The International Nomad

Some of them want to abuse you...

2008-05-14T02:20:00.002-04:00

This poor girl, doesn't realize she's in a dysfunctional relationship until it's too late - too naive, too innocent, too ready to love. She assumes that people are as forthright as she is, she's completely clueless about what happens "behind the scenes", who works behind the curtain. Sheltered by her family, even into adulthood, she has an idealized vision of how a loving relationship works - compromise is, of course, key. So is commitment, since our culture and religion teach us that flitting from one partner to another makes a woman dishonorable - stand by your man, even as he becomes more and more abusive. All that's needed now is a loser to take advantage of her trust. A lamb to the slaughter.

He never seems like a loser though. That's the problem. He's a caring guy, has similar values, seems just like the kind you'd bring home to mom. And once he's met your mom, he knows that you've committed yourself to him, he begins to change. The care evolves, from calling to check that you made it home safely, to calling every couple of hours, just to check on you. Eventually, he's wants to know where you are, what you're doing, who you're with...every second...of every day. And you put up with it. Because it's just a sign that he cares. He doesn't want anything bad to happen while you're apart. He doesn't even trust your own family to look after you the way he can.

By this time, your loved ones know that something's not quite right. They ask you to think seriously about the relationship. They do care, of course, but you've made a commitment, one you won't break, can't break - if you leave him, he will haunt you for the rest of your lonely years. Who else would want you now? Besides, he not controlling, he's caring. And once he hears of the doubts they placed in your mind (of course he'll hear about them, lovers can't have secrets from each other, can they?), he'll question your commitment everyday - you will be tested, striving to prove that your love is worthy of his. And by now, you believe you need his love, that no one can care for you the way he does. Because he's driven away every other person in your life.

So when he yells, you let it go. He just needs to let it out. Better to have him upset for a little while than not to have him at all. You become passive when he's angry, but that only makes the situation worse. Obviously, you don't care about him, otherwise his anger would have more of an effect on you, you'd have a fire in your belly, you'd fight to be with him. So each time, his temper worsens, until, pushed to the edge, you finally respond. Then he's hurt, perhaps even shedding tears. If you don't comfort him for the pain you've caused, you don't love him enough. And you resolve to keep your cool next time. Because relationships are about compromise.

Already, you're damned if you do and damned if you don't, but you don't see that. You don't know that you'll never be able to love him enough. Besides...who else would want you now?

Some things never change...

2008-04-16T00:13:00.003-04:00

Crappy.freaking.doo.!!!

I had an assignment due at midnight that I thought I did properly. When I went to submit it at 11:55 pm, I had my three parts done and ready. It's supposed to be four parts. Argh!

Then I spoke with my brother. At 11:55 pm he was mailing off his federal taxes and wondering why everyone else at the post office had two envelopes while he only had one. He forgot his state taxes until I mentioned them to him just now. Luckily, he'd also forgotten that he filed for an extension on April 14th. Ahem...LOL

Sigh. Procrastination and flakiness. They run in the family. :p

These are my confessions...

2008-04-08T23:01:00.003-04:00

I've had my profile on a Muslim matrimonial site for several months, complete with info about me, what I'm looking for, and my picture. Desperate, I know, but whaddaya gonna do? I checked my profile today and got an invitation to chat with a male member. All well and good, but this is the champ's profile message:

hi, iam32 yearsold live in canada , i like to meet nice lady for make smoll family.

Lucky me. Sigh.

I. hate. internal. medicine. sub-i.

2008-03-13T23:59:00.002-04:00

Either one of the following two things will happen soon:

My medical team will be rearranged so that it doesn't feel like a ship adrift at sea without a captain,

or

I will be found in a corner of the hospital, in the fetal position, rocking back and forth, crying and sucking my thumb.

The only reason I'm not crying now is that I had a funny thought on the way home. Instead of too many chiefs and not enough indians, my team has too many indians and not enough chiefs... :p

I was also told earlier in the day by someone I generally like and respect that I'm making a bad choice by going into surgery because:

a) I'm getting old;
b) a surgical career will not allow me to fulfill my Islamic role as a woman.

I also need to give in to the "desi rishta system", otherwise I'll never have a fulfilling life. Blergh.

More of my romantic sufferings

2008-03-10T23:59:00.002-04:00

The undergrad I went to had very few desi/Muslim kids, so we all knew each other. But, there were still enough of us that there was a normal group (three guys and me) and an outcast group (socially-awkward-guy). Anyway, our little MSA would put on events from time to time, and we actually managed to snag a few big names (John Esposito, Ingrid Mattson, Imam Zaid) in the time I was there.

