Is it okay if I rant?

Last week I was assigned to follow a Physician Assistant for a day since the MD was out of the office. I have nothing against PAs. But this one was really starting to rub me the wrong way (figuratively speaking). 

PA: Medical Student, go assess these patients.

Medical Student: Okay.

Medical Student: Patient number one has a cough that comes in paroxysms with post-tussive emesis. He has had the cough for 6 weeks. I think we should cover for pertussis.

PA: Um, no. It's just viral.

Medical Student: (what the @#%$@!!)

Medical Student: Patient number two is a well child check. Everything was fine but there is a 2/6 systolic murmur at the apex. I think it should probably be checked out.

PA: (listens at the 2nd and 4th ICS) Nope. No murmur.

Patient's Mom: I think he's right, we have been told he has a murmur and that he should have a "heart ultrasound."

PA: (listens at the apex) I found a murmur here.

Medical Student: (glares at back of PAs head)

Medical Student: Patient number three has perfect circular patch of hair loss with a boggy mass on his scalp. It's classic for a fungal infection. I think we should treat him with an oral anti-fungal.

PA: Nope. This is a lipoma or maybe a sebaceous cyst.

Medical Student: I really don't think...

PA: We need to cut it out.

Medical Student: Should we try an anti-fungal first?

PA: Nope. We need to cut it out. (makes an incision on patient's head) Weird, there is nothing in here. Oh well, stitch this up.

What a day.

How the Dementia Patient Out-smarted Me

Every once in a while you have to let go of your pride and admit that someone has gotten the better of you. Whether it be sports, politics or even the world of medicine, the time is sure to come. It just sucks when the person who gets the better of you has dementia. 

One of my patients in clinic today appeared rather confused so I decided to perform a mental status exam on her...

Medical Student: Okay, can you spell world backwards?

Patient: No.

Medical Student: You don't want to try?

Patient: Why would I do that?

Medical Student: Okay. um, I'd like you to take this pen and draw a picture of a clock face showing ten past eleven.

Patient: Fine. (starts drawing) There. (shows me picture of a circle with 11:10 written inside of it)

Medical Student: What's that?

Patient: It's a digital clock. 

Medical Student: You win. I don't care if you think the president is Woodrow Wilson. 

Learn from the best

As I go through medical school I like to see what I want to incorporate into the way I practice medicine by watching those who have gone before me. For instance, humor:

Attending: Well, you haven't been taking your medication, you aren't changing your diet, you aren't exercising and you aren't losing weight. Your kidney function is failing. It looks like you are going to have to start dialysis if you can't get with the picture.
Patient: What? Oh no! I don't want to do that. My children would just die!
Attending: No, you would be the one who dies. (chuckles)
Patient: ("I don't find that funny" stare)
Attending: (continues to chuckle)

I'm learning so much!

Moving On

Family Medicine. The "who the hell knows what is coming in next" specialty (second to emergency I suppose). My first day on family went a little something like this:

Medical Student: Hello 75-year-old lady! Lets talk about what kind of exercises you have been doing since we saw you last.
Patient: Huh? Are you kidding? The only exercise I want to do is at night in the bedroom.
Medical Student: I wish you didn't look like my grandma

Hour later...

Medical Student: Hello super stressed out angry guy! What brings you into the office today?
Patient: My wife is bipolar, has scleroderma and addicted to oxycontin.
Medical Student: (practicing his empathy) I'm so sorry to hear that. That must be really stressful for you.
Patient: Look at these pictures I took of her on my phone of her passed out on the floor.
Medical Student: I wish you hadn't shown me that.

Oh what joys will come next!?!

Make sure you lock the door

So I found out the hard way that the bathroom door on the peds unit doesn't lock that well. Actually, I would say the poor old filipino nurse who walked in on me found out the hard way. Oh well, nothing she doesn't deal with every day right?

Pneumonia

Sorry for the gigantic lack of updates. The reasons are two-fold. Firstly, everyone is so nice to me on peds that I feel like there is nothing interesting to report. I mean, it seems writing everyday that everyone loves me and gives me respect would bore most people. It's only funny when I'm getting abused. I miss surgery. Second, this happened:

Medical Student: Hello small child and family with pneumonia! I see you were just seen yesterday in the emergency department and given amoxicillin. 

Small Child: (all cutesy) mmmhmmm! (big smile) (little cough)

Medical Student: Aww, how cute, here is a sticker of mickey mouse!

Small Child: Yay! Thanks! (cutesy smile)

Medical Student: What a polite little girl! Now open wide for me!

Small Child: Okay! (coughs in my face)

Medical Student: (!#$^%@) 

Small Child: (cutesy smile) sorry...

Mom: Oh, I'm sorry...

Medical Student: (you can take sorry and shove it...) That's okay! Here is another mickey sticker!

Small Child: Yay!!

So, yes, I have been sick all week and weekend. I did not know it was humanly possible to shed this much mucus onto the earth. I wish I could extract all my goblet cells. Also, I don't care if that was gross. Suffer with me!

I cannot escape it

It's understandable when you are in the academic medicine environment to expect a certain level of pimping. I've done my fair share of griping on this blog about the questions I've received as a medical student, but in all honesty things haven't been too bad. When you exit the academic world and escape into real life, however, you tend to let your guard down. Especially when you or your family member is now a patient.

My wife needed to have a minor surgical procedure performed and was undergoing general anesthesia for the operation. I, the loyal husband that I am, was waiting by wife's side in pre-op and inevitably the surgeon came by to do the final pre-op check and asked me what I did for a living.

Surgeon: (lighting up like he just found his next hit) "Ah, so you're a medical student! What are you interested in?"
Me: "Well, I'm still trying to decide. I like peds a lot."
Surgeon: "Well, try to stop liking that. There is no money in it."
Me: "Okay..."
Surgeon: "So I'm currently injecting your wife with Versed, you know, midazolam. Then we will give her some propofol for induction."
Me: (feeling he is about to go deeper with this) "Alright..."
Surgeon: "You remember your pharmacology?"
Me: (No freaking way is this guy about to pimp me as he is about to induce my own wife) Yes...
Surgeon: "Well, what is the mechanism of action of Midazolam?"
Me:(Are you freaking kidding me?!?) That's evading me...
Surgeon: "Well, it acts on the GABA receptor."
Me: "Ah, yes, of course."
Wife: (looking off into the distance) "Is this what being high is like..."
Me: "Yes, sweetheart."

So, in the future, whenever I'm asked what I do, I am going to say that I'm an accountant. Because you never know where a pimp addict may be lurking. And the surgery went fine, in case anyone was wondering.