It's November already!?!?!

I really have been trying to blog more often, i swear I have. There are a hundred random moments during the day that make my mind go off on tangents and I tell myself, "oh, I can think about it more when I blog about it"...but that sadly hasn't been happening. Why? Well for starters, I'm easily distracted and when I start writing, i get up to eat and never return to my thought lol. But mostly, I've been crazy busy this month.

 Last month was Toxicology which I LOVED!!! It wasn't busy, but I kept myself busy reading non-stop as not to feel like a total idiot during rounds and able to understand the genius talk happening around me. Also, not to mention I didn't want to fail the end of rotation exam, which, by the way was a success! I loved it so much that it made me really contemplate trying for the fellowship. BUT, i know it's incredibly tough and before I get ahead of myself here, I need to match into a residency first!

This month i've been on ICU at County Hospital and it's been awesome! The hours are long but I love running around being busy. Not to mention, I spend most of the days in the ED admitting people and sneaking away to watch trauma's come in :) Most people dislike the county hospital because it's pretty ghetto and also IN the ghetto. But this is exactly why I love it. The patient population is very different from the annoying stuck up scottsdale people. Our population is mainly lower-income people most of which are spanish speaking only. I love the humility, gratitude, and family bond of most of my patients. I've never met harder working or more grateful people in my life. This is not to say we don't get our fair amount of crazies, we certainly do! But i'll deal with the crazies and insane social issues for patients that will actually thank me everyday for my help, try to set me up with their sons, and invite me over their homes for dinner parties when they recover :)

So I've been learning lots the past couple of months! I'm trying to fight the common theme that students get "dumber" during 4th year. I can totally see how that happens though. It's easy to set your schedule up so you're not in demanding rotations that require lots of reading. I think the thing that keeps me going is the fear of internship. I'm not necessarily scared of being an intern, I know i'm going to make many mistakes.  I know that in the beginning, i may not save lives, I'm just hoping not to hasten people's death, that's all lol.  As expected, I've also had some really touching/disturbing cases at the hospital. Sometimes I wish i didn't speak spanish so I didn't have to tell a crowd of visitors their family member has cancer or is most likely going to die over night. I usually use running as a tool to sort of let the emotions i hold back at the hospital just melt away. But this month i haven't had time for that much :( I'm training for a marathon but I'm really behind. So some nights the stress sticks around. It hasn't been too bad, but I literally almost invited a patient to my house for thanksgiving dinner last week because I felt so sad for him. Anyway, it's been a great month so far and I'm loving it in all its ghetto-ness!

In other news, interviews! I actually have one tomorrow at the county hospital for prelim year and then another this Friday for emergency med in Michigan at Genesys Reg Med Center! This whole waiting for interviews and match is stressful, but I'm just happy to be offered interviews at this point! I'm sort of getting used to the not knowing where I'll be next year, this seems to be the theme of my life. I don't love  not knowing anything past a few months, but I have faith that wherever I'm going, it's in the right direction and it will work out.

I'll finish with a few funny/cool happenings over the past couple of months:

-examining (trying to) a pt tweaking on meth and having her tell me that I have beautiful skin right before she peed on herself
-being told in less than 10s how to put in an a-line (arterial line) on a drug overdose patient and then actually doing it for the first time ever with no supervision
-being told by a charge nurse that I manage my pts very well :)
-handing a urinal to a pt and having him throw it right back at me
-breaking the doors that lead into the SICU (surgeons love that)
-charge nurse yelling at me for sneaking into a trauma
-knowing protocols for NAC (antidote for tylenol overdose) that my residents didn't know


Until next time...

Happiness hits you like a bullet in the back :)

It's been a while! Over a month, times flies when you're busy/having fun/stressed/crazy :)

When I posted last I was still in San Antonio, TX and loving the ED and the idea of possibly winding up there for residency.  I came back and jumped right into non-emergency medicine grind, the civilian residency application process, and the stress that comes with all of that. Yikes! So, September was a somewhat high stress month for me. Things that happened in September:
1. ERAS and other med student stress
2. Took care of mama after surgery
3. Got back to climbing and running (signed up for marathon)
4. Once again proved that test-taking is NOT my strongest suit
5. Once again proved that I'm not going to give up on emergency medicine
6.  and many other little things...

It doesn't seem like much when I list it, but it was somewhat of an emotional month where I struggled with myself and had to prove my passion for pursuing my future goals regardless of how difficult it is :) More specifically, battling people who discourage others from pursuing dreams because the road is unknown and challenging. I don't work that way, as you know. I've proved lots of people wrong to get here, so it's nothing new to be told I can't do something...I just don't like hearing it. Eventually however, it serves as more motivation. So, now I'm sort of in a waiting period until December as far as residencies. Until then, I'm enjoying life and not letting a damn thing discourage me. I'll take life one day at a time and work it regardless of what happens!

Anyway, in other news,  I'm going to Bogota, Colombia in February to work in a Peds ED at a hospital called Fundacion Santa Fe de Bogota!!!! It has been a LONG process to make this happen, but it will be well worth it in the end to do some international medicine, one of my biggest dreams! (especially with kids) Again, I've met resistance as to why I'm doing this, its so much work to set up. I've just resorted to telling people that I don't do things the easy way haha. It's sort of true. ANyway, I'm excited to experience how Colombia does medicine and work with local kids. Hopefully I'll make it up to the mountains and do the "doctor rounds" in the little town where my mom was born. A doc hikes up once every couple of weeks and makes home visits to the people that live up there, off the grid, living off the land. It's awesome, I'm excited! My last international medical trip was the most humbling experience of my life and put everything in perspective for me. I'm ready for that again.

So the past month has been packed with a lot of things! (like that's anything new lol) Although it has been up and down, I can honestly say that I'm extremely grateful everyday for being exactly where I am and where I'm going, although I'm not really sure of where that is. Just having faith that great things are coming!

More updates soon...

Things I love/hate...

Things I've HATED (or just disliked) about this month:

- the politics of the military (i.e. useless paperwork, people making up stupid irrational rules to get promoted, etc)
- High heels in service dress
- Blues pants!! (who ever designed the blues uniform for women needs to be tortured, seriously. )
- my bathroom faucet that leaks every 1.5 seconds and I SWEAR gets louder at night and can be heard through a steel door!
- Having BMT kids stand up and at attention when i walk into the room in the ER. I know they're conditioned to do that, but i dislike it a lot. Same goes for the "yes/no ma'am" after every question.
- Seeing a little girl with "facial droop", making several glove balloons for her, and then finding out she has a large brain tumor and has less than 1 year to live. :(
- Having crazy enlisted people yell at me for a uniform issue while they neglect the things that really matter...like a patient with sats in the 70's!!
- The wasps (ugly black ones) that seem to live and multiply in my stairwell and chase me every time I need to come to my room!
- The smallest shower known to man, that also floods the floor with every use.
- Going for a run after dark and sweating so much that my shoes are soaked, gross.
- Wearing Blues on mondays!
- Whiney BMT kids that complain about everything and don't know how to cope with a little stress.
- cynical people, especially cynical doctors that hate their life!
- Nurses that think they're doctors
- blood on my boots :(
- Seeing a sexual abuse case on a 4 yr old
- Colonel's who think they deserve special and faster treatment in the ER and refuse to be seen by medical students
- Feeling like matching at this program would take a miracle because of my board scores :-/
- People who walk around with a chip on their shoulder

Things I love/hate...

I'm almost done in San Antonio!! It seems like these past 2 months have gone by so fast! I've learned LOTS and made some awesome new friends. I hope I'm back here this time next year (fingers crossed!!!) THere are SO MANY patient stories funny, sad, and awesome from this month that It would take me forever to write about all of them. Instead I'll just list them in my love/hate lists...

Things I LOVE from this month:
- Taking care of basic trainees that are so pumped and don't even realize they've lacerated their faces in the field and are forced to come get sewn up by the MTI's, and when they arrive, ask not to be numbed up because they want to be "tough". Some of these kids are sooo pumped up about getting their asses kicked everyday...how can you not love them!
- Out of all the basic trainees that we see everyday in the ER for "lightheadedness:... basically being "wimpy"...90% of them are male! :-D
- Finding an acute appendicitis on a WWII mustang pilot! (and then sticking my finger in his butt, that part i didn't love, but how many people can say that?!)
- Convincing a resident to get a CT abdomen (and betting a cup of coffee that it finds something) and finding a weird congenital intestinal anomaly that required immediate surgery! (ok fine, maybe I was ridiculously lucky on that one, i just wanted coffee, but sometimes its better to be lucky than good!)
- Being part of an all female trauma team :)
- Finally grasping the concept that in less than 1 year, I will be a freaking doctor! (are you serious???)
- Being around people that understand exactly what I'm thinking without even having to say it
- Not being the only one who seems to have to know the age of everyone we're talking about, even non-patients ;-)
- Waking up to taps and going to sleep when I hear reveille :)  I love the schedule of an ER doc!
- Being a part of a collective "yaay!!!" when the trauma phone rings.
- Learning that I too have my own "spidey-sense" about patients and even better, that a lot of times I am right!
- Not feeling like an idiot during a resuscitation
- Being pushed by residents/staff to be better all the time
- Realizing that i'm NOT the most type A person I know ;)
- Speaking spanish to my patients and having them tell me they are "proud of me." (i'm not really sure for what, but i just say thanks lol)
- Seeing people in the exact place/places I want to be and knowing the sky's the limit.
- Talking and Writing in only acronyms and abbreviations
- Hearing the words... "i trust you doctor"
- Looking at an ultrasound and actually seeing more than black and white dots!
- Sticking needles in things
- Having a consultant doc believe that I'm actually a doctor and not a med student!
- Being in a place where, 3 years ago, seemed so far away! :)

From Dayton to San Antonio...