A couple years into college, it had become painfully obviously that socially-awkward-guy was interested in me. Now, this was no ordinary nerd. He wore bowties and blazers to class, had a briefcase instead of a backpack, and carried a pager so his mom could contact him at all times. Of course, as the victim of his attentions, I was teased to no end by my friends. :p But I was too nice (and too embarrassed) to say anything to him.

We had scheduled an event, but our budget didn't allow for a halal, catered meal; so my parents agreed to donate the food, and my mother did all the cooking. While setting up the food, she immediately recognized socially-awkward-guy as the person I had complained about to her many times. Now, if you know me and my family, you might be surprised to learn that I get my trouble-making streak from both my parents, not just my dad. So, amma-dearest got right to work. I spent the next couple of hours wondering why socially-awkward-guy was playing so enthusiastically with my much, much younger brothers (who looked at him like he was green and had horns coming out of his head) - and why he kept complimenting me on the tasty shaami kebabs. WTH?

After my mom 'fessed up to "encouraging" him with tales of my cooking skills (LMAO), I was even more mortified than I had been.

That week, I decided to take matters into my own hands and ask socially-awkward guy to leave me alone. It didn't go so well. I don't think that the conversation was helped by my decision to conduct it in a very public place (the middle of the line in the dining hall). Things continued to go down hill after I told him that I was uncomfortable with his behavior and couldn't deal with "the charade" any more. If I recall, his immediate response was a vehement "Astaghfirullah, sister, how could you think that?!" Our interaction became much more normal after that, so I thought that everything was ok.

No such luck, of course. He emailed my friends asking whether they thought he was interested in me. Then, he angrily confronted me when they all said yes. Because, of course, I must have planted that thought in their heads. Um, yeah. 'Cuz I'm evil like that.

Dear God, why can't you just send me a nice, cute, normal guy? Haven't I suffered enough? :`(

Shady "rishtas"

2008-03-10T00:10:00.003-04:00

Note: Rishta = marriage proposal sent to a woman's family by the prospective groom's family.

So the topic of awkward rishtas came up recently. Here's my contribution:

Just after high school, we went on a trip to Pakistan. We spent an afternoon at some relatives' home. I was just glad to be somewhere that I could check my email, but I was polite and made small talk.

Fast forward a few months. I'm at college and I get an email from their son asking if I would mind emailing with him because he was trying to improve his written English. Well (doh!), I agreed. We chatted back and forth for a while; then, out of the blue, I got an email declaration of "love". Shocked, I told him off and told him that I wanted nothing more to do with him if he was going to behave in this manner. Then, a couple weeks later, I got another email telling me that because of the shock of my rejection, he had fallen ill and had spent the whole time since then lying in bed, unable to eat. This overly-dramatic back and forth went on for a bit, and I eventually stopped responding.

Psycho-boy then started sending me an email every ten minutes. The first couple I read, and they were just one liners, so I deleted the rest. Finally, I got an email with the subject line "why are you deleting my emails without reading them?". Keep in mind, this guy's career specialty was internet security. Gah!

Anyway, eventually, he stopped.

Then a few months later, my dad got mad at me out of the blue. I asked my mom why, and she said "well, you should have been more open if you were interested in so-and-so". Huh?

I told her the truth about what had happened. It turns out, his dad had called my dad to express interest. My dad said that we weren't interested, and so the guy's dad said something along the lines of "well, your daughter disagrees with you, she was the one pursuing my son". WTH?!

Alas, the truth prevailed. My dad called to tell them off and hasn't spoken with their family since. :p

Anxiety (attacks)

2008-02-29T18:14:00.003-05:00

I don't know if many other people have this experience, but whenever an important event in my life is looming, I tend to dream about it. But these aren't normal dreams. They're weird.

Just a few, for your viewing pleasure.

1. In the weeks before I took the MCAT, I had a recurring dream/nightmare. In the dream, I would wake up suddenly, check the time, and find that I had ten minutes to reach the test center before the exam started (which was 20 minutes away). On top of that, I couldn't find any form of ID, which is a requirement before they'll even let you in the room. Needless to say, I made sure everything was in order the night before the actual exam.

2. I was very scared about my first histology exam - so many structures to remember, and this exam included microscope identification too. Eeek! A couple of days before the test, I was exhausted, so I decided to take a nap on the couch. I was woken up by my friend who found me sleeptalking. I had started dreaming about a particular type of cell in which the mitochondria settle at the bottom of cells. In my dream, the mitochondria refused to stay where they were supposed to, and I had become quite vocal in my concern about this state of affairs.

3. Last year, I had this dream:

On match day, I opened my envelope and found that I was accepted into my top choice of residency program. I was all excited, telling my friends, really happy, and so on; but then I woke up with my heart pounding because I realized that I hadn't actually signed up to participate in the match and it was too late to sign up now - I hadn't matched anywhere! I started to freak out.

