Somebodys trash is

You should have seen my class when we got our pagers during 3rd year orientation. It was like little kids on Christmas. Everybody was asking for your number and paging you and playing with the different ringers during our lectures. One might think medical students should have some professionalism, but this was a big day. People were going to need to get ahold of us, we had become an integral part of patient care.

Looking back is laughable. The big hospitals need 3rd years like you need another hole in your head. And still, even months in we all would get excited about actually getting a page. The residents will tell you that you hate your pager when it starts going off all the time. They're wrong, you hate it once you realize the person on the other end actually needs you. No, not needs you to save a life, needs you because, despite being physically capable of doing everything they want and need to, you as the doc need to check a box on a computer or write down what to do and how to do it. The best is when they need you to scribble your name next to something they already did and claimed you told them to.

I'm still not to that point yet. But being the only person except the attending means I get to write the notes, the orders, see the patients before the doc at 0 dark 30, I just need an extra signature and a scribble for coding and legal purposes. Also, being a student and not a nurse or scrub tech means that as long as the doc is there I can cut and suture and all kinds of shit. He'll, there's things I can do without a doc around, like tear out an NG tube (though nurses can do that too). Though I'm not needed, I'm a lot less dead weight than at my larger institution, which means if my doc is needed, I'm at least expected to be there

So what does all this jibber jabber mean? It means for the first time, after a 13 hour shift I went to sit down and the overhead sounds "Dr. Schmo please call xyz" and I wasn't all twitterpated with excitement. I hope you caught the Bambi reference for it's two disc blu ray release coming up.

Bummer

So my school likes to send students away to work with doctors in more rural settings one on one and usually you wind up living at th hospital or a nearby hotel. It's better for really getting some experience as to what living life in that specialty might be like some day. The first two weeks I spent doing one of these rotations in surgery I forgot my running shoes and was rather bummed at my lack of workout prospects. This week I almost did it again but I turned around 15 minutes into my drive to get them. It also turns out this week is the busiest yet, with two back to back 12 hour days and 6 cases scheduled for tomorrow on top of 3 nights of call. I'm starting to see why some docs find it so hard to practice what we preach...

BTW the pizza I had to pickup because the cafeteria was closed is fantastic

Time for some quick anatomy lessons

Ms. Rep was in today to make sure nothing went wrong with her company's mesh if we used it during an esophageal repair...

Ms. Rep, looking at the laparoscopy screen: What is that big vessel there running down by the esophagus?

Attending: You mean the aorta?

Ms. Rep: Oh...

One step forward, two steps back

So I was on a case a while back. Patient was elderly (I mean like super elderly) and had a ton of problems which after a weeks stay in the hospital were getting better. She was coming off her broad spec antibiotics, she was eating, her pain was gone, the only thing we couldn't get her to do yet was get out of bed, which apparently won't stop you from getting the boot from a hospital anyway. Everything was good, until I came in the morning we were going to d/c her and she had spiked a white count. No fever, no tachycardia, just a 5 point jump in her WBC's overnight.

I about shit a brick. I had literally the night before written a note stating "watch out for C. diff colitis due to broad spec antibiotics and frequent watery stools," and C. diff is one infection that can hit without prompting a fever. On the contrary, Mrs. Super old also wasn't doing much and we had fluid overloaded her once during her stay, so she was having some atelectasis and effusions (google it if need be) so my attending was afraid of pneumonia (the elderly apparently don't need either a fever or white count to have an infection, thus I'm staying away from geriatrics). Chest x-ray was ordered and another round of different antibiotics was started.

Later that same afternoon, we visit the Gerry's chart to see what her x-ray showed, and my attending finds a progress note from the primary on her case that states BOLUS OF STEROIDS WAS GIVEN YESTERDAY. For those in the crowd that don't know this one I'll save you the trip to your search engine: steroids=white count elevation. Fuck me sideways Martha, I really wish I had this piece of information when I looked at the chart 15 hours after the bolus was given.

This showed two aspects of medicine that need to be addressed. One is doctors' handwriting. The whole reason this progress note wasn't on the charts is because the attending likes to dictate or type them and put them in later, making sure they're legible. But they're daily progress notes, which should be in the chart THAT DAY. Granted, it was an oversight on my team's part as we didn't flip through the couple sheets of orders to find it, but still. Can we not have something that lets us be legible AND have notes on the chart the day they're written? Trying to be legible shouldn't cost a patient mistakes in treatment and a delay in getting the hell out of a hospital bed.

