31 March 2007

rant: female body processes

**disclaimer: if you're a guy, reading my blog, you might want to skip this post. that is, unless you're the odd-man-out who can deal with rants about the female body's processes.**

I realized recently that the contents of my posts have taken an odd turn: I've ranted about being a patient much more than I've discussed medical school. perhaps that's because being a patient has taken over medical school. at any rate, this post will not be different. i need to rant.

i've mentioned previously that i've experienced various medical problems throughout my life. enough medical problems, in fact, that my classmates would likely freak out if my case file were presented in pbl instead of our usual, tame, uncomplicated case patients. (<--i say this because we once had a case where the patient--gasp--actually had a past medical history and my whole group started whining about how difficult the case was.) amongst my myriad pathophysiologies is an endocrine disorder that basically throws everything out of whack. generally what this means is that i don't get periods unless they're induced. now before you ladies utter the ubiquitous "lucky," let me tell you, this is not a bit of good fortune i've stumbled upon. having to induce periods sucks. i once had to buy $500 in medication to induce one. how lucky is that? you're right, it's not. [and, in case you're wondering, some scientist somewhere decided that women need an average of four periods a year in order to stave off the risk of endometrial cancer; hence the necessity of the inductions. no, i'm not yet convinced it's worth all of this trouble.]

this year, since i clearly don't have enough going on, my body has decided to mutate again. so last semester, right after the term ended, i got a spontaneous period. now, this should be no big deal, right? i mean, women go through this all the time, don't they? well, most do. but i don't. which means that every time i get a spontaneous period (all of the like seven or so times it's happened in my life), i spend the two days before it comes thinking i'm going insane because, of course, i don't recognize that what i'm suffering from is a huge hormone shift and not mental instability. in essence, i regress into an inept thirteen year-old girl who cannot figure out how to stave off cramps, what types of tampons to use to prevent flooding, how to keep from crying over everything, etc, etc. it's horrid.

so, when i went to see mr_dr_do the other day and ended up crying in the parking lot? should have been a clue, right? *sigh.* i'm hopeless. i came home from that appointment and proceeded straight to my bed and have not left the house since. sometime late friday night/early saturday morning, i was up reading another novel (yep, that makes two this week...), but i couldn't focus. i seriously thought i might be having a nervous breakdown, that's how agitated and out-of-sorts i felt.

as it turns out, i'm not insane. rather, i was experiencing pms but didn't realize it until the damn thing appeared saturday. now, on top of the abdominal pain i already have because of the lap chole and wtf has been going on since, i have cramps. and i, the person who is usually very peaceful and who saves turtles from certain disastrous death on the road (<--i'm not going to live that one down anytime soon; my mom was driving the other day and i made her stop so that i could carry a turtle across the street because it was going to become road-kill if it tried to reach the pond itself; she thought for sure the turtle was going to bite my finger off!), now am so angry that i want to castrate the first guy i see. why? because *they* don't have to do this. and this--this period thing--this *sucks*! seriously, how in the hell do women get anything done if we spend so much time feeling like this? it's as if somebody is trying to hoover all the energy out of me from below. (oops, can you tell i was reading a british book? ;-) ) i want to throw a temper tantrum. seriously.

29 March 2007

the difficulties of being the patient in the doctor-patient relationship

a few days ago, i had what i thought was a good idea. i thought that, after all that i'd been through recently, it would probably be a good idea for me to go see mr_dr_do and see if we could come up with a plan for my healthcare that would maximize the possibility of me being at least somewhat healthy by the time i return to school in august. what was not a good idea: scheduling this appointment for the day after i'd gone *splat.*

i started getting anxious about the appointment last night. that was my first indication that something was wrong. i tried to think about it--why am i feeling anxious? but i really couldn't put my finger on a precise cause. i thought some of it had to do with my embarrassment over having to leave school, another part to do with the fact that i was feeling just emotionally vulnerable enough that i was afraid i would cry (why it bothers me to cry in front of doctors, i really don't know--but it really bothers me), and some to do with the fact that, ever since i was a little, little kid and experienced some GI problems, i have absolutely detested talking about my bathroom habits. to anyone. you can tell me all about yours, just don't ask me about mine. it's an odd quirk for a doctor-to-be, but at least i know where my quirks lie.

needless to say, i didn't get much sleep last night. this was okay, because i was reading a really good book (the sunday list of dreams, by kris radish) and relishing it because it's been so long since i've had a chance to read a non-science text. but it also meant that i was tired today--more tired than usual--which just means that i was all the more vulnerable by the time i arrived for my appointment. this was not a good thing.

mr_dr_do's office is quite nice. it's the only primary care office i've ever been in where i didn't feel like i was one cow in a herd of cattle. everything is simple, efficient, and, aside from the argument i'd probably get from the lady who answers the phone over this one, it's actually quiet. this is a relief for me, as i hate being stuck in waiting rooms that feel like airport gate areas, with tv's blaring, tons of general noise, and, invariably, carpet patterns that make me dizzy. so, again, when i go to mr_dr_do's office, i really have nothing to be anxious about: i'm not overwhelmed by his office and i like having him as my doctor. but today, i was anxious.

it didn't help that the assistant who retrieved me from the waiting room was not in a good mood. and here's where i run into something i don't understand about certain medical offices: what is the deal with the assistants? she took my vitals (grudgingly), then asked me why i was here to see the doctor today. now, i get that one of the most important parts of the medical record is the chief complaint (cc for short), but seldom do i feel like talking to these people, given that the physician always proceeds to enter the room and ask me the same damn set of questions. what's the point? i really, really don't know. so...i was hoping (i must be delusional) that by giving this chick (<--i don't ordinarily use this term, but anyone who dyes their hair with blond streaks and has funny patterns on fake manicured nails fits the description too well for me not to use it) my letter of withdrawal from school, i (a) wouldn't have to talk to her for much longer, and (b) between that and my cc, should've been enough information to give the doctor a clue as to why i'd appeared for this appointment. i'm not sure, though, that she actually wrote anything down. the chick soon disappeared, and i was left alone to indulge in my book. here is where the experience begins to get even more problematic. the book itself is basically about a mom who finds out that her estranged daughter has opened an adult toy store in ny to provide women with options for obtaining and maintaining sexual health. so the part i was reading was describing one of the new employee's feelings about his first day on the job. he was astounded by the number of women who came in--particularly about their ages and the fact that so many were not sexually satisfied. i went to a women's college for my undergraduate degree, so i'm pretty opinionated about this subject. i didn't start off at this college, but rather at a catholic institution, at which they didn't even sell condoms on campus (in spite of the fact that 80% of the student body was engaging in random hook-ups every weekend). i transferred out of there after my first year and entered a totally different universe. i learned that women who are educated talk about things like birth control, masturbation, toys, fetishes, body-types, etc. you couldn't go to this school without learning about these things, and, i think, by the time most women graduate, they're pretty damn liberal about this stuff. (yes, even the republican women.) so, i was getting a little homesick as i was reading this book. i miss being in a place where sexuality is celebrated instead of suppressed. and i feel odd about the fact that i've landed in a medical school where they're still rather, well, in the dark about some of these things. it bugs me, in particular, because i want to encourage women to be more in touch with their bodies and know that liking sex doesn't make you a slut. not to mention that it is a woman's right to have an orgasm. but that's just my opinion....

