Classic Gyn Patients, aka what am I getting myself into

Hmmm...so life as a 4th year really is this side of paradise, even moreso than 3rd year. Currently i'm working like a dog- this next week is 13 hour *nights* from Sunday to Sunday...there are not enough yikes for this next week! But, when I come home in the early morning hours, i'm no longer expected to study, or plan bogus presentations that no one will ever ask me to present, or really do anything. Plus I get to do fun stuff at work...most of the time. So I'm going into the field of obstetrics and gynecology and right now I'm at my second of three away rotations. We have had some classic (and I mean classic) patients this week. My resident is too kind hearted to ever say anything about them, but I think I must write about them so I can remember them in the future.

1. "C-word problems"
I absolutely hate the c-word- hate it hate it hate it to the point that I will not talk to a guy if they ever use that word in my company. But you cannot really do the same when your patient uses the word. The 'c word' is a very vulgar term for a womans vagina, and that's all i will say. So this patient was a 30 y/o with some dryness in her c-word. She says, "I go to my regular doctor and try to tell him, but he says, 'Aleshia, you know I don't deal with those problems. You know who deals with that- your gynecologist. So stop talkin to me about those problems.' Hilarious! I have a feeling he too was tired of her using the c-word.

2. 60y/o w/ Herpes sans outbreaks
This poor lady, I diagnosed her with Hepatitis just by watching her; classic features: large belly, paper skin, thin hair, skinny legs w/ large belly, spider telangectasias, even palmar erythema (that sealed the deal.) She says, " Is that unusual to have hepatatis for 20 years and never have any problems?" I urged her to check back with her primary care doctor about her hepatitis which was clearly eating away at her liver. She either had a really bad doctor or was in sick denial... She came to us b/c of suspected herpes outbreak...it was not herpes at all...How do you think you have herpes despite never having had an outbreak? Yikes people!

3. "You took what out? My uterus?!?!"
This story is one I would not actually believe unless I had been there to witness this myself. The patient was a Hispanic lady in her late 40's early 50's at the clinic with her husband for her SECOND f/u appt after her recent hysterectomy. Dr. G says, "You know you will not be having any more periods." The patient looks bewildered, looks at her husband, then back at the doctor and then asks what organ they took out. She was honestly shocked to find out that 1. her uterus was taken out during her hysterectomy and 2. that she would no longer have periods! Seriously! On her second f/u visit! Needless to mention, a psych consult was already in the works.

I love this field, but it definitely brings out the crazies!

This is my life?

Wow! Ever have those moments, when you step out of the moment and think, "This is my life? This is totally amazing!!! How am I so fortunate, so privelaged to be able to do the things I do?" Well that happened today, day 2 of surgery, day 1 in the OR. I scrubed into a shoulder arthroplasty case, and in the middle just looking at this man, lying unconscious on the table I could not help but realize how privelaged we both were. Him, for being able to have the surgery and find relief for probably chronic shoulder pain, and me, for being able to witness the insides (really just the exposed joint, muscles, and vessels) of another human being. How many people get to do this? and really enjoy it?

Wow, life as a third year sure does have its moments! :)

Goodbye medicine!

Wow, so the last entry...I talked with my resident just after that day and she talked with the intern and fixed everything. Turns out, dealing with things works, despite my best efforts to not deal with my life sometimes, it always works out better when I do deal with issues that come up.
Anyways, so this past Friday was the last day of medicine, completed with the awful shelf exam. My final thoughts on medicine. Overall, very enjoyable. I liked the patients, I liked the aspect of working with medical colleagues (via consults and team stuff). I liked the working up medical illnesses, working with patients for a few days or even a couple of weeks for the acute management purposes. I actually found working with families, even when the loved one was near death, to be very fulfilling. Negative thoughts: dealing with social issues SUCKED. I have a feeling this will be an issue in all the specialties. The team dynamic could be very frustrating, especially if some members were incompetent in their role. I'm sure there is more...but overall, I found great satisfaction in IM. We shall see.
Ob is next up! Nervous and excited. What if I don't like it? Then I suppose I will do something else. What if I absolutely love it? Then I'll have to do it, and it will be super difficulty to deal with ethical battles, for my entire career. Yikes....

