Au revoir Internal Medicine

Yo, I survived Internal Medicine.
Last Friday (the 20th) was my final exam and my last night on call. I still don't know the results of my exam and I'm trying not to think about it too much. What's done is done.

Those last 7 days where probably some of the worst of this year, comparable only to that time in January I though I had TB.

I had a real nervous break down, with tears 'n all when I though I had lost my portfolio (which is kind of like a bunch of sheets of papers with lots of signatures of doctors and residents certifying that I participated in or watched several required medical procedures). I couldn't find it hours away from the deadline. If I didn't turn it in I was not allowed to present my final exam. People I know have failed their rotation for not finishing it. I was freaking out, like, seriously. Not fun, not fun at all. I truly recommend you to take better care of your important stuff, unlike me, who carry it around and constantly forget it at nurses stations, classrooms, and the such. Bad, messy, careless me.

At the end I found it at my apartment. You see internet, dumb me had left it there in the morning when I went home after a night on call (pre-exam, for the 3rd time in a row) to take a quick shower before I had to run and take my test. Well, it was there, or at least most of it was there. I had to get some new signatures for some of the procedures, but it was ok. I was able to deliver it on time, no problems. I say this now so peacefully and serenely, but at that time I was crying like the aliens had come and taken away my family, and my computer, and killed all the kittens.

The rest of the weekend and next week I spent it studying like crazy, trying to grasp all the info I was supposed to know from all these years of medschool, and geez! do I have a lousy memory. Anyways, everybody was so stressed out. We were all like screaming at each other for the smallest of things, not eating anything for large periods of time followed by hypercaloric and fat rich meals, abandoning our friends at hospitals 40mins or so way from their houses ... mmm... or was it just me? Damn, I'm so bad at handling stress.

Anyway, the judgement day arrived. It was last friday. My roomate and I woke up early, went to have a good and real breakfast and headed to school. I could not study any longer, we were just quizzing each other. We had to sit through a whole Alternative Medicine class, listening to some shit about how massages help your body and bla bla -who cares- bla bla. Finally the time came, 11 am. We were sitted in a large auditorium and our exams were handed. It consisted in two parts, the first were 63 questions on: Cardiology, Neumology, Infectious Diseases, Nephrology, Gastroenterology and Endocrinology and the second was Oncology, eight 2-3 page long clinical cases with one question each that were based on the American Guidelines.

After the fist 10 questions I wanted to cry. I knew for sure the answer to only 2 or 3 of them. The next 20 I was also clueless. I kept going, panicking with every question. Arghh I did my best, revised the exam, cursed all those hours I wasted during this last 4 years, cursed my failing memory, cursed everyone, and then ... knock knock, who's there? Its me, your bladder. Wanna hear something fun? You have to go. Like, NOW!

I still hadn't bubbled the bubbles on my answer sheet!! I started panicking, bubbling the bubbles as fast as anyone has ever bubbled anything (yes internet, I keep writing bubbling the bubbles cause it's just so fun to say it). Yet, every 7 or so question I had to pause, to breath, cross my legs a bit more, wipe the tear coming down my cheek and then proceed. By question 54 my legs were so crossed they were almost shaped like a frikin pretzel, I couldn't hold it anymore, and the air conditioner set to freezer-like temperature just didn't help. I felt chills running down my back as I bubbled the 63rd bubble. I stood up, ran to the teacher, handed de exam, mumbled something like "I have to pee..." while running, literaly running, to the bathroom.

I came back and took the rest of the exam, and no matter how badly I was answering those questions I still had that satisfyed look only emptying your bladder can give you. I handed in my exam, not sure if I would pass or not. This exam was worth 70% of my Internal Medicine grade. Yes, 70% one frikin' exam.

Whatever, I couldn't linger very long to apreciate the aftermath of that stupid exam in my classmates, 'cause you see, internet, life hates me and to prove it it made me be on call that day. Anyways, I didn't want to stay much longer afterwards because of the innevitable review of the answers all my geeky classmates love-hate doing.

