Trust me, Im a doctor

for real, dude.

IMIED

En unas horas estare dandole una clase de otologia a:

5 autores de libros o capitulos sobre otologia
1 expresidente de la sociedad americana de otologia
THE ultimate ENT book author

And a whole bunch of other equally impressive people

Man.

I'm shitting on my pants.

And I'm not even kidding.

he's back!!

He is back!

After more than a year away from home.

Now all I have to do is go home myself, and finally the 6 of us together again.

:D

5 more days, but who is counting

Yesterday, while pre-rounding on a patient, his family was very excited about having a Medstudent involved in his care. I know, whut? But they were. They asked me a lot of questions, and made me realize a tiny little thing:

DAD
So, are you one of the doctors seing Joe*

ME
Oh hello! I haven't meet you guys. No, I am Lola, the Medical Student who will be following Joe's case.

JOE
Yeah, she came down to the endoscopy with me.

MOM
Oh! That's great dear. Are you a MS from this school?

ME
Actually I am a MS from Mexico.
to the patient,
Im going to take a quick listen to your lungs, ok? Big deep breaths...

DAD
But you came here for Medical School?

ME
No, no, I am just here for a 3 month elective rotation. All my training was done in Mexico.
To the patient, while palpating his abdomen
Im going to press a little on you belly, please let me know if any of this hurts. Sorry, but I just washed my hands, so they are very cold.

DAD
But you studied in English then? Your school, its in English right?

ME
No, all my classes have been in Spanish, except for a couple that have been in English. But mainly just Spanish.
Cheeking the patients legs for edema, palpating pulses...

MOM
Oh my! We are very impressed! Congratulations! Your English is amazing. Really!

ME
blushing
Oh, thank you haha All those TV shows I watched during my teens are proving useful now.

FAMILY
laughing
They are!

ME
to the patient, while turning on my penlight
Open up your mouth please, quick peak

MOM
So how long until you finish Medical School?

ME
thinking
Well, actually ... er...
realizing it for the first time
Its just one more week. Next friday is my last day here, and then I just go back to Mexico for Graduation.

EVERYBODY IN THE ROOM
WOW!! Congratulations!! Oh! How exciting! Its such an accomplishment! You should be very proud you your self, and very excited.

ME
blushed and still in shock
er, yes... er... thank you

JOE
Are you really almost done? How old are you? You don't look old enough to be a doctor. You are very young.

ME
Well, im 23, but I have been in Medshool for almost 6 years now. In Mexico we start right after highschool. Plus I don't really GET my degree until 2011, Mexican law states that we have to do a year of social service after Medschool before receiving our M.D.

FAMILY
Oh that is such a good idea! That is great. Repaying to society the chance they gave you to learn and all.

ME
Thinking: Yeah! Great! Its easy to say since you are not the one working one year for frikin 75 dlls a month after paying a tuition of 8,000 dlls per semester!!
Yep. Plus, otherwise a lot of the people in rural areas wouldn't have access to any health care.
turn to the patient
Well Joe, You are looking much better than yesterday. Your labs look also great. The plan for today is to keep you NPO, until maybe noon, see how you do with the clear liquids and the advance your diet as tolerated. Ok? So, I have to go now, but I'll be back in a moment with the whole team. Nice meeting you guys.

DAD
Congratulations again. It is a great accomplishment!!

I left the room, and after a couple of minutes the Nurse (who was there the whole time) comes out...

NURSE

They think you are the cuttest thing ever.

*not the real name, obviously.

So yeah, I am the cuttest thing ever, old news. But internet, I finish Medical School in 5 days. FIVE. Holly shit! No more, Sorry I'm just a Medical Student.

Ever.

Ok, now I gotta go throw up.

We lost 2 patients in one day, 15 minutes one from the other.

Then the next day, another one

and we have one more, invasive fungal sinusitis ... no white count whatsoever... 2nd failed BMT ... its like dead man walking ... he is doomed. No mater how much antifungal we tank him up with, he still needs his whites to fight the damn fungi out of his system.

I have been here for 4 weeks and already 6 patients have died in the unit.

Onc is tough, and frustrating. Its making me feel like the damn Angel of Death.

Stethoscope

I don´t know if Ive talked about this before or not, but I never carry my stethoscope around my neck. There are 2 main reasons for that.
One of the is that I actually find it heavy and the Littmann website suggest you NOT to carry it around the neck since the contact of the tubing with the lipids in the skin may cause stiffening of the former.
The second reason is that I associate the stethoscope with internists. No other doctors really carry around their stethoscope the whole day. They use it, they just don't go through life with it around their neck.

Since last year I have refused to be associated with Internal Medicine in any way possible. So one of my subtle ways of setting myself apart is by carrying my stethoscope in my pocket. I know it sounds pretty idiotic, but to me is like a secret way of showing my disagreement for them.

No one really gets it ... or so I though.

Yesterday my fellow classmate and I had a meeting with one of the ENT attendings with whom we are working on a proyect. We had to sneak out of our Onc activities in order to attend.
When we got there:

ENT ATTENDING
Hey guys! How have they been treating you in Onc?
(Shakes hand, and notices the stethoscope on my classmate's neck)
Ohhh, nooo!
A Stethoscope!
You have passed to the dark side now! haha
(turns to look at me)

ME
No, no Doctor.
Mine is safely kept inside my pocket.
(point to my stethoscope shoved inside my coat's pocket)
I am NO internist.