Then I woke up for real (yes, it was a dream within a dream :p), heart pounding, about to freak out again, when I realized that I couldn't sign up for the match because they weren't accepting applications yet.

No pressure...

2008-02-22T14:59:00.005-05:00

Wow, long time, no post.

Well, I finished off my interviews (thank God!), went to school for a couple weeks, spent some time in NYC (which included an epic battle against the scourge of the city), and now I'm back at the mothership for a bit.

Now I just have to wrestle with "the list". This is no ordinary shopping list or to-do list. It's the "rank order list", which will determine where I will live and work for the next 5-7 years.

You see, years before I was even born, the powers that be decided that a normal job market was too chaotic for filling residency positions. Instead, they put the fate of thousands of the nation's best and brightest in the capable hands of an Intel 4004.

Future residents rank the programs at which they interviewed, programs rank the candidates, and everyone's lists are fed into a computer. That computer then uses a complicated algorithm to "match" programs and candidates. Of course, some candidates go unmatched and some programs don't fill all their positions. These go on to the second step, the scramble. Theoretically, very few people end up scrambling, and most people end up at a program they like (or, at the very least, one they don't despise).

There is, of course, a lot of strategy which goes into the process (because we're all gunners and we need some way of channeling our rational/obsessive thoughts). This is mine: rank the programs I liked, in approximately the order I liked them; don't rank the programs I don't want to end up in (there were several); and hope for the best.

Oh, and procrastinate. My list is due next week and I still haven't finished it. Argh!

Breaking bad news - Sindhi style

2008-01-02T01:42:00.000-05:00

In the times before telephones and postal services, communicating over long distances was difficult. If urgent news was to be conveyed to someone who had traveled to another town or village, a messenger on horseback was sent. Thus, any traveler who saw a familiar face from his or her village could assume that bad news was on its way.

A folk story, in honor of a fellow Sindhi woman:

A man had gone on business from his village to a town several days ride away. One day, he saw a young relative approaching on horseback. Of course, his heart sank, and he braced himself to hear the bad news.

"Is everything OK?"
-"Well, Saeen (sir), I came to tell you that, unfortunately, that big knife you have..."
"Yes?"
-"Saeen, it's blunt."
"Huh?"
-"Well, it got blunt after they killed your bull"
"They killed the bull? But why?"
-"Saeen, after your father died and was buried, they decided to sacrifice it."
"My father died? But...how?"
-"Well, you know, he became very lonely and sad after your mother passed away."
"My mother passed away too?!"
-"Saeen, she was so distraught after the loss of your wife and son."
"But...but...what happened?!"
-"They did try very hard, but they couldn't escape when your house was burning down."
"My house burned down as well?!?!"
-"Saeen, yes."
"And you came here to tell me my knife was blunt?"

Folks, Pakistan's knife is blunt.

John Moore/Getty

I'm tired already

2007-12-24T21:32:00.000-05:00

It's been a couple of weeks since my last post, so I figured it was time to update my (solitary?) reader(s). 7 interviews down, 11 to go.

In that time, I've flown cross country twice, gone to six cities, had four interviews, been late for one because I was throwing up (migraine, ugh), gotten stuck in a monster of a snow storm, and taken a eight hour oral exam.

I've also caught a horrible cold. Thank goodness I have a whole 6 days to study for the nine hour written exam. :p

I really hope I didn't get adenovirus 14. Of course, I've been to each of the states it's been reported in over the last month. eek.

A different approach

2007-12-09T03:14:00.001-05:00

My most recent interview was a little offbeat.

I arrived at the hospital around 7am, in my suit, bright eyed and bushy-tailed (yeah right). Standard fare. Since I had walked a few blocks from my hotel, I'd made a quick pit-stop to make myself presentable, ie fix my now wind-blown hair and change from sneakers into my heels. After finding my way to the residency office, I introduced myself to the program coordinator; she showed me where to find breakfast before handing me a pair of scrubs and leading me to an office to change. The sneakers went back on. I was to spend the rest of the day with a couple of senior residents in the OR, and meet a few of the faculty along the way.

This wasn't entirely unexpected, the program had warned us to bring comfy shoes because we'd spend some time in the OR. I just thought that at least for part of the day I'd need my suit. Heh. Nope. I spent an hour and a half getting ready in the morning, and I really could have just rolled out of bed at 6:30 instead. :p

Overall, the interview day was pretty awesome. I think the best word would be über-benign. I was pimped by one attending on anatomy, but it was more entertaining than stress-inducing (although the residents felt badly enough about it later to apologize). Even the OR banter, while still eyebrow-raising, seemed friendlier than most that I've heard (although there was much mention of herpes and "your mom").

