Excuses to Use When Late For Rounds

-- “I had to change my scrubs. In other news… Mr. Jones -- emesis times one this morning.”

-- “I was examining Mrs. Smith when she suddenly went into V-tach and became unresponsive. I was about to call the code, when Chuck Norris walked in and gave her a roundhouse kick to the chest precordial thump by just looking at her. Don’t worry, she’s back in sinus rhythm.”

---- “Oh! We started rounds on 4South? I thought since it was Wacky Wednesday we started at the bottom of the list…”

-- “I decided to do a Ovid search on the latest journal articles related to Mr. White’s condition. I had just formed a evidence-based clinical question, picked the most appropriate MeSH, limited my search to recent publishings, and exploded diagnosis and treatment, when I realized it was time for rounds.”
(This one might actually get you out of any pimping on the patient’s condition too as you have expressed a failed attempt to research. Niiice. Double word score.)

-- “No, this isn’t fresh coffee. This is actually the same cup I’ve had since Monday. I’ve been working so hard I still haven’t had a chance to finish it, so I just keep reheating it.”

Line Up

I will be the very first to say that I am living in the dream in the NSICU leaving by 1pm everyday, but don't think that doesn't mean I'm not doing important things.

Need a central line? I'm on it. No... None of that femoral stuff, I'm going straight for the subclavian. I laugh in the face of a pneumo. Or at least see it as another chance for a procedure.

What about A-lines, you ask? Give me your hand, and I'll give you a beautiful arterial wave form. I'll even do the Allen test to be safe.

Of course, things are a touch easier when patients are heavily sedated...

Bean Update

The Butterbean has been doing alot these last few months. The Bean has all ten fingers, and all ten toes, ears, a little bit of hair... oh and girl parts! Yep, we have a She-Bean!! I know all this because I recently had a chance to meet Butterbean in person during a contraband ultrasound. She was moving about, and, as a lady should, had her legs crossed at the ankles and tried to cover herself when the doctor went to look at her girl parts.

And, just last week, she made her presence known for the first time and kicked her mama. Her mama probably deserved it. Probably because the Butterbean's blog hasn't been updated in months (yeah I said it.)

So, the Butterbean has officially celebrated her five month pre-birthday. Which means she's over half ready to come out of the oven. It won't be long now until she makes her appearance! And her Aunt Lulu can't wait!

Sound Byte from the NSICU

Standing outside the room of a patient with ESRD:

Ortho Intern, looking at what appears to be a foley bag-- "What would you rather do... Lick the floor of Trauma 2 after an alpha activation... Or drink some of that man's urine?"

Me-- "That man's in end stage renal disease. That's not his urine. That's a rectal tube. I'll take the floor of Trauma 2."

Tales from the Basement II

Woman comes into ER after being seen a few days earlier after a car crash. She is complaining of forearm pain. When I start talking to her, she expresses her extreme concern because her arm is hurting AND it's starting to change colors. The area where it hurts when you touch it has been getting darker since the accident.

Yes, this lady waited for 4 hours for me to tell her she has a bruise. Oh, and don't you worry, that visit was billed directly to middle class taxpayers.

A New Hobby

Sparked by a book found at the treasure trove of all stores T.J. Maxx, I have decided to discover my inner baker. Well, I've always enjoyed baking, so I guess it would be more accurate to say that I have decided to discover my inner Cake Boss.

Here is my latest, and first, creation which was in honor of the Cutest Boy in the World's birthday.

Caught in the Act

After month, nay, years of wondering how candy bars, gum, and breath freshners came up missing, the mystery was finally solved...

Tales from the Basement

A new series (hopefully) of posts that will chronicle a journey through a month in the ER.

A man is brought in by JPD because his arm has gone completely numb, ironically at the exact moment he was put into handcuffs. On exam, this numbness extends from his fingertips of his right hand, crossing the midline to his left shoulder blade. (Explain that one Dr. Haines...)

Other than that, physical exam was fairly normal. You know, regular rate and rhythm, clear to auscultation bilaterally, you know all that jazz. Later, on obtaining surgical history, he tells me he had his entire left lung removed.... Interesting...

