Aspiration...

I think to most people, the term "aspiration" generally has positive connotations.

It means ambition. The desire to accomplish something great.

But in a hospital, the word "aspiration" brings to chills to everyone's spine.

If someone might have aspiration we do all kinds of stuff to stop it.

We might shove a tube down their trachea and have a machine breathe for them if we think there's a risk of aspiration.

And if a kid comes in with aspiration... it's truly an ordeal!

Cause, in layman's terms, aspiration means you done breathed some vomit or somethin' into yo lungs that don't belong there. Those were layman's terms, North Florida style.

Working at hospitals has destroyed the word "aspiration" for me, and it has coincidentally taken a toll on my aspirations in medicine in ways too convoluted to describe at this moment.

Some days, I feel that if choosing a career was like picking something from a menu at a restaurant, I'd send this dish back and ask for something more tasty. I'd also make sure that my new order would actually be worth the price. Or maybe, I'd just get up and leave and never come back to the restaurant.

Damn I'm hungry now.

Mmhmm... I'm back.

Parin has inspired me to bloggity blog. Also I'm on Pediatrics, which is far less intense than surgery. Also, it's almost time to choose a specialty, which means all them issues come to the surface...

Like, why medicine? What should I do with my life? Where should I go? Should I follow him to NYC? (I know the answer to that one at least)... Do I really want to spend 80 hours a week at the hospital?

But I don't want to talk about that right now, because none of that is happening right now. And I promised myself to stay present. None of that past-dwelling or future fretting ever really helped me much.

So presently, I am a 26 year old girl. Correction, woman. At this point, I've got at least 20 white hairs sprouting from my head. And even if I didn't, I think I'm a woman now. So, I am a 26 year old woman who is learning about how to take care of people- healthy and not so healthy. A 26 year old woman who is learning about how hospitals work and how operations are undertaken; how antibiotics are given and how wounds are cared for. I'm working hard and waking up WAY earlier than I ever thought I wanted to wake up. I'm allowing myself to vent some complaints (sometimes a LOT of complaints) but I am getting better at remembering to be grateful for the amazing opportunity and privilege medical school really is. Presently I'm enjoying being in love with a wonderful person who complements me and compliments me and holds my hand when I need it but not tight enough to hurt anything. Presently I'm enjoying the fact that I am young and I can scurry along on my happy way, no arthritis or shortness of breath slowing me down. I can eat a cookie or two without having to stab my flesh and provide insulin (though I do consistently get a pang of guilt whenever there's a cookie in the same room as me). I can make plans to go to Burning Man this year and just be free. Presently, despite my graying hair and forming wrinkles, I'm enjoying being young with the world as my oyster. And I love eating oysters, too. I'm enjoying farting loudly in front of loved ones, being totally inappropriately loud and obnoxious, eating with my hands, playing video games...

And presently I can't help but fear that a career in medicine will completely RUIN all of that. The promise to me is that I will try my darndest to not let that happen.

HA see what just happened there? The sneaky fretful future thoughts just joined the party. Uninvited!

I guess one more thing to say is that though I counted my blessings in the previous paragraphs, I UNFORTUNATELY often forget how lucky I am and fall into a pattern of complaining and whining, moaning and groaning. Speaking of which- I've got some stupid tobacco assignment to do now, so that's all for today.

What third year is all about.

During the third year of medical school, the med student is a rare form of human being.

"You are here to learn" they tell you. What they don't tell you is that you are here to help out, but don't get in the way and don't be too overzealous. You are here to report your findings but no one will actually listen to you, they will only wonder why your presentation isn't exactly how they like it (and everyone likes it differently). They will quiz you on the stuff you learned in the first two years, and when this happens, a couple of things become clear: 1- you know more than the residents, 2- you are being judged for every stupid answer you give. They ask you questions, but you're not supposed to always answer them, because then you're a know it all. But if you don't answer the questions, you are not a competent medical student. You have to be professional, be on time, and be okay with standing around with no clear directions on what you're supposed to be doing. You have to meet the expectations of all of the different attendings in each of the different specialties- some will let you do everything and others make you follow them around and never leave you alone with the patient. Some want you to present the patient to them as a whole, and others just want to know about the patient's particular disease, right now, today, and everything else is extra information that the idiotic med student is giving and wasting everyone's time with. Some of them want you to go and do all sorts of irrelevant physical exams "just for pratice," regardless of the degree of distress the patient is in. Some patients know this, and they've already had 2 other people come in and do their physical exam, so they refuse to let you touch them. And then when you go back and say what happened, it's your ass. Why? Because "this is a teaching hospital and patients know that." It doesn't matter that the woman in room 4 is depressed and alone and scared. Go make her touch her nose and your finger and ask her to repeat 3 words back to you and make her walk on her tip toes and listen to her bowel sounds and poke her all over.

