It's okay, Shelby, women are havin' babies every day!

I'm having a ball on this rotation. Like I said, I'm working at a little clinic that is close to home, with a family doc that I've known of for what seems like forever. She is truly a selfless person, and just works tirelessly for that little community, and they all love her. In my trek through the different departments, I've encountered lots of M.D.s (and D.O.s) - there are two distinct ends of the spectrum. Some are "physicians", commanding respect and admiration for all that they've accomplished. And some are "docs", who are following a calling outside of themselves, and who meant it when they said in their admissions interview that they wanted to "help people". The "docs" get the respect and admiration anyway, but they'd never go looking for it. My preceptor this semester is the epitome of a Doc.

Family Medicine doctors are trained in OBGYN as well as some surgery, and you can do some, all, or none of those in your practice. My preceptor does OB (which is my next rotation, by the way, so I'm getting a jump start on some things. The Lord takes such good care of me - He's trying to build my confidence so that I won't totally panic before starting the OB rotation. I'm getting a chance to know the OB residents, attendings, and nurses as well, which is good.) On Wednesdays she's on call at the hospitals, so I spend all day with her, rounding on postpartum moms and pregnant women with other medical problems, and being around whenever one of her patients decides to deliver. (Those deliveries, by the way, are so awesome and I love them. They put me on this great natural high, because I love watching God's handiwork enter the world, and the interaction between the mom & dad and the rest of the family always brings a tear or two.)

Last Wednesday, none of the students on the OB rotation were around, because they hadn't started "Night Float" yet - and that's when the students get to be on Labor & Delivery. This week, two students in my class were there doing night float, and they were each assigned to our two laboring moms. When I heard that, my heart just sank - I didn't think they'd let two students in the room.

I went with my preceptor (I'll call her Dr. L) to check the mom's progress, and she was dilated to 10 and fully effaced, so that's when we all gown up. Plus there were some head compressions on the fetal monitor (not as scary as they sound - it just means that the baby is getting into the birth canal) and that's what sent us in there in the first place. I asked the mom if she minded if a student observed, and she said no, and I asked how many she'd be comfortable with, and she said one. My heart was recovering from the earlier sinkage, and had risen to somewhere around my pyloric sphincter, but that made it sink again, because I knew it would be the OB student and not me. I didn't say anything, though, and I chatted with mom & dad for a few minutes about the baby and names and other kids and such, and then started to leave. Mom said, "The student will be you, right?" I said no, and Dad said, "How many students would have to be in here for you to be in here?" I held up two fingers. Mom said that was fine. I asked her approximately 17 more times, and told her it was all about her and that I didn't want her to regret a thing about the experience, and she said that she wanted me there. Yay! So I got to watch that birth, and I actually made Mom, Dad and other family members in the room laugh in those awkward pauses between pushes.

At one point, Mom said that her hair must be a mess. I told her that she was beautiful, and Dad agreed. By this time we could see the top of the baby's head, and a shock of dark hair. So I said, "The baby's hair, on the other hand, is looking a little rough." Then I added, "I think he just has too much product in it." Hardy har har. That made everybody laugh. Obviously, you have to get a feel for the personality of the parents and the family (and your attending doc and resident) before you say something like that, but I am a big fan of humor. If I didn't laugh, I'd cry.

Which brings me to my next point - I was talking to the other two students that are on OB (incidentally, since a class just graduated, the rest of my class are officially fourth-year students. Yay for them!) One of the students asked if I was going to take the Step 2 review course, and I asked when it was. And the other student said, "She's not a 4th year." Which brought tears behind my eyes, because I feel like I don't belong anywhere anymore since I took some time off. One of the things that helped me through the first two hellacious years of medical school was the fact that my class and I were going through it together - I saw it as a kind of "band of brothers" thing, although everybody else in the class may think I'm crazy and I may be the only one who felt that way. But now, my class is in their last year, and I still have this rotation and three more to do. I feel like they've all moved above me and are looking down on me now, so I don't belong with them. But I don't belong in the class below me either, because I barely know them (with a few exceptions). So the camaraderie is gone, and I feel like I don't have any peers that I can talk to. It makes me really sad, actually. I even feel that I can't really talk to close friends in my class in the same way - it's kind of like they're freshmen in college and I'm still in lowly high school, and I just feel stupid. You know, typing this, I realized that I don't even feel right calling the class of 2009 "my class" anymore. So, I've been kind of keeping to myself as much as possible, but it makes me sad. Oh well. Nothing can be done about it now, and everything works out in the end. The Lord has me in the palm of His hand and carries me through my difficult days. I just can't praise Him enough. So I know I'm never truly alone.

And finally, I had a patient today who tried to quote a Bible verse to me to prove that Jesus smoked weed. I'm totally NOT convinced. I do love patients, though - they are so great. That is all.

A Good Week! Yay!

I've seen the best
I've seen the worst
I wouldn't change what I've been through
I've touched the sky
I've hit the wall
But I did what I had to

On my way here
Where I am now
I've learned to fly, I have to want to leave the ground
I've fallen hard
But I've been loved
And in the end it all works out
My faith has conquered fear
On my way here
Clay Aiken, On My Way Here

Part of the lyrics from the first single on his new album that was released Tuesday (May 6th) - I love it. It makes me cry, and it's almost like he's been living my life for the past few years (although I realize he didn't write the song.) Anyway, the whole album is good - his best yet by far, in my opinion. Of course, I will always love that voice, and the production quality and the songs seem better this time around.

So! I finished my first week back at school and I have lots to say, but I just wanted to let y'all know that I have had a GREAT week, and I am loving life right now, and I'm all-over-the-place thankful to my Lord, from whom all good things come. He is so good to me. I'll write more later about what I've been up to this week, for those of you who are interested! But for now, I'm a sleepy girl and I need a nap. :-)

Before I went back to school, I got my hair cut and my hair guy (Ron Wilson from Ron Wilson Hair Gallery, he is fantastic) talked me into highlights:

I decided after awhile that they were too red and were making me look a little washed out (and I'm translucent anyway) so I bought some Perfect 10 at Walmart and darkened the red a little. The red still shows through, but not so much, which is exactly what I wanted. I was scared as I was washing out my Walmart dye, though, because the suds? Were purple. Lavender, actually. So I was terrifed that I'd end up like one of those little ladies with violet hair. To ease your troubled mind - I didn't.

More later.

Doctors are funny!

That is, except the tactless ones that ruin the Internal Medicine clerkship for 3rd year medical students. Anyway, I found this article online from The Journal of Family Practice (Howard J. Bennett, April 1995) and it amused me. It's about humor in the medical practice, and has wit throughout. Here's a couple of my favorites:

A surgeon, an internist, and a family physician go duck hunting.

The surgeon sees a duck, shouts "Duck!" and shoots it down.

The internist sees a duck, shouts "Duck! Rule out quail! Rule out pheasant!" and shoots it down.

