It's been a while. Night float hasn't been too bad thus far. I've been able to sleep the nights I have been on. The exciting things that have happened since being on L&D which I did not get a chance to write about earlier. I was able to deliver a baby! A resident was right by my side and helped suction the little one while I just held on - amazed. Even though babies come out in blue/grayish, covered in gunk it's still amazing each and every time. The Ob doc hands them off to the nurse or pediatrician and is right back to mom. The peds dry off, suction, stimulate, etc getting the baby to cry wake up and turn pink. Then there's that moment after the baby looks like a baby and is all bundled when mom and baby are united. It gets me every time.
In other news of the area. Yesterday was SNOW!!!!!!!!!!!!!!!!!!!!!!!!!!! Ok maybe not snow snow, but FLURRIES!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
I hope you can gather the excitement that I am feeling about this.
Wednesday, November 19, 2008
Saturday, November 15, 2008
still exciting
I have not forgotten you. I've just been very tired after work and yesterday I went to see the new James Bond movie - in which I pulled a Nava and fell asleep for part of it. I'm off today for an early T-giving with Rich (a good friend of mine from school here) and his sister and her friends this evening. I'm not sure when I will be back to write more and fill you in on the rest of my first week on L&D - probably sometime on Sunday night or Monday day. I will be back to work on Sunday at 5:30pm and will be working until about 7-7:30 am or so. This is my week working as night float. We'll see how much I can mess up my sleeping schedule!
but I can say the remainder of the week continued to be exciting!
but I can say the remainder of the week continued to be exciting!
Wednesday, November 12, 2008
Pimping
Today, I was pimped. what? you might be thinking. Pimping in medical school refers to an attending (the doctor in charge of the med students & residents) or a resident who asks us questions. This can either be done with good intentions to help us learn or more maliciously to demonstrate to us our inferiority. Thankfully for me, my attending this rotation is awesome. He pimps in a friendly sort of way as he told us on our first day of orientation.
My one big pimping question for the day was to come up with 20 reasons for a C-section. Ready go!....
Let's just say this took me a while, with quite a few wrong guesses and with the help of some nurses and a 4th year medical student. But I learned. I'm going to attempt to list all 20 reasons from memory for you.
1. non-reassuring fetal heart tones
2. gastrochesis (when part of the abdominal wall is missing and guts are spilling out of it - no sac covering it, if a sac were covering it then it's an omphalecele)
3. Breech position or abnormal positioning
4. macrosomia (large baby - must be over a certain size, but this I do not remember)
5. Multiple gestation (twins with one baby presenting abnormally)
6. Abnormal Labor (failure to progress, etc)
7. placenta accreta
8. placenta previa
9. placenta abruptio
10. Herpes outbreak
11. HIV
12. Infection
13. previous uterine surgery
14. aortic stenosis
15. trauma, maternal death
16. cancer - gyn
17. cervical fibroid
18. previous classical CS
19. repeat CS
20. elective CS
21. cerclage (the 4th year came up with this one)
There you have it. the list. I'll admit I did have to cheat and look at my notes for about 5 of them.
Now on to the EXCITING part of my day.
I got to scrub in on 2 of the C-sections today AND I delivered a placenta! After the baby is delivered the uterus is pulled out of the mom and placed on her stomach. It's amazing how small the uterus becomes right after the baby is born. It contracts and clamps down to a much smaller size. It truly is fascinating. Outside of the body I think the uterus sort of looks like an uncooked chicken or turkey. Pulling the uterus out allows the physician to exam the uterus, the fallopian tubes, etc and I think grabbing the uterus helps stimulate it to contract. Also, drugs are given to augment contraction. I was allowed to follow the umbilical cord into the uterus and feel where it inserted on the placenta. Then he had me place my hand under his and he removed his had and had me move my hand in between the placenta and the uterus. I was basically scraping the placenta off the uterine wall. It was cool. Then he had the 4th year student stitch her up and we were on our way.
Watching the C-section was fascinating. It reminded me how much I enjoyed anatomy lab and dissecting the cadavers. The human body is amazing. I can't really describe how cool it is to see how different layers of the body separate from one other and that it's ok to just pull out a woman's uterus and plop it on her stomach stitch it up and plop it back in.
