently in a car accident who arrived with a relatively complicated facial laceration.  He speaks a tiny bit of English, I speak a tiny bit of Spanish.  He is a nice man, and somehow we  manage to create a rapport.

A while later he’s been moved into a room and I arrive back with the suture kit.  Now there is a dirt covered, young, white man in the room with him.  My patient’s employer introduces himself to me.  This man, no older than me, immediately (and with a lack of social graces) wants to know how long this will take.  I told him that realistically we have two more hours.  But for him, that just wouldn’t do.  Well, sir, your friend was in a car accident.  We’ve determined he doesn’t have any serious injuries but he has a pretty bad cut in a pretty bad place.  We need to do a slit lamp exam to rule out any corneal abrasions and then will need to sew him up.  By the looks of that cut the suturing alone could take over an hour.

Yeah but he still doesn’t understand why it will take two hours.  Two hours at minimun, I reminded him.  “Okay, but see,” (and he lowers his voice) “I’ve got a van outside full of five guys  outside,” (he glances over to my patient), “and there’s no AC.  Can you ask whoever is in charge if he can speed the process along?”

Um, really? You have a van outside with five men in it with no AC? Are they locked in? Aren’t they adults? Might they step outside for some fresh air? Must be a completely legal and humane operation you’ve got going on. And b.t.w., I am in charge of how long this process will take.

At this point another med student walks into the room, he’s checking to see if I need any more materials.  The boss looks at him.  Oh hey doc,  how long you think it’s going to take you to do this?

As I secure knot number two Mr. Bossman decides to confide in me about how he once sewed up his knee with no anasthetic.  Good work, buddy, you must be really tough.

Suture number three I ask my patient if he’s feeling anything.  “Feeling any pain? Need some more pain meds?” Mr. Bossman feels the need to translate for me, “Hey buddy, hurt-o?”

Listening to the conversation next door I advanced another suture through my patient’s lower eye-lid.  Mr. Bossman, who was hovering over my every move, was apparently eaves-dropping on the same conversation.

… and do you take any medications at home?

AT HOME? YES! OF COURSE I TAKE MEDS AT HOME.  AND I LIVE WITH MY STINKIN HUSBAND. TWO OF MY FIVE WORTHLESS KIDS, FIVE GRANDCHILDREN, TWO DOGS, AND ONE CAT.  AND A SON-IN-LAW, EFFING JERK.

… okay, I understand.  But can you tell me what medications you are on?

YOU THINK THAT’S YOUR BUSINESS? I CAN’T BREATH. WHO ARE YOU? YOU ARE A DOCTOR? YOU ARE FIVE YEARS OLD. I WANT TO GO TO A REAL HOSPITAL AND I WANT TO SEE A REAL DOCTOR.

I have a smile on my face because seriously, how can you not get a kick out of this stuff?  By the pattern of her speech I can tell this woman is having no real difficulty breathing and I know the resident in the room next to me is having the same thought process. I am curious to see how this conversation will play out and to see how he will manage to gracefully worm his way out of her room.  I sense my patient’s employer looking at me.  Apparently he thinks we’re good friends now.  “Wow, you must see all kinds of assholes in this place.”

I secure the last knot and  don’t bother to make eye contact. “You have no idea.”

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