Even though class doesn't start until ten I'm stuck here in the hospital because Chris needed to get into work at 8. Boo! I guess I can't complain, though, because he gets here early EVERY SINGLE day when I have to get to the hospital at the crack of dawn - even when I was on Gyn-onc and was regularly getting here at 5:30!
Today is my grandpa's 89th birthday. He's technically my "step grandpa" because my mom's father died when she was 11. But, he's the only grandpa I've got and I am super excited! He was the one who made me bacon every day when I was in B-town. I think the whole fam is going up tonight to hang out and celebrate his birthday - one more year and he'll be 90!
Well I just found out have to go over to some place in the VA and try to find some guy to sign up for some class that I apparently can't just sign up for over the phone...so I'd better get going. I hate paperwork!
Friday, February 20, 2009
Wednesday, February 18, 2009
Tweeting
Yes, I've joined the crowd and am now twittering. How do you verb that? Tweet? Twit? Twittering? I have recently begun to fear that I'm getting worse with technology now that I'm old. Seriously. What is this iPhone business and how do you use one? Tweeting? It took forever to figure how to put the widget on. Isn't it called a widget? This never used to happen when I was 22.
Today was uneventful EXCEPT I went to a peds meeting for a free lunch (and for some fantastic advice) and I got a free dinner at Malone's with the MDPhD crew. Sweet! I even got snacks from the Hospice lecturers today, so my food budget for today only included 1 piece of toast for breakfast. AWESOME.
The Peds meeting was great. I am leaning more and more towards Pediatrics (mostly because I never want to grow up) and they talked a lot about 4th year electives (which is SUPER exciting but also daunting). Right now I want to do an AI in Pediatrics (or NICU if that's possible?), back to Bardstown to work with Dr. Block, and electives in adolescent medicine, general dermatology (kids have lots of rashes), and an surgery AI in ... something else, maybe Labor/Delivery.
Speaking of 4th year, I signed up for USMLE Step 2 today. Holy crap! $1550, not including travel/lodging in Atlanta. I didn't do so amazingly hot on Step 1, so I need to rock out Step 2, which makes my problem of "test anxiety" (which I think was a major problem for my step 1 score!) become even bigger. I'm already almost having panic attacks just thinking about it. Supposedly step 2 is easier/better...but I'm not going to hold my breath. I need to go buy some books. And study.
I get ACLS certified on Saturday, meaning I will technically be certified/able to run a code in the hospital (example: patient's heart stops beating - I can do CPR, shock 'em, and push epinephrine and save their life)...which is pretty sweet but also terrifying. We'll see how that goes.
Anyway, better do a little work then go to bed...more lecture tomorrow - whoo...
PS-Wedding planning is hard! Thankfully Chris is the BEST and is super helpful when it comes to planning... it's less than 8 months away!
Today was uneventful EXCEPT I went to a peds meeting for a free lunch (and for some fantastic advice) and I got a free dinner at Malone's with the MDPhD crew. Sweet! I even got snacks from the Hospice lecturers today, so my food budget for today only included 1 piece of toast for breakfast. AWESOME.
The Peds meeting was great. I am leaning more and more towards Pediatrics (mostly because I never want to grow up) and they talked a lot about 4th year electives (which is SUPER exciting but also daunting). Right now I want to do an AI in Pediatrics (or NICU if that's possible?), back to Bardstown to work with Dr. Block, and electives in adolescent medicine, general dermatology (kids have lots of rashes), and an surgery AI in ... something else, maybe Labor/Delivery.
Speaking of 4th year, I signed up for USMLE Step 2 today. Holy crap! $1550, not including travel/lodging in Atlanta. I didn't do so amazingly hot on Step 1, so I need to rock out Step 2, which makes my problem of "test anxiety" (which I think was a major problem for my step 1 score!) become even bigger. I'm already almost having panic attacks just thinking about it. Supposedly step 2 is easier/better...but I'm not going to hold my breath. I need to go buy some books. And study.
I get ACLS certified on Saturday, meaning I will technically be certified/able to run a code in the hospital (example: patient's heart stops beating - I can do CPR, shock 'em, and push epinephrine and save their life)...which is pretty sweet but also terrifying. We'll see how that goes.
Anyway, better do a little work then go to bed...more lecture tomorrow - whoo...
PS-Wedding planning is hard! Thankfully Chris is the BEST and is super helpful when it comes to planning... it's less than 8 months away!