So I'm halfway done with my Air Force Rotations! :-)  The Wright-Pat AFB rotation was an overall great time! I'm not just saying that because it is my first choice for residency, it really was probably the best rotation I have had yet. It wasn't a crazy county ER by any means, but I think that really had it's advantages. It wasn't so over my head that all I could do was watch. I was able to handle pretty much everything that walked through the door and it really helped me mature from just taking history and physical exam, to managing the patient from start to finish independently (in most cases).  It forced me to think more like a resident and that made me learn A LOT. Not only that, but this was the first rotation where I felt the staff really put effort into giving the med students a great experience. I really felt like they cared about us rather than using us as work horses.  They, meaning the residents AND attendings, really made me feel welcome and like they genuinely wanted to help me. At a lot of rotations, it somewhat feels like they look down on you, sort of like a fraternity/sorority and you're the new pledge (not that I would know since i wasn't in either lol, i just think thats what it would be like). Dayton isn't really the most appealing city, but I would go there for the EM program to learn from these awesome people. I feel like i fit in better there.

So all that being said, I'm in San Antonio now!! I've been here for 2 days. Today was my orientation day and all I can say is this is TOTALLY DIFFERENT from the Wright-Patt program/ base.  This base, Lackland AFB, is where all all of the new enlistees get trained. Every enlisted person comes through Lackland AFB for what's called, Basic Military Training. It's essentially "boot camp" for the Air Force. So naturally, there's lots of young airmen around here learning the ways of the Air Force. Because this is a big "training" base, they do pretty much EVERYTHING by the book. The rules for pretty much EVERYTHING are highly enforced, almost to a fault.  It's not a bad thing necessarily, it is just crazy how 2 bases can be so different from one another. I haven't felt so scrutinized as far as uniform wear, proper military customs and courtesies, since i was in ROTC. I had heard that it was different here, I guess this is what they meant.

So today was a long and pretty frustrating day. Orientation consisted of running around to various offices to complete all the in-processing paperwork. In true military fashion, nobody knew what the heck was going on and it was highly disorganized and made no real sense to me. (as much as this goes against every fiber of my being, i had to just accept it and not ask why).  This was what made it very frustrating for me. Here I am running around all morning getting confusing documents signed, getting totally random immunizations and lab tests (polio, HIV, and tDap???).  I, along with 30 other students are given "priority" over anybody else who needs vaccination or tests because we "need" these done today. This is what really got me...There was an active duty MSgt who sadly had to wait for about 3 hours to get his vaccines and documents signed for his Humanitarian trip to Haiti, which he is leaving for TOMORROW, because we all had "priority". Really Air Force??? Since when does my rotation take precedence over a mission to a third world country to provide medical aid??? This along with a few other frustrating events today really took me back to the part of the Air Force that I struggle with. There's often a HUGE disparity between doing what makes sense/most efficient and what the Air Force sees as best practices. Some of the time, it seems like the AF does the opposite of what makes sense. I have some theories for why this is, but that's not really the point. Today I was reminded of exactly why I struggled to get released from the Air Force to attend med school and it almost felt like I was meeting my old enemy, beaurocracy. Obviously, today wasn't nearly on the same scale, but it was a quick taste of what that was like, and i DO NOT miss it. So I don't mean to sound like I'm complaining about the Air Force, because I'm certainly not. Some days I struggle with balancing the positive and negative, especially when I have a frustrating day like today. It pains, ESPECIALLY when things make no logical sense, to just "do what I'm told" without asking the question of why.  I know this is the way of the Air Force at times, but it's an ongoing struggle that I'm not sure i'll ever get over.  I love the air force, it has only brought me great things, but some days, as with everything in life, I get a real good reminder of the things I don't love as much. Maybe that's why it's the military, it has inherent sacrifices. As much as I don't like doing it (because it doesn't really matter at this point), these really frustrating days make me wonder how different my life would be without the AF. I honestly have no idea.

Anyway, i've heard people say "some days you are the windshield, and some days you're the bug"...today I was the bug :(  BUT, tomorrow is another day. And maybe being the bug sometimes makes the days when we're the windshield that much better! :)

I'm def going to be a windshield tomorrow!

Some Dayton Updates...

So I'm nearing the end of my time in Dayton, it went by crazy fast. Probably because I was so busy and always trying to normalize my sleep schedule...such is the life of an ER doc I suppose. All the docs here say that's the worst part, the continuous changing of sleep cycle. It really hasn't been too bad though, I actually went running at 3am one night on base, it was pretty awesome.

I have my last shift on Tuesday and I'm doing our "final presentation" that we're required to do. We also have to take a "final exam" or something on the last day. This pretty much sucks because I've heard it's random and impossible to study for. Also, my test taking track record always haunts me. After that last shift I still have like 5 days in Dayton until my flight to San Antonio, so I'm hopefully going to climb and explore a bit more.

I had my interview last week and overall, I think it went great! (but who really knows, they could've thought i was the weirdest person ever lol) I consider myself personable but when it comes to the "official dog and pony show interview" i tend to get nervous. I just am not a fan of putting on a show for people and selling myself with all of this "i'm going to tell you what you want to hear BS". And there are A LOT of applicants that I've met, not just here, but everywhere, that seem to be great at this. Maybe it's a negative thing that I somewhat struggle with the specific formalities of the things you're "supposed" to say in an interview. But, that's just not me. Sure I can interview well, but the second I try to pretend to be somebody I'm not, it goes down hill and I lose my train of thought and end up sounding like a tard. So, as I was preparing for this interview, which by the way was the biggest interview that I'll have since it's my #1 choice, I tried to not over rehearse or have any "canned" answers.  I had main points that I wanted to touch on, but I mainly tried to focus on staying calm, being myself.

My first interview was with the Chief resident. It was pretty laid back but certainly covered all the main questions, i.e  Why ER, Why AF, What are you good at, what do you suck at, etc. It was cool, but to be totally honest, the interview seemed really formal for what I was expecting from a resident. The other students confirmed that he was sort of too "by the book".  He was really nice and everything, I just felt like he was rushing through questions he "had" to ask and that made it seem somewhat impersonal.

The second interview was with the program director, and the session I was the MOST nervous for. So after all of the build up, this session turned out to be my favorite one so far. This doc (who was the same guy with the situs invrsus kid i wrote about in my previous post) is absolutely, without a doubt, one of, if not, my most favorite AF doc. We hadn't had anytime together on any shifts so I was worried he wouldn't know me that well. But as soon as we started talking it was crazy because it was so casual and informal. I honestly felt like I was talking to one of my best ROTC friends, and that made me feel really good. He didn't ask me any of the typical questions. He flat out told me he was really happy to see how much we had in common (he did ROTC also) and he wanted to hear about how I've gotten to this point. This interview was more like I was talking to a friend, it was really crazy. He wanted to hear about my ROTC life, my maintenance experiences, and how the heck I managed to get out of that to go to med school...apparently he understood how difficult that is. So i talked about that and how it started out as something I hated, but turned into one of the best experiences of my life, how it made me who I am today. I mentioned how I sort of feel like "fit in" better with my air force friends and what it means to me. Towards the end of the talk, he said some things that make me feel like the interview was a success. He told me that I'm a really unique applicant for a few reasons. The prior service thing, being in charge of more than 50 people, which in the med group, you only do when you're Lt. Col or above (aka i have more leadership experience already than him and most of the residents and practicing docs lol). But the thing that he said that made me really happy was that he told me I reminded him of himself and he could tell by my enthusiasm that I was being real. Going back to my whole thing of hating the formality of an interview, this was awesome to hear. Not only did I feel like I could be totally myself with him, he picked up on the fact that this conversation was different than the usual fake interview. That's an overall success for me, no matter what happens.

