Pain in his . . . what do you call it...?

"Why did you come to the clinic today?" As the interpreter repeated the question in Russian, I admired the patient's hat. It was a White Sox Baseball cap. I'm not into baseball myself, but it warms my heart to see him adopting the local sports teams. I wondered if it was a Christmas gift from a new chicagoan friend.

"He has pain in his . . . uhhhhhh . . . in his . . . " the interpreter trailed off, stumped. English is her fourth language, and sometimes she struggles for the right word. My pen was poised over the chart, waiting. "Pain in his . . . ass!" she said triumphantly. "His ass." They looked at me expectantly.

I set my pen down. That wasn't going in the chart, not even in quotation marks. Was the pain in his buttocks? Perianal area? Rectum? Perineum? "Could you be more specific?" I asked.

Eventually, with some pointed questioning, I uncovered a story of what sounded like hemorrhoids.

I will not detail the digital rectal exam, but suffice it to say that positioning the patient was even more challenging than getting  patient to disrobe for her complete physical. I did manage to confirm the diagnosis.

After explaining the cause and management of the problem, I and my attendings offered him some Anusol HC rectal suppositories from our cupboard and explained their use. As the interpreter passed on the information, I finished my notes, flipped the chart closed and stood up. 

"He's wondering, should these be kept in the refrigerator?" the interpreter asked me.

"No. They don't need to be refrigerated."

A long conversation with the patient followed. "Can they go in the fridge?" she asked me again.

"They don't need to be refrigerated. They can be kept at room temperature," I repeated.

Further discussions in Russian  ensued. I glanced at the clock on  computer screen, eyeing the number of patients in our virtual waiting room. I was glad I hadn't asked about the hat; we couldn't have afforded the pleasantries. The patient's voice became urgent.

"He wants to keep them in the fridge." The interpreter was exasperated.

"Why?"

"His cupboards are very warm. He's worried the suppositories might melt, and then it would be too difficult to insert in his as-"

I cut her off before she could use that decidedly unmedical word again. "Alright. He can keep them in the fridge if he prefers."

As I followed them out to the waiting room, I thought how quirky and exhausting and oddly delightful the encounter had been, and how unremarkable the same visit would have been in a regular walk-in clinic. 

Sealed with a kiss by Nandini !

Nothing without you ..

A bitter truth thats dawning upon me now- i have a limited time with my parents..despite them being the reason for my being, my all..

Since the last 20 years, living with them was like the sun rising from the east-very batural,no big deal.. Now that i'm at hostel-physically distant from them for a major part of the last 3 years, I suddenly realise-I'm home, for just.. " a vacation"!

The next 5-6 years go into career building, followed by a job, a wedlock- when again shall i be the carefree Nanu I was,with Mum and Dad at my side,every single second of my existence...

I want to get back to them forever..

Suddenly, I don't like where I am, and who I am, without them

I want to be there for them.

I want to look after them,

I want to be the one to give papa his reading glasses,

And I want to b the one to help Mum with all the work..

Life doesnt move on without them...

I'll MISS U MAMA, MISS U PAPA

YOU'RE MY LIFE ............

Sealed with a kiss by Nandini ! 

Be nice to your anesthesiologist..

The vast majority of people, I believe, have no idea what anesthesiologists actually do. Many physicians, in fact, don’t really understand what we do.  This is possible because you can go through medical school without ever having studied anesthesia, but you necessarily have to slog through internal medicine, psychiatry, surgery… just some days back  I was in Radio Shack buying an ethernet cable and this fat Asian guy behind the counter started the conversation  about college n studies and just then he made the comment  to me  “Wow, that’s like, so cool that you’re gona be  anesthesiologist, because you'll get  so much money and it’s like, so EASY!”  I just smiled sweetly at that chubby little nerd and marvelled at how he could possibly think that that was a polite thing to say. To say that to someone who had practically killed herself to make it through meds school …  He still has two un-torsed testicles, I imagine, but only because I’m such a nice girl.

The truth of it is, that a monkey can put someone to sleep and wake them up.  Seriously, I could train a simian to know how and when to turn the gas on and off. The trouble is that most people think that that is all there is to it.  But if you look even a little below the surface, you can begin to see what a lot of skill it takes to do this  job. anesthesiologist  take someone who is awake and breathing on their own and put them in a near-death state so that they will not feel pain and distress when the surgeon cuts them open from stem to stern.  The patient is so ”deep” in this situation that they cannot breathe for themselves, so we breathe for them. We manage oxygen, carbon dioxide, sugar, fluids, pain, heart rate, blood pressure… we make sure all those lines continue to intersect at that exact point needed for life.  We push drugs, make adjustments, arrange tubes and lines and padding just so. Very often the right thing needs to be done immediately if order for the patient to survive without problems.  And when I'll do this job rightly , the patient wakes up and never really understands that their life was, literally, in my hands that whole time I'm sure that will be the most amazing feeling :) 

Next time you have surgery, just remember that about your anesthesiologist. They are keeping all those lines intersecting in space, not just turning the gas on and off.

