Suicidal Patients

I've been at the county hospital for a month and a half now. And even though I've seen patients come in who have attempted suicide, I've seen way more in the past month and half than I have my entire third year of medical school. I don't know if this is a direct result of being in the county hospital or not - I just know the numbers I have seen.

I had a patient this past week who ingested, intentionally, way too much Tylenol. Acetaminophen (Tylenol) is toxic to the liver when you get over 7,000mg. This patient presented to the hospital after ingesting - drum roll please - 25,000mg! Unbelievable! Can you imagine how bad life must have been in order to do this? Oh, and if that wasn't enough, throw in quite a bit of EtOH (that's how doctors write alcohol....we're so smart!) - which is another toxic agent to the liver.

We saved the patient's life - and, subsequently, transferred the patient to the psych ward. My guess is that I will see this patient again before my time is done at the county hospital.

I had another patient this week who presented with acute pancreatitis. Apparently the patient had been drinking about a gallon of vodka the few days leading up to the current attack. Of special note - the patient was also a chronic drug seeker. My favorite. And wouldn't you know...pain control is one of the top managements of pancreatitis? Yep.

The patient was also newly homeless.

While most patients only need a few days in the hospital to get the pancreas back to "normal", this patient seemed to like the hospital and stayed about 6 days. No surprise to me...or the resident...or the attending....when we learned that the patient was taking smoke breaks during the day and bringing back dirty laundry that needed to be washed. And when we told the patient that we were planning to discharge, the patient actually said, "Well, I have some phone calls I need to make. Maybe tomorrow would be better."

I saw the patient a few days after discharge, sleeping in a car in the hospital parking lot. Looked like there was freshly cleaned laundry in there too.

I'm guessing there might be another "pancreatic attack" before I'm through.

On another note, please take a look at "Ah Yes, Residency". This post is awesome - and please note "The Shadow" which sums up my medical student experience!

ER Patient of the Day - Part 2

ME: What brings you in here today, sir?

IDIOT PATIENT: I have weakness all over.

ME: When did this start?

IDIOT PATIENT: Oh, I've had this about 2 years.

ME: Did something happen? Why did you choose today to come in for this problem?

IDIOT PATIENT: No reason. Just thought it was time to get it checked out.




Give me a break Mr. Idiot Patient....what the heck are we going to do in the ER for you to treat this generalized weakness that has been present for 2 years? You dummy!

ER Patient of the Day

***100+ white female in the ER for confusion***

PATIENT: Get in here!

ME: Hi, ma'am. Do you need help?

PATIENT: No. What do you want?

ME: Well, I heard you call for someone...so I came to see if you needed help.

PATIENT: No one helps me. You all have broken my cookies. MY COOKIES ARE BROKEN!

ME: Your cookies are broken?

PATIENT: I am over 5 years old. You all want me to die!

ME: We don't want that. We are here to help you.

PATIENT: Get out of here!

***I start leaving the room***

PATIENT: Get back in here, sir!

***Please note: I am NOT a sir......last time I checked in the mirror, I was female.......***

ME: Yes, ma'am?

PATIENT: Get someone here to help me.

***Here is when I call for a nurse...not knowing what to do with my 3rd year medical student experience***

NURSE: Can we help you, ma'am?

PATIENT: Get this off of me!!!

***Patient rips out IV. As the nurse goes to grab it from her, she starts whipping the nurse with the tubing***

PATIENT: That's mine!

NURSE: You have pulled your IV out. Stop hitting! We need to reattach this.

PATIENT: You aren't helping me. Someone has to help me all the time.

NURSE: We ARE helping you.

PATIENT: ***Looking to me*** Who are you?

ME: I'm the medical student.

PATIENT: Well, you're NOT doing a very good job at it!

ME: ***Already starting to laugh at the situation*** Oh man! You're the first patient that has EVER told me that! I'm sorry to hear you say that.

PATIENT: I'm going to tell your folks and they are NOT going to be happy about it!



Hahahaha!!! I have been laughing at this situation the rest of the day. First she whipped the nurse with her pulled-out IV tube, then told me I was not doing a good job. It was so humorous! Better than that, when I passed her room about 5 minutes later, she had no idea who I was! Hahaha....I will remember her for a LONG time!

Well, Now I Want to be a Pediatrician!

Great. Just great! What am I going to do when the time comes for me to choose an area of medicine to practice? I'm not like some other students....who go into med school knowing EXACTLY what they want to become (know-it-alls!!!). I'm one of those students who likes EVERYTHING they try. In fact, ask either of my parents and they will tell you that once I start something I like, my undiagnosed OCD kicks in and I will keep doing it until the next activity comes along.