So i guess it's out of my hands now, I did my absolute best, and left it all on the field, so to speak. I know there are LOTS of people interviewing and competing against me, I just hope I'm different enough to stand out when the board meets. But if not, if I have to fight my way through again and do a general medicine year, that;s ok too. It's not like I haven't been in that position before, except that was worse lol. I'll be fine because even when it doesn't work out, it actually does, just in a different way. ;-)

Right where I belong...

Last week's conference, although it was an incredibly stressful day, was one of my favorite days of this rotation. It was stressful because we just got the numbers from the AF for how many ER docs they needed and it sort of hit me that this whole match process is finally here. That plus seeing other students interview and hearing how competitive it is really freaked me out for a bit. The thing that brought me back down to my baseline level of insanity was a presentation by the program director. He was lecturing on thoracic emergencies and did a separate presentation about a case he has while deployed to Bagram Air base, Afghanistan.  I'm going to try to tell the story the way it was presented...

The case was about a 7yr old Afghan boy he took care of immediately after an IED (improved explosive device, basically a makeshift bomb insurgent's plant all over town) went off in village market in the middle of the day. There was a large number of women and children hit and he happened to see this boy. This sort of thing happens unfortunately, pretty frequently. Kids are brought to Bagram all the time and taken care of. This boy, however, was not like any child routinely seen anywhere. On initial exam, before delving into his blast wounds, the doc noticed something strange about his fingers and toes.  They looked something like this:

For non-medical people, it's called "clubbing" and the exact physiology of it isn't really known but it's hypothesized that it's caused by a process that allows for right to left shunting of blood in the heart and leading to the mixing of oxygenated and deoxygenated blood in the body. It has been seen in people with long standing COPD, lung cancer, TB, cystic fibrosis, etc, something basically affecting oxygen content in the blood. Anyway, so as the primary survey goes on they notice this clubbing, puncture wounds to his chest and abdomen, and some other minor cuts. So just from the clubbing alone, doc new something was not totally right. As things progress and they start the trauma series of xrays, labs, etc they quickly realize this child  is incredibly unique. His chest x-ray looks something like this:

Notice anything wrong?? (I thought of scrubs at first and how they hang the xray backwards at the beginning of the show lol) But no technical error here...his "stuff" is on the wrong side! Heart and stomach, both on the right! This kid had what is called, Situs Inversus, basically where his organs are transposed to the opposite side of his body. He also had transposition of the great vessels of his heart, aka  the main vessels of his heart were also reversed. Crazy right? How is this kid even alive?? It's crazy because transposition of the great vessels is a condition incompatible with life in 100 % of cases UNLESS, unless, unless, there is small hole in just the right spot in his heart. In other words, his heart is totally backwards and this small hole, a ventricular septal defect, is allowing this crazy rearrangement of blood vessels to adequately oxygenate his body. Holy crap right?? Mind you, this kid is 7yrs old!! Which means, for his entire life, from the day he was born, his little body has been working sooooo hard to compensate for this congenital heart abnormality. AMAZING. 

So back to his resuscitation. After docs quickly figure out sort of what they're dealing with, they get some labs back.  The only 2 real labs of importance to explaining this case are Oxygen saturation and Hematocrit. Oxygen saturation is around 81%, which is low, but not as low as expected for somebody who probably has a huge hole in their lung, normal is greater than 92. His hematocrit, just a measure of the actual red cells in a blood sample, was also 81%, normal is anywhere from 40-50%. So this kid's ox saturation and his hematocrit are the same!!! This basically means this kid's blood is incredibly thick, to the point where this level of Hct is never seen, like ever! It's another way that his body has coped with this heart disease that he has, that's one of the ways he gets more oxygen, is to make lots and lots of red blood cells to carry more oxygen. Again...amazing. 

So now the docs realize that their previous knowledge of "normal" physiology has gone totally out the window. How can you even begin to try to treat/correct/maintain his physiology when you have no freaking idea what is his "normal" in the first place? All they really know is that he needs surgery to remove metal that is in his lung and abdomen making him bleed into his belly. 

*Side note: My favorite part of this presentation was when the doc was telling how $hit was hitting the fan and he had to run back and forth between this kid and a few others. He described what I can only picture to be the extremes of emergency medicine, badass docs and nurses running around making things happen in mass chaos. (doesn't that sound incredible?) My next favorite part of the story is when the doc, after getting the kid somewhat stable, tries to get a pediatrician (since he is 7yrs old) to take over. The poor peds guy practically craps his pants at the thought and refuses! I'm sure he didn't refuse because he was a jerk, I just think he was too scared to take on the case. :-) Sorry to all my peds friends, but I had to throw this in there.

Anyway, to make a crazy awesome, but long story short, the doc ends up putting a chest tube in the kid and taking him to surgery to remove the shrapnel left in his chest and abdomen. He survived the surgery but sadly died from complications of pneumonia several days post-op :*(

It is really really sad that he didn't make it. My first thought was, poor guy, so unlucky, just caught in the wrong place. But after really thinking about it, turns out that he was actually incredibly lucky to even be in that market in the first place. He basically overcame all odds to even be breathing, let alone live for 7 years. He wasn't just lucky, he was a walking miracle. We'll never know how long he would've really lived had he not been hit with that IED, but it surely wasn't going to be very long. It's even more amazing that he survived surgery. There's so much that has to go right in his physiology to sustain him, his body has been perfecting this for years. Surgery is highly risky in "normal" people, let alone him. So all in all, the fact that he died in the end while really heartbreaking, it's just a testament to how big of a miracle his life was to begin with. 

After/during this presentation I pretty much had chills. One of my dreams is to travel the world and practice medicine in places that doesn't have doctors really. To treat people, like this little kid, who have never seen a doctor in their lives. It's a huge reason i joined the Air Force. So although I sometimes have my doubts about how the AF will impact my life, hearing stories like this puts everything back in perspective for me. Stories like that are the exact reason why I'm here. Nothing pumps me up more than to know that I will be (hopefully!!) able to go around the world and have my own stories similar to this. Of course being a doctor alone is sweet, but being one of the few people who can handle crazy cases like this one, and help people that would otherwise NEVER see a doctor is incredibly exciting. 

There's a lot to worry about right now in this stage of the game. Residency applications, board scores, what happens if I don't match, where will I live, what if I'm still single at age 50 (lol, jk), it's A LOT to think about.  I do my best NOT to think about it too much and reassure myself that things will work out, they ALWAYS do.  But that day, sitting there listening to the story about that miracle boy made me REALLY realize something. The feeling I got from it made me see that although i am unsure of LOTS of things, like where on earth I'll be next year, or what I'll be doing. One thing I DO know is that right now, pursuing this dream, (totally stressed and confused and scared) no matter what happens, I'm exactly where I belong and wouldn't have it any other way.   

Just a few more months....

So there's a lot I have to write about, but it's late, and i just got off a long shift. But I just wanted to comment on the 2 things about my shift tonight that stood out more than anything:

1. "are you a real medical doctor? As in, you went to medical school? Because you don't really look like someone who would become a doctor."

I don't take personal offense to really anything a rude patient or even more rude family member says to me. This isn't because I have no emotion and am an "ice queen" as most would say. But mainly, it's because 99% of the time, the people being rude jerks in the ED are just not smart, at all, but they somehow think they have this wealth of knowledge because they have a 4th cousin who is married to a guy who knows a doctor, or something retarded like that. Anyway, tonight I went into a patient room to see a kid with a rash. No big deal, he has a rash. My first thought was (as I'm seeing this 5yr old kid, with no apparent rash, jump up and down through the door screaming along to the cartoon on the tv)..."wow, this kid couldn't be farther from having a life emergency, dandy." This also give me the first clue that his mom probably is not the brightest crayon in the box. So I go in, start talking to the little guy and mom. Before I can really start asking questions, mom flat out asks me if I'm a real medical doctor and proceeds to clarify that she's asking if I went to actual medical school. It was funnier than insulting actually lol. I had to stop myself from laughing almost. "did she really just ask me if i'm a medical doctor that went to real medical school?"