I'm interested to see if this becomes old had seeing C-sections and how much I enjoy gyn surgery. This is the one field I thought may pull me from my passion for family medicine. Even though it's only been 2 days - I don't know. I just don't know. Only time will tell if it's so exciting and interesting because it's new or because this is IT.
My one big pimping question for the day was to come up with 20 reasons for a C-section. Ready go!....
Let's just say this took me a while, with quite a few wrong guesses and with the help of some nurses and a 4th year medical student. But I learned. I'm going to attempt to list all 20 reasons from memory for you.
1. non-reassuring fetal heart tones
2. gastrochesis (when part of the abdominal wall is missing and guts are spilling out of it - no sac covering it, if a sac were covering it then it's an omphalecele)
3. Breech position or abnormal positioning
4. macrosomia (large baby - must be over a certain size, but this I do not remember)
5. Multiple gestation (twins with one baby presenting abnormally)
6. Abnormal Labor (failure to progress, etc)
7. placenta accreta
8. placenta previa
9. placenta abruptio
10. Herpes outbreak
11. HIV
12. Infection
13. previous uterine surgery
14. aortic stenosis
15. trauma, maternal death
16. cancer - gyn
17. cervical fibroid
18. previous classical CS
19. repeat CS
20. elective CS
21. cerclage (the 4th year came up with this one)
There you have it. the list. I'll admit I did have to cheat and look at my notes for about 5 of them.
Now on to the EXCITING part of my day.
I got to scrub in on 2 of the C-sections today AND I delivered a placenta! After the baby is delivered the uterus is pulled out of the mom and placed on her stomach. It's amazing how small the uterus becomes right after the baby is born. It contracts and clamps down to a much smaller size. It truly is fascinating. Outside of the body I think the uterus sort of looks like an uncooked chicken or turkey. Pulling the uterus out allows the physician to exam the uterus, the fallopian tubes, etc and I think grabbing the uterus helps stimulate it to contract. Also, drugs are given to augment contraction. I was allowed to follow the umbilical cord into the uterus and feel where it inserted on the placenta. Then he had me place my hand under his and he removed his had and had me move my hand in between the placenta and the uterus. I was basically scraping the placenta off the uterine wall. It was cool. Then he had the 4th year student stitch her up and we were on our way.
Watching the C-section was fascinating. It reminded me how much I enjoyed anatomy lab and dissecting the cadavers. The human body is amazing. I can't really describe how cool it is to see how different layers of the body separate from one other and that it's ok to just pull out a woman's uterus and plop it on her stomach stitch it up and plop it back in.
I'm interested to see if this becomes old had seeing C-sections and how much I enjoy gyn surgery. This is the one field I thought may pull me from my passion for family medicine. Even though it's only been 2 days - I don't know. I just don't know. Only time will tell if it's so exciting and interesting because it's new or because this is IT.
Tuesday, November 11, 2008
Blood & Guts - Oh My!
1st day on L&D (labor and delivery). I'll sum it up in a few words for you in no particular order: gas, wait, vomit, push, poop, blood, fluid, lots of fluid, crying, babies.
There you have it mashed down to a handful of words - the glorious bringing of life into this world.
I would love to write more, but it's 7pm and I haven't eaten anything since lunch. I must read before bed, because I will be working with an attending and a 4th year resident tomorrow. Rest is much needed, because I am hoping tomorrow is a busy eventful day for me!
tata for now!
There you have it mashed down to a handful of words - the glorious bringing of life into this world.
I would love to write more, but it's 7pm and I haven't eaten anything since lunch. I must read before bed, because I will be working with an attending and a 4th year resident tomorrow. Rest is much needed, because I am hoping tomorrow is a busy eventful day for me!
tata for now!
Monday, November 10, 2008
Peds
So my pediatric rotation is over! bye bye York - Hello home!!!!! I'm so very happy to be back in my own bed at my own place. Once again I am able to take a shower without wearing sandals and can fall asleep without the sound of a flying helicopter. Oh the luxury. I took my Peds shelf exam (test at the end of each rotation) on Friday and then enjoyed my weekend. I do apologize for the long hiatus without writing.
the view from my room at York. Please note the helicopter pad not more than 500 yards from my window.
Here's my beautiful room - we've starting the packing process and were getting ready to head home!
