I Think I Can...

Less than a day to go...

So ready to be done with this:

Photo credit: my roommate Lamya

Pre-boards mani-pedis with friends today:

And vacation to look forward to next week.  Taking deep breaths....

Day One

The patient was not a young man, but his disabilities and medical problems far outstripped his chronological age.  Chief among them was diabetes.  Disadvantaged circumstances, hard living, some drug use here and there, and good dose of the euphamistically-termed "health illiteracy" were among the many factors that got him to where he was that day.  Admitted to our service from the ED with a chief complaint of chest pain and syncope, he nonetheless had a laundry list of different issues we would need to address, including a seeping wound left behind from the recent amputation of all of his toes on one foot, the unfortunate and unfortunately predictable consequence of an advanced diabetic foot ulcer.  It was actually the least of his worries on this hospital visit.

The resident who had worked him up introduced him to the rest of the team and summarized his lengthy problem list, verifying details with him and clarifying others.  There was a serious discussion of the points that most concerned us regarding the state of his health.  The patient nodded along.  Very little of this was new information for him, but this most recent incident seemed like it had hit home in a rather new way.  He seemed eager to collaborate; he spoke of experiencing a wake-up call and told us that he fully intended to live a long life, as healthy as he could make it.

The attending wrapped up the summary of the plan going forward, checking to make sure all the patient's questions had been answered and that all of us on the team were on the same page.  The patient shook her hand and looked around at everyone else in the room, saying how much he appreciated the help.

There were the usual "okay"s and "very good"s and "we'll be back to check in on you, sir"s as we collectively straightened up and slowly turned to shuffle for the door.  His face still worked, betraying unfinished thoughts.

"Hey, Doc?  Can I tell you somethin' that's really just been on my mind?"  His voice dropped, softer, timid, something maybe a little bashful about it.  His fingers worried the thin sheets in his lap, rolling and twisting the fabric in small movements.  His chin dropped to his chest as his eyes momentarily closed; every muscle in his face moved together to paint weariness and suffering into deep crevices.

"Diabetes just... sucks, man."  Head lurched with voice for greatest possible emphasis.  "I just... caint even tell you how much it sucks.  It just makes everything bad, man..." he heaved a great sigh.  "I just caint even describe to you all the suffering it causes me.  It's just right up there next to marriage!"  And with that, hands slapped thighs, head lurched again, this time with crackly laughter.  His eyes twinkled at us, checking to make sure we got the joke, as he shook his head, shoulders bouncing.  A fine tension dissolved as we broke into smiles along with him, an unexpected bit of levity trailing behind us as we left his room and moved on down the hallway.

Welcome to the medicine rotation.

Smartypants

She was six years old, tow-headed and blue-eyed, whip-smart and just as precocious as she could be. 

She had a raging, fluctuant abscess in her axilla about the size of an egg.  It had been there, erythematous and growing, for six weeks by the time they finally came in to be seen.  It was painful for her - and it looked it.  Luckily, the treatment of an abscess is straightforward: you incise and drain it.  For a pediatric patient, this would be done under anesthesia in the operating room.

She came in to the hospital with her father, and they were shown into one of the day surgery suites, where they would wait until she was taken back to the OR.  The surgical intern went to do her pre-operative history and get consent for the surgery.  When she was asking details about the time course of this rather large lump in the patient's armpit, her father explained that they had noticed it a few weeks back, but that he had not brought her in sooner because he had assumed it was an enlarged lymph node.  She had had a recent cold, and her father chalked it up to that for a while until he realized it wasn't resolving.  

The intern began to explain to him and his daughter that it appeared that the lump, instead of an enlarged lymph node, was actually an abscess. 

"This basically means that it is a collection of pus from an infection somewhere that the body has walled off into this pocket, and that is what we are going to drain today."

The father politely cut off her explanation, "Yes, I know what an abscess is.  I have a PhD in Biology."

The  daughter piped up:

"Yeah, and he thinks he is smarter than aaaallll the doctors!"

Surgery Dreams

... dreams that I have while on my surgery rotation, that is.  Let me know if you want to take a stab at deconstructing this one.

