Less Than Zer0

“They think that I’ve got no respect, but, everything means less than zero.”–Elvis Costello

Sign of the cross wards off the evil eye…. June 4, 2010

Filed under: Uncategorized — Kate @ 6:20 pm

Example of a pyogenic granuloma.

It’s all my fault. First all the clinic computers go down to a virus shortly after I arrive. By lunch we know all 4 campus of Texas Tech Health Sciences Center have been hit.

Then, my resident gets stuck on the wrong side of the border and has to cancel his afternoon appointments (What was he doing over there on a Friday morning to begin with?).

Two patients later, I have seen exactly one cat scratch fever & one CHF/Amphetamine abuse/chronic alcoholism/pyogenic granuloma–which translate neatly into 2 hospital admissions to my patient log.  Arranging direct admissions with pen & paper is a bit of a drag.

The clerkship director sent me home before I could do anymore damage…pray for the cat.

 

Rites of Passage April 14, 2010

Filed under: medical school — Kate @ 3:43 am

I lost my first patient tonight. I’d been present at a final code once before, but that was hardly my patient, and the family had been expecting relief from his hard fought battle with cancer for some time.

This was different. Mr. Trauma Focus (all the male patients without names get a car code name when they arrive from the ER, and though I know his name now, I’ll remember him this way) came in as a level 1 trauma motor vs pedestrian accident. I was there when we intubated him, I was there when we opened his belly and packed his wounds with lap sponges. I found additional injuries during his transfer. I preened in the angio lab, after surgery, when Dr. Tyroch, the chief trauma surgeon asked me what I did before med school and complimented me on how helpful I was in the OR.

I waited by the patient’s side as we embolized three arteries to stop more bleeding and added a filter to his largest vein to prevent clots from reaching his lungs or heart. I listened, amused, as the interventional radiologists finished their work with the oft quoted signature, “another life saved!”

And then he coded. We couldn’t find a pulse in the angio lab. So we infused more blood and hurriedly transferred him to ICU. Over the next few hours, in spite of our best efforts and his, Mr. Trauma Focus slowly lost the warmth from his body, along with copious units of blood. His systolic pressure had been below sixty for more than an hour when his pulse suddenly dropped forty beats per minute, from 112 to 67.

I told my resident, and asked if we could fetch the family. As she rose from the nurses’ desk, our patient started to code. This time, he didn’t come back. After five minutes of chest compressions with no response, the code was called. We informed the family. His son began sobbing violently while his wife stoicly comforted her child and told us they would wait for the other children before viewing the body.

I wonder at her resolve, in the face of death. Were they religious people? Did she hope for a reunion at resurrection? Or was she just in shock, and doing what had to be done until she had time to process it all?

Sometimes, rites of passage come when we don’t expect them. Mr. Trauma Focus certainly didn’t expect to walk out of the bar and get hit by a pickup truck. I didn’t expect to lose my patient tonight. Not when I came on shift, not when he arrived, not after surgery, and not during angiography. It feels numb, and solemn. Two hours of sleep before morning rounds.

 

What? Life outside the hospital? April 12, 2010

Filed under: Uncategorized — Kate @ 12:47 pm

I used to be so jealous of classmates who were far enough ahead in studies & budget to take little minibreaks on the weekend. I spent my first two years of med school in a constant struggle to stay in the black, catch up with my work, and catch up on sleep. Now that I’m just comfortable enough to allow little excursions every so often, I realize that 1) you never catch up, 2) staying on budget is overrated. Sometimes, the best thing you can do for yourself is take a few days off.

I’m sitting in a Reno airport after a lovely mountain holiday with my brother & company in & around Lake Tahoe. Climbing, hiking, sight-seeing, and as much raw fish as I could eat. How is it so easy to get wrapped up in work and career when there’s so much life waiting out on the other side?

I want to learn from these little side trips and use the lessons to make good specialty choices in medicine, but sometimes it feels like the choice is between the time vs. the money to enjoy the best things in life–like you can’t have both. But I know I don’t want to spend my entire life in the hospital or the clinic. There’s so much more out there waiting to be experienced.

 

Trauma Rounds @ 0730. Pre-rounds @ 0450. Woo!!! March 17, 2010

Filed under: Med-School Mock-Up,Medschool Quotes of the Week — Kate @ 10:48 pm

1) During review of patient abdominal CT:

—Surgical Resident IT: “Wait, is there fluid there? Go back.”

—Surgery Attending AM: “She’s a female, could it be female fluid?”

2) 25 yo active military admitted for Closed Head Injury, secondary to being dropped on his head during a litter training exercise–i.e. military speak for “how to practice transporting injured comrades without dropping them on their heads.” Guess his team really needed the practice.

3) “You’re not Irish-you must be Swedish. A good Irish girl would have brought me a bottle of Jameson today in the hospital.”–my alcoholic patient, stuck in the hospital sans recreational substances on St. Patty’s Day.

4) “blah blah blah…..Patient with multiple stab wounds, blunt trauma to the spleen, pneumothorax…[etc, etc]”–resident report

–Intern JM “Does this mean I have to give another ‘new friends’ speech?”

5) [In reference to patient on per oral trial diet after long term parenteral nutrition] “She says she felt nauseous after eating the cafeteria enchiladas yesterday.”–MS3 DD

Senior Resident GC: “D/C enchiladas.”

 

Don’t you need to know? December 1, 2008

Filed under: Absurdity,Website Highlight — Kate @ 8:03 pm
Tags: , , ,

If we are attacked by 5 year old terrorists, how useful will you be to your country?  Take

this quiz and find out. Apparently, I’m worth 25 of the little boogers.

http://www.howmanyfiveyearoldscouldyoutakeinafight.com/

 

Words to Live By. November 22, 2008

Those who know me personally can undoubtedly confirm that I have trouble keeping my mouth shut. At least I’m aware of it.  As a consequence, I tend to collect advice on how to stay quiet.  Two of my favorites:

It’s so simple to be wise. Just think of something stupid to say, and then don’t say it.–Sam Levenson

Think before you speak. Read before you think. This will give you something to think about that you didn’t make up yourself-a wise move at any age, but most especially at seventeen when you are in greatest danger of coming to annoying conclusions.–Fran Lebowitz

For wisdom less witty, but certainly just as practical, four questions generally attributed to His Holiness the Dalai Lama:

  1. Is it TRUE?
  2. Is it NECESSARY?
  3. Is it KIND?
  4. Is it HELPFUL?

I find these to be excellent checkpoints in conversation, whether the “should I or shouldn’t I?” question applies to a juicy bit of gossip or a difficult business/academic matter. I’d probably fare better if I used them more often.

For Amanda (roll over for captions):