10.30.2009
10.29.2009
Ugh. B-HCG Mix-up at the Worst Moment
Patient A is being seen in the ER for a likely 16-week miscarriage. As you may know or suspect, it's not a pleasant time for the patient, the family or the doctors. Bloody sheets and disappointment fill the room. Next to a heap of bloodied clothing sits a three year old little boy looking on nervously while pretending to color. He's wearing one of those kid leashes which appears to be tied to the chair. The doctor comes in and examines the patient, chats with the little boy and then leaves the room to order a B-HCG test. Some time later, a lab report is printed for a different patient down the hall. Her B-HCG is negative. Curious, I ask the doctor about it. In the rush of a typical ER moment, he assumes we are talking about the patient having a miscarriage. Not realizing we are on two very different pages of possibly different books, I say nothing and just ponder what in the world he's talking about. About this time, the miscarriaging woman's husband is walking by the desk. The doctor stops him to inform him, "Your wife's not pregnant. It appears she never was." The room is silent for a moment-- or maybe the voices and background noise just blurred into that slow motion gargle seen in movies. The husband is very bewildered upon hearing this strange news. And for a split second you know he wonders if his wife has feigned a pregnancy. Could it be? He asks, "What do you mean? How can this be??" The nurses and I are sitting behind the counter wondering the exact same thing but we all appear to be stunned. No one says anything. We all exchange glances and mouth confused, "What?"s. The doctor continues on, "We have no idea, but there's no record of a positive pregnancy test ever. She's not and has not recently been pregnant." The husband goes out into the waiting room while the doctor goes into the charting room to talk to the ultrasound techs. Suddenly it's occurred to me what's happened. I feel overwhelmed with guilt. I somehow must've confused the doctor into believing the B-HCG was negative on the wrong patient! Thankfully it all got fixed in the end. Unfortunately, the patient having the miscarriage had indeed been pregnant, and the patient with the negative pregnancy test also had a positive meth test (see below).
"ALL METHED UP"
Scene 1: The ER, Room 7
Patient in bed moaning and groaning about vague pain.
Doctor: (Concerned look on face, standing at bedside) Are you still using meth?
Patient: (Furrowed brow & innocent voice) No, I stopped using ages ago.
Scene 2: Doctor standing outside room 7, looking over tox-screen report, which reads: "HIGH levels of methamphetamines detected."
Doctor: (Stepping into room 7, with an annoyed look on his face) So the labwork came back and you've tested positive for meth.
Patient: (Very serious voice) I have no idea how. Great. They must've spiked my salt shaker with meth again.
10.28.2009
Doctor's Handwriting
Doctors are notorious for their awful handwriting. It's incredible that the pharmacists can even make out the drug they are to hand you a giant bottle of... let alone the proper dose and instructions. Maybe when all the hospitals have switched to complete Electronic Medical Records this won't be such an issue. The doctor will simply have to click the right boxes in the computer and out will pop your prescription in neat 12 point Helvetica font. Until this day, I will remain to be one of the few, oh and I do mean few, doctor-ish people who actually has neat, legible penmanship. Normally I like getting compliments, but the number of daily complements and comments on my handwriting is actually starting to annoy me. They flip open the patient's chart and pause at seeing my clearly printed note. An eyebrow is raised suspiciously, "Who wrote this note?! Did YOU write this note? Wow, it's so easy to read!" Another nurse walks by and mutters, "It won't last." I swear I could write complete mumbo-jumbo in that note and they would all miss it because they are so mesmerized. I think I could write stuff like, "I recommend that the patient's limbs be amputated immediately. In addition, cadaver faces should be transplanted to each of his remaining stumps." It's bothersome. I might have to start writing a little more messy just to be taken seriously in this world.
The other day, I saw this cartoon in one of those little tear-off "hospital humor" calendars. Usually they aren't very funny, but this one actually made me smile. I couldn't find it online, so I reconstructed it for you:
The other day, I saw this cartoon in one of those little tear-off "hospital humor" calendars. Usually they aren't very funny, but this one actually made me smile. I couldn't find it online, so I reconstructed it for you:
10.25.2009
Weird Dream
Right now I am on a four week Emergency Medicine rotation out in the sticks of Oregon. After working several long and bizarre days, I came home and crashed. I awoken to one of my unusual dreams which is illustrated for you below.
Suddenly I'm on a school bus sitting between the window and my mom. Only of course my mom isn't my mom in the dream. No, she's Liv Tyler, because that makes complete sense. Anyway a seat or two over is the ER doctor I'm working with. (I couldn't find a photo of him, so this concerned ER doc is sitting in as his substitute. It's a dream after all. It was probably this guy to start with.) A few seats up is the actress Megan Fox. Yes, the one in Transformers. She is very beautiful but I can't stand her none-the-less. She slowly turns in her seat making direct eye contact with in order to deliver a potent stink-eye from across the bus. I cringe and hide my face in Liv Tyler's long hair. Startled, she turns to me and instead of reprimanding me for taking refuge in her hair, she says, "Your perfume smells good!" To which I reply, "No, mom, it's your shampoo."
10.23.2009
The Personal Statement: A personal statement is required with your application for residency programs. Here is my story.
My Driveway Moment: The Scalpel vs. the Paintbrush
Personal Statement by Alpenmed
NPR calls them "driveway moments," and it was one such moment that first sparked my interest in surgery. At the time, I was finishing up a BA in Fine Art at the University of Washington and had quite artfully avoided all pre-med requirements. But on this particular day, while driving home from painting class, I was transfixed by NPR's profile with a photojournalist who had recently published a book exposing the privileged realm of the operating room. The interview with Max Aguilera-Hellweg was only half-finished by the time I pulled into the driveway, so there I remained: engine running; bucket of paintbrushes beside me; completely riveted by the world of surgery coming to life over the crackly car radio.
