Sucky Happiness

It's been some time since I've been here!

I stumbled and tripped and eventually failed anatomy by 3 (three!!!!) points.  Out of 550.  That SUCKED. SUCKED. SUCKED. It still sucks.  I'll need to remediate over the summer.  Sucky.

I've spoken with a dean of student affairs and have contacted our learning center peeps for advice but haven't told anyone else (like family).  I'm too embarrassed. 

It was so frustrating; I honored every other course and even scored perfectly on the radiology final. I'm not stupid. I'm not. I swear. Three points!

I'm so happy to be in physiology. It's amazing how much easier it is for me to study. It's like a never-ending fountain of really cool, useful information. I can seriously lose hours chasing down information...

This semester is also bunches less isolating than last. I've finally found a small group of like-minded dedicated, irreverent and curious study partners.  One of our assignments for the 'doctoring' course was to take a personality test. It turns out everyone in my study group is an INTJ.  We're basically rational curious and pedantic people who don't do feelings.  It's an awesome experience to meet up after lecture to argue with people about the role, if any, that plasma skimming has in the delineation of pulmonary zones. (you know... zones 1-3 and their ventilation efficiency).  It reminds me of my high school physics class and the arguments of black hole gravitational forces that I'd have with my friends while playing Advanced Dungeons and Dragons (I was always a tree-climbing elf- FYI)... completely irrelevant to the required class material but so interesting...

So.. despite my sucky sucky nightmare of having to repeat anatomy... life is pretty awesome. And I'm happy.

Cheers. :D

What a Wonderful Life

It's been so long since I've written and nothing very significant has happened.

I'm doing very well in my classes. They're not as challenging as I had feared and so I have unexpected free time. I've been reading quite a bit. In anticipation of gross anatomy starting next week, I've been reading Stiff by Mary Roach.  It's humorous and irreverent, yet somehow respectful.

I just finished a two hour conversation with my closest friend, an adventurer living on the other side of the world. I investigated and she's now exactly 173 degrees longitude away from me.  We hadn't spoken since I started school and it was wonderful to catch up.  She's so very different from me; she's amazingly spiritual, artistic and sensitive. She can float through a social event and engage anyone. People remember her laugh decades after meeting her. Somehow our opposites fit perfectly like Emil Fischer's Lock and Key enzymes.

One of our few similarities is our chronic singlehood. We'd rather be alone than in an unsatisfying relationship. Yet over the last few weeks, we've both met someone. Ironically, our new lovers are the ideal for the other!

She's dating a serious, bibliophilic pragmatist and I'm dating the sensitive musician, a bass player.

As I mentioned, school is going really well. I honored my first two courses and have been tapped into tutoring some of my classmates for our upcoming biochem final, a daunting endeavor.  Knowing the material enough to do well on a test is one thing; knowing it enough to explain to pedantic, obsessive medical students is something else entirely!

We met our cadavers last week. There was a ceremony. All of the students, the ministry and many of the faculty came. Several students spoke about how this lab defined the true transition into 'doctor training' unlike the distilled science that we were currently studying. During the service, I had stood next to one of our primary science lecturers and I saw hurt in his eyes. Though I felt similarly about the significance of this transition, I felt awful.

Later that week, during a lecture, the professor commented on the ceremony. It wasn't directed specifically toward the student who made the speech but we all understood who the professor meant. The student turned red and slunk into the seat. Facebook encouragement flooded his/her inbox.

Though I was only peripherally affected, the situation made me so uncomfortable. I can easily understand both perspectives and the vulnerabilities of both student and teacher. The professor put in so much work to organize meaningful and useful lectures for us. Facing the boards next year, I know I'll be thankful for the precise and detailed handouts my teacher created. Yet, the anatomy lab is the first diversion from what has essentially been an extension of our undergraduate education. It is symbolic of our transition into medical training.

