Monday, February 06, 2006
Nothing to really say about the third patient. My fourth patient has testicular cancer. That's a story for another day.
2nd patient.
Some admissions come to you because of a symptom. Chest pain. Shortness of breath. Rectal bleeding (that last one's my favorite. Oh wait, NO.)
Mrs. Kline (standard disclaimer here) is a 95 year old who came in with a lab value. WBC = 1.2 and platelets of 40 or something like that. For those of you playing at home, that's pancytopenia and that's bad. She can't fight infections and she'll bleed to death if she falls. A quick glance at her meds produced a culprit -- she'd started Imuran for her Crohn's disease. So far, she's been OK. I see her every morning and most afternoons and ask her about how she's feeling, bruises, bleeding, etc. She's a frickin' rock. Sharper than most of the doctors too. :) It'd be nice if her body showed some signs of wanting to make some cells though.
I'm a little torn. I don't think the teaching service (the part of the medical team that includes residents, interns and students) should be following this patient because she's like no work at all and there's no teaching left in the case. On the other hand, maybe I just don't want to see her get sick and die. Hard to know.
Some admissions come to you because of a symptom. Chest pain. Shortness of breath. Rectal bleeding (that last one's my favorite. Oh wait, NO.)
Mrs. Kline (standard disclaimer here) is a 95 year old who came in with a lab value. WBC = 1.2 and platelets of 40 or something like that. For those of you playing at home, that's pancytopenia and that's bad. She can't fight infections and she'll bleed to death if she falls. A quick glance at her meds produced a culprit -- she'd started Imuran for her Crohn's disease. So far, she's been OK. I see her every morning and most afternoons and ask her about how she's feeling, bruises, bleeding, etc. She's a frickin' rock. Sharper than most of the doctors too. :) It'd be nice if her body showed some signs of wanting to make some cells though.
I'm a little torn. I don't think the teaching service (the part of the medical team that includes residents, interns and students) should be following this patient because she's like no work at all and there's no teaching left in the case. On the other hand, maybe I just don't want to see her get sick and die. Hard to know.
So, my first patient.
Mrs. Bellwether (not her real name, of course) came to the ED because of chest pain. She SHOULD HAVE BEEN SO SIMPLE. Clear case of unstable angina right? Negative troponins x 3, an echo in the AM, and she'd be out the door. So clear, in fact, that my resident sorta rushed me through the admission before I got a chance to finish reading her old discharge summaries. Turns out she's pretty demented. And crazy (couldn't find any DSM-IV diagnosis for her besides major depressive disorder). Bad combination. She was pleasantly demented (always putting her clothes on and walking out of her room to god knows where She ruled out for MI but getting an echo for her was a problem because when we rolled her down (she was my only patient so I thought I'd be a good doctor and accompany her to her study. Nice, right), she freaked out and almost jumped off the gurney. I thought my medical career woulda ended right there. She ended up staying an extra two days and needed a fair amount of Haldol to keep the nurses from going apeshit. Her chest pain was almost certainly secondary to anxiety. What a waste of resources.
Mrs. Bellwether (not her real name, of course) came to the ED because of chest pain. She SHOULD HAVE BEEN SO SIMPLE. Clear case of unstable angina right? Negative troponins x 3, an echo in the AM, and she'd be out the door. So clear, in fact, that my resident sorta rushed me through the admission before I got a chance to finish reading her old discharge summaries. Turns out she's pretty demented. And crazy (couldn't find any DSM-IV diagnosis for her besides major depressive disorder). Bad combination. She was pleasantly demented (always putting her clothes on and walking out of her room to god knows where She ruled out for MI but getting an echo for her was a problem because when we rolled her down (she was my only patient so I thought I'd be a good doctor and accompany her to her study. Nice, right), she freaked out and almost jumped off the gurney. I thought my medical career woulda ended right there. She ended up staying an extra two days and needed a fair amount of Haldol to keep the nurses from going apeshit. Her chest pain was almost certainly secondary to anxiety. What a waste of resources.
So I stopped updating my blog (like two years ago!) because I figured nobody actually bothered to read it. This is almost completely true. Then I decided that it would be worth reading if I posted about patients, because there's always a good stories there. But I didn't really feel like a doctor as a third year medical student -- I felt like a third year medical student. You're on the wards, you're in the OR, you're learning, you even know some stuff, but you only get so much responsibility. So I figured I'd wait until internship before I posted. But my 4th year subinternship is much like internship, only way easier yet even more annoying because my resident has to sign all my orders (there's nothing like writing an order for a CBC and lytes and having the secretary ask you, "you're a doctor, right? no? i'm sorry, but..."). I also was going to make a new, anonymous blog for this purpose, but I'm very lazy. Some things haven't changed.