I explained I was in fact not a doctor yet, but am almost finished with ACTUAL medical school (the kind where you learn medicine and stuff). She was shocked because apparently, "you don't look like you would become a doctor."  WTF? I'm still not sure if that's a good or bad thing, i'm still sort of laughing at the whole encounter. But i assured her that despite my looks or whatever, I am qualified to be asking her questions about her son's non-existant medical emergency that she calls a rash. I basically told her some benadryl would clear up the miniscule red spot and "itching" her boy was having. 5 mins later, the attending comes in (only to appease her because I could tell she didn't believe me), and says the SAME EXACT WORDS, almost verbatim. I wish I could've had a camera to video her reaction that was SO appreciative and relieved and made it seem like the attending had just told her how to win a trillion dollars and I had told her nothing. SO...what did I learn from all of this and this crazy lady, other than the fact that apparently I don't look like a doctor and 95% of the people I see in the ED are very very unsmart. I learned that i CANNOT wait until somebody asks me that question and I can answer, YES DAMMIT I'M YOUR FREAKING DOCTOR! :-)

2. So tonight seemed to be "vaginal bleeding in pregnancy" night in the ED. We had about 5 women in a row come in for vag bleeding all less than 15 weeks or so. I got lucky enough to work all of them up and by the 3rd one, the doc was letting me pretty much solo the patients, meaning, I'd do everything, orders, exams, and they would just say a quick hello at the end, when OB/gyn came down.  My 5th lady that came in though, she was the one that gave me an experience that I don't think I'll soon forget.  She was bleeding pretty badly, hadn't felt the baby move in a couple days. When I told the attending about her he sort of grimaced and said in not so may words, he was pretty sure the baby was not viable anymore. So, with this in mind, I go in and do the pelvic to work her up just like everyone else. Mind you, this poor girl had been crying from the second she put the gown on, she had 2 previous miscarriages at around this same time. I set up the ultrasound, trying to console her without giving her false hope, but also without being unrealistic, she had lost a ton of blood. So as I'm getting the probe on her belly, doc walks in and stands there waiting to help me give her the bad news that her baby's heart isn't beating. So I look around for a few seconds and seriously, it was the craziest, one of the most emotional moments I've had in med school for some reason. Not sure if it was because you could feel the fear in the room from this girl at the thought she lost another baby. Maybe it was because it was my first time or so really being the one to find or not find a heartbeat. So after looking for about 2 seconds, I found it...it was beating strong and baby was moving. Right at that moment lots of things happened...i'm pretty sure my own heart stopped for a quick second, the patient screamed/sobbed louder than crap, and even the attending let out a "wow."  It was amazing and i was so happy that I let the probe slip and I lost the heart lol...but I found it again fast! So everyone was happy, not totally out of danger, but the baby was alive, unlike we all expected. I guess I never really grasped/felt how surreal it is to see your baby's heart beat on a screen. I've seen tons of them, but tonight it really hit me. I've never seen my own baby's heart beat (obviously!), but if this is even an indication of what that is like, all I can say is life is really a miracle. So yea, I'm pretty confident that I won't forget those couple of seconds for a long time. I should also not forget to not drop the probe during such crucial moments lol.

More updates to follow :)

Day off :-)

So today, other than a 2 hr lecture, was a day off! I have tomorrow off as well so I used today to really work on my personal statement for the residency application.  I really struggle with writing formally so it's taking me FOREVER.  I want to include things about my previous military time and past struggles I've had to get where I am. It's just really hard to articulate it the way I want it to come out. ALso, it's difficult for me to write about myself and somewhat "sell" myself to program directors. I'm a MUCH better speaker/interviewer than writer :-/  Nonetheless, it's coming along. I have my interview on July 23rd so I hope to be done with the personal statement by the beginning of next week.  As far as the interview, i'm nervous about it. I know all I can do is be myself, be honest, and hope for the best. I'm just hoping I don't say something stupid lol, i have been known to do that from time to time.

Overall though, being here, on a base again, surrounded by people in the same "boat" as me has really calmed a lot of worries I was having in the months before I came. Being disconnected from AF people and things, while still having to make plans with the AF in mind was stressing me out. It's sometimes difficult for my peers, and even my closest family and friends, to really grasp the concept of why I would even want to be in the military. They certainly support me and are behind me no matter what I do, good or bad, but that's different than somebody who just understands and gets it. I love my supporters and don't know what I would do without them. But sometimes, it's refreshing and super reassuring to be around people who I don't have to explain anything to...they just know and feel/understand where my driving force comes from, nor do they see it as a nuisance. I think I was just getting the feeling that I was alone the past couple of months. Alone in the sense that I was constantly defending and sometimes even doubting all of this Air Force thing. Now that I'm here though, I remember exactly why I make and have made certain choices for myself that could potentially make my life very difficult and non-traditional.  I guess you could say I like I belong to a "team" (wow cheesy!!!) again.  So I know it's silly to feel like I'm alone in this, because I know I'm not. Maybe I just needed to see other people doing this, and not only doing it, but being incredibly happy doing it. So being here has been great on more than one level, I needed it.

A month and a half until I'm back in AZ! With my little abbey girl and in my own bed! I still have a bit to go, but I am getting excited :-)

 It has been a good day off, and this song always makes me relax :-)  

Long day...

So I'm on my second week of my ED rotation. So far I have had a great time. Today, however, was by far my favorite day of all! We had a procedure lab where we were assigned to a live pig (about 100lbs) and got to do a bunch of procedures on them. We practiced getting intra-osseous access (basically sticking a large bore needle into a long bone when you can't get a peripheral IV), chest tubes, cricothyrotomy (hole in neck for airway),  thoracotomy (cracking open a chest), diagnostic peritoneal lavage ( flushing fluid in the abdomen looking for blood), and cardiac massage!! A couple of attendings and the program director were in my group so I either made an ass of myself of did a good job to impress them, who knows lol. But it was really awesome to be exposed to the setting where we can actually learn those types of procedures on live animals. I love that they put that much effort into teaching us on this rotation, it really makes up for the slow ED :-)

Everyday I'm here, and the more I talk to the residents, I love this program more. It's not as in your face military as San Antonio is, you get close to 5 civilian hospitals in your rotation, rather than just 1 big hospital, but most of all, the people are amazing. The people/personalities are what matter the most to me and if I can see myself happy working with these people. Granted, it IS the AF and people move around sooo much, but I feel like I can really fit in here. Also, I do want civilian hospital experience, and you get that for your entire 3 years here.  I do love the AF, but i think I will really like the civ/military mix of residency life they have here.  Sometimes they are the bane of my existence, but the homeless drunk does have his/her role in teaching students on how to be a good ED doc lol.

In other news, i've been running a good amount here. The base is pretty, pics coming soon! There's a sweet rock gym not far from here and I think i'm going to head there in the next couple of days. I've been sooo busy lately and they sneak lectures/labs in on my days off so I haven't had time to explore it yet. This week though!!

Ok more updates later!

Something I wish I didn't learn today...

It is still possible for people to fart during a rectal exam. 

Lesson learned...unfortunately. 

My first 2 shifts!

So I've been in Ohio at Wright-Pat AFB for 3 days now and I've had 2 ED shifts. Overall, they're been pretty good. The base hospital where I'm rotating is not a big place like I thought it was. There's no real trauma or real emergencies for that matter. The people that come to the base medical center are either retired military or active or they're dependents. Also, there are very few actual emergencies that come to the ER here. Most of the complaints are things that can be handled by a family med doc as an outpatient. That's just how this small hospital is set up :-/

That being said, the residency program here is actually quite awesome. As an intern/resident you actually don't spend anytime on this base hospital and you're out in the civ world at the big trauma hospitals around the Dayton area, so that's cool.

I have met some crazy awesome docs though. Although the actual flow of real emergencies is relatively low, I'm learning LOTS and getting to basically make the decisions for my patients, write the orders, and much more! So it's been great so far.

The other thing I'm learning is how different the medical side of the Air Force is from the operational side. I would NEVER think of calling a Col by his first name, much less a nick name, and here it's expected...crazy. I guess because of the team dynamics of the ED with nurses, techs, and docs, the relationship is closer and more laid back. I like that it's laid back and informal, I never really liked the whole "power hungry salute me because i'm higher ranking than you" thing that goes on.  Some people might argue that its a bad thing for the enlisted and officers to be on a first name basis when the rest of the AF is not, but trust me, everyone still knows who is the doctor and who is really in charge...regardless of the rank.  So it all works out.

Things I have learned so far:
- Don't assume that military members/dependents are less crazy than the average population...the crazy is still there, it just hides better in the military.
- I despise decisions based on pure politics, well this i already knew
- I hate being called ma'am
- How to remove a foreign body from an eye with a TB needle
- still not a fan of the pelvic exam despite my female-ness


It's 2am, and i'm falling asleep so better and more well put togther posts are coming soon!

Leaving on a Jet Plane...

So my week of post-boards relaxation has finally come to an end. I've spent the week mostly relaxing, packing slowly, watching soccer, and enjoying my free time. It was a great week, but I'm definitely ready to get back in the hospital and get back to work. I'm leaving on Monday morning at 6am for my 2 month adventure back in to the active duty Air Force. I'll be going to Wright-Patt AFB in Dayton, OH for 4 weeks and then Wilford Hall Med Center in San Antonio, TX for another month. The only difference this time is that I'll be working in the ED, not on the flight line :) .  I have sort of mixed emotions about how these next couple of months are going to go. I'm extremely excited to finally rotate at places I may actually end up and get a glimpse into what could quite possibly be my life for the next 3 years. With excitement comes the nervousness of "holy crap, I've been off active duty for 3 years, I'm gonna look like an idiot!" On top of this, there's the anxiety that I MUST impress these programs so they actually pick me from the hundreds of applicants. One good thing though, is that I feel ready to finally see what it's like to combine my Air Force life with my medical life. I've done them separately and I hope I realize and get that feeling that the combination of the two is exactly what I'm supposed to be doing. So, i'm excited/nervous/anxious/ready for the next 2 months!