I face my first standardized patient next week in the hopes of successfully completing a history. If you had asked me last year, I would have never predicted the anxiety I feel now!

Choices

I've narrowed my school choices down to two. One is in a small city just a couple of hours from my family and the other is in one of my favorite metropolitan areas a long flight from home.

Both schools are wonderful, state of the art and awash with opportunities for their students.

This is the first time that I've ever been so excited to make such a hard decision.

I'm tempted to choose metropolis because the program starts a month before small city and I can't wait to get started!!

I'm loving life right now!

I've also fallen in love :)

http://www.youtube.com/watch?v=dRPwFAoQwxc&feature=relmfu

I know.. I know.. but his voice is haunting.

'Tis the Season

We are awash with new fractures, new nursing students and bad weather in this neck of the woods. My work days are long and busy.

There was a call in tonight so busy became frenetic. There were the usual culprits of laziness but I was amazed with one of the nurses.

Airyeal* is one of the younger staff members and has always given the impression of someone who doesn't really care about anything outside the scope of her own comfort/pleasure. Tonight though, she was incredible with one of the students. She spent her entire break showing the student the ins and outs of charting, how to find information in the computer and in the chart, and what particulars are important to know as a nurse.

It was awesome and set a really good example for the rest of the preceptors. Watching their interactions totally made my night.

The Catheter Interrogation

First thing this morning, a urologist came to place a supra pubic catheter bedside. The patient had been retaining crazy amounts of urine and neither his nurses nor his orthopedic surgeon could place a foley in him. So urology was consulted.

The doctor had called in a list of supplies that he'd need bedside by 0530. Apparently he was rather rude to the evening secretary about it, saying 'everything better be ready", in a 'you people always mess up' sort of way. But I know the evening secretary is something of a sensitive whiner, so I took her report with a grain of salt.

He arrived examined the patient and then decided to try his hand at placing the foley first, giving me and the patient's nurse a new list of supplies. We have coude catheters in different sizes and foley kits stocked on the floor so much of his list was immediately manageable. But he wanted Urojet (lidocaine) syringes too. We don't have them in our McKessen so it was a short process to get them up to the floor. He needed to write an order, I faxed it to pharmacy and then immediately ran down to pick them up.

He was NOT HAPPY.

Though it took 10 minutes tops to get them (5 of which were taken by him arguing about writing the stupid order), he was incredibly put out. I heard about how ridiculous we were, how he doesn't have time for this stupid delay.. etc, eye rolls and disdain galore.

Fortunately for the patient, he was able to successfully place the foley. Whew.

A few minutes later, I stopped in the room to check on the patient and I noticed that his collection bag had over a 1200 cc in it.

I remembered reading somewhere that draining the bladder too quickly can cause the patient major discomfort so I pointed it out to his nurse. She was busy doing her end of shift med pass and instructed me to ask the urologist if she should clamp the catheter.

So I did.

I thought he would attack me.

He completely lost his temper and flayed into me.

"That's the stupidest thing I've ever heard! Why do you think to clamp the catheter? Why?" and then he waited. It took me a moment to realize that it wasn't a rhetorical questions but that he actually wanted a response.

I tried told him that I had read somewhere that it could hurt the patient if the bladder emptied too quickly but as soon as I started talking he restarted his rampage.

I was mortified. I tried to explain that I was just an aide and the messenger for the nurse but he kept at me. I can't remember everything that he said; I was flustered and just trying to escape. I remember him saying that they don't teach nurses to be doctors and thrusting a new order at me, written in block letters as though I were in grade school, DO NOT CLAMP CATHETER. It was the only completely legible order he'd written thus far.

He ended up staying to yell at me for longer than it took him to place the foley.

So much for his valuable time....


I'm totally re-writing one of my evil book characters in his honor and he's (the character) is going to suffer.



.