anyway, it was an odd thing to be reading/feeling when the doctor walked in the door. i was relieved that he didn't have the hot 3rd year med student with him this time--i don't think i could have tolerated being outnumbered by that much testosterone/eye candy just then. it was also one of those times when i felt oddly ambivalent about seeing a male doctor. and this is something i still don't understand. most of my doctors are male. my main specialist in my hometown, who has handled the majority of my healthcare up until now, is male. he's seen it all, so to speak, and i don't have any problem with that. but i was struck, when i saw mrs_dr_do the week before, at the different type of energy she brought to the patient encounter. there was something comforting about knowing she's experienced being a woman and knows what it feels like to be in this type of body, and somehow that was expressed in the way she touched me. not to mention she didn't make a big fuss over things like listening to my heart under my shirt like physicians are supposed to do. nothing makes me quite so frustrated as knowing that a physician is taking a shortcut because he's too embarrassed to put the stethoscope under my shirt. i had a surgeon do that recently, before surgery, and i was stunned. there was an assistant in the room--it wasn't like i was going to claim being molested or something. but there's the rub--in today's pc, litigious society, doctors are coerced into taking shortcuts during exams. it's not only nuts, but it has the unfortunate effect causing me to dislike my breasts even more--they're always in the way. i know, intellectually, i "shouldn't" feel this way, but sometimes i feel like it's just another thing that makes an excuse for discrimination. then again, maybe this anger i have is more about the fact that i haven't had anyone around to enjoy them in a long time. did i mention that i miss having a boyfriend? <--odd thing for a feminist to say, isn't it? but i digress.

it was pretty clear to me, from the outset of this appointment, that i was not well-prepared to be there. one of the most profound difficulties i have as a patient is knowing how much information to provide a physician with, and how detailed i should be. it seems that i either haven't been paying enough attention (how often have you been taking x for your nausea? i dunno....), which frustrates the doctor, or i've been paying too much attention (here's the list of everything i've taken, experienced, etc), and get that you-must-have-ocd look. where's the balance? i still don't know. and i'm supposed to be on the professional side of this spectrum now. ha! as if that makes a difference! so, i wasn't prepared. and given the fact that the past ten days have been like a roller-coaster, i didn't know how to answer his questions. i felt myself starting to get frustrated, which wasn't a good thing, because i was already worried that i was going to burst into tears. which brings me to another difficulty of being a patient--communication. mr_dr_do said "i heard you were feeling better," and i looked at him, completely puzzled. "my wife told me," he pointed out. i didn't realize until later, after the appointment, that what i'd said to mrs_dr_do is that i'd been feeling better up until the time i landed in the er with the severe pain, but somehow that came across as i was better in general. given that i was (am?) still a bit freaked by that episode of pain, i don't know what to say about this.

and here we have another point: my desire to please people. especially with my male doctors, who seem to be more goal-oriented, i can see that they really, really, really want to hear that i'm feeling better. and i understand that, because i really, really, really want to stop feeling like crap. but i don't know what to say when everything remains uncertain. am i glad i'm only taking 1 of the nausea pills a day versus 3? yes. but it still sucks to be nauseated and i hate the fact that i have to take the medication at all. mr_dr_do caught this ("are you taking fewer because you're feeling better or because you're tired of taking them?" my answer: "both."), and that's one of the things i like about him--he picks up on such subtleties, unlike most PCPs I've encountered who may have been equally astute (I'm not entirely sure), but certainly never took the time to listen to me long enough to catch these nuances. And these are important nuances in the life of a patient. believe me.

but i so badly wanted to be able to tell him that i was feeling better that it hurt me not to be able to do so. i always end up in the doctor's office thinking, "please, please don't hate me for being a complicated case." sometimes i even go so far as to withhold information that i want to discuss with the doctor because it's clear that s/he is getting frustrated with me. the problem with this perspective, as well, is that i often run into another problem, the one i call the fascinoma syndrome. this is when my symptoms/disease process becomes so interesting to the doctor that s/he gets so caught up in my case as to forget that I'm a human with a life and not a lab rat. *sigh* i cannot even begin to describe the complications that arise from that type of doctor-patient encounter.

the odd part about today's encounter is that it took mr_dr_do a while to realize that part of the reason i was there is that i'd left school because of the medical problems and my anxiety about them. i did end up sharing some of my concerns about all this, but i don't think i was quite clear about how i felt. then again, what the hell does my emotional state have to do with my gut? everything. and nothing.

the other odd thing about being a patient is that for the patient, each encounter with the doctor is significant. i get almost hyper vigilant when i see a physician, in that i find myself latching on to their words and expressions so that i can sort out what happened later, when i'm less overwhelmed. this means that i'm a lot more aware of the encounter than usual; whereas, for them, I'm one of a steady stream of patients they've seen that day, barely distinguishable from the rest. So, i was a little surprised that mr_dr_do thought that i was younger than i am (this also made me a tad insecure: do i seem that immature when i'm here? is it my anxiety that makes me seem young? note that i think these things instead of, hmm...might it be that i don't look like i'm almost 30? why can't i think of the positive possibilities first?!?!?), that he'd forgotten i was an english major in college, and that he hadn't realized that i'm not one of the students who has come to medical school straight from college. he seemed a bit surprised to learn that i've had a long work history in healthcare, particularly in management. too bad i didn't get to tell him some of the crazy stories about managing odd groups of super intelligent doctors with not-so-great personal skills. those stories are unforgettable.