Things I plan to do/keep up with while I'm gone:
- RUNNING!!
- SWIMMING!!!
- RIDING (i plan to participate in the SOMA 70.3 triathlon again this year in October so I gotta get my butt in gear!)
- CLIMBING
- TAKING PICTURES (of everything of course!)
- oh yea and reading and learning lots of Emergency medicine things :)

So that's what I'm up to for the next couple of months. It comes at a great time too...it's crazy HOT right now so it'll be nice to get out of AZ. Not to mention I've been wanting to get out of town lately. I love AZ but something has been making me antsy, like I need a slight change of perspective as of late. Not really sure why that is really. But hopefully I'll get a much needed change of perspective on the many things I purposely place on my already full plate. Maybe I'll just want to add more? :)

I will miss my abbey though :(  She'll be hanging out with Xiomi and they're going to keep each other from getting lonely, abbey was put on this earth for that, I'm convinced of that.

Well stay tuned for funny ER stories, angry rants of frustration, crazy ER times, and funny Sasha stories...we all know I can get myself into the craziest situations.

Losing my mind...(even more than i have already)

It's Saturday, my Step 2 board exam, my last big exam in medical school, is on Monday. I have been sticking, pretty well I might add, to a schedule I set for myself 2 months ago. I don't do anything training or studying on a regimented schedule so I'm proud of myself for doing that this time. Thus, I am losing my mind now that it is 2 days before the big test!! I am burned out from studying, have the attention span of a gnat (hence my blog posting right now) and would just like to get the dang thing over with!  I'm so over studying that I even stared at my swim goggles for a good 6 minutes straight today thinking of reasons why one side always lets water in but the other doesn't..yea, wow.

Phillip= Sasha

Wish me luck on Monday! :)

Daydreamer...

So time has been flying this month! Last month flew by probably because i didn't ever sleep, was surrounded by the crankiest people ever, and the month was a blurr, like one looong day. My cousin moved in a couple of weeks ago and we had a week to just hang out and explore arizona. She likes AZ a lot and is adjusting to the heat pretty well. I've taken her rock climbing (which she loves), to spin class, yoga, and hiking. So far i think she's enjoying it and still getting somewhat settled. I've spent my mornings on Radiology rotation that entails me reading films/CT's/MRI's/etc for about 2-3 hours and then using the rest of my free day to study. Having the day off would normally be really tempting to go hiking or spend a couple hours climbing or running. Fortunately for my studying regimen and unfortunately for my sanity, it's so dang HOT until about 10pm that the thought of even running a mile outdoors makes me have a heat stroke. I can take the heat pretty well usually, but this heat doesn't even make running enjoyable. I swam the other day and after a few laps I felt like i was swimming in a hot tub...gross. So due to this sub-optimal heat I've resorted to sticking with climbing, swimming, yoga, and spin class this month!

Anyway, I'm excited for boards to be over at the end of the month. July and Aug are going to be big months for me since I'm going to be in Ohio and Texas. I'm trying not to stress too much about these audition rotations, do my best, be myself, and just hope things go smoothly. I know one thing, I neeeeeed to find either a pool, a sweet running route, or a rock gym to make it through the month. So the stress from paperwork, board exams, setting up rotations, filling out residency applications coupled with my "free" time spent studying usually in startbucks or some other coffee shop, has made me somewhat of a daydreamer.  It usually happens when I'm distracted by people watching or taking a short break from reading (LIKE RIGHT NOW) that I start wondering what it would feel like if I didn't have med school, AF, studying, all of these things on my plate. It only lasts a few minutes, but I do try to picture myself and how life would be if I never had/wanted these things. I see a lot of my friends doing things now that I usually say I'll do "one day", I've been saying that for as long as I can remember. Not that I'm not doing anything, but sometimes I do with I had the freedom (AND MONEY!) to pick up and go somewhere for the weekend, or longer, and not feel guilty about how i'm not studying or not reading or how I'll have to watch for emails from med school things.  I'm not complaining really. I chose this and I wouldn't change anything about my life and how it has played out so far. I have met some amazing people along this path that I don't know what I would do without. I just know all of these things, the studying/books/AF/working out/my shenanigans/crazy running around all the time trying to be in 4 places at once...it's me. And really, it's tough to picture myself doing anything else. But it would be nice to actually try out the gypsy life for a short period of time. To take breaks from my daydreaming and adventurous life to study,not the other way around, would be awesome. I'm not sure that I would even know where to start, but I'm sure I could figure it out eventually. But for now, daydreaming on my study breaks will have to be the extent of my gypsyness. :-)

Song that's stuck in my head: Adele-Daydreamer

Ms. B...

So this surgery month, that is almost over, has been quite demanding of my time and patience. I don't necessarily get pimped a lot, but I am held responsible for almost everything...even when the OR lights burn out. That's clearly my fault. Not to mention my surgeon isn't the biggest "people person" with his attitude that no patient encounter should take more than 5 minutes and time=money. He's a very great surgeon, but his people skills are kind of iffy. So being around him and scrub tech's that hate their life and have a negative attitude towards everyone and everything has sort of sucked me in a little bit.  I found myself today staring at the clock as a patient was talking realizing exactly when the 5 min mark was up, getting bitterly angry at people for continuing to smoke and not control their diabetes which forces them to us for toe/foot amputations, feeling disgusted with morbidly obese people for smelling like they crapped themselves, etc. I guess I was just caught up in being bitter with my patients in general. (maybe it has to do with sleep deprivation?) Anyway, I was in the ICU today seeing a consult, homeless guy, found down in a park, bleeding from nose, mouth, rectum...needed surgery for perforated gastric ulcer and esophageal varices from years and years of drinking.  In the midst of being mad at him for drinking himself into the ICU, i walked by an old pt of mine who has been in ICU for 15 days now.  We took some of her colon out because it had twisted on itself and was necrotic and she later got pneumonia and had to be intubated. She's been intubated for over a week now and I've stopped seeing her daily because there's nothing for us to do anymore. She's slowly bouncing back and forth from getting better to doing worse with her pneumonia. But today, she was awake. I saw her looking out of her room, tube in mouth, holding this super soft pink little stuffed dog she's had since the first day i met her. Before she was intubated, she was always the sweetest lady and called me "love", well, i guess she still is sweet, she just can't talk. I hadn't seen her in a few days so I walked in to her room just to say hi and look at her tummy and i was sort of shocked by her reaction to me. I grabbed her hand first and then she just latched on like there was no tomorrow. It really caught me off guard because she was wide awake and i guess just wanted to hold my hand. After a few seconds she grabbed it and pretended to kiss my hand, around the tube in her throat of course. It just really moved me and made me sad because I hadn't been seeing her daily and it seemed like she really needed somebody to just be there and for once, not look at al her tubes, holes, drains, etc.  I stayed as long as I could but before I knew it I could hear my name being called from the hallway to hurry up and get moving, actually the surgeon calls me "girly", not even by my name lol. But Ms. B sort of made my heart sink and put things in perspective for me.

I was getting caught up in being angry and bitter, just like a lot of people in the medical field. You always run across these doctors that are just genuinely happy people and have a great attitude, but more often than not, they're bitter and hate people...I don't get it? Didn't they have to actually WANT to help people at one point? What happens in the course of residency and then years later that makes the love and compassion for people completely disappear? I can imagine that it's the "bad eggs", so to speak. The ones you see repeatedly for problems they cause themselves. The people that despite surgery after surgery, infection after infection, don't quit smoking, don't lose weight, don't take care of themselves. It's the ones that feel entitled and demand you fix what they have been doing to themselves for their entire lives in a few days. The ones that say "you're the doctor, fix it." I'm not naive and I'm not saying that I'm never going to be jaded and bitter, of course I am, it's already happening!  But I can at least acknowledge it and make the decision to not let it overtake me and lose sight of the reasons I started on this crazy journey to become a doctor, reasons like Ms. B.  Why do we allow ourselves to be bitter all the time and let the "bad eggs" leave a lasting mark. Why isn't it people like Ms. B, the great, sweet lady who got unlucky and is fighting to live, that leaves the biggest impression on us?? I know there are more bad eggs than good eggs, so it seems, maybe because the good eggs are healthy and don't need hospitals?? But the good ones definitely outweigh the ones that make me bitter. And for every 20 bad ones, 1 good one is enough for me to realize the choice I want to make.  The choice to take more than 5 minutes, let people talk a little longer, try to see their side and despite my surgeon, call patients by their name, and not, "cancer girl" or "stump man". (yes he actually calls them that, not to their face, but he doesn't know names.)  I just can see that if you let yourself fall into the bitterness black hole, then no matter which kind of people you see, eventually they will all be "bad eggs" in your eyes.  And who wants to live that way? I guess the bottom line is there are MANY, too many, bad eggs out there. Care for them, be compassionate, and even get angry at them, it's ok. But don't let them drown out the good ones, keep your eyes and heart open for them... they're the ones we started this whole battle for in the first place!

