Friday Flashback #2

THIS was my kind of week, chock full of flashbacks back to my fire department days. I mean, here were some of the classes I had this week:

Trauma (neurological)
Personality Disorders
Alcohol/Nicotine/Drug Abuse x2
Toxicology
Legal Issues

I easily saw all of these issues during a single shift. In particular, I saw all of these during one crazy call out to a MVC (motor vehicle collision).

It was really bad. Officers had marked off the scene by the time our bouncy box of flashing lights and sirens had painfully navigated past lines of jammed up traffic. I jumped out with my bags ready to go at the end of the scene closest to me ready to go, but instead of a car all I saw were tire tracks. They kept going for a while, then I saw a row of orange road medians destroyed as if Autobots and Decepticons had a big fight here. Finally off in the distance I saw the car with the wheels in the air, and realized what had happened.

Brakes slammed on at first, then one side of the car used the highway medians as a ramp, and rolled over in the air like a dolphin spiraling through the water as if doing tricks at Seaworld.

Coup, then contra-coup injury, when her car finally crashed into the pavement. It's French, and describes what happens to the soft squishy brain when it gets smacked around in a hard box. Coup- the front gets bashed as the body slams into the steering wheel. Contra-coup- when the BACK of the head rebounds just like a basketball off the edge of the hoop, but into more skull.

Trauma. Check.

I won't bother you too much with the boring stuff. Firefighters using Jaws of Life. Making sure the car would not blow up on us into a nice fireball. Carefully extracted a lady. Maintained c-spine. Quick trauma assessment. Load and go. Lined her up.


What was interesting was what happened in the back of the ambulance, just the two of us, flying towards the nearest trauma center. First, nothing my patient said made any sense at all. She looked like an intelligent, attractive professional, so I thought maybe it was another language. A little slurred. Leaned in and took a sniff. Yep, alcohol.

Alcohol/ Toxicology? Check. (To my med school peeps- brief Wernicke's area disruption too?)

So for the rest of the call, I did my medical thing, and kept checking in on my patient. Slowly, she seemed to come back, through the mist of all the chaos that had just happened. Then it got really strange.

Thank-you-thank-you-thank-you-thank-you-AH WHAT THE F@#$# is HAPPENING TO ME? She kept sobbing in gratitude, but then completely spaz out and open a can of whoop-ass all over me.

The only thing I can think of now that describes that is if she had a borderline personality disorder. I'm still not sure. Maybe it was the stress of, oh I don't know, launching her car into the air, seeing the world spin around her as phone flew through the air.

Personality Disorder? Maybe check.

Anyway, sorry this flashback did not end with a bang like the last post. I've got finals coming up, and I think I'm forgetting old memories to make way for all the stuff I am learning now. I assume we all made it to the hospital okay.

Oh almost forgot, as I was doing the rapid pat-down that is the focused trauma assessment earlier, I peeked into her ear and some plastic fell out. Huh. What's left of a bluetooth set. Too bad a cop was right next to me, and checked her phone. Yep. Texting right around when the crash happened.

Legal. Check.




(Some fictionalization. HIPPA. Duh.)

Friday Flashback

I need something to keep me sane. Whenever exam week comes around, my brain does this weird paradoxical dump. The more information I shove in, the grey matter poops out weird things. Sometimes it's notes to a song, other times it is material for this blog. If it gets really bad, I start thinking of ideas for our school's-annual tradition-that-shall-not-be-named. But for now, here is what happened when I stay up past midnight reading about street drugs. I start taking some. I'm kidding. But I write as if I did:

We had a nice lecture on street drugs this week. Our professor talked about Narcan- a drug that basically brings you back to reality if you have overdosed on certain drugs. The trick is that you have to give it slowly, or else it reverses the high way too fast. Fast enough that the patient becomes a little...well annoyed is a nice word.

Three years ago...

