I just started a new one-month elective this week!  Pediatric ICU.

A 4-year-old pre-schooler was admitted with asthma exacerbation--he was in big respiratory distress, having serious retractions of his chest and using his abdominal muscles to try to help him to breathe.

In the midst of his struggles for breath, he opened his eyes and said to his mom: "I have to go to class!"

Today I introduced my favorite movie, Shaolin Soccer, to my 9-year-old patient who plays soccer.  

9-year-old boy eagerly: Is it like they elbow each other?

Me: Better!

The kid is super excited to watch it and the family will be watching it tonight!   I feel accomplished.  Really hope they like it. :P

I had an unresponsive 11-year-old kid today who has a grumpy baseline and not really interactive, until the attending asked him about his new cat.  He instantly came alive and avidly showed the attending photos of his cat on the cell phone.  The attending then whipped out his own cell phone and showed the kid photos of his goats.

Like.

I am currently doing the Pediatric Hematology/Oncology clinic elective.

Today I had a 7-year-old patient  with unresectable ganglioneuroblastoma whose two close friends (that he knows from cancer camp) passed away recently.  His anxiety level has been sky-high and he recently said to his mom, "I don't want to die like [my friend]."  He does not feel better despite reassurances from his mother that the MRI shows that his disease is very stable.  Maannnn, death really is not something that a 7-year-old should worry about.  

Like: my attending owns goats--Gretchen, Gandalf, and Gretchen's 3 kids (who are absolutely adorable!)

(The father of Gretchen's kids is another goat named ?Alton who was chosen because of his pure bloodline that gives him blue eyes.  Gandalf is sterile although per my attending, he has "aspirations" of being a father with Gretchen).

Possibly awkward moment of the day (but only in retrospect): I was humming the hit "Whistle" off and on in the team room, and said, "It's so catchy.  I don't even know the lyrics.  I could be humming something obscene for all I know."  Intern was totally silent to that.

Just looked up the lyrics.  Yep, obscene.

I dreamed that I was a huge star of a ballet troupe performing at an upcoming upscale city-wide talent show.  Except that in the dream, I was only told that I was the star of the show one hour before the performance, and have no ballet skills whatsoever (I was not even aware that I was part of the troupe).  Somehow I ended up on stage anyway with my entire ~50-membered ballet troupe.  When the curtains rose, I had no idea what to do and entertained the audience the only way I knew how: by doing kung fu and knocking out all my fellow troupe members,  a la Jet Li vs roomful of Japanese blackbelts style (like this, but without the English dub) .  I then made my escape through the theater back door.

Perhaps this is a subconscious analogy for the Internal Medicine elective I have just begun, where I basically function as the resident.  (By the way, this dream happened while I was passed out unintentionally on the couch after a 14-hour night shift).

P.S. I have no kung fu skills in real life either.

E: So what brings you to the hospital?
Pt: Because I am sick.

Thank you for the insight.

boards studying part 2

E [gazing at the cows grazing on Mission Hills outside the window]: Why can't I just be a cow on Mission Hills?
Mom [used to this kind of nonsense coming from her daughter]: God didn't intend for you to be a cow.

boards studying + personal statement writing

E: I hate my life.
Mom: Yes, I know.  Go to sleep.

6

Mom: how do you say "six" in Spanish?
E: Seis
Mom: Sex?
E: No!  Mom, don't say 'sex.'

”The truth is, everyone is going to hurt you. You just got to find the ones worth suffering for.” -Bob Marley

Step 2 Boards Studying

In the tune of "99 Bottles of Beer":

1800 practice questions to do, 1800 practice questions
You click on one and you read the explanation, 1799 practice questions to do!

142 pages of more tips to read, 142 pages of tips!
You read one slow and remember it, 141 pages of tips!

300 pages of review book to go, 300 pages of review!
You read and think and read and think, 299 pages of review!

15 more days until the test, only 15 more days!
I am screwed I am screwed I am so screwed, 14 more days to go!

what was the point of her life?

This was one of my patients in the hospital last month during my Family Medicine rotation:

She was gray-haired and in her mid-50s, although one could mistake her to be older from her appearance.  She was fat, or, as the medical terms would put it, "super morbidly obese."  She was admitted to the hospital because she had abdominal panniculitis, which means that the fat on her belly had become infected with bacteria.  Her abdomen looked red and angry, and she became septic from the infection, necessitating a stay in the ICU.  She eventually began recovering from the infection and was transferred to the regular hospital floor, which was when I met her.

