On cat ladies and OB/GYN

I just finished my grueling OB/GYN rotation and am to start Medicine tomorrow so I thought I would take a second to record my thoughts on the rotation just past, as well as the paltry few books I managed to squeeze in. Books first, babble after: Inspired by Carl Zimmer's fabulous (bugs & gross-out heavy) blog (link), I picked up his 4. Parasite Rex, a great look at the biology and pathophysiology and just creep-out fabulousness of some of the world's wildest non-free living lifeforms. I was driven to seek out his book after a brilliant post on toxoplasmosis (link), followed by an equally incredible post on wasps that can zombify roaches (link) I added him to my blogroll as well. Since ID continues to occupy a place in my heart (and in anxiety dreams about what the hell I am going to do with my life), I especially enjoyed it, but it's written at a level that anyone can get completely into it even without much biology background. His toxo article also served to remind me of the one written by Robert Sapolsky, which was a bright spot in an otherwise mediocre anthology of science writing that I read last year. The reminder served as enough of a push to look up what Mr. Sapolsky had been up to lately, which turned out to be 5. Monkeyluv : And Other Essays on Our Lives as Animals, a charming little collection of essays, the best of which focus on debunking popular understanding of genetics, a pet peeve of one of the few professors that I remember fondly from the pre-clinical time. When my brain was mush from night-shift labor & delivery, I read 5. Gil's All-Fright Diner, a little fluff of a horror-novel satire that helped me catch some giggles and even a few hours sleep even as the winter sun blazed in my window.
There were no giggles, though, in 6. Beasts of No Nation, an incredibly depressing first-person fictional account of the life of a child soldier in an unnamed African nation in the midst of brutal internecine conflict. It was pretty good, but that was almost beside the point, because after a grinding 15 hour day in the OR with my very malignant GYN surgery attending, a few pages of this book was all that was required to reduce me to hopeless mush. Not to mention, the pidgin that the protagonist, Agu, speaks in, felt false to me, especially having just finished Pediatrics and feeling especially attuned the the uniquely beautiful cadences of child speech. Other OB/GYN musings:

• I loved delivering babies. I loved it despite the fact that it was far wetter & poopier (vaginal) and far bloodier (C-section) than I had expected. I loved being able to help people get through such a big event in their lives, and I loved that the women really liked their doctors.
• I feel like outpatient OB/GYN can really be a blast - it's really nice to talk to people about ways that they can structure their lives to have healthy abies when they want them, and no babies when they don't. Related to this, my day at Planned Parenthood, an elective that only I out of my block of fellow MSIII's took advantage of, and the 2nd trimester abortion I witnessed were also very eye-opening, and make me all the more concerned about what is (or will be) going on in certain states.
• On another note, some of my feminist concerns about the state of OB/GYN were hardly allayed by experiences with certain attendings & residents. While not malignant toward me, they were the kind of people, that given free rein sometimes become people that cross patriarchy-blaming blog entries get written about. I think, even more than the piece itself, which is the black-humored lightness that Twisty is great at, the heart-breaking comments from the women are what all med students should really read before getting all up in there with their speculums.
• The malignancy of the surgery part of the rotation made me doubtful about my desire to complete a OB/GYN residency, however. If I could operate only with Dr. BigHands, a really nice attending who I worked with out at Io Hospital (It's a satellite of the Mecca where everything else happens, and where I did my Surgery rotation in November and December), then maybe, but seeing how badly even the 4th year residents got treated by some of the attendings made the whole deal very unappealing, and Family Medicine with a fellowship in OB/GYN much more appealing.
• I sure as hell wish I had a better idea regarding the No Seriously, What The Hell Am I Going To Do With My Life-O-Meter (tm Dr. Fake Doctor of Ah, Yes). Sigh. It's getting freaking uncomfortably close (as in single-digit number of months) until I really have to decide, and I feel even more conflicted that I did starting 3rd year. I really need to find a mentor, or two, or three.

No 52 in '05... but maybe 46 in'06?

So I'm re-starting the list, and I know I'm 3-odd weeks behind the rest of the known universe in refurbishing to welcome 2006, but that is about par for the course around here. I managed to make it to 45 books in '05, more counting the trashy paperbacks that lulled me to sleep on some nights, and even more counting the horrifyingly dry books for clerkships that flung me into sleep with a vengeance :). After all that, a few highlights:
Favorite read of the year: So hard to call it; I read some truly great books this year. I would probably end up calling it as a tie between 7. The Curious Incident of The Dog in the Nighttime, 23. Extremely Loud & Incredibly Close and 44. Garlic and Sapphires . One a memoir with food writing that can make you drool on your dress pants on the bus, the other two told by naif narrators that nonetheless expose holes in the day-today fabric of life in a beautiful and heart-rending way. Gosh.
Worst read:22. The Devil Wears Prada without a doubt one of the biggest waste of time reads of the year. Probably the only one on the list that made me think, "Hmm...I could have studied instead of reading that..."
Favorite MEDICAL books(or book bundle): Unable to pick just one again - so I went with a quintet that I pre-read before passing them off to my family. As the black science-sheep of my art-crazy family, Numbers 16. What I Learned in Medical School, 15. On Call: A Doctor's Days & Nights in Residency, 36. Letters to a Young Doctor, 35. Becoming a Doctor : A Journey of Initiation in Medical School and 39. Singular Intimacies formed a pretty great quintet to hand off (along with the inimitable The House of God) to them to explain what I was doing in the echoing hall of the hospital all day & all night.
Overhyped & Underwhelming: 26. Haunted despite being by one of my favorite authors, Chuck really seemed to be floundering in this gross-out poorly edited mess of a book. It just didn't do it for me and I'm afraid the bloom may be off the rose for my reading of his next work. I have something of a different feeling about 30. Harry Potter & the Half-Blood Prince , which, while I wasn't crazy about it, especially given all the hype, I am looking forward to the 6th book.

So with 45 down this past year, I'm hoping for 46 in '06... and a career decision, yikes! Plus maybe some more reflection on life on the wards. Time will have to tell for that latter one, though.
And now, the whole list, for posterity.
45. Son of a Witch 44. Garlic and Sapphires 43. Messenger Bird 42. A Primate's Memoir 41. Anansi Boys 40. Complications: A Surgeon's Notes on an Imperfect Science 39. Singular Intimacies 38. The Dog of the Marriage 37. Proof 36. Letters to a Young Doctor 35. Becoming a Doctor : A Journey of Initiation in Medical School 34. The Constant Gardner 33. Train Go Sorry 32. W;t 31. We Need to Talk About Kevin 30. Harry Potter & the Half-Blood Prince 29. Harry Potter & the Order of the Phoenix 28. Highway 61 Resurfaced 27. Mysterious Skin 26. Haunted 25. The Healing Art: A Doctor's Black Bag of Poetry 24. Emergency Sex and Other Desperate Measures 23. Extremely Loud & Incredibly Close 22. The Devil Wears Prada 21. Even Cowgirls Get The Blues 20. Autobiography of A Face 19. Truth & Beauty 18. Buying Dad 17. Neverwhere 16. What I Learned in Medical School 15. On Call: A Doctor's Days & Nights in Residency 14. The Best American Science and Nature Writing, 2004 13. Bee Season 12. Good Omens 11. Oryx & Crake 10. The Bonesetter's Daughter 9. Long for This World 8. The Pursuit of Alice Thrift 7. The Curious Incident of The Dog in the Nighttime 6. 2004's Best Science Writing 5. Out 4. Mendel's Dwarf 3. Heart Seizure 2. Ella Minnow Pea 1. The Girl in the Flammable Skirt

4 more weeks

guten tag
Originally uploaded by Fib.

I've 4 more weeks left in the year to finish the last 10 books I would need to make my 52 books in a year goal complete. Given that the rigors of my Family Medicine rotation in Honduras and then the time demands of my rotation in Anasthesia and now General Surgery, have kept me from posting here for 8 weeks now, I'm not sure it is likely to happen. This is especially likely to be true as I have banned all Pre-Test and 1st Aid and other such study aids from the list. Ah well, a valiant effort nontheless perhaps.

Sad

Almost at the end of the first clerkship of my 3rd year. The clerkship-that-is-not-a-clerkship is a smashed-together smörgåsbord of 3 weeks of outpatient medicine, 1 of newborn nursery, 2 of outpatient pediatrics, 1 of optho & ENT, and, in my case, 4 weeks of emergency medicine. My first week was at LowincomeExurb of SmallCity, and was perfectly fine. If anything, it was a lot like a drop-in primary care clinic that mysteriously has a high percentage of drunken patients. The attendings were super available and loved to teach. I didn't realize quite how good I had it and was champing the bit toward the 'real' emergencies at TraumaRama ED.

TraumaRama ED lies dead center in the medical complex of Small City and sees 50,000 patients a year. It's a whole new world. The people, like me, who chose to do 4 weeks of EM rather than just one, get the luck (?) of being paired with 3rd year residents rather than interns or 2nd years. The intent, of course, is for us to learn more though this pairing, and be able to visualize ourselves more easily in this profession. And while I feel like the learning is probably proceeding apace, my ability to visualize myself as anything other than dust beneath the feet of, well, anyone, is small, small small.

My resident was, er... strict. He hollered if I were to say, for example "This is Ms. P, a 45 year old woman coming in today with pain in...." because those 3 little words 'coming in today' slow down the FAST. FAST. FAST. pace that he likes to see the Emergency department run at. He paced circles around me while I tried to present to the attendings. He punched me hard, in the kidneys, to demonstrate how to assess for CVA tenderness. I've never seen anyone, including him, hit a patient that hard.

I began to stutter when I tried to talk, which I haven't done in years, not since extensive speech therapy in the pink & purple room in grade school. Blushing furiously, I apologized for stammering - he asked me what stammering was in a tone that suggested I has just cursed out his mother, and when I eked out 'the same as stuttering, basically', he barked at me not to apologize for stupid shit.

