Don't get confused. I title my posts the days the events happen unless I forget :) I bet you though I abandoned this blog again....ha ha I haven't :)
Sometimes at work, i get a little uncomfortable with the way my Attendings (the big bosses) handle certain cases and the decisions they make. Of course every physician in training has experienced this at some point or another. And I am sure there are decisions I make or suggests that make others cringe.
Anyhow, I am in the epilepsy clinic this month and we have a patient with epilepsy who is complaining of increased seizures. She describes her current seizures as being different than the ones we have been treating her for all these years. With these new ones she is walking down the street or doing a chore and then all of a sudden her body freezes and she can't move a limb (she has even dropped dishes when this happens). They last for less than a minute and then she can move again, she does not lose consciousness, get confused or convulse. In fact, when these events happen in a public place like work, she tells her coworkers that she feels dizzy and needs a minute so that they don't look at her weirdly for suddenly freezing in place ( i.e. she does not really feel dizzy). These events are happening daily. She has been under a lot of stress with running her own business, and after she was diagnosed with epilepsy less than 5 years ago, she went through a divorce. Her family and kids live out of town, so she relies on friends for moral support and the bottle. Yes, for months now she drinks a bottle of wine from the time she gets off work till when she goes to sleep every single day.
So for my non physician friends...there are a couple of red flags to her story:
1) New seizure type in the setting of stress that is not responding to her medication
2) When thinking about the parts of the brain that seizures come from (cerebral cortex), they work in two ways most commonly: a seizure from one side of the brain causes symptoms in the opposite part of the body (so right side of body seizure is coming from your left brain) and so when a seizure affects both left and right sides of your body, then similarly both sides of your brain is affected (we refer to this as generalized) and you lose consciousness or have altered awareness and confusion. So for what she describes where her entire body freezes and she can talk to a coworker....yeah...very suspicious for pseudoseizures or non-epileptic psychological spells
3) A bottle of wine a day is a red flag for anyone's health even the french and italians :)
So you know what we did? (well what my attending did) He increased her seizure medicine and then wrote her a new prescription for ativan (also known as lorazepam) to take as needed when she feels these events. I raised a few objections; why are we giving benzos to an alcoholic? Can't a mix of the two stop her breathing? Also, last I checked benzos were addictive and a person can even have withdrawal seizures from them? Also, why increase her seizure meds when these new spells do not fit with epilepsy and cant we monitor her in the hospital or get an ambulatory EEG that she can wear at home to monitor these for a few days. He said the addiction data on the benzos are exaggerated and no need to bring her in or get more testing if the increased seizure meds work.
And so I left for the day baffled....I had suggested to the patient privately that she tries to get a therapist or psychiatrist or AA or something to help her with her obvious depression (she got tearful 3 times during my interview with her), I can only pray she heeds me, but since my Attending did not reinforce that I will be really surprised if she follows through.....
That being said...I am about to sip on lots of wine alone :)
Friday, March 14, 2014
Friday, January 10, 2014
January 10
I have no great titles for my posts and my brain cells are too tired today, so i will probably just name each post on this blog for the day I write it...lol so creative.
So i did an EMG (muscle testing) on a patient today and he was so cachectic. He is a liver transplant patient whose liver failed due to cirrhosis from alcohol and liver cancer. Anyhow he was telling me how he has had such a horrible time in the hospital. I was telling him that he probably had nerve damage from being positioned a certain way during his surgery, but he felt that maybe it happened after surgery because the nurses were tossing him on the bed and turning him like he was a sack of beans without a care for where he lands or if his limbs were hitting the corners of the bed. I tried to listen and sympathize, hoping that he was exaggerating a little. But then he went on to say, how at the nursing home, he pushed the call button to call the staff so he could be helped to the bathroom and the person did not come into his room until 40 minutes later and then they told him to just go on himself that they would clean it up. The man choked up as he was telling me this, because he felt that his dignity was being stripped and being already fragile he lost control and "went" on himself and when he pushed the button again they left him lying in his "shit (his words not mine)" for another half hour. Things like that just make me so sad that some people are in healthcare who don't give crap about anyone...
