Penis Envy

Um yeah, so obviously I have nothing to envy in this department. However, I believe that I have been unofficially appointed the floor "Penis Expert" after this morning.

After signing out my patients with the oncoming resident this morning, a nurse came up to me and said there was something wrong with a presurgical patient's penis. I couldn't imagine there being any real urgency to the situation as he already had a urinary catheter in. While I continued making small talk, the charge nurse went into the room and came out real fast saying, "One of you ladies needs to get in here-- NOW." So the other intern and I walked in. The other intern asked him about pain in the area and then just said "I don't know what it is."

Then I glanced down, and said, "Oh, it's a paraphimosis." This instantly led to heads whipping around in my direction and jaws dropping.

"A what?" somebody asked.

"A paraphimosis... he's uncircumcised and his foreskin is stuck. He's ok to go to the OR this morning, and he'll probably be fine once you take the catheter out, but you might as well have urology see him this afternoon."

After I stepped out of the room, more questions followed with how I knew that, and how to spell it, and all sorts of other stuff. I think they were just amazed that I had an answer for once. I explained that perhaps since the penis was such a small anatomical area that it was easier for me to remember what problems could develop in that area, whereas more complex systems like the heart and lungs just lead to confusion.

Of course the cute, tall nurse was there for all this, and now I'm sure he thinks I'm some sort of sexual deviant. Perhaps it's just as well as he doesn't meet my new age restriction (within 5 years of me).

Every now and then, be it ever so seldom, I do occasionally know what I'm talking about. Unfortunately, this time it's not exactly going to improve my reputation!

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After all that, I was wide awake, so I went to the gym and ran 2.0 miles without stopping! It was horribly slow, but at least it was something. There's a 5 K late next month that I'm thinking about signing up for just to help get myself back on track.

I spent the afternoon transplanting hostas from under my deck to around the base of the maple tree in my front yard.

da Vinci Predicament

This is probably at least part legend, but numerous times I have heard it mentioned that Leonardo da Vinci had an unusual sleeping regimen. Apparently, not willing to lose eight consecutive hours to sleep, he would sleep for two hours, wake up for four hours and repeat this cycle throughout the day. In the end, it still adds up to eight hours of sleep per day, and other than messing up one's REM cycles and hormone levels, it kind of makes sense.

This is sort of the sleep schedule that I have adopted, although mine just involves sleeping anywhere from 1-4 hours at a time, and there's no regularity to it at all. However, rather than creating numerous inventions and inspiring works of art, my writing has noticebly declined grammatically, and at work I have to constantly be reminded of what task I'm currently completing.

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This morning I slept in two hours later than intended, and it's rainy outside. Rather than getting anything done with the deck, I think I'll just lay low and maybe do some of that educational reading people keep talking about.

I did take some time to figure out the cordless drill I bought back in July. One of the rails on the deck had come loose. After bending multiple nails and splintering the wood some, I decided drilling was necessary. I'm not planning on progressing further into the world of power tools past sanders and power drills, but we'll see.

Work Rules

I'm trying to psych myself up for going in to work tonight. I am doing overnights for the next three nights. Thursday was another 24-hour shift, but it went better and I was able to sleep for about 5 hours. Since then, I have done a bit more painting on the deck, dug out some of the dirt and rocks that are causing one of the walls on my garage to bow in, and went to the gym this afternoon. There's nothing quite like spending your time off doing manual labor!

Here's a summary of work hour rules for residents if anyone is interested:

1. No more than 80 hours/week total.

2. Residents cannot be scheduled for more than 24 consecutive hours and must not stay late past 30 hours.

3. There must be a 10-hour break in between scheduled work days.

4. Residents must have at least one 24-hour consecutive break per week.

In the past there were absolutely no limitations on work hours, and I believe these restrictions have only been in place for the past 2-3 years. They are supposed to be implemented by every accredited residency program--meaning no government funding if the hospital doesn't follow the rules.