Libraries

I love books. I adore books. I hoard books. When I moved to Seattle, I culled my library from almost 1000 volumes to 200. Four years later, I moved again and culled 500 more from my collection. When I came back to the east coast 3 years ago, I sent 15 boxes ahead. 2 were clothes, one was packed with keepsakes and 12 were full of my favorite volumes.

I have no problem throwing out anything else. My great grandmother's cake pan? Bah, it's rusted and unusable. The faded notebook that she painstakingly copied recipes into? A treasure! Don't ever ask me to give up my copy of The Quiet American that I read while sipping 'white coffee' next to Hoan Kiem Lake in the sultry Viet Nam mornings.

I would rather lose a finger than the tattered A Tree Grows in Brooklyn that my grandmother read to my mother and then to me when I was a child. I was Francie. Knowing that my niece will pick up the same pages next year (when I pass it on) that 3 other generations have caressed thrills me.

I can't do libraries. I try. Over the years, I've moved a lot. I have a system: move stuff, contact PO, contact banks, get new driver's license and car registration and obtain library card. But I have never returned a library book on time. Not once. While packing yesterday, I came across 3 library books, the only books that I've checked out from the local library since moving here.

I can leave my childhood home without a backward glance (stupid albatross) but returning those books brought tears to my eyes. The one was the last book that I read to my mother before she died.

I drove home and cried. Then, I drove back, paid my $82.15 fine and checked the book out again.

Nighttime Serenade

Tonight, I stayed several hours past my shift end to sit with a confused elderly patient. "George" had a psych history and a broken hip. For various reasons, he had a triple lumen catheter and an order for TPN. Just before 2nd shift he pulled out his line and offered it to his nurse like a wedding ring, asking her to marry him.

I had worked with George before. He was unfailingly cheerful and absolutely adorable in his confusion. He was definitely one of my favorite patients. Because he was tugging on his foley and newly placed peripheral line, I volunteered to stay and guard his wandering hands.

He called me his little black Jewish kitty-cat and asked to pet my fur (I'm neither black nor Jewish) but happily acknowledged that I was a cat who didn't like to be petted and sang to me instead: "Kitty-Cat I Love You" to the tune of Bull Moose Jackson's big hit.

George didn't seem to have any short term memory; he constantly asked where he was, did his parents know he was there, why we had kidnapped him, when I was going to have my baby. (I'm not pregnant). *sigh*

Despite his misinterpretation of my physical homage to all things cheese (my little potbelly), we had a great time together telling stories and tearing pictures of cats out of the stack of magazines that someone had left him.

Outwardly, he and my mother were complete opposites. He was a tall black millwright and my mom was a tiny white schoolteacher. She died young and he had reached a blessed age. But their eyes were the same: brown and slightly bulging. He and my mom were both confused but so very loving and so happy to meet new faces.

It breaks my heart that he's transferring tomorrow to a university hospital for surgery and I won't be able to follow up on him.

Rejected and Dejected.

I received my first rejection today and to my first choice. It had been a shoot-for-the-moon dream but it still stings. I haven't heard anything positive yet. I'm trying very hard not to be pessimistic.

Tripping Down the Stairs of Higher Education

I have heard that the college experience transcends generations, that Powerpoint is the main difference between a Harvard freshman class in 1900 and a Harvard class today. My parents and I bonded over similar experiences. As a non-traditional (read: older) student though, I have always been acutely aware that in many ways my academic experience has been profoundly different than even that of those my own age.

Students now deal with the enormous lectures halls and the reviled clicker questions. The body of knowledge to learn and the competition for top grades seem to grow exponentially before our eyes.

Each generation, each class, seems to develop radical ideas that change the world and the way we learn. When our parents had few resources outside their professors and material libraries, we have virtual access to libraries and scholars across the world as well as instant access through sites like Pubmed and Biomed Central (among countless others) to cutting edge research. We can clarify any confusion we may have about lecture material from almost infinite sources during the lecture. There is a beauty in the changes that America has witnessed in higher education. It is incredibly exciting to be right there and witness new developments unfold.