ENT ATTENDING
A true surgeon.
Keeping faithful to ENT
:D

HOLLY FUCKIN SHIT

I JUST REALIZED


four more weeks ... FOUR ... F-O-U-R W-E-E-K-S

and i will have officially finished my training as a physician

SHIT

when the fuck did his happen?!

looking for empathy in the wrong places

I have 3 siblings. Of the four of us, all but one have eye refractive errors. The rest have required glasses since maybe 4th grade to correct them. My little sister and myself are particularly screwed because not only do we have an obvious dependency on glasses, but also our retinas are starting to get messed up too.
You see, I have what is called high degree axial myopia, meaning my eyes are too big for my corneas and lenses to focus appropriately on far objects and thus I am legally blind without my contacts or glasses. Pero bueno todo sea por mis ojotes tapatios!
These type of eyes have a greater susceptibility to degenerative retinal changes, including retinal detachment. If we were fatalist people, which I clearly am, we could interpret this to mean that I could go blind all of a sudden. Anytime. Permanently. If only I was ignorant about this tiny tiny fact, it would all be easier.
I am not a candidate for refractive surgery, since I have a borderline thin cornea and my degree of myopia would require shaving off most of it, leaving me with a keratoconus. Which is clearly not desirable.
I usually always wear contact lenses, actually most people have never seen me with my glasses. I do this not only because I hate how I look with glasses, but also because when people see my thick glasses they always go: "No manches que gruesos! Estas super ciega, porque no te operas?" And everytime I have to take a deep breath, and hold myself from bursting: "A ver ignorante, si tus dos malditas neuronas hicieran sinapsis y te dieras cuenta que la respuesta a tu pregunta esta implicita en tu comentario, nos ahorrariamos este momento embarazoso para ambos. Lets break it down for you, shall we? Que gruesos! = my refractory error must be quite considerable. Estas super ciega = further states the latter. Porque no te operas? = Exactly because of what you've just said, ass! Estoy super ciega! Claramente no tienes ni el mas remoto entendimiento sobre las bases de la cirugia que estas proponiendo. SO, SHHHTT IT!" You can understand why I rather just stick to the contacts. I do not posses all that self control or patience.

So anyways, yesterday my middle sister, the formerly 20/20 vision sister, was diagnosed with a MILD refractive error. Let me say that again, M-I-L-D. It would be barely noticeable except for the fact that she is a designer and has to be in front of a computer for the better part of the day messing around with lines and graphs and whatever it is that she does. She was prescribed glasses, more specifically -0.50D glasses. I tried to be supportive. You know, being the big sister and a doctor and shit I was all like: "its great, you are going to see so much better, your eyes won't get as tired, bla bla".

But when she told me how "depressed" she was and how "sad" this whole thing made her I was like, Honey, you won't get no empathy from me! Go tell your shitty-ass whining to someone with a perfect vision, not to a legally blind person!! Not to the person who has cried on her last four Ophtha checkups! Come on! You surely don't expect ME to comfort YOU! Just appreciate I'm not laughing at your damn -0.50D prescription.

So whats with this tangent?

I have an aphthous ulcer.

I have an aphthous ulcer on my lower lip frenulum. It hurts like FUCKING HELL. I tried eating my lunch today and literally a tear came down my cheek. For the whole day I couldn't get over my ulcer. It is such a pain. God! But I haven't told anyone.
Wanna guess what my patients diagnosis is?
MUCOSITIS.

She is on PCA morphine for pain control and on TPN because she can't take PO. Because of the PAIN.

Fuck.

Buh Bye Surgery, Hello Medicine

I know how to excell in surgical rotations. I know my way around the OR. I know how to be helpful, not just with the residents and doctors, but the nurses and anesthesia too. Im pretty sure mom and dad had a lot to do with it, all that "ACOMIDANSE! No nomas esten ahi parados" and "gusto les deberia dar sentirse utiles" really sunk in.

I like surgeons, and I think most of them they like me. It just fits my personality. I'm a hard-worker tough girl. I really am. I can take a lot of shit, both phisical and verbal. Emotional, not so much. But I can just suck it, and keep working under rough circumstances.

I think here in the States this has been much more noticeable. Back in Mexico you had to be hardcore sometimes, just to get through. There is no way the surgeon would give you a "bathroom break" or a "lunch break" during a case. It was either all in or just stay out of it. People here get post-call days off, on Q4! haha residents in Mexico dont get hours restrictions. You could be at the hospital for days at a time. And dont even think about opening your mouth about it, because you could land an extra day for complaining. I know it sucks, I don't support this system. Yet, it has helped me be tougher than most medstudents (and even residents) here. People are surprised that I sometimes dont go home on postcall days, or that I come round on weekends, and I'm all "thats how we roll in Mexico, man!"

Ok, enough tangent. What I want to say is, it takes me just a couple of days to figure out surgical rotations. I know how to excell in surgical rotations. But I have absolutely no idea about Medicine rotations.

Starting this Monday I'm on Hemato/Oncology.