Initially, I wasn't too impressed by the hospital (small, old) or the residents (nice enough, but almost too laid-back), but it all grew on me by the time I left. The residents got along with each other and the attendings. And they were damn impressive in the OR - the 5th year resident basically led the 2nd year through the entire case on one of them. The attending didn't bother scrubbing, he just observed. I was even allowed to suture, which is pretty nuts considering they'd only met me a couple of hours before (most surgeons are control-freaks and operate by the credo "trust no one").

In the second case I saw, I was also able to assist, initially because I was standing in the best spot to hold one of the instruments. It was a laparoscopic procedure, a case that I've seen multiple times. Usually, the med student is only allowed to be the camera person on lap cases (a job that involves much confusion and roller-coaster-type nausea). This time, though, they trusted me with their lap instruments. Crazy, I tell you. The attending just let the resident do the case again, although this time he had to assist because there were too many instruments in use.

The only other time I've been given that much leeway in the OR was when I worked with my favorite plastic surgeon. She let me "first-assist" on her cases, but only after I'd worked with her a few days and she knew I wouldn't go nuts. These people were basically letting a stranger off the street come into their domain and trusting me not to screw up.

Very refreshing. I'm sure it'll be one of the best interview days I'll have. I finally got the sense that my education would payoff one day.

Notes from the interview trail

2007-12-02T15:03:00.000-05:00

My two interviews so far have been pretty benign, even though they've been at so-called "powerhouse" programs. No one has pimped* me or even asked about my research (thank goodness - it's been about six years since I touched it!). The residents have seemed quite nice for the most part, and they seemed reasonably happy, despite the pain that surgical training can involve.

The problem is, everyone is doing the same thing - we're all on our best behavior. So how can you really evaluate what you see and what you're told?

When the program director repeatedly states "we're not a malignant program, we just work really, really hard", it can make you worry a little. If they aren't malignant, why is their reputation so strong, why are they so conscious of that and trying so hard to dispel it? Are the residents being honest when they say that they love the program, or are they just toeing the party line (especially with the program director so close by)?

This is particularly difficult for someone like me, who tends to be an open book. Apart from sometimes being too blunt for my own good, I end up expecting the same from other people. I do think there were moments of true, warts-and-all type honesty during my interviews. But those glimpses can be few and far between and hard to evaluate. You quickly start to play mind-games with yourself - what was this person's motivation for telling me that?

And, ultimately, no one really tells you how the program feels about you. In one interview, we were told that the faculty and residents were ranking us during the campus tour. By the time we returned for lunch, they had already decided who amongst the group they liked. EEEK!!!

The worst aspect of this competition is that sometimes you really like the other candidates. That's not such a bad thing, it's nice to know that at least some of your future colleagues are genuinely good people. But you may be inadvertently screwing each other out of jobs!

*pimp = "put in my place"; a practice frequently seen in medical training whereby a medical student, intern, or resident is spontaneously and relentlessly questioned by a superior on a (usually tangential) topic; allegedly based on the Socratic method, but can devolve into humiliation sessions in the wrong hands; done properly, it serves as good motivation to study the topic in more depth with minimal pain; see this for more details, or just google pimp and medicine

On the road

2007-11-19T17:48:00.000-05:00

I'm going to officially enter the fray tomorrow - interview season for 2008 residencies. EEEK!!!

I'm heading to The House of God (double eeek!!!). For some reason, they felt I was worthy of their attention. Looks like I'll have to dig out my copy of that tome. Hopefully, I won't be following the rules too closely (although I've found already that many are true).

The Rules of the House of God:

1. GOMERS DON’T DIE.
2. GOMERS GO TO GROUND.
3. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
THE PATIENT IS THE ONE WITH THE DISEASE.
4. PLACEMENT COMES FIRST.
5. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A 14 GAUGE NEEDLE AND A GOOD STRONG ARM.
6. AGE + BUN = LASIX DOSE.
7. THEY CAN ALWAYS HURT YOU MORE.
8. THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
9. IF YOU DON’T TAKE A TEMPERATURE, YOU CAN’T FIND A FEVER.
10. SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
11. IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.
12. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

I may complain about them....

2007-11-16T23:59:00.000-05:00

But I do love my parents. Despite their opinions about my love life (or lack thereof).

Besides, how many middle-aged desi ammas can earn the nickname of badass aunty?

She's a 4'10" bundle of mom-ness, despite getting smushed by an airborne tanker truck a few years ago. She still wears shalwar qameez at home, but she does away with the dupatta and wears a bandana to do housework. And she taught herself how to use AIM so she could chat with me when I'm online. :)

Letting Go

2007-11-16T16:52:00.000-05:00

Because I could not stop for Death,
He kindly stopped for me;
The carriage held but just ourselves
And Immortality.
-Emily Dickinson

In medicine, we confront death on a daily basis. It may be sad, terrifying, poignant, farcical, brutal...