The family physician sees a duck and blasts it out of the sky with a burst of machine-gun fire. As the tattered carcass falls to the ground, he remarks, "I don't know what the hell it was, but I sure got it!"

Rule out quail! Rule out pheasant! Hee. It's funny because it's true. I also like this:

To the Editor:

Last year, my husband, a pulmonary fellow, sent me a valentine; he thought that the cardiac system was receiving far too much attention on that day. I thought that your readers would enjoy the valentine.

A Pulmonologist's Valentine
Roses are red
Violets are blue
Without your lungs
Your blood would be too.

Here's the whole thing, if you're interested: Humor in the Medical Literature - Editorial

Heavy-handed moderators and the posters who don't love them

I was searching for something online the other day, I don't even remember what, and I ran across a post on http://www.healthboards.com/ that seemed to be an answer to my query (although I could only see a snippet, given that Google is such a tease!) When I tried to go to the boards and see the actual post, it required registration to see anything that had been posted. Well, okey dokey. So I registered, filled out my profile (which, for one thing, asked for "occupation" and so I listed, "medical student".)

Then I read the post that matched my search, and I perused the site and posted two more things. I returned yesterday to find that my account had been suspended. What the February? (I don't care if Ellen DeGeneres is a big ol' lesbian. She makes me laugh, and I don't laugh much anymore, and therefore I love her.)

Anyway.

The big scary "SUSPENDED, YOU LAWLESS THUG!!!!!!!!!!!!!!" page gave an email address to which to direct appeals. And appeal I did:

Hello,

I just visited HealthBoards.com to login - I only registered the other day (username: kimberly78) and made two posts, one on an skin treatment regimen that has worked well for me and the other on the pain management boards. When I visited today to check for any responses, I see my account has been suspended for the following reason:

"Peer Sharing Only - Med School"

Huh? What did I do wrong here? I would very much like an explanation and for my account to be reinstated. Thank you.

~Kim

Today, I got this email back:

This website is a peer support group for patients, only. The terms of use are very clear that you may not register or post on the message boards as a board topic professional/student.

From the rules:

Do not register or post or reveal your past, current or future board topic or healthcare profession, in any way. The boards are to be used for PEER support, only. Professional titles lend undue weight to what is to be only your opinion. Members are to share health
opinions and advice as PEERS.

You need to know that the Posting Rules and moderator instructions are enforced.

Thank you for your understanding.

Administrator

www.healthboards.com

Whoopsie. I guess I shouldn't have signed my post, "Kim, a third-year medical student who has been going to medical school for three years, during which time they have been teaching me medicine so that when I finish this school to prepare doctors of medicine, I will be a physician (an M.D.) who knows and can practice medicine."

Seriously though, Jiminy Christmas. That was a little snooty, Mr./Ms. Gestapo Moderator. (It hearkens back to the fugly brown moderator edits that I got when the loony bird Clackhouse began (before I fully realized their loony-birdness and got the heck out, although I still enjoy reading them once in awhile for a good fix of crazy). I was always getting edited at their banana republic because they hated me a really lot.)

But this guy/girl hasn't quite had enough time to hate me, you know? Furthermore - not just in medicine, but can anyone who has learned anything give their opinion without taking into account what they know? Are we all supposed to go, "La la la la la! I've forgotten everything I've ever learned, and now, here is my ignorant opinion!" Geesh. I guess this means I can't use health forums, never ever again.

It makes me wonder if this moderator is someone who applied to medical school and didn't get in. Heh. Actually, he/she probably is an actual physician or something (or, if it's a girl, she's obviously a nurse because girls can't be anything else, right?) and just has a stick between his/her gluteus maximii butt cheeks.

[an inside joke] Yes, Lori et al., I didn't read the effin' FAQ. So shoot me. :-) [/inside joke]

An ER visit worth writing home about (preceded by some TMI, just so you know)

Lately, I've been having a little medical issue that isn't quite related to my pancreas - well heck, I'll just tell you. This fentanyl patch that I wear, being an opiate, has the unfortunate habit of slowing down peristalsis of the intestine (meaning that it slows your gut to a crawl and greatly decreases its squeeze-squeeze-squeezage.) While I am on a "bowel regimen" (probably too much information, sorry) of MiraLax and Colace, I will admit that I maybe haven't been 100% faithful to the regimen. Occasionally I'll skip a day. (Nevermore though, nevermore.)

Anyway, the thing is, I was literally full of crap. Hardy har har.

It actually has made me really, really sick - I feel so sluggish and spend lots of time sleeping. I have no energy and not much of an appetite, and I stay nauseated with abdominal cramping, on top of the pancreatitis. I've been working with an urgent care doctor who first tried lactulose. No go. Then magnesium citrate, which may as well have been water. Then he took an xray, saw that I'm indeed full of crap (but not visibly obstructed and there are no dilatations - i.e., areas that look like they're about to explode.) So now, I'm on the five-star regimen: mineral oil 3x/day, lactulose 2x/day, and MiraLax, Colace and Sennakot once a day. Fuuuuuun. Guess what, though? All of that stuff just made the cramping and nausea worse. So I finally went to the emergency room (and you know how I HATE being an ER patient - if you don't know, see previous posts here and here.)

I went to a different ER than I went to in those two horrible accounts, though (if you know me and are from around here, it's the "green" one, not the "blue" one. The one where you're more likely to find the most medical students.) Well, they were ridiculously nice. They asked me if I was in pain and gave me some Dilaudid and Zofran without me even having to beg and plead for relief. Then they did some "washing out" procedures which I totally don't want to do again, and then they gave me another dose of meds and sent me home. But the ER docs were SO nice, and the experience was just a 180 from the mean and ignorant doctors I encountered at the "Blue Hospital".

I'm still feeling really tired and sluggish with general malaise, but maybe it's getting better. We'll see. I go to the pain clinic on Wednesday, and I'm going to ask for an extra dose of my breakthrough meds for each day because six days out of seven, I have about 5-6 hours of severe pain (in addition to the other two peaks of breakthrough pain) and nothing to treat it with. That's one of the reasons went back on leave - I just can't work with that much pain. I complained about it at my last appointment, and do you know what they gave me? Seroquel. Which is an atypical antipsychotic. I'm beginning to think that I don't like this clinic as much as I thought I did. Please pray that the appointment will go well - it's Wednesday afternoon.

But for now, yay for the Green ER!

On leave AGAIN

So, I spent a month in Family Medicine and I LOVED it - if I can slog my way through the rest of school, I am pretty sure that I will end up trying to match in Family. But for right now, my pancreatitis and my anxiety have other plans. I am, to say the least, so sad and disappointed right now. But I wanted to let you know what was going on, since some of you have contacted me to see how things are going. I would appreciate your prayers.

Geeeeeeeeez! I've been gone for awhile.

