Island Med Student

I just got home from a long day of peds ER. Luckily, our attending let us go a bit early, so I actually have about 8 ounces worth of energy to post a blog entry.

Still loving the kiddies and emergency medicine. Saw about 100,000,000 viral URIs (maybe I exaggerate a little bit) and AGEs. Still getting used to restraining kiddies. It’s strange because as a psych tech, I restrained about a million adults, but for some reason, it seems more tragic and difficult doing it to a child. Holding them down to draw blood or put in an IV line can be challenging! Kids are WAY more strong than I gave them credit for before doing a pediatrics rotation. I’ve also learned the ins and outs of putting on urine bags, which is a new skill for me.

I’ve learned that handling the parents and their concerns is a very important skills in peds. I’ve also gotten a lot better at performing exams on unwilling kiddies. Always auscultate BEFORE you perform an otoscopic or abdominal exam! That way you can listen before they start screaming and crying. I’ve also learned that it’s sometimes easier to examine a baby while you’re holding them (and bouncing up and down) so that they aren’t crying and wiggling away.

The most important that I’ve learned is that the director of the program really hit the nail on the head when she said, “children are not just small adults.” There really is an art to understanding the intricacies of pediatrics. Kids are not just small adults, for sure!

Note: Photos all taken during my walk home from the hospital today. I love my little Bushwick bodegas!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

I feel like lately I have a million ideas/things to write about during the day. But by the time I get home, I have lost the energy to write about them. Please do forgive me. But I am loving working in the nursery/NICU, and I’m learning many things every day.

I was following one newborn in particular, whose story turned quite interesting. I can’t share the details, for privacy sake, but I can say that it involved a psychiatric consult for the mother. Out of all the newborns in the nursery, I happened to have one whose stay involved a psych consult! It was sad for the patient, but incredibly interesting for me. I was able to use my psych knowledge and background to assist in the hospital care. I really was thrilled that I had insight into the case, and it served to further clench my decision to pursue psychiatry. I can say right now that I definitely made the right specialty choice. Psychiatry truly is a perfect fit for me!

My apologies for being too tired to share any more wonderful insights. Please enjoy my photos for now!

1) A tea party gone wrong?
2) People selling drugs on my block?
3) My shopping cart addiction
4) Barbie homicide crime scene
5) Bumper cars

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

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

That’s a mouthful.

Anyway, as promised, here are some short and sweet tidbits learned in my infectious diseases rotation (please forgive my abbreviations and lack of links, I’m not in a typing or linking mood):

1) Elderly or very young pt comes in with h/o fever, headache, nuchal rigidity. Could be n. meningitides, so give Rocephin, Listeria > give ampicillin, or s. pneumo > give vancomycin.

2) Pt comes in with sore throat, difficulty swallowing > think group a strep or anaerobes so give unasyn or PCN + clindamycin.

3) Pt bit by cat and has erythema > give clinda for anaerobes, and a PCN for staph and strep OR give unasyn or augmentin (if you add a BLI to a PCN, it covers anarobes as well).

4) Pt w/ cellulitis > think staph or strep > give vanco or bactrim if not resistant. If they have an ulcer or abscess, give vanco bc of skin breakdown.

5) All quinolones have atypical coverage (random factoid).

6) Chronic COPDer on steroids, could be pseudomonas! (or s. peumo or atypicals) so give MAXIPIME! Covers all.

7) Healthcare associated pneumonia > give carbapenem + vanco.

8 ) Community acquired pneumonia > give zithromax (covers atypicals) + ceftriaxone.

9) Febrile pt, increased WBC, RUQ tenderness > give flagyl (to cover anaerobes) + 3rd gen ceph (for gram negatives).

Sorry if that confuses anyone, but it helps me remember when I type it up as well.

Please enjoy the photos along with this random post. All taken in Bushwick over the past 2 days. I will never tire of taking photos of trash.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

Here is a short list of some things learned in my infectious diseases rotation today:

1) Penicillins are good for treating most gram positives except enterococcus and listeria (ampicillin is the drug of choice).

2) Penicillin is good for staph and strep (unless resistant).

3) For Clostridia Perfringens, penicillin works well.

4) For anaerobes, use a penicilllin + beta lactamase inhibitor.

5) For bites, Unasyn is super.

6) For intra-abdominal infections, use Flagyl + a 3rd generation cephalosporin.

7) Penicillins are excreted by the kidneys, except for the semi-synthetic ones.

8 ) All 3rd generation cephalosporins cross the blood brain barrier.

9) Ceftriaxone is good for meningitis, and community acquired pneumonia, but can cause biliary sludging.

10) Cefotaxime is the drug of choice for neonatal meningitis.

11) Vancomycin is good for staph infections and c diff.