so, what makes a patient unforgettable? and why do we, as patients, care so much about what the doctor recalls about our personal lives? is it because the medicine impacts upon these lives? or are we merely making a mad cry for attention? or could it be both? i really don't know.

there was more to the encounter today--a lot more--but i won't ramble on about all the details. i think my point has been made. being a patient? it sucks. being the doctor? well, i guess i'll find that one out soon enough.

what i do know is that i left mr_dr_do's office today feeling out of sorts and confused. once again, i made it to the car before i started crying...but i'm not even sure why i cried. nothing bad had happened. i did get some help. so why did i feel so odd about the encounter?

maybe i'm just tired of being the difficult patient.

going awol: my exceptionally difficult decision

when i last posted, i'd just experienced a day from hell in which my body revolted and the medical system pretty much tortured me. the time since then has been turbulent, to say the least. and what i'm about to describe may well surprise you.

first, my ct scan came back relatively normal. normal enough, that is, to rule out any kind of pathological process for my pain. the antispasmodics worked nicely to reduce spasms, but my gut remained tender and sore for several days. on the up side, my mom returned to town and proceeded to feed me--so i'm finally off my diet of applesauce, rice, toast and bananas. believe me, this is a good thing.

the whole experience of the pain, the er, etc, however, left me feeling quite anxious. most of you already know that i have a tendency to be an anxious person (again, i was the cautious one of the kids; my brother was the one always running toward fire instead of away from it, like me). but i have good reason for my anxieties regarding my healthcare. to bring the point home without offering too much information, i'll turn 30 this summer, and in this decade of my 20s, i'll have lost 3 different internal body parts, been put through chemical menopause, have endured four surgeries (three abdominal, one routine loss of wisdom teeth), spent more money than i've earned trying to pay for all the procedures and doctors' visits, and, at one point, counted up that I'd been put through more than 24 pelvic &/or rectal exams in a period of 18 months. No, i'm not making this up. and i don't have munchausen's, either. i've merely had a string of really, really, really bad luck. speaking of which, does anyone know where i can get a body transplant? or a refund? or at least some *good* luck? i feel like i could be despair.com's poster child.

so...anyway...let's just say that the recent medical events have pushed some major buttons in me and that now i'm at the point of feeling rather depressed by all of it. it didn't help that i was under tremendous stress in school. in fact, tremendous may be putting it lightly. since i failed a course in the fall (i'm blushing; this still embarrasses the heck out of me), mwms put me on "probation." i'm not the only one out of 163 that's now on the dean's hit list; in fact, 3 didn't even get a chance to return for this semester--but it still really stings to be in this position. not to mention that it makes me doubt myself even more. it's a tough spot to be in, considering that this is precisely the point when i need confidence the most. but the worst thing was the pressure of knowing that if i failed another class, i'd lose my seat in medical school. for good. and i've worked way too long and way too hard to get here to let that happen.

the_godfather has been working hard to coach me through this process and I really don't think i'd have gotten this far without him. in fact, i'm convinced i wouldn't have. but what he showed me last week was probably the most powerful thing of all. i've been doubting myself so much that i keep getting paralyzed. i freeze on tests and i've generally been feeling, well, stupid. in pbl last week, however, something major shifted.

throughout the week, i ended up in positions where i was leading the group. this was particularly profound last friday, when i was given the role of scribe (the person who writes case information on the board and directs the flow of the group discussion). that day, i realized that my intensive liberal arts training, in spite lacking science training, prepared me for clinical cases in an amazing way. i know how to ask questions. i know how to lead group discussion. i know how to teach. and, somehow, through all of this, i've developed instinct--this sense that i know how to approach a case in a logical, yet thorough, manner. and i remember the human side of it all, too, which is not always an easy feat when your patient is on paper and your whole group is intent on "solving the case" rather than thinking of it as a real live situation that we'll face someday soon. i was stunned by what i was able to do in pbl on friday. during wrap-up, all my group-mates commented on it. since beginning of medical school last august, it was the first time i've felt confident in my abilities. and let me tell you: it felt really, really good.

friday afternoon, after a long discussion with some of my classmates, i went for my weekly meeting with the_godfather. before i reached his office, though, i ran into biochem_enthusiast, my facilitator from the first 10 weeks of these past two semesters. he is also an exceptional teacher and a very interesting person, even if he does sometimes get hyper-obsessed with those pesky little molecules that do everything in our bodies. ;-) he was concerned about me and, for the second time, questioned as to whether i should take a leave of absence. hmm...

i went to see the_godfather next. 28 days out from a big pbl exam that would basically cover all of neuroanatomy (on which we have not been lectured; we've merely read the book and taught ourselves), i was starting to hit the peak of my panic. and that's when everything began to unravel. the_godfather pointed out that i was performing well in pbl--so well, in fact, that i'm often two steps ahead of my colleagues. he also noted that this is not showing in my exams because i'm freezing. i mentioned that i'd tried taking some anti-anxiety medication, but that it had been sedating (and therefore not very helpful for exam-taking purposes), but he stopped me. "this is not a physiological problem," he said. "this is a mental problem." and, in hearing him say that, i knew he was absolutely right. he was also quite accurate in pointing out that i've had a rough year. i threw out my back right at the beginning of the year, which subsequently threw off my studies at a crucial time, and then, right about the moment i was recovering from that, my grandmother died, as did one of my favorite high school teachers with whom i was close. combine that with undiagnosed gallstones and the pain they cause and, well, you get where i'm going: first semester was a nightmare. [a note on this: i wrote a lot during that time, but i haven't published it here yet. i haven't decided whether i'll go back and add these to the blog or not, but i thought i should explain why some of this is just being mentioned for the first time.]

when you add into the mix that this semester has involved illness, surgery, recovery, and more illness, it's clear that i haven't had the opportunity to adequately learn the material, let alone show that i've learned it. so, to make a long story shorter, i finally made the decision to take a leave of absence from medical school.


