Psycho Circus

And yes, I am a member of the KISS army.

Well, my first venture into the land of the living sure has been a unique one...

I was told of some problems they have had with students in the past about posting material on a blog (such as this one!) so my information is going to remain very general and short, as some of the extremely interesting incidents are quite identifying...

I am at Worcester State Hospital on ward 5B, which is a unit for "clients" that have been here for at least a couple months. The other area where I will spend my time is 1A, a forensic evaluation unit where people (prisoners) go to receive court evaluation.

The clients on 5B are crazy. There is a wide range of disorders, most involving some sort of psychosis or pyschotic disease (schizophrenia, schizoaffective disorder, simple psychosis, etc.). There are also some clients with borderline personality disorder. Talk about walking on eggshells... these people always think you have something against them or dislike them, while they desire strong relationships, they constantly yell everything and engage in self-mutilating behaviors, and seem like they compete with one another to see who can be the worst borderline in the hospital.

It is both boring and interesting. There isnt a lot of patient interaction, but there is a lot of observation and busy work. I did get to perform an otoscopic exam and check out a nasty boil on someones lip...oh, and I almost got bit by a patient trying to assist the nurse taking a blood pressure. Other than that, it's pretty quiet. Maybe it'll get a bit spicier when I am down on 1A.

Hope everyone else is doing well. Write soon!

Finally having a *blast* in Women's Health

Hey all. Tuesday began my first day in Women's Health in Brockton. First though, a quick update on my former Pedi rotation. The last time I contributed to this blog, I was complaining about not really being thrown in with patients right away. Well, eventually, I was doing lots of annual physicals for all the *kiddos* and seeing many a sick patient. I was beginning to wonder if there was anything other than the "sore throat, cough, fever x3 days" chief complaint, other than the "cough, vomiting, fever x3days" variant. Such is life in the winter with children. Yuck. I was still relatively nervous around tiny babies (namely their hypervigilant parents) but got through it all. :) All in all, I loved my preceptors and the patients seemed to like me. yay!

On to Women's Health! The first day, I was to meet the doctor in the OR for a hysterectomy. I was shown the changing room, told to change into scrubs and the nurse educator would be with me soon to show me how to scrub. Well, I learned that the single time in December practicing scrubbing was certainly not sufficient because the nurse made me feel like a fool, "your arms should be higher... you haven't scrubbed that surface long enough.... no, now rinse..... you need more lather.... you suck at life." Well, the last bit may not have actually been said by her but by my subconscious mind - but it was just as clearly heard. I got to observe two abdominal hysterectomies that day. We went to a local outpatient surgical center to watch a D&C. Good lord, what brutality that is. Dear uterus: please stay healthy so as to avoid such torture. Thank you.

Off to the office! Yes, this is a rotation with several locations. Office, surgi-center, main OR and also the local free clinic. The office is fast and he has many patients. Annual PAPs, IUDs, Colposcopies, prenatal checks. For anyone who knows me, I am not a huge fan of babies and the process of growing one but it's super fun to find the heartbeat!

The next day was the first day I got to scrub in for a surgery; a vaginal hysterectomy. I was kind of nervous, because there was a larger than usual audience that day: some second-year med students from Tufts observing, in addition to the usual crowd. So, I was the lucky duck who got to assit. About 35 minutes or so into it, I noticed that I was getting the sweat moustache under my mask. "Ew, I am so hot and sweaty..." I think to myself... "Don't be silly, hold this retractor and shut up" said myself. Ehn. Well, it wasn't too much longer before I felt a bit of cold sweat, and my hearing and vision did the "snow on TV" thing. EEHH!!! So, I said very frankly, "I am afraid I am not feeling well and need to leave, I am sorry." Retractors down. Quickly moving to nearest stool. Embarrassing but it's that or fall on my head, getting concussed AND ruining the sterile field. Everyone was really nice, offered OJ, advice, etc. I was annoyed more than anything. I realize that this has happened to everyone when first starting out but I wanted to finish assisting! It was totally fun and awesome. Next time, Gadget.

To finish the week, I observed a C-section on a whale-like woman. Sorry to be insensitive but lordy.... we went back to the office for appointments. The most memorable being a consult with a 70ish woman who is using testosterone gel for her libido. She was a riot, telling me how, "my sex life had been great until my husband passed away... I masturbate often and with this gel, I feel sexy and I want intercourse and I think I have found a partner". Wow. Awesome. I could have gone my entire life without knowing that but hey... more power to you.
The week ended with an IUD insertion for a very sensitive patient. She made me feel so bad for her that I couldn't help but hold her hand and pat her knee while she winced and cringed. Ehhh... she appreciated my support.
That's that. I'm having fun and I definitely think I could spend my days helping my fellow women with the nasty, uncomfy, yet necessary things in life.

Surgery

Hey Everybody!!! Krupa and I are doing surgery at Brockton and we had the most amazing first day! We started at 7:30a and ended 5:30p (short day apparently). The docs are super nice! We followed one doc today and scrubbed in on 4 of his cases (Lap-Chole/Indirect Inguinal Hernia Repair/Rectal Prolapse Repair/SBO Repair). I got to control the camera during the lap-chole and bag the GB before removing it, helped remove an appendix during the SBO, cut a bunch of fascia, sutured, cauterized and even did a foley cath! And we're standing next to the surgeon the whole time! I love surgery! Anyone who has this rotation will definitely be getting the most out of it! Hope everyone's doing well.

Before I Return to the Land of the Living...

So, the past week or so I have been performing autopsies on and off depending if the cases allow. Most of the drug/OD cases get thrown my way, as there is little I can really screw up. On occasion, the supposedly run of the mill drug death turns into something much more interesting...