I was scared out of my mind honestly. My patient was sitting up on the stretcher eyes wide open as if I was the devil. I had just finished my training as an EMT-I and was alone in the back of the ambulance while my paramedic partner sped our ambulance down the highway. First day on the job. What do I get? A suspected drug dealer who was probably doing some of her own goods. We found her responsive only to pain, loaded her up, and started some IV's. Without thinking I prepped the Narcan, and just popped it in. Bam. As my partner turned on the lights and sirens and started to head to the hospital, my patient started to stir.

Cool I thought. Pharmacology at work. The nerd inside me was kind of excited. Well it was excited until the patient sat up and stared at me as if she was possessed. Then she started to panic. I had no idea what I was doing by that point. "Um...you should probably relax..." I mumbled while my brain froze. Froze some more while the patient started to yell and take off all of her restraints.

"Umm...ma'am...let's not do that..." I can't remember why but I stood up in an ambulance zooming down the highway at 80 mph, and tried to push her back into the stretcher. Not a good idea to tango in the box at that speed.

Then it really went down hill. "LEMME GO YOU MUTHAFUCKAGETMEOUTTATHISSHIT-"

And that's when she actually opened up the backlatch of the ambulance, and suddenly I saw the surprised look on the driver behind us. I don't know about you, but I totally see the insides of an ambulance while it is flying down the highway everyday.

"JESUS CHRIST. What the fuck is going down back there?"

Luckily years of experience told my partner NOT to slam on the brakes. Or else I would be posting this post from a hospital bed. (But now I realize ambulances really don't have emergency lights- you know the the red triangle you push that flashes all of your blinkers. Kind of redundant, no?)

Anyway, after I nearly tackled the patient to keep her inside of the moving vehicle, we finally rolled to a stop on the side of the highway. Let's just say I learned some interesting knots that night.

Later in the hospital break room, my partner THOROUGHLY educated me. Life lesson of the day: Narcan needs to be giving SLOWLY, or else you have one pissed off druggie.


(standard fictionalization applied to protect privacy)

Today, I was a doctor

For an hour, I had an MD behind my name.

I slipped on a long white coat, became a real doctor, and saw a patient.

This all started when our awesome ethics facilitator realized we had no idea what an ECMO (extra-corporal membrane oxygenation) machine was. We had been debating end of life care, agreeing that it was best to pull life support for our hypothetical patient.

"Do you guys know what ECMO is?"

Did we actually know what it would mean to take away the only thing keeping a fellow human alive? Would we be able to pull life support when it was time?

"No? Let's go see!"

We were dressed in jeans and sandals. Great for the weather outside. Not exactly professional.

"Oh wait...none of you have white coats. Okay, we can fix that."

So she leads us to the ICU floor, finds this restricted area and punches in a code, and accesses all the spare white coats of all the ICU attendings. I remember we were all looking furtively around in case someone walks in on us.

After she made sure we all got coats of attendings that weren't on...she waltz us onto the floor, and shows us what real medicine looks like.

It looks like a precious little infant sprawled on a gurney with tubes as wide as her neck attached directly to her heart that did not beat. It looks like two young parents looking apprehensively at the 9 "doctors" in long coats crowded around a bank of monitors that a dedicated nurse must attend to 24/7. It looks like hope, shaped like tiny spikes of a heart the size of your nose finding the will to beat.

I just hope she didn't look down and see all of our toes peeking out under shorts, jeans, and flip flops...

From a dinner party to holding a severed ear

It seems like my life is boring unless I am in the emergency room. I finally came back after months away to end up holding a nearly severed ear while the ENT surgeon tried to reattach it. This is why I don't go chasing after large animals at night.

It was really fun holding up the ear the entire time. The ENT resident was really nice and quizzed us on relevant stuff, and taught me a lot about suturing material. There were 4 of us hanging out in the shock room, so I had a good time chatting it up with some good friends while druggies were dragged in and out in various stages of lucidity.

Highlight of the night was when I just walked in and started a line. Wow am I rusty, but I got in on the first try. Wooooo!

