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