I really can't complain: right now I'm scheduled for 66 hours/week, including conference time. My residency program audits our hours as the hospital can be fined for violations. I have several friends who matched in a new program that has not been playing by the rules. One of them worked over 100 hours/week during July, and I am curious to see how she's been holding up. Opponents to the new limitations say that residents need to work a ton of hours to see enough cases, but research has shown that many more mistakes are made when residents are fatigued.

Call Girl

Well, I survived my first 24-hour shift on call on Monday. It was rough as I started the shift on 4 hours of sleep. Much of my night was spent trying to get a particular study done on a trauma patient that we thought had ruptured his esophagus. There were problems getting ahold of the right people to push the test through. I had trouble finding the study to order properly in the computer system that I'm not used to using. In the end, a major 4-person trauma came into the ER at the time my patient was scheduled to get his study, so we got bumped.

Today I found out that after all that, the study turned out to be negative. I'm happy about it though, as it'll work out much better for the patient who already has a long recovery ahead with numerous back and facial fractures.

I was really nervous about this rotation as the previous intern had encountered all sorts of problems, but most of my pages involved pain issues. I did have one difficult floor patient who was extremely moody and kept having the nurse page me for stupid things. It was also disturbing that every time I went to see him, he was just a little more naked. I don't know if he was trying to impress me, but paging me at 10 pm, 10:45 pm, 12:00 am, 4:00 am, 4:30 am, and 5:15 am does not make me happy. Overall it was a long shift, and I managed to get about 20 minutes of sleep total. It wasn't as bad as I expected, just naggingly annoying and a constant reminder of why I don't want to be a hospitalist or work on the floor.

When I got home that morning, I took a four-hour nap. Then I got down to business, working on the deck for about 3 hours and then mowing the lawn. Tomorrow I have another 24-hour shift, and I'm not looking forward to it. I think it will be a little bit smoother as I should at least be familiar with some of the patients on our service.

Sleeping With the Enemy

Last night, I couldn't get to sleep. Partly because my circadian rhythm is all screwed up, and partly because there was a stranger in my bedroom. This little bastard kept buzzing all over the place, and no matter how many times I swung at it, I couldn't catch him.



For some reason, he kept returning to rest on the lamp by my bed in spite of having access to the entire room. My natural reaction was to get pissed off at the stupid insect for buzzing all about, and then I thought about what I remembered about flies: they have a really short life span. Maybe he was frustrated with the fact that he couldn't find a mate, and had but minutes/hours left in his small, tiny life. Maybe he decided to spend his last breaths frantically trying to find his destiny rather than waiting for life to come to him. And maybe, just maybe I need to get more sleep.

Rain, Rain, Go Away...

Yesterday, my plans were to wake up early and start priming and painting the deck. However, instead of hitting snooze on my alarm clock, I must have turned it off. Instead of getting up just after 8 am, I woke up at 12:45 pm! I was able to get primer on about 1/3 of the railing, but that took forever. These projects always take tons more time than I expect. I did wake up at 8 this morning, but it had already started raining, so it looks like the deck project will have to wait for another day off.

Last night, we had dinner at one of the other intern's homes. I was supposed to host a poker night tonight, but instead we played poker last night after dinner. I did much better this time, and lasted a little bit longer. However, I left at 1:45 am and three of the guys were still going. I'm curious to see who ended up with all the dough, as this time we had a $10 buy-in.

Tomorrow there's a party at our department chair's lake house. I've only met him once before, and the forecast says more rain ahead, but since we interns dodged the last departmental function, we're all going to this one in full force.

Sometimes I want to just stay in bed and turn off the phone, but at the same time I don't want to be the hermit out of the crew. I like being around people most of the time, but every now and then I just don't want to talk to anybody.

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On a separate note, we will soon be conducting a study on the safety of taser guns. One of the researchers leaked it to me that participants will be paid $150 to be tasered. I asked him if female interns could sign up, and he just looked at me like I was crazy. I know it hurts, but how long could the pain last? Anyway, it sounds like they won't be using female test subjects for this study, so I guess I'm out of luck.

Pink Elephants

I suppose that if one were to stay up late on a worknight polishing off a bottle of wine with a coworker and watching a chick flick, one would have some serious bad karma coming their way the next morning.