Tuesday, February 17, 2009
This counts
25 Random Things About Me
1. I love making cakes but I don’t like to eat lots of them.
2. I have a stuffed rabbit named Puppy that I’ve had since I was a baby.
3. My stomach can be louder than anyone’s I’ve ever known.
4. I can touch my nose with my tongue.
5. I did CPR on a guy once. He died. I don’t think it was my CPR skills, though, probably more due to the bullet in his heart.
6. I have a lot of clothes and they are semi-organized by season and color.
7. I wear my red glasses every day so that my patients and attending can recognize me easily.
8. I’m usually cold. That doesn’t make me happy.
9. I won the spelling bee in 5th grade.
10. I’m marrying my best friend and study buddy on 10/17/09!
11. I went by “Katherine” in middle school to sound older but changed it back in high school because “Katie” sounded more fun.
12. My goldfish live ridiculously long lives, and I name them after cities I’ve lived in.
13. I did half of the P90X workouts and I think that’s a pretty big deal.
14. I was in the marching band for 6 years and loved every minute of it.
15. The headboard of my bed has a music box in it that plays “It’s a Small World” – my bed is handmade by my late grandfather and my dad installed the music box when I was little.
16. I have microfleece sheets that are my favorite thing ever. Ever.
17. I always sleep prone, I can’t breathe otherwise.
18. I’ve been to a gay bar and a strip club.
19. When I was about five years old, one of my favorite foods was lima beans. My favorite pizza was mushroom and olive. And I always dipped my hostess donuts in black coffee.
20. My first “real” job was at Blimpie. Before that I was a little league umpire.
21. Sometimes I worry that med school has taken away my ability to be a compassionate human being.
22. I like to lick and smell things. Even if they’re not edible. Especially if they’re not edible.
23. I will use the same tissue 100 times.
24. Over 5 alarms are set to wake me up in the morning because one of my greatest fears is being late/missing school.
25. I drive with a Pope JP2 prayer card in the dashboard of my car.
1. I love making cakes but I don’t like to eat lots of them.
2. I have a stuffed rabbit named Puppy that I’ve had since I was a baby.
3. My stomach can be louder than anyone’s I’ve ever known.
4. I can touch my nose with my tongue.
5. I did CPR on a guy once. He died. I don’t think it was my CPR skills, though, probably more due to the bullet in his heart.
6. I have a lot of clothes and they are semi-organized by season and color.
7. I wear my red glasses every day so that my patients and attending can recognize me easily.
8. I’m usually cold. That doesn’t make me happy.
9. I won the spelling bee in 5th grade.
10. I’m marrying my best friend and study buddy on 10/17/09!
11. I went by “Katherine” in middle school to sound older but changed it back in high school because “Katie” sounded more fun.
12. My goldfish live ridiculously long lives, and I name them after cities I’ve lived in.
13. I did half of the P90X workouts and I think that’s a pretty big deal.
14. I was in the marching band for 6 years and loved every minute of it.
15. The headboard of my bed has a music box in it that plays “It’s a Small World” – my bed is handmade by my late grandfather and my dad installed the music box when I was little.
16. I have microfleece sheets that are my favorite thing ever. Ever.
17. I always sleep prone, I can’t breathe otherwise.
18. I’ve been to a gay bar and a strip club.
19. When I was about five years old, one of my favorite foods was lima beans. My favorite pizza was mushroom and olive. And I always dipped my hostess donuts in black coffee.
20. My first “real” job was at Blimpie. Before that I was a little league umpire.
21. Sometimes I worry that med school has taken away my ability to be a compassionate human being.
22. I like to lick and smell things. Even if they’re not edible. Especially if they’re not edible.
23. I will use the same tissue 100 times.
24. Over 5 alarms are set to wake me up in the morning because one of my greatest fears is being late/missing school.
25. I drive with a Pope JP2 prayer card in the dashboard of my car.
holy wedding bells, batman
I'm getting married in eight months!
Holy cow.
I've got a lot to do this afternoon (since I have the WHOLE afternoon off-woohoo!) but hopefully writing a REAL post will be on the list.
In the meantime, check out my cool website:
http://twistandsimmons.shutterfly.com/
It's not done yet, so don't get all excited yet, but it's pretty sweet, eh? :)
Holy cow.
I've got a lot to do this afternoon (since I have the WHOLE afternoon off-woohoo!) but hopefully writing a REAL post will be on the list.
