Monday, March 11, 2013

Christmas morning

That's what Match week feels like.  Waiting for Christmas morning.

Where you don't quite know exactly what you will get to unwrap on that special day, but you know what was on your list, and you know what you wanted the most, and you really really really hope you get it. 

But in the meantime, the nervous/excited anticipation just builds and builds until you can't sleep. 

Except with Match Day, there's no way to peek!  Argh.

Fingers crossed for Friday!!!

Thursday, February 14, 2013

Geriatrics month and Happy Valentine's Day!

This  month I am on geriatrics.  It's an elective, not a required rotation, but I think that it should be for medical students.  The only thing medical school teaches you is how to ask a specified list of questions, perform a basic physical exam, develop a "differential diagnosis" (ie a list of what you think could be the diagnosis), and how to prescribe a pill to attempt to fix the problem.

Medical school is not designed to teach you how to deal with someone's social, emotional, and psychological issues.  Well, somewhat on the psych issues, but really you only have 1 month for that.  But let's say you have an 80 year old man come into your office.  He can't see really well; he can't hear really well; he doesn't have good balance; he lost his wife to breast cancer last year; he has trouble emptying his bladder; he sometimes has to empty his bladder too frequently, usually at night, at least 2-3 times; he has trouble remembering things; he takes 8 different medications for his variety of medical problems; and his only 2 children live on the other side of the country.

Medical school teaching:  prescribe Flomax and tell him you'll see him again in a month.

How does that help this poor guy??  It doesn't.

He's a fall risk, meaning he's likely to break a hip.  He may be depressed after losing his wife; he might not even be eating after losing his wife-- maybe she always cooked for him.  He's not sleeping well if he's always getting up at night. He has too many medications for his poor memory to manage on his own. He can't drive himself to the store if he can't see really well.  Prescribing him a medication for his urination is only the tip of the iceberg.  And his only family lives hundreds of miles away.

Geriatrics is all about treating the patient as a whole person.  Geriatricians don't really focus on the medical problems; they leave those to the primary care doctors.  Instead, they focus on functionality.  How can we make this patient more functional so that they can enjoy the rest of their life?  And sometimes the question is simply, "How can we make this patient more comfortable until the end of their life?"

When an elderly patient meets with a geriatrician, these are the things they talk about:
- How are you getting around?  Do you use a walker/cane/wheelchair?  Have you fallen?
- How are you sleeping?  How many times to you get up at night to use the restroom?
- How is your appetite? Have you lost weight?
- Do you have family that helps you?
- Who helps you with your medications?  Are you taking your medications?
- Have you noticed any trouble with your memory?
- Do you feel sad or hopeless/helpless? (depression is very prevalent and very under-diagnosed in the elderly!)
etc. etc. etc. you get the idea.

I think that in order to become a well-rounded physician, no matter what field you are going into, every medical student should work with a geriatrician and/or palliative care doctor for at least a month.  Otherwise, it's too easy to forget why people really need doctors in the first place.  Especially the elderly.

Aside from my soapbox, here are some of my memorable moments of the month so far:

Doctor:  "Do you have any teeth left?"
95 year old woman:  "Don't know where my teeth went.  I musta been hit.  Or maybe I fell.  I don't know what the incident was.  Isn't that weird?  But I have no teeth."

Doctor:  (after patient became highly agitated and borderline combative) "Well that concludes our visit" ::wheels patient in wheelchair out the door::
95 year old woman: (whispers angrily to me as she is being wheeled backward) "I've never heard so much s**t in my life!"

Doctor:  "Just touch my finger with your pointer finger and then touch your nose."
95 year old woman: "My, you have the straightest finger I have ever seen.  You could be a traffic cop!"  ::starts imitating a traffic cop::

Doctor: "Do you have any difficulty urinating?"
85 year old man:  ::turns to me:: "Pardon me, ma'am"  ::turns back to doctor:: "I have a lot of trouble urinating."

And, of course, my favorite, being asked 3 times by the same 95 year old man with dementia if I have a boyfriend.