Perhaps that explains the SEVEN patients that showed up this morning needing the next dose in their rabies vaccination series. Not that it was hard work, just a TREMENDOUS amount of paperwork. The patients had found a bat in their home. Since they crushed it's widdle head when they captured it, it couldn't be studied for rabies. No negative testing, means no certainty; which means a five-shot prophylactic series over the course a couple weeks for everyone involved.

Then there was the laceration guy. Every time I cleaned this guy up, I found a new laceration that needed repairing. I had a medical student with me, so I would do the more challenging parts, lining up jagged edges and such, and then supervised her stitching up the straight parts. Finally, just as we were getting ready to discharge him, his mother pointed out a HUGE scalp laceration we had missed. It was so embarassing. I had examined his head when I cleared him from the spine board. I didn't feel any lumps or bumps, painful areas, and there was no blood on my gloves. I guess his thick, lustrous hair hid it from me. Finally, I numbed him up, stapled, and sent him on his way. By the time I finished my dictations, it was two hours past my shift. And to think that this morning, the chief resident was giving me and my fellow intern a hard time about having an empty department! I don't know where my day went, but there were certainly no lunch, or even bathroom breaks.

Today was the end of my pediatric emergency block. I start a surgery rotation on Monday, so I'm planning on catching up on my sleep and maybe doing some stuff around the house this weekend.

Space for Rent

My psychiatry rotation during my third year of medical school was pretty random. I was placed with an addiction specialist, who specialized in sexual addiction. As you can imagine, I heard some interesting conversations that month. I don't know how much of an understanding I gained of the psychiatric profession, but as I was not allowed to directly interview the patients myself, I had quite a bit of time to reflect on my own thoughts that month.

One of the things the doctor kept repeatedly saying to his patients was that they had to "let things go, and not let people rent space in your head for free." A lot of our patients would hang on to one sliver of time for years, and never be able to let one altercation or instant in time go.

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Late last night, I was guilty of letting someone rent space in my head. I saw a teenager who kept having episodes of fainting and dizzyness over the past year. He kept describing a barrage of symptoms that didn't really seem to all fit together. After making sure that his heart and electrolytes were fine, I had to call in a consultant.

The resident finally came to see the patient two hours later. This patient had arrived in our department at about 7 pm and it was now midnight. Granted, while I was seeing other patients, the resident spent at least a half-hour talking to the patient. Later, I saw him on the phone, and then he left. When I walked by my patient's room, I noticed that he was in his street clothes. He told me that the neurologist had said that he could go home.

I checked his chart: there was nothing written down.

I talked to his nurse: she said that she hadn't been told anything about the plan for the patient.

It was now almost 1 am: I had the resident paged. I asked him what his recommendation was, and he said that his attending just wanted to send the patient home and have him follow-up with his regular doctor. I asked him if he'd written a note in the patient's chart. He said no, that he had dictated his note. I said I needed some sort of documentation in the chart that he had seen the patient and what the recommendation was, as his dictation would not be transcribed or visible in the computer for several days.

He told me it has never been an issue before, and then demanded to talk to my attending.

I told my attending what had happened, and he just kind of said, "This has been a problem with consultants since I got here in 1993." I asked him to back me up, and explain to the resident that if he doesn't write a note in the chart, or at least speak with me about the patient, I have no way of knowing what the recommendation is. Fortunately, my attending backed me up.

I ended up staying until after 3:30 am (my shift ended at 2:00) catching up on my own dictations and preparing a case for conference on Wednesday. About 3 am, I saw the resident slink into the department and write a note. He didn't bother to talk to me, which is fine. I was still pissed off when I got home, and am still a little annoyed today.

I can handle being criticized by other departments when they don't like our workups or don't think that they are being appropriately consulted. However, when they do finally get their special-selves in to see the patient, I expect them to conduct themselves professionally. Most of them do write notes, and this is pretty much a resident-run hospital.