Now the question arises, could I see myself as a Pediatrician? My answer is I don't think so. I do enjoy kids and the newborns. Healthy little kiddos can be very cute and entertaining. There is also a lot of parental education involved in Pediatrics - more than I realized before. Patient education is very important and an aspect of medicine that I do enjoy. Ingrained in the specialty is the concept of preventative medicine, which I think is of the utmost importance. So you're probably wondering why not peds? For the most part there are happy little tykes who come to the doctor for their well-child visits, but those kids in that age range where stranger anxiety has set in and they scream throughout an entire encounter are not for me. I'm talking about kids who shiver in fear of the doctor and sit there crying while I'm just talking to mom - not even touching them. I'm sorry, but I would rather not deal with that a few times a day. Once in a while I could handle it, but not everyday. There is also too much talk about poop! All babies - are they drinking/eating and pooping ok. Mom's will come to you with all sorts of questions about poop. The frequncy, consistency, color, etc. Heck, they'll even bring in diapers to show you. I myself may one day fall victim and become a poop watcher if I have my own children. But I don't feel the need to hear about poop 15x's a day. An adult conversation is needed every once in a while. I think peds is a good speciality with a lot to offer certain people. It's also needed, because raising healthy kids and educating parents on how to do that is a difficult thing.
There is more. I learned that I highly doubt inpatient hospital medicine is for me. I hate waking up patient's early in the morning who are trying to recover in order to get a history of the previous days events and perform an exam. Discussing patient's during rounds is alright. (rounds - is where the team who is caring for the floor or a group of patient's gets together and goes over all of the patient's on the floor and what the plan is for them, etc). Then during inpatient you order tests that need to be done that day and then you sit and wait. Wait for one of the patient's to need you or you wait for new patient's to be admitted. I do not feel I see enough patient's while on service in the hospital and you only know them for a brief bit before they are off and on their way. The other big deterrent from inpatient is the smell. Thank goodness the Peds floor didn't smell, but there was another adult unit I walked through to get to peds that reeked. Not cool.
So there you have it a brief summary of my peds experience. I still have more stories to tell from there and will hopefully get to them soon.
Now I'm on to my next adventure (if you want to call it that) - the world of obstetrics and gynecology. I have heard my classmates describe babies looking like aliens and placentas smelling like egg yolk. Oh the fun I have to look forward to!
the view from my room at York. Please note the helicopter pad not more than 500 yards from my window.
Here's my beautiful room - we've starting the packing process and were getting ready to head home!
Now the question arises, could I see myself as a Pediatrician? My answer is I don't think so. I do enjoy kids and the newborns. Healthy little kiddos can be very cute and entertaining. There is also a lot of parental education involved in Pediatrics - more than I realized before. Patient education is very important and an aspect of medicine that I do enjoy. Ingrained in the specialty is the concept of preventative medicine, which I think is of the utmost importance. So you're probably wondering why not peds? For the most part there are happy little tykes who come to the doctor for their well-child visits, but those kids in that age range where stranger anxiety has set in and they scream throughout an entire encounter are not for me. I'm talking about kids who shiver in fear of the doctor and sit there crying while I'm just talking to mom - not even touching them. I'm sorry, but I would rather not deal with that a few times a day. Once in a while I could handle it, but not everyday. There is also too much talk about poop! All babies - are they drinking/eating and pooping ok. Mom's will come to you with all sorts of questions about poop. The frequncy, consistency, color, etc. Heck, they'll even bring in diapers to show you. I myself may one day fall victim and become a poop watcher if I have my own children. But I don't feel the need to hear about poop 15x's a day. An adult conversation is needed every once in a while. I think peds is a good speciality with a lot to offer certain people. It's also needed, because raising healthy kids and educating parents on how to do that is a difficult thing.
There is more. I learned that I highly doubt inpatient hospital medicine is for me. I hate waking up patient's early in the morning who are trying to recover in order to get a history of the previous days events and perform an exam. Discussing patient's during rounds is alright. (rounds - is where the team who is caring for the floor or a group of patient's gets together and goes over all of the patient's on the floor and what the plan is for them, etc). Then during inpatient you order tests that need to be done that day and then you sit and wait. Wait for one of the patient's to need you or you wait for new patient's to be admitted. I do not feel I see enough patient's while on service in the hospital and you only know them for a brief bit before they are off and on their way. The other big deterrent from inpatient is the smell. Thank goodness the Peds floor didn't smell, but there was another adult unit I walked through to get to peds that reeked. Not cool.
