Hey reader,
today was another good day.
It started off with me coming to critical care unit rounds at 7:30am that my attending had invited me to last week. When I met them, they informed me though that there'd be a conference on pulmonary hypertension upstairs. Oh and there would be bagels a resident said. Sold!
The conference was interesting. I met Jess there. She told me she'd be doing a lot of right heart caths today so I stopped by there after the conference. There, she just asked me to check up on our old patients - the whole service! Now that would be much more of a shocker if the service had consisted of more than three patients. Muahahah!
This way I had leisure to check out morning report at 10, which was a somewhat-interesting discussion on how the U of C hospitals should extend community clinic services. Between around 11:15 and noon I actually did look up the labs on the patients and checked in on them. I was back in A700 in time for the lunch conference :D .
For the first time (in the history of the residency program as I later learned), there was actually a drug rep there who sponsored the lunch and handed out journal articles and leaflets. I conveniently (but honestly) missed the piece of paper on the wall stating that this lunch was restricted to interns and sub-interns. I guess that's why the rep did not hand out the articles to me. I'm clearly identifiable by my horrible short coat. A second-wave medstudent from Germany whom we had warned was wearing his regular long coat, so he was "welcome" to the lunch I guess.
Well, whatever. I got food.
After I sat down, somehow a conversation with the person next to me began. Turned out that he, as well, wasn't really entitled to his long, white coat. He turned out to be a sociology major, there to observe. His thesis had something to do with social networks in the medical profession and specifically how people are perceived by others, like some people that are deemed knowledgeable by their peers yet not arrogant, but pleasant to work with. Like my current attending. He had been following a lot of medical teams around over almost a year by now and only had time to come to the lunch meeting for the first time today. He, of course, was very interested in what I had to say about my impressions here and I very much enjoyed exchanging them with someone who was in very similar shoes. We both had been thrown into these "teams" that were alien in many ways for either of us. The noon conference on an interesting case of lupus complicated by myocarditis interrupted us, but on the whole we spent about 2 hours talking. And I did have the time to do that. That was so nice.
And with Brainy (who will be a prime subject for his research) and the mentoring program we're trying to build in Germany and differences between US and German systems we did not run out of discussion topics, so we said we'd meet for lunch again some time.
So around 2:30pm I strolled back to the cath lab, where Jess was doing the same thing I had left her with: right heart caths, just got done doing the seventh. While she was almost done, she asked me to page Brainy to find out when she would want to round. Turned out she was right through the doors of the cath lab in the cardiac critical care unit (nice infrastructure!) basically waiting to round with us. I actually brought her into the cath lab, because the first patient we'd be rounding on had just had pieces of his replacement heart removed by Jess.
So we saved ourselves that trip. Mentioning that second patient only evoked tirades from the female rest of the team about what a sexist womanizing jerk he was. Seeking to provoke, as I usually do, I threw in that I liked him. My attending then explained to me that the advantage of her being smaller than me was that she was perfectly positioned for a right hook to my jaw. She demonstrated the movement and I saw her point. Dude, can you imagine a German attending kidding around with a mere medstudent like that?
They ended up deciding that we didn't need to see that patient that day.
That left only one patient to see, which we did. He had been sent to the floor from the ICU today and was ostensibly doing just peachy.
The three of us subsequently chatted pleasantly for a while until Brainy sent us home around 4.
Brilliant!
Monday, May 14, 2007
Sunday, May 13, 2007
Catching up
Hello readers,
I grew a bit tired of blogging, which is strange since I have basically way fewer patients to see and therefore more time during the day.
On Wednesday, yet again, my attending changed. And if I was impressed with the last one, this new one is even more incredible. She has never admitted to her actual age, keeps making up numbers jokingly. So I'll have to guess her at around 35. She's born in Chicago, daughter of a sociology major and a physician somewhere in Switzerland, I think. She studied European history in college, which is where her comments about Hegel she shot at me during rounds must have come from.
When I first saw her, in the ER, she was in the middle of listening to the presentation of a patient by the ER resident. She was scribbling down things on a pad, looking up the patient's labs and sending text pages on the computer while intermittently grabbing the phone when her pages were answered. In between, the attending shot short questions towards the resident when she had forgotten to mention something. She would talk fast, but friendly. It seemed like she could remind you that the thing between left atrium and ventricle was the mitral valve and still make you believe that it wasn't a big thing to forget and that it could happen to anyone. In the middle of all of this, one of her ever-moving hands reached out towards me, she smiled and introduced herself to me with her nickname and last name. I had time to shake that hand and say my own first name (I have given up using my last name permanently over here) before the fraction of her focus I was allotted at that time was taken away again. I didn't mind, on the contrary, I was pleased with her productivity. Rounds would be good.
