Island Med Student

The awesome venn diagram above is from indexed, a wonderful site that I read every day.

Today, I finished my 4-week nephrology rotation. Learned a lot. Only 12 more weeks of med school to go!!

My apologies for my lack of “stuff learned” tidbits during my nephrology rotation. Perhaps it’s my senioritis, perhaps it’s my “residency tunnel vision,” perhaps it’s laziness, or perhaps it’s just nephrology, but I have just been uninspired/unmotivated to write about the things I’ve learned during my nephrology rotation.

It’s definitely not for lack of learning, though. I’ve learned quite a bit during my 4-week elective. Tomorrow will be my last day, and then Monday it’s on to Pain Management.

One thing I know for sure is that nephrology seems to be a somewhat depressing field to me. The vast majority of the patients we are consulted on are very, very ill. Most of them are nursing home patients or otherwise rapidly decompensating. The prognoses are generally very grave. It seems that once your kidneys are on their way out, many times, so are you. It’s a sad, but true fact that I’ve experienced lately.

I’d say that I’ve heard “at this point, it’s about making the patient comfortable” all too many times. There tends to be very little that the doctors can do to “save” the patient, once a nephrologist has been consulted. There are exceptions, but I’ve found this to be true most of the time.

The photos from this post were taken during my walk this morning. The snow was coming down hard, and I enjoyed tunneling through the cold flakes of water during my journey to the hospital.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

Today was a long but rewarding day at the hospital for me. HIPAA and my fatigued state both prevent me from giving the entire and long story, so I’ll give you the short, and edited version. A patient came into the ER with an incredibly high electrolyte level. No one was exactly sure what was going on, but the patient was uncooperative and combative. I showed up as a nephrology student on the case, just as a medicine resident attempted to place a Foley.

After multiple attempts, the resident resigned to having the patient sign a refusal form. After he left to get the form, I found myself alone with the patient. The resident had explained to the patient that refusing treatment would mean certain death, but the patient didn’t seem phased.

So, I asked a simple question. “Do you want to die?” He replied with a definitive yes, and after asking a few more questions, I realized that his electrolyte imbalance was due to a suicide attempt.

The gist is that because of my questioning, we realized what was actually going on with the patient, and were eventually able to help him. I’m glad he lived. And I’m glad I was able to contribute something.

Enjoy the Brooklyn photos above. Oh, and 2 points to anyone who gets the reference in the title of this post.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

I promised I would never apologize for my lack of posting “med-student-related” content on my site. However, I still feel compelled to at least explain to everyone why I haven’t been posting all kinds of fun med student content. As I wrote in my recent Medscape post “A Bad Case of Senioritis,” I’ve just not been feeling the med school vibe as of late. I’ve found myself becoming somewhat apathetic and unmotivated. It’s not that I don’t enjoy medicine anymore, it’s just that I am not enjoying med school as much as I used to.

My current nephrology rotation is packed with med students, and there is quite a lot of standing around at times. I’m just so tired of “hanging around” at the hospital, with my proverbial thumb in my butt. And it’s not that I feel like I know everything, or that I’m 100% ready to be a full-fledged doctor. But I do feel ready to at least start trying.

Yes, I’m scared, and yes, I still have so much to learn. But I’m ready to work hard. I’m ready to contribute more. I’m ready for a paycheck. I’m ready to call myself a doctor. Perhaps I’m putting my cart in front of my doggy, but I just really need to start working.

So, in lieu of wonderful stories about being a med student, please enjoy the photos in this post, all taken in my neighborhood in Bushwick, Brooklyn.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

Today was an okay day at the hospital. I spent the majority of my time in the dialysis unit (I’m doing a nephrology rotation). I have so much to say about this, but not the time or energy to say it right now.

But I will make one quick comment. I’ve seen a lot of sadness in medicine. But the three most saddening, and even horrific things I’ve seen are debridement of stage IV/V ulcers (especially on elderly and awake patients), amputations, and dialysis. I don’t know how I’d ever deal with having any of these three procedures. And the common thread that almost always ties them all together? Diabetes and hypertension. The so-called “silent killers.” They don’t seem so silent to me.

Check out my post on Medscape to read a story about my patient who loves almonds.