Just yesterday, we had two interesting cases. The first I was not performing, as the person had a history of von Hippel Lindau, a rare genetic disorder that is characterized by brain tumors and an increased incidence of tumors if other organs. This person did have surgery to remove cerebellar tumors and had a ventricular shunt put in, which was cool to see the tube run down the neck and empty out into the peritoneum. This person ended up having a COD listed as MI, which was pretty evident upon gross sectioning.

The second case was a person with a known history of tuberous sclerosis, yet another rare genetic disorder with tumors in multiple organ systems. Kind of strange to see two rare cases in one day. Anywho, this case was being done out of hesitation, as the person had a recent dx of a stable remus fx but the next of kin was screaming that the nursing home was at fault. Because the case didnt sound very promising, Duval let me take the lead. I got the neck, tongue, heart and lungs out without much incident, except the left lung being completely adherant to the chest wall. When it came time to remove the intestine, i reflected back the duodenum/illeum and found this large black discoloration that was seemingly in the mesentary. Turns out, the decedant had MULTIPLE, HUGE, tumors in both kidneys, enough so that there was no way to distinguish kidney tissue from tumor. The estimated weight of the kidneys were 1000 and over 2000 grams! (In case you dont know, kidneys usually weigh under 200...). What appeared to have happened, is that, one of the tumors on the right side eroded a vessel that caused bleeding into/around the kidney, and eventually death (This was clearly no boating accident...).

Today I spent all day at the state crime lab, which was not exceptionally exciting. Tomorrow, I have to give my final presentation to Andrew and Duval and then go out to lunch. Even if we dont have cases tomorrow, it still feels like I went out on a bang.

See everyone real soon!

Pretty Much The Same

This post is from Tina, from a while back. Somehow, it did not make it on to the web (I dont know how/why, Im not that much of a nerd):

Hey all! I haven't written sooner b/c, honestly, this is my first bit of free time since we started on Monday. After reading other posts, it seems like my rotation is much the same as everyone elses. Lots of autonomy...thrown into the mix on the first day, and lots of hours....working about 12 a day. Whoo! So far, I've really enjoyed my hospital rounds in the mornings, checking out the newborns. They're just so dang cute. Haven't seen anything crazy yet, but I do know of a couple of Lyme arthritis cases that have been seen in the past year, so know that there is potential in this type of rural setting to see just about anything. Oh, on a side note, I did get to see a really rip-roaring ear infection! Bubbles actually coming out of the ear. Nice! Okay, on that note, peace out. Gotta log my Typhon data.

way up north...

Since the last time I have posted, there hasn't been a ton of excitement. After all, the coolest cases stay in the ER and don't come over to intermediate care. Plus I had the joy of catching a GI bug whcih kept me home for two days (and I am glad today was scheduled as a day off for a bit more recovery).

THere have been a lot more ear infections, URIs, some UTIs, back pain and dental pain. We had one person come in with constipation x8 days. Turns out he had a bowel obstruction, we (meaning they) dropped an NG tube, got a CT and admitted him. He is actually a really nice guy and we have been following up on him and visiting him on the floor. He even sent "his ER girls" flowers to thank us for "saving him". They were going to do a colonoscopy, but after a couple of days of abx he actually passed some stool. So they were thinking diverticulitis and planning on discharging him. Until he stopped up again, so when they did scope, they could only get up to the sigmoid before finding the obstruction. Sigh. They were supposed to perform a resection with a colostomy on Monday, but since I have been out I don't know what the result was. I know what they were thinking, but I hope it isn't the case. Anyway, I am thinking this might be an interesting case to present (I am EOR #2) so I need to find out what I need to do to get copies of films and reports.

I hadn't been getting a chance to do any procedures for a while, then Saturday hit. I was working with a different woman than normal and we almost never stopped. We didn't get lunch until after 3 in the afternoon, and dinner was at 7:30 or so. I was able to do two digital blocks. One was to remove a large splinter from under the fingernail of a kid, the other was to I&D a nasty abscess on a finger (a two-fer). I sutured an arm, and was trying to to the chin of a 5 year old until he freaked out. I ended up helping to hold him with one hand, while keeping the other sterile to hand stuff to my preceptor for the day. I will say that little kids and sutures are nota good mix! Oh, I also got to watch the ER docs reduce a dislocated shoulder on a large (muscular, not fat) guy. The normal conscious sedation was not enough to relax the muscles, so they had to call in anesthesia for backup.

I can't believe that we are almost done with this rotation! it has flown by. I definitely feel more confident than I did at the beginning, but I know I still have a lot to learn.

You, Me, and the OCME

Good news! I have been doing autopsies, ALL BY MYSELF! (I'm such a big boy) The only part that I havent done yet is the skull, but I think I'll ask if I can do that soon. Eventhough I havent seen any cool pathology recently, it's great being able to do a procedure from beginning to end. Do you have any idea how many people OD in this state?!?! Jesus, it's like an epidemic... and they aren't skinny heroine-chic drug addicts either, these are corn-fed, BMI of 35+ drug users.

Besides the drug deaths and myocardial infarctions secondary to coronary artery disease and hypertension, I did see a case where the person was in a car accident, but refused treatment, only to return the next day complaining of neck pain, was diagnosed with multiple cervicle fractures (including C1) only to refuse treatment again, return the following day where they were admitted, died, and was then downstairs within a matter of hours. There are several words I could use to describe this person, one starts with "fuckingstupid", they other with "fuckingmoron"...

As Bob likes to say: "Just another happy ending in the Tri-State"