In the meantime, check out my cool website:
http://twistandsimmons.shutterfly.com/
It's not done yet, so don't get all excited yet, but it's pretty sweet, eh? :)
Saturday, February 14, 2009
St. Valentine's and the UK med finale
I suppose I'm long overdue for a post. I really think about writing every day, but I feel like my life is sort of dull so I don't really bother writing most days. That's lame, isn't it? :)
Anyway, it's Valentine's day, a day that a lot of people seem to blow out of proportion - either making a huge fuss over what they get from their honey or their frustration with a lack thereof. I think it's nice to celebrate love but we should celebrate it more than once a year. And we don't really need to celebrate with flowers, chocolates, and teddy bears. Those are better as surprises, anyway. As for my day, I plan to study quite a lot (for our midterm on Monday), maybe try on some wedding dresses with my mom, and maybe cook some special food with Chris.
Off that soapbox.
Medicine at UK has come to an end. It had a lot of ups and downs. A whole lot of downs. Patients who come into UK aren't your "average" patient. People who come to UK are sick. I've been caring for a man all week who I was on edge about every minute because I thought he was going to code on us and die. His liver was dead, his kidneys were failing, his lung was filled with fluid, he was yellow as a banana, and confused because the ammonia levels in his bloodstream were building up. We told him his prognosis was slim (I entered his lab values into a program and it gave him an estimated 97% mortality rate)...but he and his family insisted on him being a full code (meaning we do CPR and put you on a ventilator if something goes wrong). We told him it would probably just prolong his misery, but they didn't even want to consider it. I don't really blame them - he was only 52 but he looked like he was 80. I went to see him on Thursday and he was actually doing great, he was asking if he could go home. Thursday night he coded and is now in the ICU. I am curious to see what happens but I know what is ultimately going to happen. He is never going to get better.
"never getting better" is something that's really frustrating to me. As a doctor, if I can't make you better, I should just make you comfortable and let you be. But I still can't help but feel like that's a failure. Like we gave up.
Another frustration was that I had too many questions. I have a mystery patient. She's 44. She acquired type 1 diabetes at age 22 (old for Type 1). She needed a liver transplant at age 27 for "Hep C" even though she has NO hep C in her bloodstream now, and probably not then. Why did she need her liver transplanted? I have no clue. And nobody seems to care. She has two brothers with "Common Variable Immune Deficiency" that presented in their early 40s-A disease that presents almost always before 30 and is not that heritable. Since July, she'd been building ascites (fluid in her abdomen) and was coming into the hospital to have a TIPS procedure done to shunt the fluid back in her bloodstream, basically. She also stopped menstruating in July. I think there's a connection. Who just hits menopause when they're 44 and have no symptoms at all? Nobody else believes me, or at least nobody else cares! I want to figure out what the crap is wrong with her and basically everyone else just takes everything as it stands. Maybe I'm just not burnt out enough yet. Who knows.
PS- I am tossing around alpha-1 antitrypsin deficiency and hemochromatosis (her skin is so brown, but supposedly uses tanning beds) in my differential. A1-AT would be great but she has no lung involvement. Hemochromatosis would be weird for her to present so early. But why can't we just order the tests anyway? Maybe if we found the cause we could prevent the complications. Just sayin'
Anyway, UK medicine was frustrating to say the least. I felt like I knew nothing most of the time, was largely ignored, and we rounded for what seemed like an eternity. I liked the mystery but hated that no one else appreciated it. I didn't like that so many people in the hospital could have prevented it by taking care of themselves in the first place, and my tax dollars are paying for it. The more time I was there, the more I wanted to do peds. :)
Anyway, Chris just brought me in homemade heart-shaped pumpkin chip pancakes - how cute is that?! I gotta go get some before Patrick comes down and eats them all! :)
Anyway, it's Valentine's day, a day that a lot of people seem to blow out of proportion - either making a huge fuss over what they get from their honey or their frustration with a lack thereof. I think it's nice to celebrate love but we should celebrate it more than once a year. And we don't really need to celebrate with flowers, chocolates, and teddy bears. Those are better as surprises, anyway. As for my day, I plan to study quite a lot (for our midterm on Monday), maybe try on some wedding dresses with my mom, and maybe cook some special food with Chris.
Off that soapbox.
