26 May 2006

Rough day in the ER

Last night I got my first taste of the thick skin I assume to you need to survive medical school and life in a hospital. It's emotionally tumultuous and on a bad day it's hard to remember that (hopefully) in the end you do more good than bad.
Before my shift we had a 4 hour orientation to the research studies going on in the ER at the moment. Three of them we were already trained on, so it was a complete waste of everyone's time. The fourth was announced as a go-live today, so basically myself and the other associate on duty were expected to march into the ER with the (unedited) forms and just start enrolling. It wouldn't have been a problem if the forms had been designed for a hospital site (as opposed to outpatient clinic) and the PI knew that cardiac patients (her most interesting population) were off-limits because the coronary studies would get priority.
Confusing and draining.
Ok, so paperwork isn't that bad and it can all be figured out. And you can catch up when the board is messy, even if you do feel a little disorganised. And you can eat enough graham crackers to stop feeling like you're going to keel over. But what's rough is when your patients keep telling you they don't want to talk to you, or enrolling and then withdrawing... or the nurse loses/throws out the blood you need.
But then you lose a patient because they walk out of the ER against medical advice and your standing there with the EKG and you know that person really shouldn't have left. Or you do a domestic violence screening and the woman breaks down and tells you all about her monster of a husband and how she's trying to divorce him, but he's lying to the courts about her. Or your neurocog patient who doesn't finish the tests because they are in head CT and on their way up for neurosurgery. Or the kid who fell off his bike and can't stop crying because he can't remember anything. He looks at his hands if they're unfamiliar and his face is splotched with the bright pink of skin that's been torn off.
Just as your finishing all the paperwork and spinning last bloods two doctors come up to you. One gives you a lecture on not approaching the patients too early and potentially causing double sticks. The other looks at your forms and says "What are you still doing here? What? What... you want extra credit or something for staying late?" No. No, I don't. I just want you to fill out the damn form so I can go home.
The next morning you wake up and find an email waiting for you... be sure to approach the patients early so as to get the bloods you need... copied to the whole damn world.
And we're back to frustrating.

Despite the whining... I love it there. Thursday nights are the best part of my week. If I could stay until 2:30 am every week, I would.

24 May 2006

Bowel Programs

This week on the surgical rehab floor I learned a little about bowel programs, something you've probably not thought of if you've never spent time in a hospital. The nurses spend a fair amount of time monitoring how often and how much you urinate and empty your bowels. There are even special chairs for this. Nice white plastic contraptions.
Almost as soon as I arrived for my shift a nurse called me into a patient room and asked if I would sit with the patient while he moved his bowels as it was taking some time and he had meds to attend too. So I sat there on the bed and tried, really tried, to have a conversation with this (not so lucid) patient between his gripping the chair sides and squeezing his eyes shut... wow, he kept saying, oh wow.
When the nurse returned I was informed the patient was severely impacted and had just been administered a supository (a butt pill). Apparently this wasn't sufficient because despite the groaning nothing was actually leaving patient's colon. Out came the maximum strength enema and another 20 minutes of sitting. Nothing.
At this point the nurse gave the patient a shower and decided to just put a diaper on him and call it a night. Problem is, the patient can't stand unaided, so I was recruited to pull the diaper up over his butt while the nurse held him up. It was this moment that the patient experienced some anal leakage (and bleeding). Nevertheless the patient was transferred to bed and the nurse and I cleaned up.
About an hour later the patient was caught trying to get out of bed (a no no since he can't walk). When questioned what he needed he expressed the need to "take a crap." The nurse was called in and the patient examined, but he was still unable to expell the impacted feces. At this point the nurse asked me to fetch some lubricant (can anyone guess where this is going?) which I brought back with some extra pairs of gloves. The nurse then proceeded to lubricate the rectum of the patient and break up the large, very solid mass lodged in his colon. Thankfully I was called out of the room by the other nurse on duty...
... only to find I had been called to another bowl issue. the first patient's neighbor was experiencing an unexpected bowl movement and needed to be placed on his toilet and washed (a process I assisted more than carried out since I am not a nurse). When I took the used toilet to be disposed and cleaned I saw what looked like a large orange hairball inside. This of course had to be brought to the nurse's attention.
By the end of the shift all bowels had been sucessfully moved and the smell on the ward confirmed it. As did the stack of brown gloves in the trash. Eew.