~ ~ ~ 

Last night, I dreamt that I was in some sort of indoor/outdoor castle for some sort of interview (unclear what the interview as for - it seemed to be some sort of admissions or job interview, or possibly both - you know how things can do that in dreams) and I was interviewing with a close friend, and the interviewer was a surgeon (again, not entirely clear why, maybe the school/job had to do with surgery, I don't know, but he was a very important and intimidating person.)  And I thought it was all going quite well, until at one point, for some reason, I had to stand up to deliver my responses for that part of the interview, and for some reason, there was what I thought was a hand-sanitizer dispenser on the wall next to me, and for some reason I knew that I had to clean my hands before I would be allowed to speak, and so I  stood up, reached out my hand, dispensed some into my open palm and then proceeded to rub my hands together, immediately realizing that I had made a mistake, and that it was actually regular soap instead of sanitizer, and so now I was in the middle of this very important interview, wearing a suit, with both hands entirely covered in liquid soap.  No sooner had I made this tragic error than the surgeon-interviewer lowered his chin, scowling at me from under furrowed brow, folded his hands on his lap and announced that my interview was over.  And my very good friend, who had been seated behind me while all of this happened, laughed at me and said something to the effect of "too bad for you" before continuing to converse with the interviewer, with whom she suddenly was best friends. 

It was awful.  

And then after that my flying skills came in handy when I joined some sort of outdoor field game involving something like keep-away with a small French horn.  Whatever.

On second thought, if you know anything about dream interpretation, I probably don't want to hear your read on this.

~ ~ ~

PS.  Last night, we hosted a Christmas-cookie-baking party at our house... sooooo you can guess what my dinner was when I arrived home twenty minutes ago.  Also, I am seriously contemplating sleeping in clean scrubs so that I can save the 38 seconds that it takes to put them on in the morning.  Don't judge.  I am also going to bed NOW... it's 8:30 pm and I have to get up in less than 8 hours already. Sweet sleepy Jesus.

Oy.

The costume changes alone are exhausting.

for tomorrow: clinic clothes, OR clothes, workout clothes

Compliment

Sooo.... I sort of love neuro!  Huh.  Who knew?  More on that later.

I hustled out of the hospital an hour ago.  

It was one of those situations where your resident turns to you as says, Well, hey, we're about done here... and you have your test on Friday... so why don't you get out of here?  And then your response is to be like, Really?  Well, is there anything else I can do?  Are you sure?  And you are trying not to look too anxious/excited about it but meanwhile every fiber of your being is aching to make a mad dash for the exit.  And in this case it's sadly not because you are hoping to make it out in time to meet up with friends for happy hour or enjoy the ridiculously perfect September-in-Atlanta weather, but because you are woefully unprepared for an exam coming up in about 40 hours or so and freaking out about it just a little.

Anyway, as a team we said our goodbyes, and I hightailed it to my car in the visitor/guest parking garage, where I had parked this morning because a) it was the last day of the rotation and I figured paying for one day of parking wouldn't kill me, b) it gave me just a couple of extra minutes this morning, and c) because, tragically, my luck finally ran out at the super secret parking spot I have been using for two weeks and I got a ticket there yesterday.

As I power-walked through the hospital and out onto the street, I grabbed an apple from my bag and chowed down, ravenous.  Got to my car, flung my bags and white coat inside, hopped in and threw it in reverse.

The dress I wore today is a recent new-to-me purchase from one of my favorite thrift shops.  Sleeveless,  racerback, reversible (!), super comfortable.  Also still a decent length for work, although just barely.  I definitely wouldn't wear anything shorter.  You know how when you are wearing a short-ish skirt and you sit down, you need to sort of adjust a little?  And you know how when you jump in your car all fast-like, you might not bother to give your skirt that little tug?  Because you aren't in public, you're just in your car.  Anyway, yeah, that was me... not indecent, or anything like that, just driving in a short skirt, sleeveless, racerback dress.