Medicine at UK has come to an end. It had a lot of ups and downs. A whole lot of downs. Patients who come into UK aren't your "average" patient. People who come to UK are sick. I've been caring for a man all week who I was on edge about every minute because I thought he was going to code on us and die. His liver was dead, his kidneys were failing, his lung was filled with fluid, he was yellow as a banana, and confused because the ammonia levels in his bloodstream were building up. We told him his prognosis was slim (I entered his lab values into a program and it gave him an estimated 97% mortality rate)...but he and his family insisted on him being a full code (meaning we do CPR and put you on a ventilator if something goes wrong). We told him it would probably just prolong his misery, but they didn't even want to consider it. I don't really blame them - he was only 52 but he looked like he was 80. I went to see him on Thursday and he was actually doing great, he was asking if he could go home. Thursday night he coded and is now in the ICU. I am curious to see what happens but I know what is ultimately going to happen. He is never going to get better.
"never getting better" is something that's really frustrating to me. As a doctor, if I can't make you better, I should just make you comfortable and let you be. But I still can't help but feel like that's a failure. Like we gave up.
Another frustration was that I had too many questions. I have a mystery patient. She's 44. She acquired type 1 diabetes at age 22 (old for Type 1). She needed a liver transplant at age 27 for "Hep C" even though she has NO hep C in her bloodstream now, and probably not then. Why did she need her liver transplanted? I have no clue. And nobody seems to care. She has two brothers with "Common Variable Immune Deficiency" that presented in their early 40s-A disease that presents almost always before 30 and is not that heritable. Since July, she'd been building ascites (fluid in her abdomen) and was coming into the hospital to have a TIPS procedure done to shunt the fluid back in her bloodstream, basically. She also stopped menstruating in July. I think there's a connection. Who just hits menopause when they're 44 and have no symptoms at all? Nobody else believes me, or at least nobody else cares! I want to figure out what the crap is wrong with her and basically everyone else just takes everything as it stands. Maybe I'm just not burnt out enough yet. Who knows.
PS- I am tossing around alpha-1 antitrypsin deficiency and hemochromatosis (her skin is so brown, but supposedly uses tanning beds) in my differential. A1-AT would be great but she has no lung involvement. Hemochromatosis would be weird for her to present so early. But why can't we just order the tests anyway? Maybe if we found the cause we could prevent the complications. Just sayin'
Anyway, UK medicine was frustrating to say the least. I felt like I knew nothing most of the time, was largely ignored, and we rounded for what seemed like an eternity. I liked the mystery but hated that no one else appreciated it. I didn't like that so many people in the hospital could have prevented it by taking care of themselves in the first place, and my tax dollars are paying for it. The more time I was there, the more I wanted to do peds. :)
Anyway, Chris just brought me in homemade heart-shaped pumpkin chip pancakes - how cute is that?! I gotta go get some before Patrick comes down and eats them all! :)
Sunday, February 8, 2009
Finally - a day off!
After working the past seven days straight, I have a day off today. Woohoo!
What have I accomplished? Nothing. Well, as long as you don't count making a "to-do" list all morning.
I suppose I should be getting on that....
What have I accomplished? Nothing. Well, as long as you don't count making a "to-do" list all morning.
I suppose I should be getting on that....
Wednesday, February 4, 2009
tragedies every day
Life on Medicine can be really sad sometimes. Today's patients were especially sad.
My first patient was a 32 year old man. He was having trouble breathing so he went to the ER. He weighs well over 400 pounds. That in and of itself is what makes me sad - that this man has just begun his life and is so limited in what he can and cannot do. He did have a really interesting case, though. He has low O2 sats naturally ("natually" due to his morbid obesity) and has sleep apnea and his O2 goes far down while he's asleep. So the ER people put him on an oxygen mask with bipap to help with his O2. Unfortuntely, he is a chronic CO2 retainer (we think) and the extra oxygen told his brain he didn't need to breathe so he didn't exhale the high amount of CO2 that was building up in his body. He became acidotic and began to respiratory arrest, but they took off the mask and he started breathing again.