Its a strange world to me, internal medicine. I feel akward around internists, like they are judging me and thinking how stupid I am. Which being honest, is probably what they are doing indeed. They look at people with resent. I think its because they know so much yet their lifes usually suck so bad, they blame happy people for it. These damn boring geeky people. I know I sometimes say I'm a geek, but I'm sooo not this type of geek, Im a cool, easy-going geek.

So anyways, we'll see how it all goes on Monday. Any suggestions on how to get internists to not hate me will be appreciated. I will definitely not go so far as to try and get this people to like me, cause you know, it would be easier to get a monkey to learn to stepdance and get him into Riverdance.

Last day

So, my ENT rotation is over. Friday November 6 was my last day, and it couldn't have been more perfect. My very last case was a partial mandibulectomy, modified radical left neck dissection with preservation of SCM and spinal nerve, reconstruction with a vascularized bone-containing free flap from the fibula, and skin graft to cover the donor site. All this for a highly differenciated invasive Squamous cell carcinoma. DUDE! Even writing this gives me the chills!It was a mother-fucking monster case that lasted since 8am to about 9:30 pm.

Did I care I was standing up for 12 hours straight? No! I was on such an adrenaline high during the whole case, I barely cared about my swollen feet. Did I care that my only meal that day was half a glass of orange juice and a muffin I had at 7am? Hell no! Eating is for pansies. I got to close the donor site defect, and I fucking took the skin graft. ME! I slided the dermatome and TOOK the graft. Internet, I was soo awsome.

I love it that ENTs here can be hardcore surgeons. With the drill, and the hammer, and all the blood and bone splashing all over our goggles and gowns. This is what I want to do. This is exactly what I want to become. Internet, I know I sound like a freaky blood thirsty person, and I probably am to some extent. But you just had to be there. You had to be there to appreciate the talent a surgeons need to not panic when the frikin i yugular perfs and streams of blood that soak your shoes start coming out someone's neck. The skill it takes to keep you mind cool, detect the bleeding source, clamp it, suction, tie, and move forward. These are real people we are dealing with, and decisions taken within seconds can drastically change an outcome. Lifes are on the line. I don't just like bloody surgeries. I like surgeries that succed, that help improve a patient's life, that save lifes. The blood is just an extra.

Even though I'm sad it is all over now, I can't help but look back and smile. I loved every moment of this past 6 weeks. I learned a lot, not just ENT stuff, I learned a lot about myself. I had a great time. I realized I can wake up by myself everyday at 5am, which I'm sure no one ever though possible. Me included. Its just, I finally found something that is worth it.

So internet, I was definitely out with a bang!

ENT Vs. Penis Doctors

ENT RESIDENT
Hey man! How are you doing?
(turns to me)
This is XXX, we did our intern year together. He is a PENIS doctor now.

UROLOGY RESIDENT
Dude! Why do you have to say PENIS doctor?! Just say Urologist.

ENT RESIDENT
Don't be ashamed, man. Be straigh forward about your deal. We are ENTs, Ear Nose and Throat. We don't hide behind Otolaryngology.

Halloween

Man,

America's Youth is so fucked up.

I'm going to invest in rehab centers or something. From what I saw today that's where everyone is headed to.

Politically INcorrect

The thing that surprised me the most when I first arrived to the O.R.s here was not the DaVinci (which by the way I got to play with a little) or the awesome surgeries that take place here every day. Actually, it was how politically correct everyone is. No cursing during the whole surgery. At all. The 12-hour-long surgery. Not even a "shit" slipped in the conversation.

Coming from a place where cursing, yelling and being everything but politically correct is the rule, this clearly shocked me. A lot. No. Actually, it shocked me a whole fucking lot.

Until this guy came in. I love this guy.

It was just a regular day in the OR. My second week, just starting to get the hang of everything. I got assigned to a monster case with this young attending I've never worked with before.

Right after we opened her neck:

"What the fuck is wrong with this lady! There is so much shit going on here, I don't know where to start" Turns to me and adds, "Sorry, I curse a lot. But there really is too much weird shit going on here"

I couldn't help laughing. It definitely made my day. Through out the entire surgery he would go "what the fuck fuck dude!" or "holly shit, man!".

The case ended up really bad, we had to take some really big chunks from that ladies face and neck.

Then, the second case. An almost routine nasopharyngeal DL w/ biopsy turned out to be the real surprise of the day. The patient was this really pleasant 29yo guy who ended up having SCC all over his nasopharynx, hypopharynx, and tonsill bed. The path results shocked us all, we really didn't expected such an extensive disease. As the doctor put it, "Wow! I feel fucking bad about this shit. This guy is fucked. Totally fucked"

For me it was a great day. I curse a lot, probably more than I would like to. So this guy made me feel much more at ease, comfortable and just more fit. This kind of silly and small details make this whole experience a bit more real to me. Everything is so picture-perfect that I sometimes get the feeling that its just too good to be true.

So, anyways. By the end of the day we were all:

"Fuck it. I'm done. I'm going home"

"I can hear my eyes moving"

I saw a patient with superior canal dehiscence syndrome today!!

Dude!!

It's frikin true!! The CAN hear everything going on inside them.

"I can hear my intestines moving, and my eyes moving, my hair and just basically anything going on on my left side"

My eyes were gleaming, much like dog's would while staring at a meat market, as we explored her:

VORs on head thrust showed hypofunction of L superior canal

Tunning forks showed bone>air conduction (she could hear it even when placed at the frikin ankle!)

