Thursday, July 28, 2011

Patients as Diseases

Yesterday I had a sudden strange epiphany: we tend to treat patients as diseases. The people who've come into the hospitals have "become" their diseases. We're more likely to say something like, "my diabetic patient" as opposed to "my patient with diabetes." Subtle difference perhaps, but a difference nonetheless.

It just hit me. Outside of their diseases - there sole reason for coming into the hospital - I knew next to nothing about my patients. I didn't know that my HIV patient was once a baker and a tanner (it said so in his chart). I didn't know that my DVT patient lives with his son and grandchildren (he randomly told me one day). I didn't know my patients as people, only as pathologies. It suddenly didn't sit particularly well with me.

On the one hand, by focusing on their pathologies, I can do my job more efficiently and figure out what's wrong and how to (hopefully) fix it. But on the other hand, there's so much more to the patient than their diseases and there's an element of humanity that's somewhat missing. I mentioned this to one of my friends who's on the same rotation track as me, and he says, "Welcome to the real world."

Yesterday my attending and I were rounding one of our patients with diabetes. She'll likely need her toe amputated because it's basically dead and rotting. And she started crying. My attending says to her (paraphrased), "You have become your disease. You have to get your life back and control this, don't let your disease control you. Knowing what it is is half the battle. The hard part is what you do, and I know it's not easy. But you must not let your disease control you."

We're all so wrapped up in the medicine, in the problems, that we fail to see the bigger picture of the world we live in. I don't know if knowing my patients as people would contribute to better patient care. Maybe it would help me understand how and why one of my patients became so obese that she could no longer sit up, roll on her side, or walk. And maybe, just maybe, it'd give me that small window of opportunity to help my patient manage her health once she leaves so that I never see her again.

Monday, July 25, 2011

Nothing to Do

"Nothing to do." NTD. At the end of our day, we leave a small blurb to the night team taking over on our patients. That's the phrase for most of our patients since we already did the majority of their work-up during the day. Basically all the night team has to do is monitor our patients and make sure nothing major goes wrong, lol.

Anyway, last week I felt like a total bum. The new attending I'm working with is starting here brand new and was getting used to the system. She didn't really let me do as much as my first attending and she relied on the PA a lot. That's okay, I understand. But for the better part of that week I felt like I didn't have any "ownership" over my patients, which I didn't like. So for most of last week I had "nothing to do."

I'm regaining that again now and most of what I did under my first attending. One of the things I did do last week was call ID (infectious disease) consults. A lot. We kept getting patients with unknown sources of infection and whatnot. On Saturday, the ID fellow and Dr. P (remember him?) came by to round on our patient. I hadn't seen Dr. P in a long while, so it was great to see him! :-)

Anyway, my pharmacist friend linked this vid to me and I like it a lot:

And I'm not sure where I found this vid, but it's also very cute. :-)

Friday, July 15, 2011

A Good Day

It's been a good day.

1. I finally had an adult patient with a "fix-able" disease. He had pseudogout, which is readily cured with medication. I called the rheum consult and happened to be there when they came by to examine the patient. So I went in with them to see what I could learn. I had forgotten how much I liked rheumatology, haha.

2. I was able to answer most of my attending's questions without sounding/feeling stupid. This feels like an achievement for me because sometimes I feel like no matter how much I read, I fail to recall what the attending determines to be the most salient points. But today I was prepared (or at least phrased my answer in an acceptable way if I didn't exactly know the answer).

3. My attending gave me feedback on my performance. She told me how proud she was of my progress from day 1 to today. I went from an unsure and kind of shell-shocked student to someone who's confident and proactive in taking responsibility in my patient care. And I do feel like a different person since day 1 last week (I almost can't believe I've been doing this for 2 weeks already!). I chose the hospitalist service precisely because I knew my attending would throw me into the fray and force me to be an independent learner without training wheels, and I got what I wanted.

4. As such, my attending offered to write me a letter of recommendation for residency later! She told me how she's written LORs and how she's called residency programs to give her former students an extra edge. Now, when an attending offers to write a LOR, that means that the attending truly regarded you highly. I hope I can continue this momentum with future attendings on rotations down the road.

5. I met the city's oldest woman cop/detective! She quickly became my favorite patient (though she wasn't technically my patient). She was great to talk to. :-)
Yesterday I hung out with Drew a bit. I picked him up from his house and we went to a coffee shop. We sat down and chatted and people-watched. He kept pointing out all the cute guys and guessing which were likely gay. Btw, I still don't get what people see in asses/what they notice about it; it's simply a body part that I rarely pay attention to. Someone enlighten me?

Anyway we had some good convo. He told me about this guy he likes and likes him back, but they both agreed that neither were in any position to date the other. I suppose that keeps the window open for me a bit, but Drew alluded to the fact that he just got comfortable being single again and would like to stay that way for a bit longer. I'll respect that . . . and also I couldn't get the right words I had wanted to say out of my mouth, lol. And I still couldn't get a feel if I even have a shot. Fail.