And I thought Jen was the embodiment of the ability to multitask - this new attending was like Jen with a quad core processor.
A resident I know from renal consults, who is now on the ICU team that the new attending also rounds with, found a nice way to describe what her impact on her surroundings is. While the new attending - let's call her Brainy (heheh) - was busy working up a patient with the rest of the team and the ICU staff, the resident and I stood to the side and he muttered to me
"dude .. she's like a tornado."
True. But now in this picture that I've drawn so far, you'd probably imagine Brainy to be excited or appear stressed-out. And here's the strange thing, that couldn't be further from the truth. She's more laid back than almost any attending (except for the first one I had over here, no one can match that guy when it comes to taking life easy). She'll never speak in anything but a calm tone albeit fast and direct. Every other phrase coming out of her mouth will be ironic or funny in some other way but to the point. At the same time, she will never try to make you feel inferior (you just inherently do) despite the fact that the collective jaws of the heart failure team will drop every so often when she just never seems to run out of answers to just about any question there is.
For example - a patient post heart transplant turned up with undulating fevers that no one in the hospital could find a reason for in the past weeks. Outside the patient's room, while flying through the pages of the chart, Brainy asked for the patient's tacrolimus level (an immunosuppressant for the transplant). It was rather high. Brainy frowned a bit, skipped ahead to the medications list and then asked the nurse practitioner to hold his tacrolimus dose for three days. She also said that they shouldn't even bother drawing blood for another level tonight, it would be high again. Naturally, the team sported blank expressions and one of us managed to blurt out the question how she came to these conclusions. She pointed at the medication list, specifically a rather new order of voriconazole and looked at us with wide, but friendly eyes. This didn't help us much so she quickly explained that voriconazole will inhibit cytochrome P450 3A4/5, which is responsible for tacrolimus metabolism. Uh-huh. Well - you can still write this off to being her tools of the trade. She's in heart failure and involved with a lot of transplants. Big deal. But it got better.
After asking this same patient questions that we could halfway relate to about contact to kettle, cats and rabbits the patient said he hadn't had any contact to those kinds of animals. Oh, just his niece had brought a turtle. Instantly, Brainy asked the nurse practitioner to add cultures for salmonella. Turtles have salmonella? Of course they do. Did any of the rest of the team know that? Nope. After Brainy imparted some more wisdom on the patient (including how to clean your ears without a q-tip) we left that patient's room and Jess confronted Brainy with "how do you know all this?". Brainy just downplayed it as not being a big deal as she would always do.
But this woman is not limited to theoretical knowledge. We rounded on another patient who had broken his leg while carrying another person's heart in his chest (which is where we came in). He was going to be operated on by ortho as soon as the swelling in his leg would go down and his platelets (that were down for some unknown reason) were back up. Now, cooling the leg would have been helpful with the swelling, right? So Brainy asked the primary team's resident that took care of the patient why there was no ice on the patient's broken leg. The resident replied that he had written for it, but the nurses couldn't do it because the ice packs they had were too small for the leg, they'd always fall off. Brainy abruptly went to the nearest garbage container, took out the trash bag and gave it to me to hold, grabbed a fresh garbage bag that they keep inside these containers, went to the ice machine in the nourishment room, filled it and that was that. While doing all this, however, she would NOT give anyone a hard time about it. She would not even say anything about people having lost common sense and practical skills somewhere around their medical training. I challenge anyone to not even making a single remark in that direction in this situation.
The next day, that same patient was to receive one of those little plastic machines that you blow into for breathing exercise. You know, with the three little balls you have to blow up. The resident said he agreed that he should have received that thing and started practicing the sooner the better but the nurses just hadn't gotten around to giving him one yet despite him writing the order. He was a rather tall resident, so he had to duck when Brainy opened a closet high up on the wall right in front of the patient's door. It contains a number of frequently-used items in patient care, such as urine cups, syringes, foley bags - and the little plastic breathing exercisers. She took one and handed it to the resident. She also advised the patient to drink a lot of cherry juice and stay away from watermelons during the summer. By now, I have totally forgotten why but I'm sure it makes total sense just like all the other pieces of knowledge this attending has been spraying out.
Can you tell I'm a fan?
Now don't get me wrong, I believe I couldn't stand her personally if she kept up the pace she brings to work every day. But since I only see her at work and we have a minuscule patient load I get to profit immensely from her - since she enjoys teaching.
Problem is that CS, Jess and Brainy all keep stacking journal articles on me "to read" - the number of these being only directly proportional to the amount of bad conscience I come to work with, since the number of articles I'll read will remain constant right around zero.