Arghh!

9 weeks into my 3rd year, and today was the first day that I just absolutely hated. My feeling of discontent was not caused by a patient, or some delay in a meeting, or being in the wrong place, but by the simple fact that I was trying to see patients(and for once we had patients) and trying to learn, and the intern did not really have time to even assign me a patient, or even send me in the right direction. I love this year, almost exclusively b/c I get to ask questions all the time, I get good answers back immediatley and I get to spend time with different people on a daily basis and share in part of their life story. People say 3rd year is all about adjusting to new people and new circumstances and still manage to learn how to be a doctor in the middle of everything. Dealing with frustrations is just part of the 'doctor skill set'...I guess.

Honestly

Honestly, my decision to go into the medical field was multi-factorial, but one of the features of the field I found so attractive was the ability to find an ultimate diagnosis for someone with symptoms they are not all too familiar with. To find clarity to a puzzle that seemed all together impossible to solve.
What's causing that burning pain in your chest after you eat a large burger and fries?
Oh it's reflux, caused by your weak LES and your love of smoking and beer. We can help you with a PPI and counseling for your 'risky behavior.'
But so many problems are not cut and dry....so many!
My current pt. has a lot of different and newly onset medical problems, and his major problem we cannot even properly diagnose. We performed the proper diagnostic test, an LP, and the results were negative, but we are still treating him for presumed GBS. I thought so much more of medicine would be- here are the symptoms- here are the test to do- and then this is how you treat the disease.
Not the case- just like in life, there is are so few black and white things---everythings in shades of grey. There are no more +/-; just 1-99% confidence with large error margins.

Hospital Depression

I am the kind of person who does not immediately pick up on sadness or depression in another person- I don't want to attribute this to my general aloof character, but rather to the many manifestations of depression- anger, over compensation, denial, out right sadness...human emotions can be tricky. The hospital is a place people can easily become depressed- being around illness and death all the time can bring a person down. The hospital is also a place that attracts lonely people with depression. There is evidence somewhere in some journal that probably makes the conclusion that depressed people generally have more health complaints. Don't quote me, but it makes sense- people just don't care for themselves when they are sad. Anyways, there are a lot of lonely people out there.
Dr.- Do you have any family here?
Pt- No.
Dr.- Do you have any close friends that can help care for you?
Pt.- No, it's just me.

How depressing and lonely! I'm very fortunate to have been born into an amazing family that I truly love! I cannot imagine being in a situation in which I would rather be alone than near my family! Very sad.

obs

My observations of the day:
1. Storms here don't just happen quickly; they often brew and brew, and then maybe the rain falls, but sometimes the stormy part dies out before it begins. I love it. I love the rain, but I could just watch the storm build all day. The anticipation of the downpour, the lightning, the thunder is like waiting for Christmas morning to come to see what is in the small box under the tree. Love it!
2. Healthcare= Social work. Most people go into this field because they have a true desire to help people. But what happens when people are lazy, unkind, don't want you to help them and just want to be fixed without any strings attached? What happens when people think they are entitled to unlimited welfare and healthcare, but do not want to be burdened with any responsibility? Less than six weeks in, and I am finally getting the cold hard truth about healthcare. But that still leaves us with an enormous burden of trying to make sick people better, even if they are not currently able to or wanting to be helped. How do we change the hearts of people that are so unhappy with themselves that they appear stuck in a vicious cycle of absolutely rejecting help with their health? Many things for me to think about over the course of the year, and unfortunately probably plenty of patients to remind me of this problem.
3. I love the hospital in the early AM hours. It's quiet, patients are resting, people do not seem as sad to be in the hospital, and the entire day awaits to solve medical mysteries and restore people to health. At the same time, it is a little creepy- lots of zombie- like students standing around the hospital corridors in green scrubs and white coats. Nurses checking in at the tele station. The flicker of a light from a patients hospital bed. All together, it's a very creepy place. But then the sun rises and the craziness begins.
Some days it's just nice to take in the little blessings when they come your way.