For example, Einstein fundamentally changed the world of physics for future students like Richard Feynman who, in turn, amended it for the new generations. Lisa Randall is continuing this evolution for current and future scholars. The biochemistry that I learned last year is radically different that that I would have learned had I studied it with my high school classmates. When they were studying advanced biochemistry lab techniques, the human genome had not been completely mapped. Certain technologies, like gene sequencing, that were cost-prohibitive to even postgraduate research centers then are now common in undergraduate laboratories. I was able to witness the development of new approaches like the development and use of homing endonucleases to cut HIV DNA that already been inserted into the host chromosome. But despite seemingly vast differences, the feel of college is the same.

Students are taught in essentially the same manner. Though we see a growing trend of non-traditional early learning philosophies (e.g. Montessori), at the collegiate level, the lecture method grips the undergraduate world just as we see in favorite stories like Tom Brown’s Schooldays or Tales of St. Austin’s. We suffer the same 500 seat lecture halls that our parents did as freshman, and at the graduate level, the fierce defense of one’s dissertation to a critical examining panel echoes softly in the memories of Cambridge’s fierce Wrangler mathematical examinations. Both parents and children relate to and laugh at the antics of Rodney Dangerfield in Back to School.

The students themselves are essentially the same. Roger Ashcam who wrote The Schoolmaster, a treatise on proper teaching in the 1560s, claimed “Some wits, moderate enough by nature, be many times marred by overmuch study and the use of some sciences, namely, Music, Arithmetic, and Geometry. These sciences, as they sharpen men’s wits overmuch, so they change men’s manners oversore… Mark all mathematical heads, which be only and wholly bent to those sciences, how solitary they be themselves, how unfit to live with others…” We can assume had he known the future evolution of chemistry & physics, he would have also securely included their scholars. We can all see this truth today. Everyone, regardless of her age, can remember growing up with a Milhouse, Urkel or Screech.

We see in the structures of universities, their classic Georgian or Gothic architecture, a lingering look to the past. The traditions of Greek Life, though on the wane, still exist. Students are still proud of being a multi-generational legacy. Memories of college shared between generations are that of a place out of time: days that start late and nights that never end.

The substance of academia is in constant transformation but the experience of being there is fundamentally the same. Though some of those newly found ideas shake the foundations of our world, our experiences, those joys found in intellectual awakening and the contribution of ideas to the great body of knowledge, may be shared trans-generationally.

As Ronald J. Daniels told the most recent freshman class of John Hopkins University “So although universities are in one sense symbols of permanence, they are – owing to their devotion to ideas -- paradoxically incredible engines of change. They change science and art, history and philosophy – even our understanding of what it means to be human – by the ideas they generate.”

Why am I waxing poetic over the college experience? Having dined at the smorgasbord of learning delights, having been able to choose to study something in depth under the guidance of great scholars, I have recognized how important it was in the development, the maturation of my character. The pleasure I feel when I can go to an art museum with an (somewhat) educated eye or read something, understand and appreciate some of its underlying social, economic historical forces is indescribable. But it is more than that. I was a full-fledged adult with strong opinions and curiosity before I pursued my college education. Post-college, I can look back and recognize that my full-fledged status did not mean fully formed. I know that my thinking and opinion formation now is deeper and more critical than before and I hope (and expect) that as I continue on in my education, that I will grow keener and more thoughtful.

On a greater scale, education is the driving strength of the development of our culture and nation. We would not be able to compete in the global market without the innovation an educated population develops. Those symbols of permanence and engines of change are undeniably some of the greatest sources of the innovation required to keep our country one of the most enlightened and innovative nations in the world.

I know that certain medias’ portray ‘the educated elite’ as unnecessary and even threatening to ‘normal people’; I see the fundamentalists try to disparage and discredit scientists in their attempt to sell creationism over evolution and I always laughed at the silliness. I mean, all of the comforts in our life, the luxuries (food, clean water, electricity, medicine etc) that allow us to focus on things other than physical survival, are due to the innovations by the very people that are being discredited.