The next patient was on the other side of the size spectrum - a teeny 86yo lady who weighed about 86 pounds. If that. Anyway, she came in because her leg was swollen and painful (=DVT). She has a blood clot that goes all the way from her knee to her hip. While examining her, we noticed a mass in her lower right abdomen LITERALLY the size of a small watermelon. A huge, firm, lumpy mass. When asked if she noticed it she sort of brushed it off like she'd maybe noted something but didn't really think anything of it. She had no other medical problems (because she had never seen a doctor) except this DVT and the fact that she was cachectic from the cancer - she used to be my size. We did a CT scan and it showed a HUGE renal cell carcinoma with mets to the liver and lung. We had to go talk to her today about the diagnosis (we're not "sure" it is cancer without the biopsy so we just told her it was a "mass likely to be cancer"). The hardest part about it was that in her (shared) room, there were EIGHT family members with her, as well as the 5 people on our team. I felt like we were having a town meeting instead of talking about her cancer prognosis.
If that wasn't enough to depress you, the patient I picked up this afternoon almost had me in tears.
She's 28 years old (I already identified with her since she's so young) and just got out of the ICU for carbon monoxide poisoning. Last week she lost power so she and her husband used the kerosene heater. Unfortunately, they both had severe CO poisoning, and it took a while until family found them. She also is a type 1 diabetic, so by the time they found her she had DKA, and the lack of oxygen to her tissues had caused her to have a major heart attack. All at 28 years old. She's off the ventilator but still pretty confused. The worst part of the entire story is that her husband actually died from the poisoning, and no one has told her yet. It's not our medical job to tell her (the family is going to but was at the funeral today) and honestly that kind of psychological stress is more than she needs right now. Even so, it killed me to stand in that room and talk with a girl my age who will never see her husband again.
Even though it's depressing, these patients teach me a lot about life. Like not to take it for granted. I could go to sleep and not wake up tomorrow, and so could anybody. I try to remember to tell my brother "I love you," to give extra big hugs to Chris, and to call my friends and family so they know that I care.
I have to hope that we're making them better. Maybe not today, but maybe someday.
My first patient was a 32 year old man. He was having trouble breathing so he went to the ER. He weighs well over 400 pounds. That in and of itself is what makes me sad - that this man has just begun his life and is so limited in what he can and cannot do. He did have a really interesting case, though. He has low O2 sats naturally ("natually" due to his morbid obesity) and has sleep apnea and his O2 goes far down while he's asleep. So the ER people put him on an oxygen mask with bipap to help with his O2. Unfortuntely, he is a chronic CO2 retainer (we think) and the extra oxygen told his brain he didn't need to breathe so he didn't exhale the high amount of CO2 that was building up in his body. He became acidotic and began to respiratory arrest, but they took off the mask and he started breathing again.
The next patient was on the other side of the size spectrum - a teeny 86yo lady who weighed about 86 pounds. If that. Anyway, she came in because her leg was swollen and painful (=DVT). She has a blood clot that goes all the way from her knee to her hip. While examining her, we noticed a mass in her lower right abdomen LITERALLY the size of a small watermelon. A huge, firm, lumpy mass. When asked if she noticed it she sort of brushed it off like she'd maybe noted something but didn't really think anything of it. She had no other medical problems (because she had never seen a doctor) except this DVT and the fact that she was cachectic from the cancer - she used to be my size. We did a CT scan and it showed a HUGE renal cell carcinoma with mets to the liver and lung. We had to go talk to her today about the diagnosis (we're not "sure" it is cancer without the biopsy so we just told her it was a "mass likely to be cancer"). The hardest part about it was that in her (shared) room, there were EIGHT family members with her, as well as the 5 people on our team. I felt like we were having a town meeting instead of talking about her cancer prognosis.
If that wasn't enough to depress you, the patient I picked up this afternoon almost had me in tears.
She's 28 years old (I already identified with her since she's so young) and just got out of the ICU for carbon monoxide poisoning. Last week she lost power so she and her husband used the kerosene heater. Unfortunately, they both had severe CO poisoning, and it took a while until family found them. She also is a type 1 diabetic, so by the time they found her she had DKA, and the lack of oxygen to her tissues had caused her to have a major heart attack. All at 28 years old. She's off the ventilator but still pretty confused. The worst part of the entire story is that her husband actually died from the poisoning, and no one has told her yet. It's not our medical job to tell her (the family is going to but was at the funeral today) and honestly that kind of psychological stress is more than she needs right now. Even so, it killed me to stand in that room and talk with a girl my age who will never see her husband again.
Even though it's depressing, these patients teach me a lot about life. Like not to take it for granted. I could go to sleep and not wake up tomorrow, and so could anybody. I try to remember to tell my brother "I love you," to give extra big hugs to Chris, and to call my friends and family so they know that I care.
I have to hope that we're making them better. Maybe not today, but maybe someday.
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