Sometimes it seems like the emergency room at my hospital is a wormhole between two universes: one where I and the other medical professionals live, and one where the patients live. Some of the differences between these two were unsurprising to me: I already knew that our patient population tends to visit the ER for situations where I’d just pop some Tylenol, for example. (And there are a lot of reasons for that; if you don’t know much about medical issues you might not have any way of knowing whether something’s life-threatening, and if you don’t have access to a primary doctor there’s no one to call when you’re not sure whether to come in, nor is there any way you can just go see your doctor in a week if it doesn’t get better.)
One of the differences I saw this month really struck me, though. I saw quite a few young women with complaints of nausea, vomiting, abdominal pain, tiredness, missed periods, etc. Many of them received a diagnosis of “normal pregnancy.” What got me was that none of these teenagers seemed upset to find out they were pregnant! If I had turned up pregnant at 16, I would have thought my life was over. Apparently (I didn’t see any with their moms there) the mothers are excited to find out that their daughters are pregnant, too. Again, if this had happened to me, I know my mom would have still loved and supported me, but her first word would not have been “Congratulations!” (Of course, my mom did not have me when she was 16, either.)
This is the first thing in med school that has made me feel naive and idealistic. I thought that education was key, and if young people knew about their bodies and their options for preventing pregnancy, and birth control was made available, the teenage birth rate would decline. Now I’m not so sure - if pregnancy is seen as a *happy* thing for high school kids, if they don’t see it as a huge roadblock on their paths in life, what’s the motivation to abstain or use condoms? I guess it’s good that girls who become pregnant aren’t ostracized, but I think this might be a little too far in the other direction!
The other day, I saw another interesting and weird aspect of this. I went in to see a patient whose chief complaint was “nausea/vomiting/need pregnancy test”. She’d been waiting for a few hours in the waiting room, then maybe 20 minutes in the exam room, which really isn’t bad for people who show up with non-urgent complaints. During those 20 minutes she’d been out to the nurses’ station multiple times asking for food (so apparently her nausea wasn’t so bad) and to use the phone. So I went in to see her with the thought that we’d do her pregnancy test, let her know what was going on (at least she wasn’t going to be too surprised if it was positive), and send her out.
ME: [Introduce myself.] So, what’s been going on?
PATIENT: I need a pregnancy test.
ME: OK, we can do that here. When was your last period?
PATIENT: The beginning of August. I’m healthy, I’m 20 years old, I weigh 160 pounds, what else do you need to know, can we just do the pregnancy test and get me out of here?
ME: Well, we can do that, but whenever somebody comes in to the hospital we have to talk to them and examine them to make sure we aren’t missing anything serious.
PATIENT: Fine. Can I have something to eat? I’m hungry.
ME: So your nausea and vomiting is better?
PATIENT: Yeah I just throw up in the mornings. And I’m tired and hungry the rest of the time and my nipples hurt. I’m pregnant, OK? I took a home test.
ME: Oh, you did? What did it say?
PATIENT: It was positive. Three of them.
ME: So… are you expecting this one to be different? [probably not an example of good doctor-patient communication skills, but I was just really confused about why she’d be there if she already knew she was pregnant.]
PATIENT: No, I just need a paper that says I’m pregnant so I can go on WIC.
So I finished examining her, counseled her to stop smoking, told her about getting prenatal care, etc. She ended up being pregnant (surprise!) and very unhappy that she’d had to wait another hour or so to see the doctor to get discharged. I don’t know what the actual WIC requirements are, but it seems like it would be cheaper for them to accept the results of a home pregnancy test with verification in the WIC office, than having the taxpayers pay for emergency room visits for pregnancy tests.
[As always when I post about patients, some details have been changed.]
I’m halfway through my Emergency Medicine rotation, having already completed three months of Internal Medicine (general adult medicine). Unfortunately I don’t think I’m any closer to knowing what I want to do with my life, except I guess that it’s definitely some branch of medicine!