Case in point: Pediatrics. I LOVED IT! Despite the fact that I battled a bout of bronchitis, a raging sore throat, and croup for 3 out of the 4 weeks I was in peds, I STILL loved it. Working with kids was awesome! And cute. Even while they coughed in my face with runny green snot coming out their nose, they were cute.

So here is the battle playing out in my head...

I have loved both OB/Gyn AND Pediatrics. I thought I would love Psych.....but I psyched myself out of that one with my stint in Corpus Christi. Even though I'm not in this whole thing for the money, it DOES sort of play a role in the decision making process....just being honest. If you take two things you love, why not choose the one that sets you up better in the future? But then think of lifestyle.....and this is where the battle comes for me......because I think more about the LIFESTYLE than I have ever thought about the money I could make. Do you choose the mega salary that takes you away from your family? Or do you sacrifice a big chunk of that salary to have a family life too? It seems like an easy answer to me. I would choose my family every single time. (Hi Mom!!!!) But then why does everyone always say, "Don't do pediatrics!" I don't get it. The doctors I worked with only worked 4 out of 5 days....and they only had call time (from home) maybe 3 days a month. Sounds like a pretty good lifestyle to me.

Can anyone shed some light on this? Honest, I think I could make a pretty good pediatrician....

Psychiatry Case Study

A 62 year old female is being treated in a psych ward. She has been there for the past 6 months. You get called on a consult to come visit with her.

DOCTOR: Hello, Miss ______. Tell me how you are feeling today.

PATIENT: I am feeling great. Just fine. No problems.

DOCTOR: What is going on in your head today?

PATIENT: Nothing at all. I am feeling great. Just fine. No problems.

DOCTOR: I hear you told the nurse you were going on a trip.

PATIENT: Oh, yes. We are going to Africa. On a safari. We are leaving soon.

DOCTOR: Oh, really?

PATIENT: Yes. To Africa. I have a flight soon.

DOCTOR: I see. I also hear you think you are pregnant.

PATIENT: Yes. (*Patient frowns) I'm afraid so. Dr. ____ told me I was.

DOCTOR: Well, how old are you? Do you think you are pregnant at that age?

PATIENT: I'm 62. My sister had her baby at 67.

DOCTOR: Really? Are you having any symptoms of being pregnant?

PATIENT: Oh yes. (*Sick face) I have been feeling sick in the morning. And I can feel the baby.

DOCTOR: Are you going to follow through with the pregnancy?

PATIENT: Oh yes. I have had 2 miscarriages. That is too sad.

DOCTOR: So let me get this straight. You are 62. You feel you are pregnant. And, you are going on a trip to Africa???

PATIENT: Yes.

DOCTOR: Okay. So, who is the father of the baby?

PATIENT: (*Starts rambling) I don't know who the father is. I was raped. I was raped by 17 men. They raped me. It was very sad. Very traumatic. But they were all killed. You see, I was in the Marines. And they didn't want those men to do that again. So, they killed them all. Shot every single one of them. It was bad. I am going on a trip to Africa. I leave soon. And I am pregnant.

DOCTOR: You were in the Marines?

PATIENT: Yes.

DOCTOR: When?

PATIENT: 4 months ago.

DOCTOR: I see. Well, lets plan to talk again tomorrow. Okay?

PATIENT: Sure. Bye doc!


What's your diagnosis????????





SCHIZOPHRENIA. This patient was displaying delusional thoughts, disorganized thinking and speech, and had a history of hallucinations. She was matter-of-fact about her answers...saying she had been in the Marines 4 months ago, had been raped by 17 men and was pregnant, and was planning a trip to Africa. It was reality to her. However, she had been in a locked facility the whole time. None of her stories had actually happened.

Interesting, huh???? Want to know a secret?????

This is one of my patients today!!! Yep. Very interesting!!! We'll see what happens tomorrow!

Cutting Suture

Today, I got to cut suture during the hysterectomy!!! And, I didn't forget to take off my ring when scrubbing in this time!!!

Amazing the things that can excite a 3rd year medical student just starting her clinical rotations...

Good News!

I just got some good news that I wanted to share with my loyal fans...

At the beginning of March, I decided to apply for a Summer Institute for Medical Students at the Betty Ford Rehabilitation Center out in Palm Springs, California. It is a week long program that immerses medical students in the care and management of patients who have substance abuse problems.

We get to spend time with the patients, share in small group discussions with them, and learn how to deal with addiction. I have been really anxious waiting to hear back!

This morning, I received a call from California telling me I had been accepted into the program during the week of June 18!!!!! I am SO EXCITED about this opportunity!!! Not only do I get to spend time at the Betty Ford Center in Palm Springs, but they pay for my flight, hotel, and food! Plus, one of my good friends at school, Abby, was accepted for the same week!!!