I did, however, manage to get him to take his shirt off in front of me. But I assure you it's for a legit reason. He had this rather nasty cough on and off as well as some sinus issues. I just so happened (unplanned, I assure you) to have my white coat and stethoscope in the back seat of my car. So he humored me in allowing me to listen to his lungs and heart. His heart sounded good but his upper lungs did sound a bit congested to me.

All in all, it's always great to hang out with him when we manage to align our schedules.

Wednesday, July 13, 2011

Mixed Feelings

Today was a day full of mixed feelings.
I got my Step 1 USMLE Board Exam score. I passed . . . but I didn't do nearly as well as I was hoping or expecting. In fact, I did almost 20 points worse than estimated. T.T I really have no choice but to accept my score because once you pass this exam, you can't re-take it. I did solidly below average for all medical specialties, even pediatrics and internal medicine.

For a few hours I had some serious doubts about my aptitude and ability to just know/remember medical knowledge. I had doubts on whether or not I really "belong" here. Then I remind myself that it's just one test, just one number. I have chances to redeem myself on my residency application in a couple years - I've already done a lot my first two years, I've held quite a number of leadership positions, I'll have an MPH behind my name as well. All I need to do now is obtain amazing letters of rec and rock Step 2 next summer . . .

It's not over quite yet. I may still have a shot at a top 10-15 pediatric residency spot (I just have to work even harder for it)!!
And for the past couple days I've been taking care of a patient who's been getting increasingly agitated. Last night he refused all medical treatment. When I read this in the nurses' progress notes I went to his room to talk to him. I explained to him why he's here, what we're trying to do, that his meds are working, etc. He didn't believe me. So I asked him what he thought his problems were and how we could better help him. I wanted his perspective of his health. But he snapped back that "I'm not the doctor! Don't ask me! I don't care about no perspective."

I reported all of this to my attending, who then went with me to see the patient again. He was judged "decisional" and he just wanted to go home. He left a few hours later AMA (against medical advice). In a way it felt like a "loss" because there was nothing I/we could do to improve his medical problem, because we can't force care upon someone who doesn't want it and is competent to make his/her own decisions.

Later I recounted this to my pharmacist friend, and here's a snippet of our convo that followed:

Her: "Awww. But wow, [Aek], I am seriously impressed. You're going to make an awesome doctor."
Me: "Lol, impressed by what?"
Her: "I've seen attendings handle difficult patients like that. But not residents. And definitely not med students."
Me: "But isn't that what we're supposed to do? . . . Like, that's part of the job description, lol, to talk to patients and see what's going on."
Her: "Yes, lol."
Me: "And try to help."
Her: "But you seem to have said all the right things. Even though they didn't work. Some people are better at it than others."

I'm glad that she has faith in me. I'm glad that my attending seems to be giving me some positive encouragement/feedback, even when I feel like a dumbass some days when I can't answer her questions as satisfactorily as I think she would like. All I can do is try my best and do what's best for my patients. Knowledge isn't everything, but knowing how to find and utilize knowledge is. Perhaps there is hope.

Saturday, July 9, 2011

The One to Make Me Dance?

Today I drove about 4 hours to make it to my friend's wedding. In fact, my best friend from undergrad and my roommate freshman year. But more about that later when I've returned home and had time to process the pics I took a bit more.

I can't remember if I've mentioned this, but I always have mixed feelings during every wedding I attend. On the one hand, I'm really happy for the new couple and the potential of their lives together. But on the other hand, I'm also rather sad for myself and still being so so single. This is only accented during the dancing portion of the reception, which I utterly dread.

First all, I feel rather awkward with/in my own body (hands aside - years of playing the piano and cello have mediated that, lol). And second, I usually don't have anyone to dance with because I attend most of the wedding solo too; and if I did have someone to dance with, I'm also not sure what to do. It's all just a really awkward moment for me unless I've had 4+ shots of alcohol within the last 30 minutes or so, haha.

I'm still looking for that one person who can make me dance and not feel like an utter fool. Where is this person who can motivate me onto the dance floor and dance with them (or at all)? A part of me is sick of just sitting on the sidelines waiting. And a part of me is just too comfortable not exposing myself like that on the dance floor. I mean, I even feel embarrassed attempting to dance in the privacy of my own apartment!
Anyway, on an unrelated note, Drew is now single. Again. Things didn't work out between him and his boyfriend and they broke up on friendly terms. It's been about 2 weeks since the break-up. In the intervening time, at least 3-4 guys have asked him out on dates, all of whom he had soundly rejected. For good reason! They should've given him at least 2 weeks to get over his last boyfriend - such quick rebound is good for no one.

But now 2 weeks are up. I don't know if I should make any kind of move while this window is still temporarily open. I don't want to be yet another guy asking him out on a date as I think that'd hurt our friendship (or at least make things a tad awkward in the future).

What I really want to do is just ask him if he'd ever consider dating me. And depending on his response I'd then ask him out (or not). But I also feel like it's cheesy to do that. Yet again, I don't want to be "yet another guy." Argh. What to do?!