She was unable to get out of bed, not because she was in the hospital, but because of her obesity.  Her large abdomen rolled over and covered the top of her legs, which were stubby and stuck out as if they were out of place.  She lay in bed all day, dependent on the hospital staff to arrange her food tray table in front of her so she could eat.  After the sepsis and infection began resolving, her hospital course was beset by other problems.  She developed thrush of her mouth and tongue.  She was found to have a urinary tract infection.  She had severe nausea and vomiting.  She experienced an allergic reaction to one of the medications, resulting in a swollen tongue and slurred speech that made it difficult for her to communicate.  She developed large purulent ulcers on her skin. She was sometimes delirious, jumbling the time and recent events.  And, judging by what we could get from her own confused account, she was severely constipated, as she had not had a bowel movement in the twenty or so days she had been in the hospital.  Yet, when questioned about constipation, she always stated that she felt fine.

Because of her obesity, she was derided behind her back by her doctors, who said she became so large because she was "JFN"--Just Fucking Nuts.  I once tried to ask her what she was like as a child, in order to determine the etiology of her obesity, and she simply stated "I had always been large."  Before I could continue, however, we were interrupted by an orderly who entered the room.  According to my attending physician, she would tell him that she did not overeat, but then he would see Twinkies wrappers filling the trashcan.  I asked who brought her food at home when she was not even mobile, and the attending said her family--they were the Enablers.  Because she was also bedbound at home, she was on Disability and had 24-hour care--the attending dryly noted that "We pay for it."  Because of her constipation, we ordered laxatives that need to be inserted rectally.  I told the ordering doctor that the nurses probably would not be able to insert it, as I had already overheard the nurses stating the patient was hard to turn, and the ordering doctor simply said, "That is their problem."  

Overall, however, she was getting better and better.  With all the medical interventions in the hospital, her abdominal infection and sepsis completely resolved, her thrush disappeared, her UTI cured, her nausea and vomiting abated, her allergic reaction to the medication improved, her ulcers healed, and her confusion cleared. The last time I saw her, she looked as healthy as could be, and was feeling great.

A few days later, however, my attending physician told me that she died.  Her death took me by surprise, as she had improved significantly in the hospital.  According to my attending, as she was being transferred to another facility to manage her obesity, she suddenly turned ashen gray and her blood pressure bottomed out.  My attending theorized that the prolonged constipation probably caused her bowels to perforate, leading to her sudden demise.

I know I had taken care of her for only a few days.  Most of my talks with her focused on her physical symptoms; I never had a real conversation with her about her personal life.  I did not know her personally.  I knew that she did not present as the nicest person--her interactions with the nurses could be rather curt.  With what I do know--that she lay in bed all day and was unable to do anything, that she was disrespected by some of her physicians, that she was very sick and developed many medical complications because of her obesity, and that she ultimately died unexpectedly at a relatively young age--I do wonder:  

What was the purpose of her life?

Things I want to do if and when I have an income, free time, and motivation

In no particular order,

1. learn guitar
2. practice martial arts, especially yong mu do
3. fly a kite
4. bake
5. cook 
6. ride a hot air balloon
7. draw
8. learn Korean
9. have a vegetable garden?
10. plant a few fruit trees (although not as many as my dad, who has 71 fruit trees in the family yard by our last count.  By the way, we live in a suburban neighborhood, not a farm).
11. hike hike hike
12. aquarium
13. take rock-climbing classes
14. watch action movies
15. read for fun for once
16. quilt?
17. travel? (road trip!)
18. learn to shoot? (I think I know someone who will like this one).
19. learn to lock-pick

likes...

In order to prevent med school from turning us into grouchy grumps, Jensine and I have been sharing with each other back and forth what we like about medical school.

Elaine's Like of the Day:

the way non-medical people mix up medical terms

Parent in the Emergency Room, talking about her child: Yes, he's had chicken pops.
Classmate: Uh, you mean chicken pox?
Parent: Yes, chicken pops.

