coping

how is the language we're speaking the same?
shape shifter have you discovered a change?

why does the soul hallucinate?
i've got control, i shift my shape

your eyes, they swell like a riot, deranged
tomorrow you're laughing like a child again

why does the soul hallucinate?
i've got control, i shift my shape
if flesh and bone do not contain
the mirrors don't reflect my face

psycho, you killer, you cancer, my friend
why don't you give me an answer for when
when you'll let it go
when you'll let it go
when you'll let it go

shape shifter, local natives

bye bye, babies!

so i survived OB/GYN. !!! this is big, people. all-in-all i was pleased with my performance, although henry will tell you i whined my way through the entire 8-week rotation.

i actually ended up enjoying OB more than i thought. it's definitely one of those specialties (like trauma surgery) where you acquire awesome stories to tell at dinner parties (y'know, one day when you have time to go to dinner parties and friends who throw them). in retrospect, i am actually thankful for my newfound ability to wield a speculum, acquire and interpret a wet prep of vaginal discharge, and manage every aspect of a pregnancy. and i will say that when i got to deliver my first baby, it was - without a doubt - one of the most rewarding and beautiful things i have done in my short medical career.

and now i am one week into my four-week block of studying for 2nd round of boards and preparing my residency application. that's right, my RESIDENCY APPLICATION. after a lot of strife this past week, my application is mostly complete and ready to be sent to 20 (yes, twenty) residency programs on sept 1 when they start accepting them. it is completely befuddling to me that in less than 8 months, i will actually be an MD. simultaneously exciting and terrifying. sort of like a roller coaster, although maybe that's a bad analogy considering that i vomit every time i get on one.

after i take the USMLE step 2 CK exam on september 17, i fully plan to venture back into the world of pleasure reading. i have a stack of books i've been acquiring over the past few years in medical school (which in their own right have been acquiring about a 1/4" of dust). a few among them: inside the outbreaks, by mark pendergrast - a historical/ investigative report about the epidemology intelligence service at the CDC, aka my dream job; every patient tells a story, by lisa sanders - the writer who helped inspire the series House, MD; a few titles by my favorite author ian mcewan, saturday (from my dear from amanda) and the innocent; and my stroke of insight, by jill bolte taylor - a neuroscientist who had a stroke and wrote her story.

ahhhhh, 4th year. hurry up and be awesome! for now, though, i'm happy to bask in the glory of OB/GYN being over -- and the fact that i won't have to look at another vagina for a very long time.

when i go down

in case this is my first blog post you've ever read, newsflash: i've been sort of a downer lately. life's been getting me down. one of the things that has added insult to injury was henry and i didn't get to properly celebrate our wedding anniversary earlier in july due to my all-consuming schedule.

and then - as if a direct gift from heaven (and i truly believe it was) - came my OB clinic week. i was scheduled for a few afternoon clinics, with friday and the weekend off. holy cow! thank you, jesus! so henry whisked me off to panama city beach, fl for a weekend getaway. it'll be 3 weeks of delivering babies starting tomorrow, but i feel refreshed and ready to go. bring on the baby-mamas!

here are a few pictures:

when i go down

i lift my eyes to you
i won't look very far
cause you'll be there
with open arms
to lift me up again

.relient k.

futility

although i attempted to be optimistic on gyn-onc, it eventually got the best of me: between the hours, the scutwork, and the overwhelming sadness. during the two weeks i was on, three of our patients died (including one i took care of every day). additionally, i helped operate on a number of women with late stage ovarian cancer who had prognoses of maybe 6 months. i laughed with them. i cried with them. ultimately, there was nothing i (or any of us) could do for them medically.

i will never forget the morning ms. p died. it was like any other day, but it was somehow so different. i went in to round on her at about 4:30am (as i normally did), and she was lying on her side, awake.

"how did you sleep?" i asked her, apologizing as i always did for the early hour.

"not well." she looked different. she was breathing fast. "help me sit up a little, will ya?" she reached for my arm. i helped her sit up in bed as i counted her respiratory rate. it was too fast. we both half-glanced at the infomercial blaring on the tv. it seemed so irrelevant and intrusive.

"any pain?" i placed my stethoscope on her chest.

"nah, sweetie. just trouble breathin'." she was sitting up in bed now, but every muscle in her body looked uncomfortably drawn.

"try to rest, ms. p. i'll be back with one of your doctors."

my resident went to see her. she was a 50yr old lady with known metastatic cancer; our plan was to continue to follow her symptoms and offer any comfort care we could.

around 7am, i went to the operating room to help with a case. we'd been operating for about an hour when we received a call to the OR - ms. p had died. just like that. gone. i was scrubbed in to the operation and my entire job as a medical student consisted of cutting suture and retracting... i was so distracted for the next 10min i had to be reminded to cut.

sigh. her time was coming sooner or later... it was just hard for me in my small understanding of mortality to experience sooner. but here i am. and there she is -- in a better place.

attempt at optimism

i'm currently on my OB/GYN clerkship, 3 weeks in. my first two weeks were pretty cush -- i was on REI (reproductive endocrinology and infertility). as my resident simply put: it was our task to knock people up. the hours were awesome.

starting week 3, i am now on Gyn-Onc surgery (gynecological cancer). we operate on & treat vaginal/cervical/uterine/ovarian cancer. the hours suck. get there at 4am - usually leave around 5:30pm. this rotation is something of a UAB med school rite of passage. we stay incredibly busy all day long, have very sick patients (1 died today), and work with intimidating attendings.

3 days down, 11 to go. in an attempt to keep my morale up, i am dedicating the rest of this post to all the positives i can come up with about Gyn-Onc:

1. no AM traffic & ideal parking spot: getting there before 4am everyday means i have literally no competition for commute or parking.