Sealed with a kiss by Nandini !

Friendly Loneliness............

Why do I love loneliness..?

Caz loneliness spends time with me..

It listens to me, enlightens me..

To laugh and to cry, it allows me..

Lets me be my very true self..

Lets me fly to times of all tense..

And when I'm lost.. with none with me..

Loneliness alone.. gives me company..

Then why wouldn't I love lonliness..?

Its in loneliness alone, that I find the real "me"..

  

Sealed with a kiss by Nandini !

attitude !!

The longer I live, the more I realize the impact of attitude on my life. Attitude to me, is more important than facts. It is more important than the past, than money, than failures, than circumstances, than successes, than what other people think or say or do. It is more important that appearance, giftedness or skill. It will make or break a company....a home. The remarkable thing is we have a choice everyday regarding the attitude we will embrace for that day. We cannot change our past...we cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing we can do is play on the string we have, and that is our attitude..I am convinced that life is 10% what happens to me and 90% how I react to it. And so it is with you...we are in charge of our attitude.

Sealed with a kiss be Nandini !

Question for Me.. ?

Hello ppl..

Today as  I open my blog/comments I was astonished to see that I have A question  from one of my reader :O , Oh boy !!!

I'll do my best to reply and hope this will help you .

QUESTION : My name is Taj. Let me just start off by saying I am 100% sure that I am going into the medical field. There's no backing down on my part. I am a highschool junior getting ready to start applying to schools next year and my first choice is the Sophie Davis School of Biomedical Education, a 7yr BS/MD program (not sure if you  heard of it). Also any advice you can give on surviving pre-med and medical school I will gladly take :)

I am really interested in anesthesiology and cardiology so my question is really for YOU  I wanted to know how and when did you juggle and decide when to get Marry,have kids and also what do you  love about your career and why and how you  decided to be an  anesthesiologist ? Thanx in Advance !

My Answer:Thanks so much for your questions! I think first of all that it important to keep an open mind going into medical school. You get exposed to so many new things, and there are whole fields of medicine that you never contemplated before that you end up learning about. Anesthesia, in fact, was something I thought nothing about and never did a lick of in medical school. I looked into anesthesia  just before I was about to start my CR  fact is that you have to pick a specialty based on limited information (you can't see everything by fall of your 3rd year) and a significant number of people end up switching.
Within that spectrum, anesthesia definitely falls into my nonworking brain . I thought about ENT and OB,and then decided to go with   anesthesia!! I love that I'll be  the one who gets to push the drugs- I'll think it, I'll give it, I'll see the results- no waiting for a nurse to fill the written order.

I also do not think that the assumption is correct that anesthesiologists are somehow antisocial. I love that I have to establish rapport very quickly with people who are at a very stressful time in their lives- about to head into the OR for a surgery. I'll get to  work with kids, parents, laboring women, awake women having C-sections. Some of the anesthesiologists I know are rather extroverted. But I do like that a portion of my patients do go to sleep, after I have talked to them. I also think that I'll  enjoy lots of small procedures like  intubations, invasive lines, epidurals, nerve blocks, echocardiography. They are not curative but they are hands-on. It would not be enough for a surgeon, but they'll be fun for me. I also love that I'll get to take care of one patient at a time. No worrying about all the other patients on my service and I'll get to  know them literally inside out. I'll know every drop that has gone in and out. I won't have to juggle daily hematorits in my head for 12 patients over 10 days.
Finally, I would be remiss if I didn't mention that  anesthesia will  allow me to separate work and family life a little more easily. When I'll leave the hospital, I'll pretty much leave work at work- no worrying about this or that patient- they are no longer my direct responsibility. That psychological freedom works well for me. All that being said, it's not for everyone. Sitting in a room charting vitals on an easy case gets boring for anyone. I think that there are so many intangibles that cause one to pick a specialty- when you rotate as a medical student and meet attendings and residents whom you enjoy and feel comfortable with, you end up wanting to be like them. 

I think it's so great that you're starting to ask such good questions. Just remember to stay open-minded. You might end up at a place you'd never have imagined when you started.

All The Best.

Sealed with a kiss by Nandini !

What to expect when you’re expecting…to begin clinical rotations !

Finally, the post I have been meaning to write for a very long time. I get questions about clinical rotations very frequently, so below is Nandini’s guide to medical school clinical rotations, in FAQ format..

1) What is a clinical rotation?

It’s a period of time that you spend at a given hospital (or clinic, doctor’s office, etc.), gaining hands-on clinical experience from seeing patients and learning from patients, nurses, residents, attendings, and anyone else who chooses to teach you.

2) How many clinical rotations do I have to complete?