So i did an EMG (muscle testing) on a patient today and he was so cachectic. He is a liver transplant patient whose liver failed due to cirrhosis from alcohol and liver cancer. Anyhow he was telling me how he has had such a horrible time in the hospital. I was telling him that he probably had nerve damage from being positioned a certain way during his surgery, but he felt that maybe it happened after surgery because the nurses were tossing him on the bed and turning him like he was a sack of beans without a care for where he lands or if his limbs were hitting the corners of the bed. I tried to listen and sympathize, hoping that he was exaggerating a little. But then he went on to say, how at the nursing home, he pushed the call button to call the staff so he could be helped to the bathroom and the person did not come into his room until 40 minutes later and then they told him to just go on himself that they would clean it up. The man choked up as he was telling me this, because he felt that his dignity was being stripped and being already fragile he lost control and "went" on himself and when he pushed the button again they left him lying in his "shit (his words not mine)" for another half hour. Things like that just make me so sad that some people are in healthcare who don't give crap about anyone...
Friday, December 27, 2013
Welcome back
Wow....where did 3 years go?
Yeah I need to change that profile pic that looks like a porn star, instead of a respectable physician. You can tell it was posted in my "young" days.
Okay...so I survived 4.5 years of undergrad, 1 year post baccalaureate program, 4 yrs med school, 4 years of neurology residency and now I am halfway through with my 1 year of neurophysiology fellowship. People hear these things, because neuro has to do with the brain/nervous system and think I am smart which makes me feel like the biggest fraud, because I really don't feel smart and I feel like things I read, I forget the next week. I am not being humble, I know this because my friend asks me gynecological questions and I am clueless and have to look it up. My bf asked me where testosterone was made in females and I had thoughts but still had to confirm by looking it up. Yes, they say I am a specialist, but I tell you some of my attendings and even classmates know everything about our field and remember every aspect of medicine they ever learned. Well, that being said my strength lies in my ability to connect with my patients, and I genuinely care for them. I also now try not to slack on reading. Thank God for audio stuff and Through all this I have had mental and emotional stress but also felt fulfilled by what I do. That is a good thing because I, like many other medical professionals lag behind my non medical friends in financial and personal accomplishments it seems. Anyhow, enough personal mulling here is a story for you:
So we read an EEG (electroencephalogram-test to detect seizures) this week on a 1 day old infant. His mother shows up at the Emergency room with stomach and back pains and they find out she is pregnant. They ask her how far along she is and she is not sure, thinks her last menstrual period was in April. SO they do an ultrasound and estimate baby to be 35 weeks and ask her where she has been getting care. Homechick says she hasn't had any prenatal care because she has been too busy to get to it and lost her medicaid. More questions, reveal that she is 33 years old and this is her 13the pregnancy...yes oh, I did not stutter, THIRTEENTH! She lost 2 kids but this will be baby number 11 that will reside in her apartment with her other 10 and her man. She has been treated in the past for gonorrhea, trich and chlamydia but luckily her HIV test was negative.
So, the baby was born limp, no heart rate, no breath sounds, within his first 4 minutes of life he had to be intubated (breathing tube down his throat and placed on ventilator to breath for him) and then they did chest compressions on his tiny chest for 6 minutes before a pulse returned. Next, they noticed that all his labs were abnormal indicating multi-organ failure and they see him twitching abnormally and this is where we (neurology) comes in, because they order the EEG to see if he was having seizures. His EEG was flat...which means no brain activity at this time. And now begins the conversation with parents on what to do next as far as withdrawing care. The whole situation was just amazing and sad. I couldn't help but wonder if a child is already born dead...why do resuscitative efforts? Because you bring the child back, but after God knows how many minutes of brain death outside the womb not to talk of in utero, what kind of quality of life will he have? How will mom take care of him with 10 siblings?
Let me end this post on a cheery note of saying, life as a fellow is infinitesimally better than life as a resident or medical student :)
Yeah I need to change that profile pic that looks like a porn star, instead of a respectable physician. You can tell it was posted in my "young" days.