Hopefully, some random reader (you know, when this blog actually gets readers) will let me know if I'm violating HIPAA or not.
Hopefully, some random reader (you know, when this blog actually gets readers) will let me know if I'm violating HIPAA or not.
Sunday, October 12, 2003
Long time no post.
Records:
Just bought The Soft Bulletin, by the Flaming Lips. Obviously, it's a modern classic. Haven't picked out favorites yet besides "A Spoonful Weighs a Ton"--hell, haven't even heard the whole thing yet. I'm pumped that I got a used copy (still $9.99 here in Beantown--damn that's a lot), but apparently it's the UK, not the US version. Which means I get an extra track, miss a track that's on the US version, and get a different running order. The purist in me is a bit livid.
Manitoba, Up In Flames. Absolutely brilliant record. I have not heard two better songs all year than "Hendrix with Ko" or "Jacknuggeted." There are so many elements here I don't even know where to begin: breakbeat, psychedelia, folk guitar, chill vocals. Definitely the album of the year to this point (and yes, I do have Hail to the Thief).
Movies:
Intolerable Cruelty. Don't be fooled by the previews. Yes, the first half of the movie is basically the sum of all the different commercial spots, and looks like an homage to To Have and Have Not, with Catherine Zeta-Jones being more Bacall than Lauren Bacall. However, the film looks as if it's going to end well before the full running time, and that's where things become interesting, i.e. vintage Coen Brothers twists and ironic dismissals. The whole affair comes off as more slight than than their previous flicks, with the obvious exception of The Big Lebowski. But what kind of romantic comedy is heavy? Picked up Ethan Coen's book of short stories the other day--definitely worth a read. Still dying to see Kill Bill.
Sports:
Cubs just lost. But they're going back to Wrigley, and only three teams have come back from 3-1 in any LCS. It's still as good as over.
Records:
Just bought The Soft Bulletin, by the Flaming Lips. Obviously, it's a modern classic. Haven't picked out favorites yet besides "A Spoonful Weighs a Ton"--hell, haven't even heard the whole thing yet. I'm pumped that I got a used copy (still $9.99 here in Beantown--damn that's a lot), but apparently it's the UK, not the US version. Which means I get an extra track, miss a track that's on the US version, and get a different running order. The purist in me is a bit livid.
Manitoba, Up In Flames. Absolutely brilliant record. I have not heard two better songs all year than "Hendrix with Ko" or "Jacknuggeted." There are so many elements here I don't even know where to begin: breakbeat, psychedelia, folk guitar, chill vocals. Definitely the album of the year to this point (and yes, I do have Hail to the Thief).
Movies:
Intolerable Cruelty. Don't be fooled by the previews. Yes, the first half of the movie is basically the sum of all the different commercial spots, and looks like an homage to To Have and Have Not, with Catherine Zeta-Jones being more Bacall than Lauren Bacall. However, the film looks as if it's going to end well before the full running time, and that's where things become interesting, i.e. vintage Coen Brothers twists and ironic dismissals. The whole affair comes off as more slight than than their previous flicks, with the obvious exception of The Big Lebowski. But what kind of romantic comedy is heavy? Picked up Ethan Coen's book of short stories the other day--definitely worth a read. Still dying to see Kill Bill.
Sports:
Cubs just lost. But they're going back to Wrigley, and only three teams have come back from 3-1 in any LCS. It's still as good as over.
Thursday, October 02, 2003
Song of the day (month?):
Back to you
It always comes around
Back to you
I tried to forget you
I tried to stay away
But it's too late
I'm so good at forgetting
And I quit ever game I play
But forgive me, love
I can't turn and walk away
Back to you
It always comes around
Back to you
I walk with your shadow
I'm sleeping in my bed
With your silhouette
should have smiled in that picture
If it's the last that I'll see of you
It's the least that you
Could not do
Leave the light on
I'll never give up on you
Leave the light on
For me too
Back to me
I know that it comes
Back to me
Doesn't it scare you
Your will is not as strong
As it used to be
-John Mayer, "Back To You"
Back to you
It always comes around
Back to you
I tried to forget you
I tried to stay away
But it's too late
I'm so good at forgetting
And I quit ever game I play
But forgive me, love
I can't turn and walk away
Back to you
It always comes around
Back to you
I walk with your shadow
I'm sleeping in my bed
With your silhouette
should have smiled in that picture
If it's the last that I'll see of you
It's the least that you
Could not do
Leave the light on
I'll never give up on you
Leave the light on
For me too
Back to me
I know that it comes
Back to me
Doesn't it scare you
Your will is not as strong
As it used to be
-John Mayer, "Back To You"
Sunday, September 28, 2003
Musculoskeletal neoplasms suck. Chondrosarcoma, osteoblastoma, osteoid-osteoma, Ewing sarcoma, chondroblastoma....THEY'RE ALL GETTING MIXED UP IN MY HEAD! Damn it. Now I finally understand how the boards are going to pull down my pants and taunt me. Looks like I will be doing my anesthesiology residency in Alaska.