I might have LOL'd

recently seen on gchat->

friend: do anything exciting lately?

me: no
me: unless you count cutting people open and playing with their guts exciting

morbid? maybe a little. insenstive? GTFO

....and for the record, I find it very exciting. So much so I don't care about pulling 12-16 hour days without lunch(suck on that one unions)

O....M....G

For those that don't know, when you work inpatient, you get used to the population having a certain....aroma. The kind you get when you're deathly ill and not bathing appropriately. It's a completely understandable situation and you get over it...unless you meet that stench in the clinic.

We had a lady come in today with a BMI roughly in the low to mid 50's (important in a sec) and I got sent to see her first. I notice on her chart that she reports a 1/2ppd smoking history, which is complete BS because you could smell it on her through the door. Being a gentleman, I left the physical exam for when I could be supervised by my female attending (word to the wise, don't try an exam unsupervised on a female without at least SOMEONE else there). Unfortunately, I'm on gen surg at the moment, and we HAD to do an abdominal exam. I really don't mind doing one on obese people with the exception that you're not going to find anything, its the fact that we quickly found out this chick rarely bathes and certainly doesn't hit in between her folds. The smell alone was overpowering. Putrid even. Bleh.

So in conclusion, shower for f**k's sake. Please. Thanks.

Weekend Follies

This story has no medicine to it, unless you count the possibility of 'roid rage.

A couple of my buddies went to a club last night. Being mostly med students, we're a pretty diverse crowd with a fair share of asains and indians etc etc. So my buddies go to leave and smartly choose to have a friend pick them up. While waiting for said friend in the entry way of the club to avoid standing in negative degree temps, the bouncers decided to get a little antsy. They tell my buddies that they have to leave, despite there being a good sized group of [all white] people still in the club. So my friends step outside and the brown guy makes the joke about racial profiling. This leads to little guy using his phone to video the fact that they're getting harassed by the bouncers while all the other people get to stay inside and be warm. Of course, the tubby 2x4's just get more upset and kick a door in little guys face and then start pushing all my friends towards the parking lot. Despite not putting up any resistance, little guy gets punched in the face by the biggest bouncer for telling him to stop pushing. Little guy gets brave, swings back, and all 6 bouncers chase him. Little guy runs for all he's worth around the parking lot until the stress makes him stop and hurl, and little bouncer catches up to him and also punches him in the face.

Luckily the cops showed up about now and put an end to the madness, but unfortunately they didn't feel like arresting the bouncers. And if you're wondering why I'm narrating the story from a 3rd person perspective, its because I had left before everyone had gone to the club to sleep in my nice warm bed. Which is probably a good thing because I get a temper. O well, maybe next time.

Headaches

Let me start by saying that if for some reason you figure out where I go to school, don't let them know about this post. I recently heard about a grad student getting kicked out of their program over Facebook, but I'm pretty sure it was because what they said could be interpreted as a threat. Either way, play it safe.

So a long while back I decide to go our university ER for what I was worried could be a broken ankle. I got charged 50 bucks up front for a copay, which I didn't know I had because when we utilize university facilities/physicians, we don't get charged a deductible/copay. It was whatever though, because that's what my card said and I figured it would be just as expensive to get crutches to hold me over the weekend (it was, of course, a Friday at 5p and our clinic wouldn't be open until Monday). Verdict was bad sprain, and I was given an ice pack, an ace bandage, and an aircast. Woo.

But of course that's not how the story ends. No sir. And after fighting with the hospital billing staff, my insurance, and some medical supplier, I think finally have a decent idea of why I wound up paying QUADRUPLE that cost. First off, that air cast I got wasn't supplied by the hospital but by a medical supplier. Now, this makes sense in terms of our general ER population. Guy/girl comes in, sprained ankle, walks out without intention of paying for treatment. Hospital doesn't have to foot the entire bill because XYZ med is going to bill for their equipment and eat whatever isn't paid. Works out well until you get a university student who would only come to that ER to avoid paying out of network deductibles, and that XYZ med is seen by university insurance as a "referral" and you wind up with a pretty nice charge for a plastic piece of crap. Loops holes need to be created because this, IMHO, is counterproductive.

And still the story drags on. I also got a nice $100 fee put under my deductible section relating to said ER visit. I call up the insurers, tell them I don't pay deductibles when I go to university facilities. Kind lady on the other end of the phone says that copays and deductibles get logged under the same column by their [shitty] computer program. So I ask what copay, I paid my 50 bucks upfront. She says yes but you owed 150. I said not according to the card I had, that updated copay came on a card mailed in October and I went to the ER in Sept. She informs me my policy effective date went to work over two months before I received my card. After some research, I find that our university has a waiver date a month and a half after the policy effective date, so that the insureres can't deliver cards until at least 2 months after we've already been on a plan. Now how much sense does that make?

I'll tell you. Nill. I'm done now.