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.
Frustrating.
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.
Heartbreaking.
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.
Maddening.
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.

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.

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.

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.

Bio Exam III and Final

I just took two exams; you get 10 questions. As per a reader's request, I will not post the answers in the comments, you can :)

Q1. What is anhydrobiosys?
Q2. What is parthenogenesis? (hint: check a previous post)
Q3. What is necessary for the activation of a cytotoxic T cell?
Q4. Name the three phases of the uterine cycle and the corresponding phases of the ovarian cycle.
Q5. What are Leydig cells and what stimulate them/ do they secrete?
Q6. Name, in order, the regions of the stomach, small intestine, large intestine and their sphincters.
Q7. What is the common name for Nematoda? Nemertea? Which is segmented?
Q8. Name one difference between bacteria and archea. Which is more closely related to eukaryotes?
Q9. Name, in order, the parts of a nephron.
Q10. What hormones does the adrenal medulla secrete? The adrenal cortex?

Extra Credit: Write the bicarb buffer equation.

Sunday funnies...

... on Tuesday.

As the elevator car left our floor
Big Sue caught her tits in the door
She yelled a good deal
But had they been real
She'd have yelled considerably more

Nymphomanaic Alice
Used a dynamite stick for a phallus
They found her vagina
In North Carolina
And her asshole in Buckingham Palace

Proof that girls are evil

A gem I found while cleaning my desk... procrastinating during chemistry revision...

Proof that Girls are Evil

Girls = Time x Money
but... Time = Money
so... Girls = Money ^2
but... Money = rt(evil)
and... Money ^2 = [ rt(evil) ]^2
substitute and reduce to get...
Girls = Evil

Lab Practical

The lab exam was not nearly as fearsome as I had, well, feared. Two questions per station (some with four parts), 20 stations, with a mixture of anatomy and theory. Rather than describe what was going though my head... here's your very own, mini lab quiz:



Q1. The two organs clearly visible in the above dissected shark are...?



Q2. Name the phylum of the animal above and two shared derived characters of that phyla.



Q3. The red tube above the white globules in the above dissected rat are? Is this rat male or female?

Q4. Mitochondrial DNA IS/IS NOT highly conserved and is this useful for exploring evolutionary relationships between RECENTLY/DISTANTLY diverging species?



Q5. The dull blue feather looking organ in the squid above is the ______? What phylum is this animal and what kind of circulatory system does it have?

Q6. If ANF was being released in your system, you would have (choose as many as apply):
a. highly concentrated urine
b. inhibited ADH
c. increaed urine volume
d. increased Cl- in the urine

If you want the answers, check the comments.

Finals

Yes, we've hit that wonderful time in the semester when the sun is finally out and the whole school is holed up in the library cramming as much information into their heads as possible. I am reasonably lucky, no back to back exams this time through... but there are a lot of points in the air and well, I could use them all.

We have a bio lab practical this Saturday, which involved such ridiculousness as looking at a 16 hour old frog embryo and naming the number of cells and their configuration. Or looking at a dissected fetal pig and finding the salivary glands (harder than you might think). A week later is the third exam and final (together)... Why are the antibodies passed through breast milk (IgA) temporary? What's the difference between Nemertea and Nematoda? Anyone... anyone?

I'm not even thinking about chem yet (which may or may not prove harmful)...

I got my starting date (May 9) for the weekly hospital gig though... hopefully that will provide some amusing anecdotes.

Dissection VI & Urine

This was a quickie dissection, a kidney, done in the midst of a renal function lab. What this entailed was urinating at 30 minute intervals and measuring the chloride concentration, specific gravity, and volume at each urination. Groups of five people each participated in a different "treatment" condition (salt, caffiene, 1000mL water) and the idea was to see what different effects these would have against a control (200mL water). Unfortunately our control group (myself included) was a complete mess so our results were essentially "we knew what should have happened..."

If anyone should be under the impression that "oh, you did something remotely medical", well, you're wrong. What we did was play with our own urine for three hours in a warm room next to preserved kidneys that reek of formalin having not eaten for several hours (requirement for the lab) while watching a beautiful sunny Saturday float by our lab room window. There was no diagnosis, no puzzle to solve, and I'm pretty sure we violated HIPAA (lab results being considered protected health information).

Normally I love lab, but this is one of those things that sounded better in someone's head than in real life.

Desert Hydration

Our most recent biology lecture was on the always thrilling topic of renal function, which means kidneys and peeing. Now, our professor is welll-known for her eccentric stories; the one about catching frogs to feed the ducks was a gem. So was the frozen snakes for curtain rods. Well, during renal function she discussed potty training and how she made a bet with her husband that she could have their son trained by his first birthday. That didn't quite happen. Since she lost the bet, she had to drink urine, not only that, but drink it in front of her class. So yes, my biology professor whipped out a bottle of yellow fluid, told us she lost the bet, and took a few sips. If it was anyone else I would assume it was apple juice, but no, with Dr. W, it was definately urine. Wow. I mean ick.

Procrastination II

Oompa Loompa Doompety Doo
Here comes neutralization part deux
Oompa Loompa Doompety Dee
A chapter about soluability...

What do you get when you stir in a salt?
At K s p dissociation halts
Use the a + b root to find the s
Get K e q with help from Hess
It's just another M R A...

Oompa Loompa Doompety Da
Use M R A and you will go far
Now you can find the I P too
Like the Oompa Loompa Doompety Doo!

Procrastination

Oompa Loompa Doompety Do
I've got a neutralization for you.
Oompa Loompa Doompety Dee
If you like chemistry listen to me...

What's the p H mixing acid and base?
How much H F reacts with the O H?
Neutralize half, it's a buffer you'll get
Now p H is pretty much set
Oh! But it's still basic...