Friday, September 26, 2003
Ugh, my head is killing me. Napping after 6 pm is a bad idea.
Purchases:
So I bought the newest Manitoba LP. It's great. I haven't formulated any real thoughts about it (stay tuned, it's coming), but it's just swell. I picked it up at Newbury Comics, which is selling all regular merchandise at 20% off. I love that place--it's the only place to buy new CDs. Unless you like whoring yourself to Virgin (haha, get it? Never mind).
I also bought a shirt at Diesel, which I had never done before. Actually, it's not a regular old Diesel shirt--it's 55DSL. The thing I hate about the Diesel store in Boston is that it's damn small (I think the Chicago one was like five times as big. Can't remember who I went there with. Fostin?), and it's a bitch to figure out who's a customer and who's an employee. Everybody's wearing some combination of Diesel, Puma, D & G, and the like, so they all have the same dirty, Euro-trashy appearance. It's weird. And the clerks don't treat you all that well. And there's like thirty of them of them for a tiny little store that could be run by three. Those guys make nice stuff though. The shirt is all stretchy and stuff but there's just cotton, no Lycra. I don't know why I like their ad campaigns or the art on their T-shirts, but I do.
I hate that. I hate it when I appreciate something and I can't elucidate my feelings about it. Makes me feel like a toddler again.
Purchases:
So I bought the newest Manitoba LP. It's great. I haven't formulated any real thoughts about it (stay tuned, it's coming), but it's just swell. I picked it up at Newbury Comics, which is selling all regular merchandise at 20% off. I love that place--it's the only place to buy new CDs. Unless you like whoring yourself to Virgin (haha, get it? Never mind).
I also bought a shirt at Diesel, which I had never done before. Actually, it's not a regular old Diesel shirt--it's 55DSL. The thing I hate about the Diesel store in Boston is that it's damn small (I think the Chicago one was like five times as big. Can't remember who I went there with. Fostin?), and it's a bitch to figure out who's a customer and who's an employee. Everybody's wearing some combination of Diesel, Puma, D & G, and the like, so they all have the same dirty, Euro-trashy appearance. It's weird. And the clerks don't treat you all that well. And there's like thirty of them of them for a tiny little store that could be run by three. Those guys make nice stuff though. The shirt is all stretchy and stuff but there's just cotton, no Lycra. I don't know why I like their ad campaigns or the art on their T-shirts, but I do.
I hate that. I hate it when I appreciate something and I can't elucidate my feelings about it. Makes me feel like a toddler again.
Movies:
Saw The Rundown after class today. We all loved it. The main attraction for John and I was Christopher Walken, but Seann William Scott (you know, Stifler) was great too (if a little one-dimensional. He was a bit too Stifleresque, kinda like Jason Biggs was too Jimesque in Anything Else). I saw the trailer for this movie about a zillion times and didn't even realize it was coming out until Geoff brought it up today. It's basically a silly action-adventure buddy flick, but it's very well done. The Rock does a good job of being Arnold, Stifler's funny, Rosario Dawson was hot, and Walken was Walken. Lots of neat camera tricks and beautiful scenery. And the fight scenes were out of this world.
As if that weren't enough, we saw three previews for movies that I simply must see ASAP: Intolerable Cruelty (new Coen bros), Kill Bill (new Tarantino), and The Matrix Revolutions. I don't get it: do movie execs sit together and decide to give us crap for months at a time before releasing the good stuff in the fall?
Saw The Rundown after class today. We all loved it. The main attraction for John and I was Christopher Walken, but Seann William Scott (you know, Stifler) was great too (if a little one-dimensional. He was a bit too Stifleresque, kinda like Jason Biggs was too Jimesque in Anything Else). I saw the trailer for this movie about a zillion times and didn't even realize it was coming out until Geoff brought it up today. It's basically a silly action-adventure buddy flick, but it's very well done. The Rock does a good job of being Arnold, Stifler's funny, Rosario Dawson was hot, and Walken was Walken. Lots of neat camera tricks and beautiful scenery. And the fight scenes were out of this world.
As if that weren't enough, we saw three previews for movies that I simply must see ASAP: Intolerable Cruelty (new Coen bros), Kill Bill (new Tarantino), and The Matrix Revolutions. I don't get it: do movie execs sit together and decide to give us crap for months at a time before releasing the good stuff in the fall?