I will leave you with one last story to think about:
An elderly woman is sitting in a wheelchair with nursing home staff all around her.  The doctor is looking at the woman's pressure ulcer on the heel of her foot.  The nurse tells the doctor that the patient is 104 years old.  "Wow!" we all exclaim.  In an attempt to start a conversation about this with the patient, the doctor asks the patient, "How old are you?" The patient doesn't respond.  The doctor gets down on his knees, face to face with the patient, "How old are you?"  The patient shakes her head, looks confused, and says, "I have trouble hearing."  The doctor gets closer and louder, "How old are you?"  Still a confused look, and she says, "I don't know..."  By now the whole room is assuming that the patient has dementia, and we are ready to move on.

The nurse gets on her knees to the patient's right side, "How old are you?"

"I'm 104 years old, can you believe it?  I was born in 1908," the patient says.  Everyone in the room smiles, entirely impressed.

The nurse turns to the doctor, "Her right ear is the good one."

This story has 2 great morals:
1)  Just because someone looks confused, doesn't respond, or says "I don't know" does NOT mean they are dumb or demented.  They may just be hard of hearing.
2)  Always consult the nurses!  They know their patients more than anyone else does.

Monday, December 31, 2012

The end of the interview trail!

These pictures represent just a smattering of the last 3 months for me.  I've stayed in more hotels in the last 3 months than I have in the last 3 years.  It got to the point where I wasn't even unpacking my toiletries in between each interview!  Insanity.

But, thankfully, the interview trail has finally ended.  I managed to cram all of my interviews into Oct-Dec so that I wouldn't have to travel in January (snow=bad).  Now I just wait for Match Day, March 15th!  Well, first I have to submit an official ranked list of my program choices.  Then I can sit and wait!

Let's see... the top ten highlights of/lessons learned from the interview trail:

1)  I drove for 3 hours on, essentially, a flat tire; thankfully, it was patchable.
2)  I have learned that the little muffins at continental breakfasts will always be gross, despite how tasty they may seem on their serving platter.
3)  Waiting 10 mins for shower to get hot = not fun.  Especially when you give up waiting after 2 mins, settle for a freezing cold shower, and then 8 mins later, at the end of your shower, the water gets hot.
4)  Under-the-window air conditioners/furnaces can be extremely loud. One even sounded like a lawnmower.  A mini-fridge can be loud, too.  There was one that sounded like a miniature spaceship taking off every time it kicked on.
5)  It is more convenient to change out of an interview suit in the car in the parking garage than it is to drive around for 15 mins following bad GPS directions, finally locate a McDonalds, and then lug regular clothes into the restroom and change in a tiny stall.  Not worth it.
6)  If a program director asks you, "So what does your husband do?", you should respond with, "Which one?"  (Didn't try this, unfortunately! The best things to say always come too late!)
7)  If a program tells you there will be a shuttle service from the hotel, don't depend on it.
8)  If a program only tells you all about the wonderful city it's located in and nothing about the program itself, something must be wrong with the program.
9)  If a program laughs at you for drinking a non-alcoholic beverage, something must be wrong with the program.
10)  Always keep an eye out for interesting sights on the road!  For example:

(note: picture taken in a parking lot, not while driving!)

Well, it's been a long 3 months, but it's finally over!  Yay!  5 months til M.D.!

and Happy New Years Eve!

Sunday, December 2, 2012

Lovebirds are destructive.

Thankfully, I have managed to cram all of my interviews mostly into Oct/Nov, so I only have 3 left for the month of December, woohoo!  While interviewing involves getting free food, it also involves a lot of smiling and acting like you're interested even after you've seen something that leads you to think, "Nope, not going here.  No way."  It's unfortunate that you can't just leave after you've seen enough. 

I will update more about interviews when they are all done since I took pictures along the way to specifically post here at the end of the interview trail. 

For now, I will share this lovely and little-known fact about lovebirds:  they are very destructive. 

For example, look at this picture, and think about what it could be:

It obviously appears to be some type of cardboard box.  But what kind of box?  How big was it?  Let's turn it over and find out:

This was a Cinnamon Toast Crunch cereal box.  It looks like a hungry grizzly bear stole it from an unattended camp site.  But no.  It's just Alice's handiwork. 

