Tuesday, April 27, 2010

To die or not to die?

I have a thing about terminal illnesses and the media, and how we as a society look at them and "survival", whatever that means. It's a subject I think about a lot because, when you're in the hospital, there will always be a certain number of patients who are pretty much just biding their time before they die, from a clinical standpoint.

Those patients may or may not know whether they are dying, though, and even if they know, may or may not be willing to accept that. As a community, doctors have moved away (and been pushed away) from paternalistic medicine, in which doctors called all the shots regarding future care, and sometimes did it without the patient even knowing. In today's world, the patient's wishes and goals for treatment outcome are the first priority, and it is the reason we are so focused on explanation of risks and benefits of treatment vs non-treatment. The result of all this is that when a patient has a terminal illness, we have to tell the patient that, and the first question that comes up is "How much time do I have left?". The doctor's knee-jerk response, at least inside the brain, is the statistical probability of survival at a 6 month, 1 year and 5 year interval. It is just AWFUL to watch someone fight and fail fighting what is, clinically and statistically, a losing battle. So we stick to the numbers, and don't give hope.

The reason I was thinking about this situation is that I came across 2 articles today, on patients who have had terminal illnesses and how they chose to deal with them. The first one comes from the NY Times, titled "17 Years Later, Stage 4 Survivor Is Savoring a Life Well Lived". In it, a writer details her way of celebrating the time-till-death that never was - she was given about 2 years to live following her breast cancer diagnosis, and is now celebrating 17. She posts to other Stage 4 survivors to give hope and a reminder that she is still around, defying expectations. The second article comes from CNN, titled "Death at 25: Blogging the end of a life". This details the life and death of a brave 25 year old diagnosed with cystic fibrosis, who used her blog as a way to chronicle and accept her path towards death, while still fighting.

I don't know which is better, honestly. Of course, everyone's story is personal. And everyone has the right to speak to the truths of their lives. But I always wonder about the other patients and their families. Do they read these pieces and think "Hey, you can BEAT it!"? I remember a flurry when Patrick Swayze announced his diagnosis of pancreatic cancer - everyone declared to the media that he would BEAT it and SURVIVE and be this magical story, and I felt awful second-guessing that, because I knew the 1-year survival rate was dismal. I just didn't think it was fair to give false hope via the media, and make other families of pancreatic cancer victims feel miserable when their moms or dads died. Is that the right message for someone who, statistically, won't survive? And how are we defining beating it, anyways?

I personally don't feel society gives enough credit to those brave enough to die with dignity, and know when to stop. But I imagine that if I had been in that brave young girl's position with cystic fibrosis, I would want to have some hope despite all the medical reasons to say no. One needs hope to live, and thrive, and look in the mirror everyday and say that you didn't take a step backward in life.

I just don't know where the line is.

Friday, April 23, 2010

countdown to done-ness

I have to admit, I'm struggling to find things to write about from my current medical life because I kind of don't have one. Radiology is just SO DAMN CHILL (and yet they drink coffee nonstop) that I don't have a ton to say about it. Really, there are only 5 days left till DONENESS WITH MEDICAL SCHOOL (although graduation doesn't come till later in May). So instead, I'm reaching into the archives of my mind to bring you...


This story comes from a Brooklyn hospital, where I did a surgical sub-internship last fall. It was later in the afternoon when one of the residents got a call from his senior, saying he needed to do an admission on a young guy with a foreign body. The resident stayed on the phone, asking for MR number, last name, etc then suddenly burst out laughing and couldn't stop for a few minutes. He hung up the phone, and I asked him what the case was. "Uhhh, this dude stuck a dildo inside his butt, and now he can't get it out. A DILDO."

I admit, it was pretty funny. We saw the x-ray, which looked something like this, and it was really hard not to lose it completely.