Loud sound induction of eye movements seen with Frenzel goggles (God, I love Frenzel goggles!)
Wait a minute! Www-what? Loud sound induction of eye movements??
Hell yeah, internet!! I saw a frikin Tullio phenomenom!!

Valsalva maneuver and tragal pressure did not elicit symptoms (but how cool would that have been, a Hennebert sign)


Her audiometry with clear bone hyperacusia on AS

CT revealed a 90 degree dehiscence on her L superior canal that even I could see!!

:D

Man, today was certainly a great day!

I shall follow them. See where they lead.

"Far away there in the sunshine are my highest aspirations. I may no reach them, but I can look up and see their beauty, believe in them, and follow where they lead."

--Louisa May Alcott

Comments on this blog

So internet, apparently we have some new visitors.

It seems like a couple of people have just begun reading this blog. Which means 2 things:

1. Hang in there faithful long-time readers, soon you'll be enough to actually appear on web-stats. I'm keeping my fingers crossed!

2. I have to explain a little bit how we roll here.
First of all, yes I mix languages. If you know me in person you'll know I'm even worst when I talk. If you don't, trust me. I'm way worst when you hear me live. Secondly, no, I don't usually re-read or even proof-read this these posts. So they are usually swamped with typos, run-ons, spelling and/or grammar mistakes (uppsie, I just noticed that this. See? SWAMPED). Third, you can definitely point out this errors, however I do not promise I will change them. I might. Yet I don't want no compromise. Fourth, I cannot keep up a constant pace with the postings. I will occasionally write way too many post and then be gone for several weeks. Deal with it. Miss me! It makes it better when I finally come back. Fifth, I think I am kinda funny, but you might differ. Sorry, there's not much I can do about it. Sixth, I curse and whine a lot. Sorry, but again, there's not much I can (or want to) do about it. Seventh, I almost forgot. Since I basically write this for myself (yes, yes, I know I just said I don't re-read this shit. But that doesn't mean I don't plan to) I refer to y'all impersonally as internet.

I guess that's all. Thanks for reading my ramblings.

dead end

PATIENT
(in a very skeptical-kinda rude tone)
So I'm here because I get this dizzy spells. My primary care physician tells me its something to do with some tiny stones inside my ear but I told him I wanted to see a specialist. So he sent me here to ENT

OTONEUROLOGIST
Ok, lets examine you, shall we.

(interrogates, explores and finally comes to an assessment)

Well, as your PCP said, you have a condition we call BPPV.

(Starts pointing to an Ear Chart)

Your internal ear has 2 parts, the hearing and the balance systems. The balance system is composed of 3 semicircular canals, an utricle and a sacule. The last two contain small calcium rocks called "otoconia" and sometimes, we don't always know why, these tiny rocks migrate from the utricle to the canals. This stimulates the canals and the brain thinks you are moving when you are not, so you get these vertigo episodes. It is a very common cause of vertigo, and as it name states, it is a benign condition ... bla bla

(keeps going on about the diagnosis, treatment and prognosis)

PATIENT
(skeptically interrupts)
Mmm... so this is what YOU think I have? You can't do any tests or x-rays?

ME
(thinking)
Really? Where did YOU go to medschool, lady?

DOCTOR
(patiently)
I'm pretty sure this is what is causing your vertigo. We can do some maneuvers here at the clinic and then give you some exercises to practice at home to help get rid of the vertigo.

PATIENT
Mmm... and isn't here a "BALANCE" specialist I can see?
(she really emphasized on BALANCE)

DOCTOR
(awkwardly and humbly)
Well, actually, I AM the balance specialist in this Clinic.

PATIENT
Oh, well then ...
(resigning herself...)

And may I point out, she "resigned herself" to trust one of the BEST otoneurologist on the east coast, who specializes in BALANCE disorders at a a frikin' center of excellence for VESTIBULAR disorders at what is rated the #1 OHNS hospital in the US.

I mean, DUDE!! What the fuck do this fucking people want!!

Arrghh I HATE these patients who trust their frikin' google search more than they trust doctors.

Just go and frikin google yourself up. Quit wasting everybody's time and resources.

please?

Medical Mysteries

I hanged out with one of this docs all day.

And as he explained me the vestibular system physiology, he started doodling some labyrinths on a random piece of paper and then was all, oh wait. Looked through his computer files, and came up with this pdf file of a book chapter. You know, that book chapter HE wrote. On guess what, VESTIBULAR SYSTEM PHYSIOLOGY!

haha

This place is surreal for a geek like myself.

So, what did YOU do today?
:P

This is where I get my passive-agressiveness from

So I emailed my family and friends a picture. It was a pretty funny picture, so I kinda expected some reaction from the recipients. Yet the next day barely 3 people had replied me.

Why? I wondered.

I later realized that some people weren't able to see it because the file was extension-less. So I resent the file (with a brief explanation and apology), and within hours several people replied my email.

One of them was my dad:

claro que los que sabemos ver fotos si la pudimos ver

saludos mi niña

muy bonita foto

My dad, a man of brief yet powerful words.

zero will power

Dude

I've been sitting in front of my computer for almost 7 hours and have barely read 1 article

what the fuck is wrong with me!