In other news, after interviewing the director and an associate director of the residency program in internal medicine the chicagoans got together
and worked on the mentoring system we're supposed to institute at our medschool back in Munich. It's slowly taking shape and at least I for one believe that it's going to be an extremely cool program.
And on Friday all of the chicagoans came to Looptopia - a brand new festival premiering this year in Chicago celebrating the loop.
There were artists on the streets and numerous events all over the buildings around the loop. It wasn't that much of a success for us though, since we didn't have much of a plan of what events to go to and we ended up waiting in line most of the time and giving up and walking out somewhere halfway through.
Allright, that should do for now and keep you busy. I'm off to do happier things like finally finishing that book on EKGs or something.
Blog to you later.
I grew a bit tired of blogging, which is strange since I have basically way fewer patients to see and therefore more time during the day.
On Wednesday, yet again, my attending changed. And if I was impressed with the last one, this new one is even more incredible. She has never admitted to her actual age, keeps making up numbers jokingly. So I'll have to guess her at around 35. She's born in Chicago, daughter of a sociology major and a physician somewhere in Switzerland, I think. She studied European history in college, which is where her comments about Hegel she shot at me during rounds must have come from.
When I first saw her, in the ER, she was in the middle of listening to the presentation of a patient by the ER resident. She was scribbling down things on a pad, looking up the patient's labs and sending text pages on the computer while intermittently grabbing the phone when her pages were answered. In between, the attending shot short questions towards the resident when she had forgotten to mention something. She would talk fast, but friendly. It seemed like she could remind you that the thing between left atrium and ventricle was the mitral valve and still make you believe that it wasn't a big thing to forget and that it could happen to anyone. In the middle of all of this, one of her ever-moving hands reached out towards me, she smiled and introduced herself to me with her nickname and last name. I had time to shake that hand and say my own first name (I have given up using my last name permanently over here) before the fraction of her focus I was allotted at that time was taken away again. I didn't mind, on the contrary, I was pleased with her productivity. Rounds would be good.
And I thought Jen was the embodiment of the ability to multitask - this new attending was like Jen with a quad core processor.
A resident I know from renal consults, who is now on the ICU team that the new attending also rounds with, found a nice way to describe what her impact on her surroundings is. While the new attending - let's call her Brainy (heheh) - was busy working up a patient with the rest of the team and the ICU staff, the resident and I stood to the side and he muttered to me
"dude .. she's like a tornado."
True. But now in this picture that I've drawn so far, you'd probably imagine Brainy to be excited or appear stressed-out. And here's the strange thing, that couldn't be further from the truth. She's more laid back than almost any attending (except for the first one I had over here, no one can match that guy when it comes to taking life easy). She'll never speak in anything but a calm tone albeit fast and direct. Every other phrase coming out of her mouth will be ironic or funny in some other way but to the point. At the same time, she will never try to make you feel inferior (you just inherently do) despite the fact that the collective jaws of the heart failure team will drop every so often when she just never seems to run out of answers to just about any question there is.
For example - a patient post heart transplant turned up with undulating fevers that no one in the hospital could find a reason for in the past weeks. Outside the patient's room, while flying through the pages of the chart, Brainy asked for the patient's tacrolimus level (an immunosuppressant for the transplant). It was rather high. Brainy frowned a bit, skipped ahead to the medications list and then asked the nurse practitioner to hold his tacrolimus dose for three days. She also said that they shouldn't even bother drawing blood for another level tonight, it would be high again. Naturally, the team sported blank expressions and one of us managed to blurt out the question how she came to these conclusions. She pointed at the medication list, specifically a rather new order of voriconazole and looked at us with wide, but friendly eyes. This didn't help us much so she quickly explained that voriconazole will inhibit cytochrome P450 3A4/5, which is responsible for tacrolimus metabolism. Uh-huh. Well - you can still write this off to being her tools of the trade. She's in heart failure and involved with a lot of transplants. Big deal. But it got better.
After asking this same patient questions that we could halfway relate to about contact to kettle, cats and rabbits the patient said he hadn't had any contact to those kinds of animals. Oh, just his niece had brought a turtle. Instantly, Brainy asked the nurse practitioner to add cultures for salmonella. Turtles have salmonella? Of course they do. Did any of the rest of the team know that? Nope. After Brainy imparted some more wisdom on the patient (including how to clean your ears without a q-tip) we left that patient's room and Jess confronted Brainy with "how do you know all this?". Brainy just downplayed it as not being a big deal as she would always do.