I whipped around corners, winding my way down to the ground level, shifting with my right hand and stealing bites of my apple from my left, nibbling all the way down to the core just as I pulled up to the booth to pay for my decadent day of legal, covered parking.  The attendant was a beautiful Ethiopian woman with large eyes and a lovely accent.  I tossed the apple core back into my lunch bag and fished for my wallet.  

She rang me up and handed my credit card back to me along with a receipt.  And then she said, "What were you eating?"  I grinned.  "Apple," I said.  She said, "All the people they has the nice body, when you ask, they say 'apple'."

I laughed and thanked her, totally delighted.  Then I went ahead and ate the second apple I had on my drive home.  :)

Snapshot

So apparently there is some sort of convention on t.v.?

Just kidding.  Sort of.

(Truth?  I was kind of vaguely aware of its timing/existence but wasn't paying much attention.  Today, though, a surprising number of both patients and doctors mentioned it.)

~ ~ ~

This afternoon in the neurology clinic, I visited with a patient who has Parkinson's Disease and his wife.  They were just lovely people.  Very genteel.  I know that is a word that isn't really used anymore, but for whatever reason that is the one that kept popping into my head as I talked with them.  Something about his boat shoes and her red lipstick and his round gold-rimmed glasses perched atop his purplish nose and the way that both of their hair was perfectly in place: his nearly pure white, hers jet black.  But mostly, I think, it was their lilting Atlanta accents, impossible to miss yet still easy to understand.

I admired the way they shifted easily between talking about his disease progression and joking about life with Parkinson's, trading personal stories with the doctor and taking notes on new medication regimens, teasing each other and asking me about medical school.  

Towards the end of the visit, almost as an afterthought, the patient said, "Hey doc, I was meaning to ask you... is there somethin' I should do about my glasses?  I've been gettin' some double vision lately.... is that related to the Parkinson's?  Or just somethin' else?"

My attending said that yes, this was something that could develop in patients with this disease, and asked for a little more information.  The patient's wife prompted him to give the most recent example.

"Well, it seems to happen especially at night or when I'm tired.  Like last night, we were up watching the Republican National Convention and it started happenin', the seein' double," he said.  "And shoot, seein' two of those guys is just way too much!"

Snapshot

The elevator door opened onto the main floor.  

I took a left, feet dragging ever so slightly, shoulders noticeably stooped after a day on my feet.  It hadn't even an especially long day.  We had rounded in the morning, then there had been a couple of surgery cases, nothing major, then we saw a couple of patients and then my resident said I could go by mid-afternoon.  

Still, it was mid-afternoon, about the time when I really start to crash.  My resident had said, "Get out of here! Go enjoy your life!"  I told him that actually, I just needed to go study.  And I knew that what was about to ensue was my daily battle with myself - Should I go to my workout?  Do I go home and study?  How will I not succumb to my overwhelming desire - and need - for a nap?

I walked down the narrow hall on the main floor of the hospital, heading in the direction of the cafeteria and the exit.  Not a super-busy time of day, traffic-wise, in the halls.  Some days, especially when I am feeling down or exhausted, I make it a little personal challenge to smile and greet or at least give a little nod to people as they pass me in the hospital.  Some people give no response and then I feel sort of awkward.  But some people pay me back right away with warm and friendly greetings, and that always just makes me feel about 2 inches taller and 10 degrees happier, no matter what else has been going on.

From a ways off down the hall, I could see a policeman - just his head and his shoulders poking out from behind an elderly couple in front of him - walking in my direction.  As we came closer to each other, I could make out from his posture and his gait that he was pushing a wheelchair.

I smiled and nodded at the elderly couple as I passed them.  They didn't look at me.  Moving right along, my eyes met the policeman's and we both smiled at each other and nodded.  Then I glanced at the wheelchair he was pushing.  

Sitting in it was a big, fat watermelon.

My smile cracked open wide and I laughed out loud.  The policeman kept smiling and nodded again, eyes on me the whole time.  A second later, we were already past each other and moving in opposite directions.  My mouth hung open in a stupid grin as I shook my head, weariness evaporated.  And then from behind me, moving off down the hallway, came his deep baritone laughter, joining mine.