My first month was ambulatory medicine (general adult care in the office setting) except that it wasn’t; I was with a pulmonologist who spent half of his time in the hospital and half in the office. Probably 80% of the time was lung-related problems, though he did an admirable amount of general medicine work, which I have the impression is unusual for specialists though I don’t know for sure. He would, for example, notice that a patient was extremely anemic (or, even better, he’d pay attention when I noticed and pointed it out), and make sure that the patient got the appropriate workup and treatment. And he saw some patients in the office who were just general practice, or who were not really his patients but were really in need of treatment (his dry cleaner’s wife, or some such person, was having trouble with depression and he let her come in that same day; as he told me, she might be better served by a psychiatrist but she’s not about to see one, is she?). So I did actually get a good picture of medicine.
I very much enjoyed working in the office, seeing lots of patients but getting to know them, and coming up with plans. Most of the downsides were due to being a student - it’s somewhat stressful to spend all your time with one person for a month and depend on them for your grade, no matter how great they are, and having little control over what you’re doing is rough as well. The hours were a little hard, but we were only working 10 hours a day; the bad part was that it was far away so I was also spending up to 2 hours a day in the car, which does eventually get tiring. So while there was some unavoidable stress (tracking down lab results, getting staff to do things that needed to be done, making difficult decisions, etc) that is always going to be part of a physician’s life, I thought outpatient internal medicine sounded overall like an excellent choice.
Thoughts on other rotations to follow, at an as-yet-undetermined interval.
I’ve always had some difficulty with identifying pictures. I am pretty sure it’s genetic, as I’m the daughter of a woman who didn’t understand what the red hand on crosswalk signs referred to (hint: it’s in contrast to the green or white walking person). (Hi mom!)
This caused me some trouble in first-grade phonics, with those mimeographed worksheets that showed a picture and then some letters, and you had to circle the one that the name of the object started or ended with. Sometimes I couldn’t figure out the picture at all, and sometimes there were difficulties with names. One that I remember very clearly showed a picture like this:
(image from this mildly amusing site)
I circled C for Cup. It wasn’t until I got the worksheet back with a big red X that I learned most people would call that a Mug.
This disability occasionally causes trouble in med school, since photos of medical conditions are usually cropped to include only the affected portion of the body, and often oriented strangely. I spend a lot of time in lectures like this morning’s (on anaerobic bacteria) whispering to my neighbor, “what IS that?”
Strangely enough, there are three words frequently encountered in medical school that feature the pronunciation n[?]-’mä-nik (where [?] signifies a sometimes-varying vowel sound) and contain a silent consonant. Though they are frequently confused, each word is different, as is each silent consonant. A quick guide, including a mnemonic to keep them straight:
mnemonic: a memory aid. M is for Memory.
pneumonic: relating to the lungs; e.g. pneumonic plague. P is for Pulmonary (or Plague).
pathognomonic: definitively characteristic of a particular disease. G is for Guess (what you don’t have to do if you see a pathognomonic sign).
(gnomonic: a kind of map projection; not likely to be found in medical school.)
When I first announced my intentions of going to medical school, probably the second most common response (after “how long does that take?”) was “are you kidding? You’re way too squeamish!”
Well, it turns out that I’m pretty stubborn, and I decided that squeamishness shouldn’t stop me from doing whatever I wanted to do.
I’m cutting this post so that those who are really squeamish don’t have to hear about it. There’s not too much graphic description, but definitely mentions of things that might make you go “ew.”
Read the rest of this entry »
I’m a member of the CPR teaching team at my school. We’re Red Cross certified as instructors, and we teach CPR to various groups throughout the year: incoming first-years, rising third-years about to go into the hospitals for clerkships, and laypeople attending Mini Med School.
During orientation this month I taught groups of first years. I had a good time and got to meet quite a few of my new schoolmates. And it’s a fun class to teach because there are a lot of opportunities for jokes, and I like making people laugh.
