Tag Archives: medical student

by the way, it’s sunday

I think was feeling a bit nostalgic tonight. I got out of work early and for the first time in what feels like 9 months, it was still light out for my walk home.  I also may have hallucinated the smell of spring in the air.  Not entirely sure what day it was or what to do with a whole extra one hour of free time, I decided to read through some of my old posts and I– as I have said to myself many times before– realized I need to write more.  I have so many stories from this year.  Some are disturbing, some are sad, most of them are just dumbly entertaining.

As I try to get my act together, allow me to refer you to a post I wrote almost exactly two years ago about what was, in retrospect, maybe one of my favorite days of medical school.

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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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oh hello, uterus

We were scrubbed and gowned, standing in the OR around a pregnant, sterilized belly.

My attending said to the resident, “you’ve done enough of these, right?  Right.  Okay, then let the med student take a turn.”

My pulse rate doubled.  Shit. And so I reluctantly turned to the scrub nurse, “Scalpel, please.”

Scalpel in hand I sliced through the skin and into the fascia, trying to hold my hand steady and maneuver a straight line.  At first I was too shy, “Come on, med student, CUT.”  But as I neared midline I had the hang of it.  Not bad, I thought, and found myself secretly hoping the procedure called for another incision.  A number of steps later we’re through the rectus sheath, pulling in either direction on the rectus muscle, and there it was, the uterus.  Inside that ball of a compartment is a tiny little human being.  The resident made the cut through the uterus, fluid gushed and spurted, and we saw the head.  Well, I guess they saw the head.  I saw fluid and smooth surfaces, shiny surfaces, dark surfaces and blood.

Extracting the head out of the uterus took some muscle.  I applied fundal pressure on the upper abdomen while the resident pulled.  And finally, a baby. I was so wrapped up in things I forgot to notice whether it was a boy or a girl.

I was sweaty and tired and ready to de-gown but looked up and realized the abdomen was still wide open.  Oh right, not finished.  We pulled out the uterus and plopped it on her abdomen.  Oh hello, uterus.  Wait, what? Really? This is how we do this? Through the blood we stitched it back together and shoved it back inside so we could could start putting her back together, layer by layer.  When we got to the rectus sheath, the only part of the procedure in which the sutures are proven to make a difference, the attending handed me the needle and pick-ups.  Shit.  Okay, I guess I’m gonna sew this up.

Once again, my hands were shaking, my mask was foggy, and by this time I was wondering if they would make fun of me for sweating through my gown.  I was taking my sweet old time (because that’s all I’m capable of at this point) and everyone in the room (scrub nurse, circulating nurse, anesthesiologist, attending, resident) was willing me to hurry-the-f-up with their pissed-off glares.  Sorry guys, I know it’s 2am, did I mention I have never done this before?

But I did it.  I cut her up and sewed her up.  And she got a little baby girl.

To the scrub nurse: “Suture scissors, please.” The resident cut suture 1cm above the knot. “Needle down.”

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because i come from the land of lawyers…

I found this amusing.

from A Cartoon Guide to Becoming a Doctor (just added to my blogroll).

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just another day at school

I walked into the building wearing my scrubs, not really sure where I was supposed to go.  There was a room on the right with a lot of scary looking dudes in it… that definitely has potential, I thought to myself.  I lurked over toward the door and peeked in when some really big dude walked up to me and blocked the entire doorway with his body,

“Can I help you?”.

“Uhm, I’m looking for SWAT team training?”

“Yeah, well, we’re building bombs in here. Try the door down on the right.”

Right.  Well, I found my classroom.  If you are going to pick a day to be late, make sure it’s on a day when you get to walk in into a room and have 100 scary looking testosterone-filled eyes immediately stop watching the video of a man being shot down in the field and turn to stare at you, the sole, really out-of-place-looking, tall, blonde, awkward girl.  I took a seat in the back and listened as my mentor taught the men about wound packing, the proper defensive positioning when attending to a man in the field, applying tourniquets 3 inches above the wound, and needle decompressions.  As the time passed I think the guys got used to my presence.  I could tell because they stopped glancing at me nervously every time there was a “tea-bag” or “donkey punch” reference.  I was surprised when one of them even spoke to me, “Can I borrow a highlighter? I’ll trade you a bullet…”

Next thing I know I’m in the medic vehicle, Van Halen is blasting, the sun is shining, the windows are wide open and we are tailing a cop car down some back roads at an uncomfortably fast speed.  We pull into a hidden cove and find the sniper team getting ready to drill.  They want to know if I’ve ever shot a gun before.  Ha.  “Nope, never.” Then they want to know if I’m some kind of liberal. I give a hardy laugh to dodge the question.

Now I’m standing to the right of two men wearing camo pants tucked into their army boots, black SWAT shirts, buzz cuts, goatees, and guns around their waists.  In front of me is a metal silhouette, my target.  A third guy just a few steps away from me tosses a Flash Bang on the ground.  BOOM! Um, it’s smoky and I can’t see what the hell is going on.  Though I am holding an extremely large gun the green scrubs and pony tail kind of negate any hope of looking intimidating.

“You realize I’m going to need a little extra instruction, right?”

“Just grab it with your left hand and put your arm through here.  Good.  Now this part goes where your bra strap lies.”

Um, what is going on here. “Okay, like this?”

“Oh my god you look incredibly awkward.”

Sorry this is the first time I’ve ever held a gun, much less a semi-automatic machine gun. No big deal.

“So… this gun is really heavy.”

“You are such a girl. Put your finger on the trigger, aim the red dot at the head, and shoot.”

BANG. I look around.  No, you did not make that noise, you haven’t even shot the gun yet.  BANG! This time I actually did pull the trigger, not much of a kickback and I hit the metal target. BANG! Hit it again.

“Stick your butt out! This isn’t like those other exercises you do! Bend your knees and stick your butt out!”

And what other exercises are you speaking of, Steaky?

BANGBANGBANGBANGBANG!

This is kind of fun.

An hour later I am hiding behind a door on the second floor of an abandoned building.  I have a grenade (that they promised me was dead) in my hand.  I hear them yelling from below, “Alright men, listen up! There are three bad guys wearing green pajamas hiding in the building.  GO!”

One part of the team snuck up the stairs and came in on the second floor, the other team came from the floor above.  As soon as a man went down my job was to jump out of my hiding place, scream really loud, and throw my grenade at them.  Fifteen scary men are approaching with guns.  I am hiding behind a door.  A man goes down.  They are frantically putting pressure on the fake wound and fumbling with the bandage and I’m supposed to jump out from behind a door, scream, and throw a five pound grenade at them? You’ve got to be kidding me.  Luckily they saw me (oops) and fake shot me before I had to chuck the bomb at some big scary guy’s nose.

“Hey doc, you coming back next time?”  Are they talking to me? I think the enormous men are talking to me.

I could be scutting around the hospital, chasing down labs, preforming rectal exams, writing notes, getting my attendings coffee, or doing this…

“See you in two weeks, boys.”

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