Now I dont know whether I should just call it a day and sleep ... or try to make up this damn gap and study until it's time to get ready for clinic at 6:30am.

It's a good 4 hours of sleep, but It's also a good 4 hours of study.

Hmm ... tough call

Does it hurt? Really?

I understand that different people have totally different pain thresholds. I do. Really.

Its just that sometimes is so hard to believe how such ridiculous stimuli can possibly cause painful reactions in some patients while others can manage pain so incredibly.

My last night on call we had a consult for a 9 yo female with a sore throat and severe dysphagia that ended up being a bilateral peritonsillar abscess and required I&D under local anesthesia. During the whole evaluation and procedure the girl was a rockstar. She cooperated with us, followed all the instructions and allowed us to manage it on her bedside.

Did it hurt? Hell yeah! It hurt even before we saw her (she would jolt of pain every time she tried to swallow) And that I&D is certainly no piece of cake. But still, she put up with it, even as tears came running down her cheeks while holding her mother's hand. Man, I was so impressed.

As we were finishing draining, I could see the girl was making her very last effort to keep her shit together to not just shut her mouth and tell us to get the fuck out and stop torturing her.

And then, almost as we were done, the damn mother released the girl's hand from her own and said in a kinda rude tone:

"Honey, don't squeeze so hard. You know, it really hurts!"

4th ventricle mass

One of the patients we rounded on today was post-op resection of fourth ventricle mass.

Final path report came in today.

Histological Diagnosis:

EPENDYMOMA

And Im not even joking!

My rockstars arent like your rockstars

I know its totally geek-y to be excited about this... But, I'm meeting Dr. Charles Cummings in just a couple of hours!

Oh Man!!




On a kinda related subject, this morning at the cafeteria

SUB-I
(asking for advice for his residency application)
So, any comments about the places you interviewed at? Any weird vibes or anything like that? Cause I've hear a lot of different comments. I actually had a lot of people tell me that this place (JH) had a really nerdy vibe.

ENT INTERN
Yeah, that's probably true for most places. You can't be a total idiot and match at any ENT program.

ENT RESIDENT 1
Or any surgical specialty for what that matters. Most ENTs are quite nerdy, but so it is with Plastics or Ophthalmology

ENT RESIDENT 2
Not Ophtha dude! We're not THAT bad

:D

o_O

shit shit shit shit shit shit

P A N I C O

P A N I C O




dude ... this is for real now

not that geeky ...

When I crossed the border to get to my Houston rotation I almost didn't make it. The customs officers were really mean and they just wouldn't let me in. Anyways, after a lot of sweating and almost an hour of stress they gave me the darn permit for just one month, so for my upcoming 3-month rotation I would need to request it again (I was going to leave the US and return to Mexico anyways, but still, they would have made me come back just to renew it)

Anyways, I had a bit of PTSD and was really anxious of going through customs again. I prepared a gazillion papers, asked my school for letters, printed my plane tickets, printed my acceptance to the dorms, etc. I had every possible document I though they could ask for (plus, I secured my computer as best I could and logged out of all my email accounts in BB and laptop ... I learned that for my bro :P)

Still, I was shaking when I got to that desk. Literally shaking. This is what happened:

CUSTOMS OFFICER
What is the purpose of your trip to the U.S?

ME
I'm doing a clinical elective at a hospital
Clumsily I reach for my letter of acceptance from the university

CUSTOMS OFFICER
What are you studying?
Checking my passport and visa

ME
Medicine
Hand him the letters

CUSTOMS OFFICER
Oh, great. And what hospital are you going to?

ME
JHH

CUSTOMS OFFICER
Wow! Thats impresive!
Smiles, and starts reading the letter and filling out some data on his computer
Well, you don't look that geeky

ME
Mmm... I'm going to take that as a compliment, I think.
Jokingly (of course)

CUSTOMS OFFICER

Yeah, you should. Now put your right 4 fingers on the scanner...

AND PROCEEDS TO STAMP MY PASSPORT AND GIVES ME THE VISA PERMIT FOR 6 MONTHS!!

I was totally resisting the urge to make a victory dance as I walked away from that desk.

:D

Houston, we've got a problem

hi guys, miss me?? you know... ME TOOO!!

YEAH, YEAH, ive been for quite a long time, but you know what? im tired of making excuses. I just never found time for writing.

so, moving on..

maybe... or maybe not ... will sometime write about my 3 month rotation at my home town. For know, I'll just say I did Psychiatry, Dermatology and Neurology. A month each. I loved them all, which turned out to be a surprise, especially for Psichiatry. You know, I actually considered it for a while as a future specialty. But I'm not talking about it now.

I'm currently at Houston Texas, doing an elective in Dermatology. I am loving it!!
I could totally be a dermatologist if it wasnt' for all the feet and nails involved and no surgery to compensate that with.
Also, this Derm rotation has made me DISTURBINGLY aware of how many frikin' skin conditions people all around me have. I mean, I'm riding the frikin' bus and all I can see is the woman next to me and her damn Seborreic Keratoses (an I'm like, do you realize it takes like 30 seconds to get rid of those FREAKISH spots on your face??), or the guy in front of me with a odd spot I would definitely biopsy (cause it might be a melanoma, dude!).
Every time I see myself at the mirror all I can think of is that damn sun spot on my left temple, or the comedones on my nose, or how would I treat them (by the way, I'm sooo doing botox as soon as I have enough money to pay for it) Or like everytime come out of the shower, I will do a quickie skin check, you know, cause I'm afraid I depeloping a melanoma or something.
I am SERIOUSLY running away from the sun, cause I just refuse to have sun damage.