Sunday, September 21, 2003
This is one of the best Johnny Cash obits I've seen:
http://www.pitchforkmedia.com/watw/03-09/cashandcurrency.shtml
http://www.pitchforkmedia.com/watw/03-09/cashandcurrency.shtml
From the Onion:
Indian-American Couple's Accent Makes Fight Adorable
SAN DIEGO—A witness to an argument between Indian-Americans Soumitra and Vineeta Chattergee reported Monday that she thoroughly enjoyed the vicious fight. "They were at each other's throats, arguing about which one wrote the check that caused an overdraft," said eyewitness Shelly Knight, who was delighted by the heated exchange while standing in line at Citibank. "Usually, I can't stand it when couples go at it in public, but that accent made them sound so cute." Knight added that she was slightly disappointed when Soumitra stormed out.
Indian-American Couple's Accent Makes Fight Adorable
SAN DIEGO—A witness to an argument between Indian-Americans Soumitra and Vineeta Chattergee reported Monday that she thoroughly enjoyed the vicious fight. "They were at each other's throats, arguing about which one wrote the check that caused an overdraft," said eyewitness Shelly Knight, who was delighted by the heated exchange while standing in line at Citibank. "Usually, I can't stand it when couples go at it in public, but that accent made them sound so cute." Knight added that she was slightly disappointed when Soumitra stormed out.
Whoa, haven't updated this thing in a while. The Maker's Mark pork was freakin' awesome. Recently "discovered" Trader Joe's. They have the best (and affordable) bruschetta spreads. Their fish is pretty reasonably priced--tried salmon and cod there so far--moving onto tilapia and mahi mahi soon. This is good because Shaw's keeps jacking up prices on chicken and pork, the rat bastards.
Decided to go study at the Espresso Royale at BU today. They play the best music there. I asked the dude what was playing after a particularly hot track, and he replied, "Manitoba." So everybody should go buy some Manitoba. They sound like the Beach Boys circa 2047. Lovely stuff! Death Cab for Cutie is great too (download at epitonic.com).
Saw _Anything Else_ last night. There are two types of people: those who hate Woody Allen, and those who dig him. I am most definitely in the latter camp. It's too bad he decided on Jason Biggs for his main character this time--Biggs was horribly miscast. There were some definitely witty rebukes to both the far Left and the far Right with respect to 9/11, which none of the critics seem to have caught (you know, bashing in the car windows instead of slinking off to write satire like "good Jewish intellectuals", the survival kit thing. It's all there). I think it's horribly unfair to say that Allen makes the same movie over and over. He may play similar (wonderfully misogynistic) characters, and New York is almost always New York, but every one of his films is different, in my opinion. Allen would do well to think a little more about the cinematography though. Couldn't help but think maybe this movie would have been even better as a play or even a short book.
Decided to go study at the Espresso Royale at BU today. They play the best music there. I asked the dude what was playing after a particularly hot track, and he replied, "Manitoba." So everybody should go buy some Manitoba. They sound like the Beach Boys circa 2047. Lovely stuff! Death Cab for Cutie is great too (download at epitonic.com).
Saw _Anything Else_ last night. There are two types of people: those who hate Woody Allen, and those who dig him. I am most definitely in the latter camp. It's too bad he decided on Jason Biggs for his main character this time--Biggs was horribly miscast. There were some definitely witty rebukes to both the far Left and the far Right with respect to 9/11, which none of the critics seem to have caught (you know, bashing in the car windows instead of slinking off to write satire like "good Jewish intellectuals", the survival kit thing. It's all there). I think it's horribly unfair to say that Allen makes the same movie over and over. He may play similar (wonderfully misogynistic) characters, and New York is almost always New York, but every one of his films is different, in my opinion. Allen would do well to think a little more about the cinematography though. Couldn't help but think maybe this movie would have been even better as a play or even a short book.
Tuesday, August 12, 2003
Everybody should check out meetup.com. It's shown up in the press because Howard Dean supporters use it or lot, but I think I might go to the next Indie or Radiohead Meetup in Boston. The Maker's Mark Pork isn't gonna happen until tomorrow night, but I did have some more bourbon tonight as a reward for totally kicking Negotiations in the ass. It actually goes amazing with smoked almonds. Beer:pretzels ::Bourbon:Smoked Almonds. I shit you not.
I saw two Masshole fights today. This state is completely ridiculous.
My negotiation final is going to suck. The cases for the final are crazy--they're about kidnapping and the freakin' Israeli-Arab conflict. What the hell is wrong with good old negotiating for a car or something? I just want to study medicine again.
I saw two Masshole fights today. This state is completely ridiculous.
My negotiation final is going to suck. The cases for the final are crazy--they're about kidnapping and the freakin' Israeli-Arab conflict. What the hell is wrong with good old negotiating for a car or something? I just want to study medicine again.