I have no excuse - just holidays, my birthday, and sickness. Did you know I've been sick on about 26 of the last 29 birthdays? It's kind of my trademark. You should see some of the pictures that I have from my birthdays when I was a wee tot - standing in front of a flickering Snoopy cake, looking unsure whether to blow on it or barf on it. Actually, in this day and age, you COULD see that picture. I'm at the apartment, though, and the picture's at home - I'll scan and add it later. I was so darn cute when I was a kid, I'd hate to deprive you of my cherubian face and my dark curls. (I'm not being vain - because while I was a cute kid, I'm not so cute anymore. So.)

What have I been doing, you ask? Let's see. I ushered in Christmas Eve. Then I ushered it out and ushered in Christmas. Then I ushered it out and ushered in my birthday (my 29th birthday - this is the one that I just keep celebrating the anniversary of, right?) and my pancreas reared it's ugly head even higher than normal. And then I got some sort of virus that came complete with lots of barfage, weird leg pain and twitching. That stayed around until New Year's Eve. Scott was very sweet through that whole viral crap - he came up to see me almost every day and was all attentive and stuff. Awww.

Then I started back to school on January 7th - I'm on my Family Practice rotation. So far, I really like it. It's soooooooo much better than my foray into Internal Medicine (I blame a lot of that debacle, though, on the fact that I was so sick and everyone was all, "How dare you be human!!!") This time, a whole different me showed up to the first day of the rotation. I am a lot more interested, responsible, and attentive when I don't feel like someone is stabbing me in the gut.

And I've watched Reign Over Me, Juno, and Enchanted. I'd recommend them all - especially Juno. I adore Michael Cera (is he too young to join my Geek Love Fake Boyfriend Brigade? I'll have to check.) And Ellen Page makes a great debut. It's funny, heartwarming, and just very darn good.

Oh, and I saw a toenail fungus yesterday. I itched the whole rest of the day. I know that Trichophyton (Trichophytons?) don't have legs and couldn't have jumped on me, but still. The mind is a powerful thing. Also, did you know that adults most commonly get toenail infestations by dermatophytes, which invade normal keratin? And that older adults (i.e., geriatric adults) most commonly get toenails infected with mold, which invade irregular keratin? I didn't either.

How to have your spirit crushed in 10 minutes or less

My last rotation, before I took "personal leave" for this rotation (which should have been my OBGYN) was Internal Medicine. I expected this to be difficult, because medical students know that the internists, especially general internists, are supposed to be the "thinkers". They have to know a little bit about everything. They have to know indications and contraindications for a whole slew of drugs, compared to the relatively minute number that psychiatrists master (don't get me wrong, psychiatrists know their drugs and they know them well). They have to know classic and not-so-classic presentations for a bunch of different conditions. They have to be able to work algorhithms in their head when the occasional zebra comes through the door. They interpret a ton of lab tests and radiology studies and they have to know when they should order more. In my Internal Medicine review books was a ton of information (the textbook itself, Cecil's Internal Medicine, was a workout to even carry.) And I was looking forward to learning it all, hoping to shine on this rotation since I had previously planned to try for a residency in Internal Medicine at the hospital that I was assigned to for my 4 weeks of inpatient service.

But.

I have pancreatitis. And if you've been reading my blog, you know I had a ton of problems with doctors right as the Internal Medicine rotation began, getting me off to a bad start with everyone - having to call in sick and looking like a slacker. My 4 weeks of outpatient service was first, so calling in wasn't a huge deal to the physician I would be working with for the day (it's not like I was part of a team yet - this was outpatient) but since the rotation was organized so smushedly (is that a word?), we only had a couple of days to spend on each specialty. So miss a day, miss pulmonary medicine. Or whatever. Anyway, it didn't exactly further my learning.

And then when my trusty GI doctor, the one who has cared for my pancreatic maladies (and those of my other family members) for YEARS, decided to be a giant buttface one day and tell me that he'd treat my pancreatitis, but he couldn't treat my pain. I'd have to go to a pain clinic for that. (Okay, there ARE no treatments for chronic hereditary pancreatitis except for pain management. If someone knows of an effective one, PLEASE, do tell.) I begged him to just treat me for the duration of this rotation, about six more weeks - to not make me try to find new doctors and switch my medications all around in the middle of this difficult rotation. Nope. He was committed to his buttfacedness. So I was forced to try to find new doctors and switch my medications all around in the middle of the difficult rotation.

I ended up finding a pretty great pain clinic and a good, compassionate doctor who treats me like a person, a patient in pain, instead of a junkie - but I had to go through a couple of bad doctors to get there. And I was in horrible pain for most of the rotation, operating at about 60% of my capabilities. All that severe pain, with no end in sight, eventually ended up making me seriously depressed, which didn't help matters at all.

And it REALLY, REALLY helps to be paired with a student who will actually work with you*. I wasn't, and I felt like one of the attending physicians that I worked with on inpatient was at times comparing the two of us (which they should not do.) Actually, I'll go ahead and stick a little story right here. I got to the hospital one Thursday morning by at least 6:30AM, in order to see my four patients and write a good SOAP note in their charts before 9:00AM prerounds. (And somewhere in there, I had to travel about 10 minutes to another hospital for a one-hour neurology conference, which was held at 8AM every Thursday morning. And I liked neuro, by the way.) Now, I had seen my first patient and was at least halfway through my progress note for her by the time my fellow student got to the hospital. I saw her head down the hall to the call room, where prerounds were held and where we would stash our stuff while rounding. She saw me, too. I saw two more patients and wrote notes on them, ran into the other 3rd year student a time or two as I rushed between floors, and (a little late, I'll admit) had to leave at about 7:55AM for neuro conference without seeing my 4th patient, who had had surgery and was in surgical ICU. I wasn't sure if we just breeze in and see her anyway - sometimes there are infection precautions and whatnot. So I thought I'd ask first. On my way down the hall to the main entrance, I saw my attending and I swear he seemed to glare at me. Maybe I was imagining things. Anyway.

I walked to my car (a meeeeeeellion miles away, because lowly medical students have to park a few yards past the moon at the hospital, so low on the totem pole are we) drove the 10 minutes to the other hospital, parked by the moon again, walked 18 miles to the building where neuro conference is held, went up the elevator, down the hall, and tried to enter as quietly as possible so I wouldn't disrupt ... my fellow Internal Medicine students, who were sitting there chatting. Huh? Note that the student who was on service with me was not there. All of the other students who was supposed to be there were there. There were no residents or interns, though, and no neurologist. So after a few minutes we decided that there must be no conference, and we dispersed back to our respective assignments.

I flew into the call room when I got back to the hospital, right at the beginning of prerounds. Late - huff, puff, huff, puff - drat! I explained to the team (attending, senior resident, other residents, interns, pharmacy resident, and the other third-year student) that I had been at the nonexistent neuro conference that no one told us didn't exist this week. The other student didn't say anything.