On the other hand and on a brighter note, the third year med student gets to sit in the room with a patient for an hour or more. No one is relying on the third year med student to write any orders or actually take care of anyone. It is a chance to connect in a way that no one else on the team can. The third year medical student is learning every day. Learning and integrating the past two years of hard work. Seeing why we needed to learn every cross section of the brainstem and the names of all of the major drugs and drug classes and the reasons why certain diseases do what they do.

The learning goes beyong academics, though. You also learn, through first-hand observation, what kind of physician you want to be, and what you don't want to be. I have seen some truly insensitive, awful physicians and residents. The things that scares me the most is those physicians who have forgotten to look at people in the eyes. Or maybe they never did. The ones who have forgotten that each patient is a person, not a disease. The ones break awful news, such as "you tested positive for HIV" without asking the patient if it's okay to say that in front of a family member who is in the room. Without asking the patient if it's okay that 2 med students and 3 residents are also in the room. Without any concern for the fact that on the other side of a thin curtain, there is another patient in the room. Without going through anything that looks remotely similar the breaking bad news protocol, SPIKES, that we learned in our second year of med school. I can't remember what SPIKES stands for (ok, shame on me), but essentially, you prepare the patient to hear the bad news, you ask them what they know about the disease, you ask if they're ready to hear it. You show a shred of human emotion and look them in the eyes when you tell them.

I understand that for the sake of efficiency and in order to be fair to other patients, physicians can seem a bit cold and impersonal. But just because I understand it doesn't mean I will accept it.

I look forward to meeting more and more physicians who are not monsters, who are not jaded, who are not cold and impersonal. I have already met a few role models, and I am excited to meet a few more. Even the non-role models are good to have. They serve as reminders of what NOT to become.

Geri geri bo berry banana fana fo ferry me my mo merry... geri

-atrics... is over!

My four day rendezvous with this specialty is over (for now). I love the patients, but the doctor I was with the most didn't let me do ANYTHING. NOTHING! Poo! I think I listened to a couple of hearts but that's about it. Either way, I still learned a lot from him.

Old people are pretty cool to work with. So sweet and old and tired and wrinkly, some so close to death, they're all so full of... LIFE. They've been around for a while, they've reproduced and their progeny has reproduced and, in some cases, that spawn of their spawn has reproduced. It's crazy. I love listening to their crazy stories. Especially the old guys at the VA hospital.

As I leave this rotation, I think about the possibility of being a Geriatrician. The problems are complex, and some patients are so difficult to deal with, particularly any patients with dementia or Alzheimer's disease. The career involves dealing with death and dying, as well as working with the patient's family members- which can be quite challenging. It seems like a career with a lot of sad cases, and I do cry a lot, but... I kind of like that intensity. I imagine I might stop being a big baby if I dealt with the stuff on a daily basis.

Speaking of sad, today I watched a woman score a 3 or 4 (out of 30) on the MMSE- Mini Mental Status Exam. A score below 20 means severe impairment. The test includes all kinds of simple questions that assess attention span, thinking, memory, language, and something else that I can't remember right now (maybe I need to take an MMSE). She didn't know the day of the week or where she was, she could only repeat 2 of 3 words, then she could only recall 1 of those words when prompted later. It was remarkable. She seemed like a regular sweet old lady when we walked in the room, but her brother told us about her memory issues and with a simple test that we learned in our first year of medical school, it became painfully clear that this woman was suffering from Alzheimer's diseae and that that she was on her way to progressive decline. It was so sad. It was also quite touching to see that her brother was with her, taking care of her, making sure she ate properly and didn't hurt herself.

This rotation has, above everything, shown me the value of family and the harsh reality that is lonliness in old age. I think for good measure, I'll make sure to have at least 5 or 6 children, in the hopes that one of them will take care of me when I'm old and gray (just in case my siblings fall through).

Next up, 3 weeks of Neurology in beautiful Jacksonville. And by "beautiful" I mean "potentially beautiful but I don't actually know because I hide at the dorms for fear of my life." No, seriously, you hear gunshots right next to the hospital. Miami feels like a warm safe nest compared to this place!

Career assessment, Part 4,567

Today I got to do wound care at the VA hospital. Man oh man!

