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| After a month of working at the MTU, I think I'm enjoying it. Well, at least that's what i try to tell my self. Some days I function purely on caffeine. I love my patients. It may not be true the other way round at times. Some of the oldest and sickest patients are on my floor, and many of them were admitted with a gigantic list of issues.
Things can get complicated. For example, I had this one patient who presented to Emerge with shortness of breath and anemia. Aside from that she came in with a million other things such as: unresolving pneumonia, chronic kidney disease with baseline Creatinine sitting at 300 (normal would be less than 110), diabetic retinopathy and neuropathy, neuropathic pain, chronic obstructive pulmonary disease, yada yada. Don't even go to her bottomless well of medications. Following her from day to day was quite a mission. We didn't know what was causing her profound anemia, so we ordered a barrage of tests on her. We were considering Sarcoidosis (yes, this differential comes out on House MD quite a lot) at one point because she had some weird lung CTs, kidney involvement, some enlarged lymph nodes, and partly due to her ethnicity, but after working her up we decided it was something else. She somehow developed pericardial effusion, which is when you get fluid around your heart, and she had a pulsus paradoxus (it's this thing where you get a cool change in blood pressure with inspiration) of 10mmHg, which was pretty cool because i dont get to do that often. Anyways, long story short, yesterday, we finally managed to get an upper GI scope and Colonoscope done on her. We had always suspected her anemia was due to a bleeding somewhere in her GI tract, be it hemorrhoids or colon cancer. However, it turned out to be some oozing ulcers in her stomach. And now the shocker... she also had extensive melanoma in her stomach. What???? I was pretty shocked. I never thought you can get a primary melanoma in there. Metastasis from the skin, yes, but a primary?
Anyways, it was my last day there yesterday. I was a little sad, but I'll be moving onto Neprhology next which is less hectic(i hope). I need a little downtime too. Call nights at nephro won't be at the Emerge, which would be chilll. Stayed a little later than usual to finish off dictating discharge summaries and to write transfer notes on all my patients so that the next horde of people coming in to inherit my patients will know what's going on. You kind of get attached to them, as you see them everyday and they are your patients. I get quite good turnover, i guess because i'm such a great healer... lol. Anyways, my patients have been quite interesting, which also means a billion issues and a freakin long transfer note. There is this HIV guy i have that has all the opportunistic infections under the sun, but that's a different story.
Of course, last day at the service also means evaluations. I was a little surprised. Apparently i exceeded expectations in terms of knowledge. They did say that i was quiet. But my attending was nice about it. She said it is okay to be quiet, but sometimes it's good to show off that you know by answering questions. Oh well. Apparently i am conscientious and have good rapport with the patients. Well, i can remember a few of them who really liked me but some of them hated my guts because i kept coming in to examine them when they were trying to sleep. There was this little old lady, who, i can say was my favorite patient. Barium swallow showed a huge gastric cancer (for which she was crying all weekend and i felt sorry for her) but when we scoped her we found nothing. Telling her family the good news was wonderful.
The resident i worked with was a great guy too. All the residents, at least in IM, were really impressive. I'm only 1.5 years away from being a resident. I hope i'll be as good in the future.
One thing i do hate about this though.... i haven't had time to practise kung fu in 5 months at least. This freaking sucks. I tried to touch my toes and it hurt. I'm back to square one to where i was 6 years ago. I guess i'll try to set aside some time to stretch more.
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| Just got my USMLE score. I got a 99!!!!! Oh my goodness!!! That was unexpected! I guess all my efforts were not in vain. I can't believe it. I don't usually get presents for Xmas, but i guess yeah... i get to celebrate Christmas early this year :) I'm actually sitting in my tiny office here in my Psych posting. It's a snow storm outside. I wonder if any of the patients will show up this afternoon due to the snow. I was really anxious, constantly checking my email, waiting for my USMLE score report. I guess i can breathe easier now for the rest of the day. Now to pass my fam med and psych finals.... | | |
| I just took on the Beast that is the USMLE step 1. Months of study, foregoing exercise and pleasure, and an 8 hour long exam later, it is finally over. I hope I passed. I don't think i'd want to go through it again. We will see how I do in 3 weeks.
I guess I can finally concentrate on my Psychiatry rotation now. Psych has been great. I'm posted at a consult service, where we look after the psychiatric health of really sick patients in the wards. I've met many wonderful, strong individuals.
My ankle is killing me. I've had bone spurs in the joint for sometime but for the past 4 days it swelled up like a balloon. The weird thing is that i dont remember spraining it, and now i'm limping around in pain. This sucks. It's funny how a little pain can make me feel so much older.
Well, I guess i better go study for my exam in 3 weeks. Haven't started because of the damn USMLEs. I'm on call on Friday and Sunday too. Bummer.
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| Today was the first snow day of the season. It wasn't much. Just a flurry. I was cycling between the Victoria General and the Infirmary to assess a patient when it rained and i was swearing at the sky. I was cold and soaking wet. After the assessment, on the way to a teaching session it was snowing. It was cool. Cool but not fun. Snow flakes were going into my eyes. Times like this i wish i had a car.
I was assessing him for depression. As i looked out the window, it was then that i realized it was snowing outside. I felt happy. I wanted to share my happiness with him but i guess he's had more than enough snow and more than enough on his plate. He has been admitted for 3 months and was in constant pain. Who wouldn't be depressed. All i could do was to be kind.
Turns out he wasn't clinically depressed. He was just being human. When i went back to see him with my attending, he told my attending that i did a good job and made him feel a better. On the way out the attending glanced back and told me, 'good job'. I guess that kind of made my day.
Had my first night on call last Thurs. The pager is like a freaking ticking bomb. I was so jumpy. Whenever someone else gets paged i jumped and checked my pager. It makes the most annoying siren ever too. The night was quite uneventful except for this girl who tried to kill herself by taking 20 acetaminophen at 6 am in the morning.
1 more week left till my board exam. At this point i'm just glad to be able to finally get it over with and concentrate on my rotations and to study for my Psych/Fam med exam in December.
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| "Death is always on the way, but the fact that you don't know when it
will arrive seems to take away from the finiteness of life. It is that
terrible precision that we hate so much. But because we don't know, we
get to think of life as an inexhaustible well. Yet everything happens
only a certain number of times, and a very small number really. How
many more times will you remember as certain afternoon of your
childhood, some afternoon that's so deeply a part of your being that
you can't even conceive of your life without it? Perhaps 4 and 5 times
more. Perhaps not even. How many more times will you watch the full
moon rise? Perhaps 20. And yet it all seems limitless."
The Sheltering Sky, Paul Bowles, 1949
Interesting fact - this quote was written on Brandon Lee's
tombstone. He actually used this quote as well in his last
interview whilst filming 'The Crow' (awesome film btw).
Here are a few really nice pictures of the sky that i've taken since
i've came here. Some of the best sky photos i've taken thats for
sure.
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