Hard to imagine a hour ago I was munching on hor d'ourves celebrating a friend's recent engagement. Now if I only had a motorcycle...

Anatomy is craazy! Immunology is dramatic!

I'm on Head and Neck anatomy right now. It is all we have left to do, but I feel like I just started because it is so complicated! This block is 6 weeks long, but it is going at double-triple the rate of the whole fall semester.

Thank goodness for Visiblebody.com

That site is crazy. I LOVE IT.


Immunology has always had a special place in my heart. It was one of the big reasons why I am so in awe of the human body. I get the feeling military physicians might find immunology very familiar, because that is all it is. In a nutshell, our body is in an epic battle for survival. The high tech tools, strategies, and dirty tricks we use is mind blowing.

Your blood is strewn with mines, your skin is crawling with spies, sentries, and snipers. The calvary gets called in, mobile command centers migrate to field locations, and oh dear god the complex signaling involved is CRAZY! Things get cleaved, imploded, and exploded. Things gang up on each other, others commit suicide. Sometimes your body wins, lots of times it loses. Badly. Mothers will try to kill their babies, and men destroy their own sperm.

And I am less than half way through the course. And after that...there are two blocks of Infectious Disease. I can't wait!

Sweet Dreams

Good stuff coming soon, I promise. Lots of ideas just bubbling around. Amazing what you can do when you start to have regular sleep.

Before: lived in a dorm for the past five years. Last three, on the corner of the medical center on one of the busiest streets in town. Last year, on first floor, woken up by ambulances every night.

-Last 2 years, drove an ambulance all hours of the night, roughly every 3rd night. For. Two. Years.

-Essentially, I have never had regular sleep since high school. Oh wait. That didn't count. Perhaps not since my days of recess thanks to a teenager's messed up hormones?




Now: 7-8 hours a night. Undisturbed, thanks to a nice cushy place with a great non-nocturnal roommate. My brain is aliiive again! I am even off of caffeine ever since I went cold-turkey this break.

It also really helps that I am on a nice workout/run schedule again. The link is definitely there: the better sleep you get, the more energy you have during the day to have fun and play; the more exercise you get, you enjoy better quality sleep. Win win! Yay.

Endocrinology rocks.

One advantage about the way my preclinical curriculum is set up is that it is very similar to college.

Most med schools will put you in a bulimic state of learning: you spend a solid month in one class, learning all of human body's anatomy for example. You spend days memorizing every aspect of every piece of tissue until you start dreaming about it. Then come test time you have to vomit it all up. Repeat for every class, and it is a wonder we remember anything at all.

However, my days are spent learning all of the subjects at once by systems. Right now I am looking at butts and genitalia. I get to know everything about it: histology, anatomy, physiology, etc. I should know everything doctors know about how the body is when nothing is broken. I think it is great because everything is skillfully woven together, and I do not have to learn all about the hand in one day, then revisit it months later. The best part is that we get to keep the same professor for the whole subject, instead of the usual parade of PhD's needed to sustain a solid month scheduling for one subject.

I particularly love the endocrinology. The professor is pretty popular for several reasons, a great approach to teaching and a light British accent that all makes us swoon in particular.

Today, he proved he is also a gift to mankind by serving as the right hand of GOD, destroying rare diseases left and right. How so, you ask? Well we had a special session in class today, where he brought in two patients affected with diabetes. I won't go into too much detail, but basically one patient was recently afflicted with diabetes. That was the easy part, bread and butter cases for endocrinologist such as our professor.

The hard part was that the patient was had a extremely extremely rare form of diabetes. For months the patient was confined in the ICU while her blood sugar levels raced between record breaking highs, then record breaking lows. After her clinicians exhausted all options, including injecting ungodly levels of insulin to fight off the wave of sugar in her blood, our professor tried a specific anti-inflammatory drug.