2. crazy awesome surgery: yesterday i helped take a tumor out of a lady's belly that was the same shape as a football but about 1.5x its size. holy cow. my attending was on a high; it was insane. today i got to watch an operation with "the robot" - the da vinci robot surgery. it's wicked.

3. potential weight loss: it's hard to eat breakfast at 3am when i wake up, and often there is not time throughout the day for a proper lunch. we are on our feet a lot. burned calories > consumed calories? time will tell.

4. fellow students: i'm working with 3 brand new MS3s. they're awesome. i am trying to get them oriented to wards. it is delightfully refreshing how not-jaded they are (and kind of scary how far i've come in that department).

5. perspective & conditioning: nursing shift changes twice while i am on duty and hearing all three sets of nurses complain about their tiredness/workload/etc has rendered me much less likely to complain. lame of them. win for me.

6. it's only 2 weeks. i can do anything for 2 weeks, right?

and because i can't stop singing it (to myself, my residents aren't amused) every time i think about the da vinci robot surgery:

domo arigato, mr. roboto, domo arigato mr. roboto ::incredibly convincing robot dance::

altered mental status

although i owe the interwebz a decent post about my glorious month on the famed (and often infamous) tinsley harrison internal medicine service, today i will whet your appetite with an anecdote.

every patient who comes in to the hospital has recorded a "chief complaint" which is the reason for coming in his or her own words ("chest hurts" or "short of breath" etc). the best chief complaint from my personal annals: "this bitch just slapped me" (true story! courtesy of a psych patient). however, if the patient is unconscious or otherwise unable to give a CC, "altered mental status" is written.

enter: tonight's anecdote's patient. altered mental status, but doing much better. as we were rounding this past weekend, post call (read: having been awake for 30hrs straight) our attending entered the room and began questioning the patient with some typical orienting questions "what day is it? what's your name?" etc. the patient feigned sleep, rolled around in bed, then her eyes popped open.

"where are you?" my attending prodded.

"yoooou tuuuube." the patient drawled.

i smirked; bit my tongue hard. my attending unfazed.

"and what's your name?" she continued.

"charlotte," the patient started, seeming to collect herself. we all looked at our rounds papers to see if she had gotten the answer right.

"charlotte's web." the patient finished with a grin.

"oh, ok. get some rest." we quietly exited the room with our lips pressed together. the door shut behind us, and i lost it, totally rolling in hilarity. everyone was smiling.

she'll get better... but until then, her child-like confidence in her imaginary location and identity will help us get through the day. and on tinsley - that's all we can ask for.

The Bird

i will update soon about this month on Tinsley for my acting internship! it's going great. but first, i have to talk about... The Bird.

as far as i'm involved, this all started a few weeks ago, although i've heard that The Bird has been around since last year in other locations.

so here's the set-up: everyday i park in my parking lot near children's hospital and walk the few blocks to university hospital (west pavilion). i created a schematic for reference (this is hardcore, people). the red arrows depict my walking route.

so one morning a few weeks ago, i was walking on the right side of the street and passed the first "X" on the map. i saw The Bird perched on one of the parking meters up ahead but didn't think much of it... until it started flying at me like a torpedo. WTF? i reacted reflexively and jumped to the side, only to feel something thump me on the head a few moments later. i walked a little quicker, and then i heard its awful call and saw it. it was chasing me! i squealed and started running. it flew into me about 2 more times before i lost it.

at this point, i was completely confused. i ducked into the psychiatry hospital (near the second "X" on the map). my conclusion: The Bird had a nest, and i must have gotten too close to it. the behavior still seemed incredibly violent, but animals can be pretty protective and territorial. plan: walk on opposite side of street.

after a few days of walking on the left side of the road, we met again at the second "X". same circumstances: i saw The Bird from a few yards off on a parking meter. although i suspected it would attack again, i stupidly continued on my way. the carnage? 3 times to my head. i tried to whack it with my bag, but it was not deterred.

it was about this time facebook statuses and twitter updates started rolling in: my classmates were also being attacked. what could be done? i started walking inside - there's an enclosed walkway through children's hospital to university. amazing how such a small, deranged creature can change our daily patterns.

so on one particular morning last week, about a week or so after i resolved to walk inside, i was coming in pretty early for call (around 6am). i decided to press my luck with walking outside, especially since The Bird had moved further down on my walk - i figured i could always duck into the psych hospital (how fitting) if i needed to. the chorus of early morning birdsong made me nervous, and i was watching the sky suspiciously, fully expecting every bird to swoop down and peck my eyes out. i probably looked like a lunatic. you bet i accounted for every parking meter. there were two people walking about 20-30yds in front of me, and i watched as they entered and exited the "danger zone" unscathed... and BOOM. back of the head. then, BOOM, BOOM. back of the head, arm. i started running, at this point too far past the psych hospital to duck in. (third "X")

needless to say, i have been walking inside the past week. i have been trying to explain to henry why bringing my tennis racquet with me would be a good tactic, but he keeps saying bird guts on the racquet would be suboptimal. i don't care, though. i think it's about time for bloodshed. i'm not usually a violent person, but this bird has waged three unprovoked battles against me and countless more against unsuspecting passers-by. i can watch the sidewalk from the indoor walkway, and yesterday i watched a guy hold a book over his head as a shield as he passed through. two of my fellow acting interns were both attacked walking in yesterday morning and today.

all of this to say...

if you are driving on 7th ave at UAB in the next few days, and you happen see someone in a white coat, stethoscope around the neck, hair flying everywhere as she uses a tennis racquet/umbrella/bag/book to impale with intent to kill a deranged mockingbird, please smile and continue on your way knowing that social justice is being done.

cheers!