Disposition and plan on this patient? Discharge to jail.

Three Quarters Down

I have officially passed my Step 2 CK! The score came in, and I was happy. Not only did I pass, but I actually did better than I would have ever imagined taking into account the utter despair I felt when I left the testing center that down.

Unfortunately, a passing score on the CK is only half the battle. I had to take the other half of the Step 2 this week The Clinical Skills exam was designed to weed out foreign physicians that can't speek a lick of English who are trying to chase the American dream.

It's 8 hours of interviewing fake patients. The actors playing that are only allowed to say specifically scripted lines ("No. My back does not hurt.") which makes it very difficult for me to stay in my fake doctor character. But, I made it through the day. So, now, all I need is a passing score, and I'm home free to graduation.

The CK

For Step 1, the fear of the test was born out of the fact that although it seemed like an infinite amount of information, it was learnable. If you memorized one more fact, you could hopefully get one more question correct. Therefore the amount and hours of studying was directly related to your score.

Step 2 CK, however, was a whole new beast. It was a test on management and treatment of patients. These topics are why it is called the "art of medicine." You can't memorize the answers to these scenarios. You have to pull from your entire wealth of knowledge, and combining it with a mix of intuition and discretion. This made studying painful. You can't learn clinical decision making in a book. That random fact about gangrene doesn't put you any closer to getting an answer right.

But, despite all this. It's over. I took it. It was the longest, most demeaning test of my life. I have never left an exam feeling less confident. Guess I better get used to it; that's probably how I'll feel my entire intern year.

Newbies

I went to the school library yesterday hoping that being surrounded by vast chronicles of knowledge would inspire me to stay motivated in my studying. While there I saw my first M3. I knew it was a new M3 by his clean white short white coat with a few bare essentials in the pockets but not quite overloaded as it could be and the look of excitement mixed with panic on his face.

At first, seeing the M3 made me feel really cool and important. "Look at him, so lost and overwhelmed. But, I.. I am a seasoned veteran! I know the codes to the supply closets and where to find standardized order forms! I am an M4!"

But then it made me feel old.

Then reality set in and I started to freak out-- I'm now the one that is suppose to know the answers if the M3 doesnt. I'm the one who is suppose to actually know what the next step in management of the patient is. I'm the one who is suppose to be working on a CV and a personal statement and residency applications! Oh, and I'm the one who is going to be a DOCTOR in a year!!!

Bring on the Zofran...

Back to the Grindstone

So I finished my week of Board Exams (finals, basically), and I took an entire week off. Yep, despite the fact I brought books for the six hour drive, I ended up playing my new Nintendo DS instead. And, all that time spent laying about with my Step 2 Secrets book within arms reach, I decided to focus on tanning, napping, and watching America's Funniest Videos instead.

But now I'm back to Jackson, the real world, and yes, even studying.

As of right now, I have 334 hours to study for my USMLE Step 2 Exam. I've set myself up on a fairly strict study plan, supplemented by a solid prayer plan. I'm hoping the combination of the two will pull me through.

Torture

For the Chinese it was drops of water, for the British it was the Iron Maiden. For me, it is a week long of exams. Every day my desire to study lessens. I seem to be turning my exams a little earlier each day as move through the exams quicker, my will to care gone.

Good news, one more.

Butterbean alla Canizaro

It's official, and officially out of the bag, I am going to be an Auntie! Yep, featured above is my little neice/nephew, only the size of a butterbean right now. But as it turns out, I love butterbeans! Don't worry, there will be lots of updates on this one!

Double Feature

Recently the Jackson installment of the Miller Gang joined together to go see a movie. Which turned into two, with a quick meal involving Wendy's and a big purse in the middle. First on the agenda, Star Trek.

I loved it. I've never been a huge Trekkie. I think I've only seen two of the older Star Trek movies, one when James T. Kirk comes back to save the whales, and one when Jean Luke Picard meets up with James T. Kirk to save the universe. But, this movie had a great mix of old and new. It explained everything to a non-Trekkie, and gave me just enough glimpses of classic Star Trek to make me feel cool (hey, everybody has heard "live long and prosper.") I think they've made a Trekkie out of me yet. Oh, and Chris Pine beats William Shatner anyday.

