Last-day-of-rotation-Tuesday Tuesday

It is Top Ten Tuesday day, but given that I can’t even keep up with the books released years ago and the list is the top ten 2014 releases I am looking forward to, I feel that it is pointless to try to do it.

So, I present to you last-day-of-rotation-Tuesday Tuesday.

Yes, I feel like the two Tuesdays in the title are necessary.

What that means, I don’t know.

I will, however say that these past four weeks, I have learned that I can learn about Infectious Diseases.  The learning curve is huge and that is pretty cool.

Also, I realized this week that it wasn’t me lecturing my husband about the importance of the flu shot, me telling him that we have a few people I was following on ID with the flu or even the TV reports of deaths from the flu in another province to convince him to get a flu shot.  It was… Drumroll please… His barber.  True story.  There is a man chopping hair who is doing his part to promote public health.  That is awesome.

Seriously, he went to get a haircut and got a flu shot that I have been semi-nagging about for months on the way home.  Pretty awesome.  Now if only I can get him to make an appointment with our doctor to get his TDaP and MMR updated.  If only.

I also learned last week that (disgusting fact) tampons cause toxic shock syndrome by acting as a physiologic abscess.  ICK.  Thank goodness they sorted out which materials promoted bacterial growth and that high absorbency tampons were the main culprits back in the 80s before I really considered this an important issue.

Oh, and that toxic shock syndrome can occur not in women and not in tampon use.  Okay, I did know that, but I never really thought about it that much or considered it as a high level differential until this rotation.

On to Neurology tomorrow.  Yet another rotation that makes me nervous due to my sheer ignorance.  I can do brain tumours.  Everything else is going to be a bit sketchy until I can read and see a few cases.  Thank goodness for lots of references, good staff and basic medical knowledge.

I had a friend in med school who was awesome at neuro… So awesome that she plans to do it for a living one day. I wish she was here to tell me what to do.

I sense another giant learning curve about to start.

Only 6 off-service rotations to go…

ID compared to House, MD

It is Medical Monday, yet again.  Actually, I feel like it has been a long time since the last Medical Monday.  Either way, it is time to hook up with some other medical related blogs for some medical and Monday-ish goodness.

As some of you who read this blog regularly know, I am currently on an Infectious Diseases rotation and I have likened it a bit to the TV show House, MD.

I have been giving it some thought (and noticing the continued strange popularity of my post General Surgery Is NOT Grey’s Anatomy) and decided that it is time I both prove and dispel some more TV related medical show perceptions, this time referring to House, MD.

First of all, why House?

For starters, it is one of the other medical shows I watch(ed).  Also, when I think of real medical specialties that are kind of like “diagnostician” I think Internal Medicine and, more specifically, ID or Rheumatology because they get to see some of the weird and wonderful.  And I am sure in some big places, someone really is a diagnostician specializing in the really complex cases.  That being said, it isn’t a residency or a common position.  At least, I don’t know any, so this is my reasonable facsimile.

The similarities:

  • There really is a gaggle of people who deal with the complicated cases.
  • People do sit in a group and bounce ideas off of one another complete with internet and journal searches and a white board, or more commonly, a sheet of paper.

    Image from teichdoesmedicine.blogspot.com.

  • Someone who is generally much smarter than everyone else does lead the pack (and sometimes bosses people around).
  • Often times, much of the staff are not fans of the person in charge of the hospital.
  • Patients do lie.  For reals.

    Okay, not everybody. Image from Iamilliontrees.net.

  • The days can be crazy long and chaotic, but also interspersed with mind numbing waiting and boredom (or time for other antics).
  • When you just think you have someone or something figured out, there is a twist (sometimes).

    Image from eatliver.com.

  • Sarcoidosis, lupus and obscure infections are often somewhere on the differential.

    Or is it? Image from http://www.quickmeme.com.

  • You do have to work in places you don’t always like to or want to in order to keep the hospital running and such.

The differences:

  • Patients do tell the truth.
  • One does not generally have a team of fellows who were staff in every other area of the hospital.  Those people often just stick to their own jobs.
  • You can’t just go around running your own lab tests, diagnostic scans and procedures all willy nilly.  There are people specially trained to do all of those things better than the doctors on the show.
  • You would lose your job for screwing around with a clinical trial, stealing drugs, blatantly endangering patients, etcetera.
  • A good start to making a correct diagnosis is a good history and physicial.  They tend to skip that step.
  • A next important step to a correct diagnosis is doing the correct diagnostic test.  Most of the scans they do aren’t appropriate and then the images are not actually of the scan they claimed to order.  In fact, they often put the patient in the incorrect machine.
  • You can’t order everything STAT.  That would make “STAT” routine.
  • There are more staff in the hospital than the “Diagnostician” and a lone oncologist who happens to treat EVERYONE (including children) with cancer.

    I do quite like their bromance, though. Image from tinyobsessions.wordpress.com.