Well, this varies slightly from school to school, but most students must complete required “core” rotations, and “elective” rotations. Core rotations include:

Pediatrics: 6 weeks
Obstetrics/Gynecology: 6 weeks
Internal Medicine: 12 weeks
Surgery: 12 weeks
Family Medicine (considered an elective by some schools): 6 weeks

“Elective” rotations are just that. They are voluntary. You can usually choose which elective rotations to do, but most schools require a certain number of “medicine” or “surgery” sub-specialty electives. My College  requires a total of 30 weeks of electives.

3) How do I schedule rotations?

The answer to this question really depends on your school.  You apply for core rotations through the clinical department. You can request roations at any of the affiliated hospitals, and they will try to schedule you for them. Keep in mind, however, that they can only schedule you for availalbe slots. So, what you get will depend upon your schedule, and availability. For elective rotations, you can can request them through your college  clinical departemnt, or you can contact the hospital directly.

4) How do I know which rotations are best?

My best advice? Ask around. Word of mouth seems to be the best way to find the best rotations. I don’t think ValueMD has much merit. And see question numbers 13 and 14, for more information related to this.

5) What do med students actually DO during clinical rotations?

EVERYTHING!

Okay, let me be more specific. Here are some common things you will do:

- Perform, write-up, and present H&Ps (histories and physicals)
- Write SOAP notes on patients (progress notes)
- Follow up on things related to your patients. This includes (but is not limited to!) following up on lab results, radiological reports, consults, etc. The more you know about your patient, the better you can help them, and the more your residents and attendings will love you.
- Perform “procedures.” Examples include drawing blood, placing lines, placing NG tubes, suturing, putting in foley catheters, and anything else you can imagine. As far as what you are allowed/expected to do, this really varies from hospital to hospital. But at minimum you should be prepared to draw blood, place lines, and hold retractors (for long periods of time!). As far as training for the procedures is concerned, this also varies from hospital to hospital. But remember the golden rule: NEVER perform a procedure if you have no idea how to do it!
- Round on patients.
- Attend all lectures, presentations, etc.
- Present information on various clinical topics.

6) What are “rounds?”

Some attendings prefer sitting rounds, some prefer walking rounds, and some do a combination of both. Rounding on patients simply means going through the list of patients and presenting information on each one of them. If they are a new patient, you are expected to present the entire case. If they are not, you may just need to provide an update. You then generally go from room to room as the attendings and residents talk to and examine the patients. Expect to be asked many questions during rounds. And this is a great opportunity for you to ask questions as well!

7) What is the “hierarchy” in the hospital?

Med students are the lowest on the totem pole, then residents, then fellows, then attendings. Sometimes you will work only with the residents, and sometimes with the attendings, and sometimes all of the above.

8 ) Will I receive traditional (didactic) lectures during my clinical years?

Again, this really varies highly from hospital to hospital and rotation to rotation. I’ve received lectures in almost every one of my rotations (all the cores), but the amount of time I spent in lectures versus other activities varied widely. You will “learn” clinical medicine via many routes. This includes didactic lectures, “teaching” rounds, and of course, at the patient’s bedside.

9) What is “pimping” and should I be scared?

“Pimping” simply refers to a higher-up (usually an attending, but can also be a resident) asking questions (sometimes in a machine-gun style) about anything and everything. No, you should not be scared. But yes, you probably will be anyway. It’s scary to be put on the spot. And you will never know the answer to all of the questions. But you should remember that you’re not expected to know all of the answers. Keep that in mind, and you will be less stressed out by the situation.

10) What is the schedule like for clinical rotations?

Again, this varies WIDELY based on the hospital and the rotation. Expect to spend longer hours during your core rotations versus electives. Almost all core rotations also involve “on call” hours, which involves staying late or during the night. An average day at the hospital during a core might go something like this:

6:00 – Report to hospital for morning sitting rounds
7:00 – See your patients, write SOAP notes
10:00 – Walking rounds
1:00 – Lunch
3:30 – Follow up on patients
4:30 – Lectures
6:00 – Walking or sitting rounds again
8:00 – Go home

Again, this is just a  my schedule . Night calls vary from a few hours, to 12-hour or 24-hour shifts. Most rotations give you “post-call” days. This means that if you have a call shift, you are allowed to go home afterwards and have the rest of the day off before you come in again the next day.

11) Are there written exams?

Again, this varies, but most of the core rotations will have quizzes and exams. Of course, you will also need to take your board exams (USMLE, etc.) and Shelf exams, if your school requires them.

12) How are you evaluated?

This varies. But for most rotations, your grade is ultimately based on your exam scores and your “clinical performance,” which is based on your clinical skills, clinical knowledge, professionalism, and other areas of performance.

13) What’s the most important piece of advice you can give about clinical rotations?

That you get out what you put in!

Yes, the hospital matters. Yes, the attendings and residents matter. Everything matters. But the most important piece of the puzzle, and the one that YOU have ultimate control over? Yourself. If you show up early, volunteer to stay late, ask questions, and are a very motivated leaner, you will succeed and learn how to be an amazing doctor. It’s as easy as that.

That’s all I can think of for now! I hope this helps some of you out there.I will add them to the list!

Sealed with kiss by Nandini !