I am frustrated by the Obesity Epidemic

My Family Medicine homework assignment, in which my rotation group discusses using Motivational Interviewing to implement lifestyle changes in our patients:

One thing that struck me was how we healthcare practitioners sometimes feel we care more about the patients’ health than the patients themselves.  I think this may sometimes be true because we are exposed everyday to the serious complications of common ailments such as diabetes, high blood pressure, high cholesterol, and smoking, especially if we work in an inpatient setting.  That is, we often see the terrible effects of stroke, heart attack, amputations, and tobacco-related cancers.  With these frequent exposures, we are reminded of the eventual potential consequences of an unhealthy lifestyle.  Patients, on the other hand, do not work in a healthcare setting.  They undoubtedly often hear about the complications from the media or from us, but they do not necessarily see it firsthand.  For the patients who do NOT have family members or friends who suffer from the complications, they may not be as “intimidated” into implementing lifestyle changes.  I know I wouldn’t be.

In fact, I feel like the milieu in Richmond may even promote certain unhealthy habits.  For example, in outpatient Internal Medicine, I had an overweight patient who was actually happy that she had gained weight, because she said most other people in her life are also big.  She implied that being big as well makes her feel more fit in.  It seems that the predominance of overweight people here in Richmond (the 3^rd most obese city in the nation) makes being overweight normal, and therefore even acceptable.  In Surgery rotation, I had a patient who had ideal body weight.  The Nurse Practitioner commented that she is "tiny."  I retorted, “She is not 'tiny.'  She is normal.  Just that everyone else is big.”  While I may have been a bit short with my comment to the nurse practitioner, as someone who has lived in cities where most people have ideal body weight, I believe the prevalence of obesity here in Richmond has actually skewed our standards and made the denizens here less aware of just how serious the obesity epidemic is.

you know Summer is here when...

... there is a jump in the number and variety of animal roadkill on the streets.  I am seeing all kinds of animals!  And they are right smack in the middle of the road instead of moved to the side, which means the road cleaning folks can't keep up with the rate of roadkill production.  Granted, Virginia also has lots of open country areas where these poor things frolic.

Swerving to keep my wheels gore and splatter-free!

Today in Family Medicine...

best lines of the day:

After I wrote the prescriptions and handed them to the patient: "Wow, I don't know if the Pharmacy can fill this.  It's actually legible."

Little old lady who has arthritis, when counseled to cut back on certain activities: "My pain gets worse when I bowl, but... they need me!"

Interesting line from the Office Manager as I came back for second helpings of the delicious cake she made and other pharm rep-provided food: "I don't know how Elaine is so skinny.  She is always hungry."

Just sayin'

Apparently I have been blurting out whatever is on my mind just a bit too much during the Surgery rotation these past two months.  Here is the latest example:


"Your anus is too tight."

Try saying THAT to your Urology chief resident.

Alright, here is the context.  I was nagging the chief to order a rectal laxative suppository for a patient who had a prostatectomy.  Chief started discussing with the team about how suppository insertion in such patients needs to be gentle and thus has to be done by the urologists instead of the nurses.  Chief formed a fist and told me to insert a chocolate and peanut M&M into the side of his fist as practice, which resulted in me uttering the above line.  Then...

4th year resident: [doubled over] That's the best line ever!

classmate: [collapses from standing to squatting position and slaps her thigh in laughter]

2nd year resident: [literally shakes his head, albeit with a smile on his face]

Unfortunately, I was too distracted by everyone else's reaction to catch the Chief's facial expression in time.  Once again, whoops.

Pardon me here while I deviate from my normal behavior

While at my Pediatrics clinic, sometimes I feel like going like this:

Hello you cutie adorable precious bald happy baby who grabs and puts everything in your mouth.  Awww chubbly wubbly goo goo gaa gaa you are killing me here you handsome smiley lady-killer you.  How come your parents get to hold you, I want to hold you tooooo.  He he ha ha.  Don't try to eat my stethoscope, it yucky.  Woo waa woo waa gurgle gurgle.  Ooh what's this what's this... ah it's my otoscope light for your ears... aww you are so cute for cooperating, you charming kiddo.  Don't grow up, stay cute like that you hear.  Woo wee boo bah [continues making ridiculous random nonsensical baby sounds]

I am pretty sure the old me would be quite horrified at what I have become.  Interesting development here.