after working so hard for so many years to get here, it's hard to believe that i've made the decision to step away from medical school. in fact, it feels completely surreal. but here i am, one day after the official clearance from dean_honey (who, upon hearing my decision, said "honey, you're making the right decision. you should've done this months ago. i'm glad you've gotten over your stubbornness."), and i feel like i've been shot out of a cannon or something. it's...overwhelming.

so what does this all mean? well, other than another $50K in student loans (i must be crazy to be doing this), it means that i get to repeat the first year of medical school. so now i'll be in the class of 2011 instead of 2010. this feels *very* strange to me.

on the upside, though, i now have four months to get my health under control (<--maybe that's not the best phrase to use...maybe i should say more balanced...because i clearly have no control over this crap whatsoever). i also will have a chance to fill in some of the gaps in my education (since i wasn't a science major in college, i still have some areas of science that are unfamiliar to me, in spite of all those post bacc classes i took). if i can find someone willing to hire an overqualified slave (will work for food!), i may be able to earn a little money, too. that would certainly feel good.

in the meantime, though, i'm reminded of one of my favorite episodes of the west wing. (yes, i'm a wingnut. i loved that show. i'm not usually addicted to tv, but i never missed that one.) in it, cj is exercising on a treadmill and her pager goes off. so she's trying to check her pager and talk to the guy next to her. that's when she trips--splat--and gets thrown off the treadmill. that's *exactly* what this feels like.


20 March 2007

the human pincushion

today began as a good day. thanks to the recent med changes made by mr_dr_do, i'd had a relatively productive weekend (one where i at least slept at night and was awake during the day--amazing how much that helps!) and i got to pbl bright and early, ready to dig in to another case. we'd just switched facilitators the week before (for our pbl groups, there are 8 students and 1 facilitator. the groups shift every semester, while we switch facilitators every 10 weeks or so) and i'd had the miraculously good fortune of getting my advisor, the_godfather, as a facilitator for this section of the term. i cannot even begin to tell you how excited i was by this. the_godfather is an amazing teacher, not to mention one of those rare people who can be honest and diplomatic at the same time. i knew he would mold our group dynamics to the point that we'd become a productive, respectful, and self-sufficient learning group.

when the_godfather walked into the room that morning, he asked me how i was feeling. it was the first time since the surgery that i reflexively and unhesitatingly said, "good!" and really meant it. we began our case, which involved some difficult interpretations of a CT scan, where we were trying to find one of the strangest-sounding tumors you can imagine (a pheochromocytoma). i had the opportunity, in the midst of this, to ask some particularly crucial questions. my colleagues tried to ignore me, but i became more persistent than usual. heck, i was feeling well--and i was very excited about how this case was teaching us to combine neuroanatomy and endocrinology. so, i particularly kept pushing for the group to identify a big glowing spot on the CT scan (in a CT, the stuff that shows up bright white is either really dense, like bone, or something that has picked up a lot of contrast material, if contrast was used, such as blood vessels). after a few minutes of tangents, the_godfather finally said to the group, "and what is that big glowing spot there?" sure enough, it turned out to be the tumor.

By the time we finished reading the scan, we'd been in group for almost an hour. then, all of a sudden, out of nowhere, my gut spazzed out. it was one of those experiences of pain where at first you think, 'oh, that really hurts...but it'll pass...it's probably gas or something.' but it didn't get better. in fact, it got worse. a *lot* worse. i lost track of where the group conversation had gone. i was trying to breathe and desperately hoping i wouldn't throw up on the table. within what must have only been a few moments, though, i broke out into a cold sweat. that's when i started to realize i was in trouble. after about ten minutes of sitting there like this, i finally whispered to the_godfather that i needed to leave. now.

i packed my books and practically ran from the room. i got to my car, hoping, again, that being out in the fresh air might make me feel better, but my pain was increasing. i didn't even think about it--i knew i needed to go to the er. stat. given that my mom, who'd stayed with me for a while after the surgery, had gone back home for a bit, i knew i had a small window in which to get myself to the hospital. fortunately, this new planned urban development (pud) i live in has a hospital in the middle of it, so i only had to drive a few miles.

i got to the er and it was busy considering the size of the small place. it took about 45 minutes before i was brought into an exam room, and, at that point, my pain had already begun to dissipate. i was relieved that it hadn't gotten worse, but also a tad undone by the fact that it had had a sudden onset and such deep intensity. the attending physician finally came in, poked my belly, and said he'd run some tests. he then asked me if i wanted anything for the pain. i didn't, at that point, feel that i needed a painkiller so much as an anti-spasmodic--a medication that would relax my muscles and stop them from remaining in this horrible contracted state. he agreed, and then went on his way. a little bit later, one of the nurses comes in with an injection. i raised my eyebrow at this--the antispasmodic i'd requested comes in a fast-acting sublingual form, as well as tablets, so i was surprised by the choice of an injection. now, my medical history is lengthy and complicated enough that i've long gotten over my fear of needles. i've even had to give myself intramuscular injections before. but i must say that any medication that does not last as long as the injection site remains sore is a medication that really needs to be rethunk. my butt hurt like mad for the rest of the day.

i slowly started to feel better, but still was unwilling to uncurl myself from around the quasi-pillow they'd provided me. a guy, resembling the age of a sixteen year-old, came in and placed my iv. i was surprised--and relieved--that he got it on the first try, as i have notoriously difficult veins. he drew several vials of my blood and then capped off the port in case i needed iv access later. then i waited. and shivered. and waited some more. an er is, truly, a terribly uncomfortable place to be when you're ill. i didn't want to complain--where i come from, er waits are usually about 12 hours long, and that's just to get through triage. so being in this small hospital, i actually felt relieved. it was a busy morning, but i knew that busy is relative. besides, i've worked long enough in healthcare to know when to be patient. the billing rep who came into the room to get my insurance information nearly passed out when i automatically handed her my insurance card, driver's license, and credit card for the copayment before she had a chance to ask. she spent the rest of the morning periodically walking past my room, popping her head in, and threatening to make me work if i didn't get out of there soon.