All the attendings have their own styles and quirks and such, and this particular attending would sometimes see patients on our list before prerounds, without the whole team. He happened to see two of my three patients, so I only had one to present, while the other student (who, remember, got to be at the hospital for an extra hour while I was being faked out) had seen four patients, none of which had already been seen and three of which happened to fall in a row on our patient list, so it seemed like she presented in her annoying "baby" voice forever. (She would present to the team - all guys except for me and the pharmacy resident - in this cutesy voice that sounds nothing like the way she really talks.)

I presented my one patient (although I did interject a little with my morning impressions when the attending brought up my other patients - an attempt to be more aggressive) - a patient that I had picked up the night before (when we weren't required to be there, mind you.) I checked the list and saw that he had just been admitted, so I went to his room and spent about 45 minutes getting a good history from his daughter-in-law, because the patient was a poor historian due to some head injuries. When we reached the end of the list, I asked the attending about my other patient - the one in surgical intensive care, and asked if I could still check on her. He seemed indignant and said that yes, we could - he had seen her that morning. I told him (and the team) that I would have checked on her this morning, but I was hurrying to get to the neuro conference that no one told me was canceled. The attending said, "[The other student] knew. [The other student] was here early this morning." Apparently, an intern had filled the other student in on the neuro cancellation and she hadn't bothered to page or call me to let me know (she did have both numbers.) Also, she knew I was there well before she was, but she didn't feel the need to point that out - she just let me look bad in front of the whole team. Wonderful. And one of my friends on the rotation told me later that the other student had told her during lunch that she had felt sorry for me when the attending pointed out in front of everyone that she knew about the conference and that she was there early that morning. Grrrr! I didn't need her pity, I needed her to speak up and say, "Actually, Kim was already here when I got here."

*If you're a third year (or fourth year) medical student and your modus operandi matches that of my fellow student - well, just don't. You make things twice as hard for the other students that you work with, you don't let them learn as much as they would otherwise, and you leave them with a bad impression of you. I think I'd rather work with almost anyone else in my class other than this girl. She was awful to be paired with.

All right, finally we get to my horrendous evaluation, the one that still has me questioning my choice of career even today. I went to the attending's office for a little "sit down" where I expected some constructive criticism (which I can take, by the way - and I realize this is a chip off of the iceberg of the yelling and the criticizing that I will get along the line), my strengths and weaknesses to be noted - that kind of thing. Instead, I was told that my first week with him was "difficult at best" and "a failure". The second week was "a little better" but "still not good". My presentations were just so-so. (For what it's worth, another attending in Medicine that I worked with for my first two years said that my presentations were excellent by the end of my 2nd year. Who to believe? Who knows.) My progress notes weren't good. My knowledge base wasn't there (isn't that what the USMLE Step One and the Internal Medicine miniboard test, both of which I passed by the grace of God? Hmmm.) He said that the assessment and plan portion of the note needed lots of work. (That was actually the only constructive part of the barrage of criticism that I could pick out. But here's the thing - I thought that the daily progress note should focus on the subjective and objective part - issues that had occurred overnight, how the patient was feeling this morning, that kind of thing. New complaints, resolution of old complaints, etc. Unless there was a new problem, I didn't see a need for the third year medical student to formulate a big detailed plan, when the patient had an attending, a chief resident, and an intern looking after him. Nevertheless, I tried to do my A/P better from then on - as redundant as I felt it was.) He wondered how I had made it this far, given the fact that I'm a terrible student and I suck so much. I told him that during the first two "classroom" years, that if I had a particularly painful day or days, missing class wasn't a big deal. And also, I was trying to find a new doctor and messing with my medications during most of this rotation. That didn't impress him much. He proceeded to make sure I didn't feel at all special - telling me about a resident that lost both parents suddenly yet continued to work, and how he lost a parent during his third year and pressed right on. At this point I was crying, out of frustration more than anything, because I was so tired of trying to get people to understand my illness and to understand that it's real. I felt like he was kicking me while I was down. At this point he said, "You cry a lot" which I'm not sure if that was an observation specific to me, or just a prediction for the clinical years and residency - like, "One will cry a lot." I don't know. My skin is getting thicker, though, believe it or not. Mom heard something on the radio the other day - Charles Swindoll, I think - about keeping a tender heart and a thick skin. Good advice for the physician and physician-in-training - have a tender heart for your patients and your loved ones, and a thick skin for superiors such as this attending. He suggested that I take some time off to get better. I said that I won't get better - it's in my genes and I'll always have it. But my talk with him turned out to be the proverbial straw that broke the camel's pancreas, and I decided to go ahead and take some personal leave - to get my medication straightened out and my pain under control (as much as possible, anyway) and to hopefully dig out of this super-deep depressing hole that I'd managed to fall in.

I'm still not out of the hole - and now I'm anxious about starting Family Medicine on January 7th, because I'm afraid it will be a repeat and I'll come up short, again. My talk with the attending is as fresh in my mind as it was that day - I replay it daily to myself and question, "Am I going to be a horrible doctor? How *have* I gotten this far?" I know it's the Lord holding me up because medicine is my calling, but is it? Did God send this attending to tell me to go down another path? I don't know. I'm praying about it. I'm still bumfuzzled, though, as to how my fellow student got rave reviews (I know she got "Honors" from one resident while I got only "Pass", because I happened to see it.) She may have talked more during rounds, but her answers were completely implausible sometimes (The attending asks, "This patient has just returned from a heart cath - why am I going to ask her about back pain?" to which the other student blurts, "Aortic dissection!" I knew that it WASN'T aortic dissection (that's a stupid answer - sorry) but I didn't know that it's to assess for retroperitoneal bleed. I do now, though, and won't forget it!), and I'm not the type to blurt answers just so I can allow everyone the privilege of hearing my fake cutesy voice. I want to think about the question first and try to give at least an educated guess, but she didn't give me time. She may have seemed a tad more enthusiastic than I did, but it wasn't much - I would have ran past her in the enthusiasm department had I felt well, because I love medicine and it continually interests me. She didn't spend more time at the hospital than I did. I often went in in the evening to pick up a couple of new patients, and spent time talking to them and reading about their illness, and to check on the patients I was already following. I am truly interested in the patients - I would wake up each morning wondering what kind of night they'd had. She may have felt up to doing more reading than I did - I'll freely admit that. Sometimes the pain wore me down to the point that I could do nothing but hit the couch and sleep for a couple of hours when my day was finished. But still, I fought it out until the end and I managed a B in the rotation. Thank You, Lord.

And then I heard from a very reliable source that the buzz in the Medicine department was, "Kim's performance is not up to par." That's just fantastic. I'd wanted to leave a good, lasting impression on the Medicine faculty & residents, and instead I did just the opposite. It makes me so sad.

