Friday, May 21, 2004

Good news, I still have feelings. Okay, clarification. I was worried that 2 months at UH had killed my compassion for patients but all it took was an 11 yo screaming at the top of her lungs for me to realize that I still cared. She cut her hand trying to catch a falling jar of pickles (sorry folks, she didn't save the pickles... I know, I was disappointed too). At first it didn't look too bad, just a little oozing. Then the attending went and probed a little more and a little stream of blood squirted up (like that scene in national lampoon's european vacation when they hit the bicycle guy...but not as drastic). Anyway, so we had to tie off the squirter but the mom refused to let us sedate her daughter. So the girl was screaming at the top of her lungs...it was LOUD! And it almost made me want to cry and start yelling at the residents and attending to hurry up damnit! After much poking and prodding and pathetic attempts to tie off the bleeder, they pulled out a clot and then the bleeding just stopped on its own. Then I came home cause my time was over and nothing cool was going to happen to the girl except watching her scream while they put stitches in her hand after xrays to close the wound. Fun huh?
~me~ at 10:51 PM

Thursday, May 20, 2004

My dad tells me that the spoon was rarely used, if at all. I personally don't remember much except the threat so I guess that's so. It was easy to tell when my mom was getting mad though thanks in part to my parents giving us 4 names (1 first name, 2 middle, and a last name). When she was getting pushed too far or if we said some smart aleck remark, it was usually the first 2 she would say. Rarely did we get the first 3.

Anyway, Oh wait, I have to poo.

Okay, where was I...oh yes, today while listening to my heart and it's extra sound (remember, I'm convincing myself that it's a split S1), I decided to see if I could get it to split some more and try to close it by exhaling. You see, on further reading, I learned that I could close a split S1 by exhaling and open it by inhaling. Now, this is opposite of a split S2 - inhaling splits the S2 while exhaling closes it. So while I was playing around with my split S1 (I suppose I got it to close though I'm not sure), I finally was able to hear my S2 split on inhaling! It was so cool! That's normal by the way. So I did it again and again to make sure I wasn't just hearing my split s1 and I'm positive that it was my s2 splitting. I know this means nothing to you folks but it was cool, just trust me on this one. I've been trying to split my S2 ever since I learned about it last year during clinical diagnosis.

today I saw a nasty impetigo. Actually, it was atopic dermatitis but the little kid scratched it so much that it was on its way to being a cellulitis or and abscess. It didn't have the typical honey crusted lesions (buzz phrase) but if he didn't scratch, perhaps it would. So we're trying oral antibiotics, oral allergy meds, and topical steroids and hoping for the best. Poor kid. Hopefully he won't scar too badly.
~me~ at 3:04 PM

Wednesday, May 19, 2004

Today I saw something that made me laugh. A parent made an appointment for her 2 and a half child with the chief complaint of "major behavioral problems." Um...he's 2. I didn't think most 2-3 year olds were particularly obediant. Okay, I'm sure they do the basics like following commands to stop or sit but even then, it seems like you can't say a kid has major problems until maybe 4. Dr. E said that usually it's the result of parents not consistently disciplining their kids and while she too had a laugh about the reason for the visit, the most that can be done is to give the parent suggestions on discipline and motivation. Hmmm...sure, she has kids, she can give good examples. I was a kid so I suppose I could give examples from my childhood like the good ole wooden spoon for extra naughty times (no memory of how often that occurred - either cause it was rare or I've suppressed the memories)...course I'd hate to be involved in a child abuse case only to hear the parent say, "but the doctor said I could hit him when he was being very naughty and he's always very naughty." Yeah, not a good thing. She said sticker chart but really it depends on the parent spending more time playing with the kid than watching tv.
~me~ at 5:29 PM

Tuesday, May 18, 2004

I love my vanilla sugar lip balm! It's like eating cookies when I put it on. Ymmmm....cookies. Speaking of cookies, I love my cornflake crunch Kauai Kookies (thanks dad)! They're very tasty, especially after dipping them in strawberry or chocolate milk. Actually, i was talking with an obese 8 year old today and I was asking about his diet and he said that he didn't like Strawberry milk and I had to tell him how wrong he was to deny himself of such goodness. Then I realized that not only did he not need strawberry milk, but he shouldn't be drinking chocolate milk either. Oh well, perhaps if he were skinny, it would have been less of a bad thing to encourage the consumption of flavored milk. Poor kid. On the plus side (for me I guess), it was incredibly easy to visualize his tympanic membranes. What else...nothing. So back to reading I go.
~me~ at 5:15 PM

Okay, I'm annoyed at one of the attendings. We were listening to the heart of a new baby and she claims there was a 2/6 murmur so I listen and I don't hear shit. So she says "You should be hearing that because you ARE in your 6th block and should have ample experience listening to hearts." Whatever. Very few of my adult patients (maybe 2 or 3) had murmurs per the staff docs on those teams I was on (the residents didn't hear it either). And the kids that I've seen with murmurs that other staff called 2/6 I could hear crystal clear the moment I put my stethoscope on their chests. This kid had nothing except breath sounds that could be mistaken for a flow murmur but watching the chest move I could tell that I was hearing those instead of a murmur. So she then says to use her stethoscope and really, that made no difference. I didn't feel bad though because Dan couldn't hear anything either. Then she listened again and said that she had to search harder for it that time but that it was definitely there. Sure...Maybe if they weren't talking and the stupid machines weren't making noise I could detect this "murmur" of hers but at this moment, I'm convinced that there wasn't one there or that it was so soft that only an experienced doctor as she could convince herself that it was there. But don't tell me that 2-3 patients with murmurs should automatically make me an expert at hearing virtually inaudible sounds and calling them murmurs. I watched her at morning report and she has a strong personality...kind of reminds me of how christina can be when she's certain of something...I guess I can be like that too.
~me~ at 12:16 PM

Sunday, May 16, 2004

Okay, I gave up on working on those stupid fluid/electrolyte problems because I got to the last problem and he used a random number and gave no rationale and I'm tired of assuming different reasons for number choices. In fact, I'm tired of this whole year of the "guess what I'm thinking" game that attendings and residents play. Why don't they guess what I'M thinking! THough I guess I should be glad they can't read my mind at those moments or my evals would have been lower due to unprofessionalism. Is it something about having an MD after your name that you forget what you went through as a student?!? And I bet every single one of these people said at some point during their student years, "when I'm a resident or attending, I certainly won't put my students through this crap." I'm hungry
~me~ at 5:32 PM

I don't know why this pisses me off so much, but it really really irritates me when teachers don't use the same numbers for their calculations from problem to problem when the number should be the same. Or if they use a different constant value, they don't explain why. This random number choice really pisses me off. It's all plug and chug anyway so that's why I know it shouldn't irritate me because I can easily tell that I went through the right motions but ugh! This particular teacher's rounding is quite erratic as well...sometimes he rounds up, other times he rounds down and for a bunch of people who make it their goal to mention time and again how we need to be as precise as possible when dealing with kids, they round like it doesn't matter at all. I know, I'm being silly and OCD about this...I can't help it.
~me~ at 4:47 PM