I may ask him if he's free to hang out this coming Thursday afternoon/evening (because that's the earliest time during this week that I know I have some time off from rotations). I could ask him on the spot then. If he said yes things would actually work out nicely because I get my Step 1 board exam score this Wednesday, so he'd be either celebrating or commiserating with me depending on my score, lol.

He's one of the few people I've met who doesn't fail to make me smile and laugh when we hang out. I really enjoy spending time with him even as just friends. He may be one who can make me dance, lol. Argh, I don't want to mess this up. What should I do? Would things work out anyway since we're both so busy? :-/

Friday, July 8, 2011

Survived my First Week

. . . of my medicine rotation.

It's actually not too bad. I'm on the hospitalist team, so it's just me, a physician's assistant (PA), and an attending physician. There are no other med students, interns, or residents on my team. And the hours are surprisingly nice - 8am until whenever I finish (usually between 3pm and 4:30pm) and no call. But man, talk about throwing you out to the wolves! On day 1 I had to do an independent history & physical (H&P) on a newly admitted patient. On day 2 I had to follow-up with the patient (now "my" patient), write a medical note complete with non-retarded assessment and plan for his treatment while he was in the hospital.

And on day 4 I had two newly admitted patients for which I had to do H&P's, write their medical notes, call consulting services, write orders for labs and meds, get consent, and learned how to write an admission note. I've learned and done a lot in this short week - possibly more than I had all of M1 and M2 years combined (or so it feels, lol).

It's been a great experience so far. I've really had to take responsibility and ownership over "my" 3 patients, and I'm slowly figuring out the system. I know I have friends with me on our medicine rotation at different locations who've done less for each of their patients. I've been so busy that I don't even notice how hungry and tired I am until I leave each day - I've just been in this kind of hyper-focused state to do what I can for my patients (if that makes any sense at all, lol). I hope at the end of each day I truly did something to help them and contribute to their care while in the hospital.

Time for bed. I've been granted the weekend off so I can make it to my friend's wedding.

Wednesday, July 6, 2011

Let . . .

Breathe by ~theflickerees on deviantART

Come here, lay with me,
Inhaling our breathes
On this lazy summer day.

Let the sun
caress us
in its warm embrace,
Let the breeze
fill us
with the breath of life.

And we may gaze
at the clouds
And imagine
sweet dreams of tomorrow.

Let us enjoy this day
Nothing to do,
Nowhere to go,
Just lounging around
in each other's company.

Let us close our eyes
and pretend,
Just for a moment,
That the world
stopped turning
And that time
gave pause.

That it is just
you and me -
Whoever you are,
Wherever you are,
Exhaling with me
the breath of yesterday.

Friday, July 1, 2011

Epic Wedding

This post is long overdue. A couple weeks ago I drove down to St. Louis, MO with Michelle for a mutual friend's wedding. Michelle has a relative who lives near St. Louis, so we crashed at his place for the first night we were there.

That first night, we went to the Mehendi ceremony where the women got henna done. The bride's henna was really cool all over her hands.

The following morning was the Christian ceremony (groom's side) at Graham Chapel at Washington University. Though we left early so we could get there early, the universe didn't want that to happen. The highway I took narrowed down to one lane at one point and we were stuck in pretty much stand-still traffic for a good 15-20 minutes. I took the first exit I could find only to find the bridge I had to cross was demolished. I just went back on the highway and surprisingly it was fine after that blockade.

The Christian wedding was pretty sweet and short. After that wedding and taking a few pics, we went to the hotel where the rest of the events were held to attend the luncheon. By the way, almost every meal was provided buffet style with Americano and Indian options. Both were delicious and I was stuffed after every meal without fail. Probably gained like 10 lbs from all that food . . .

Anyway, after the luncheon there was a couple hours' lull as they set up for the Hindi ceremony later that afternoon. Unlike the Christian ceremony, which was about 40-45 minutes long, the Hindi ceremony was about 1.5 hours long. It was really cool though as I had never attended an Indian wedding before.

Finally, after the Hindi ceremony came the reception, which was really nice. Throughout the 2 days, the bride wore a total of 3 dresses, 2 of them being saris. She looked so good in all her dresses! I was so stuffed from the food that I couldn't finish a small slice of cake and attempting to dance was painful. Oh well.

The following morning, Michelle and I checked out of the hotel and decided to see some stuff around in St. Louis before heading back. We first went to the Shaw Botanical Garden where a really awesome tour guide gave us a most excellent tour of the gardens. It was such a beautiful place.

After that, we headed for The Hill area for lunch. But being Sunday and in a heavy Italian district, most places were closed. We did find a pizza place that was open (which was delicious) and then topped that off by going to a gelato place afterwards.

Finally before heading out, we had to see the Gateway Arch, probably the most iconic symbol of St. Louis. We didn't go up to the top but we took plenty of pics around it. All in all, it was a great trip with a couple of minor bumps along the way.