Somewhere, there is an attending physician that gets to bill for his opinion on this case that he discussed with his resident. If his opinion is important enough for him to bill for, or that I have sought it out, it needs to be documented. For them to not bother to even speak to us is not only rude, but potentially harmful to the patient. It is completely unprofessional and potentially dangerous for him to expect the patient to tell me what's going on. Even though I'm calling him for an opinion, unless that patient gets admitted, he/she is still in my care as long as they're in the department.

Hopefully, as I think this is a pediatric resident, I won't have to work with him all that often. However, I do want to find out more about what the official policy is on consults. One shouldn't be able to get payment for an opinion that you don't share with your colleague, and I certainly wouldn't have put up with this crap since 1993! I suppose it is a little unorthodox for an intern one-month into her residency to be calling out a senior resident, but seriously: do your job right, and I won't have to tell you how to do it. After four years of college, four more of medical school and whatever number of years in residency, one should have communication skills slightly better than your average chimpanzee.

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On a happier note, yesterday I picked these up at the grocery store:


My ex-boyfriend was a huge Seinfeld fan, and he got me hooked on them. Some time ago, they stopped selling them in Arizona, so I was happy to see them here yesterday.

Also, I put seed into the bird feeder left behind by the sellers. It was then that I noticed the company name: Droll Yankees. Something about that just makes me happy.

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For some reason, when I look at my blog, I can't see my last two entries. Is anyone else having this problem?

EtOH

If a 15 year-old comes into your department late on a Saturday night spitting, kicking, and swearing is it wrong to set up a pool and take bets on what her blood alcohol level is?

I was off by 0.03

Pathetic

Chris was talking about parenting on his blog. On Monday night, I had a parent that sunk to a whole new low.

I walked into the room and there she was, a perfectly-formed child with golden locks in her stroller, all alone. Eventually, after scouring the hallways, I found her mother. It turned out the child was there for some episodes of vomiting. On exam, she looked pretty good, so we decided to see if she was tolerating oral intakes before sending her home. So, like with many of my pediatric patients, I asked the nurse to give the patient a popsicle. 20 minutes later the nurse flags me down, and says that she thinks the child is finished and ready to go. Funny thing is that although the little girl is only 12 months old, there's not a trace of popsicle on her face or clothes.

The nurse tells me that the popsicle was orange, and well... I guess I was a little pissed off to go in there to find that it was mom who was sitting there with the orange mouth and tongue. What kind of parent steals a popsicle from a sick child? Finally, we put some apple juice in the child's sippy cup and the nurse watched her gulp it down. Most of the parents I encounter are at the opposite end of the spectrum with being over-protective. I worry about the ignored kids though.

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On Wednesday, after conference and a nap, I tried to meet up with some of the other interns for a game of ultimate frisbee. We didn't have enough players, so instead we ended up going to see "Talladega Nights: the Ballad of Ricky Bobby" which was not Will Ferrell's best work. Afterwards, four of us sat around nursing beers while they tried to teach me Texas Hold'em. I lost $1.50, but it took them about 2 hours to clean me out. Somehow it was suggested that I host a poker night next weekend, but I don't know if I can get my house ready for that many people.

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On Thursday, I played softball for our residency team. We only lost 13-5, but it was the playoffs. Afterwards, I helped one of the other interns with moving some of his girlfriend's stuff into his apartment.

Late last night I tried to give BDG (blind date guy) his walking papers. I tried to explain that I didn't think I wanted to develop anything long-distance (we had talked about him coming out for a visit next weekend) and told him that I was overwhelmed. It was 4 am though when he called, so I'm not sure how coherent I was, and the last thing I remember him saying was "well, sleep on it." I don't know, I guess I just figure that right now it's better for me to be all alone and lonely rather than feeling committed to someone hundreds of miles away and still lonely. And, although we've been talking off and on for about six months now, it's not like either one of us have schedules that are regular enough to even be emotionally supportive of each other.

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So, I wasn't in the most fabulous mood today when I went into work. Added on top of that was the stupid assortment of men parking loud trucks and trailers randomly outside my bedroom window at 8 am. I am normally a good driver, but this morning as I pulled out of my driveway, I kind of knocked over one of their safety cones and felt my tire brush against their trailer. As I sped off, I saw at least six male sets of eyes staring at me. Yes, I am now that crazy woman driver in the neighborhood.