Criticism of medical students from preceptors is a tough thing - preceptors either don't give it when it's necessary because they're afraid of hurting the student's feelings or getting a bad evaluation from that student. Or, they criticize TOO much, to the point where they've beaten the student down. I actually like constructive criticism and a discussion of strengths/weaknesses from preceptors/mentors/attendings/residents that I have worked with for a substantial amount of time - because geez, there is so much to learn and so many procedures and tactics to pick up, and knowing what I really need to focus on would be GREAT. Having someone bluntly go after my character, though? Not so helpful.

Good GRIEF. Sorry this is so long, for those of you who are still awake. It feels good to get it off of my chest, though. Any thoughts?

Busy, sick, busy, sick, sick, sick.

The title basically sums up my past 7 or 8 weeks - my "personal leave" from this rotation. I had so much I wanted to get accomplished, and have done none of it because I've felt so flippin' awful. If I do feel like writing soon (hopefully I will - and prayers that I'll feel better are always appreciated), here's what you'll see:

• What the Internal Medicine rotation was like for me
• The evaluation with an attending physician who completely crushed my spirit and still has me wondering if I should be in medical school in the first place
• My Christmas photo shoot Gabe (and now Reed)
• Gabe's little brother Reed's entry into the world
• Christmas
• Some health & beauty products that I luuuurrrrve lately
• Your Fentanyl Patch and You
• A few good movies
• The recipe for some yummy fruit salad that I've been making lately (only 2 Weight Watchers points per cup!)
• My hope that I will soon wake up, discover that the past 2 1/2 years were only a terrible nightmare, and find that I am just preparing to start medical school, without pancreatitis or debilitating anxiety and depression - and that I'll be able to perform the way I could if I weren't shackled with this hateful pain and anxiety. Actually, that wouldn't be a whole post - it's just a thought.

I'll try to feel like writing. :-)

Shameless self-promotion, which may be interesting if you're looking for gifts for a beloved geek or medical student

So, I have a store set up at Cafepress. And it has stuff in it. And it's not all Ramble Strip stuff, because I realize that wearing "Ramble Strip" doesn't have that wide of an appeal, you know? Well, I would hope that it does, but it just doesn't. Anyway, I do have some items (clothing mostly - T-shirts, sweatshirts, tank tops, hats, etc.) that may be appropriate for those of the geek persuasion - your favorite nerd, a dorky acquaintance, you know. There's also some general medical student/doctor stuff there. So if you're looking for gifts, you might want to take a gander. Here's a sample of the slogans that are in the shop (either in "Medicine" or "Geek Love"). Most things come in a pretty wide range of colors, and the products I've bought for myself have been good quality - they wash well, keep their shape, that kind of thing. And I've found that for me, they're true to size. If you have any other medicine-related or geeky slogans that you want me to slap onto some products, let me know. We can work out a profit-splitting arrangement! Each product image is linked to the Cafepress page where you can find it.

My Brain is Hung Like a Horse

Curse Words Are Nothing To Swear By

Keep Out of Direct Sunlight

Geeks Make My Heart Go S1, S2, S1, S2

My Invisibility Cloak Must Have Malfunctioned

Be the Doctor Your Parents Wanted You to Marry (there's also a kids' version of this that says, "I'm Gonna Be the Doctor My Mommy Wants Me to Marry")

I Fear That Medical School Has Driven Me Completely Insane

Real Men Marry Doctors

Medical Stud(ent)

The mirror image of the word 'narcissist'

Optometrists Can't Keep Themselves From Making Spectacles

'I'm Quoting Myself,' I Said

You Can't Spell SARCASM Without L-E-T-T-E-R-S

Now, are those not all freaking awesome? Well, most of them are. Your life is incomplete without one, you know. Let's see, what else? Oh, "You Buy T-Shirts Now!" tm IMAO.

I may be climbing out of my pit

It's been a rough couple of months, y'all. I can barely talk about it without crying, because it was just so full of disappointment and sadness and pain, and it was like I was someone else entirely that I didn't even recognize nor did I like very much at all. (I do have horrible self-esteem and can't find much at all that's good about myself - except for Christ in my heart, of course, but that's Him, not me - but over the past couple of months, I *really* despised myself.) I'm sorry the posts have been so sparse lately, and I'm sorry that when I did post, that it was all about doctors and so on and so forth. Interestingly, my traffic has gone up quite a bit over the past 2 months. Figure that.

Anyway, I hope you, dear readers (I first typed "deer readers" - heh. Scott would be proud - that's what's on his mind at this time of year, too) don't have the idea that I'm some sort of drug-seeking pill-head. Instead, I'm a chronic pain patient struggling to learn to be a doctor, a good one - working 70-80 hour weeks in addition to trying to study in between, and also trying to spend time with my Scott, my family and friends, and some MUCH needed time at the Y. Oh, and sleeping, sometimes. It's hard to do that when it feels like someone is stabbing you in the gut, and pulling the knife around to your back. And then when you go to your doctor or to the ED for help, they instead berate you and you end up sobbing because of their jaded lack of compassion, it's discouraging.

Being in severe pain all the time, all the while being expected to perform in a superhuman manner (and getting bad evaluations when you don't - more on that later) and having more doors slammed in your face - it made me feel more hopeless and sad than I have felt in a long time. I didn't know if I was ever going to get help, or if this pain was going to become a part of my daily life. A Google search found a lot of information on depression resulting from chronic pain. I don't know what the answer is, fellow members of the healthcare system, but we have an underserved population of people here. I don't know how we weed out the true sufferers from the addicts and the dealers. But something needs to be done. And the way I heard other providers refer to patients requiring pain medication was less than encouraging.

I am doing all of the "alternative" stuff that the Interwebz recommends for pancreatitis - an antioxidant blend (the one I take is by Nature Made, with Vitamin A, 100% as Beta-Carotene - 10,000 IU, 200% RDA; Vitamin C: 250 mg, 417% RDA; Vitamin E: 200 IU, 667% RDA; Zinc: 7.5 mg, 50% RDA; Selenium: 15 mcg, 21% RDA; Copper: 1 mg, 50% RDA; Manganese: 1.5 mg, 75% RDA), and I'm also taking an additional selenium supplement, my trusty enzymes (amylase and lipase, aka Creon 10), and a couple of doses of Advil a day for anti-inflammatory properties.

I'm still hurting, though - I do have a new pain doc, and I'll talk about him later - I think I'm going to like him. He and his office staff are already a billion times kinder than the other Pain Clinic Which Shall Not Be Named.

I just didn't want you guys to think that I was an addict who was obsessed with getting my fix. Is that what you think? What DO you think? Let's have it, I can take it. It's why I have comments on my blog - I want to know what people think about what I write, and I appreciate and consider them all. Except the trolls, of course, which I just kick back under the bridge; and the potty-mouths, who I edit and *then* consider. :-)

I'm thinking that I should instead enter a profession in which you're allowed to be human - one where you can not know the answers to a few questions, or oversleep once or twice a year, or accidentally show up at the wrong place occasionally. One in which you can be sick, sad, or tired.