Maybe I'll get to see Keith Urban! (I'm pretty sure he spent time there!)

Happy Easter Everyone!!!

D.O. vs M.D.

I have had some inquiries as to what the difference between an M.D. and a D.O. (Doctor of Osteopathy) is....so I thought I would write a little blog about it. There was a recent "letter to the editor" excerpt written in TIME magazine where an M.D. made some derogatory comments about about D.O.'s. The President of the American Osteopathic Association responded to this letter with some good thoughts:

"Hands Off the Osteopaths
I am deeply disappointed that Scott Haig, M.D., referred to osteopathic physicians (D.O.s) as "osteopathic manipulators" and lumped osteopathy in with what he calls "nothing-really-works-anyway-therapies" [Feb. 12]. D.O.s are physicians who receive extra training to examine and treat patients using a technique called osteopathic manipulative treatment. They also deliver babies, perform brain surgery and serve as family physicians to the underserved. D.O.s have been advocating solutions to issues such as Medicare physician-reimbursement cuts and medical-liability-insurance increases. Haig has done a disservice to 59,000 D.O.s in the U.S., including the former physician to President George H.W. Bush, the former U.S. Army surgeon general and physicians for professional sports teams.
JOHN A. STROSNIDER, D.O., PRESIDENT
AMERICAN OSTEOPATHIC ASSOCIATION"

Here is how I explain the difference to people:

I think it is crazy, and stupid, to say that one profession is better than the other. I have come across so many doctors in my life....some are awesome, have great bedside manner, and care very much for their patients. Some doctors are in it for the money. Regardless of whether you are a D.O. or M.D., you can find doctors - both good and bad.

When looking at medical schools, it came down to two for me: The University of Iowa (M.D.) and Des Moines University (D.O.). As I researched the schools further, DMU had more of the qualities I was looking for. I wanted to go to a small school....I wanted teachers who had open-door policies and were always available.....and I wanted to learn with a hands-on approach. DMU fit that mold for me....and I have been VERY happy with my decision to go there.

A D.O. has all the same training as an M.D. We take the same curriculum.....have similar schedules......have to pass the state licensing boards......and can practice in any area of medicine. D.O.'s, however, are ALSO trained for 2 years in a modality of treatment called Osteopathic Manipulative Medicine. The philosophy of osteopathic medicine is that the body has the inherent capacity to heal itself...and by aiding the body's own mechanisms, we can help heal the patient. We strive to treat the patient as opposed to just the symptom. It is with this training that I feel I have something different to offer patients. I can treat them the same as any M.D. would - but I can utilize this treatment as well.

I feel proud to be a student of an Osteopathic medical school...and I will be proud to carry the letters D.O. after my name.

Med School Update

I've kept you all updated on my rotations.....but it has been a while since I updated you on what is going on at school and in my life.

First off, I have battled my procrastination problems!!! Well, almost. But, I don't have a test the rest of the week...so what better time to update my blog than now? Usually, I update this the night before a test.

Secondly, my tests have been going GREAT lately. I'm pleased to say that I have forged my way into the "above average" category with my scores. It may be due to the fact that I have actually put some effort into studying lately....or the fact that I am doing more "quality" studying....but it also helps that over half of my class is already going psycho with board studying and neglecting regular studying. Whatever....I'm ABOVE AVERAGE!!! Hahaha...

We just finished Reproduction and have just started Renal. Did you know that breast feeding requires higher caloric intake than pregnancy itself? I just found that so interesting..... Renal? Not so fun so far.... The physicians have been throwing out terms that we have never heard of....and it is REALLY confusing. I'm working my way through it....first test is on Tuesday....I'm hoping to keep the ABOVE AVERAGE streak alive!

I also just had my SPAL (Standardized Patient Assessment Lab) on Monday...and that went really well. I'm pretty sure I diagnosed the patient correctly....and when I gave the oral presentation to the attending physician, she told me that I was "the first student she was able to ask questions to because she knew I understood what I was doing." Wow! What a compliment!!! I really had her fooled!!! (Nah...I actually DID know what I was doing this time!)

Everything else is going awesome! I have Neonate lab one week from today and I am really excited about that. I've also got a TON of lunch lectures coming up in ER club. (Did I ever mention that I am the Secretary of ER club??? Again....ABOVE AVERAGE! YESSSSSSSS!!!)

In other news: I spent the weekend of February 9 down in St. Louis with my boyfriend, Brandon. We stayed with my Aunt and Uncle's family and had an AWESOME time!! They took such good care of us! The above picture is from the top of the Arch....what a view! It was a really fun trip and I hope the two of us can meet there again!

I hope this blog finds everyone happy and healthy! Have a GREAT rest of the week!!!

I Wish I Was This Creative On Tests: