Helplessness

I'm just not having much success at coming up with new reflections.  I opened the blog to try to write one last night but finally gave up.  I guess tonight I just want to spend a little time talking about something that came up at work today.  I was talking with one particularly distraught mom.  Her very young (weeks old) daughter was being worked up to rule out sepsis (bloodstream infection with additional features), and it had been a nightmarish day.  In addition to the various normal blood tests required, a lumbar puncture (aka spinal tap) is necessary for the workup, so between all the testing and the fact that her daughter was in the emergency room and simply waiting for a bed to be ready before being admitted to the hospital, mom was pretty much beside herself.  And the worst of it, she acknowledged, was the sense of helplessness, the realization that she couldn't do anything to make this better for her baby.  And she had no choice but to accept that; there were really no alternatives.

I think most of us feel helpless from time to time, if not more frequently.  We see things playing out, we see how much pain certain events are causing, but we are powerless to stop or alter them.  Sometimes we try anyway, knowing that we will fail, knowing that we'll probably do more harm than good, simply because we cannot bear to feel helpless.  But I also think that Lent is about an example of helplessness that became the basis for human salvation.  If He chose to become helpless on the cross for our sake...maybe there's a lesson for us there?  Just a thought.

Anyway, that's all for me tonight.  Hope everyone's doing well...till next time, peace and God bless!

Gripes and blessings

Finished work at 11.  Got home at 11:30.  Lecture tomorrow morning at 7 -- have to take a 6:30 bus in.  Because everyone will be fully awake and attentive for a 7 AM lecture.  Riiiiiiight.  Anyway, that's my excuse for why this is going to be ridiculously short.  I get to work in the peds ED again this week (my favorite site by far), and it reminds me that although we're often asked to make sacrifices and deal with things that are difficult (and these tend to take center stage during Lent), there's also a lot that we are given that is easy and joyful.  This, for me, is one of those things, and realizing that is its own defining moment.

Anyway, that's it for me tonight.  Continued prayers for some special intentions would be appreciated.  Hope everyone's doing well; till next time, peace and God bless!

In good conscience

I have to admit that my conscience is bothering me a bit after yesterday's OSCEs.  You see, after going through a mockup of a well visit for an adolescent patient, I was told by the observing physician that I should have included counseling about contraception during the "appointment."  I stuttered briefly before explaining that I couldn't really do that in good conscience because of my faith.  "Well, all you really need to be willing to do is refer her to someone..."  I just nodded.  But as I continue to think about it, an old question rears its head: if I refer her to someone else whom I know will provide counseling I believe to be morally wrong, how different is that from simply providing the counseling myself?  I mean, it feels in a lot of ways like it's merely semantics, the same as Pilate washing his hands of the Crucifixion -- something to make me feel better rather than something altering the fundamental moral quality of the choice.  I don't know, maybe I'm overthinking it, but this scenario always leaves me feeling guilty and uncomfortable.  Of course, the flip side is that I'm legally required to provide this referral, and I could probably be barred from practice if I don't offer said referral.  Makes for a bit of a quandary, no?  Maybe peds critical care or neonatology is the way to go after all -- these types of moral questions probably don't pop up quite so often in those populations.  Anyway, if people have thoughts on the subject, I'd really appreciate if you'd be willing to share.

That's all for tonight...Mass tomorrow, then I should probably get some work done.  Till next time, peace and God bless!

St. Luke Society

As those of you who read my entries back in September know, it's very easy for a Catholic student to feel alone in medical school -- especially this medical school.  But it looks like that may be a thing of the past thanks to a group of first- and second- (soon to be second- and third-) years who have finally made the idea of a Catholic fellowship at the school a reality.  It'll be an official group, the St. Luke Society, and will be able to host events and everything, but most importantly it'll be a support system for those of us who aspire to be truly Catholic physicians.  It'll be wonderful to see how this group grows and progresses, and hopefully it'll make this particular cross a little easier to bear.

Anyhow, that's it for me.  Just finished family medicine (the exam was a disaster...I hope I passed) and I'm completely wiped out, so I'm off to bed.  Till next time, peace and God bless!

Interlude

I'm back from Altoona and I'm too exhausted to write anything intelligent or even coherent tonight, so I'll write an actual reflection (as well as commenting on a couple of patients) tomorrow.  Of course, I also need to do some studying tomorrow, but I don't think I'll have too much trouble with that.  Anyway, I'm off to bed.  Till next time, peace and God bless!

Sacrifice vs. suffering, part II

Ok, so is sacrifice more than merely sought-after suffering?  I mean, it kind of seems that way, right?  But if suffering is intrinsically an evil (forgive the atrocious philosophical formulation there; I simply can't come up with a better way to phrase it at this hour), then seeking after it for its own sake would be wrong -- as it would be to mutilate oneself.  But then sacrifice implies purpose, doesn't it?  It does not pursue suffering in itself but rather pursues the discipline and the nearness to God.  Ugh...I'm not explaining this well, and my half-asleep brain isn't helping matters.  Rather than continue to push forward and butcher my arguments and logic, I'll think about it on my drive back to Pittsburgh tomorrow and see what I come up with.

Till next time, peace and God bless!

Sacrifice and suffering, part I

So this is an internal debate I have with myself from time to time...usually right after a shelf exam when I don't want anything vaguely medical violating my precious neurons for a couple of days.  It's kind of a long topic, and I don't think I'll be getting through it tonight.  As we've established previously, the concept of sacrifice is central to Lent.  But how does sacrifice relate to suffering?  Suffering, if I understand it properly, is not in itself a good thing.  For suffering to be a good, it must have a purpose; furthermore, the one who is suffering must accept that purpose (or, at the very least, must accept that the suffering has some purpose despite being unable to comprehend fully what it might be).  It is not itself a good; rather, without the context of purpose and acceptance, suffering is an evil.  Practically speaking, I think it's pretty hard to claim otherwise.  And that which is evil is never to be sought after, especially for its own sake.  So then the question becomes "what is sacrifice?"  After all, we're deliberately giving things up, making life a little harder for ourselves (sometimes a LOT harder).  Does that mean that by our sacrifice we're seeking out suffering?  That's the thought to ponder tonight, and that's where I'll start from tomorrow.

Till next time, peace and God bless!

The Transfiguration

The Transfiguration has always struck me as being a little...well, inexplicable, I suppose.  It's easy to imagine how overwhelming it would have been for the apostles at Christ's side.  I mean, intellectually they believe that He's the Messiah, but it's a whole different thing to see the power of God suddenly unveiled before you.  And even that was most likely but a taste of His true glory.  The seemingly mundane Jesus revealed His splendor before their eyes.  I think there are definite Eucharistic overtones here (glory revealed through the veil of flesh), but I also think that it also prefigures the ultimate end of Lent (and, really, of all human life) -- to see God as He is, not merely as we with our limited capacity believe Him to be.

Anyhow, that's all for tonight.  Back tomorrow.  Hope everyone is doing well.  Till next time, peace and God bless!

Apologetics

One obstacle I seem to run into frequently is the question of to what extent I need to defend my faith and my beliefs.  I mean, I can't simply be insulted every time someone makes a joke or light-hearted comment (or else I'd be offended pretty much all the time), but where's the threshold for when I need to speak up?  Is it sufficient that I always tell new people (e.g. residents) that I'm Catholic?  Do I need to say something when they tease me about my faith? (For clarification, this has always been lighthearted and without any malicious intent; I've never actually been slighted for my faith by any residents, just the one attending whom I've mentioned before.)  There have been times that I probably should have spoken up, should have tried to correct a misconception, but I either chickened out or didn't think it would make a difference.  In some cases, I don't say anything because I worry about how it will change people's opinions of me.  So when do I speak up?  And how do I make sure I consistently speak the truth with charity?  Thoughts would be greatly appreciated.

That's all for tonight...hope everyone is doing well.  Till next time, peace and God bless!

Reflections on reflecting

All right, I've got to admit, this is harder than I thought it would be.  It's challenging to come up with a new topic to write about every night, and equally so to do some of these topics justice.  But part of the reason I'm doing this is because it's challenging.  It forces me to think -- every night -- about Lent, about my faith, about so many different things.  It gives me no choice but to open my mind and my heart, even if only a smidge.  All of my Lenten resolutions in the past have been of the "giving things up" variety.  Some of those were pretty challenging, but none of them forced me to spend at least a little time in contemplation about why I was doing something crazy (like giving up chocolate).  Sure, I'm familiar with the theory that you're supposed to give up something that hurts at least a little bit, but I think now it's a lot more valuable when it's coupled with a sacrifice of "taking on" rather than "giving up."

Unfortunately, there's not much to tell from the world of family medicine today.  The patients were pretty straightforward, most of the difficult families were gone (along with one or two of the really great ones), and all our admissions came to us because of foul-ups somewhere in the chain of communication.  Still, though, I have to say that my experience here has been far better than I ever expected.  If not for the useless busy work they insist on forcing us to complete, this would be a really good clerkship.  As it is, I'll be singing the praises of the Altoona placement, but I'm still frustrated by the rotation itself.  Hmm...now that I think about it, the experience with somewhat extended drives might also come in handy...

Anyway, that's all from me for tonight.  Back tomorrow with further writing (that maybe three people will read...including me.  Twice.)  Hope everyone's doing well...peace and God bless!

A mini-reflection and other stories

I'm exhausted, so just a quick reflection and then a couple of other quick things will have to suffice for tonight's update.  One thing that's been on my mind (especially today after dealing with some highly unpleasant individuals) is how amazing God's love for us must be if He allowed His Son to suffer and die for our sakes even knowing how depraved and unkind we can be.  The thought brought me up short a couple of times today when trying to deal with some rather difficult families.

Quick thing number 1: Happy St. Patrick's day!  May the road ever rise to meet you, may the wind be always at your back, may the rain fall soft upon your fields, and until we meet again, may God hold you in the palm of His hand.

Quick thing number 2: Congratulations to Nicole and Veronica (as well as the other MS4s) on your residency matches!  Thoughts and prayers for you, and I'm sure I'm not the only one wishing you all the best in your programs!

That's all for me for tonight.  Hope everyone's doing well; till next time, peace and God bless!

Lenten Reflections, Part VIII - The Color Purple

Seems a little odd sometimes that the color associated with Lent is purple -- the same color associated with the elite in ancient Roman society, the color of the Emperor himself.  It's an awfully majestic color for a season in which humility is the main course.  Why not something a little more understated, a bit more subdued?  Because "Jesus Christ, though in the form of God, did not regard equality with God something to be grasped.  Rather, He emptied Himself, taking the form of a slave..."  The ruler of all things, Creator of the universe, humbled Himself for our sakes, and we commemorate His sacrifice in this (and many other) ways.

Quick update from the world of family medicine -- if you're on home oxygen, please stop smoking.  Especially if you're actively using said oxygen with a nasal cannula.  No, it's not "just air."  But I guess if you really like fireworks, go ahead -- just don't blame me when I'm trying to take care of the third degree burns on your face and your partially denuded scalp.  This has been a public service announcement.

Anyway, don't know if any of the above post makes any sense.  I'm a little out of it tonight.  Hope everyone is doing well...till next time, peace and God bless!

Lenten Reflections, Part VII - First Steps

We're a week into Lent, and I can't decide whether to qualify that statement with an "only" or an "already."  In some ways, it's the slowest season of the liturgical year for me -- mostly because I'm a wimp and don't like giving up things that I enjoy.  At the same time, though, it never seems like it's quite long enough -- I always feel like I haven't prepared well enough, that I've left things undone.  So I'm both cheered and a bit miffed by the fact that the first steps of Lent are already behind us.  Guess all that can be done is to make the most of the rest of it, right?

One other thing I wanted to mention -- apparently today was the day for the 4th years (soon to be PGY-1s) to find out whether they matched into a residency program.  They don't know where yet (that'll be in a couple of days), but hopefully they do know that they've matched.  So please pray for all of them, that they'll end up where they want to be.

That's all for me tonight...more reflections and a brief family med update tomorrow.  Till next time, peace and God bless!

Lenten Reflections VI - Sacrifice

Katherine raised a really good point earlier today.  One of the traditions of Lent is that of sacrifice -- giving up something that matters, something that it hurts a little to let go of.  Why do we do it?  First, we do so to allow the seeds of spiritual discipline to be established within ourselves.  Second, we remember and honor Christ's great sacrifice by our smaller ones.  And, in fact (and those of you more learned in Church teaching than I, please correct me if I'm off base here), we participate in the Cross by willingly joining our offering to His.  That's why the "what" of the sacrifice doesn't so much matter as the trajectory (poor choice of words, but it's late and I can't come up with a better) -- what I mean by this is that a small sacrifice freely given to the glory of God participates far more deeply in the mystery of the Cross than a crushing sacrifice without any particular goal.  I needed to remind myself of that -- I think for the last couple of years I've given up things that were very difficult for me (by the way, giving up meat is MUCH easier than giving up chocolate, and don't ever try both at once if you value your sanity) but I never really spent much time thinking about the why.  It was just something I didn't really think about, something I did because it was Lent.  So this year I decided to take the advice of a priest whom I respect very deeply.  He recommended, rather than giving many things up, that I instead give up one thing and replace it with something that would help me to grow in a spiritual discipline -- reading the lives of the saints, praying Compline, something like that.  So I'm trying that this year; we'll see how it goes.

Oh, by the way, this is apparently my 100th blog post.  Only took me about 2 years.  Figured I'd mention it.  Anyhow, hope everyone is doing well...till next time, peace and God bless!

Lenten Reflections, Part V - First Sunday

The first Sunday of Lent is always a little strange, always a bit of an adjustment.  Having been in a routine for nearly a year (although with a few weeks off for Advent), I feel like every year I'm just preparing to sing (or pray) the Gloria when I realize "oh wait, that disappears for the next six weeks."  Same thing with the Gospel acclamation -- all of a sudden it's "praise to You, Lord Jesus Christ, king of endless glory!"  It marks a transition, and it's tricky for me to make the adjustments -- just like it's tricky to make the adjustments to the discipline of Lent.  I don't actually think I've ever managed to do either of those things well, really.  Maybe I'll get it this year?

Anyway, that's all for now.  Starting on a week of inpatient in the morning...it'll be early, but it should be ok, we'll see how it works out.  Till next time, peace and God bless!

Lenten Reflections, Part IV - Getting Back Up Again

It's so easy to stumble and fall...no matter where we are, we're never really very far from temptation, and far better people than I have taken a few spills in this journey we call life.  The fact is that it's easy to sin and difficult to repent.  It's hard for me to admit my failings to myself (let alone someone else), and all too often I ignore things that need to be addressed.  And then there's the opposite end of the spectrum, of which I'm also guilty -- being unwilling to forgive myself for the wrongs I've done.  I know it's not just me, either.  One friend of mine, a far holier individual than I could ever dream of being, constantly struggles with feelings of guilt for "not doing enough" despite the fact that she lives her faith as fully and completely as I've ever witnessed someone do.  It's hard to forgive, and sometimes it's particularly hard to forgive ourselves.  But if we ever hope to rise to our feet after falling on our faces, it's a necessary step.  And, as in all things, we don't have to do it alone.  Let us pray that God will help us to lift the crosses we lay upon ourselves and to forgive ourselves for our faults and failings (full disclosure: stolen from a Danielle Rose song; I know pretty much the entire song but can't remember the title.  Because that's apparently how my mind works).

That's all for tonight.  Hope everyone's doing well...till next time, peace and God bless!

Lenten Reflections, Part III - Counting Blessings

Every so often before I come to post on here, I read the blog of a friend who's currently serving overseas.  Her tales do two things.  First, they make me feel like a totally inadequate human being.  I'm stressing / griping about my shelf exam or my work schedule?  The longest I've ever had to work at a stretch is 30 hours, and I wasn't doing that under fire.  Second, they remind me how blessed I am and how many people would dearly love to have the opportunities I've had.  And this is the Lenten connection for tonight -- everything good we have is a blessing, a gift, and very much not our own doing.  We are surrounded by grace, whether we recognize it or not (and honestly, I often don't -- see the "griping about meaningless stuff" above).  The ultimate manifestation of this grace, of the blessings we receive, can be seen in the Cross.  No greater gift, no greater love, no greater grace, no greater blessing -- the gift of the Son Himself, sacrificed for our sake.  So let's take some time during these 40 days to reflect on the Cross and its meaning in our lives as a way of counting our blessings.

Anyhow, I'm back in Pittsburgh for the weekend.  Gotta say, the last two drives between Altoona and Pittsburgh have been astoundingly un-fun...March is a bad time to be making this trip.  Oh well, eight work-days left till the end of the rotation and a permanent return to Pittsburgh.  No especially interesting stories from today, although seeing the babies in the nursery is always amazing.  Anyhow, that's all for tonight.  I'm going to go count another one of my blessings -- the ability to sleep in my own bed tonight!  Till next time, peace and God bless!

Lenten Reflections, Part II

At first glance, Lent doesn't really seem too glorious, does it?  In fact, it seems pretty much the opposite -- dark, dreary, forbidding.  So why do we sing songs like "The Glory of these Forty Days"?  It's a season of self-denial, of discipline, of penance and of turning away from sin.  It's sort of like menial spiritual labor -- scrubbing floors, taking out the trash, you know, that kind of thing.  Nothing glorious about it, right?  (Of course there is...I wouldn't be setting it up like this otherwise, would I?)  In fact, I see two ways in which Lent is a truly glorious season.  First, the work of Lent is the work of our own participation in our salvation.  We are incapable of saving ourselves -- such a feat can only be accomplished by the One Who is infinitely greater than any and all sin.  But one of His many gifts to us (although sometimes it doesn't seem like much of a gift, does it?) is the ability to cooperate with His grace, to allow ourselves to be drawn nearer to Him.  The "menial labor" isn't menial at all -- rather, it one of the ways in which God allows us to give ourselves to Him, to offer our lives to His will in all its perfection.  Why else is Lent glorious?  Because it is directed toward the Cross -- and the empty tomb.  Lent is the road along which we travel to the mysteries that are the cornerstone of our faith -- the death of the Son and His Resurrection.  It is glorious because it points beyond itself to the very source of our salvation.  Pretty tough to be more glorious than that.

Anyway, that's my reflection for tonight.  Family medicine is ok, although I'm less than pleased with the administration of the clerkship (the clinical side out in Altoona is actually pretty good -- better than I expected), but that's another story.  I was also hoping to have stories from my Stat MedEvac helo ride today, but the weather didn't cooperate, the bird was grounded, and I got to see lots of low acuity uninteresting patients instead.  Oh well.  Hopefully I'll get to go up before the clerkship ends.

Guess that's all for now.  Hope everyone is doing well; if you're looking for prayer intentions, I have a couple of special intentions that could definitely use some reinforcement (ask if you want more details).  Till next time, peace and God bless!

Lenten Reflections, Part I - Ash Wednesday

So as part of my Lent this year, I hope to write a brief spiritual reflection here each evening, possibly interspersed with updates from my rotations.  Tonight, at the very beginning of the Lenten season, I just wanted to spend a couple of words on the next few weeks.

Lent itself is a time of prayerful reflection, a time to look deep within our own souls.  I think, if we're being honest with ourselves, most of us (including me) will find a host of imperfections, blemishes, and sins.  There will almost inevitably be something within ourselves that we find repugnant, disturbing, and hateful.  In fact, it may be so distressing that we choose to ignore it...you know, the old "I can't see you so you can't see me" mentality.  It's too painful to admit that such flaws could exist within ourselves, so we just never drag them into the light, never allow ourselves to contemplate and deal with them.  And in many ways, Lent exists precisely for that purpose -- to remind us to examine the dark corners of our hearts, minds, and souls and to allow them to be illuminated by the incalculable love of Christ on the cross.  It is a time for us to open ourselves, to surrender all we have and all we are, to the One who created us and sent His Son to redeem us.  It's a tough journey, there's no denying that, and it seems even more daunting looking at the path stretching into the future from Ash Wednesday.  But He reminds us that we'll never be alone on that path; He'll be with us every step of the way.

Anyhow, that's all for tonight.  More reflections tomorrow.  Till then, peace and God bless!

Sometimes your best just isn't enough...

He finally ended up in the ICU today.  According to the nurse, the CCM doc took one look at him and started the transfer process.  Last I heard they were talking about intubating him.  This one's gonna sting for a while.  We had fixed him.  He was better.  He was going home.  And then this, on our watch, while we were taking care of him.  Yeah, I'm taking it personally.  Yeah, I feel like I failed.  It's going to be a while before I stop berating myself about the things I should have done differently.  Damn it, he was BETTER!  This didn't have to happen!  There has to have been some way we could have stopped it...there has to be...

*Sigh* sorry, it's been a rough couple of days.  Prayers for this patient and his family would really be appreciated.  At this point it would be a miracle for him to leave the hospital in the same condition as when he arrived...anyhow, till next time, peace and God bless...

Condition C

Long day = short update.  Seems I was unfortunately right about the patient I mentioned last night.  At first, it seemed like things were going much better today...he was more with it, alert, oriented, communicative.  But as the day wore on it became clear that some things just weren't quite right.  He was still running fevers despite being on antibiotics.  He was still breathing too quickly.  His heart was beating even faster than it was yesterday and it just looked ugly on the monitor...lots of PVCs, atrial fib, even non-sustained v tach. (Non-medical people: if you're really interested, you'll have to ask for a specific translation, because this one requires a lot of explaining.)  And then his IV blew.  And the IV team couldn't get access.  And he started having longer runs of v tach.  And his temperature went up.  Without an IV we couldn't give him fluids, antibiotics, beta-blockers to control his heart rate, anything.  So after ascertaining his code status with his power of attorney (my first time getting a code status on my own...more about that next post) I grabbed my intern and attending who decided to call a Condition C.  Long story short, by the end of the day he looked pretty bad and was getting a central line from the CCM fellow.  It's probably about 50-50 whether he ends up in the ICU overnight, and if that happens...well, we'll cross that bridge when we come to it, but I'm afraid it'll work out poorly.

So yeah, that's the update for the evening...wish it were a happier one.  Now I'm off to grab a few hours of sleep before long call tomorrow.  *Sigh*  Till next time, peace and God bless!

Every now and again...

...you just have one of those days.  Days that you wish you could just erase and forget even though you know there's a lesson in there somewhere.  Days that leave you questioning yourself, your abilities, your competence and wondering if you've made a wrong turn somewhere in life.  Days that rank among the most unpleasant of defining moments.

So I have this one patient.  I've been taking care of him for a week now.  He came in with viral gastroenteritis, a really common bug that's unpleasant for a couple of days (nausea, vomiting, diarrhea) and then goes away.  We gave him some fluids, watched him for a day, and prepared to send him home.  What's that you say?  The bed at the nursing home has already been filled?  You didn't even hold it for 24 hours?  Oh, that's ok, because it's GREAT for people to stay in the hospital for a week when they're well.  It's not like you can catch all manner of horrible nasty illnesses or anything.  (...yeah, you see where this is going...)  And sure enough, yesterday he spiked a fever to over 102 F.  And started puking.  And becoming tachypneic (translation: breathing faster than usual).  He turned out to have pneumonia, probably from aspirating something or another.  That would be bad enough.  Except it's not the end of the story.  You see, today his blood cultures grew out Gram (+) cocci in clusters.  That means staph.  Probably S. aureus.  Possibly MRSA.  For the non-medical folks: that's BADBADBAD.  S. aureus bacteremia has about a 30% mortality rate.  The last patient I knew who had it died.  And oh-by-the-way, did I mention that because of his demographics and current condition he has about a 30% chance of not surviving the pneumonia?  Or that he's immunocompromised because he's a transplant patient?  We've been working on summary statements; here's one: this guy is NOT going to do well.  Maybe he'll pull through.  But even if he does, it's not going to be a short, easy process.  It's going to take some time, and he's likely not to regain his former level of function.  And as I worked on writing his note and putting his orders in today, I wondered what I had missed.  Had I failed to see something that would have given some warning?  Or worse, had I inadvertently done something that contributed to him getting sick?  Had I missed some finding, some cue, some opportunity to prevent his nightmare in the first place?  What could I have, should I have done differently?  Where did I screw up?  What did I do wrong?  I'll probably never have answers to those questions -- I'm not even sure there ARE answers to all of them -- but I couldn't stop running through them in my head today.  And as Dad pointed out, maybe that's not all bad.  Maybe it's a thought process I need to allow myself to run through, as he called it, a "mini-M&M" [that's "Morbidity and Mortality" btw] that forces me to analyze my thought processes and holes in my reasoning, that helps me recognize patterns, gaps, and things I need to change next time.  Because there WILL be a next time.  Instead of an old guy with pneumonia, it might be a young kid with appendicitis, but many of the principles will still apply.  Don't let your preconceptions get the best of you.  Sometimes short-term discomfort prevents long-term death.  Err on the side of getting help.  Just because you're "only a med student" doesn't mean you're not right, and it ALSO doesn't mean your team won't listen to you.  If something looks wrong, treat it like it is until you find out a reason.  Too much information is often worse than too little.  And no matter how sure you are that you've got a handle on everything, remember that the plot *ALWAYS* thickens.

Anyway, those are my musings for the evening.  Prayers for my patient would be appreciated...we'll see how he does tomorrow.  Hope everyone is doing well!  Till next time, peace and God bless!

A Promising Start

It's later than I anticipated, so just a short post tonight.  Didn't end up doing much today...in typical Pitt Med fashion we were told to be at the hospital by 8:15 but the residents were told they were supposed to meet us at 9.  Oh well, gave us a chance to chat for a while.  By the time we met our team they had already admitted 3 of 4 patients for the day and the senior resident decided just to have my classmate and I more or less take it easy.  On the whole, though, it seems like the resident will be awesome and the attending appears to have an interest in teaching, so this should be ok.  The interns also seem great but they'll be switching on Wednesday, so we'll see what the new ones are like.  Anyhow, so far so good...we'll see what tomorrow brings.  Till next time, peace and God bless!

Internal Medicine, Part the Second

So after a month at the VA, now I start down the hill at Montefiore.  This promises to be a widely different experience for a number of reasons.  For example, in a couple hundred hours spent at the VA, my team admitted exactly one female patient, whom I did not take care of.  Thus, I haven't done a history and physical on an adult female since...jeez, since Ob-Gyn (aka the worst rotation in medical school). It'll be interesting to see how this goes.  Also, attitudes tend to be very different at Monty vs. the VA.  While there were a few vets who were tough to get along with, it really was only a few.  Most of them are wonderful for a medical student to work with because they let us try things (like the I&D -- that's "incision and drainage" for the non-medical folk in the audience -- I performed on a relatively large abscess the other day), they forgive mistakes, and they don't blame the doctors if they choose not to follow medical advice.  Oh, and they also tell really great stories sometimes.  We'll see, but I think those things are likely to be scarce in Monty.  On the other hand, I hear that my team is pretty good and my teaching attending is a doc I've known since the first day of medical school, so I'm cautiously optimistic.

Before embarking on the second half of this rotation, though, I need to write about one patient to close the door on the first part.  One guy I took care of was a spry old fellow in his early/mid 80s who'd been having left lower quadrant abdominal pain for a number of weeks.  He finally "made the mistake" (his words, although jokingly) of telling his wife who insisted that he come to the ED.  "I thought they'd give me some pills and send me home," he said.  Well, there aren't too many things that cause LLQ pain in an adult male, so the ED doc got a CT scan which showed hydronephrosis (a swollen, obstructed ureter).  The radiologist thought there might be a pyelonephritis (kidney infection), but the urologists disagreed.  The guy had blood in his urine, they said, and it looked to them like he had a hematoma in his kidney that was gumming up the works.  So he was admitted to our service for workup and monitoring until urology could stick a scope up there to see what was going on.  It didn't seem all that concerning.  If he had an infection, we'd hit him with ciprofloxacin (an antibiotic) until we could get cultures back; if he had a hematoma, urology would take care of it when they scoped him.  Except it didn't turn out that way.  Two days later my resident got a call from the urologist.  After she hung up, she turned to me.  "He has cancer.  Transitional cell carcinoma.  It was all over the pathology."  I asked if she wanted me to tell him.  Fortunately I had an awesome resident -- she shook her head.  "It's not your job.  If you want, we can go together."  So I went upstairs while she ran a quick errand, but Murphy's Law being what it is, I immediately ran into the veteran's wife.  Apparently she had already heard from the urologist, but all she had gotten was "It's cancer" before the uro guys were whisked away to their next case.  She was understandably distraught and had numerous questions that I tried to answer.  After a few minutes my resident found me, answered the rest of the wife's questions, and then gathered everyone in the patient's room to break the news to him.  He dealt with it surprisingly well, but it was still the first time I'd ever had to be part of a conversation to deliver such an unexpected and frightening diagnosis. I'm sure it won't be the last.  Fortunately, my resident provided me with a terrific example of how to go about delivering bad news that I'll hopefully be able to draw on in the future.  Also of note, we initially expected a pretty grim prognosis based on what urology had seen.  It looked like a high-grade cancer, and we feared that it would also be high-stage.  But when we did our staging, it didn't appear to have spread even to the local lymph nodes -- potentially a very good sign.  So we'll see what happens, but at least the outlook isn't as bleak as we originally thought.  Prayers for him would be very much appreciated.

Anyhow that's all for tonight.  If I'm not on long call tomorrow, I'll post about my first day at Monty in the evening.  Till then, peace and God bless!

American heroes

Yeesh. So much for New Year's resolutions. Internal medicine isn't particularly a good rotation for trying to post frequently. One quick thought before I head to bed, though...I'm working up at the VA this month and it has been a very interesting experience. The vets, as you might guess, are a pretty variable group...some are polite, some are not. Some are willing to work their tails off to get better, some are not. Some are the sweetest, most amazing people you could ever hope to meet and others are crusty, tough old codgers. But boy, what an honor it has been taking care of them. I've had multiple patients who served in World War II...can you even imagine? Guys who fought Rommel in North Africa, who served with Patton in Europe, participated in the invasion of Italy...just unbelievable. I've talked with countless Vietnam vets who were derided for serving their country...I hope I'm able to express to them, even a little bit, the enormous debt of gratitude we owe them for their service. I've met younger guys who fought in the Gulf War or in Afghanistan. What do you even say to them? How can you possibly thank them enough for what they've done, what they continue to do? I've met guys who have received multiple Purple Hearts, who have earned medals for their gallantry in combat. And yet almost to a man if you tell them that they're heroes they'll laugh at you. "I did my job," they say. It's never been more of an honor to do mine.

Anyway, that's all for tonight. Don't know when I'll next have time to post; hopefully before too long. Till then, peace and God bless!

Starting the new year

Gah, break was far too short...I felt like I barely got home before I had to turn around and come back to this place.  Not surprisingly, at the moment I pretty much hate Pittsburgh with every bone in my body, but I know that'll moderate pretty quickly.  Unless the Patriots and Steelers happen to meet in the AFC Championship game.  At that point all bets are off.

Anyway, I started internal medicine today...sounds like it's going to be a bit of a grind.  We work 6 days a week (only because we're required by law to have at least one day off) and since I'm up at the VA the burden both in terms of patient load and in terms of the complexity of the individual patients is very high.  On the one hand, that can mean some pretty late days; on the other, it means a lot of responsibility (which is great fun and great learning).  I'm cautiously optimistic about the next two months, and even though it's definitely NOT the population I want to work with long-term (the vets are generally a lot better than most adults, but even they just can't compare with the kids) I think there will be a lot of opportunities to learn and grow as a person and as a physician-to-be.

One of my New Year's resolutions is to post on here more regularly.  We'll see what happens.  With a bit of discipline I'll have more updates for you tomorrow.  Hope you all had a merry and blessed Christmas and a very happy New Year!  Till next time, peace and God bless!