Not so much when we saw the patient, as he was unfortunately a sweet guy in a significant amount of discomfort (and was utterly humiliated to boot). His story was that he had placed the dildo inside his rectum, and not been able to retrieve it. He waited a full day hoping that a bowel movement would force the dildo out, but instead had no movements at all and began to get more and more distended and uncomfortable. The resident tried to have a feel inside to see if he could yank the damn thing out, but the patient was just in too much pain, so the decision was made to take the guy to the OR and sedate him a bit.

The anesthesiologist seemed to have a better understanding of how hard this would be, because the chief resident's assurances of "Oh, this will only take a few minutes, go ahead and use an LMA if you want" was met with extreme yet quiet skepticism. The idea, which seemed simple at the time, was to have one person place a hand inside the rectum while a few of us pushed on the abdomen, forcing the dildo back out. SIMPLE, RIGHT?? ~sigh~ Well, it was not. I am not exaggerating when I say that I pushed on that damn belly for 2 and a half hours while no less than 3 different surgeons tried their hand at grasping the dildo. And by hand, I mean hand plus wrist plus forearm plus beyond the elbow. Yes, folks, three people were past their elbow inside the patient's rectum and STILL could not grasp that dildo.

(For those of you out there interested in the mechanics of the dildo problem, this was a skinnier dildo that did not have a base shaped like testicles. So there was nothing to grab onto, and the surgeons could only feel it with the tips of their fingers before it slipped beyond the sigmoid colon.)

We tried using clamps, graspers, even the scary Ob-Gyn surgical tray to grab the dildo. We tried propping the rectum open with a weighted speculum. We tried pushing from every angle imaginable to try to push the dildo around the colonic curve it was stuck on, all to no avail. I don't know when it started, but each time a surgeon placed an arm inside, it came out just POURING nice fresh blood.

The result: the guy wound up getting intubated, sliced open (yes, an actual exploratory laparotomy) and the dildo was pushed back out the rectum by squeezing it from the sigmoid colon like toothpaste from a toothpaste tube. Except that his butt was not minty fresh goodness, let me tell you.

The best part? This guy was the second one in two weeks to show up to the emergency room with the same exact complaint.

Wednesday, April 21, 2010

Dear KFC, I hate you.

I am in the middle of a fast food craving.

For the past week, straight.

I don't know what the heck is going on. It just won't end! Normally when I go to the hospital I aim for a sandwich, but somehow I keep going for the ribs or fried chicken or pot pie. And when I get home, I have to crave more bad for me things. Now, I don't have the best willpower to begin with (today's lunch was ribs, macaroni and chocolate cake), but I have been trying super hard to semi-limit the craziness.

But, F****** KFC chicken!!!!

I'm watching Gilmore Girls (don't even think about laughing) and KFC keeps running ads for its new campaign to support Susan G. Komen (breast cancer). It's a wonderful group that does tons of activities, like walks and races and fundraisers. A lot of it gets done in the NYC area and it really gets the city involved.



The other thing is, I'm fairly sure that a fatty diet is in fact a risk factor for breast cancer. *checks UpToDate* yes, there is an association (a mild one, but still). Does it seem odd that KFC, a fast food company, is trying to promote health? I mean, yes, it's good if any company takes an interest, but...I don't know.

...I may have to eat at the diner tonight.

Friday, April 16, 2010

an addendum to yesterday's post

My friend T, working in the emergency department of the hospital I'm at, called me this afternoon to tell me a great story about a new patient she saw, in keeping with the theme of objects-in-the-vagina-that-don't-belong. Apparently, this lady came in saying that she took a klonopin, just ONE, then got so messed up from it that she actually placed a days-of-the-week pillbox... in the vagina.

And here she is, 5 days later, not sure if it's still there, not sure how to get it out. My friend T astutely pointed out that you do not get knocked out from one pill and then feel compelled to place objects into the vagina, and that this patient is probably not giving us the whole story. Also, that the patient may think the pillbox is in the vagina when it is really in the anus, and not understand the difference, anatomically. (Hey now, not everyone's comfortable with their own hoo-hoo!!) The patient insisted on a female doctor and student, unfortunately not realizing that the male attendings, radiologists, radiology technicians and potentially surgeons / ob-gyns would all be seeing it too.