Arghh, its exhausting.

I don't think I couldn't be a dermatologist, its too stressful for me.

Although I do love it. For real. I love knowing exactly what is that spot on my patient's skin, or what to recommend them. I know it sounds dumb, but you can absolutely change people's live by improving their skin condition. Plus, you get to FUCKING CURE CANCER on an office consult. With a 15 minutes procedure. On local anesthesia. Top that, Oncology!

Anyways, I have to go now. I'm kinda at a party, and people are frowning upon me for being at the computer instead of, you now, socializing.

So, bye byee

PS: Im a tipsy little drunk. So, forgive any typos or run-ons .. or just complete none sense I might have written above. Blame my friend, the vodka .

I have wanted this t-shirt for YEARS!!

don't you just love its pure geekness
:D

I touched a beating carotid today

WOW!
I love love LOVE surgery!

I can't believe it!! Today I TOUCHED a breathing trachea and a beating carotid!! I could PERFECTLY identify every cartilage ring. The carotid had a strong pulse I could totally feel. Right there. I was touching the adventitia.

Jeez, talk about adrenaline.

I can't believe someone does this everyday. And gets paid.

Stream of conciousness

I've never been good at making decisions.

I think too much on every possible outcome ... the unlikely, the impossible ... then eventually lose a lot of time rambling so that in the end I take a rushed and unfounded decision.

I don't have a method, or anything of the sort which might help me make a good choice. I just ... mmm... I don't know ... I cannot even explain my decision making.

I guess most times I just start dismissing options and go with the one left... And for good or bad, I'll make up my mind and stick to this decision. As groundless as it might be.

It has always been easier for me to stick to school, study, follow the rules, do what I'm expected. It involves taking fewer decisions.

Anyways, that's what got me into Medschool.

Troubled? Maybe. But I haven't come up with a better system, and it had worked fine for me for the past 23 years.

The problem arose when these decisions (as small and trivial as they seemed at first) became more and more important, and they started affecting my life, for real. That's when the shit hit the fan.

It's like building a tower on loose sand. A little wind hits it and there's nowhere to hold on to. The building eventually starts collapsing.

This is kinda how I've been feeling for a year or so. Maybe longer.

I feel like I'm running aimlessly. I haven't been focused. I'm working basically just by inertia. I don't know what I'm doing or why I'm doing it most of the time. My heart is not on my work anymore.

Things have started to get harder. There is much more at stake now. It's not just a matter of studying more as it has been before. Now it's different, its no game anymore. This time it's for real. The decisions I take will mark what I'll be doing for the next couple years. I'm so nervous to take a bad turn and end up lost.

Occasionally I have wanted to quit it all, start from scratch, make new choices. Better choices. But, as I said before, for good or bad ... once I make a decision, I'm gonna stick to it. And I have.

I don't regret it. Even now I don't imagine myself doing anything else but what I'm doing right now, and I am happy, its just that many times I feel uncertain as to what comes next.

Some days I just don't want to study anymore. I'm tired of school. I'm sick of patients. I don't want to listen to that old lady ramble for an hour about her life. I don't want to wake up early, and stick a schedule somebody else assigns me. I don't want to be a liability to my parents.

But then there are these others days, when I'm great. When I love what I do, and I'm exited not only because I understand what happens to my patients, but because I know I can help them. When I'm trilled to feel an artery beat or to look at a beautiful tympanum. Oh, I wish more days where like this.

Bit cyclothymic, no?

I guess I'm just tired and drained out.

The thing is, I have been tired and drained out for too long. It has started affecting my life. I have been so worried about making the wrong choices, that I have been putting them off. I need to get my act together and focus. I can no longer be on stand-by mode, watching my life go by without me being a part of it. There cannot be any excuses now.

Come on, girl ... Seize the moment!

Eyes, ears, nose, throats and some brain too

I'm finally on vacations!! I just finished the first of my two free weeks we get in between semesters (actually its 2 trimesters) and goodness, do they fly fast.

First of all I would like to explain my medical whereabouts for the past 4 months.
During March (uppssie... it has been quite a long time) I rotated in Ophthalmology and Otolaryngology (ENT). It a little complicated to explain how that month fitted 2 specialties, but in practice it was pretty simple.

Ophthalmology - Two days a week I would go to a private yet charitable (is that a word? beneficencia publica anyone?) with an Ophthalmologist graduated from my school to take class and afterward be assigned a resident of various services, say Uveitis, Retina, Glaucoma, General Ophtha etc..
I L O V E D it! Can I please get a slit lamp for my birthday?? They are the coolest medical equipment I can think of, and the eyes... oh goodness!! I could see eyes all day and not get bored. Retinas are so so sooooo pretty, and in this hospital I got the chance to see some really cool things:
* not one, but 4 crystalline lens subluxations... FOUR... I mean... JESUS!! You could see the zonules so perfectly, it was unbelievable! Like teeny tiny white hairs holding the lens.
* a central serous retinopathy ... it looks just like a drop of water right above the macule! And in case of doubt ... we made an OCT to corroborate ... you read correctly, we did an OCT right that second!
* the most beautiful papilledema I have seen!
* Avastin intravitral injections. I so wanna stick a needle in an eye!

