this time it's personal

Peds is over. I want more. It's not just the kids - the whole family gets involved and it's all such a warm fuzzy feeling. When kids get better, it feels like you're releasing such potential back into the world.

I had been following one notoriously difficult patient for several weeks on two different services (my team jokes that she "followed" me to my new service). She was constantly surly, listless, bitter, uncooperative with all of the nurses/doctors, her parents were impossible to track down to obtain consent, and to top it off, she was a medical enigma.

After 3 straight weeks of seeing her, barely making any progress (medically or otherwise), she was finally scheduled for a procedure on a day when her parents couldn't be there. She looked up at me, confessed she was scared, and shyly asked if I could go to the procedure with her and stay at her side until she "fell asleep" (from the anesthesia). I began to visit her more and more often outside of my required morning rounds. Our team ended up diagnosing her definitively, and I discharged her on the very last day of my peds clerkship. She was a completely changed person - smiling, energetic, relieved to know "what was wrong with her"... and thanked me for listening and being nice when no one else did.

I know it's cheesy, but I'm convinced there was some element of fate there... how else to explain her being on both of my services AND leaving exactly when I did? I'd like to think I made a difference in her life (and I do hope I did), but she definitely made a lasting impression on me. It's all too easy to become impersonal in this line of work.

Tomorrow I begin my first day of trauma surgery. On call, no less. So really it's my first two days, all wrapped up into one very long day-to-night-to-day.

scut

Today was a big day for procedures. I got to remove the staples from my patient's liver transplant incision. And then I went in on my other patient's EGD/colonoscopy. It's like a video game - or the Magic School Bus. But on a real person!

Then I spent a few hours writing up admit/discharge orders like the little bottom-of-the-totem-pole-bitch that I am. Do endless amounts of redundant paperwork? Yes sir. Right away. I ENJOY meaningless scutwork and 13-hr work days. It's not like I have, you know, a shelf exam to study for this week. Shall I also lick the bottom of your shoe while I'm at it?

On an unrelated note: I somehow manage to injure myself constantly. Bumps, bruises, lacerations, you name it. If I were under 18, CPS would have removed me from parental custody already.

pedi GI

Q&A with an MS3 (me!) on pediatric GI service.

What does a typical day smell like?
Well, pretty much like poop. Kidding. A lot of patients are actually here for liver transplant, malabsorption, or pancreatic disease.

So... GI docs don't work with poop?
Don't get me wrong, I've done my share of "cleaning out" kids with fecal impaction. Medically, this involves infusing Golytely* (osmotically active PEG, combined with electrolytes) down a nasogastric tube and waiting until the kid is dripping clear out the other end. Practically, this translates to several days' worth - literally a shitload - of stale, built-up, previously rock-hard fecal matter. We actually put adult diapers on my little 2-year-old when he finally (and explosively) began stooling after 2 days of continuous Golytely.
*Har har. So punny, those drug companies!

Ew, diapers filled with poop.
Yes. And then they send in the third year medical student to pry open the dirty diapers to document texture, color, presence of blood/mucus, odors, etc. Believe it or not, some GI diseases are described in textbooks as producing "foul-smelling stools." Who is writing these textbooks???

What about buttholes?
Yes, we do that too. Sometimes this just means looking for anal fissures. Other times I have to insert a finger. All in a good morning's work before lunch!

Is it true that GI doctors use food descriptions for poop textures?
Yes. Two notable examples are "banana" and "Wolf Brand Chili."

I've heard you enjoy humorous poop stories. Is poop still funny?
Definitely.

doctor?

Dad
Can you take a look at my feet & tell me what's wrong? (takes off shoes)

Jo
Aauughh!! How long have you had that??

Dad
Since high school.

Jo
And you've never gone to a dermatologist?? I don't know - maybe some topical miconazole. Or even some oral griseofulvin because that looks pretty bad. Seriously, go see a dermatologist.

Dad
Oh yeah, I did. She prescribed mico - what you said. But I didn't fill it.

Jo
... good job Dad.