But this woman is not limited to theoretical knowledge. We rounded on another patient who had broken his leg while carrying another person's heart in his chest (which is where we came in). He was going to be operated on by ortho as soon as the swelling in his leg would go down and his platelets (that were down for some unknown reason) were back up. Now, cooling the leg would have been helpful with the swelling, right? So Brainy asked the primary team's resident that took care of the patient why there was no ice on the patient's broken leg. The resident replied that he had written for it, but the nurses couldn't do it because the ice packs they had were too small for the leg, they'd always fall off. Brainy abruptly went to the nearest garbage container, took out the trash bag and gave it to me to hold, grabbed a fresh garbage bag that they keep inside these containers, went to the ice machine in the nourishment room, filled it and that was that. While doing all this, however, she would NOT give anyone a hard time about it. She would not even say anything about people having lost common sense and practical skills somewhere around their medical training. I challenge anyone to not even making a single remark in that direction in this situation.
The next day, that same patient was to receive one of those little plastic machines that you blow into for breathing exercise. You know, with the three little balls you have to blow up. The resident said he agreed that he should have received that thing and started practicing the sooner the better but the nurses just hadn't gotten around to giving him one yet despite him writing the order. He was a rather tall resident, so he had to duck when Brainy opened a closet high up on the wall right in front of the patient's door. It contains a number of frequently-used items in patient care, such as urine cups, syringes, foley bags - and the little plastic breathing exercisers. She took one and handed it to the resident. She also advised the patient to drink a lot of cherry juice and stay away from watermelons during the summer. By now, I have totally forgotten why but I'm sure it makes total sense just like all the other pieces of knowledge this attending has been spraying out.
Can you tell I'm a fan?
Now don't get me wrong, I believe I couldn't stand her personally if she kept up the pace she brings to work every day. But since I only see her at work and we have a minuscule patient load I get to profit immensely from her - since she enjoys teaching.
Problem is that CS, Jess and Brainy all keep stacking journal articles on me "to read" - the number of these being only directly proportional to the amount of bad conscience I come to work with, since the number of articles I'll read will remain constant right around zero.
In other news, after interviewing the director and an associate director of the residency program in internal medicine the chicagoans got together
and worked on the mentoring system we're supposed to institute at our medschool back in Munich. It's slowly taking shape and at least I for one believe that it's going to be an extremely cool program.And on Friday all of the chicagoans came to Looptopia - a brand new festival premiering this year in Chicago celebrating the loop.
There were artists on the streets and numerous events all over the buildings around the loop. It wasn't that much of a success for us though, since we didn't have much of a plan of what events to go to and we ended up waiting in line most of the time and giving up and walking out somewhere halfway through.Allright, that should do for now and keep you busy. I'm off to do happier things like finally finishing that book on EKGs or something.
Blog to you later.
Monday, May 7, 2007
Finally!
Better late than never .. after playing basketball for a few hours with a couple of sociology students, we went for dinner and a few drinks in chinatown. Finally reminded me a bit of high school over here, when we used to take someone's car and go out to eat somewhere at least every other night.
Good times.
Of course, I still have not read those papers my fellow has given me that I should have been long done with. But since today was another "weird" day and we never "had a chance" to "sit down" and "discuss" as she put it and tomorrow is shaping up to be another one of those weird (or rather, usual) days I think I'll be just fine :)
Anyway, I need to catch up on missed sleep again after having been listening to a-capella-trash-metal till 2am last night (do ask!) and I need to have my liver work on the Tsingtao in my system.
Blog to you later.
Good times.
Of course, I still have not read those papers my fellow has given me that I should have been long done with. But since today was another "weird" day and we never "had a chance" to "sit down" and "discuss" as she put it and tomorrow is shaping up to be another one of those weird (or rather, usual) days I think I'll be just fine :)
Anyway, I need to catch up on missed sleep again after having been listening to a-capella-trash-metal till 2am last night (do ask!) and I need to have my liver work on the Tsingtao in my system.
Blog to you later.
Saturday, May 5, 2007
Small, strange world.
I've been getting used to weird coincidences lately. Still, today was a bit stranger than most other days.
The line at Hyde Park Produce was exceptionally long today, from the cash register all the way back to the deli counter. In line in front of me was a couple and the girl was wearing a sweater with a little label from the show "popstars". I couldn't refrain from asking whether you would actually have to be in the show to get a sweater like that or whether you could buy them. She turned bright red and kept saying how "peinlich" wearing the sweater was for her. Heheh. Anyway, she had a PhD in neuroscience and he was a post-doc in biochemistry, both from Germany naturally, with him currently working on tumor immunology with the same mouse strain I am (or used to be). He's using retroviral treatments though in contrast to my immunostimulatory molecules. There had to be a tiny difference, otherwise chances are I would have known him.
