Not a fairy tale but something like that

Life may not have fairy tale endings of happily-ever-after.

But....

Plus, there is happiness if you know where to look.

I have just two days of medical school left and I recently found out that my first medicine patient is home and no longer on dialysis. This is good news, the best news possible! I expected for him to be on a kidney transplant list or worse by now. But instead he is living his life and his kidneys are functioning well enough to allow him to skip dialysis. He is so young and has so much life ahead of him. I can only hope that he gets to live it.

I also found out that one of my neurosurgery patients is making amazing progress at rehab. Prior to being a neurosurgery patient he was an amazing, smart, able-bodied father and grandfather. And then he fell off a ladder while doing some home repairs. He left the hospital with very limited control of one extremity and was largely non-communicative with a trach and G-tube in place. I  really didn't know know what kind of life he would live again.  However he is now in a wheelchair, wheeling himself around, as well as eating and talking. I saw a video of him yesterday and could not believe it was the same patient that graced the service the entire month I was on.

I am so glad I have some happy patient stories to end medical school with. (I have plenty of not so happy endings to share too, but not today.)

Today is about reflecting on the good.

The amazing, brave and resilient patients I have met.
The thoughtful and helpful nurses and staff.
The dedicated professors and attendings.
The mentors that have taken the time to inspire and help me become who I am today.
My wonderful support system: my husband, my parents, my dear friends.

I did not get here by myself. The end of medical school is around the corner but it is not my celebration alone. I appreciate everyone who helped me along the way. There were dragons and they were slain.

Life may not be about fairy tale endings but my end of medical school is happily-ever-after or close enough to it for me.

"she's a hyper little bird"

Evidently these are the words that my attending spoke about me yesterday as I stepped ran off the elevator. I think it was a compliment?

It was a busy day and we had just finished rounding for the morning when I saw my dear patient's husband (from IM-TSS elective 2 months back) standing in the elevator bank.  CC was one of my FP (favorite patients) and she was on the service the entire time I was a student.  Over the course of the month I got to know her and her husband well. CC is dying and due to a very messed-up health care system will likely spend the rest of her life in the hospital... She was admitted in December so it has already been months despite the fact that a SNF or Rehab Hospital would be much better for her and her family.... They are not ready for Hospice and due to her health conditions would require around the clock nursing services and a hospital bed to go home which her family is unable to provide. She even has "good" insurance but has been denied from 17 different facilities (at last count). I can't even begin to explain how mad this makes me. She sits in the hospital trying not to die from something iatrogenic while we wait for emergency Medical to be approved so that maybe we can find placement. Anyhow, it has been almost two months since she was "my" patient but I still stop by and see her occasionally and check up on her. And I hadn't seen her husband in awhile and wanted to check in with him. So I jumped off the elevator and my attending turned to the other student to discuss my behavior.

But back to Cardiology. I am starting to enjoy the service more now that I only have 8 days left! And it has been busy which I much prefer to the alternative of sitting in the library waiting for my pager to go off. Better just to run around all day and see 11 consults (3 of them solo and before 10am) and be called a "hyper little bird" then to do nothing or pretend to study EKG arrhythmias in the library while not-so-secretly wishing I was anywhere else. Yesterday was busy, but good.

This morning I am reflecting on a number of things but mainly I am just trying to be appreciative of what I have, the experiences I have been blessed with and the life that I get to live.

Time to go to work and live up to my attending's words now... Happy Hump Day to you!

And just because this made me smile. It is a bit late but in honor of the match being over and no more "maybes" enjoy this.

total apathy and mid-night realizations

I have the worst case of senioritis. I am so unmotivated to go to work and once there I really have to try to care because right now I just don't. I am doing a month of cardiology as my final elective and while it should be interesting and good review on reading ECGs I simply find it torturous to be tied to a pager waiting for the next consult to come in. I really don't have much love for CHF or the intricacies of transesophageal echocardiograms. I am going to be a Child Neurologist and I am SO excited to see kids and think about the brain, however adults and their hearts, not so much.

I wrote these words a day or so ago and while they were true at the time and remain so there is a small caveat. I think that 90% of why I am "checked-out" other than the about to graduate thing is that I am bored to death. I actually had a real-bonafied, my patient is having an STEMI consult and the ER really did need a cardiologist and I woke up from a dream thinking about my patient. And the fact that I was at work almost three hours beyond the normal pager time didn't even bother me. Because I do like medicine and learning and when I feel important/needed/useful and even more so feel that the patient is benefiting from my time then I am more than happy to be at the hospital. It is just that up until yesterday most of the consults were a waste of time.

Seriously, I've had consults such as: patient with new onset V-tach, non-symptomatic, unsustained for 8 beats in the middle of the night. Please evaluate. Guess what? Motion artifact. You wasted an hour of my time and 10 minutes of my attending's time so that we could tell you that your consult was BS. I guess this was due diligence and now I will hopefully never make the same mistake so I did learn something but this happens all the time!

Surgical clearance consults. Yes, they have to be done but please don't ask Family Medicine to do the consult and Cardiology to do the same consult. We both show up and then feel obligated to do the consult because you asked but we are just duplicating each other's work, wasting time and using resources that could better be used for say that patient that is having an MI or the new admit. And this is all so that maybe you will get your surgical clearance a bit earlier from one of the services. Not cool.

Consults for medical management help. Unless you have actually tried all of the evidence based medicine guidelines for managing said problem and are actually asking for help because the patient is especially complicated please don't consult cardiology for every CHF patient on hospital day 1 that may need more medication. The attending cardiologist will not give you firm medication recs. if you haven't at least tried for 24-48 hours, so why bother to ask?


And in other news... I am thinking of changing blog names and sites. My island days are behind me and residency is around the corner. But if anyone has particular SGU questions or would like a final post or two before I do so, let me know.

I'm off to Houston tonight to hopefully secure an apartment and tour my new city. So that is exciting.

Only 10 more days of medical school left!
Happy Friday!