Click Here To View the Entry

Have you ever noticed that sometimes the most emotional or worst days tend to be the ones where you learn the most? Well for me, that was true today. I had a particularly stressful day at the hospital. It was probably the combination of PMS, a huge patient load, and a longer than normal day.

When I was at the point that I was so tired that I had mentally “checked out” I got a text message from my partner Micah. He had accidentally broken the freon line in the refrigerator when attempting to defrost it, and the cookie jar fell into the dog bowl. Now, I know this isn’t the worst sequence of events that could happen to someone, but I was so already stressed out that it sent me over the edge. I started imagining Micah and my three doggies all lying dead on my apartment floor after having been exposed to the toxic fumes. I imagined having to call 911 and some sort of doggy 911 all at the same time. That, and my favorite cookies were now in the doggy bowls. If that weren’t enough, I imagined the already half-dead doggies consuming the chocolate cookies and dying from that as well. All while Micah lay dead on the floor already, without being able to save them.

Yes, I have somewhat of an overactive imagination. But everything together just sort of sent me into a mental downward spiral.

Then I met the last patient of the day. She was being dialyzed when I met her. Her health conditions sounded like a medical textbook: diabetes mellitus, hypertension, CAD, double above the knee amputations, asthma, AIDS, Hep C, s/p MI and CVA, CKD and ESRD on hemodialysis, metastatic colon CA, anasarca, SBP, pneumonia, and sepsis. She should have gone a long time ago, but she was still hanging on. I tried to talk to her but she just mumbled incomprehensibly. Eventually she asked me for some water. I asked my attending if I could give it to her even though she was NPO and on fluid restriction. I mean, yes she wasn’t supposed to have it. But at this point, did it really matter? Or would giving her a few sips of water to help with her cracked, dry lips and mouth be the humane thing to do? My attending agreed, and I raised her bed and put the cup of water to her lips. She thanked me.

Afterwards my mind went back to my dead partner, dead dogs, and broken fridge. As horrible as my day had been, compared to this poor lady, my life wasn’t all that bad.

It’s really all about perspective. One extraordinary thing about working in a hospital with incredibly sick folks is that it gives you perspective. Every day. And for that I am incredibly grateful.

Photo above is my new “fire escape refrigerator.” I guess 20 degree whether isn’t always a bad thing.

I had a fun and not-so-fun day at the hospital today. I’ve pretty much determined that I’m a busy bee. If I am not working, and just standing around, trying not to get in the way of nurses, and looking like a silly med student, I’m not happy. If I am doing any kind of work (may it be patient care, bedpan emptying, or even paperwork), I am very happy. I need to be busy. I need to feel needed. I guess that’s just the way I’ve always been.

After I got home from the hospital, I went on a sweet run. After that I took a bubble bath and I’m now about to make some din din. I was going to post some “stuff learned” in nephrology, and some other stimulating and thoughtful content but I just don’t have it in me today. Instead, please enjoy the photos with this post (sometimes I think in photos, instead of words).

1) What I woke up to this morning. 3 dogs and 2 humans in a full-size bed. Crowded much?
2) My lunch yesterday. The “ultimate feast” at the red lob. Thanks Bob (mom) for the gift certificates!
3) Laundry day with Scope and Molly. (When you live in a studio apartment your bed is a place to sleep, eat, work, love, play, AND get work done.)
4) A photo I took on my walk to the hospital today. Don’t you just hate it when you lose your tighty whities in the street?!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

Today was the first day of my nephrology elective rotation. I learned some stuff that I will share soon. It was good to be back in the hospital. It’s amazing how different it feels when you’ve been away for a while. The smell of feces seems to be stronger, the patients seem sicker, and the realities of the hospital are so much more real.

When I came home, I convinced my body to go on an 8-mile run into Manhattan. Turns out I really should have eaten beforehand. Halfway across the Williamsburg Bridge my body started to tire in protest of it’s calorie-deprived state. I need to re-establish eating times in order to accommodate my new hospital schedule.

It was horribly cold today as well. Bitterly cold. But I still managed to capture the 4 photos in this post. The first one is a shopping cart that I photograph all the time…I like to see how it changes as time goes by. The second two photos are of other shopping carts that I found along my journey, and the last photo is of yet another baby stroller that bit the dust.

I had a patient today with pancreatic cancer. His cachectic body was a strange juxtaposition against his very jovial attitude. More to come on that soon. And more about nephrology, I promise!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series