I give Star Trek a ONE on the Pain Scale.

Next up, Angels and Demons. Now, I have been adament for a long time that this book was much better than The DaVinci Code, and I think the same holds true for the movie. Tom Hanks' hair isn't nearly as skanky; the premise isn't nearly as far fetched and controversial. Plus, it holds a special place in my heart because I've been there. I've seen some of the landmarks in the movie, heck I specifically searched out some just because of the book.

Without the hunk factor, and probably partially due to the fact I knew what was going to happen and it was my second movie to watch in that day and my booty was going numb, I give Angels and Demons a THREE on the Pain Scale.

Graduations

This past week I have enjoyed two commencements. First, the Cutest Boy in the World walked across the big stage. He started at one end as just another student, but stepped off the other end as a Doctor of Physical Therapy. I was so proud. In the words of a mother on a game show, "That's my baby!"

Then, a few short days later my other baby walked to the tune of Pomp and Circumstance. Lanie graduated from Obedience School with a Bachelor in Decent Behavior. We did not bring home the Top Dog Award, again this year, but she did get an honorable mention for Perfect Attendance.

Let the Studying Commence

After 11 months of getting through M3 year on the most minimal studying required, it is finally time to get serious. Boards are upon me, and the Step 2 is following quickly on their tails. But, if I can make it through this next month especially, then the dream begins: M4 year. Except for the whole "choosing what I want to do when I grow up, filling out applications, and interviewing" thing...

Pi Phi Wedding

After a three year dry spell, the Pi Phi 2002 Pledge Class had a wedding this weekend. Girls came from near and far to see one of our own tie the knot... And to spend a reunion weekend in New Orleans. Surprisingly, the weekend went smoothly. The wedding went without a hitch, no one went to the ER for stitches, everyone kept their shoes on, and as far as I know everyone made it back to the hotel.

Happiest Place on Earth

This week I am working in the happiest place on Earth, the well baby nursery. There are lots of little beds filled with happy, healthy, chubby babies. And I get to squeeze them on a daily basis. And, if I have some down time, I just grab one up and rock him/her for a while. I can't help but leave with a smile on my face.

Happy Numpsey Day!

Home Improvement

I'm not sure how exactly it happened. I don't know if I got fed up with the stick down fake tile in the kitchen not matching the adjacent living room's beautiful new tile floor, or if somehow I forgot how incredibly painful it was to tile the first half, but somehow the Cutest Boy in the World and I opted to finish our ongoing home improvement project. We're officially over the worst part of our adventure, having layed backerboard and mortared down the tile. Of course, we still have another three days worth of work that will probably take us ten. Moral of the story, I now know why God created Mexicans...

Wolverine Origins

I love X-Men, and anything mutant. So, of course, I was very excited to go see the new Wolverine movie. It did not disappoint. It had everything I wanted... Lots of new mutants with their fun mutant powers, some oldies but goodies mutants from the original comics and cartoons, jam packed full of action fight scenes, and a touch of romance...

Oh, and Hugh Jackman is only fully clothed in approximately 30 minutes total of the movie. And he is NOT ugly.



I give this movie a ONE on the Pain Scale.

Burnt Out

I have been on Pediatric Wards for 24 days.

I have been an M3 for 11 months.

I have had 53 days off in the last 339 days, which averages to one day off every 6.4 days.

And I am officially burnt out.

I'm tired of getting up in the morning to write progress notes that no one ever reads. I'm tired of having exams, and boards, and Step 2s looming in my future. I'm tired of constantly asking about bowel movements.


On the other hand, I will be an M.D. in 13 months, and will be doing this for the rest of my life.

Bueno Cinco de Mayo, Ya'll

Fluids

This week I was hit with an old fashioned stomach bug that rendered me worthless on the bathroom floor for the better part of 9 hours. On the brink of dying, my life was saved by a doctor working the night shift, a prescription for Zofran, and a 24hr pharmacy. Although I slept for 22 of the next 24 hours, the damage had been done. My fluid status was in dire straits. And after attempting to survive rounds, I realized that the pain in the general area of my kidneys and the fact that I had not peed for about a day was not normal. I needed fluids. And I needed them now.