I don't know if I'm cut out for this, y'all - I really don't. I don't think I'm smart enough and I'm not good enough. And it really sucks, because I've been doing the very best that I can. It REALLY sucks. (Rather, *I* suck about 50% of the time, or so I've been told.) If you have a chronic illness, I wouldn't go into medicine.

On a more upbeat note than the crappy evaluation that I just got - I did find a doctor to manage my pancreatitis who seems to actually be sympathetic and kind. Hallelujah and praise the Lord for that! Although being forced to look for him in the middle of my internal medicine rotation really screwed me up.

Ugh. I'm tired of crying all the dang time.

And finally, a PSA - there was a car accident yesterday involving someone with the same name as mine, on the road that I travel to go home (home, home - not the apartment.) So Mom and Dad and I have been fielding a bunch of phone calls, emails, Facebook messages, and the like with people checking on me. That really makes me feel good, because I generally assume that no one cares if I'm alive or not. Especially since I'm the worst medical student that ever lived. But thanks to everyone who has inquired about me today - it made my day a little better!

Aaaaaaugh.

Just so I can keep track of this - feel free to scroll if health stuff bores you. I'm feeling SarahK when she complains that she knows more about her celiac disease than her doctors do. As y'all know, I have chronic pancreatitis (the hereditary kind, not the alcoholic kind - the only drink I've ever had is one drink of champagne at my cousin's wedding. Yes, I am Sandy from Grease, without the leather pants.)

I was part of a genetic study in the 90s that mapped the gene to chromosome 7. The molecule that keeps trypsin inactive until it leaves the pancreas (the molecule is called PTI, if I recall correctly) is messed up, so trypsin gets activated in the pancreatic duct and chews up the pancreas. Not fun. And I'm convinced that mine is exacerbated by stress, because I've been in constant pain since I started medical school, the most stressful time of my life.

For some reason, for the past couple of days, my pain isn't even controlled with my Vicodin HP (hydrocodone/APAP 10/660). As an aside, my GI doctor sent me to a pain clinic, and I went with a current dosage of the 10/660 as 1 tablet q6 prn. (One every six hours, or 4 per day, as needed.) The pain clinic (at which I saw a physician's assistant, not a doctor) gave me a lecture on taking pain medications (I think that in order to work in a pain clinic, you should have had chronic pain yourself. You know? I don't WANT to be on pain medication, and I usually hate when people pull "rights" out of nowhere, but I believe that people have the right to be comfortable and functional if possible. I think it's part of the "pursuit of happiness" thing.) So after the lecture, at which point I felt like crapola, the PA gave me a prescription for a 25mcg/hr fentanyl (duragesic) patch. This is what my GI doctor and I thought might be a good option for me, along with something short-acting for breakthrough pain, because it would work well when I was at the hospital working for hours and hours without time to eat, drink, or pee - and it also provides a constant, steady medication level - no more peaks and painful troughs, and no more chronic ingestion of liver-munching acetaminophen. Everybody wins.

So the first day that I wore the patch was painful, because they didn't give me anything for breakthrough pain and the patch takes about 12 hours to get into systemic circulation. But once it was in - MY PAIN WAS GONE. I woke up the next morning with no pain, no grogginess - it was so great that I thought I was dead and in heaven. And then I saw that I was still fat - no glorified body. But anyway, later that day, I started feeling weak, dizzy and lightheaded. The next morning was even worse. I couldn't get through to a human on the pain clinic's line, so I just went there (and got scolded because they usually ignore walk-ins.) LUCKY FOR ME, they said, they weren't busy. So they removed the patch, told me to bring the rest of the patches back, and gave me a prescription for the 10/660, 3 per day. The pain clinic gives me less pain control than my GI doctor. Great.

Like I said before I got on the pain clinic tangent, for the past couple of days, I've just been in horrible, intractable pain. I didn't know what to do besides go to the ER, so to the ER I went. (And I'm not a revolving door patient - I haven't been to the ER for at least 6 years.) The first ER visit, on Wednesday afternoon, didn't work out because there were approximately three million people waiting, and I didn't want to wait there for the rest of my life. They told me that it clears out in the wee hours of the morning, so at the wee hour of 3AM, I went back. This time I saw a doctor, but it went horribly - the doctor was an evil man who missed the day that they taught empathy and compassion in medical school. He also wouldn't listen to me when, after he told me that my amylase and lipase weren't elevated (translation - "You're a lying, thuggish drug-seeker"), I told him that when pancreatitis is chronic, the cells are so damaged that the enzymes don't usually go up anymore*. They did give me a shot of Dilaudid and Zofran which was heavenly considering I've been in miserable with no relief for 2 days. I thought they'd admit me to let me be NPO and let the evil pancreas rest for a day or two to possibly break the pain cycle, but since the doctor could tell that there's obviously nothing wrong with me because the magic enzymes didn't say so, they didn't. I left there crying because they made me feel like a liar and I knew I'd be hurting again in several hours. And I'm beyond worried about missing clerkship days. I hope I don't get kicked out of medical school, and I hope I don't end up with a different class (no offense to the c/o 2010, but my class is just so awesome and I ::heart:: them. Except one. He knows who he is.)

I called my GI doctor when I woke up from the lovely Dilaudid fog, and told them that the experience had been horrible. They told me that I should call my primary care doctor, who I should have given the ER as my doctor (what do I know? I was there for a GI problem, so I gave them the GI doctor's name. Oh well.) Problem is, my primary care doctor is not in the office today, and the doctors on call for him are all, "Her enzymes must be elevated or she's a malingerer. A MALINGERER!" I'm likely to leave with a diagnosis of Munchausen's Syndrome, but I'm headed back to the ER. I want a couple of days to be NPO, with an IV so I don't get dehydrated, and pain control until this thing breaks. I've got things to do, y'all. I have the weekend to get better, and I hope I'm still a medical student on Monday.

Psychiatry Miniboard

Each rotation culminates in an NBME (National Board of Medical Examiners) miniboard exam, so that we can be somewhat standardized (you know, so people can't open up their own Billy Bob's School of Medicine and start churning out inadequate doctors.)

This is a useful outline that the NBME provides to help you figure out how much weight each subject carries on the exam for each discipline, and includes a few sample questions. Here's the psych miniboard outline:

• General Principles - 5-10%
• Promoting Health and Health Maintenance - 1-5%
• Understanding Mechanisms of Disease - 10-15%
• Mental disorders usually first diagnosed in infancy, childhood, or adolescence - 5-10%
• Substance-related disorders - 5-10%
• Schizophrenia and other psychotic disorders - 5-10%
• Mood disorders - 5-10%
• Anxiety disorders - 5-10%
• Somatoform disorders - 1-5%
• Other disorders/conditions - 5-10% (this probably includes personality disorders, because there was some of that)
• Applying Principles of Management - 20-25%
• Diseases of the Nervous System and Special Senses - 10-15%

The NBME also exists to be the bane of medical students' existence (I picture them all to look like Mr. Burns from the Simpsons - sitting around being animated, rubbing their palms together and going, "Yesssssss ...") The psychiatry miniboard, incidentally, wasn't bad at all. Other than reading a little throughout the rotation for our every-other-week quizzes, and doing further reading about a few major patients that I wrote up, I only studied hard(ish) for a day or two. I am a compulsive book-buyer, and I used Lange Psychiatry Q&A 9th edition, Blueprints Psychiatry, and First Aid for the Psychiatry Clerkship. I don't think there was anything that I couldn't answer by using these books, had I studied a little more (I looked up items that I didn't know later. As Christy says, I may be the only person on earth who studies more AFTER the exam that I do before it. Heh.)