It worked. In fact, it worked so well the patient was completely off any diabetes medicine when she spoke to our class. It turned out the patient had type 1 diabetes that attacked late in life when it really only shows up in kids. That kind of diabetes happens when your own body utterly renders the cells that makes insulin dead to the world, leaving none that can help you keep your blood sugar down. It is as if you want to go through a door that you have a key for, but someone stuffed gum into hole, so in frustration you keep jamming your key into the hole trying to get in. Our professor simply took out the gum, in one smooth stroke, with just one drug.

Now that is thinking outside of the box.

Thanksgiving is. So. Close.

Something going around that really struck me...






I am thankful for the teenagers who are complaining about doing chores -- that means they are home and safe.

... for homework. It means we live in a country where education is valued and encouraged for all.

... for the taxes I pay; it means I have income.

... for the mess that I have to clean up after parties, because it means I am surrounded by friends.

... for the clothes that fit a little 'too snug' because it means I have enough to eat.

... for the lawn to mow, windows to wash and gutters to clean; it means I have a home.

... for the parking spot I found at the far end of the parking lot, because it means I am capable of walking and am blessed with transportation.

... for my huge heating bill, because it means I am warm.

... for the person behind me in church that sings off key, because it means I can hear.

... for the pile of laundry and ironing, because it means I have clothes to wear.

... for all the complaining I hear about the government; it means we have freedom of speech.

... for the alarm that goes off early in the morning because it means that I am alive!

Author unknown

Tankmate!

Check out this post from my tankmate about our very first day in anatomy lab.

This is sort to make up for my dearth of posts during that critical time of my life. Let me know if you want to hear more about anything!

PS - This is what you've been missing out on:

http://streetanatomy.com/2009/10/26/hello-anatomical-kitty/

Quitting

Quitting. I thought about it today.

A big soft-skills final exam is coming up, and I feel totally unprepared. I mean yes, I know how to do a brief history/physical exam already, but not the "full" one that allows physicians to explore the full spectrum of disease a patient might have. My exam consisted of the ABC's - is your Airway open? Good. Can you Breath? Even better. Do you have a Circulation? Dandy. That's the big idea for medics out in the field.

But now, I actually need to be able to feel for splenomegaly, and listen for heart murmurs. What? My preceptorship is in the highest socio-economic strata of this part of the state. Before I even started my preceptor visits, he warned me on the phone that I might not be able to do as much as I could.

At the time, I brushed it off, thinking my previous experience would be fine. So up until today, I half-assed my visits. I played along, and thus became complacent. I didn't get any chance to practice skills that will enable me to detect diseases and tease out differential diagnoses.

As test time got closer and closer, I started to panic. My classmates started to catch up to me, and I realized I had gotten rusty. Some of them had preceptors that let them loose, and as a result they learned and learned about the most fundamental skills a physician should be perfect at. Soon, jealousy took hold, and I wanted to defect to perhaps another preceptor site. It was rare to do so, but it is possible. For example, one of my classmates was assigned to a gastroenterologist. When she needed to learn how to take vital signs, all of her patients just needed to get scoped.

I walked into the pediatrics clinic today, I mentally took a deep breath. It was the last visit of the year. Maybe forever. So let's make the most of it, I thought. If I piss off some anxious parent fussing over their trust fund kid...screw it. I need to learn, so that I can help scores of future patients.

I just kept jumping in all day, and surprisingly, no one stopped me. It reminded me of when I first realized what I could do as a supervisor EMT, leading a team at a major rollover accident. I just did it.

At the end of the day, my preceptor had a simple visit, but had grown up with the patient's grandfather. After almost six decades of friendship, my preceptor's friend passed away the same year as his wife, only a couple years ago. Everyone in the room teared up except for me when this was brought up. My preceptor had such a enduring bond with the families of his patients. It just took me a semester to realize it. My biggest lesson yet.

I'm not going to quit. I can still get a lot of learning experiences here, and my preceptor isn't some concierge physician catering to the rich and famous. He has taken care of many PARENTS of the patients here, and is a pillar of the local community here. I can learn so much from him, and I am going to stay.