But there are increasing unhappy trends in our status as the innovative and educated nation that make it more difficult to laugh off silliness. For the first time, we are looking into a future whose children will be less educated than their parents. They'll be less educated in a world of growing education opportunities. As a population, we need more, not less, education to compete on the global stage. We need more education to evolve as a society. Last year, the United States fell to an international rank of eighteenth in secondary education. That is almost as low as an developed nation can fall. We seem to be losing our drive to become the strongest or we're using a warped meter stick to measure our progress. Whatever the cause of this educational downturn, I’m just saying that I probably won’t be dismissing any silly attitudes anymore.

*The statistics I cited are from the Organisation for Economic Co-operation and Development.

Choices

Finishing my stint on third shift this morning, I stepped into the clear cool air and watched the beautiful blushing sunrise. It was a serene moment after a long night and a tense early morning.

One of our patients had left AMA just after morning labs. Last week, high on cocaine, Russell** started a bar fight and injured his shoulder. Dr. Joe told him that the surgery would be delayed for several days to allow his body to metabolize the cocaine. Russ was not happy to be stuck in the hospital for a week and recompensed by abusing the nursing staff: dumping his urinal over his sheets and the floor, barking at us when we walked by and spitting at anyone who came into the room.

We, of course, avoided him as much as possible. Well, Dr. Joe neglected to mention to Russ that he would have to have another drug screen before the surgery. Apparently his visiting friends had decided to bring him more drugs instead of flowers. When the lab tech went in to draw his blood, he went a little nutso, pulled out his IV and, blood dripping down his elbow, stormed out of the room toward the nurses' station screaming about bovine stool and ordering us to procreate with ourselves. Thinking he was going to attack us, we called a security code.

After the grey coats wrestled him back to his room, Dr. Joe came up and told him that the surgery was, yet again, delayed. Russ decided that he didn't want the surgery and demanded to be allowed to leave. Dr. Joe, quite angry and quite willing, retrieved the AMA paperwork and Russ left.

I stopped by the grocery store for cat food on my way home. I settled in the express line as a heavyset young woman unloaded her cart of items with the corresponding WIC vouchers on the counter. I had the rest of the day off and so buried my natural impatience with a magazine.

I soon found myself eavesdropping on the transaction ahead of me. The woman, refusing to pay the 58c difference for a bunch of grapes, told the cashier to take some grapes out of the bunch. I watched as the scan was voided, grapes removed, rescanned, voided, grapes removed, rescanned, voided, grapes removed, rescanned, voided and then grapes added one by one until the weight matched the amount allowed by the WIC voucher. *sigh*.. "day off.. day off.. day off.. breathe.."

The cheese came next without issue. The juice wasn't juice but punch and not allowed under the rules of the program. Argument. Huffing. Return with Lemonade. Argument. Huffing. Apple Juice.

Finally, the cashier began scanning the non WIC items: HungryMan dinners, bagels, jars of baby food and beer. Total $21.53. Oh, only have $18.37.. Big eyes look at the cashier then move to me. I bury my face in the magazine. Hummm... Ok, take the baby food off.

I drove home judging her. I drank my black coffee and judged her. I thought about the choices that she could have made but didn't. I began to reflect on the decisions that I have made that could be better and I felt guilty. I could have had something other than that blueberry muffin this morning. I could have had tea instead of wine last weekend. I make awful decisions all the time: too much cheese, not enough greens, not enough water, reading trashy novels instead of literature, watching True Blood. I have a degree in chemistry and a passion for studying nutrition. I still make crappy lifestyle choices. I think most people do.

Lady, you're doing alright. Keep going to your classes at WIC and keep fighting for every grape. Please just don't do it in the express line. And don't date anyone with a gimpy shoulder; he's bad news.

