our guest room

so a week or so ago when i was procrastinating studying for my neuro shelf exam, i came up with an entirely new layout for most of our apartment.

oops.

better yet, i went ahead and arranged it, too. henry just shakes his head and rolls his eyes, but ask him what he thinks of it now and he will genuinely tell you it's lovely. see? i'm a revolutionary. :-P

here are a few pictures of the new layout in our second bedroom. it's a guest room / sitting room / library now -- many thanks to my parents for lending us my old twin bed.

rockin' the VA

since last i posted, i took my shelf exam in neurology and have started my internal medicine clerkship.

whew! what a delightful relief. i love medicine.

i have been assigned to the VA (Veterans' Administration) Hospital for 4 weeks and Cooper Green (our county hospital for indigent care) for 4 weeks. this is good and bad. the VA is government run, so there are a lot of hoops to jump through. i had to be fingerprinted, get a new badge, get new computer codes, etc. on the flip side, the VA has all electronic medical records which is BEAUTIFUL. adios, illegible notes! computers are magnificent. Cooper Green, in stark contrast, does almost nothing on the computer. the staff and resources are limited there, which causes a lot of stress. even so, i'll have a lot more opportunity to help out and learn procedures there.

i'm currently at the VA with a team of two interns, a resident, an attending (nephrologist), and another medical student. it's been great. we've even had a few patients who we've had to go through a differential diagnosis "Dr. House" style.

best part of VA so far: yesterday afternoon i went to do an H&P (history and physical exam) on an older gentleman who came in with chest pain. he'd been there for most of the day already but hadn't been allowed to eat because of a probable test we would perform. he didn't end up getting the test yesterday, so a dinner tray was ordered... but it hadn't showed up yet. enter: sharon. it was probably dumb luck that i remembered there's a stash of graham crackers and peanut butter at the nurse's station. bingo! so i went and grabbed a handful and a big cup of ice water. i can't even explain to you the look on his face when i walked into his room with a handful of food. ecstatic. so delighted in fact, that he went on to tell me about his recent cocaine use that no one else could get him to fess up to. who says being a doctor is all about the books?

worst part of the VA so far: getting locked in a stairwell for 30 minutes this morning at 6am. ugh. all of the exterior doors at the VA are locked after/before hours, so i had to come in through the emergency room. i got really turned around and went up a different stairwell than normal, fully expecting to get to my floor and then just find my way around. no such luck. i got into the stairwell and the door locked behind me... every door on every floor was locked. even the emergency exit door on the ground floor was locked! i was fortunate to have my cell phone with me and the VA operator's number, otherwise i have no idea what i would have done. i tried to bang on doors, but no one was around at that hour. it was miserable. i just kept running up and down stairs hoping a door was really unlocked. then, after a security officer came and "rescued me", i had to explain to my interns why i was sweaty, frazzled, and had been missing for 30 minutes. ::facepalm::

normal.

during rounds this morning, we saw one of our patients who is from very rural alabama. his language is barely intelligible - but according to his wife, this is normal. he's been very sick, but is getting a lot better the past few days.
my attending: "so, do you think he's recovering well, back to baseline?"
patient's wife: "yeah. he flipped all of y'all the bird when you walked out. that's normal for him."

still a little bit of your song in my ear

between being at the hospital 30 hours overnight saturday into sunday, sleeping, then going back monday and being there 30 hours again (until noon tuesday), i'm weary. today wasn't too bad. i'm just weary. people die... and i don't know that i'll ever get used to it.

stones taught me to fly
love, it taught me to cry
so come on courage, teach me to be shy
'cause it's not hard to fall
and i don't want to lose
it's not hard to grow
when you know that you just don't know
.damien rice.

well put.

no one means all he says, and yet very few say all they mean, for words are slippery and thought is viscous.
.henry adams.

on call

so i'm on call. i have been since 7am this morning. it's been a pretty good day - pretty constant flow of stuff to do and patients to see. i'm actually in the call room right now, about to hop in bed to catch a few Zzzs in case i have to get up in a few hours to see a patient emergently.

i really enjoy being on call. i don't love being away from home and henry, and it can be boring at times, but today i've had some excellent one-on-one teaching from my resident. i've seen patients by myself at the VA hospital and university emergency department. i've done neuro exams while the neuro resident is watching and ready to critique me (! anxiety provoking at first, getting much better at this). i've read CTs, MRIs and chest x-rays.

i think what struck me most today was the emotional rollercoaster i can be on if i let myself. when i first got here at 7, i saw one of my regular patients who is recovering from a stroke. he looked the best i'd ever seen him: when i walked into his room he declared "i want ice cream." i winked and grinned. "only if you cooperate with your physical therapy today!" shortly afterwards, i rounded with my attending physician and watched as all support was withdrawn from a young man who came in last night with a stroke that left him brain dead. although i never knew him, it was incredibly difficult to watch him be withdrawn from life support, struggle to breathe, and pass on.

in a matter of a few hours i went from practically giddy to relatively devastated. every new patient allows me to see life for what it is: unexpected joy and incomprehensible sorrow. i always knew i was supposed to be a doctor to take care of people; i never knew it would take care of me back. what a blessing it is to truly live and experience life, both at its best and its worst.

i went back later to see my ice cream-requesting patient and found him sleeping peacefully with three empty cups of ice cream on his bed tray. he heard me walk in and looked at me very seriously. "doctor? i have a question." i braced myself. "can you get me a popsicle? the ice cream was good, but i need a popsicle."

after all, we're only human
always fighting what we're feeling
hurt instead of healing
after all we're only human
is there any other reason
why we stay instead of leaving?
after all
.jon mclaughlin.

hospital happy hour.

little known fact: the hospital keeps a stock of beer in the pharmacy.

it's bud lite.

and no, it's not for the pharmacists (although i'm sure they'd love to knock one back every once in a while with the amount of things we have them mix up for our patients). it's pretty commonly known that someone who abuses alcohol can have serious symptoms of physiological withdrawal if they stop abruptly. in the hospital, we try to manage these symptoms the best we can, but sometimes very sick patients cannot tolerate the sedatives we give in order to control the withdrawal symptoms. and in such a case, doctor's orders are to knock one back.

we've been taking care of a patient this week with that exact problem -- but he came into our care after having a stroke and is currently unable to swallow. have no fear! the pharmacy has something for that too: 98% ethanol by IV drip. if i'm not mistaken, that's 196 proof. holy crap. i never thought it would be my job as a physician to keep my patient in a drunken stupor... the hilarity found in such a serious job delights me daily. cheers!

beginning of the rest of my life.

so i've been on neurology for a little over a week now. i'm working with the stroke team, then i will switch to general neurology next week. i had my first overnight call last thursday: 1 hour of sleep, 29 hours straight at the hospital. even though that sounds positively awful (which physiologically, it was), i am overjoyed to be in the hospital.

i have a million thoughts going through my head about my experiences, and i keep prodding myself to record them in my journal or this blog. between waking up at 5am, being at the hospital until 6pm, trying to catch up with henry over dinner, and possibly getting some studying in (we take the NBME shelf exams at the end of each rotation), it's been pretty hard to manage even 5 hours of sleep a night, let alone any internet mischief. but i will try.

confusion never stops
closing walls and ticking clocks
gonna come back and take you home
i could not stop that you now know
singing
come out upon my seas
cursed missed opportunities
am i part of the cure?
or am i part of the disease?
singing
you are, you are, you are
and nothing else compares.
.coldplay.