i think it was about 1:30pm when the doctor finally reappeared (the whole incident had started at just after 9am). he said that all my tests were negative and that i probably was just experiencing irritable bowel syndrome (ibs) from the surgery. that surprised me--ever since my appendix ruptured eight years ago (and wasn't diagnosed for over two months...), every doctor i've seen has given me this wastebasket diagnosis. [a note here: a wastebasket diagnosis is one that is given when there are clearly a constellation of symptoms that people have that can be grouped together, but where the cause is unknown. it's sort of like saying, we don't know what's wrong with you, but here's a label for it. it doesn't describe anything about how or why the problems occur, how it might progress, or even what might treat it best. hence the term, wastebasket diagnosis.] i get it--my bowel is pissed off. but any one's bowel would be pissed off after 2.5 months of purulent infection, followed by two surgeries and a host of other complicating factors. never, though, had my "ibs" ever caused pain that severe. never. nor had i ever read about someone experiencing this type of pain with ibs as the underlying cause. so i was, needless to say, skeptical. he then said he'd give me a prescription of the antispasmodic i'd been shot with; when i asked if it would impair my cognitive function (an important thing to know when one is a first year medical student), he said, "well, do you feel extremely sleepy now?" i didn't feel extremely sleepy right then--but i knew i was still on an adrenaline rush from the pain and my subsequent fear. so, thinking he'd proven his point, he attempted to leave, but before he could i asked about what i should do if the pain comes back this intensely again. he just shrugged, said to take the medication, and basically blew me off.

by the time the nurse came in with my discharge papers, i was angry. it didn't help that the first thing the nurse asked was whether or not i'd driven myself to the hospital. my response: why, yes, i had. to which the nurse replied, "oh. i don't know if you should drive after taking this medication, it can make you drowsy." i pointed out that the doctor had just told me that this wouldn't impair my function, but the nurse read down the sheet, found the section on side-effects, and sure enough, first thing: "may cause drowsiness or dizziness; avoid driving or operating heavy machinery until you know how this medication will affect you." it was a good thing the doctor was gone by this point, because i might have hit him if he'd still been around.

after finally getting the catheter removed from my arm and climbing back into my warm clothes, i left. i stepped out into the sunlight and walked to my car. i got into the car, and that's when i lost it. i just started crying...i couldn't believe i'd just been treated like an idiot by (yet another) physician...i couldn't believe i'd just paid out the nose for this privilege (er visits have a hefty copayment with my insurance)...and i couldn't believe that after all of this, i had no more idea as to what had just happened to me than i did when it started.

i decided to call the dr_do's and see if they could see me. fortunately their office is awesome (i swear, i have never seen a primary care physicians'/family practice office run so smoothly or be so accessible), and mrs_dr_do agreed to see me. within an hour, i was in her office, explaining what had happened. i'd had her as a professor for one of my classes in the fall, but had never seen her as a patient. i was a bit nervous about this at first (i'm really damn picky about who i allow to treat me after what i've been through over the years), but she immediately put me at ease. she was incredibly helpful, gave me advice, and then ordered a CT scan for me. since i could either go for the CT right then, or wait ten days for the first available spot, i decided to take the appointment that evening. i drove from their office to the CT place, which, fortunately, is only about a block from where i live.

i like this radiology center--i'd been there for my second abdominal ultrasound a few months prior, when my gallstones were finally discovered. the staff there is incredibly nice, and they do some neat things to ensure patient comfort--like providing us with scrubs to wear for the test instead of making us wear those ridiculous paper-thin hospital gowns. i felt relieved to be there and eager to get to the bottom of my problems.

unfortunately, however, i hadn't had anything to drink since before 8am except for the awful, horrible, barium contrast material. so i knew i was dehydrated, which is not a good position for me to be in when someone wants to place an iv in one of my veins. i inherited tiny, deep, rolly veins--in short, i'm a difficult stick. some phlebotomists continue to run in the opposite direction when they see me coming, that's how bad it is. but i'd been having good luck with labs in this town so far, so i wasn't overly worried. at least, not after the first attempt. then there was the second attempt. and a third. at this point, i was ready to let the guy do the damn scan without the intravenous contrast. but he said he'd try one more time (and not dig around this time) to see if he could get it. i guess for me, the fourth time is the charm, because he finally hit a vein in my hand and got the catheter to stay in place. by this time, though, i felt absolutely ill. the insides of both my elbows were raw, as were the backs of my hands. it sucked, to say the least.

antecubital fossa
(i.e. inside elbow)

back of right hand

in an attempt to appease me, though, the technician let me look at my CT scans on the computer. it was exciting to know that i could read them; thrilling to know that i didn't have a pheochromocytoma like the morning's patient; and basically amazing to get to see my body on a screen like that. i could see where the surgical clips had been placed during my laparoscopic cholecystectomy--so that was pretty amazing, too.

by the time i left the imaging center, though, i was a complete mess. i came home, tried to write out some of my feelings on this blog, but ended up saving it for publication until later. mrs_dr_do had insisted that i take a narcotic as well as an antispasmodic for the pain (my gut had been so tender when she examined me that i kept apologizing for guarding the whole time), and, although i really dislike taking narcotics, i followed her instructions and then proceeded to sleep through monday night and almost the entire day tuesday.

i was still sore when i awoke, but the medications had clearly helped. what i couldn't shake, though, was the fact that i'd spent a day as a human pincushion...and got no answers from it. the whole experience left me feeling bewildered, frustrated, angry, and a bit horrified that i'd gone from feeling well to feeling like someone was wringing my guts from the inside, within a matter of moments.

the lingering fears remain: will i ever feel better? will i ever have a consistent period of time where my interactions with the healthcare profession as a patient are positive? what the hell just happened to me? is something wrong, or am i going crazy? will i forever be a human pincushion? i guess only time will tell....