  • As a consultant, you consult, not make all the decisions.
  • People don’t code that often.  At least they don’t code that often and survive.
  • Patients die.
  • Sometimes you just don’t figure out the answer and the person either dies or gets better and you don’t know why.  That isn’t a failure.  Just life.
  • Breaking into someone’s home, car, workplace and so forth is a felony, not medicine.
  • It takes much more time to figure out complicated and novel cases.
  • You can’t just throw drugs at people (or take them away) and expect them to get better.
  • If it walks like a duck and quacks like a duck, it is probably a duck, not a zebra.  House almost always gets the zebra.
  • Sometimes, it really is lupus or sarcoidosis.

    Image from housemdconfessions.tumblr.com.

  • Nobody would let you practice medicine on that many drugs.  No matter how good you are.
  • You can’t just go taking over in the OR, bursting into the OR or really, doing anything in the OR if you are not currently practicing as a surgeon.

    No. Just, no. Image from housemd-guide.com.

  • There is a financial and ethical limit to how much you can and should do.
  • Doctors aren’t immune to whatever the guy in the bed has.

Ringing in 2014… By partying like it is 1994.

Yet another New Year’s Eve on call.

5 ID consults today… 5.

How festive.

On the bright side, it was home call, so the Child and D came over and we partied like it was 1994.

The 1994 making factor… The pager.

No. Clearly someone is trying to still push the paging concept. Image via braddye.com.

Clearly, nobody really wanted to use a pager after 2000 and the pager would have been pretty cool around that era

Also, we ate pizza made on Danny’s Pizza crust, which we recall from our childhoods as cool… Thus, more 1994.

And the visitors left before 11.  Also reminiscent of our childhoods where I wouldn’t be awake after something like 9 on New Years Eve.

This makes this New Years substantially better than last year where I got to watch fireworks from a patient’s room and ordered in Chinese food with the nurses.  I rang in the New Year sorting out a transfusion reaction and spent part of the night with someone with mass GI bleeding.

Progress, my friends.  Progress.

Even if our party was circa 1994.

Now, Patrick and I are watching Mr. Bean’s New Years episode to keep me awake until the real New Year.

Image from mrbean.wikia.com.

It reminds him of when his Uncle babysat he and his siblings and they watched it and then ran around a field banging pots and pans to ring in the new year.  He claims this is a tradition… The banging of pots and pans.  I have never heard of it.  I also didn’t stay up until midnight until I was 13 (for y2k, actually).

Happy New Year.

Stunned in a sea of infection

I am stunned in a sea of infection.

No, I do not have a delirium.  I just happen to be rotating through Infectious Diseases (herein ID).

I haven’t felt this dumb in a few rotations.

Image via escapeinabook.blogspot.com.

Okay, I haven’t been on a new rotation in a few rotations, so I guess that it is fair game.

But still… Last time I felt this stunned was Bone Marrow Transplant and prior to that, Cardiology.

I wish it was as cool as running around in hazmat suits trying to ward off the next pandemic superbug.  And some days, it feels a tiny bit like that.  Most of the time, it involves looking at stinky post-op wound infections (oh boy, did I ever smell a doozy today) and trying to sort our prolonged febrile neutropenias.

I like the detective work that can come from ID.  Sometimes, you have to piece together the presentation and patterns in fevers or bacteria to figure out the cause.  Sometimes, you get to find that kind of rare, super cool cause of something.  Just like on  House, MD but without the overqualified and giant team who can do whatever they basically want around the hospital… So, not really like that at all.

Image from housemdconfessions.tumblr.com.

I love the problem solving side of consult-based medicine.  The swoop in a problem solve is cool, but as I think I have said before, I much prefer the continuity of care that is being the prirmary caregiver.

But back to my feeling stunned…

I have never been a big one for microbiology and things.  Antibiotics are a big black box.  I know the go to antibiotic for the common problems and beyond that, I look it up or, well, call ID.  And anything beyond your common yeast infection or virus is basically outside of my comfort zone.

Thus, I find it challenging to sort out a lot of these cases.  It isn’t in my natural knowledge base and sometimes, I struggle even to know how or where to look it up.I get that this is the reason why we do this rotation.

I just hate that floundering feeling of seeing consults and follow-ups and sometimes not really having a clear grasp of what the plan is or will be.  And yes, that happens on most rotations at times, but as you learn, it happens less and less.  It just seems that hopping to this rotation, it is currently happening more and more.

It all comes with time and experience and reading. But until then, it also comes with a lot of, “I’ll look that up” or “I need to talk to my staff doctor about this” and, of course, the “I don’t know.”  Oh, and a lot of changes to my “assessment and plans,” which make me cringe a little.

That is the thing with medicine, the more you learn, the more you learn you don’t know.  This is yet again another area where I clearly don’t know a lot… At least I figured out that much.