Anyway, that was the "small" part of the world - here's the strange part.
I went to the pharmacy afterwards to get water and milk, but also because I had a herpes blister on my lips (guess I may have been immunosuppressing myself lately with poor nutrition, little sleep and endogenous steroids). I quickly scanned the aisles of this huge (compared to German ones) pharmacy and then went to the "pharmacist"'s counter. Said pharmacist was apparently working in the aisles, the aids said. So they asked me whether they could help me. Sure enough, I thought, this is easy enough.
So I said
"I'm looking for some topical acyclovir for lip herpes."
- "What?"
"Acyclovir. Like in an ointment."
- "Uhhh .. do you have a prescription?"
"A prescription? No I don't. I have a herpes blister on my lip. Here. Look."
- "Uhhh .."
"I'm just looking for some acyclovir ointment to put on there."
- "Oh, you mean like a cold sore?"
"A what now?"
- "A cold sore."
"If that's what you call it."
- "Uhhh .. I think you're looking for Abreva."
"Am I. So where's that."
- "It should be there!" (Points to end of an aisle)
So I go look, there's several kinds of chap stick and finally I find a label of "Abreva" saying I should contact customer service for this. The pharmacist aids said if it wasn't there I should go up to the cash register.
So I got my milk and my two gallons of water and stepped up to the cash register, asking for Abreva. That prompted the person at the register to point to another rack of worthless chap stick among all the candy, lighters and magazines and to comment "we may be out of it".
I couldn't refrain from replying "Isn't this supposed to be a pharmacy?".
This building could house at least three full-fledged German pharmacies that carry multiple formulations of topical acyclovir which is one of the safest drugs in the world. And this 24h-open so-called pharmacy offers beans in a can, fresh milk and frozen pizza for crying out loud but nothing to take care of a friggin' blister on your lips.
That's messed up dude.
The line at Hyde Park Produce was exceptionally long today, from the cash register all the way back to the deli counter. In line in front of me was a couple and the girl was wearing a sweater with a little label from the show "popstars". I couldn't refrain from asking whether you would actually have to be in the show to get a sweater like that or whether you could buy them. She turned bright red and kept saying how "peinlich" wearing the sweater was for her. Heheh. Anyway, she had a PhD in neuroscience and he was a post-doc in biochemistry, both from Germany naturally, with him currently working on tumor immunology with the same mouse strain I am (or used to be). He's using retroviral treatments though in contrast to my immunostimulatory molecules. There had to be a tiny difference, otherwise chances are I would have known him.
Anyway, that was the "small" part of the world - here's the strange part.
I went to the pharmacy afterwards to get water and milk, but also because I had a herpes blister on my lips (guess I may have been immunosuppressing myself lately with poor nutrition, little sleep and endogenous steroids). I quickly scanned the aisles of this huge (compared to German ones) pharmacy and then went to the "pharmacist"'s counter. Said pharmacist was apparently working in the aisles, the aids said. So they asked me whether they could help me. Sure enough, I thought, this is easy enough.
So I said
"I'm looking for some topical acyclovir for lip herpes."
- "What?"
"Acyclovir. Like in an ointment."
- "Uhhh .. do you have a prescription?"
"A prescription? No I don't. I have a herpes blister on my lip. Here. Look."
- "Uhhh .."
"I'm just looking for some acyclovir ointment to put on there."
- "Oh, you mean like a cold sore?"
"A what now?"
- "A cold sore."
"If that's what you call it."
- "Uhhh .. I think you're looking for Abreva."
"Am I. So where's that."
- "It should be there!" (Points to end of an aisle)
So I go look, there's several kinds of chap stick and finally I find a label of "Abreva" saying I should contact customer service for this. The pharmacist aids said if it wasn't there I should go up to the cash register.
So I got my milk and my two gallons of water and stepped up to the cash register, asking for Abreva. That prompted the person at the register to point to another rack of worthless chap stick among all the candy, lighters and magazines and to comment "we may be out of it".
I couldn't refrain from replying "Isn't this supposed to be a pharmacy?".
This building could house at least three full-fledged German pharmacies that carry multiple formulations of topical acyclovir which is one of the safest drugs in the world. And this 24h-open so-called pharmacy offers beans in a can, fresh milk and frozen pizza for crying out loud but nothing to take care of a friggin' blister on your lips.
That's messed up dude.
Friday, May 4, 2007
Murphy's Law or just bad karma?
Miraculously, my team was willing to let me go at 4pm today. 4pm!
But hey, that doesn't sound like something that could happen to me, does it? Of course not. CS had scheduled a meeting for us at 6pm since the beginning of the week.
That would have been fine any other day up until now but they had to have a heart for me on Friday.