My driveway moment would take a few years to truly park itself in my life, but my copy of Sacred Heart arrived almost immediately. The glossy color-plates were my first real look at surgery and I was mesmerized by the gloved hands deep in the guts of a living person and of a sectioned skull revealing a gray brain glistening under bright lights it was never meant to see. My first, self-righteous, thought was "Who dares violate the human body in such a manner?" After learning of the patients' histories and grasping their life-or-death needs, my thoughts quickly changed: "Who would dare not to do this?"
Several years later, I entered Columbia University's Post-Bacc Pre-Med program, unknowingly following in the footsteps of Aguilera-Hellweg, who went into medicine after his visceral experiences in the O.R. Being an observer was no longer enough for him. And it was no longer enough for me.
The first day of my general surgery rotation began with the excision of a simple lipoma and finished off with a grueling upper lobectomy. It was perfect. And somewhere in the middle of that 16-hour day I knew, with certainty, that I had to become a surgeon. One of my most poignant moments came after a late night return call to the hospital for a possible appendicitis in a truly miserable six year-old: It was thrilling-- one of the most memorable moments of my life-- being able to perform most of the open appendectomy myself under the guidance of Dr. _____. But my true satisfaction came upon returning to the hospital early the next morning to find an adorable little girl in pink pajamas watching cartoons in Spanish and smiling.
My acute sense of completion that morning stemmed, I believe, from my innate desire to intervene directly in my patients' health. What I love about surgery most might be that it comes with this unique privilege: making a connection that extends beyond pontificating or pharmaceutical remedies.
I still like to experience the world through my hands as well as through my mind, and surgery allows me a medical career especially well-suited to my extensive artistic training. As surgeon Leonard Shlain puts it in his book Art & Physics: "...a surgeon is both artist and scientist. The craft demands a finely honed sense of aesthetics: A maxim of the profession is if an operation does not 'look' beautiful it most likely will not function beautifully..."
There have been many--many--medical books in my life since I first opened Sacred Heart. And, since my "driveway moment," I have been exposed to an expansive array of medicine. While I enjoy many aspects of other disciplines in medicine and love the challenges offered by several, it is surgery and surgery alone that ties all of my passions together in a way that is truly fulfilling.
Here is Max Aguilera-Hellweg's fantastic website: http://maxaguilerahellweg.com/
Personal Statement by Alpenmed
NPR calls them "driveway moments," and it was one such moment that first sparked my interest in surgery. At the time, I was finishing up a BA in Fine Art at the University of Washington and had quite artfully avoided all pre-med requirements. But on this particular day, while driving home from painting class, I was transfixed by NPR's profile with a photojournalist who had recently published a book exposing the privileged realm of the operating room. The interview with Max Aguilera-Hellweg was only half-finished by the time I pulled into the driveway, so there I remained: engine running; bucket of paintbrushes beside me; completely riveted by the world of surgery coming to life over the crackly car radio.
My driveway moment would take a few years to truly park itself in my life, but my copy of Sacred Heart arrived almost immediately. The glossy color-plates were my first real look at surgery and I was mesmerized by the gloved hands deep in the guts of a living person and of a sectioned skull revealing a gray brain glistening under bright lights it was never meant to see. My first, self-righteous, thought was "Who dares violate the human body in such a manner?" After learning of the patients' histories and grasping their life-or-death needs, my thoughts quickly changed: "Who would dare not to do this?"
Several years later, I entered Columbia University's Post-Bacc Pre-Med program, unknowingly following in the footsteps of Aguilera-Hellweg, who went into medicine after his visceral experiences in the O.R. Being an observer was no longer enough for him. And it was no longer enough for me.
The first day of my general surgery rotation began with the excision of a simple lipoma and finished off with a grueling upper lobectomy. It was perfect. And somewhere in the middle of that 16-hour day I knew, with certainty, that I had to become a surgeon. One of my most poignant moments came after a late night return call to the hospital for a possible appendicitis in a truly miserable six year-old: It was thrilling-- one of the most memorable moments of my life-- being able to perform most of the open appendectomy myself under the guidance of Dr. _____. But my true satisfaction came upon returning to the hospital early the next morning to find an adorable little girl in pink pajamas watching cartoons in Spanish and smiling.
My acute sense of completion that morning stemmed, I believe, from my innate desire to intervene directly in my patients' health. What I love about surgery most might be that it comes with this unique privilege: making a connection that extends beyond pontificating or pharmaceutical remedies.
I still like to experience the world through my hands as well as through my mind, and surgery allows me a medical career especially well-suited to my extensive artistic training. As surgeon Leonard Shlain puts it in his book Art & Physics: "...a surgeon is both artist and scientist. The craft demands a finely honed sense of aesthetics: A maxim of the profession is if an operation does not 'look' beautiful it most likely will not function beautifully..."
There have been many--many--medical books in my life since I first opened Sacred Heart. And, since my "driveway moment," I have been exposed to an expansive array of medicine. While I enjoy many aspects of other disciplines in medicine and love the challenges offered by several, it is surgery and surgery alone that ties all of my passions together in a way that is truly fulfilling.
Here is Max Aguilera-Hellweg's fantastic website: http://maxaguilerahellweg.com/
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