Most rotations require a score at the 11th percentile to pass the exam (except OBGYN, which I think is 22nd percentile, and Family Medicine, which is somewhere around the 5th percentile because it includes surgery and OB questions, which are separate rotations that the student may or may not have had yet. The Family Medicine department gives its own exam in addition to the NBME one.)

So, I really liked psychiatry. Not just because the hours were really good or because the material wasn't beat-your-head-against-the-wall hard, but because it was interesting. I had a great group of fellow students to work with, too. I'm going to miss them when I start Internal Medicine tomorrow! I'm thinking of doing some time in psych as an elective next year, because no matter what your specialty is, you're going to deal with psychiatric patients and psychopharmacology. I would like to actually have a little extra training (seeing how I'm planning on a primary care residency) instead of just giving my patients whatever antidepressant that is written on my ink pen! (Not that primary care providers do that - I'm not insinuating that.)

A hairy situation

One of the most interesting cases that I saw during my psych rotation (which, by the way, ended on Friday with the NBME miniboard*) was a pediatric patient who presented with abdominal pain and an episode of vomiting. Some sort of scan (not sure if it was a CT or MRI) revealed a mass that was about the size of two footballs, which could be easily felt when palpating the abdomen. The size could be estimated by percussing and by using the scratch test, too.

When they figured out what it was, they consulted us in our psychiatry dungeon (psych & behavioral health is in the basement of the hospital.) It was HAIR. The patient's scalp had a few bald spots, and questioning revealed that she was pulling out her hair and chewing on it. Rapunzel syndrome at its finest. They told us about bezoars (glorified human hairballs) in GI pathology last year, and then followed up by telling us that we'd never ever see one. The surgeon that removed this patient's bezoar hadn't seen one. And the images that were taken after surgery were amazing - the patient's stomach was so full of hair that the bezoar looked like a cast of a stomach made of hair after it was removed. Her intestines had to be scoped 70 feet to remove all of the strands.

I went on a consult with the child psychiatrist, when the patient was a few days post-op, and we couldn't find any other OCD-type behaviors, so I don't know what was going on. And I expected her to look malnourished, because she had been doing this for at least two years and, judging by the size of the resected hairball, should have definitely had obstruction problems (she didn't until the week she came to the hospital.) She said that she drank 1 gallon of chocolate milk every day, which provided her with enough calories, I guess - but milk also curdles and adds to the mass. Nice, huh?

There's some pictures and other interesting information on trichotillomania (hair pulling) here - I don't want to post the pictures, lest I make someone spew on their monitor!

*Each rotation culminates in an NBME (National Board of Medical Examiners) miniboard exam - which I'll talk about in a separate post, because the hairball? Deserves to stand on its own.

The Psychiatry Stuff That I Was Too Lazy To Post the Other Day

Now that I'm on my last week of my rotation, I guess I should talk about it a little bit. Sorry I've been so scarce - I've been moving (more on that later) and just busy and tired.

Anyway, I'm in psychiatry for 8 weeks - and our schedules are split into "primary" and "secondary" assignments. The primary assignment is the one that we do in the mornings, and it changes every 2 weeks. The secondary one is our afternoon stuff, and it stays basically the same throughout the 8 weeks. So for the first two weeks, I was at the "main hospital" (the one that is closely associated with the medical school) in the mornings, and we did/observed outpatient therapy and med checks for both adults and children, and covered psych consults for the hospital (along with the attending and/or the resident, of course.) The outpatient stuff work was slow, because most of the doctors and therapists were on vacation, and patients also tend to cancel appointments. But the consults were interesting - I saw a case of delirium (which I think was brought on by both a head injury and withdrawal from a bunch of substances) in a guy who had been in an ATV accident (without a helmet, of course.) I think it would help the whole "Don't be an idiot, wear a helmet when you're on an ATV" campaign if they just showed a clip of this poor guy thrashing around in his bed. He was so sad. And we saw a couple of cases of delirium, and that was about it for my consult experience so far. (I should mention that they keep our rotations "standardized" by giving us a list of procedures we're supposed to either observe or do, and patient encounters that we're supposed to have, and we have to have a certain percentage of them signed off before we can pass the rotation. So patient encounters for psychiatry are things like, ADHD-adult; ADHD-child; Anxiety Disorder; Bipolar Disorder; Conduct Disorder; Delirium, Dementia, Domestic Violence; Eating Disorder; Major Depressive Disorder; Mental Retardation/Developmental Delay - adult; Mental Retardation/Developmental Delay - child; Obsessive Compulsive Disorder; Oppositional Defiant Disorder; Panic Disorder; Personality Disorder(s); Schizophrenia; Substance Abuse/Dependence; Tourette's, etc. And for procedures, we have to do some Mental Status Exams, Substance Abuse Assessment, attend an Alcoholics Anonymous meeting, Psychological Testing, Electroconvulsive Therapy, etc.) For the rest of those mornings for the first two weeks, I observed some child therapy, some play therapy, adult med checks, and watched some DVDs of those patient encounters (like The Teachings of Jon for MR/DD Adult, or Thin for Eating Disorders, or The Basketball Diaries for Substance Abuse/Dependence.) In the afternoons, I have lectures on Monday and Friday, see my Hospice patient on Wednesday, see patients in Student Clinic on Thursday, and Tuesday afternoon I have off.