After CS came by the residents' workroom though and declared that it looks more like 6:30 I did go home and I'm now waiting for the page - it's 6:05pm right now.
In other news, there's nothing out of the ordinary to report for today except that I stepped out of the very boring cardiology grand rounds to go up to the residents' luncheon in A700 and didn't regret it, for after several other announcements they projected this hilarious and nerd-a-licious persiflage of a Justin Timberlake song on the silver screen as well as the three plasma panels in the room.
I'll take my gym stuff with me to the hospital later - if CS ever does page us to come.
Blog to you later.
But hey, that doesn't sound like something that could happen to me, does it? Of course not. CS had scheduled a meeting for us at 6pm since the beginning of the week.
That would have been fine any other day up until now but they had to have a heart for me on Friday.
After CS came by the residents' workroom though and declared that it looks more like 6:30 I did go home and I'm now waiting for the page - it's 6:05pm right now.
In other news, there's nothing out of the ordinary to report for today except that I stepped out of the very boring cardiology grand rounds to go up to the residents' luncheon in A700 and didn't regret it, for after several other announcements they projected this hilarious and nerd-a-licious persiflage of a Justin Timberlake song on the silver screen as well as the three plasma panels in the room.
I'll take my gym stuff with me to the hospital later - if CS ever does page us to come.
Blog to you later.
Thursday, May 3, 2007
Day three
at the new service.
Life's kind of okay.
Feet are hurting but rounds were still done at a somewhat-reasonable 6:30pm despite the attending having been in clinic again today.
The morning started slowly, after the transplant meeting at 7:30am. Yesterday I was told it would start on time, so I arrived at 7:30 sharp and naturally, I was the first one in the conference room. "On time" my behind. But they did start at 7:40. I'm not sure why I "had" to be there - I mean it was nice to see CT (cardiothoracic) surgeons are the same kind of narcissistic studs they are back in Munich. But I can't say I learned a whole lot or had anything to contribute to the mostly organizational meeting.
Anyway, after the meeting my current fellow, let's call her Jess from now on, told me that I was actually free to do what I wanted. Wow, that's new. She said I could follow up on whichever patient I wanted, she would want to teach me a thing or two about heart failure around 11:30 and there was going to be a conference on door-to-balloon-time at noon (that is in addition to the M&M meeting at the same time). Cool stuff. I could also follow the attending to clinic if I wanted but the resident was already doing that today. So I declined .. for one thing I didn't want to double-team looking over his shoulder all day plus then Jess would have no one to see new consults - should they actually come in. Which today, they would.
But first things first, around 8:30 I went up to A700 for the nice, usual Thursday ample warm cholesterol-packed breakfast. Yum. And guess who I found already sitting at a table there .. three Germans. During the course of the morning, we came and went but we still maintained a strong German presence in that room most of the time. I would have had to start getting smart about the first thing about heart failure but hey, I'm lazy and I'll prefer conversation over studying any time. So that's what I did for the following hour and a half, until morning report at 10. After a somewhat-interesting but not terribly new lecture on rhabdo I went to look at my young lawyer with the questionable sarcoidosis in his heart before going to see Jess.
As I have getting used to with my fellows, she was getting paged every five minutes while handing me and orally summarizing a few more papers. I'm not sure whether she expects me to read all this stuff any time soon or in my life, for that matter. She gave me six papers yesterday, three more today, which is in addition to the three I got from Carolin - all of these on heart failure - not even counting all the stuff from uptodate I printed on sarcoidosis (half of which I actually have read). I'm afraid this may very well turn out to be a sad waste of trees.
But interestingly, she also had two new consults. I actually had to ask whether I should see one of them and the answer was "sure, if you like". If I like? Really cool stuff. Sure I "liked" .. but then I had to choose which one. One was 77, with amyloid cardiomyopathy requiring pressors that the primary team now has trouble weaning off. The other one was 22 (!) with chest pain. Why would he be on the heart failure service? Well, because his dad knows someone that knows our attending. And as we know, our attending is good.
So I had to pick between 77-year-old guy with amyloidosis and 22-year-old with chest pain. Considering my past karma with everything I touch turning into case reports (if the biopsy's positive for sarcoidosis, we're actually going to write one) I just couldn't be responsible for this 22-year-old turning out to have some rare deadly disease. So I took the 77-year-old.
Before that though, I went up to A700 for some pizza and juicy M&M. M&Ms are usually packed, and so it was today, even though Borat was the only German I saw there. But I guess it was better that way, the place was packed despite the fact that they took out the room separator with some residents actually having to stand in the back.