21 May 2006

Tagged again: oddities

Tagged and I'm it. Apparently the idea is to mention 6 odd things about yourself so here we go, six strange things you (probably) don't know about me:

1. I change into my pajamas when I'm at home, even if it's the middle of the day. It's a habit from a college roommate, but seriously, what's more comfy than PJ's?

2. I'd rather buy books than borrow them from a library; I just like owning them.

3. I'll put things into my agenda even after they've happened. That way I can look back and recall the night I went spontaneously went to drinks with so and so was Wednesday, not Thursday, for example.

4. I don't like ice cream cones. Give me a cup anyday. Or better, yet, the carton.

5. I sing in my car, when I'm alone. The top-of-my lungs, Carnegie Hall performance kind of singing, even though I couldn't carry a tune if you put a gun to my head.

6. I find it incredibly uncomfortable and nearly impossible to sit properly in a chair. I need to have one leg folded under me, be crosslegged, something.

16 hours in the hospital: week 1

And we have come to the end of the first week of summer session: all 4 classes, two tutoring shifts, and 16 hours in the hospital. And it was fun! I'm not being sarcastic here, I've definately taken on too much (par for the course) and I simply won't drop anything because I can't bear to give any of it up. Some highlights...
- In NeuroChem when the professor went over the finer points of cocaine delivery via snorting vs. freebasing and the resulting bioavailability curves.
- In Chem lab when the professor spent 20 minutes belittling post bacs and then mentioned that we'd likely have the highest grades in the class by the end.
- In tutoring (my job) when one of the students (veterans) told the head of the program I was inspiring and he wanted me to be his math teacher.
- In the post-surgery rehab ward when I had to take a patient (in a wheelchair) down to the front to smoke. Do you have any idea the looks you get when you ask a stranger for a lighter for the old man in the gown in the wheelchair while wearing a hospital ID and jacket?
- Realising I cannot get consistant readings on an electronic scale. Seriously, how did my crucible spontaneouly lose 2g?
- Watching the Emergency Room doctors treat a quadruple gunshot victim and then being sent to pick up their chinese food.
- Showing up to cell bio/biochem and realising everyone (practically) I know is in the class... and that it's moving to the coldest room on campus. I'm going to be wearing wool sweaters every Wednesday in the Philly humidity to avoid hypothermia.
- Having friends over Friday night for a cozy dinner and being able to congratulate Audra on getting into GW... way to go chica!
- Two lazy weekend mornings. Sleeping in, eating pancakes...
- Making to the movies... MI III is entertaining, Da Vinci code not so much.

11 May 2006

Inpatient Post-Surgery

It was my first night on the ward I am volunteering on in the hosptial and to my surprise, I actually managed to remember the CNA, RN, etc names! The patients were really interesting, some of them have been there for quite some time and I don't think there was a single one under the age of 50. A couple of guys in one room were rooting for opposing teams in the basketball team, which made for some fun conversations and light hearted smack talking. A woman with a leg injury was hell bent on seeing the baseball game (Mets -Philles) but it wasn't on any channels in the hosptial so we went searching everywhere for a radio.. more fun that it probably sounds.

On the unusual side there was a woman in a helmet whose brain was exposed. She had an edema and they couldn't close the wound (thus the helmet). She was rather large and immobile too so it made everything from changing into fresh gowns to serving dinner and changing bedpans a challenge. There was the 70 year old man with a penile implant... who couldn't keep it in his gown! and the man with a colostomy bag... we had to change it, well ok, the CNA had to change it, and it ended up spurting everywhere! Ick... guess who got to help clean ; )

Between Spring and Summer

Monday brings the beginning of summer classes and my job, both of which are exciting, but the 12 days in between have been really relaxing. First I had orientation for my job and it was one of the more inspiring few hours I've ever witnessed. I tutor veterans who want to try and go to college and one of them talked about how he wanted this so his kids would be proud of their dad and would know that they could go to college too.

After orientation was Audra's BBQ, which was a fun and relaxing outdoor yumfest. Best moment, Taner scooping ice cream for us all :) Or maybe Abi, Taner's HUGE dog, farting in the car!

I spent a few days in NYC where I saw David Blaine underwater - he was living in a human fishbowl for eight days. I saw the Natural History Museum for the first time too... and recognised all the words laid into the marble floor: gnathosomes, tetrapods, amniotes...

Back in Philly was a fun trip to Ikea to pick up furniture... I'm still a little weirded out by owning furniture. They had a big tub of blue balls to play in, which made everything better... that and the ice cream cones :)

And now... my fridge isn't working and I need to go and buy my textbooks. Yup, I smell summer session approaching.