The first code I participated in was all of these, and more. I was on call on a Saturday evening in April with another 3rd year medical student, W. It had been a slow day, so we were just hanging around, studying and chatting. W had taken a bathroom break but she'd been gone for a while. I gave her a call.

Me: Hey, where'd you go?
W: Uh, we're at a code
Me: What?! I didn't hear them call it! Where are you guys?
W: 6th floor, [our resident] and I just got here - where are you?
Me: On my way up there

The sixth floor was where ventilator-dependent patients were placed - not a good sign. I raced up the stairs, knowing that when I reached there, the inevitable crowd would lead me to the right room.

She was a young woman, diagnosed with an aggressive cancer while her children were still children. Even though her condition was recently determined to be terminal, her husband had insisted that everything possible be done for her. Death had been looming for weeks, but he wanted their children to have their mother for as long as possible, no matter how ill she was. On a quiet weekend afternoon, with no family nearby, her body was finally giving up.

She wasn't a wife or a mother now. She was our patient, one we were trying to hold on to, at her family's demand, and this code wasn't going well.

A couple of residents were taking turns pumping her full of medications and pounding on her chest, the respiratory therapist was trying to keep the bag attached to her tracheostomy, and W was standing in a corner, holding an up IV bag and looking like she wanted to either cry or vomit.

I caught our resident's attention and asked what I could do. I became the designated runner, assigned to get various pieces of equipment from the supply room. There was a slight problem, though: I was only on my second week of the rotation, so I didn't know the codes to the supply rooms, where anything was kept in there, or even which adapters were the correct ones for the pre-filled syringes of epinephrine and atropine. Luckily, there were plenty of people around who did know what they were doing, so my total ineptitude didn't impact the situation at all.

I was more useful relieving W from her imitation of an IV pole.

The code went from bad to worse. The patient's heart wasn't responding to medications, chest compressions, or electrical shocks. The pumping of the ambu-bag was interrupted by attempts to clear the secretions which were plugging up her trachea. Blood-tinged froth bubbled from her mouth and nose. Her pulse was thready at best, and her blood pressure was too low for the machine to detect.

Finally, the doctor running the code allowed us to admit that we had lost this battle: "I'm going to call this one. Everyone agree?" She named the major team members one-by-one, making sure that there was a consensus; we couldn't do any more, other than let her go.

As the techs, nurses, and residents filed out, W and I stayed. The doctor taught us the steps of confirming brain death: the patient was totally unresponsive; she didn't have any brainstem reflexes; there were no breath sounds. We were instructed to ignore the slight fluttering of her eyelids before they hid her dull eyes - it was merely a spurious sign of residual electrical activity, not an attempt to show us she was still clinging to this world.

Neither of us was sure what we should say or do next. No lecture, no group project, no role-play session can prepare you for a moment like this.

We tried to help with the clean up, using damp towels to wash away the blood of a woman we had never known alive. We covered her limp, broken body with a clean sheet, as though to conceal our colleagues' defeat.

She was finally at peace. We were not.

Ugh!

2007-11-14T00:59:00.001-05:00

Don't mind me...

2007-11-13T15:57:00.000-05:00

I'm going to find myself a nice hole to crawl into.

I got the verbal beat down from my mom today. Apparently hoping for some "spark" or "chemistry" with a prospective husband is asking too much. Especially for a girl like me, one past her expiration date, one whose failed prior relationship is now common knowledge on the aunty circuit.

You know what I hate about all this? It makes me feel like a total failure.

Why couldn't I just be content with letting my parents find me a husband from "back home" as soon as I graduated from college?

The bigger they are, the louder they cry (Part 2)

2007-11-12T18:04:00.000-05:00

So the same day as the screaming marine, we had another wien- I mean whiner.

This older gentleman was inebriated and had gotten into a fender-bender. The police found him stumbling around at the scene and sent him our way with a police escort.

He was, unsurprisingly, belligerent throughout our encounter with him. The yells were persistent throughout his quick workup, but all that remained by the time I ambled in was the foley. He just wasn't peeing. The intern and tech looked at each other and then to me. They smiled. Crap!

I couldn't find the kit, so I pulled another one off the shelf. The whining began as I got everything ready. "What are you doing?!" he bellowed when I started to clean him. I explained the procedure and got started. I had barely inserted the tube when he almost leapt off the table, obliterating my nice little sterile field. I looked from the intern to the tech - did I have to re-prep? They were a little preoccupied, try to tackle him to keep him on the table. "Keep going!" they both yelled when they saw that I had paused.

When I finished, we cleaned up after ourselves.