After the M&M meeting, I went to see my patient. While working him up using chart and computer in the nursing station actually Jen came by. We had a nice chat, wallowing in memories of the good times we had together after having been separated for less than a week and of course making fun of the ridiculously long rounding times I was suffering from with my current attending. And following CS's suggestion, I did belatedly take her up on her offer to write an evaluation for me. Who knows, I might consider a career with the pill-pushers after all.
I just don't know anymore.
Anyway, quite a while later, at precisely 2:59pm, Jess paged me that we were "apparently" starting rounds in the ICU "now". I was at that time still extensively chatting with my new patient and his wife (attending's exuberant bedside manner already rubbing off), rushed through the exam at that point and met the team in the ICU. The attending was still discussing (what else) stuff with the ICU team, since he double-staffed as their attending as well. Meanwhile Jess was sitting at one of the computers there frantically looking up stuff on patients. She said our attending had just "dropped three more consults on her". That's not a nice thing to do minutes before rounds.
I asked her whether I could help her in any way and she declined. But having a hunch about rounds taking a while again today I sneaked out while the attending was talking to another family on the ICU down to the gift shop to get supplies (i.e. water and candy) to better make it through the rest of the day. I asked Jess and the resident whether they wanted anything and only the Indian guy accepted. I bought more though which Jess would later be grateful for after we had gone to cath the sarcoidosis suspect in the middle of rounds and her blood sugar was running low as well.
Anyway, I'll spare you the details about rounds and I'll get myself back home before it's dark again. Have been blogging for 40 minutes again. I guess I'm addicted. Will go into rehab back in good old Germany.
Oh by the way, the team is determined to take me to a karaoke place next Thursday. I'll be sure to vocally make them regret that.
Blog to you later.
Life's kind of okay.
Feet are hurting but rounds were still done at a somewhat-reasonable 6:30pm despite the attending having been in clinic again today.
The morning started slowly, after the transplant meeting at 7:30am. Yesterday I was told it would start on time, so I arrived at 7:30 sharp and naturally, I was the first one in the conference room. "On time" my behind. But they did start at 7:40. I'm not sure why I "had" to be there - I mean it was nice to see CT (cardiothoracic) surgeons are the same kind of narcissistic studs they are back in Munich. But I can't say I learned a whole lot or had anything to contribute to the mostly organizational meeting.
Anyway, after the meeting my current fellow, let's call her Jess from now on, told me that I was actually free to do what I wanted. Wow, that's new. She said I could follow up on whichever patient I wanted, she would want to teach me a thing or two about heart failure around 11:30 and there was going to be a conference on door-to-balloon-time at noon (that is in addition to the M&M meeting at the same time). Cool stuff. I could also follow the attending to clinic if I wanted but the resident was already doing that today. So I declined .. for one thing I didn't want to double-team looking over his shoulder all day plus then Jess would have no one to see new consults - should they actually come in. Which today, they would.
But first things first, around 8:30 I went up to A700 for the nice, usual Thursday ample warm cholesterol-packed breakfast. Yum. And guess who I found already sitting at a table there .. three Germans. During the course of the morning, we came and went but we still maintained a strong German presence in that room most of the time. I would have had to start getting smart about the first thing about heart failure but hey, I'm lazy and I'll prefer conversation over studying any time. So that's what I did for the following hour and a half, until morning report at 10. After a somewhat-interesting but not terribly new lecture on rhabdo I went to look at my young lawyer with the questionable sarcoidosis in his heart before going to see Jess.
As I have getting used to with my fellows, she was getting paged every five minutes while handing me and orally summarizing a few more papers. I'm not sure whether she expects me to read all this stuff any time soon or in my life, for that matter. She gave me six papers yesterday, three more today, which is in addition to the three I got from Carolin - all of these on heart failure - not even counting all the stuff from uptodate I printed on sarcoidosis (half of which I actually have read). I'm afraid this may very well turn out to be a sad waste of trees.
But interestingly, she also had two new consults. I actually had to ask whether I should see one of them and the answer was "sure, if you like". If I like? Really cool stuff. Sure I "liked" .. but then I had to choose which one. One was 77, with amyloid cardiomyopathy requiring pressors that the primary team now has trouble weaning off. The other one was 22 (!) with chest pain. Why would he be on the heart failure service? Well, because his dad knows someone that knows our attending. And as we know, our attending is good.
So I had to pick between 77-year-old guy with amyloidosis and 22-year-old with chest pain. Considering my past karma with everything I touch turning into case reports (if the biopsy's positive for sarcoidosis, we're actually going to write one) I just couldn't be responsible for this 22-year-old turning out to have some rare deadly disease. So I took the 77-year-old.