I noticed something amusing during this running of the course. Partway through the class, I hand out several baby-sized manikins to practice infant rescue breaths and CPR. After they’ve practiced I lecture a little more before we go on to the next skill, so the “babies” are floating around among the students. It’s funny to watch what they do with them.
About a third of the students cuddle them, holding them as they’d hold actual human babies. This doesn’t appear intentional - they’re not playing with the dolls, just automatically holding them. These individuals are approximately half male and half female.
Another third or so play with the manikins in ways that would likely cause shaken baby syndrome in real infants - holding them by the ankle, tossing them back and forth, that sort of thing. The majority of these students are male, but females are well-represented as well.
Most of the remaining students ignore the dolls once they’ve finished practicing on them.
But there are always one or two students who take the manikins apart (the faces come off and there are removable sponge “lungs”) to find out how they work. These students - both males and females - are almost invariably former engineering majors.
The second year of med school started yesterday. So far, so good. The second-year lecture hall is much nicer than the first-year one; there are more aisles so people actually fill in the middle, and the HVAC system works better so I’m wearing short sleeves and not freezing. (I was a bit chilly yesterday in a tank top, but not so much that I had to leave, unlike certain times last year.)
Grades are back - while last year was pass/fail, this year we have honors/high pass/pass/fail. Scheduling is by various-length blocks: first we have pharmacology, pathology, and ENT for three weeks, then a week of tests, then the next block is something like two months long. Most of the time we get the Friday of exam week off so there are long weekends to recuperate, which will be nice.
This year is supposed to have a much heavier workload than first year (we don’t usually have afternoons off, for one thing, and we have to learn a lot more data) but it should be a little more interesting because the information is more directly relevant.
Somehow I’ve ended up helping to run several student groups. I’m semi-officially one of the people in charge of the CPR teaching team and the Gay-Straight Alliance. And I’ll continue to be involved with the Perinatal Project (which provides prenatal information to at-risk pregnant women), the Young Scientist Program (which teaches science to school kids), and probably the Reproductive Health program (aimed at middle schoolers). Although that sounds like a ridiculous number of teaching volunteer programs, it’s actually only half or less of the teaching teams that are available here, so I’m restraining myself if you think about it. I do plan to keep teaching test prep as well, but probably only on a substitute basis in the interests of keeping my schedule reasonable.
I might post more if I continue bringing my computer to class. I’ve been wanting to do several posts wrapping up the first-year experience; we’ll see how that goes.
I’m currently sitting in a delightfully nerdy lecture about STD transmission. The lecturer is discussing various models drawing from different areas of study. First there was population biology stuff with assortative and non-assortative mating, and then there was graph theory to analyze sexual networks, with references “betweenness” and “centrality”. I’m very amused.
(It’s also a good lecture in general; he’s emphasized the need to respect people’s decisions about their own sexual behavior, the fact that not everyone is at risk, and the fact that while you can predict whether certain groups are likely to be at risk, you can’t definitely say that a given individual is or is not at risk without private information.)
I had a histology exam this morning at 9. Last night I studied until I was sleepy, then set my alarm for 6 so I could review slides until it was time to go. Then I experienced the following series of unfortunate events:
- This morning, my alarm didn’t go off. Luckily, I woke up at 7:30, so I wasn’t completely screwed, and I did get to go over a few slides, but I was pretty nervous about missing that last hour or so of review.
- Having squeezed in as much review as I could, I cut the time a little too close and got stuck in the 9AM medical center traffic, so I had to park at a meter right outside the building in order to make it on time (it’s partially a projected exam, and if you miss a slide, tough luck).
- The test took two and a half hours, an hour more than I’d expected and 30 minutes longer than I’d paid the meter for.
- Sure enough, I got a ticket.
- The ticket was partially snow-covered, so I didn’t see it until I turned on the windshield wipers, causing the actual ticket part to fly away.
So now I have the envelope for a ticket, and I have to call the city tomorrow to find out how much my ticket was for.
On the plus side, I’m pretty sure I did well on the test.