My crappy 'tude eventually righted itself again this afternoon. I saw a 6 year old who had fallen off of her horse and hurt her back. I was nice to her, but not extraordinarily so. Y'all, she drew a picture of me! It says "Doctor Smiley" and even has a stethoscope, and there are kids and a dog lined up to see me. It's hanging on my fridge right now. This morning I woke up drained and defeated, and tonight I feel much more content. It's funny how a little thing like that can make your day.

Hike 2

These are from a state park that is very close to my house. I don't know if it's because I'm from the desert, but to me the surroundings here seem so unreal, like I'm in a magazine or movie. I guess eventually all the wonder at trees and water will wear off, but for now I'm enchanted. I noticed that there are cross-country skiing trails around the lake, so I'm hoping to look into that this winter.

My dad thought this was a dogwood tree?

Leaves from a tulip tree:

Hike 1

These pictures are from the first hike that I went on with my parents. After almost a mile of scrambling up wet rocks, the trail culminated at an old fire tower, with spectacular views of nearby lakes that were hidden from the road.

Half-Assery

Lately, I've been on autopilot. At work, I keep busy and try to see more and more patients. I think I'm managing a better patient load, however I can't help but wonder whether or not I'm doing my best. I'm not really looking things up in between patients. I'm not really keeping up with my assigned reading, and often I don't feel like I'm learning as much as I should be. I guess a lot of it still has to do with spending time figuring out all of the details (for example, not hanging up on the surgeon who is finally returning my page 2 hours later!), too.

I have seen some cool things. I correctly assessed and started the workup on a patient with a neck fracture all by myself. I convinced the most skeptical of attendings today that my patient had strep throat. I met an amazing young boy with growth hormone deficiency that returned a second night in a row and requested me to be his doctor. And today, a young teenager who was rather sullen and skeptical of my knowledge last week was excited to spot me from across the department where her father was being treated and came all the way over to say hello.

I really don't know what the hell I'm doing, and it's scary. Today, only one of my medication orders got re-written by a nurse. I'm on the phone with people who have oodles more knowledge and life experience than I do, describing symptoms and findings improperly... and so far, they're actually tolerating me. Granted, I have pissed off a few people here and there, but the ones I seem to encounter again and again, I'm slowly winning over.

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My parents left tonight after we went out to dinner one last time. I think they had fun exploring the area, and although I didn't get to spend quite as much time with them as I would have liked, it was still nice to see some familiar faces. However, now I can go back to my hot bubble baths and avoiding civilization when I don't feel like dealing with people.

In the meantime though, there are friends I've been neglecting. My best friend's in a mess, and I hate that I'm not there to distract her with my stupidity. Another friend is debating postponing her wedding, and there are many more that I really owe a phone call or two.

And then there's all the unpacking, and projects around the house. Even my blog's been neglected:

Open All Night

Today is my transition day for switching back to day shifts. I'm not sure what to think of night shifts just yet. I'm on the pediatric side this month, which has its advantages and disadvantages.

Pros:
-Most kiddos are in bed by the time my shift starts at 10 pm, so there's a definite slow-down point at the triage desk.
-Kids are resiliant, and many show definite improvement in a few hours' time.
-The nurses on the pediatric side really know their stuff, and have saved me numerous times already when converting doses.

Cons:
-It's hard to be sympathetic with some of the stuff that comes in. Canker sores do not equal an EMERGENCY!
-Too often the problem lies with poop- there's either too much of it, too little of it, or it "looks funny"
-Parents don't like hearing that you can't find out what's wrong with their child in a few hours' time.

I'm actually liking working with the kids more than I had anticipated. Last night I saw a young boy who swallowed a metal marble. After confirming that it had passed into his intestinal tract with x-rays, we were able to send him right home. I like the quick cases, and it's much more gratifying to see relatively healthy patients that can go home, rather than spending hourse waiting for lab results and consultants, and still not knowing what's wrong with your patient.