Friday, September 26, 2008

Melt Down

I fancy myself as someone who does a pretty good job of holding it together, 99% of the time. I'm the "rock" in most of my relationships. People can count on me, I'm rarely late, I'm reliable. I'm like a Rolex.

Today, I had a melt down.

I presented a talk with a nurse practitioner at an AIDS conference in LA this afternoon. It was great. We both spent time in Kenya -- she's been living there for 4 years, working with some of the same people with whome I worked. She lives about an hour north of where I was, and in the HIV world in Western Kenya, everyone knows everyone. So, I got hear how my old friends were doing, how the country was, etc. I felt so connected. We met last night at the pre-conference dinner, and we really hit it off. It's hard to live there and not automatically bond with anyone who's also lived there.

So, the conference was a big success today. The NP and I spoke about HIV in Africa and how to make a successful program there. I'd been working on my portion of the talk for weeks, so I'm relieved to have it done. Needless to say, talking about HIV in Africa always makes me emotionally vulnerable, and talking about my time in Kenya is like picking off a scab.

Then, my phone breaks. It just locks up and it won't unstick. I try everything, and I eventually have to go to the Verizon store. The nice man there wasn't able to fix it, so they had to reset it -- I would lose everything. I had backed it up a few days prior, so I thought it would be no big deal.

I get home, and I can't get the phone to sync with the desktop. I'm sitting there with the phone in my hand, connected to the computer, and I just lost it. I'm literally bawling as I frantically search through program files, Windows applications, etc. I finally get it to work and calm myself down. My contacts and calendar appear on the phone, so I think I'm out of the woods. Oh, no. The medical programs I put on are gone. They, apparently, weren't backed up, even though I thought that's what I was doing every time I hit "Back up my Device." Cue the tears...and yes, I'm back to being a blubbering mess. I go back to the websites, download everything again (fortunately it's all free), and a mere two hours after starting the project, my phone is darn close to being the way it was. Except I lost all my pictures. Dang.

So, I'm an emotional wreck. I was frustrated that this stupid phone had so much control over me. (I'm working tomorrow, so I need the medical programs to be there!) And, I realized after gaining some greater insight, that I really just want to get back to Kenya. I was jealous that the NP gets to fly back on Tuesday. I was jealous that she gets to go back to really impacting a community. I was frustrated with spinning my wheels at the VA. It all came to a head, and I reacted like a champion: buckets of tears.

Once again I'm reminded that I'm no Superman. I'm just a girl, and a doctor, and I just want to make a difference.

Sunday, September 21, 2008

"I Can't Do This..."

Some people have known since the day they got their Fischer Price medical kit that they wanted to be a doctor. Some people knew when they got to high school biology. Not me. I decided to start pre-med in college because it would be easier to transfer out and finish in 4 years than to transfer in. I thought it would be a challenge, and I like intellectual challenges. But, it also scared me to death. I thought about optometry school, so I wouldn't have to take the MCAT. I abandoned that idea when I spent a summer working for an optometrist and was so bored I almost poked my own eyes out.

So, I get to med school, and I scrape by the first two years of classes. I get to the part I really want to do -- the clinical years. Ah, the clinical years. They seemed so glamorous when you're sitting in the library studying the nerves of the brachial plexus. Students running around in short white coats -- running with a purpose! They have people that need them, that are waiting for them. So much better than sitting with flash cards about pharmacology.

So, Day #1 of 3rd year comes. I'm doing General Surgery first. Three months of surgery. My first three weeks were going to be with the vascular surgery team. Red Surgery. Our Chief is K - she's driven, determined, and a little eccentric. Ok, more than a little. She wants nothing more than to prove herself. She's transferred into the program and wants people to take her seriously. The intern is haggard already (he's been on the job for 2 weeks before we started). He just wants to survive his time on the service. He also thinks K is a whackjob. Then there are the 3 of us 3rd year med students. A, C and me. A and C are super smart, both now doing anesthesiology.

So, Day #1. K and the intern take us around to our patients. They've decided that 6 is a good number. That is, we each now have 6 patients of our very own. In retrospect, that is WAY to many patients for 3rd year students on Day #1. But, I digress.

My first patient is Mr. B. We walk into the room, the motley crew we are - 3 med students in khaki's and short white coats, an intern in scrubs who hasn't shaved in at least 3 days, and K - scrubs with ballerina flats on, hair in a bun, and eyes piercing through her glasses. She means business.

So, we go in to see Mr. B who is about 60 and has had his esophagus removed because of cancer. He now has his stomach where his esophagus was and his small intestine where his stomach was. Imagine that they just pulled the opening of the stomach up into the throat. It's called, appropriately enough, a "pull through." His course was complicatd by an abdominal wound infection and dehiscence. That means that the wound is open, not sutured close. He just has a few big retention sutures holding his fascia together. Below the fascia is the abdominal cavity. The remainder of his abdomenal wall is open -- from the skin, to the fat to the muscles, all open. So, K is explaining to me that Mr. B is my patient. As she rehashes his history, she is taking his bandages off and pulling out a long, long stretch of gauze that is packed into Mr. Brown's abdomen. She pulls out the roll of gauze, not unlike a circus clown pulling scarf, after scarf, after scarf out of his open mouth.