Crying at Work

In Floating, I alluded to the reality that staff on my floor don't always do their jobs thoroughly. It's a major frustration; the onus of work usually falls on the shoulders of only a handful of people.

I get particularly fed up when our manager seems to coddle the biggest transgressors. He does have his favorites. Usually leaving before our shift starts, he's not much of a presence and I've always attributed his lack of enforcing job responsibility to his ignorance of what really happens during the evening.

When I first started, I really liked my manager. He was welcoming and warm and seemed to really try to create a happy work environment. As the first months past, he seemed really receptive to all of my little ideas for the unit, posting bed phone numbers over the information board in each room, changing the location of the linen carts to be more generally accessible etc. I reorganized the way that the medical teams, patients and nurses were listed on our charge board, color coding them to make the information much easier to read. You should have seen the way they did it before, it would take minutes to figure out who the doctor and lead nurse was for each patient! I was allowed to join the unit council (their first aide!) and I thought, despite my lowly status as a grunt, my thoughts, ideas and concerns were being heard. I took on all the training of new PCAs and attended workshops to improve my clinical mentoring skills.

Last month, another aide, ignoring an imminently dangerous situation for the patient, neglected to do something important. I stepped in and performed the required task, then followed the her to the nurses station. I confronted the aide and told her that she could not disregard those types of situations.

Well, she started to cry and complained that she was having a really bad day. Her brother was having oral surgery to have his wisdom teeth removed and she was so anxious about it. She became hysterical,(seriously!) and needed a twenty minute smoke break to regain her composure. Of course, I was rolling my mental eyes the entire time.

The next day, I was called into the NM's office and scolded. He informed me that it was not my place to police my coworkers(!) and that, and I quote, "not everyone has your work ethic". I told him that I was indeed having trouble adjusting to lack of my* work ethic in my coworkers and that my actions stemmed purely from my concern for the patient. He nodded sympathetically and asked me to work on my tolerance.

Of course, I've thought that maybe I was out of line or too harsh with the other aide. I talked it over with one of the nurses who had been present though. She reassured me that it happened as I remembered: 10 seconds of me getting the aide's attention, telling her to do her job and her becoming histrionic. She confessed that she too has been scolded for scolding someone else.

I'm currently looking for a new job** but I'm saddened and frustrated by the entire scenario. I absolutely love the work that my job entails (but not the poop part) and I hate that I'm leaving with such sourness. All that I've read about the evolution of healthcare shows that the culture is one of increasing openness to policing each other in the effort to generate fewer mistakes. To be slapped in the face with the very antithesis was shocking.


*my work ethic being that I actually do my job!
**I did call the 'anonymous' hotline two weeks later for an incident that I wasn't directly involved in. I haven't seen nor heard any outcomes but I hope that someone is looking into the mess that is my unit.

Juggling Thoughts

We have a nurse on our unit. John* is incredible with the patients and acutely intuitive about their well-being. He's saved several lives by noticing that a patient is 'off' and calling the appropriate people to take care of it.

He sucks at multitasking though. His medicines are always administered late and he can't give a decent concise report during shift change. We all, nurses and aides alike, dread following his group. There's always information missing and tons of catch-up to do before we can start our own assignments.

I recently read Dr. Ofri's Lancet contribution and thought about John and then about my own future as a physician. My experience thus far has been relatively painless. There's a certain triage that people use when they multitask. Providing orange juice for a glucose reading of 56 trumps the coffee for a visitor in room 654. Occasionally, When I'm juggling 10-15 requests, I'll sometimes overlook one.

It scares me that I may forget something vital when I'm a physician. Will I remember to order a CBC on a patient with a GI bleed? How can I be smart enough to manage the care of so many patients when I can forget to bring someone a ginger ale?

Dr. Ofri's editorial has relived my mind (somewhat) in that I won't be the only doctor with these fears.