12) Polymixin B is nephrotoxic and is only good for gram negatives.

And I learned much more!

Note: Sorry for the crappy quality of the pics with this post. I was too tired to put more energy into them!

Today was my last day of anesthesiology. I completely enjoyed my 2 week rotation. I learned a lot about anesthesiology and had a lot of fun. I have absolutely no interest in going into anesthesiology, but the concepts and skills I learned are very applicable to medicine in general, especially emergency medicine.

I have a few interviews next week, and a huge gap in my schedule right now. I won’t be starting pediatrics until February (very long story), so I have to plug in my schedule with some more electives.

The weather has been yucky the past few days, but walking home today was great. I figured out a cool new path to get home, which involves taking a shortcut through a park. As a parkophiliac, this is a very wonderful thing to me. Today, on my way home, a young kid asked me if he could borrow my cellphone to call his mom. Of course, I let him do so, and afterwards, he went on and on about how he wanted to get the same phone. He was probably around 7 years old…and he wanted a cellphone! I guess I’m old for even thinking that is strange.

Anyway, I have a bunch of errands to catch up on (including email replies) and other stuff to do this weekend. I’m looking forward to more interviewing next week.

I met a third-year med student today at the hospital cafeteria. She was so in awe that I was a fourth-year student, about to enter residency. I remember when that was me! How quickly things things change. And how strange and wonderful it is that the next step always seems the most challenging and amazing. Such is life!

Please enjoy the photo with this post. My discarded baby stroller addiction continues!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

I enjoyed my day of anesthesiology today. I got to help out on two cases: a TAH BSO and an emergency tracheostomy on an awake patient.

I just got an invitation to Ross University’s chapter of Physician for Human Rights’s (I used to be the president and webmaster) annual Thanksgiving dinner for the Grange Home for the elderly in Dominica. Oh, how I wish I could attend. I am proud to the max that I was the impetus for this event 2 years ago. It makes me happy to no end to know that the tradition is being continued!

Please enjoy the three photos in this post: 2 wall murals taken in Bushwick yesterday, and a pic from the current generation of PHR’s folks at the Grange.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

I woke up this morning from a dream, singing the song “Am-A-Do” by Bob Marley. Very strange. Anyway, I realized that I had not written anything here for a few days.

Nothing too exciting going on lately. I’m totally enjoying anesthesiology so far. I have one more week to go. I like getting practice setting up IVs, and I’m getting much better. Friday I had a really interesting case. I can’t give the details, of course, but I can say it involved a foreign object that had slipped into a patient’s heart. The patient could not undergo general anesthesia because she was too high risk due to her severe COPD. So, we had to use MAC (monitored anesthesia care). The patient was completely awake and alert throughout the procedure. I stayed by her head and gave her a play by play, as she wanted to know what was going on the whole time. I reassured her, and kept her comfortable. It was a very interesting experience.

Today, it’s supposed to get up to 66 degrees! So, I’m planning to go on a nice, long run. I have to finish up some errands as well.

Oh, and if anyone is reading this and you recently received an email invitation from me for some crazy app, don’t click on the link! I sent it accidentally to everyone in my address book because of my crappy French! Long story, but just delete the email. My apologies!

It’s time to go outside for a doggy walk and to check the temperature! Adios!

Note: Photos are more iPhone pics taken on my walk to the hospital. Enjoy!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

Today was a great day in anesthesiology. I actually learned quite a bit and successfully set up three IVs, which made me happy.

Some random tidbits learned?

1) Never give Lactacted Ringers to a patient with renal failure, because it contains potassium and the patient can become hyperkalemic.

2) How to perform a TURP (Transurethral Resection of Prostate), and how to avoid TURP syndrome by properly hydrating the patient (use normal saline, and don’t over-hydrate) and use the right anesthetic (a spinal block is a good option, and is what the doctor used today).

3) All about neuromuscular blocking drugs (actually, I presented the topic).

4) How to set up an IV by sono guidance.

And MUCH much more that I am too tired to write about.

Enjoy the photo with this post, which is yet another iPhone shot taken on my way to the hospital.

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

After a long day of anesthesiology, I’m pooped to the max. I have to create a presentation on neuromuscular blocking drugs for tomorrow, so I don’t have any time for sharing wonderful pearls of anesthesiology wisdom with everyone right now.

One random factoid that I learned is that opiates are the only analgesic/anesthetic agents that cause a decrease in respiratory RATE. Other drugs can depress respiration, but they affect the tidal volume or O2 sat, not the rate.

Also, I observed two toes being amputated today. Diabetes does horribly evil things.

Please enjoy all the photos in this post. I took them all on my walk home from the hospital today. A lovely trash pile with baby paraphernalia, and a bed and stroller that bit the dust.

Good night sweet world!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series