Okay...so I survived 4.5 years of undergrad, 1 year post baccalaureate program, 4 yrs med school, 4 years of neurology residency and now I am halfway through with my 1 year of neurophysiology fellowship. People hear these things, because neuro has to do with the brain/nervous system and think I am smart which makes me feel like the biggest fraud, because I really don't feel smart and I feel like things I read, I forget the next week. I am not being humble, I know this because my friend asks me gynecological questions and I am clueless and have to look it up. My bf asked me where testosterone was made in females and I had thoughts but still had to confirm by looking it up. Yes, they say I am a specialist, but I tell you some of my attendings and even classmates know everything about our field and remember every aspect of medicine they ever learned. Well, that being said my strength lies in my ability to connect with my patients, and I genuinely care for them. I also now try not to slack on reading. Thank God for audio stuff and Through all this I have had mental and emotional stress but also felt fulfilled by what I do. That is a good thing because I, like many other medical professionals lag behind my non medical friends in financial and personal accomplishments it seems. Anyhow, enough personal mulling here is a story for you:
So we read an EEG (electroencephalogram-test to detect seizures) this week on a 1 day old infant. His mother shows up at the Emergency room with stomach and back pains and they find out she is pregnant. They ask her how far along she is and she is not sure, thinks her last menstrual period was in April. SO they do an ultrasound and estimate baby to be 35 weeks and ask her where she has been getting care. Homechick says she hasn't had any prenatal care because she has been too busy to get to it and lost her medicaid. More questions, reveal that she is 33 years old and this is her 13the pregnancy...yes oh, I did not stutter, THIRTEENTH! She lost 2 kids but this will be baby number 11 that will reside in her apartment with her other 10 and her man. She has been treated in the past for gonorrhea, trich and chlamydia but luckily her HIV test was negative.
So, the baby was born limp, no heart rate, no breath sounds, within his first 4 minutes of life he had to be intubated (breathing tube down his throat and placed on ventilator to breath for him) and then they did chest compressions on his tiny chest for 6 minutes before a pulse returned. Next, they noticed that all his labs were abnormal indicating multi-organ failure and they see him twitching abnormally and this is where we (neurology) comes in, because they order the EEG to see if he was having seizures. His EEG was flat...which means no brain activity at this time. And now begins the conversation with parents on what to do next as far as withdrawing care. The whole situation was just amazing and sad. I couldn't help but wonder if a child is already born dead...why do resuscitative efforts? Because you bring the child back, but after God knows how many minutes of brain death outside the womb not to talk of in utero, what kind of quality of life will he have? How will mom take care of him with 10 siblings?
Let me end this post on a cheery note of saying, life as a fellow is infinitesimally better than life as a resident or medical student :)
Monday, July 19, 2010
Residency
Wow...so many cobwebs in this space.
Anyhow, this is the perfect place to let my thoughts roam. Man...this residency shindig is kicking my ass physically, emotionally and mentally. Have you ever felt so miserable and helpless that you just want to quit your job? So, one of the problems with my situation is that there is no one I can talk to. It's either they don't understand the situation since they haven't done this or even if they appear to understand, I can't continuously keep whining, complaining about the situation...after all I do have 3 more years of being disgruntled left. No one can fully prepare you for residency. It is a hard thing to explain. Medical school was hard, being away from family in a foreign land is hard...but this is quite simply the hardest. I wake up early 95% of the time. I work late 85% of the time. Last academic year, I had 4 weekends off the entire year. I have sometimes had to go 20days without a day off. I don't know if this is the crux of the matter; but all i know, is that I care less and less about learning. I also care less and less about patient care. I just simply feel sad. My body and psyche need more days off. It is not uncommon for me to cry myself to sleep, when the whole day seems like a power struggle between some disgruntled patient and my senior or administration, with me being torn in the middle. I never realized how important "rest" is until residency. I don't have my family in close vicinity, neither do I have a significant other...that quite simply and honestly makes it harder. I have friends...yea, i talk to them ever so often but it is not enough. Sometimes, it is not all about talking. If I come home, so stressed and upset, it would be nice to just have someone hug me, and tell me it will be ok. I can't explain it except to say that when I was in medical school and had my room mate, there were things she could see and understand, that a phone call simply cannot convey. They say life as an attending is great, I have no doubt it is, but how can I survive the next 3 years? WHy did I not do dentistry or pharmacy? WHy did i not pick a specialty that has easier residency like radiology or pathology or psychiatry? WHy did i not match into an easier program? I have no idea. I am on an H1 visa, so I cant just up and quit, or up and find another residency. Plus, as I was researching changing residency programs, I kept getting calls from my Loan people saying that my period of deferment has passed and I need to start making payments. How do I feel? TRAPPED!!!