For her sake, I hope it can be retrieved manually...

Tuesday, April 13, 2010

The Tampon Incident

Today was an absurdly boring day in radiology, and so I shall tell...

Tales from Ob-Gyn HELLLLLLLL!!!!!!!

Actually, this story comes from a few months ago, when I had finished all of my gyn rotations. I got multiple calls from a girlfriend of mine while I was relaxing in the evening, and with spotty reception, she had left a number of voicemails with increasing intensity referring to a "medical problem that's kind of urgent". When I got them, I was running through various versions of OMG-HER-MOM-IS-HAVING-A-HEART-ATTACK. So, tenuously, I called back.

The Tampon, a one act play:

Me: Hey M, what's up?
M: Oooh! SO glad you called. We have...a situation. And you're my medical go-to.
Me: Ok, what's the matter?
M: It's my sister.
Me: ...your sister? ~thinks of own sister and different panic attack sets in~
M: Yeah. She...well...she got drunk. And then she had sex.
Me: ~scenarios persist in worsening~
M: And...she's having her period. Um...she can't find the tampon.
Me: ...Huh? What do you mean, she can't find the tampon?
M: The tampon. She doesn't remember having taken it out before having sex. And now she can't find it. And we don't know what to do.
Me: ~internal giggle~ Ok, this isn't as bad as you think. ~internal giggle~
M: She's worried that it went into her uterus. She's worried she's going to get toxic shock syndrome.
Me: Well, TSS is of course a risk with tampons but less so today than it was before, because they changed the way tampons are made. I suppose it COULD go in the uterus but I think that's kind of unlikely. Tell her to have a good feel inside first, all the way back to the cervix. It will feel like a little firm donut. She needs to sweep all around the vagina, in front of and around the cervix. Do you think she can do that?
M: ~internal giggle~ I think so. But what if it DID go in her uterus?
Me: Hmmm. Well, in that case the best thing would be to see her ob-gyn first thing in the morning. But I think the most likely scenario is that she took the tampon out and just doesn't remember. Maybe it fell out during sex.
M: Well, her boyfriend did say he didn't remember feeling it.
Me: ...well then I guess he'd be the expert..in that department... ~actual giggle~
Me and M: ~giggles all around~
Me: Just let her know she can call me if she needs to. But I think she's ok. I really doubt it went IN the uterus. It's not that big and the cervical os is pretty small if she's never had a kid. If it went in the uterus, you'd see the tampon string sticking out of her cervical os, into the vagina. She'd at least be able to feel that string if she really pokes around. I mean a GOOD POKE.
M: ~giggle~ Ok. Thanks hon. I'll tell her. Byeeee!
~end of conversation~
Me: Officially, awesome-est friend-calling-about-medical-problem-situation EVER.


she's a yes-man

I went to my boyfriend's house for the weekend, to spend time with his parents. Whenever I go there, I'm always overwhelmed by all of the artwork from his and his sister's childhood - so much of it is adorable, skilled and amusing to peruse. It makes me think about the things we save over the years, the things that matter and mean something.

The reason I bring it up is that I got something of my own to hold onto. My first graduation gift! And it's a doozy. Months and months ago, my boyfriend made me stand against a wall and take head shots at multiple angles, presumably so that he could give them to the police for when I'm found lying face down in a ditch. But here's the result instead:

For the first time ever, a piece of memorabilia that shows me as a real, REAL doctor! And I'll get to treasure it forever and ever on my grownup doctor's desk in my grownup doctor's office in my grownup doctor's practice!!! AND IT'S A FRICKIN' BOBBLEHEAD DOLL!!!!!

(I may have melted a little.)

Monday, April 12, 2010

AHA! I knew I had a future in vascular surgery

Ever since a meltdown I had a few weeks ago, I have been attempting to master the art of crochet. A girlfriend of mine (and one damn hot devil-in-a-red-dress) has been after me for months to try it, and finally got me to go to a crochet knit-and-bitch with her friends. I decided to give it a shot because, after all, it will improve fine motor skills and hand-eye coordination and blah blah blah. But it's actually pretty damn cool that a person can make some gorgeous pieces using squishy soft skeins, and it gives me something to do with my hands whenever I'm bored / frustrated / avoiding studying for Step III.