Ok now I'm off to study and sleep before 9pm. I have 1 case tomorrow and then get the rest of the day off!! woot! :)

The beat goes on...

Semi quick update on rotation:

I've been really busy the past few weeks! I'm on a surgery rotation that actually isn't as physically demanding as my last surgery rotation, it's more of a mental game. My doc is great, tough on students and makes us work hard, but still great. The 3am wake ups followed by mostly 12-15hr days, 5 days a week is kind of tiring. But the worst part of this rotation has been dealing with the personalities in the OR. My day consists of quietly rounding on my own from 4am-6am on about 8-11 patients, making sure the charts are all in order and everyone has been checked on before doc get's there at 6am...no big deal, despite the fact that I'm not entirely awake and looking closely at colostomies and freshly amputated stumps isn't the greatest smell that early in the morning.  (not that its ever a great smell!) My real work starts around 7am when the first case begins and I assist on surgeries while dodging bullets from the scrub tech (hands instruments to doc) and first assist (a nurse that helps the surgeon operate). It seems like no matter what I do, or how great I do something, they always have a negative comment or something to scold me for. I'm not a sensitive person in these situations and i can take a scolding without letting it get to me pretty dang well, but when people who have 1/3 the education I have start yelling at me...I have a problem. Not only yelling at me, but the scrub tech actually stabbed me with a suture needle when she was yelling at me and yanked it out of my hand! I'll just say that we had some SERIOUS words right then and the day after, and since then, she's been fine. :)  I just don't tolerate blatant disrespect and people taking their problems and bad attitudes out on me. ESPECIALLY from a menopausal scrub tech...sorry you're having hot flashes lady, deal with it!!! But all in all, I'm enjoying the rotation. My sewing skills are improving and i'm learning lots of different techniques.

What I really wanted to write about tonight was how things change.  As in a change of heart, change of perspective, and i guess just how things can just change in the blink of an eye.  I'm pretty sure that everything changes in some way or another. People always say "Time change everything/everyone", and for the most part, I think that's true. But I just get amazed at how certain things, beliefs, ideas, goals, etc can change seemingly overnight, taking no time at all. Maybe it's just that the gradual changes don't affect us as drastically.  An example, our last case on Friday was an operation on a man to remove part of his colon that was full of cancer. He had abdominal pain on Thursday, came to the hospital that night, and by friday at noon, he was told he had stage 4 colon cancer, needed part of his colon removed and was told he probably wouldn't live another year.  During the surgery the doc had me literally feel the inside of his abdominal wall and his intestines and all I could feel were little bumps...all tumor seeds. This 56 yr old man went from working full time, living a happy life with wife and 4 kids to knowing his entire abdominal wall was being overtaken by cancer and he would die soon.  His life changed in the time it took us to say the words.

 Another example, the end of a relationship. Generally speaking, when you're genuinely happy with someone, time seems to go by fast. Everything looks a little different and you sort of feel like your heart is smiling all the time. But it's crazy to me how all of that can go away overnight and you're right back to where you left off.  Something sets the ball rolling in the wrong direction (sometimes without you even knowing) and without warning, here you are, back in a familiar place, feeling just like you never left. I guess all you can do is pick up where you left off and keep going.

I guess my point is that you just never know. I'm constantly amazed at how drastically and quickly our lives can change. One minute you're blissfully happy and your life/health has a great outlook, and before you realize it, it's all different, maybe for better, maybe for worse. Either way, nothing really seems to ever stay the same and it's just a matter of how and how soon things are going to change.  Makes me want to just enjoy the right now, all the time, because tomorrow it can all be different, and the only thing you can do is react.

One of my favorite songs my one of my top 5 bands...
The Temper Trap- Soldier On

An exciting week of being a nurse AND a PA! (warning- gory picture:)

So far my month in the ED has been pretty dang awesome. I've learned so much about medicine but probably more about people that come into the ER. I really really really do my best not to judge people but in the ED, you almost have to. It's crazy how great people can act to try to get pain meds from you, I've been fooled so many times already. They use the typical

"doc, I know you can help me, not many people have been able to. THere has to be something going on with me, this pain is unbearable (all while in tears) and I wouldn't be here if i wasn't at my wits end."

So naive newbie over here buys into it and really starts thinking of all the terrible things that could have bee n missed on a CT or the multitude of other studies the pt has had, all of which are completely normal. I distress myself thinking of all the things on a differential and present it to my attending really concerned. He takes one look in the room, without even really entering the room, and goes, "ok, got it, she's going home." His explanation was that she has "the look." Apparently, and i think I am starting to catch on, whether its good or bad, the look is just something you can just pick up after years working in an ED. There really isn't a way to describe it, its has no real specific features, but you know it when you see it. Is it just a biased/prejudiced opinion against the way some people look that come into the ED? Maybe, to some extent. But when "the look" proves to have a specificity of about 98% for diagnosing somebody as a "frequent flyer, drug addict that makes up stories for pain meds", I'd say there's some validity to that, not just biased and jaded opinion.

Here are some more highlights from this past week:

-On the way to work, not even in the ED yet, was driving and witnessed a teen vs. car accident right in front of me! It was pretty scary seeing the kid fly in the air and land on the street not even 20 ft from my car. For a split second I thought "holy crap, this kid is dead, I really hope there's a doctor in the area..."
And then i had the "oh crap, this is all me...the doctor in the area...ahhhhh that's me!!!" So before I could finish that thought and even begin to freak out about how I wasn't really sure what I was doing, my car was parked in the middle of the street and i was running over, in full scrubs as i was on my way to the ED, to see what was left of this poor kid who, by the way, was hit straight on by an extremely old driver going no less than 40mph!  The kid, Antonio, was 16yrs about, was laying on his back just moaning in pain, left arm road rashed to hell, totally mangled, lacs all over his face. It was crazy because for the first time ever, I was telling people what to do, what not to do, and to calm down. It was funny, if you're a med student you'll appreciate this, I almost spouted off the "sir sir are you ok? you call 911, you  go get a crash cart!" line from BLS/ACLS lol. But anyway, he was lucid enough to know what happened and to thankfully tell me his mom's phone number.  It was almost 8 minutes before the paramedics came and all i really did was hold his head still and straight and have someone else hold his legs. After a few minutes he lost consciousness and most likely went into shock, just in time for the paramedics! (whew!) So I was able to talk to the medics and give them pretty much the story and most of what they needed. As I'm standing there with Antonio's blood on me, about to turn around and head back to the car to head to work, one of the medics walk over, shakes my hand and says..."thank you, he's lucky such a great nurse was around to help."   Awesome lol.

- Going with the same "all females in scrubs are everything BUT doctors" theme, I was called "PA" by an asshole doc for my ENTIRE shift yesterday. It's me third week in the ED, he's seen me a million times with other docs. And he calls me, not even by my name, just "PA." He says things like "hey Dr. B, i got this great case for PA if she's interested." Most of me wanted to just correct him and tell him to at least learn my f'ing name. I don't mind as much if you think I'm a PA or a nurse, but at least have the respect to learn somebody's name for God's sake!

- Saw a lady with  blood glucose of 1617, this is not readable on a finger stick. She came in in DKA (diabetic ketoacidosis) with a pH of 6.7. The pH that is compatible with life is no less than 7.0. We intubated her, pumped her with fluids and insulin as fast as we could, and just sort of watched her deteriorate. Her husband was out of town an last spoke to her at 0730 and found her at 6:00pm...which means she was probably in DKA most of the day. Her husband didn't seem too concerned in the ED, she'd been in DKA before, just not this bad. He said her insulin pump hadn't been working right lately. His only comment was "so is she saying overnight?" It was really sad to stand next to the doc who flat out told him, "well actually, her chances of living until tomorrow are slim."

- Got to reduce this sweet complete wrist disarticulation:

 The story was this mexican lady who, naturally, was skateboarding at 2am while drunk fell and landed on her wrist. Her hand was literally dangling by the skin and that bone popping out is her ulna. The pre-reduction x-ray showed that both radius and ulna weren't even close to her carpal bones, pretty gnarly. Needles to say, the reduction was cool. I yanked on the hand while helping the doc push the bones back into the right spot. I was super lucky that night, thank you lady for being drunk and contributing to my learning!











