downright nauseated.

i'm nauseated. and not in that physical i-can-go-take-my-zofran-to-fix-it way. i'm psychologically nauseated.

the second anatomy exam is on monday. <--this is the main reason for my present distress. while the first exam covered 2 weeks of material and was worth 10% of our grade (the anatomy professors dubbed it the "welcome to medical school" exam), the second exam covers everything we've learned over the past 4 weeks (i.e. all the way back to day 1) and is worth 30% of our grade. needless to say, i'm anxious! (as are the other 160+ people in my class...but maybe that goes without saying!)

i'm having an exceptionally difficult time focusing. it's amazing what can capture my attention when i'm supposed to be focused on anatomy. i knew i was getting truly neurotic on thursday when i found myself cleaning out the litterbox. i *hate* cleaning the litterbox. yet, there i was, hosing it down in the front yard. <--yeah, i wasn't just replacing the litter...i was *scrubbing* the damn thing. in the meantime, my roommate was upstairs scrubbing the dishes. i guess this kind of anxious neurosis is contagious. although, when i said that to her, she said, "dead tissue is contagious?" oh boy. that's neurosis, not necrosis! (<--thank god!)

anyway...i shouldn't be spending time posting right now. rather, i should be learning everything about the back, arms, & legs. but i couldn't help but take a moment to share the little discussed nasty underbelly of medical school: psychological nausea. i ought to come up with an icd-9 code for that one...after the test, that is. ;-)

the ponderous patient: a panic attack

i swore when i began this whole medical school process that i wasn't going to be one of those medical students who thinks she has every disease or physical problem about which she reads. (i knew i'd be the student with 500 different colored pens and notecards, but that OCD behavior began long before I ever considered this path.) i actually have made a point *not* to read about any treatments I've needed or medications I've taken since beginning med school, because I've been certain that my subconscious will suck up the information like a heavy-duty paper towel sucks up blue liquid on a commercial and that I would, ergo, become one of *those* students....

so. yesterday the cats woke me up at (i kid you not) 6am. i guess they decided it was play time. i disagreed, but couldn't go back to sleep, so i chose to drag myself out of bed and plop myself in front of my computer. i ended up chatting with j.p. (who never sleeps anymore) via gmail talk for quite some time. when the conversation was over, i decided to get myself a glass of chocolate soy milk. <--this has become my new favorite food. yes, i am that pathetic, being so unable to eat anything that tastes good that now fat-free soy chocolate milk is, to me, absolutely delicious. (have i mentioned recently that i'd like my gallbladder back?) so, as i was reaching into my near barren refrigerator for my yummy carton of chocolate soy milk, i noticed that i had a bright pinkred circle on my arm. i put down the carton, rubbed my eyes, and looked at my arm again. still pinkred. "hmm..." i thought, walking over to the ray of sun coming through livingroom window and looking at the spot again. still pinkred. uh-oh.

did i mention that the bright pinkred circle was precisely in the same location as where i had had a tb test done the day before?

so. i make my stupidest move ever and do what i've sworn not to do: i pull out my microbiology textbook. i flip to the index and look for tb and skin reaction. i turn to page 234. and i gasp. there, on the page, is a picture of someone's arm with--you guessed it--a big pinkred spot. "aaaggghhh!" i think. then i read a bit, realize that the circle's size matters, so i go find the handful of coins i keep in my backpack for those marathon lecture days when i cannot stay awake without making a mad-dash to grab a coke from the vending machine. "hmm... not as big as a quarter, but about the same size as a nickel. g-r-e-a-t." having had enough of my microbiology text, i toss it on the floor in disgust.

i then sit down at my computer and do a google image search for tb and skin reaction. up pops about 10 pages of images of arms with--you guessed it--round pinkred dots. it's about at this point that i believe i began cursing. audibly. i scanned a few pages and paragraphs--from places like nih.gov, not bigpinkspot.com--and see a few brilliant key words: weight loss, nausea, loss of appetite, yada, yada, yada; the sites list out about 60 % of the symptoms I've been experiencing lately. more cursing ensues.

my mind starts racing. i spent years working at a medical center that put me at high risk for tb, but i now comparatively live in the proverbial boonies. i had a tb test last year around this time (it's one of those annually "required" tests for medical school) and it was negative. "how the f*ck could i have gotten tb?" i wondered. in spite of the advertisements posted by medical schools, there really isn't any clinical contact during the first year of school. not unless you consider cpr to be a clinical contact experience, which i don't. so it's not like i've been around any patients. and, loathe as i am to admit it, i live in yuppie land. seriously. mcmansions, mcdogs, mcbabies, mchummers, mcgolfers--you mc it, we've got it. except for tb. tb is just not one of those things that gets mc'd. not in this day and age, anyway....

i start thinking about how crappy i've felt in the past year and all the medical problems i've been experiencing during my soon-to-be-over 20s. nobody my age should have this many medical problems. so, once again, up pops the hypothesis: what if all these things are not random individual events? could i have an immune disorder? it certainly would explain a lot...not to mention that one of the populations that most easily contracts tb involves those who are immunocompromised. hmm....

by this point, it's 10 till 9 am. just time for the doctor's office to open. i feel like a schmuck doing it, but i call at exactly 9 am. <--the emotionality about calling stems from having been on the other end of that phone on more than one occasion. medical staff are like any other mortals. talking to them first thing in the morning, just before or after lunch, or in the 5 minutes before closing--it's a bad idea. it gets you labeled as one of *those* patients. the kind of patients who copy down the phone number for the office's back line--since it appears on caller id when you call them to give them test results and such--and then proceed to call that number incessantly if they can't get through on the main number. as if there were enough hands to pick up another ringing phone! note to patients: just don't do it.

the nurse calls me back a while later and asks if the area is raised. nope, just redpink. round. and starting to get kinda itchy. she tells me not to put anything on it--no lotions, creams, soaps, etc--and to come in at my scheduled time on friday to have it checked. "some people have an allergic reaction," she says. so. i realize that there's nothing i can do about this bright redpink spot on my arm except wait.

this means that i now have to focus on my emotions, which have suddenly gone haywire. why did this freak me out so much? i really can't say. my only guess is that, at a certain point, we all hit our limits for the quantity and quality of physical ailments that we can take in any given period of time. for whatever reason (lack of sleep?), this damn redpink spot scares me.

i do the only thing i can think to do: i take a xanax and crawl back into bed.

needless to say, the redpink spot faded over the course of the day and gave rise to a purplegreen bruise. today, there is nothing on my arm save the remnants of said bruise, which is now about the size of a pencil eraser. definitely not tb material. not even in the least.
so. with my tail between my legs, i went into the doctor's office this afternoon to have the spot "read." "where's this pink spot you were worried about?" asks the receptionist, the nurse, and the doctor...although not all at the same time. it's a pity that we're not having hoodie weather, because i could have really used something to hide under. *blush*

so. it's official then: i'm as paranoid as the next medical student, if not more. i was hoping not to catch the disease bug, but like the highlighters, the notecards, the supplemental textbooks, and the 1,001 questions, all fingers point at me. even as a patient, i'm the penultimate med school nerd. penultimate because there are still a few worse than i am--they're the ones still sitting in the doctor's waiting room. ;-)

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.

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.

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....

self-doubt

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....

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....