Except, this is all I have to show for 1 month's work:

Yes, it's a sad blue square. But today I shall be meeting said sexy girlfriend in the city, and hopefully she'll sort me out on how to switch from blue to charcoal grey-black yarn. Yea!!

PS, I was crocheting in radiology earlier today thinking that even if I mastered crochet, it still wouldn't give me the hand skills I need to do surgery. Until I read this: http://www.sciencedaily.com/releases/2007/10/071022122214.htm ...Teehee!!

Wednesday, April 7, 2010

i can see your insides

Radiology started on Monday, and I must say that I am SO glad I put this rotation last. It's fantastic. Amazing. Truly a joy. Here's what happened on the first day:

~ Sarada standing outside of PACS reading room with other students ~

Radiology Resident: So...we're pretty relaxed. It's a pretty chill rotation. Yeah.
Us: Okay...
RR: Yeah... we're pretty casual.
Us: Right. So when do you want us to show up? 8? 9?
RR: Oh, you know. Just...whenever... we're pretty casual.
Us: ...whenever?
RR: Yeah. Oh, and we have lectures. But you can just come to the ones you want. It's very chill...yeah.
Us: ...Chill.
RR: (sips coffee) Yeah. We're chill.

We couldn't believe it, so we asked the students on the rotation before us. On average, people showed up like 2-3 days per week.

(Warning: I'm going to throw out a WTF, but it's going to be in the best possible way.)


I just love this rotation =)

Tuesday, April 6, 2010

is there a doctor in the house?

Huzzah! I have survived the weekend =)

Things started innocently enough, I spent Friday night with my high school friends playing Literature (it's like Go Fish with vengeance) and eating brownies. It's always therapeutic seeing my friends from home, because they're all irritatingly smarter and simultaneously far more relaxed than I am.

But, oh, then came the wedding. I should perhaps mention (in case you couldn't tell) that I'm Indian and weddings aren't normal affairs, they're Weddings. This one required us to BE THERE at 8 am for the actual ceremony, which lasted several hours and included raucous wedding-goers paying no attention, as well as the groom sitting on the stage twiddling his thumbs and wondering where everyone had gone.

I spent the entire wedding day trying to satisfy everyone with various choices on hairstyle, dress, jewelry and shoes, but inevitably I can never satisfy a majority of the crowd and I had to endure several unkind comments. I do feel it's a bit odd how much importance Indians place on something as moldable as hairstyle. Over the last two years, the big to-do was about the fact that I had cut off 8 inches (to donate to Pantene Beautiful Hair for wig-making), and was sporting a cute bob which I had the audacity to maintain and even trim progressively shorter. This year, the stink was over my Betty Page bangs (accompanied by now-long hair). I know hair is a woman's crowning glory and all, but honestly! This is the culture in which men and women routinely shave their heads in devotion to God, a move I actually quite admire because I think it's pretty gutsy to say "Hey World, I really don't care about something as silly as hair because there are more important things in life". (The best part is that Indians are totally clueless that their hair is sold by temples to American women as hair extensions. They honestly think it's going TO GOD. Thanks, Chris Rock !)

The fact of the matter is, I decided to put bangs in both because someone had been suggesting it to me, as well as because I discovered it was an easy way to look like I had made effort to look good when in fact I had rolled out of bed and brushed my teeth. I was tired of looking manly and gross and tired, and I definitely don't want to look like surgery is kicking my ass when it is, so this was a way to reclaim my Hot Sexy Womanhood with just a tiny bit of effort. And I like it, and I'm happy with it. So nyah.

