Tuesday, June 22, 2010

pixie-land and smartpeopleville

i don't know why TKR reminds me of a little pixie. by no means is he, however, little. it's just the way he stares. and smiles. and speaks. and gasps. like a perfect country gentleman from somewhere in hampshire. and it amuses me how he speaks in bouts of german. fascinating, to say the least. he encourages me. daily. and i love it.

so far cardiac's going great. mostly in the ICU, rounding. a patient passed away last night. he was post-op for around 40 days. admitted patients are just interesting. delirium is very common in this unit. and i didn't miss an opportunity to meet this 50-something year old female weighing well over 120 kilos (who TKR politely describes as having a slightly high BMI) and thinking her bed is made of ice. another dude next to her bed is a funeral director.

so far things have been interesting. will keep you posted

PS. in conversation with AI this morning, i love how she said, and i quote, yea yea. i know it's time for you to go back to smartpeopleville (re: H ).

Monday, June 21, 2010

when i went to the surgical oncology ward today, i completely lost it. i was wailing on the floor. i needed a nurse to assist me back to cardiac icu

later in the morning, when i was sitting in the cafeteria. a middle-aged woman appeared to stop. beside me. her husband was pushing her wheel chair around. she was stage iv myeloma. had lost all her hair. her bones terribly brittle. intimidated eyes. a dry foaming mouth.

yet, she forgot to sell her smile.

Monday, June 14, 2010

Glee and other tales

the past few days have been a little slow, but fairly productive and very interesting, to say the least. i managed to watch an episode of Glee -now this was not out of an uncanny personal desire to see yet another sassy high-school-musical-genre show, but i read in the Times something about the social implications portrayed in the show; so i thought i'd check it out. maybe one episode doesn't do justice, but the singing was fairly good. i didn't really see any social implications apart from this haggard mother divorcing an abusive husband who is apparently having an extra-marital affair with a "tattooed monster", and of course you never miss a flick of this sort without teenage pregnancy and baby-adoption drama. anyway, Times probably has a point and maybe i didn't quite see it from just one episode.

boston so far has been going well. managed to go to chinatown yesterday. it was a really colorful and exotic part of the city. B and i ate at a local gourmet dumpling house which served roasted pig heart as its delicacy. i wanted to try it out really badly, but controlled my desire in eccentricities for fear of falling ill and not being able to go to work. random observation: there are a lot of asians in boston. it's pretty cool. an interesting mix.

i've also been traipsing around the campus a lot. and i love it. every time i look at those pillars, it just really makes me want to just burst inside and see what it's like. but i'll wait till i get the official tour. i have a few appointments lined up to meet a few people there, so we'll see how that goes. i use the library a lot, and it's a cool spot to just relax and read up a few articles after standing in the OR. sometimes, i managed to catch a quick nap and get back to work.

cardio wise it's going great. ICU rounds are awesome and hilarious. these attendings have a great sense of humor! Dr EK randomly asked me a series of three questions the other day about the exact location of the diverticula and i had no friggin' idea. and then VT stepped in and says he's not a medical student Dr K. he paused for about a micro-second. so wait you're not a medical student? that means you're like a student student? like those that go to college? oh like a college student? i aptly made the clarification that i indeed am an undergrad in a college in Indiana and not at H (since every mortal and microbe in the hospital conveniently assumes so) and moved on from there. ever since that colorful encounter we have discussed what is the meaning of ghee, who invented peanut butter and why i was interested in medicine.

i took some time out to read Cohn's surgery book. and it's awesome. read up two chapters on aortic aneurysms and stem-cell induced myocardial regeneration. the latter chapter was pretty old, since i know a not of new therapies have come out since the article was written, but it was still a good info-read. i've also been working on sutures a little bit, and trying to do things. oh and i forgot to mention, saturday morning was interesting. one of the resident interns, XS (calls himself X-man) didn't show up to work. we tried contacting his beeper only to be answered by some rogue who found it on the street and christened herself Roy Roberts! that's a very cheesy name. and then one of the RNs assumed that he was dead or possibly kidnapped and packaged off to the far east. also SM (who is by the way, a very attractive woman -more so because she is a surgeon) got a little worked up. i kinda giggled because i knew it was probably going to turn out to be yet another hangover story (which i later found out it was), but i didn't say much at the time.

that's pretty much how it has been. will update soon!

Thursday, June 10, 2010

lost in charles

i've been constantly thinking about the little boy i saw at the train station yesterday. he was probably fourteen or fifteen years of age. smooth auburn hair brushed neatly back. uncanny palor on his face. wheeling his father around on the wheelchair. and midst of the confusion of the train station he looked so lost. i could tell a bare frustration on his face. his father was trying to keep the pace and distract. but he smiled when i looked at him. i smiled back. calmly yet awkwardly. i wanted to say. is there anything i can do? but i didn't. i just smiled. and waved a cheerful goodbye/hello: i'm not sure which one it was supposed to mean.

but since then, i have a strange tingling sensation in my brain. i hope it goes away soon. i know it's not a feeling of guilt. it's a little discomforting.

hospital's going well. i'm learning each day. little by little. slowly yet surely.