So, any normal person would have gone to the ER. Oh, no... I've paid entirely too much into the MS Health Care system in the form of tuition to sit in the waiting room with the peons! I started calling in favors. This is how I ended up in a small computer room on the second floor of the hospital having a surgery intern start an IV. Despite the fact that this is not in her normal job description, she stuck my dehydrated vein like a champ. At this point of the procedure, when blood started pouring out the end of the angiocath onto my leg, is when her ignorance to actually hooking up an IV became apparent. But, 100ml later of precious life fluid on my scrubs later, I was ready. With a few liters of fluids in my bag, some IV tubing, and a whole lot of gusto, I headed home to turn my bedroom into my very own ICU.


The line worked great. Fluids flowed right in. Maybe using a floor lamp as an IV pole was a bit ghetto, but I think I get points for creativity. And not counting a 10 minute pulmonary edema scare including shortness of breath, dry cough, and chest pain, my rehydration went without a hitch. So, I am back to normal fluid volume status.


Oh yeah, take that Montezuma....

On Call

When you think of a doctor on call, images of someone in scrubs walking briskly down a hallway, white coat flapping in the wind, and the sound of a pager incessantly beeping and the words "Code Blue Room 114" probably come to mind.

However, when you think of an M3 on call, a more accurate description would be two students sitting in a lounge, maybe sleeping on the couch or playing on the computer wondering when they'll get to go home... no beepers, no Codes...

Yeah... I'm the one at the computer...

Senior Planning: Part Duex

Senior Planning Day came and went. Yes, I even turned in a schedule. But have I made a decision on what I'm going to be when I grow up? The answer to that is a resounding heck no...

Instead, I have turned in a schedule that allows me to postpone the decision a few more precious months. I actually don't think I have to have an answer until November when applications are due, and even then I can delay the inevitable by applying in more than one specialty.

So, for anyone out there who is sitting on the edge of their seats waiting to know which clinic to make an appointment with in 2010 for Dr. Miller, you might want to start some prophylactic heparin for the DVTs you might develop.

Birthday Baby

As fate would have it, I was assigned to be on Labor and Delivery the week of my birthday. And as my pure and undeniable bad luck dictated, I was working L&D nights.

Well, trying to be positive, the good news is I had the opportunity before me to deliver my very own birthday baby. And just to keep it real special, my resident was no other than my very own sister, Dr. Can-O'-Whoop-Ass.

I would like to believe this baby knew the gravity of the task at hand. It had pretty big shoes to fill to share my birthday (my silver annivesary of birth, if you will). So, instead of coming into this world the regular old, fairly undramatic way of through the birth canal head first, at about 1am this baby decided to send it's umbilical cord as a scouting party. This condition (called cord prolapse) is an emergency. So with Dr. COWA on the OR table underneath the drapes desperately trying to hold the umbilical cord in the uterus to prevent the baby from essentially suffocating itself, I scrubbed in to help cut the baby out in a STAT C-section (skin cut to deliver time less than 90 seconds).

So, it was dramatic, maybe a little over the top. But, I have to admit, Birthday Baby, you did me proud. I like your moves. I like your style.

Spring Cleaning

So, working 12 hour days, being on call every 4th day, and overall hating my life for the last 3 months did not exactly lend itself to coming home from work to clean my house. Plus, with The Cutest Boy in the World out of town, I didn't have the motivation or need to prepared to entertain. So, the Studio 54 has been slowly gathering a layer of dust, Louis hair, and empty water cups.

But now life is returning to its semi-normal state. So, today, was Spring Cleaning day. The Cutest Boy in the World helped hang pictures, do heavy lifting, and even the occasional sweeping. I spent the day trying to figure out where to put all the random stuff that piles up in 3 months, cleaning up old Lanie tail blood, rotating loads of laundry, and doing a whole lot of dusting.

Yet, somehow, hours later, the house still seems to be in disarray. Why is it that things just seem to get worse long before it ever gets better? And where does all this dust come from? And how much does it cost to hire a maid???

Senior Planning

The time is finally upon me to make the decision I have been postponing for 7 years... What do I want to be when I grow up?

Tomorrow we plan our senior schedules, the first year of medical school that we actually get to choose electives to help gear our education toward our specific future professions. And yet, here I am, feeling barely closer to making that decision than I was 7 years ago. So, when everyone is worrying and talking about what electives to take, I'm going to remain focused on the only thing I know for sure--- I'm going to get 4 months off next year, and love it.

Benign Gyn

I've started my OB-GYN rotation-- 6 weeks of va-jayjays, ba-jingos, and the occasional hoo-ha. And the rotation has started on Benign Gyn, a nice mix of Pap smears, hysterectomies; clinic time and OR time.

My thoughts thus far:
- I am definitely not a Medicine person. I'm finally DOING something!
- It's so so very nice to be back in the OR, even if my life does mostly consist of retracting with the occasional suction.
- Pelvic exams are a lot less awkward than I first expected. Much less so than the dreaded Dr. DRE. At least women who come to the gyno are expecting the exam... As compared to that person who comes in with fatigue and gets a surprise gloved finger up the rectum.

We'll see how it goes...

The End of Medicine

So, I have put in my time. I have finished my rotation on Medicine. It was... Well, let's just focus on the positive and say that's it's over.

(For clarity sake-- "Medicine" is the specialty that is kinda the catch all. Like if you were going into the hospital just because you were sick, you'd be treated by a Medicine doctor.)

As predicted, I'm just not a Medicine girl. It was 3 months, call every 4th night. And lots of sitting around (or often standing in the hallway) talking about things, about patients, about plans, about orders--- for hours upon hours... Yet never actually DOING anything.

Once again-- positive, it's over. Even more positive-- another specialty marked off the list.

Song From Past

Do you ever hear an old song that you haven't heard in many years and you actually had forgotten existed yet you still know all the words? That happened to me the other day. I heard "In the Light" by DC Talk, and as I was singing along, I realized how great the lyrics are. I have decided that it should be played more often, maybe daily...


I keep trying to find a life
On my own, apart from You
I am the king of excuses
I've got one for every selfish thing I do

What's going on inside of me?
I despise my own behavior
This only serves to confirm my suspicions
That I'm still a man in need of a Savior

I wanna be in the Light
As You are in the Light
I wanna shine like the stars in the heavens
Oh, Lord be my Light and be my salvation
Cause all I want is to be in the Light
All I want is to be in the Light

The disease of self runs through my blood
It's a cancer fatal to my soul
Every attempt on my behalf has failed
To bring this sickness under control

Tell me, what's going on inside of me?
I despise my own behavior
This only serves to confirm my suspicions
That I'm still a man in need of a Savior

I wanna be in the Light
As You are in the Light
I wanna shine like the stars in the heavens
Oh, Lord be my Light and be my salvation
Cause all I want is to be in the Light
All I want is to be in the Light

The Dark Side

I have debated for a long time on whether I want to get a new phone. I have researched service providers and all the latest phones and gadgets, yet I was no closer to making a decision than when I started. Then the Zoolander phone made the decision for me. I accidently dropped Blue Steel and it broke into three pieces. So I went to the AT&T store, and joined the Dark Side. I bought an iPhone. And I love it.

Angel of Death

Angel of Death. 007. Dr. Flatline.

I have gone 24 years without killing anyone. Yet, in the last month, I've had 4 patients die.

I can take this one of a few ways...

1) Assume that it was due to my own negligence, and file a malpractice suit against myself.
2) Quit medical school now and start selling off non-vital organs to pay off my school loans.
3) Blame it on the service and decide that I'm just not meant to be a Medicine doctor, based purely on this.
4) Shake it off, realize that there was nothing I did or didn't do that caused their deaths, and just keep on working my tail off trying to be the best I can.

So, as predictable as an AfterSchool Special, I've chosen #4. But let it be said that 1 through 3 are still really really high in consideration.

No Comment

I will not comment on my sabbatical. I'd love to say I was doing something so super cool for the last two months that I didn't have time to blog... The truth is probably somewhere closer to the opposite: I've been doing something so super mind numbing I could not bring myself to write about it...