The original plan after learning of this destructiveness was to put Alice in a box and mail her back to Africa, a lovebird's native homeland.  However, she quickly proved that she was too smart for our plan:

So, alas, we are stuck with the crazy lovebirds and their destructiveness.  Thankfully, there is always enough cardboard to satisfy Alice's appetite.  And when she gets bored with that, there's always the phone book:

Or maybe not.

Tuesday, October 30, 2012

Four years

"Wherever you are,

      I hope you can see me smiling"

Sunday, October 21, 2012

What. The. Heck. Is. THAT??

Well.  It finally happened.  Alice laid an egg.  She is almost four years old, so we thought she was unable to produce eggs.  Apparently, she was just saving this hidden talent for a rainy day.

Unfortunately, this egg was dropped from its bearer from the highest perch in the cage.  The bottom is therefore busted up.  There were no survivors.

Alice is going to make a wonderful mother one day.

Now, you may say, "Hey! If you have baby lovebirds, you can just sell them!"  True.  But raising baby lovebirds is NOT a lucrative business.  It is time consuming and disgusting. (see image of baby lovebird below).  And we would have to raise the babies entirely ourselves because Alice would eat them. Therefore, I hope that none of the eggs that Alice ever lays are fertilized.  Meaning hopefully Einstein is infertile.  Do they do spaying/neutering for birds?  I do not know.  Perhaps I should have gone to veterinary school. 

I never thought this day would come.  Oh, and now we somehow have to find a way to replace Alice's calcium in her empty little bones because apparently making an egg is hard work.  Online, they suggest cooking an egg and having the bird eat the shell (Ironic).  Thankfully, I do have an egg handy...

However, Alice does not eat anything that is not part of her normal diet.  Meaning if it's not paper, she won't touch it. 

So that's what happened today.  Never a dull moment.

Here is the egg in all of its glory:

For size comparison, here is a picture with a bobby pin (top), a Kit Kat bar (bottom), and the egg (middle).

And here is the proud mother herself.  Children beware.

Sunday, September 30, 2012

Bird Castle

Welcome to bird castle.  This is a lovely 3 story, custom-made, full-cardboard abode. It comes complete with its own teepee (green arrow) and secret hideout (red arrow).

The lovebirds have been basically living in a single box for about a week now.  From the second they are released from their cages until they are returned to their cages for bedtime, they have sat in 1 box chewing it to ridiculous pieces.  So I felt bad that they just had a 1 room play pen and decided to build them a castle.  We'll see how it goes.  They may try to kill each other in it :/  That's why there's a secret hideout (red arrow).  Einstein is smart enough to go in the secret passageway to get in there, while Alice will never figure it out (in theory).

That's how I spent the last day of my month-long vacation.  That and doing laundry and getting groceries.  Oh and I watched Mrs. Doubtfire.  So overall not a bad day!

But starting tomorrow, real life begins again :(  I have to proctor a lab exam as the first of my pathology TA duties.  Then it seems like this month consists of a ton of meetings.  Oh well.  I probably should stop watching TV all day anyways.

I have 4 interviews lined up thus far-- IU, Creighton in Nebraska, UIC in Peoria, and Grand Rapids.  The dean's letter is released tomorrow, so I'm assuming the rest of the invites come in after that.  It's going to be a busy few months coming up!

Went to the lake again this weekend for a hike.  See picture below.  We didn't get lost this time thankfully!
That picture was taken from this wooden deck thing that we had to climb up 20 crooked stairs to get to :/  Super safe!

Well I suppose that's all that's new for now.  Hope everyone had a lovely weekend!

UPDATE:  Here is a picture of the birds actually playing with bird castle!  Additionally, I'm not sure how well the "secret hideout" will work... one of them chewed open the leather knot that held the box closed haha.  Oh and Alice is currently destroyed the teepee, as seen below.  The doorway to it is now twice as wide.  She must think she didn't fit? :/