Nurse: Hey, is there any reason you guys gave him an 18 french?
Tech: That wasn't a 16? No wonder he was jumping off the table...
Tech, me, intern (sheepishly): Ooops

The cop in the corner was giggling the whole time.

The bigger they are, the louder they cry

2007-11-11T21:00:00.000-05:00

Working on the Trauma service is fun...in a tortuous kind of way.

Several trauma pagers go off simultaneously: "30M critical, ETA 5min"

A 30 year old man is on his way to the ER. He was assessed in the field and classified as being in critical condition. He's expected to arrive in 5 minutes.

My resident and I gulp down the last few bites of of our 4pm lunch and start the dash to the ER. By the time we get there, the team is set up. The room is already at a quiet hum, the anticipation palpable. They have a little more information on the patient for us. He's a young man who was horsing around with friends and heard a snap in his neck, they called 911. It could be anything from a neck strain to a broken neck with total paralysis from the neck down. We'll find out soon.

"Trauma on the ramp". They're here. The hum evolves a into cacophony.

As instructions are being yelled out, we descend on the man. The EMT tells his story: "30 year old man, was wrestling with his friends a few hours ago, he felt a snap in his neck. They stopped, he felt OK for a while, then called us because his legs went numb. No meds or medical history, but he's a former marine, multiple prior traumas including shrapnel in his lungs and legs from Iraq."

Damn. A couple years older than me and he's a war vet. And we can't get MRIs with the metal in his chest. Perfect for a neck injury.

By the time the EMT's done, we've stripped the patient and the primary survey's already complete: airways, breathing, and circulation are fine. The neck collar is switched, and secondary survey is underway. Mild neck tenderness, so minimal movement until the CTs are done. No abdominal injuries on ultrasound. He's moving all his limbs and has normal sensation. Time to log-roll the guy, so we can check out his back and, ahem, rectal tone.

I stand by his legs and cross arms with the tech, who's standing by his chest. The ER resident is holding the neck, and on his count, we roll the patient towards us. Ooof. Did I mention that the guy is over 6' tall and 200 lbs? I'm about a foot shorter and half the weight. The tech isn't much bigger than me, but we manage to keep him on the table. The yelp tells us that his rectal tone is, indeed, normal.

Overall, he doesn't seem badly injured at all, but we're not taking any chances. He's going to get a full set of CTs to get a look at his spine, so he'll need an IV for the contrast. We also need to get a urine sample. Standard operating procedure.

You'd think this would be the easy part. Yeah, right!

The nurse tells him she's going to stick his arm for the IV. He announces to the room that he hates needles. Eyes roll in unison. Great. He tells us that he really, really hates needles. He asks for something to bite down on. Seriously? The fun starts when the poking begins (isn't that always the way? ;)). He's already screaming, cursing like a sailor despite the washcloth in his mouth. His blood pressure and heart rate are through the roof for the first time since he came in. We try to calm him down. The needle's nowhere near his arm yet.

He saves the blood-curdling scream for that moment when he feels it.

We expect that kind of thing from kids. Heck, lots of adults are nervous about needles. But this guy has shrapnel in his lungs! You'd think he could take a little needle like a man.

A few minutes later, we're almost deaf and I've heard a few novel phrases from our patient. We've been jokingly arguing about who gets to tell him about the foley. The resident eventually takes the straightforward approach. "OK dude, you have to pee for us. If you can't do that, I'm going to have to put a tube in your bladder". His eyes get big. "Where do I pee?" She hands him the urinal. Nothing for a few minutes, until the foley threat is reiterated. We have our urine. Off to the CT scanner.

He was fine in the end, just a bad strain. No more wrestling for him.

My poor ears will never be the same though.

I am not laughing with you

2007-11-10T16:51:00.000-05:00

I've always considered myself a sensitive person. Like most people in the medical field, I've developed a few defenses (mostly humor), but my positive demeanor is often commented on by patients and families. This is something I work on actively because I've had family members with serious illnesses -- I try to treat patients and their families with the same respect I would expect. Still, some things you just have to laugh at.

During my psychiatry rotation, I was working at a locked acute impatient unit. There are many rules on the floors, governing everything from food to where individual patients can and cannot be at particular times. Patients are treated humanely, but there are strict rules in place for everyone's protection. As a med student, my role was pretty simple - just talk to my patients and document how they were doing that day.

We had our fair share of characters - the patient who attempted suicide while in the hospital (twice); the level three sex offender whose first friend on the unit was the youngest woman there; the chronically angry man who punched out a mirror because "the doc's head was in it". Fun bunch. ;)

And then there was Mr. M. A thoroughly delightful (?!) man, Mr. M was admitted because he was depressed. Here was a reasonably intelligent, middle-aged guy, in a dead-end job, no assets, never really had a successful relationship, still pondering the what if's and if only's of his life. Enough reasons to be angst-ridden I suppose.