But the real highlight of the evening came during the reception. I was assigned to The Children's Table (aka where all the twenty-something people are) when an auntie ran up, stating dramatically that a close family friend was experiencing chest pain and EMS was coming and WHERE IN THE HECK ARE YOUR PARENTS??? I went into total doctor mode, circling the hall several times in search of them (they were right in the middle of the dance floor with the cameras, natch) and pulled them out to the front hall, thinking he'd be sitting there all by himself. Of course, there was a crowd of at least 40 people just standing and staring at him. EMS was already on top of it and about to take him out, when it occurred to me that he might feel a bit odd and scared with everyone just staring at him. So I mentioned it to my dad, who suggested that I be helpful and try to encourage everyone to go back into the reception. I walked up to the first person I saw and tried to gently suggest we all go in. The uncle just gave me a stern look. It took me about 15 seconds to realize the guy was a thoracic surgeon. It took me about 45 seconds to look around the room and realize there were at least 15 attending physicians all standing there, discussing the best course of action (including the pathologist), because after all, this was an INDIAN wedding. And about 2 minutes to realize there was no way in hell they were going to listen to a lowly 4th year medical student in a sari and bangs and abandon all their doctorly instincts.

Friday, April 2, 2010

last day of ICU

Nobody ever believes me when I say this, but I'm always so sad to leave the ICU. Maybe it's just because I'm not a resident taking care of high-maintenance, fussy, demanding patients ("What? You mean you DON'T want that ridiculously long thick inflexible tube down your throat making you choke and hyperventilate?? What nonsense. Stop whining."), but I just love that there's so much to do and learn and get involved with. And I also love that when patients turn around, they really do it.

My "kid", as I've started to call him, is doing wonderfully. I don't want to jinx him, but he's so good that he's started giving everyone attitude. I don't know how you do that when you're sedated, intubated, restrained and still have an open belly, but there it is. He isn't swollen anymore, he can actually move his legs, he's asking for food and he's getting pissy. LOVE IT =) It's just cool because this kid was THISCLOSE to death and now it looks like he's really going to have a shot at a normal life. Honestly, hats off to the (admittedly warring) attendings who managed him so well. It really goes to show what being vigilant and acting fast can do. There were so many places where he could have been mismanaged, simply because he was so sick that minor errors could turn into major problems. But they didn't, and he's pissy. It's just terrific!

I'm home for the weekend, and have been officially booked by my parents to attend an all day wedding. And by all day, I mean that the family actually expects guests to be there at 8 am for the pre-wedding ceremony, followed by the wedding, followed by lunch, followed by hiatus, followed by reception, followed by dinner, followed by looooong drive home. The worst part is, that's what everyone's going to do! My mom asked me about coming to this wedding, and I agreed because it would be a chance to see family members, etc. But she then later got upset that I wasn't going out of GENUINE INTEREST IN THE BRIDE AND GROOM, which I couldn't quite understand because I barely know the chick. (I did one cultural dance with her, over 10 years ago, in a group of at least 10 kids. Give me a break.) And though she did have a point about not going to someone's wedding and wasting money, etc if I don't actually care about the bride, it brought up a broader point between my mom and I when it comes to socializing.

My parents are generally speaking, social butterflies. They are well-respected in the community, are involved in multiple organizations and charities, and are each quite talented in their own way. My sister, being a terribly diplomatic and friendly girl, is also. But I have never been, and while I have a large and well-connected group of friends dating back two decades, I've never really appeared social to my parents. And predictably, this has been exacerbated by medical school. It is singlehandedly the most isolating experience of my life, despite there always being classmates or patients or other doctors around, because it always feels like your friends and family don't get it. Things they take for granted, like simple hanging out or spontaneous parties, I couldn't, and so when casual events like weddings for non-family/BFFs came up, I just couldn't be motivated. It just seemed INEFFICIENT to be putting that time towards people that didn't feature majorly in my life, since I couldn't even devote time to them the way I used to. On the other hand, it is somewhat useful to practice that skill that is known as chit-chatting, so I don't evolve into a total hermit. And so, I shall go tomorrow, without complaint. Except for when my dress starts to cut into my respiration.