And I learned things, lots of things from him. And some small voice in me agreed every time he made me feel small. And I tried to console myself by thinking that he must have learned in this way, back when he was a MSIII at his BigIvyLeague med school. Isn't it good to learn the same way as folks in the 'Ivys do? All the same, right now I feel sad, because I wanted to love this clerkship unabashedly and I have been hating myself so much that I couldn't spare any emotion to love what I was a part of. And so it was with complete and utter shock that I heard last night that this resident - who I thought hated me, after all our shifts together, thought I was in the top 5% of my class.

Even now, I feel the flush burn my chest - there MUST be better ways than this - two weeks of feeling small as an ant mean that I'm good? My head will explode from cognitive dissonance if I think about it any more. There must be a better way. 1 more 10-12 hour shift left - a new resident this time because all of the others have left for a big confrence. I think I need some distance before I decide how I feel about this field, because right now how I feel about me is far too much in the way.

Leaping off the page...

It's been a strange few weeks - the week of Emergency medicine was great fun, but draining, ENT was less fun, and very draining; now I am in outpatient medicine, which I think I would love if I wasn't such a moron about drugs. My school doesn't have a formal pharmacology course, and I never learned the non-generic names of many of the most common drugs in use, so when I am being pimped on this or that TradeName drug, I frequently gabble and stammer like an aphasic troll.

Also vertigo-inducing is the fact that my patients seem to be leaping off the page into the clinics. I finished reading W;t and then had an English professor at our local huge private university present to ENT clinic with chemo-induced tinnitus. Wit is famous to most from the HBO movie with the fabulous Emma Thompson, but I have soft spot in my heart for the little playlet in its book form, as that is how I first read it. My two favorite passages in the book both deal with language and medicine, subjects, as you might imagine, that remain close to my heart,

Vivian: I receive chemotherapy, throw up, am subjected to countless indignities, feel better, go home. Eight cycles. Eight neat little strophes. Oh, there have been the usual variations, subplots, red herrings: hepatotoxicity (liver poison), neuropathy (nerve death).
[Righteously] They are medical terms. I look them up. It has always been my custom to treat words with respect.
[...]
Medical terms are less evocative. Still, I want to know what the doctors mean when they... anatomize me. And I will grant that in this particular field of endeavor they possess a more potent arsenal of terminology than I. My only defense is the acquisition of vocabulary.

My real-life Vivian Bearing was a little less sharp and caustic than her literary counterpart, but no less attuned to words and their power. She sharply corrected the resident when he described her 'ringing' as a 'buzzing' in his presentation to the attending, and noted that she hardly thought there was a flock of bees behind her at any moment. I liked her very much, and (shamefully also rather liked seeing the somewhat awful and obstreperous resident with whom I worked that week wrong-footed for once.

I was reminded too, of my terrible, horrible patient in my last day of Pediatrics while reading We Need to Talk About Kevin, which I picked up after reading a recommendation on Flea's lovely book blog. I hope and pray the story of the little boy who I saw in clinic ends in a more happy way than this horror story. To give some context, the little boy was only 4, but he made even the 3rd year seasoned Pediatric resident come out of the room shaking! When you are a mere four years old yet travel with your own bouncer simply to keep you in physical control, have the horrible ingenuity to force your own hand down your throat to induce vomiting, and then to hold that vomitus in your mouth to spit at people in between screaming the foulest curses I have ever heard (INCLUDING work in a juvenile detention center)... well, things look bleak for a happy ending. I loved my outpatient pediatrics rotation, but it is this sad, horrible, little boy has stuck in my head with an eerie permanence rather than all of the wonderful parts.

The most recent book that has sent characters from its pages into the clinics was Train Go Sorry. In addition to being a captivating story of a woman my age finding her way and reflecting on a childhood that seemed unusual only in retrospect, this book educated me on Deaf life, and Deaf culture in a depth that is amazing in a memoir-style book. It's a bit embarrassing to admit how little I knew about Deaf culture and the many languages and schools within it, especially given the proximity of where I grew up in D.C. to Galludet University, which functions in the book as a kind of half lode-star/half holy grail. Into my preceptor's office on Wednesday whirls an incredibly friendly, completely non-verbal, profoundly Deaf man with diabetes raging so out of control that we almost ended up admitting him. There was no translator available, and the nurses had grown frustrated with his odd syntax in the note-writing communication style we had adopted, so when I went in and not only realized that he was writing in ALS syntax, but that if you spoke and wrote at the same time, he could lip read and get more meaning. The patient and I actually ended up developing a strong relationship, and as the compromise for not admitting him was that he come back every day for the rest of the week, I actually got a taste of having my 'own' patient. I also got a sour taste, though, as my preceptor, though voluble with praise for my ability to communicate with the patient, talked at him/past him/to me instead of him. As described so well in the book it was a moment when I experienced the dreadful impotence of the translator - incapable of making a connection between the two of them no matter how much I wished for it.