I like the topic/concept of medicine, I just simply HATE HATE HATE residency, and if could do it all over again, my love of medicine is not enough for me to go through residency...and I would not do it. Well..this was just a vent. I am done for now. I have no choice, but to try one day at a time. Today was a good day, but i still feel exhausted. Been thinking I should look into whether we get free counseling sessions, maybe that might help...sigh.
Thursday, August 13, 2009
Veterans
It's been a hot minute. My purpose of opening this blog was to jot about DAILY events at work 1. as a stress reliever and 2. so that I might sell a book one day or get a TV script, since America loves medical shows. Anyhow, that is obviously not happening, cos when I get home, I plop on my bed or couch to sleep or veg.
So I have spent the last 1.5 odd weeks at the ICU in the Veterans Hospital and it's been such an eye opener. The hospital itself is beautiful, pretty clean and has a first class computer system where tests, medical records, xrays etc can all be accessed online. Not feeling the cafeteria though. But despite all the amenities, the patients themselves are some of the saddest I have ever seen. In addition to all their regular medical problems, ALL of them that actually served in some war all have some mental illness/substance abuse/alcoholism component which makes treating them harder, yes, but makes it that much sadder.
So I have learnt that no matter how good those army benefits sound, is it really worth it when you can't function in society afterwards? I am definitely grateful to all the young soldiers out there fighting for their country 'cos someone has to do it...but I can't help but feel sad for them too.
So I have spent the last 1.5 odd weeks at the ICU in the Veterans Hospital and it's been such an eye opener. The hospital itself is beautiful, pretty clean and has a first class computer system where tests, medical records, xrays etc can all be accessed online. Not feeling the cafeteria though. But despite all the amenities, the patients themselves are some of the saddest I have ever seen. In addition to all their regular medical problems, ALL of them that actually served in some war all have some mental illness/substance abuse/alcoholism component which makes treating them harder, yes, but makes it that much sadder.
So I have learnt that no matter how good those army benefits sound, is it really worth it when you can't function in society afterwards? I am definitely grateful to all the young soldiers out there fighting for their country 'cos someone has to do it...but I can't help but feel sad for them too.
Wednesday, June 17, 2009
Orientation
Day 1 of orientation was great overall! I had that feeling of being a newbie and having to introduce myself to others, feeling awkward, sure i looked fat in my white pants etc. But I was so glad, that the residents were nice. The chief resident is HILARIOUS! had us quaking with fear initially, but he was just joking.
First impressions:
I come from a private med school/hospital so I have been a little spoiled. This hospital is associated with a state university so like all state funded thingies, is not maintained well in certain areas. They are not completely rid of paper charts, while i can't remember the last time i saw somethng not on computer. However, I am psyched at being exposed to something different.
- this hospital is a freaking maze, i hope i learn my way quick!
- I LOVE that the cafeteria has starbucks and a chinese restauant
-fellow intern B is cute and pretty chatty. He's engaged so don't worry I am not entertaining lustful thoughts.
- this hospital doesn't have much money. I don't even know if I have any perks, this one they've been hiding the contracts from us :)
First impressions:
I come from a private med school/hospital so I have been a little spoiled. This hospital is associated with a state university so like all state funded thingies, is not maintained well in certain areas. They are not completely rid of paper charts, while i can't remember the last time i saw somethng not on computer. However, I am psyched at being exposed to something different.
- this hospital is a freaking maze, i hope i learn my way quick!
- I LOVE that the cafeteria has starbucks and a chinese restauant
-fellow intern B is cute and pretty chatty. He's engaged so don't worry I am not entertaining lustful thoughts.
- this hospital doesn't have much money. I don't even know if I have any perks, this one they've been hiding the contracts from us :)
Sunday, June 14, 2009
Congrats
Wow I can't believe I am attempting a new blog. Anyways I didn't like how my professional life sometimes crossed into my other blog, so i decided to have an outlet for my expriences as a newly minted physcian. With all the mental/emotional pressure physicians are prone to, here's hoping that this will be cathartic. Forgive the wacky colors, I just needed something mega cheery for the days I feel like killing myself after work.
Subscribe to:
Posts (Atom)