The first case was a nasty leg wound... and the guy was in excruciating pain. I had to leave the room for fear of falling on my face. My face was hot and I was dizzy as all hell. The smell... the oozing pus... blegh. About 5 minutes after I was brave enough to come back, the nurse made me use a culture swab... right on there. On that oozing nastiness. But somehow I made it through that time. I think seeing him suffer was what did me in the first time, and by the time I had returned he had calmed down a bit. Perhaps I was able to do it without feeling queasy because I was focusing on the fact that this nurse was undeniably terrible person for making me do this knowing that I had left earlier because I was not feeling well. I'm glad I did it, because I had felt bad for the patient after I left. I mean, imagine, you go to the clinic to have your awful, debilitating wounds cleaned out and you're in terrible pain, and the girly med student has to excuse herself because she is so disgusted, meanwhile YOU are the one who's suffering! Poor guy!

So, of course, like clockwork, what happened??? That huge, neon, flashing sign showed up in the back of my mind:

wrong career - wrong career - wrong career

I hate that sign. It seems to shine brighter at times like these, when I feel like a total whimp-o.

But hey, at least I'm a student and on loans and no one's expecting me to get a job right now. I'm unemployed and that's okay! Plus when I do finish, I'll have job security. Soooo... even if it's the wrong career, at least it's not one that was a total waste of time to pursue (I hope).

Regardless, this woozy whimpy girl shit has got to stop! *snaps fingers and swivels neck*

I'm supposed to be this strong, intelligent woman who will take care of people one day. Instead, I'm like "eeeewwww pus! OMG It smellllls." I swaer, by the beard of Zeus, next time I'm staying in the room. And if I faint, I faint. But I'll make sure to stand next to someone who looks soft to fall on, like a chubby person. Or maybe I'll sit down or something and allow myself to just pass out in the chair, then maybe no one will notice. And I'll be cured!

Geriatrics?

I was toying with the idea of Geriatrics as a career (it's on a long list)... but today might really affect that decision.

Today I went to a nursing home/geriatrics medical center. The lobby was tastefully decorated in warm colors and mahogany. It looked like it belonged to a cozy bed and breakfast. There was even a nice small fountain, and I said to myself "that's a nice fountain" and proceeded cluelessly...

I kept walking and the warm cozy happy lobby turns into a strange, sad, place that engages all five senses and then some. The sight of flaccid withering people, the smell of urine, the sounds of suffering and nurse call bells, and the feeling of wrinkly, pasty skin as I examined people who have lived more than 3 times as long as I have. There was an eerie sensation that death was lurking nearby, and it was impossible to ignore the overwhelming feeling of sadness for those suffering patients and fear of the future of my own family and friends at this stage of their lives.

The nursing home had a neat physical therapy room and I checked out the calendar and spotted some cool activities for the residents to enjoy. I had noticed that all of the patients had nice maniures, and discovered later that it was on the calendar as well. That was cute. All in all, I'm sure it's a great place for the elderly compared to some other nursing homes, but in the end, it's still a nursing home.

The patients that made me the most sad were the ones with cognitive decline/dementia. They seem lost and empty, just waiting for their bodies to catch up with their brains and expire.

Death itself is not so bad. It means peace for so many of these people. The physician I am following told me that for many patients, he will not treat an infection or he might withdraw all medications if it means that their suffering will end. Essentially, it is much better to let an elderly suffering person pass away than to keep them alive and pump them full of meds. Keeping someone alive if they're in agony is barbaric, but sadly sometimes mistaken for true medical care. A good physician will do his or her best to reduce suffering, not just prolong life.

In this nursing home, I saw a lot of suffering. And it's not just patient who is suffering, but also their loved ones.

I am grateful for every single person who goes into Geriatrics and takes care of the old folk. It is challenging and delicate, and surely not the most fun job in the world.

Quotables....

"You're dating a Jew? I don't really like them Jews" - A patient, to me
"See, we doctors, we're not people people. We're science people." -A robot disguised as an attending physician.

Ok, yeah, the second quote was actually a physician that I worked with recently. Doctors ARE people people. Or they should be, at least.

He made that comment at the beginning of my 2 hours following him around. I tried to put it aside and just observe his style. Mechanical, efficient, quick. The patients love him. He is overly excited when they do stuff right and applauds them loudly, yelling things like "beautiful!" and "magnificent!" whenever blood glucose measurements are good and hypertension's under control. It's like he's the Emeril of medicine. "So, is this dude a good doctor"... I asked myself. Well, let's see here: patients like him, check. Patients are doing exceptionally well with him, check. He is thorough, check. He dictates his notes IN THE ROOM just after patient interview, which seems so weird to me, but actually probably reduces medical error. His awkwardness is trumped by all that other good stuff. Hooray! He's a good doctor. But he's not a people person.

That's so weird to me. Maybe he's learned to be a people person, and he doesn't realize it yet.