I know most of you (medical and non medical readers) don't understand my excitement .. but I'm talking about TEXTBOOK images ... LIVEEE!! All those retinal and corneal thingies you read about: microaneurisms, druses, flame hemorrhages, corneal lacerations, conjuntivitis etc etc but right in front of you!! At your disposal to fully explore and analyze! I'm telling you, I did not want to leave that place ever!
The residents were so nice, I particularly liked hanging out with one who is even weirder than me... and that's a hard thing to outdo. He got so excited with every eye he checked, and if there was any weird or interesting finding he immediately dragged me from wherever I was so I could check it out too: "Come see this beautiful retina", "You have got to see this eye and tell me what you see".
It was a great experience. I learned a lot and I even learned to use my direct ophthalmoscope properly. So kudos for that.


Otolaryngology: now, this is a bit trickier to explain. See, two days a week we spent the mornings at the department of NeuroOtology at the National Institute of Neurology and Neurosurgery, and the afternoons at a private practice with an Otolaryngologist, and the third day we stayed the whole day with this doctor. Understood? No? don't panic, it is quite irrelevant, I just tend to give a lot of useless details that sometimes turn out to be confusing.
Anyhow, the private practice was great. The doctor is excellent in so many ways: the way he treats patients, his work ethic, etc plus for the first time in my medical life, someone was excited about my liking of ENT. So it might be a biased opinion about this doc, heh. We got to see many larynxes, noses and ears via the endoscope, which happens to be a great teaching instrument, since the students (like me) get to see in the screen exactly what the doctor wants you to see, and even save images for future reference. All this without bothering the patient more than their regular check up. We also attended several ENT surgeries in this private hospital (adenoidectomies, timpanoplasties, septumplasties etc)
The NeuroOtology part was also very interesting. We saw some pretty cool nistagmus (I finally understood how to perform the Dix Hallpike test), facial palsies, vertigo and the best ... brain surgery. Why brain surgery? well, ENTs participate in various neurosurgeries, for example: transsphenoidal surgery, vestibular schwannoma removal, frontal sinus cranialization etc. So there you go, ENT its not just about mucus, serum and spit.
The hardest thing about brain surgery is not the gazillion hours they last, or the fact that you have to be standing (as Medstudents, the surgeons obviously are seated) ... oh no, the hard part is fighting the impulse of sticking your finger into the brain RIGHT IN FRONT OF YOU!! INCHES AWAY!! The one that looks so squishy and poke-able!

Mmm... have I embarrassed myself enough already? Is there any doubt I'm a weird-medical-bloody-gross freak? I hope not :P

Anyways, I have to get some sleep. Sorry internet, but you'll just have to wait till the next post to find out what I've been doing the past three months. Nighty nite!

on the change of colors

yes, I notice they don't match the banner

yes, I also notice they are not pretty

yes, I also notice there are splashes of red fonts here and there

no, I do not care


***

here's is my attempt of explanation:

The red was just hurting my eyes ... This laptop doesn't have Photoshop ... I am an html illiterate ... Its just temporal (I hope)

Thyroid, arytenoid, cricoid, epiglottis .... and... and...

Ay dios!!

Ya mejor no quiero ...

Ya me empezo a entrar el panico y la ansiedad ... like for real

I cannot believe I am going here ... and I cannot even remember the friking cartilages of the larynx

:S

Robyn - Be mine

Its really not meant for anyone, nor does it describe how I feel right now. Asi que ni se sientan aludidos ... I'm just posting this because a recent musical exchange with a dear friend made me remember it. Besides, its just such a beautiful performance. Enjoy!

Updates part two

hoho, I just realized I never published this post. Funny, ain't it? mmm... no?


Ok, now where were we? Oh right, February.

So my 2nd rotation was in Radiology. We went to a National Institute (which means its a Public Health Governmental Hospital, a reference center for the whole county)

It was SUCH a change from T&O, I mean, DUDE! ONE DAY I WAS FREE BY 11:30 AM!! hahaha I mean, it was just that one day, but still, it was so cool to be home by 3 after going to the gym, showering and running a couple of errands.

Anyways, I loveed Radiology, I'm actually considering it as a possible specialty option. The imaging studies you have these days are wow. MRIs rock! Its just ridiculous the details you get. I even learned to like Ultrasounds, partially because I finally could somewhat understand them.

We were supposed to rotate 1 week in CT, then MRI, then US, then General Roentenography (i wonder how you pronounce that damn word). Yet, our arrival to the Radiology Department clashed with a Annual Radiology Course, which meant that only a few residents were at the hospital. We decided to attend the course and pretend like we knew what the talks where about. It was interesting and understandable at times, yet really technical at others.

Anyways, that was our first week, the second I rotated in MRI, which practically meant sitting in front of a 4 screen setup interpreting and dictating MRIs. Gee! Thats life! I finally understood my brother's obsession with screens. I loooovvvveeeeddd the gazillion pixels wrapping me, the simultaneous scrolling of all the different scans, the dimmed lights to enhance the view, the ridiculous detail you can get with MRIs, I loved it all! Oh goodness, it was like medical-geeks heaven!!