He'd been depressed most of his life but had been pretty functional as an adult, until the last few years. Of course, no one knew how to help him properly. The doctors wouldn't give him the medicine he knew would work for him. His ex-girlfriend didn't have enough patience for him. His twin brother...well, that was a whole other story.

Mr. M was a fairly talented musician, apparently quite popular in his youth. But his brother (three minutes older!) insisted on joining the band and ended up breaking up the group, taking Mr. M's friends with him. Then, when he became ill, his brother was insensitive. So uncaring, in fact, that he became a therapist (and had the audacity to become a successful one!).

Women didn't respect him, his family didn't respect him, hell, he didn't respect himself.

So after a few weeks, I knew three things about Mr. M:

1. His life sucked
2. Nobody loved him
3. It was all his insensitive brother's fault

We got along pretty well despite his total lack of insight. I even overlooked the obligatory invitation to go on a date with him. And everything was fine until he decided to break the rules on telephone use. Since I was the one who caught him, I had to be the one to "set limits". That little, um, episode ended with me trying to lock him out of the nurses' station (and succeeding in locking out the department chairman instead...oops).

Later that afternoon, Mr. M had a rather angry conversation with the attending regarding our little confrontation. I heard the tail end of it (I don't think anyone on the unit could avoid hearing):

Dr. C: Mr. M, I understand that you're upset, but she's only trying to help you, and you were brea-
Mr. M: Oh yeah?! Well, she wasn't helping me at all. In fact, she's INSENSITIVE! She's the most insensitive person I've ever met, she's in the wrong field, and she should not be allowed to work with patients EVER AGAIN!!!

I listened from a nearby conference room with one of the other students, both of us not sure whether to laugh or be scared as his complaints devolved into a full-blown rant. In one afternoon, I had managed to undo several weeks of work, going from being one of the few good guys to joining the multitude of bad guys. Ah, the joys of a borderline personality's splitting. Yay me!

Before I left that night, one of the nurses pulled me aside and said "Don't worry, you're one of the most sensitive students I've worked with. Remember, it's them, not you".

Splitting: In patients with personality disorders, the tendency to see an individual as all good (sensitive, caring, generous, polite, etc) or all bad (insensitive, uncaring, stingy, rude, etc). These patients have a difficult time accepting that people they like may have negative qualities and vice versa.

I can't even cry myself to sleep...

2007-11-10T01:32:00.000-05:00

It's 1:30 on a Friday night, and my life is so pathetic that I'm in tears. But insomnia hits and sleep refuses to rescue me from myself.

I've been having a tough time lately. I'm pretty sure the people I see and speak to most often wouldn't know it though. I guess I've always been good at putting up a brave front, and I have a hard time reaching out to ask other people for help. I've been that way for as long as I can remember. Is it because I don't want to bother the few friends I have and push them away or because I have a hard time sharing my feelings or...what? I don't know.

The tears have been building up for a few days now, and I'm scared.

I'm scared about school and my academic future. I can't focus on studying. It's become bad enough that I had to push back the date for my board exams. I haven't started studying because I'm afraid, and I'm afraid because I haven't started studying. I have a lot of interviews for general surgery, which is great. I'm not complaining. But I don't have any for my first choice. Not one. I've always known that was a possibility. But it's now my reality. They don't like me.

I'm scared I'll end up alone. I don't want to settle. I tried that. It didn't work. I had six months of happiness and I feel like I'm going to pay for that time for the rest of my life. That sounds melodramatic, I know. But I'm so afraid that I've done it to myself, that I had one shot, and I blew it.

There was one person I liked throughout my teens and into college. We were probably pretty compatible, but I didn't think he was interested. So when I met my ex, I set aside my feelings for the other guy. I settled, figuring that I found a pretty decent substitute, that I could be happy with what I had instead of what would never be. And I was happy. For six months.

A few years and lots of pain later, I was finally able to say "enough". I accepted that things weren't working, that I had made a mistake, but I didn't need to live with it. I broke up with him.

I'd already been back in touch with the first guy by this time. We became friendly again. From talking to other people, it seemed like he may have had feelings for me at one point too. The irony. I wasn't sure, but I thought that there might still be a chance now. I was fantastically wrong. I can't blame him though. I would probably feel the same way, not wanting "used goods" if I had managed to keep out of trouble myself. I deserve it for being so impatient. Being lonely at ~28 is my punishment for trying to force something at the age of 22.

One thought dawned on me through the sobs tonight. Perhaps I'm just not supposed to have that kind of love in my life. I never thought I would be a surgeon because of the lifestyle, but maybe that is God's mercy for me - by being so busy, I won't have much time to dwell on my loneliness. If that is His plan, I can't say that I'll ever learn to like it. But I don't have a choice.