For the second two weeks, I went to a private inpatient hospital for my morning assignment. That's where things started to get interesting, because that's where I started to see schizophrenic patients, patients with psychosis, that sort of thing. We (Todd and I) would get to the hospital around 9 (okay, he would get there at 9, I'd get there circa 9:15), see a couple of patients and write SOAP notes/progress notes, and when our attending got there at 9:30 or 10, we'd see some patients with him or get a mini-lecture from him on, say, Borderline Personality Disorder, if we'd seen a patient with it that morning. This was where I started having my "I can't believe they're letting me do this!" moments - when I was grabbing charts and writing notes (in BLACK INK, for the love of all that's good and pure - I wrote in blue ink exactly once, and it was such a BAD THING that I might as well have pricked the patient's finger and written with their blood) and also talking to patients and asking them personal questions, and they'd actually TELL ME. Signing my progress notes with my name followed by "MS-III" IS fun, I have to admit. I'll bet MS-IV will feel even better, if I make it to that point. I had two really interesting patients at that hospital - one was bipolar and had been really manic for about 5 days, not sleeping at all during that time. At the end of this lack of sleep, he got one of those Nigerian scam emails, and had a little bit of a psychotic break, and believed it. He became delusional about having millions of dollars in various international banks, and insisted that he was a descendent of the ruler of a country in Africa. I got to follow him almost the entire time he was a patient there, and it was great to get to see him get better with the mood stabilizer meds. He also had an episode of acute dystonia after they started him on Zyprexa (which is muscle spasm in the neck and shoulders) - and I learned that you treat that with Benadryl, of all things. It's the anticholinergic properties of Benadryl that fix it. And then there was another patient with schizophrenia who believed that people could hear him think. He said that he was "allergic to photos" - that if he looked at a picture for too long, he would "fill it up" and that the people who could hear him think would die. I looked forward to seeing how he was doing every morning.

And then for the next two weeks, I was at a different inpatient hospital, with some very, very sick folks. At the end of my two weeks there, even these patients - who were terribly delusional and psychotic at admission or committment - are showing some improvement. That's really rewarding, even though I had nothing to do with it. :-) For the last two weeks, I'm back at the first hospital - the outpatient stuff and the consults. Yesterday I had my oral exam (on an adolescent patient in a 30-day inpatient program at one of the hospitals - on which I got a 97, woo! Thank the Lord.) Friday I have my miniboard exam, and that will be all for psychiatry.

If I think of anything else interesting from the past eight weeks that I left out (and I'm sure I will, because something interesting happens every day) I'll post about it ... well, sometime.

These Are Your Heels On A Psychiatry Rotation. Or, Jessica Simpson Causes Large Fluid-Filled Lesions.

I haven't said nearly enough about my foray into the sleepy, "I can't believe they're letting me do this!" world of clinical medical education. Now, this has been entirely different from the first two basic science years of medical school. First and most imporant, we have to dress up every day (blah blah blah professionalcakes) instead of looking like we just woke up four minutes before. And unfortunately, I'm too fat for most of my "professional" clothes, so I had to buy a bunch of new stuff (that's not the unfortunate part - the unfortunate part is that I'm quickly approaching the size of a small house.) I had to be careful in top selection - cap sleeves must be avoided at all costs, because a shirt with cap sleeves might as well say, "Look at me! I have sausage arms!" They're worse than sleeveless, even. And then we move on to shoes. Since safety requirements dictate that we wear shoes that are completely closed-toe, and comfort requirements dictate that I can't wear much of a heel or anything like that - I pretty much look like I'm sharing shoes with my great-grandmother. The very first day, I wore this cute pair of Jessica Simpson wedges (ballet flats with a wee heel - the marriage of cute and comfortable. Or so I thought.)

At the end of the day, I had blisters as big as my head (and that's BIG.) I later managed to rip the skin off of the blisters by dutifully walking a couple of laps around the park in my orthopedic-looking-but-very-comfy-and-functional Masai Barefoot Technology shoes from Bliss. Check out my scary blisters, and my cracked heels which I cannot fix despite the 1,023,872 heel creams I've tried. And when those suckers crack, they HURT - a lot more than something that small should hurt. I have a crack on the bottom of each heel right now, and I have developed this odd walk-on-my-toes mechanism, which makes me look like I might be cognitively impaired. Anyway, the blisters:

And the next day, I still had to wear shoes, because barefoot student doctors are generally frowned upon. So I ended up buying TWO sets of not-at-all-fashionable shoes with toes - a regular pair in a couple of different colors and a backless pair in those same colors. (I love shoes, though, so I can't really complain. I just wish my shoes in current rotation could be could be cuter.) I actually like being dressed up, though - I feel like a real grownup going off to work or something. (Ha ha, I'm so not a real grownup, though.)

As you know, I'm on the psychiatry rotation, which is known for being the easier one. This was a good one for me to start with, since I don't adapt to change well and it takes me a little while to get used to new routines and such. So it's better that I don't have 4:45AM-8:00PM days (see "Surgery") right off the bat. Eeeeugh, 4:45AM. I really don't know how I'm going to manage that, y'all. I have a hard time rolling out of bed at 6:30. And I've learned that my psychiatry preceptors (i.e., the psychiatrists) are not unlike me. One of them told me that he hates morning. A couple of them don't roll into the hospital until around 9:30 or 10. That's AWESOME. I might consider going into psychiatry solely for that reason. Just kidding. Although I do think this rotation has been really interesting, particularly the inpatient stuff. I'm learning a lot from my patients.

And now I'm tired. To be continued. I also need to tell y'all about my Pain Clinic experience.

Dreams, psychiatry, and future blogging

Y'ALL! I've missed you. I don't know why I'm not writing more - it's not like I'm at the hospital 24/7 or anything (I'm on psychiatry, for crying out loud!) I guess I'm just not feeling creative or something. Although I do have a lot to write about - speaking of that, here's the thing about HIPAA and patient talk. HIPAA, as I understand it, means that I can't talk about patients in any way that would allow them to be identified. So I can tell you about the patient who equates West Virginia with Egypt:

Me (doing a mini mental status exam): Do you know what state [current city] is in? (I was expecting a correct answer, because she did get the city right.)
Patient: West Virginia.
Me: That's corr-
Patient: You know, Egypt.
Me: -rect? Okay.

And you would have no idea who that patient was. You could even go onto the floor at the hospital where I'm currently working and still not be able to pick her out based on that. So I will not discuss patients in a way that allows them to be identified, but I may discuss them if I'm talking about a particular concept in psychiatry, or something that deeply affected me, or whatever. [/obligatory HIPAA statement, because I signed approximately 10^3 forms stating that I won't violate it or else they'll kill my kitty cats and let the air out of my tires. Oh, and chop off my big toe.]

With that said, I can't stop dreaming about my rotation. Seriously. I either dream about psychiatry, psychiatric patients, the other students on this rotation with me (which, despite popular-but-ridiculous belief, I have NO CONTROL OVER and it does not mean that I want to jump their bones in any way, shape or form), or marriage. For instance, I recently dreamed that Scott and I got married and moved to Australia, where I had to take Step One again (the horror!) and Scott's personality changed so that he was a completely different person. He was also wearing yellow capri pants, which was very disturbing. And then last night I dreamed that every person I talked to exhibited an inappropriate affect. This is when someone laughs as they tell you about the death of a person close to them, or smiles at strange points in the conversation - it also applies for crying or being sad at weird times as well. So everyone in my dream had an inappropriate affect, and I would point at each one of them and declare, "Inappropriate affect!" I don't think I'm right in the head, y'all.

Re: Future blogging - I bought a book called The Book Of Myself - A Do-It-Yourself Autobiography in 201 Questions, and I think I'll answer some of the qu