- Witnessed a carotid massage ACTUALLY convert somebody back to normal sinus rhythm...that actually worked! I thought it was just in books. It converted right back to a-fib in 5 minutes and we had to cardiovert her, it worked for a bit! Crazy!

- For the first time I appreciated the honesty of a drug addict. Lady came in for being "zonked out" in a grocery store, nobody knew what was wrong with her, she walked there, sat down, and was out of it. After medics and nurses asking her if she had pain anywhere, the whole sleu of "protocol" questions, I was annoyed at her babbling and fighting with everyone and spitting on me, I just asked "what's wrong with you???" She politely responded in her slurred speech "nothing,  just took a handful of methadone and xanax." My response, "ok great, bye!"


That's it for now. I'm in the Peds ED next week so I'm excited to be with the little ones that just make me happy.  Something about a Madagascar decorated portable x-ray that just makes me smile :-)

"Suck It Up America"- This is what's wrong with healthcare-worth the read!

So this is not my writing, but I COMPLETELY agree with it!


Sunday Forum: Suck it up, America

We have become a nation of whining hypochondriacs, and the only way to fix a broken health-care system is for all of us to get a grip, says DR. THOMAS A. DOYLE
Sunday, October 11, 2009
Pittsburgh Post-Gazette

Emergency departments are distilleries that boil complex blends of trauma, stress and emotion down to the essence of immediacy: What needs to be done, right now, to fix the problem. Working the past 20 years in such environments has shown me with great clarity what is wrong (and right) with our nation’s medical system.

It’s obvious to me that despite all the furor and rancor, what is being debated in Washington currently is not health-care reform. It’s only health-care insurance reform. It addresses the undeniably important issues of who is going to pay and how, but completely misses the point of why.
Health care costs too much in our country because we deliver too much health care. We deliver too much because we demand too much. And we demand it for all the wrong reasons. We’re turning into a nation of anxious wimps.

I still love my job; very few things are as emotionally rewarding as relieving true pain and suffering, sharing compassionate care and actually saving lives. Illness and injury will always require the best efforts our medical system can provide. But emergency departments nationwide are being overwhelmed by the non-emergent, and doctors in general are asked to treat what doesn’t need treatment.
In a single night I had patients come in to our emergency department, most brought by ambulance, for the following complaints: I smoked marijuana and got dizzy; I got stung by a bee and it hurts; I got drunk and have a hangover; I sat out in the sun and got sunburn; I ate Mexican food and threw up; I picked my nose and it bled, but now it stopped; I just had sex and want to know if I’m pregnant.
Since all my colleagues and I have worked our shifts while suffering from worse symptoms than these (well, not the marijuana, I hope), we have understandably lost some of our natural empathy for such patients. When working with a cold, flu or headache, I often feel I am like one of those cute little animal signs in amusement parks that say “you must be taller than me to ride this ride” only mine should read “you must be sicker than me to come to our emergency department.” You’d be surprised how many patients wouldn’t qualify.

At a time when we have an unprecedented obsession with health (Dr. Oz, “The Doctors,” Oprah and a host of daytime talk shows make the smallest issues seem like apocalyptic pandemics) we have substandard national wellness. This is largely because the media focuses on the exotic and the sensational and ignores the mundane.

Our society has warped our perception of true risk. We are taught to fear vaccinations, mold, shark attacks, airplanes and breast implants when we really should worry about smoking, drug abuse, obesity, cars and basic hygiene. If you go by pharmaceutical advertisement budgets, our most critical health needs are to have sex and fall asleep.

Somehow we have developed an expectation that our health should always be perfect, and if it isn’t, there should be a pill to fix it. With every ache and sniffle we run to the doctor or purchase useless quackery such as the dietary supplement Airborne or homeopathic cures (to the tune of tens of billions of dollars a year). We demand unnecessary diagnostic testing, narcotics for bruises and sprains, antibiotics for our viruses (which do absolutely no good). And due to time constraints on physicians, fear of lawsuits and the pressure to keep patients satisfied, we usually get them.
Yet the great secret of medicine is that almost everything we see will get better (or worse) no matter how we treat it. Usually better.

The human body is exquisitely talented at healing. If bodies didn’t heal by themselves, we’d be up the creek. Even in an intensive care unit, with our most advanced techniques applied, all we’re really doing is optimizing the conditions under which natural healing can occur. We give oxygen and fluids in the right proportions, raise or lower the blood pressure as needed and allow the natural healing mechanisms time to do their work. It’s as if you could put your car in the service garage, make sure you give it plenty of gas, oil and brake fluid and that transmission should fix itself in no time.

The bottom line is that most conditions are self-limited. This doesn’t mesh well with our immediate-gratification, instant-action society. But usually that bronchitis or back ache or poison ivy or stomach flu just needs time to get better. Take two aspirin and call me in the morning wasn’t your doctor being lazy in the middle of the night; it was sound medical practice. As a wise pediatrician colleague of mine once told me, “Our best medicines are Tincture of Time and Elixir of Neglect.” Taking drugs for things that go away on their own is rarely helpful and often harmful.

We’ve become a nation of hypochondriacs. Every sneeze is swine flu, every headache a tumor. And at great expense, we deliver fantastically prompt, thorough and largely unnecessary care.
There is tremendous financial pressure on physicians to keep patients happy. But unlike business, in medicine the customer isn’t always right. Sometimes a doctor needs to show tough love and deny patients the quick fix.

A good physician needs to have the guts to stand up to people and tell them that their baby gets ear infections because they smoke cigarettes. That it’s time to admit they are alcoholics. That they need to suck it up and deal with discomfort because narcotics will just make everything worse. That what’s really wrong with them is that they are just too damned fat. Unfortunately, this type of advice rarely leads to high patient satisfaction scores.

Modern medicine is a blessing which improves all our lives. But until we start educating the general populace about what really affects health and what a doctor is capable (and more importantly, incapable) of fixing, we will continue to waste a large portion of our health-care dollar on treatments which just don’t make any difference.

Anita Dufalla/Post-Gazette
Dr. Thomas A. Doyle is a specialist in emergency medicine who practices in Sewickley (tomdoy@aol.com). This is an excerpt from a book he is writing called “Suck It Up, America: The Tough Choices Needed for Real Health-Care Reform.”

Read more: http://www.post-gazette.com/pg/09284/1004304-109.stm#ixzz0TgtnEINR

Tri and some other funny ED quotes...

So first a disclaimer about my excessively large blog picture- I swear I'm not that narcissistic to put up a huge pic of myself, I'm just trying to figure out how to make a collage of pics and use that as my blog picture and i can't figure it out, while not making it so freaking huge...work in progress :)

Reflections about my Triathlon-
Overall it went really well. Having my family there to support me was the best part though. All my races in the past have been with a couple of friends in the crowd, and while I love them, it was something else to have a lot of family there. They've never seen me race in anything and other than my dad, I'm not sure they even understood how big of a part of my life this is! So, I was really excited to see them there supporting me and it really reminded me that we really are nothing without family.

The swim in the ocean, although it was short, was a new experience for me. After being punched in the chest while warming up by a guy who was swimming in the wrong direction 30 mins before start time, I realized this swim would be the toughest part! I will say that i certainly didn't feel as cramped and like I was trying to swim over people as I do in a lake. The waves and chop were what made me nervous. I was lucky that I breathe on my Right side because I could sight all along the shore, that was nice. At one point I got really scared when I looked up to see the buoys and i saw nothing but open water...ahh! The first thing I could think of was omg i've been swimming deeper and deeper this whole time and i'm going to swim so far out right into a shark's mouth! But then I looked again and saw them not too far away in front, i just happened to be in a down slope of a wave lol. Other obstacles were the hundreds of jellyfish everywhere just waiting to sting me (they failed), drinking the saltwater, and actually being able to see the bottom of the ocean floor. Seeing the floor was different than swimming in a deep black lake because it added both a sense of comfort and fear to my thoughts. I could see that there were no huge creatures swimming under me as opposed to a lake where I'm blissfully ignorant to the creatures in the water...but then again, I was scared that I would actually SEE the shark that is about to bite my leg off! Maybe I should be thinking more about the swim time/technique than my imminent death by shark/jellyfish attack eh? But maybe it made the time pass faster because before I knew it I was at the last buoy and out of the water in 19 mins :) I was predicting about 15 mins, but I'll take it for my first open water swim!

The Bike and run were smooth, but slow sailing. I used my dad's bike, which was great! It was incredibly windy and going up some of the intercostal ramps was gorgeously brutal most of the time! I tried not to wear myself out and enjoy the weather and scenery while not being too much of a turtle on the bike. My time was about average mainly because I hadn't been riding much in the months leading up to it, oh well, I had a fun ride. Running is always my easiest leg of the race, luckily it's at the end. I use it as a time to think about the first 2 parts of the race and either yell at myself for sucking at swim and bike and force myself to make it up at the end, or just cruising along taking everything in. In this case I was just cruising along people watching mostly lol. It was a short distance and it was HOT! I ended up passing several people I saw fly by me on their bikes, this always makes me feel good :)
I saw my family towards the end and they were there waiting for me as I finished and I'll never forget my little cousin's comment "where have you been?!" lol...love it!