On the third week I was in Ultrasound, quite a change to see everything as in a snowstorm instead of the high quality MRI pictures. I struggled at first to see what the resident was telling me was clearly noticeable, but eventually developed a liking for it. I particularly liked kidney US, and thyroid FNABs. The resident I rotated with was incredibly nice and helpful, always explaining and asking questions.

The last week I rotated in General Radiology. A resident, a technician and I spent the mornings doing contrast studies. Gastroesophageal series, barium enemas, cystographies, hysterosalpingographies, and any procedure that involved contrast.

It was a great rotation, I enjoyed the whole Radiology atmosphere. I can totally see myself as a radiologist in the future ... however ... during the 4th week I asked permission to attend a surgery a friend invited me to, and damn ... the feeling you get in the OR is just unparalleled.

Plus, I have to admit, it was SO hard not fall asleep during the procedures and interpretation. I mean, the dimmed lights, the silence, the nice AC ... everything was pro-sleeping. I tried my best, but sometimes I just couldn't help it.

So I just ended up more confused than before about the course my life may take after I finish Medschool. Up until now I think the options are ENT Vs. Radiology ... however I haven't fully dismissed Ophthalmology and Pathology. (Yes I AM lazy and wish to never again live a life resembling anything I went through last year)

Right now I just started my Ophthalmology-ENT rotation, so this shall be interesting.

I'll try to keep you posted Internet, but I make no promises.

SELF REMINDER

Change the layout of this blog, it's starting to make my eyes hurt

You know you have been gone for a while when...

the address bar on your browser doen't remember your blog's URL ...

DAMN!

And the worst thing is... I have been doing close to NOTHING this past month.

Shame on me

Moving on...

- º -

Let's begin with the updates, shall we.

Sooooo... 2009 came with many changes. First of all I started living ind Mexico City. I'll be here as part of my first 3-month-long clinical rotation of this... my SIXTH... and last year of Medschool. Did you catch that? L-A-S-T

Huzzaah!

Anyways, I came here to rotate in Radiology, Trauma & Orthopaedics and ENT & Ophtalmology (1 month each). So far I've finished T&O, and am currently spending my last week in the Radiology department. They have been two great months, very very light compared to last year.

During January a friend of mine and I rotated in T&O, it consisted basically in shadowing an attending throughout the day. The day began at around 9 o'clock and finish about 12 hours later. It was quite tiring because every single we would wrap up very... very late... sometimes even past 11 o'clock. I would get home and just sleep until the next day. However, I have to say it wasn't at all bad. I mean, the doctor was very very nice with us. He spoiled us, you know, he would treat us with coffee breaks, dinners, breakfasts etc.
We would tag along to visit his hospitalized patients, to his appointments and his ER consults etc. It was cool in the way that you could really get an idea of how a doctor's life is, you know after medical training. It was quite eye opening.
Yet, since all this was done in a private-medicine environment, the doctor sent us to a public trauma hospital to an on call nigh every week. To get some on the field practice. That was nice too. They would let us would put casts, sutures, reduce fractures, etc, very didactic. The residents were extremely nice with us and always tried to explain us the procedures. They don't usually have interns (which here in Mexico is what they call the Medstudents who are doing their last year(s) of training, their clinical practices), so it was kind of a nice change for them to have a couple of eager girls around. Plus, they are guys, you know ortho-guys ... so girls are always welcome.
All an' all I think it is a great clinical rotation. It is not as academical as we were used to. We didn't have any classes, or exams or any "real" academic activities per se. However, it was one of those life lessons that teach you what kind of doctor you want to be, and what kind of medicine you would like to practice, bla bla. It was good.
On the down side, if you ask me which are the muscles of the forearm my answer will be nothing but a blank stare. But hey! One can't have it all. It's a small price to pay! (Besides, even if I had studied them, two months from now my answer would still be some rambling and then the same blank stare).

On february...
Arghhh I'm too tired and sleepy to go on.
I could just save the draft to finish it later and post it but... given the previous history... that could take weeks. So I'm going to post it like this and hopefully within this week I'll finish the updates.

Any complains please keep them to yourselves. I shall not hear of them

:D
heh

xox

PS: I really missed you, Internet. I'm sorry for the long absence

The longer you've been gone...

the harder it is to comeback.

I've been thinking about posting for a couple of weeks, but I kept thinking:

I haven't written for so long, my first post can not be about the hard as rock cookies my sisters and I baked, or my recently discovered claustrophobia while riding the MetroBus with a gazillion other people, or bla bla


So I decided to just post anything... and take the pressure off.

See you back soon.

Bienvenidos a la capital

YO
Ay mira! Ahi hay una gasolinera, y queda super cerca del depa! Super bien

SIS
No! No vayas a poner gasolina ahi

YO
Uuh? Por?

SIS
Es que ahi roban!

YO
(despues de considerarlo un momento)
Roban, de que te asaltan? ... O de que no le echan bien gasolina?

SIS
Pues de que no echan bien la gasolina, mensa!

YO
Pues es que aqui no me sorprenderia que fuera lo otro