So there you have it a brief summary of my peds experience. I still have more stories to tell from there and will hopefully get to them soon.
Now I'm on to my next adventure (if you want to call it that) - the world of obstetrics and gynecology. I have heard my classmates describe babies looking like aliens and placentas smelling like egg yolk. Oh the fun I have to look forward to!
Wednesday, November 5, 2008
Making History
Yes We Can!
I helped make history yesterday. I exercised my right to vote, even though I didn't get a sticker to prove it :( Oh well. I stayed up late enough to find out the results, but went to bed before Obama's acceptance speech. I watched it today on my computer though. Yesterday truly was history in the making. I do not think it's fully sunk in that something has changed. Watching his acceptance speech seemed surreal, because when you say President of the United States - I don't necessarily see a picture of George Bush pop into my head, but rather a generic image of an old white guy. That's about to change!
I'm sitting here trying to think about what to write. I'm stuck - all I have is a feeling. America jus took a big step forward. It feels big. Now all we can do is hope it turns out good.
Picture of celebratory cupcakes mel and I made!
I helped make history yesterday. I exercised my right to vote, even though I didn't get a sticker to prove it :( Oh well. I stayed up late enough to find out the results, but went to bed before Obama's acceptance speech. I watched it today on my computer though. Yesterday truly was history in the making. I do not think it's fully sunk in that something has changed. Watching his acceptance speech seemed surreal, because when you say President of the United States - I don't necessarily see a picture of George Bush pop into my head, but rather a generic image of an old white guy. That's about to change!
I'm sitting here trying to think about what to write. I'm stuck - all I have is a feeling. America jus took a big step forward. It feels big. Now all we can do is hope it turns out good.
Picture of celebratory cupcakes mel and I made!
Monday, November 3, 2008
self diagnosing
I know, I know - I have stories to fill you in on that I've been hinting at, but have yet to write about. Soon, I will get there. The weekend's busy with relaxing and studying. I have a test coming up on Friday. Worked today and have a 1/2 days for the rest of the week. VOTING TOMORROW!!!!!!
They say as medical students go through medical school that oftentimes we will become hypochondriacs and self-diagnose ourselves. I went to the doctor once and he specifically asked me what we were studying in school, because he wanted to know if that's where my symptoms were coming from. I've been pretty good at not falling into this trap. In 2nd year during every organ system block (cardio, gastrointerology, hematology, etc) I did choose which diseases I thought were the worst and would never want to get, but I didn't usually come down with the signs and symptoms. Well...the other day while studying I came across something that explains nearly perfectly something I have had for a few years, but never really worried about. It's a random sharp chest pain I would get once every few months, no association with anything, etc.
Below is what I've diagnosed myself with...
"Precordial catch syndrome is a benign cause of chest wall pain. It is by far the most common cause of chest pain in children but is of unknown etiology. It occurs most commonly in adolescents and is characterized by sudden, sporadic onset of sharp pain, usually along the left sternal border, which is often exacerbated with deep inspiration. These pains are brief, lasting seconds to a few minutes, and resolve spontaneously. The pain can often be "broken" with a forced deep inspiration."
I've never tried the forced deep inspiration to break the pain. Next time I'll know what to try ;)
They say as medical students go through medical school that oftentimes we will become hypochondriacs and self-diagnose ourselves. I went to the doctor once and he specifically asked me what we were studying in school, because he wanted to know if that's where my symptoms were coming from. I've been pretty good at not falling into this trap. In 2nd year during every organ system block (cardio, gastrointerology, hematology, etc) I did choose which diseases I thought were the worst and would never want to get, but I didn't usually come down with the signs and symptoms. Well...the other day while studying I came across something that explains nearly perfectly something I have had for a few years, but never really worried about. It's a random sharp chest pain I would get once every few months, no association with anything, etc.
Below is what I've diagnosed myself with...
"Precordial catch syndrome is a benign cause of chest wall pain. It is by far the most common cause of chest pain in children but is of unknown etiology. It occurs most commonly in adolescents and is characterized by sudden, sporadic onset of sharp pain, usually along the left sternal border, which is often exacerbated with deep inspiration. These pains are brief, lasting seconds to a few minutes, and resolve spontaneously. The pain can often be "broken" with a forced deep inspiration."
I've never tried the forced deep inspiration to break the pain. Next time I'll know what to try ;)
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