I drove to the hospital and stayed there until midnight. Afterwards I joined my friends (or what was left of them after several hours of heavy drinking) at a party to celebrate we made it alive through IM.

It's all over now, at least until the results come out and I find out if I passed or not. Keep your fingers crossed!

Deadlines

Shit shit shit

Tengo que entregar pinches 6 historias clinicas con análisis, corregidas y evaluadas por un médico externo para el viernes y llevo 3 hechas 0 corregidas

Shit shit SHIT

I hate my procrastinator-self

aaaarrgghhhhhh

uy, por cierto... el jueves tengo guardia, el viernes aparte de estas cosas tengo examen de infectologia ... ha! IM SO FUCKIN FAILING THIS SHIT

Jelous, am I?

Ok, enough of that eerie post. You kind of just have to move on, or this things will get you.

So, for the past 2 or 3 weeks, I've been having weird sleeping schedules. I tend to be up until very late at night, either cause I'm having trouble sleeping, I've sleept through the entire afternoon, or I'm actually studying. Well, around 3 or 4 am, almost every night I've been up, I start hearing noises. The first couple of times I just tried to ignore it, closed the windows and keep doing whatever I was doing, until I finally got intrigued. I opened the window and paid attention to the sounds, and then I realized what that noise was. My neighbors were having sex! And not just any sex, they where either having incredibly good sex or that girl is just one loud gal. They kept going almost without faltering for about an hour, ONE WHOLE HOUR of screaming hot sex!! I was all, you have got to be kidding me. No matter how loud my headphones where, I knew the screaming was still going on. I could not concentrate anymore. I kept thinking, who are these people?

Then I listened a bit more, and even though the girl was very loud and clearly audible, I never heard a second voice. So it's either an incredibly quiet guy (or girl), or this girl got herself a fucking amazing vibrator. I've been trying to figure out which apartment the noise comes from, but its just hard to tell. Still, whenever I see a girl enter any of the potential apartments, I give her the look. Yes, the I-know-what-you've-been-doing-missy look.

On call

Yesterday a patient died, actually my patient died. I've seen dead people and Ive seen people die before, but I've never stood there, helpless, just waiting for a flat line in order to pronounce the death.
He was in his 50s, he had a severe mental impairment and an acute pneumonia. He was looking pretty bad since arrived, his O2 sat started dropping. His ABG showed a respiratory acidosis. My resident decided it was time to intubate him, she and I talked to the patient's family and got them to sign the consent. When the time came to intubate him, she handed me the tube. It was my shot, she said, I've seen it done several time, now it was my turn to do it. I put on my gloves, took a deep breath. They handed me the laryngoscope, I inserted the blade into his mouth. His macroglossia and abundant secretions made it pretty hard just to get a look at his larynx. After some stressful seconds I though I had a clear shot so I passed the tube, we insufflated the balloon and bagged him.
The resident checked his thorax, he wasn't venting properly, the tube was probably not in. Fuck! I've missed the cords and inserted it in the esophagus. We deflated the balloon, took the tube out and started preparing a new tube. Another intern took my place while I silently moved over. After some difficulties, she finally inserted the tube. We checked, it was in his trachea as it was meant in the first place. We plugged the O2 and started bagging him. Still his secretions wouldn't let him vent properly. His lips started to turn blueish, his fingers too. His O2 sat started dropping. He wasn't oxygenating. We rechecked the tube was in place, it was. His pulse was fine. We kept bagging. His O2 sat still too low, dropping more and more. Suddenly his pulse began to get faint. Then it was imperceptible. He was crashing.
We started CPR, kept the vent, nothing.
1mg of epinephrine , still nothing
1mg of atropine, still no pulse
His EKG showed almost no activity.
We kept the CPR until the doctor finally told us to stop. There was nothing we could do now. We stopped the heart compressions but kept the vent. His heart showed only isolated impulses in the EKG, mostly due to the drugs we've just given him. No pulse could be felt.
So we waited. We stood there for some 10-15 minutes until his hear finally showed no electric activity. We printed his EKG, an isoelectric line. He was all white but his blueish lips. We pronounced his death.
He died at 17:31hrs on the last of may.