Saturday, June 5, 2010

even thought saturday mornings can be very lazy and lousy. sometimes. i try and make full use of it. which comes to my point: i went to the hospital today.

stuff i learned/did:

learned the technique of bronchoscopy/ what it looks like through the scope.

pulled out chest tubes. chest tubes are placed perioperatively to drain fluids from the chest. that was interesting. Dr V mentioned that you've got to hum a long hum while pulling out the tubes because you need to create the negative pressure inside so as to prevent bubbles, etc. but Dr V let me do the stuff. it was really cool.

talked about the plus and minuses of private practice vs hospital employment. Dr Cohen had very interesting points. i guess you need to make a choice at some point. Dr V made an intelligent point. he goes. so if i'm a plastic surgeon and want to do private practice i really need to work on people like michael jackson and the rest will follow. and then he goes, god forbid i ever have to do cardiology work on him.

figured out a gameplan for tomorrow. Dr V wants me to present a patient. i'm a little nervous but hey, this is how we learn right? so i'm probably going to present a patient who was operated for mitral valve repair. we'll see how it goes. i've been asked to go there tomorrow morning at 6:30

dr S was fun today too. saw a few chest x-rays. learned what it looks like if the central line snaps. but thank god, in that patient, it didn't. she has 7 other lines going anyway!

more tomorrow. yes i work 7 days a week. and i love it

Friday, June 4, 2010

shapiro 6w

friday morning. started work around 7 this morning. i was initially confused what i was supposed to do today or where to go. but then JW messaged me last night to work with him. he's a nice guy. very down to earth. doesn't show off his knowledge!

anyway, so we started rounds on 6 West in Shapiro where the intensive care unit is. JW and I weren't sure exactly which team we should join. but it turned out just fine. we tagged along with dr david silver. an anesthesiology attending, who specializes in cardiac anesthesia. we both thought he was a great teacher. couple of things we learned (and i will discuss in more details later):

1) patients on ventilators who need sedation need to occasionally be on sedation holiday so that over-dose of sedatives does not cause delirium.
2) there is the RAS scale for sedation, which should be matched against when diagnosing a patient
3) the CAM scale is for delirium
4) we learned about acute respiratory distress syndrome (ARDS) and the need for peep-ing so as to prevent total lung failure
5) learned the clincal symptoms of leukocytosis
6) Need for esophageal balloon to actually measure internal pressure. important to note that big breasts and other anterior weights (like obesity affecting abdomen) can actually affect internal pressure sig.
7) also post-oped a pt who was diagnosed with a heart tumor! had never heard/seen that before!

I'll talk in more details about these jargons in an upcoming post! till then, thanks for stopping by!

Thursday, June 3, 2010

clinical expedition day 1

7:00 am: conference in the morning. they had m&m which is the short form for morbidity and mortality. 8 complications with 6 deaths. one of the biggest discussions yesterday was on HIT. HIT stands for heparin-induced thrombocytopenia. what that basically means is the heparin, an anti-coagulant can actually go and reduce platelet count in the human body leading to complications. so the question arose should we test for HIT in a patient pre-operative procedure or what should be the best way to administer this. i don't exactly remember where the debate ended up, but in short it was undecided.

after that, Dr R. showed me around Shapiro. it's a really nice building. very glassy and flashy. had gone to the ICU for a catch-up round! met the fellows. pretty interesting stuff.

afternoon, basically had clinics with Dr B. most diagnoses involved mitral valve stenoses. so we had to weigh out, along with the patient's family, whether we wanted valve replacement or repair! need to choose between mechanical valve and pig/cow valve. some patients have really interesting social history. remember one lady, probably Portuguese, with large hazel eyes, reddish-brown hair, artificial curls, and heavy eye-make up. came with a complaint of severe shortness of breath. she admits to snorting cocaine everyday, marijuana 3 times a week and heavy smoking and daily consumption of alcohol. she smiles for twenty seconds and adds that she never forgets her calcium pills. paradox after paradox you encounter in this professions. no excuses, no judgments allowed! do your work and get outta here!

other than that, i read up on aortic dissection. cases tomorrow are mitral valve replacement and coronary artery bypass graft. so i'm reading up on them.

Tuesday, June 1, 2010

countway excursion

not my best day today. i've just been a mess of emotions. went into the attendings office and bawled sporadically. it felt so good. but unreal. it was so raw. and coarse. i did not feel embarassed. at all. i knew this was coming. but i didn't realize that my attending will be the victim.

why this sudden reaction you ask. i think part of it is a feeling of personal failure. part of it is this unreal sheath beneath which I feel like i'm pushing every day. talking to B. i don't know. about the same thing over and over again. and while i sit in the countway library this evening, pondering over the occurrences of the past few weeks, it makes me shiver and cower in embarrassment and in pain. i felt negated and i felt pushed and plowed. oh goodness, over-ridden! and i couldn't take it any more this evening. so i let loose. completely. but he cheered me up. Dr B.

other than that. i love harvard. and the medical school is marvelous. i keep thinking about S all the time. i don't know why. i miss her a lot. and i wish she was here. so that i could tell her i loved her. once upon a time, when she would have never guessed. but this square of ashen stones is like a garland of budding blossoms. gerberas and orchids. so beautiful and pleasant. and amidst this garland is an established generation drenched in pain, brevity, angst and disdain. and how competitive they are. oh that look on their eyes!

today was mostly orientation. went to the abrams conference room at 10:00. we had 4 videos to watch and answer questions about them. funny part is no one really cared about watching the videos since the supervisor was calling out all the answers of the safety quiz anyway. after that, went up to meet Dr B. and i really like him. he asked me to go to conference tomorrow morning at 7. and then i'm on OR duty. am excited about meeting the chief resident!

that's all for today. more tomorrow!