Before that though, I went up to A700 for some pizza and juicy M&M. M&Ms are usually packed, and so it was today, even though Borat was the only German I saw there. But I guess it was better that way, the place was packed despite the fact that they took out the room separator with some residents actually having to stand in the back.
After the M&M meeting, I went to see my patient. While working him up using chart and computer in the nursing station actually Jen came by. We had a nice chat, wallowing in memories of the good times we had together after having been separated for less than a week and of course making fun of the ridiculously long rounding times I was suffering from with my current attending. And following CS's suggestion, I did belatedly take her up on her offer to write an evaluation for me. Who knows, I might consider a career with the pill-pushers after all.
I just don't know anymore.
Anyway, quite a while later, at precisely 2:59pm, Jess paged me that we were "apparently" starting rounds in the ICU "now". I was at that time still extensively chatting with my new patient and his wife (attending's exuberant bedside manner already rubbing off), rushed through the exam at that point and met the team in the ICU. The attending was still discussing (what else) stuff with the ICU team, since he double-staffed as their attending as well. Meanwhile Jess was sitting at one of the computers there frantically looking up stuff on patients. She said our attending had just "dropped three more consults on her". That's not a nice thing to do minutes before rounds.
I asked her whether I could help her in any way and she declined. But having a hunch about rounds taking a while again today I sneaked out while the attending was talking to another family on the ICU down to the gift shop to get supplies (i.e. water and candy) to better make it through the rest of the day. I asked Jess and the resident whether they wanted anything and only the Indian guy accepted. I bought more though which Jess would later be grateful for after we had gone to cath the sarcoidosis suspect in the middle of rounds and her blood sugar was running low as well.
Anyway, I'll spare you the details about rounds and I'll get myself back home before it's dark again. Have been blogging for 40 minutes again. I guess I'm addicted. Will go into rehab back in good old Germany.
Oh by the way, the team is determined to take me to a karaoke place next Thursday. I'll be sure to vocally make them regret that.
Blog to you later.
Wednesday, May 2, 2007
Special touch
There seems to be another recurring theme - my very first patient on a new service apparently regularly turns out to be case report-worthy.
Remember, the patient I saw on the very first morning I started in this hospital was the deaf-mute lady that ingested 50,000 units of vitamin D per day for an entire year and came in wildly hypercalcemic.
I also told you about the young guy yesterday that could easily bench press me. Turns out, heart failure apparently was the right service for this guy after all. (Actually, general cards, electrophysiology as well as we ourselves were all consulting on this same guy.) During rounds today (that thankfully ended with only two hours of overtime), we got a call from the general cards attending that had evaluated this guy's cardiac MRI, who was apparently very excited about it. So we went to his office and had a look. He demonstrated patchy hyperintense infiltrates in the myocardium very much consistent with sarcoidosis (or maybe some other form of myocarditis). We call-conferenced with the electrophysiology attending and my current attending on the heart failure service received kudos for actually having come up with sarcoidosis on the differential in this guy even before the MRI.
So we (fellow, resident and I) had our work cut out for ourselves .. look up sarcoidosis and its manifestation in the heart till tomorrow.
So that's what I'll get started on while still here in the hospital, since I'll need access to uptodate and medical journals.
But I'm hungry, tired (got only 5 hours last night) and my feet hurt up to the knees.
Surgery suddenly looks very attractive right now. My feet are going to hurt anyway and at least I won't have to think anymore.
Blog to you later.
Remember, the patient I saw on the very first morning I started in this hospital was the deaf-mute lady that ingested 50,000 units of vitamin D per day for an entire year and came in wildly hypercalcemic.
I also told you about the young guy yesterday that could easily bench press me. Turns out, heart failure apparently was the right service for this guy after all. (Actually, general cards, electrophysiology as well as we ourselves were all consulting on this same guy.) During rounds today (that thankfully ended with only two hours of overtime), we got a call from the general cards attending that had evaluated this guy's cardiac MRI, who was apparently very excited about it. So we went to his office and had a look. He demonstrated patchy hyperintense infiltrates in the myocardium very much consistent with sarcoidosis (or maybe some other form of myocarditis). We call-conferenced with the electrophysiology attending and my current attending on the heart failure service received kudos for actually having come up with sarcoidosis on the differential in this guy even before the MRI.
So we (fellow, resident and I) had our work cut out for ourselves .. look up sarcoidosis and its manifestation in the heart till tomorrow.
So that's what I'll get started on while still here in the hospital, since I'll need access to uptodate and medical journals.
But I'm hungry, tired (got only 5 hours last night) and my feet hurt up to the knees.
Surgery suddenly looks very attractive right now. My feet are going to hurt anyway and at least I won't have to think anymore.
Blog to you later.
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