Some experiences in the ED this week and reasons I LOVE it:

- Had a lady tell me that she talked to God and he wanted me to know that he was always with me and my family no matter what happened. Made me worried at first because when old people (she was 90 and surprisingly not demented) start talking to God it usually means they're going to die. Later made me sort of emotional because I believed her. Crazy things happen in the ED, I just thanked her for the message and told her I'd never forget it.

- Saw a lady actively tweaking on meth. I never knew what "tweaking" meant but now I'll never forget it. She was very coherent and alert (which was surprising) but she looked like she was crawling out of her skin. Her head was jerking all over the place, her feet were doing these weird movements, and her hands went back and forth from fists to all these weird movements. It was crazy but mostly incredibly sad to see. I flat out asked her why she did meth and she replied that she just got out of jail and had been on meth for 6 days straight, she was sad because she couldn't see her 12 yr old son. She was actually brought in by a city bus driver, yes the driver pulled his bus up to the ER drive through/drop off, and brought her in because he was worried. (I guess there still are some good people in this world...or he just wanted her off his bus lol) Despite my usual cynicism with the angry drug addicts, I actually felt sad for this lady as she cried through her cracked out state talking about her son. She wasn't my patient, I just went in to see what "tweaking" actually meant and we ended up talking for about 15 mins about her son and how he's going to be her reason for living and to stop killing herself. It was a great conversation I never thought I'd have with somebody who was "tweaking" on meth for 6 days.

- Was a split second from getting into it with an ER TECH who told me I wasn't "allowed" to be part of a code because I was just a student and I was in "the way".  A TECH, for those that don't know, are people that get trained for a few months to work in the ED assisting nurses/docs with little procedures, IV's, and basically filling any gaps.  Let me just say that I'm a VERY calm person in the ED and I don't fight with people, or have an attitude and i CERTAINLY do not overstep my boundaries because after all, I AM learning, and I AM a student, and until I can master many more skills/knowledge, I don't think I, or anybody, should feel entitled or like we have some power over those on our team, regardless of our roleS or future role. That being said, I sooo wanted to kindly remind that tech that I've gone to more school than her probably 5 times over and that not only was I ALLOWED to watch, but I was actually going to be the one at the head of the table on this code (thanks to my awesome attending) and in a few short months, I would be the one telling her to get out of the way thankyouverymuch!!!!! BUT of course, I didn't say anything to her, I didn't need to really. I just took my coat off, walked to the head of the pt with my attending and proceeded to intubate the patient and call out orders to the nurses who are actually ALLOWED to put them in.  After all was said and done in my head I was thinking "Take that ER tech, now who's not allowed!? In your face!!"  lol...I'm a mature person, I swear.  It's these little victories that make my days awesome!  Oh and that intubation took a turn for the worse when he started vomiting black as I'm trying to see the cords...real nice. I ended up trying for about 6 minutes and was SOOOOOOO mad at myself (still am) when I couldn't get it. I felt better when the attending struggled before getting it though. Oh well, maybe next time! :)

- Chief complaint: "I'm high on crack. I usually take 100mg of morphine twice a day and I'd like my dose now and a cheeseburger."

- As I walk into the room to meet her for the first time ever, patient starts yelling at me "are you fu@*ing kidding me??? You aren't even old enough to know anything about kidney stones!".....I just told her i'd take that as a compliment and just turned around and walked out lol.

- Son of my above mentioned patient that coded and I tried to intubate, "I saw him lying on the floor for a couple hours but he's usually passed out drunk by noon so I didnt think anything of it. But when I brought him another beer and he wasn't breathing I figured I should call 911."  


These are just a few reasons I love the ED and my life!

Song for the night...

Post on the tri is coming soon! Crazy day, love this song!  I always ask myself this about things in my life...

It must be an accelerated program...

Crazy of the night...

CC: hand pain

I walk up to a 22 yr old girl in a hall bed and find her drawing organic chemistry equations on her sheets and giggling to herself...

Me: Hi S, what seems to be going on with your hand?

S: I'm working on my doctorate in chemistry, I have 1 year left, and this asshole in my lab spilled calcium oxalate on my hand today and it was burning and I just want to make sure crystals don't precipitate in my tendons.

Me: (trying to remember something about organic chemistry and decide if this girl is crazy or not) Oh ok, well i see that your hand isn't really burned at all, so that's good. Where is the pain exactly?

S: You aren't a chemist so you don't know the molecular composition behind anything but trust me, i've worked out the equations and i know my tendons are being saturated with crystals and I need calcium gluconate to bind them and stop the reaction.

Me: Nope, I'm not a chemist, but the strength in your hand is normal and judging from the little pain you have right now along with your normal x-ray and lack of burns, there doesn't seem to be any reason to think you have any damage to your hand or any need for Calcium gluconate.

S: Let me speak to toxicology and educate them on the chemistry behind this, you don't understand, I'm not leaving until I get calcium gluconate.

Me: Well, let me talk to my attending and we'll be back to talk to you. One last thing, where are you doing your doctorate?

S: Maricopa Community College

Me: .......nice.

First ED shift!

So today was my first ED shift and it was awesome. To start off with, one of my attendings went to UF and is the VP of the Scottsdale Gator club and said he could get me cheap tickets to Gator games!!!! That just made my whole rotation from the beginning. But on top of that I got to do so much more than I thought. To sum it up, I did this today:

- had a patient tell me he tried to shoot himeslf but his gun jammed

- pelvic exam on a lady with a prolapsed bladder...that was weird.

- participated in a code/defibrillation (that was pretty scary and awesome at the same time!!)

- watched a crazy 22 yr old patient punch a nurse in the back of the head
- watched same crazy 22yr old patient get restrained against her will by the cops and in the process set off a schizophrenic in the hallway
- listened to crazy 22yr old and schizophrenic argue through the hallway about how who was going to kill who...for 2 hours.

- intubated a 21 yr old kid with severe asthma (also really scary)

- sutured a lady's head lac completely alone (the docs really trust me for some reason haha)

So I'm still really surprised I got to do all of this on my first day. I never thought they would let me do that much, esp on my first day, it was great. I think a part of it was that it was just a busy day and I got lucky enough to get cool cases today, but we shall see I guess.  I'm working night shift for the next 2 days and I'm not so sure the middle of the night is that exciting.  I'm purposely staying up late right now so I can sleep in late tomorrow haha...i can just see myself dozing off before I even have to be at work tomorrow! More stories to come I'm sure :-)

Getting ready for 4th year!

So It's April! Where did March go??? This year is going by so fast already, it's scary. Before I know it it's going to be December! I was in Kirksville a few days ago for OMSIII testing, and wow...I don't miss it AT ALL!!! I miss my friends but honestly, you couldn't pay me enough to move back there. It served its purpose, and i don't mean to sound like I hated it, because I didn't. I appreciate the quiet beauty and convenience of the small town, but 2 years is enough. Also, there are a lot of bad memories that I would rather leave in Kirksville and not revisit. So I'm happy to say that the next time I go there it will be my most exciting trip to kirksville as well as my last...graduation!!! :)

In other news I have officially started my 4th year of medical school! I start my first ER rotation tomorrow and I'm really excited. THe docs I'm with seem pretty cool and I hope to learn as much as I can before I do my military rotations.  I can only imagine the stories I'm going to get this month, I'll keep you posted! Also, I'm going home to FL this weekend to see family and do a short triathlon :)  I'm not in the best shape for a triathlon, but it's a short race. I'm really excited for my family to be there supporting me, that has never happened before. I've never done a race in FL or close enough where family can watch, so I'm pumped about that. My dad already asked if he can follow me in a car...he clearly doesn't know how triathlon's work lol. ALso, Abbey is coming back with me!! I've missed her so much. She keeps me sane and I need her to take me for walks again.

So these next few months are going to be super busy for me. I have boards, which I NEED to blow out of the water, work my butt off on my audition rotations, and apply for residencies (i just got so nervous just typing that right now) lol.  I know the rest of this year is going to be SO stressful, I can already feel it coming. I also know myself and how I can let stress overcome me and drive me crazy. So, one day at a time, that's my goal, for everything.  I know I'm still going to worry/stress, but I can at least make a conscious effort to take it easy, enjoy right now, travel, experience new things and people while I have the chance. So much of my time is spent planning for the life I want in the future. That is a good thing, so long as I don't ignore the time I have in the present.

Song for the night:  "wheel" John Mayer...one of my favorite songs.