Oompa Loompa Doompety Da
Strong acid strong base with moles on par
It will have p H seven too
Like the Oompa Loompa Doompety Do!

The originals.

Exhibit A

Lord Melvyn Bragg has written a book entitled Twelve Books that Changed the World and the BBC now was a forum asking readers what their selections would have been. The criteria loosely translates to: books that changed the world to that in which we now live. He included selections from Charles Darwin, George Orwell, and Adam Smith, among others.

Many of the public responded with the Bible, a few with Albert Camus, several with Ann Rand, and many concurred with Orwell, but one notable member of the public, Mark Keen from Swindon, submitted the DaVinci Code. He has got to be kidding. I mean seriously. I like my insubstantial fiction now and then just as much as the next person, but what exactly is true about the post-DaVinci Code world that was not true of the pre-DaVinci Code world? Upsetting the religous community and constantly being in the press are not world changing qualities, or else we would have to include TomKat and Lindsay Lohan as world-altering figures. Please.

On the American side of the pond the New York Times magazine has an interview this week with Bonnie Fuller, the editorial director of American Media. I won't even go into the appalling book she's recently written titled The Joys of Much too Much but instead will mention the transcribed statement "I guess I am registered as a Democrat. I guess, because you have to register?" How exactly did this woman become editor of some of the most widely read women's magazines? Granted, Glamour isn't exactly a hot bed of political debate, but even they put "register to vote" as a "Do!" And shame on the New York Times for called Ms. Fuller "a symbol of female accomplishment." We can do so much better.

Hosptial Training III

All I can say is... brilliant fun! There is a team in the hospital responsible for transporting inpatients between their rooms and various tests (ie xray, ultrasound) and back or discharging them. For my last five hours of training I shadowed this team and ended up spending lots of time with several really interesting patients.

Easily the most interesting was a man who had heart problems and a severe buildup of fluid in his legs (preventing him from voluntary movement). He was a very nice man and we chatted for nearly two hours while we got him to xray and had four chest films taken ( they blew the tube in the xray machine due to the high dose of radiation) - he told me all about his godsons, whom apparently I would quite like as they are footballers (read: soccer) and are 6'3'' and 6'4'' and very handsome ;) After we finished he wanted to stand up and re-adjust his gown and his placement on the bed so we helped him stand up (he farted) and as soon as he was up ... "did you bring the bedpan? I really need to pee!" Of course, we hadn't brought the bedpan. By the time we made is out of xray this man had three radiologic nurses and three transporters attending to him.

The first transport of the day was a woman who had come in through the ER and needed an ultrasound. We arrive with a stretcher and the doctor stopped us in the hallway, "she's not going to fit on that." Apparently there are oversized beds we can use for, well, oversize patients, but they are a huge pain in the butt because finding one in the hospital is tough and you have to dissassemble the arms to get them through doorways. "you can try, she must have been on one in the ER, but... good luck." Try we did, and managed it too. Luckily she was mobile and could walk over to it herself (it would have taken a 4 horse team to lift her) - this woman was EASILY the largest human I've ever seen in person. Her boobs were at her belly button, her arms were bigger than my hips and her ankles were the size of my head.

The whole experience has made me quite excited for my time there. Maybe after the summer (I'm registered for far more courses than is advisable) I'll see if I can get a job in the hospital. One that pays.

Dissection V: Fetal Pig & Rat

This dissection was the toughest yet: finding the neck glands of the pig was next to impossible. It was also slightly disturbing to crack the ribs when we folded the sternum back to poke around the pericardial space. The anatomy was incredibky similar to what we learn in human physiology though, so it was also intensely interesting.

The liver was noticably less fatty than in the shark, but most of the organs were the same colour in the pig, making it harder to differentiate. There were also many more peritoneal membranes so the dissection technique was understandably more prolonged, involved, and cautious. In fact, my partner and I were the last ones to finish and we didn't quite get our eye done correctly, but we'll be doing another eye later in the semester, so I'm not worried. I will say, that what we did manage to complete was quite well done (if I may say so myself) and we destroyed none of the organs in the process. We were even able to differentiate some of the major musculature in the pectoral region.

We had an exam and a lab quiz immediately prior to dissection, both of which went well. I think I managed to keep my special connective tissues and my stratified squamous epithelia straight :)

Dissection IV: Dogfish Shark

Without a doubt the coolest dissection yet, especially because our TA returned (there was a sub last time) and there was no lab quiz. We dissected the dogfish shark, right down to cutting open the skull and stomach. The stench was, well, it was powerfull and there was definately some projectile sperm while examining the male reproductive organs, but for the first time you could really see the homology between the dissection subject and well, our future patients.



The liver was stunning. Not because it was elegant, but because it was huge and so luxuriously slimy. Since it's largely lipids it has this sleek sheeny texture. The kidneys were unusual since they are on the abdominal wall surface and run the length of the shark. Even more interesting is that the vas deferns (sperm transport ducts) are on the surface of the kidneys. Sperm travels though the kidneys and then the vas deferns to the seminal vesicles which leave the shark throught he cloaca (think: anus) and travel into the female on one of the two claspers.

Ah... and here's the good bit. The male shark has TWO claspers. What do they do? Well, one of them penetrates the female cloaca, hooks itself in there, delivers the sperm, and then releases. What this means is... the shark has TWO penises. Call me 15, but I think that is... unusually well endowed?

The brain was also the most developed we've seen to date... in three distinct sections. Carving off the skull piece by piece was quite the task though - it took us about 20 mins, but we managed to keep the brain in tact, including all the olfactory bulbs. I did finish the afternoon with rather a long shower though because formaline is such a cloying perfume.