18 March 2007


like the proverbial deer in headlights, i'm paralyzed. i've spent the past hour "trying" to read a chapter from my neuroanatomy textbook, but without any success. but there's the rub: in medical school, is there such a thing as success? and if so, what does it look like? i ask because i haven't found it yet....

throughout this whole first year, my colleagues and i have been involved in a dance of sorts--one where we're constantly being evaluated (there is, i kid you not, an exam of some kind every week, if not more often) and consequently re-evaluating ourselves. it was suggested to me, when i was a pre-medical student, that it takes aggression to survive and succeed in medical school; this, of course, was always presented to me in the context of me being deemed by someone to not have enough aggression to get into medical school, let alone through it. what i'm finding, however, is that it isn't aggression that is needed to be successful here. rather, it seems one must be completely unaware of any self-doubt one might have--and that's where i get definitively stuck.

over the christmas "break," i spent some time with my younger brother--i'll call him super_blaze for reasons that will soon become evident--who has decided to train for a triathlon. he'd gotten a training book that he shared with me. in it, there was an anecdotal story that i found quite interesting. it was about bumble bees. apparently, some scientists decided to study the bumble bee to see how it flies. after all, it's shape isn't exactly aerodynamic, nor are its proportions particularly indicative of flight capacity. so, the scientists did tests, and more tests, and even more tests. do you know what they determined? their studies proved that the bumble bee can't fly. as the book aptly noted, it's a good thing nobody told the bumblebee that. :-)

i suspect this is a quality that must also be inherent in someone training for a triathlon--after all, is it not hubris to assume that one can swim, run, and bike all those miles in one stretch? apparently super_blaze doesn't think so, because he's doing it. and it's amazing. but then, he's always been the type of person who can, for instance, jump off an eighty foot water tower and enjoy it. (<--no, i'm not making that up. he did that. and he didn't end up in the er, either.)

but i'm not super_blaze. (i must have been the practice trial in the gene development department for my family, because i developed with an intense fear of adrenaline endeavors, as well as a predisposition for losing body parts in spite of being relatively kind to my body....) i'm rather conscious of the fact that i cannot fly. in fact, one might say that i'm hyper-conscious of my limitations. but i'm beginning to think that, rather than serving as some protective function, this awareness is turning out to be a barrier. one that, in particular, precludes success in medical school.

so...how do i unlearn the consciousness that trying to learn all of neuroanatomy in six weeks is absurd? how do i convince myself that i can learn this, rather than assuming from the outset that i'm doomed to fail (again)? if i've already experienced failure here, then how come i'm so afraid of having it happen again? why am i so tangled up in my feelings about all of this?

i sure wish i had some answers....

17 March 2007

blog tweaks

i decided to add some flavor to my blog and i want to share some of the changes, since they may not be readily apparent.

the most important change is my addition of case files. for those of you who've studied medicine and/or have been a patient long enough that you know how to read your own chart, my creative license will be readily apparent to you. for those of you who haven't studied medicine, a bit of background information here: during the first semester of medical school, medical students learn how to take a patient's history. this is always recorded in a particular manner and then presented back to the more senior member of the medical team as a "SOAP" note. since i want my blog to remain semi-anonymous, i didn't want to describe people by their real names. but people are what make my life colorful, so i wanted a way to bring them into my posts. hence, i made up "case files" for some of the people i talk about. the pseudonyms in the posts will allow you to link back to the case files so that you can learn more about that person if you so desire. i see it as a way of providing more context for my ramblings. [N.B. these case files are meant to be funny. they in no way represent a popularity contest or anything of the sort, and for some, identifying information has been tweaked to protect the innocent (or not so innocent, as the case may be!)].

in addition, thanks to google, snap and librarything, i've been able to add some neat features to the sidebar (like links to medical articles i read and find interesting) and also a preview feature for the links in posts (hover your mouse cursor over "history" in the paragraph above and you'll see what i mean). i've had fun with these; if there's anything else you'd like me to add, just let me know. i'm discovering that people put all sorts of random information in their sidebars, like what they read last, the last movie they saw, or their "favorites." i tend to want to share things, like articles and books, that open up peoples' knowledge of medicine and health care.

i also added a post about problem-based learning (pbl) since so much of my education is in that format right now. it helps explain all the little things that i may forget to describe when i'm writing a post.

so...that's the 411 for now. if you have any requests, please let me know! :-)

13 March 2007

an addiction?

can blogging become an addiction? if so, i'm in trouble. it's not even the writing itself that sucks me into the time abyss, but rather that this is yet another tekkie thing for me to learn--and yes, i'm a geek. a gadget whore. i should come with a warning label. today it would say: this is my brain without any sleep. any questions?

so it seems i'll be playing around with my blog template for days to come, especially since google is always adding such great features, and because my friends' sites inspire me to do more. the best thing about today (other than getting to be the female guinea pig for my clinical exam class...but more on that later....)? wee me. it's all j.p.'s fault. you'll see....

little known facts about women & aging

this semester, in addition to being inundated with work for PBL, OMM, & CE, we first year medical students also have the privilege of taking on 4 additional 5-week classes: ethics, geriatrics, public health, & healthcare management. for geriatrics, one of our assignments is to write a review of an article. the particular one i chose, "comprehensive evaluation of the older woman," (H Amin MD et al. Symposium on Geriatrics: "Comprehensive Evaluation of the Older Woman." Mayo Clin Proc. 2003;78:1175-1185.) offered some surprising information. Here are some of the little-known facts I learned:

  • in general, the aging woman accounts for nearly 70% of the caregivers of older persons and a woman is more likely to live alone, experience more years of dependency, and, in her later years, experience more financial difficulty and/or poverty than a man
  • dementia, defined as an acquired persistent and progressive impairment in intellectual function with compromise in multiple cognitive domains is the fourth leading cause of death in older women, with a prevalence of 25% to 47% in patients over 85
  • delirium, defined as an acute, fluctuating disturbance of consciousness, associated with a change in cognition or the development of perceptual disturbances, and has two causes: an underlying medical condition or medication. the most common cause? polypharmacy (i.e. 5+ medications--including vitamins & herbal supplements--taken on a daily basis)
  • the prevalence of major and subclinical depression in older women is 15% and women aged 65+ are 2x as likely to have depression as men of the same age (so much for the theory that hormones cause our mood swings, eh?)
  • women are twice as likely as men to suffer urinary incontinence
  • falls are the 6th leading cause of death in elderly persons and contribute to 40% of nursing home admissions; there's a 20% mortality in the first year after sustaining a hip fracture
  • the lifetime mortality risk of coronary heart disease (CHD) among postmenopausal women is 31% compared with 2.8% for hip fracture, 2.8% for breast cancer, & 0.7% for endometrial cancer; of women 65+, 55% experience functional limitations, morbidity, & impairment of quality of life due to CHD (and yet we hear more about cancer than we ever do about CHD)
  • more than 1/3rd of women (ages 20-70 years) in the united states have hypertension, 25% have hyperlipidemia, 25% are smokers, 25% are obese, & nearly 60% are sedentary (i.e. all this mortality is relatively preventable)
  • nearly 70% of sudden deaths in women are from unrecognized CHD; in women, 40% of all coronary (i.e. heart) events are fatal, but women with CHD are not treated as aggressively as men (traditionally, anyway--let's hope that's changing!)
  • women who smoke present with their first MI (i.e. heart attack) 19 years earlier than female nonsmokers
  • the onset of type 2 diabetes can be reduced by 58% in women who exercise moderately 2.5 hours per week; improvement in cardiovascular risk has been shown even in women who walked only 1 hour per week
  • the lifetime risk of developing hypertension (i.e. high blood pressure) in people who never had it before who are 55+ is 90%; in persons over 50, the risk of cerebrovascular disease DOUBLES for each 20/10-mmHg increment of blood pressure level
  • more than 80% of patients with diabetes die of cardiovascular disease; the risk of CHD in women with diabetes is 3 to 7 times higher than in women without diabetes
  • after age 65, the risk of developing uterine cancer increases by 2x and the risk of ovarian cancer by 3x; and yet...15% of women aged 65 to 74 and 38% of women over 75 have never had a PAP smear
  • endometrial cancer is the most common invasive gynecologic malignancy (but we're not even close to having developed a reliable test for it)
  • age is the most predominant risk for breast cancer; 1/3rd of breast cancer cases are in women over 70; an increased risk of breast cancer was found in people who drink alcohol (but alcohol lowered the risk of CHD...pick your poison?)
  • decreased sexual activity is influenced by the fact that by age 80+, there are 39 men for every 100 women; the geriatric population has the second highest rate of HIV infection after teenagers (proving that viagra should be packaged with condoms)
  • in women aged 65+, 31% did not graduate from high school

11 March 2007

dazed & confused

i'm not sure how much i've written about my post-op experience. i seem to be in a never-ending battle vis-a-vis how much personal information to reveal here. that may sound funny after posting pictures of my healing gut, but, well, that was my gut. to me, emotions are much more personal.

four weeks out from surgery, i'm still being blasted by those pesky emotions. so much so, in fact, that i've had an incredible amount of difficulty sleeping...well, at least at normal times...i seem to only be awake in the wee hours of the night, which, contrary to what one might expect, is not a good thing. given that this was starting to make me feel crazy, i decided to go back to my primary care physician (pcp), mr_dr_do. [in an effort to maintain some degree of privacy, i've decided to follow granola_mom's lead and use euphemistic names in place of actual ones. in this instance, my pcp, who is a doctor of osteopathy, is in practice with his wife, mrs_dr_do, who is the fabulous female professor that my school managed to chase off.] mr_dr_do, upon hearing me say that i was beginning to fear that i am just going crazy, said "i hate that word." :-) he's been one of the few physicians i've ever encountered who unabashedly acknowledges the real difficulties of being ill without blaming me for my symptoms. amazing, no?

anyway, mr_dr_do decided to add to my ever-lengthening list of medications. [yes, "good people," as dean_honey likes to say, even physicians-to-be and physicians themselves have medical problems and have to take medication. contrary to past popular opinion, physicians are not infallible superheroes. <--and if you have one that thinks s/he is, run for your life in the opposite direction, stat!] the good news is that, as a result, i've finally gotten some decent sleep. the bad news? i feel dazed and confused.

for instance, at this moment, i should be studying for one of the three exams i have coming up over the next two days. [yes, you read that right: 3 exams in 2 days. and i'm literally paying for this. maybe it's time to re-think the crazy diagnosis....] however, since i keep catching myself staring off into space, lost in thought, instead of focusing on my studies, i decided that perhaps a writing session would do me some good. at least then i'm doing something instead of staring. i also decided to sit on my porch to write, since that way i'll get some sun, which may convince my body that day is day and night is night and not the other way around.

sitting on the porch is still a little strange for me, though. i live on the second floor, above one of the smaller units in my condo complex. these smaller units are invariably inhabited by retirees who spend an inordinate amount of time at home. the good news is that this means there's a built-in security system; the bad news is that someone is always watching me. so when i sit on the porch and hear little_old_man below me sneeze, am i supposed to say "bless you"? when little_old_woman starts cursing in spanish (<--thanks to my friends growing up, i pretty much only learned the bad words in spanish, in spite of being in a city that is predominantly hispanic), is it inappropriate if i begin laughing? what is the etiquette of sharing living space (even if only auditorily or visually) with other people? i wonder....

but i digress. i was talking about emotions, wasn't i? hmm....

lately my emotions have brought me nothing but confusion. as i'm learning (albeit the hard way), surgical recovery is not a linear slope back to health. rather, it's more like a roller coaster, fraught with ups, downs, upsidedowns, and inbetweens. when you add surgical recovery to the stress of being a first year medical student...it's beyond comprehension, let alone my writing abilities, to describe precisely what this feels like.

as you may have noticed from my last post, i tend to get angry more easily than usual. i also am not as good at censoring myself. the never-ending sense of frustration is what hits me hardest, though. i hate feeling scattered and unable to focus. i hate that, in spite of my place on the dean's hit list (it takes talent, does it not, to go from the dean's list in college to the dean's hit list in medical school? maybe not. both the student doctor and mr_dr_do mentioned having had difficulties with medical school. it took me until this week to earn my first A on an exam. imagine what that kind of challenge poses to 160 type-A students? okay, now you have a sense of the atmosphere at school.), i cannot force myself to sit down and study for hours on end. the "maybe-it's-time-to-take-a-leave-of-absence" rumblings have begun, mostly because, unlike most professional schools, mine takes attendance. oh, and attendance is mandatory. nevermind that we're all too anal-retentive to miss class except in dire circumstances.... do they really want me to barf on the floor in the middle of lecture?

anyway, i fear i'm starting to whine rather than write, and my typing, as soft as it is, seems to bother little_old_woman (i do recognize the phrases 'too fast' and 'girl upstairs' in addition to all the four-letter words i won't mention here--who knew that little old ladies cursed so much?!?!?), so i'm going to sign off for now. besides, i'm sure there will be more ramblings from this dazed & confused medical student soon....