The gauze is called Kerlex, and it's covered in nasty pus, blood, dried skin, etc. It's about 3 feet of Kerlex. She tosses it into the biohazard bag. She turns to me and says, "So, you'll need to repack Mr. B three times every day. Whatever you're doing, whatever your day is like, you have to unpack and pack Mr. B three times. So, don't go home at night unless you've packed him." She takes the Kerlex and shows me how to wet it with saline and how to pack it into his wound. She starts again, "You'll want to make sure you pack it into the far corners, because we're trying to pull out all the infection each time we do this. We can't leave any area unpacked." Then, she adds, quite nonchalantly I think, "And don't press too hard, or you'll eviscerate him." She looks up at us: "You'll poke into the abdominal cavity and his insides will then be outside. If he eviscerates, you page me. Immediately."

I walked out of Mr. B's room feeling nauseated. We walked out to the stairway and ascended to the next floor to see the next patient. K is talking about how shit runs downhill so if the attending is having a bad day we all will be having a bad day. We, as med students, are at the bottom of the shit hill. I thought I was going to pass out. I was lightheaded, I thought I was going to vomit, and everything started to go blurry. Wow, I thought, I can't do this! I made the wrong decision. Can I get a refund on my Stafford Loans? Where do I go to quit? The Dean's Office?

We went around to the other patients. I decided that I would give it one day. After all, C and A all needed me. I couldn't leave my fellow students high and dry...we were in this together!

So, I did it. Every day for 3 weeks (I got but 1 day off in those 3 weeks). I'd pack him when I got in, at 4am. I'd pack him before lunch around 12pm. And then I'd pack him before I went home, around 9pm. Three times a day, every day. I didn't skip one. He was usually delirious and out of it. Occasionally he was combative, and I'd have to duck and weave as he threw punches at, unaware that I was trying to save his life...or at least not eviscerate him.

Well, many months after I left the comfort of my dysfunctional family known as the Red Team, I was walking into a different unit and K sees me. She tells me that Mr. B is not only awake and talking, but he's ready to go to a rehab facility on his pathway home. "You made a big difference in him," she said. "Actually, I don't think he's be alive if it weren't for your three times a day wound packing."

As you can see K, the Red Team and Mr. B made quit an impression on me. I retell his story often, both to remind the current students of how good they have it, and to show them that even one measly 3rd year med student can make a big difference in some one's life.

Monday, September 15, 2008

The VA

We lovingly refer to the VA -- the Veterans Administration -- as the VA, pronounced "vah." The VA and I have a love-hate relationship. On the one hand, these men and women served our country -- often against their wishes in Vietnam -- and anything I can do to diagnose, treat or help in anyway I'm glad (even honored) to do. On the other hand, it has to be the most inefficient place I have ever worked.

Last week the MRI broke. What did that mean? It meant we needed to wait for a part, which is understandable. When a part breaks, you wait for that part to be replaced. Was there an all-alert call out to get the nearest part brought over ASAP so that we could get the MRI back up and cranking out scans? Oh, no. Not for the brave men and women who once wore the Uniform. No. We had to wait for the part to be flown in...from Germany. Really? Germany was the one and only place to go for this part? Oooookaaaaay.

Just one frustration for me in the past 2 weeks. We'll see if I don't have a break down in the next 2.

Saturday, September 6, 2008

Fall is (Almost) Here

So, it's early September, it's not so freakin' hot, and the stores have started to put out mass quantities of candy in orange and black bins. Everything is pointing to the fact that it's almost fall. My favorite time of year.

Back at Valpo, when it got to be fall, it would cool off, the leaves would change and we'd have a few days of rain. As it got to turn more to winter, there'd be snow and the inevitable slush -- old snow made dirty, wet, cold and nasty by rain and/or the warming of the environment so that the snow would melt. Like someone took a dirty brown slurpee and covered the earth with it.

On those cold, rainy days, my now-husband-then-boyfriend would say to me as we ran to the cafeteria trying to not get too wet, "Where are all those fall fans?!?" He loves the summer, which probably has something to do with why we live in Los Angeles now. But, back at Valpo, I'd laugh and raise my hand -- I loved the fall. The rain, the slush, the cold was so refreshing! Such a contradiction to the hot, humid summer we just had.

So, around this time, besides missing fall, I miss my family. This is probably the hardest time for me to be away from home. So many of my memories are of the family during fall -- school starting, volleyball season in swing, raking leaves, shovelling snow, just being outside and playing together. There are no leave changes here, no real rain (not until January, if at all), and none of my family is here. [This picture is circa 1985, our annual "First Day of School" photo]

I'm secretly hoping that they all find reasons to move out this way. Short of that, I'm hoping we make enough money to visit them often. Hopefully this will be the last of my homesick ramblings for awhile. I'm at the VA this month, which should provide enough fodder for discussion that I can focus this blog back on life on the wards!