10 March 2007

time for change!

first, i decided it was time to change my blog template. the dots were starting to drive me crazy. alas, my attempts to find some really neat artistic template failed when i realized that i was spending too much time tweaking and not enough time studying. so, for now, my html alterations on font, plus a different blogger template, will have to suffice.

but, when i titled this post "time for change," i wasn't thinking primarily about the template, or the impending daylight savings time debacle (does anyone know *why* we still do this? does it stem from hubris? i need my hour, dagnabit!). no, my thoughts were of a more radical sort: thoughts that call for alteration of our conventions.

my problem, at present, has to do with the conventions of being a woman in medical school. more specifically, my problem has to do with american definitions of "modesty," particularly in clinical settings. it's been insulting enough to be a female patient, one who gets asked to don a paper gown for every examination. does anybody really think that wrapping myself in paper preserves my modesty or my dignity? the darn things are practically translucent! not to mention they slide off with the slightest movement, rendering one nearly or totally naked in spite of the paper. but i digress. this week's problem isn't about being a patient, it's about the insult of being a female medical student.

****disclaimer: if you're the sort of person who cannot cope with precise anatomical descriptions of the human body, you might want to skip this post.****

that said, medical students, as i may have mentioned previously, learn the art of physical examination by practicing on one another. we do this in a large room, with a handful of physician instructors who wander around and monitor/amend our progress. it should, for all intents and purposes, be a very professional learning environment...right? wrong. first off, let me mention that the school chased off the only female physician instructor for our clinical exam class. (don't even get me started on how i feel about that--she was, after all, our best lecturer and really the only female role model here within an age range to which we could relate--i could vent for hours about my anger over her absence.) so, now, our clinical examination class (we call it ce for short) is led entirely by a staff of male physicians, most of whom are retired from clinical practice and/or getting there. don't get me wrong--some of these guys are brilliant and it's a privilege to get to learn from people who have been in practice for a number of years (i.e. 30+). since it's one of the anatomists/deans that refers to me (and every other woman in the class) as "honey," i can even say i have comparatively good rapport with these men.

however, on tuesday, our ce lab covered the cardiac exam. the night before, we got an email from one of the primary instructors, reminding us to wear our omm (osteopathic manipulative medicine) attire. this consists of shorts or sweatpants and a t-shirt. for the women, it also means we have to wear a sports bra. (the professor's email blithely mentioned that this piece of the attire was optional for the men.) supposedly, we have to wear sports bras to "preserve modesty" when doing the exam. whatever....

the cardiac exam requires that we remove our shirts, which is no big deal since we do it every week for our omm class anyway. however, in order to properly perform a cardiac exam (at least in the thorough manner in which we're taught to do it--i've never actually seen a physician perform each and every one of the components of the entire physical exam in a real clinical setting), we have to palpate the chest for the pmi (the pmi is the point of maximum impulse; it's about a 1cm spot on the chest where you can feel the heart beat up against the sternum/breastbone). when the physician instructor demonstrated this technique to the class, he (of course) chose some young chiseled man as his specimen. in order to find the pmi, the professor noted, we should find the level of the nipple line and move slightly inferior (below) that. any of you who are female readers should already begin to see the problem here. but did the professor mention it? no.

so, he instructs us to begin practicing on each other. several of the female students and i began working on each other. we quickly noticed a big problem: breasts. first off, when breasts are bound up in a tight-fitting sports bra, they don't move a whole lot. you can't really separate them, lift them, or otherwise get them out of the way without getting bound up and/or stuck in the elastic of the fabric. so, we tried to feel for the pmi around them. no luck. we tried to find the pmi on ourselves (so as not to have to molest our lab partners); again, no luck. at the 4th and 5th intercostal spaces (the areas between the fourth and fifth ribs), there is, in many of us, simply too much tissue to get anywhere near the breastbone. we were stumped. so, we did what any normal group of students would do: we called over one of our professors to ask for help.

the professor, upon hearing our question, turned bright red. by this point in the day (we'd had 5 hours of lecture already), i was too tired to censor myself, so i said, "haven't you seen like a million breasts in clinical practice? what's the big deal?" he stammered a bit and then said that it's different when it comes to students. what's different? i thought, my breasts? but fortunately, i bit my tongue before the questions came out of my mouth. essentially, we got no answer from him as to how to perform the exam properly. we were only given the impression that, in a room full of 80 students and a dozen faculty, the men were still afraid that someone would claim inappropriate behavior if they demonstrated on us.

after class, a bunch of us gathered and began talking about the experience. now i, having been a women's college graduate, really have no problem with breasts. (they're breasts, people! i wanted to shout. parts are parts!) in fact, as a medical student, after having seen cadavers and the like, i really don't have a problem with any body parts. but i also recognize that i am not everyone. some of my closest friends here are muslim. as such, they cannot remove their t-shirts in lab because we're in a co-ed lab. i asked one of them why the school did not offer her a separate lab session; apparently, one of the other medical schools kicked a muslim student out of school because she requested this. (can they do that?!?!? isn't that against our civil rights or something?!?!?)

is it 1950 again?

needless to say, i am angry. part of me wants to go to the next lab braless, but i have a feeling that'd give half the old guys heart attacks, and then i'd actually have to *use* the new cpr skills i just learned and...well...i'm not ready for that. i did end up emailing one of the professors and asking him to address the issue at the next session, but he hasn't replied to my message. am i surprised? no.

so, what is a girl to do? you might ask. for starters, never call a female over the age of 18 a girl. or honey for that matter. as for my solution? i scraped up my pennies and joined now.

04 March 2007

a drug to endorse?

I'm not usually the type of person to endorse medications, but this is one that just may be necessary to take in order to survive medical school. It goes well with the mandatory despair.com calendar.

Thanks, j.p., for passing along the latest pharmacological miracle pill! ;-)

a little disclaimer...

i'm a medical student. just a student. so please, don't take anything i say too seriously. remember that i was an english literature major as an undergrad, so there is much fiction to be found in these pages. do you think i'm telling a story about you or your illness? more likely, you're tapping into my sense of "everyman"--that is, your story resonates with what i write here because it's not so uncommon after all. need help? please, please go see your physician. <--i'm not her. yet. ;-)