So when the tears stop, I'll confront the truth. I might even learn to accept it and live with it. They don't like me.

Medical Entertainments (ye seconde parte)

2007-11-07T17:40:00.000-05:00

OK, disclaimer time: I do not dislike overweight or obese people - many of my nearest and dearest sport extra pounds. However, this is, indeed, a "fat patient" story. Please stop reading if you are going to be offended. Also, this is a PG-13 rated incident. If you are younger than 13, please don't let any adult find you reading this. Identifying details have been changed.

Setting:
The same community hospital where the previous entry's events occurred. This place is fairly well know for bariatric surgery, particularly laparoscopic procedures.

Characters:
The patient, Mr. G - an unfortunate man who is morbidly obese (well over 500 lbs)
Attending and fellow - aka, the ones who do the surgery but don't have to be there when things go wrong at 7pm
Assorted residents and student - the poor souls left to deal with the mess
The foley catheter - the root of all evil in this story

Mood:
Absurd

Plot:
This story begins on a dark and stormy night. The day residents have just finished signing out to the on-call resident when a pager goes off. A quick phone call leaves the chief resident with a confused, slightly panicked look upon his face.

Chief Resident: They said Mr. G's foley broke.
Resident B: You mean it fell out...Wait, isn't he the guy whose lap procedure got converted to an open one - he was so big that the instruments couldn't get through his abdominal fat...bwahahaha! You get to put that back in! Hahahaha.
Chief: No, the nurse said it broke.
B: Hah, foleys don't break. Still, haha, you get to put it back in. Sucka!
Chief: Dude, I'm serious, they said it broke. Part of it is still inside his urethra.
B (no longer laughing): Please tell me you're kidding, right?
Chief: I wish I was kidding. And guess what. You guys all have to come for this.
All residents: No way man, you're on your own buddy, etc.
Chief: Er, guys, the man's abdomen reaches his knees, there's no way I can reach far enough to do anything...unless you want me to leave it for the morning...
All: grudgingly agree

On the way to the floor, the team members attempt to rope another resident into the job. After hearing Mr. G and foley in the same sentence, he runs in the opposite direction. One resident does manage to catch up to him, but he holds onto a railing with such tenacity that we are forced to leave him behind. Once on the floor, the chief assesses the situation. He examines the available pieces of the foley, determining that it did, in fact, break. Time for everyone to glove up.

Hoping that the remaining tubing might just be trapped under the patient, he positions the team to provide maximum exposure of Mr. G's privates. The bed is placed into the trendelenburg position (or rather, as close as possible to flat before the patient yells, "I can't breath any more!"). The two burliest men in the room stand on either side of the bed, each holding on to one end of a sheet. Said sheet is placed underneath the ample panniculus in an attempt to hoist it out of the way. The only shortcoming in this plan is that the panniculus is massive enough to spill over the top of the sheet. The chief then places two of the smaller team members, including yours truly, toward the foot of the bed to push back this overflowing tide of skin and fat.

With the abdomen thus suspended, the chief looks and finds...nothing? Well, there is an immense scrotum, but no penis and certainly no broken foley visible. The remaining junior resident is told to get sterile gloves on and get ready for a rescue mission (if looks could kill...). Several minutes later, the penis is found within a mound of pubic fat, the broken foley parts extricated, and a new catheter placed. By this time, it feels like the room is 110 degrees, everyone is bright red and sweaty, and a musty odor permeates the area.

After restoring the patient to his original position, congratulations are in order, but only after the procedure is documented with typical surgeon conciseness: "Informed foley broke, all remaining parts of catheter removed, new foley placed, please page if any problems". Mr. G was now free to resume activities as tolerated, which really meant laying in bed and eating a low calorie liquid diet.

The nurse found pie crumbs in his bed a few days later.

Medical Entertainments (series 1, episode 1)

2007-11-06T15:17:00.000-05:00

At the suggestion of a friend, I'm going to share stories from my time on the wards. Identifying details have been changed to protect the guilty.

I did my surgery rotation at a community hospital. Being a petite, cheerful young woman, I stuck out like a sore thumb amongst the surgical residents, most of whom stood at least a foot taller than me and wore perpetual scowls. Of course, I got a little extra attention from the older (male) demographic. The following exchange took place between me, an male patient in his eighties (one day after major surgery), and his equally elderly "lady friend":

Rabs (after introducing myself): Good morning Mr. A! How are you feeling today?
Mr. A: mumbles incoherently
Rabs (turning to Ms. X): How's he been doing this morning?
Ms. X: Pretty well, he's not in too much pain, and he's been eating a little. So you're going to be a doctor?
Rabs: Well, yes, in a couple of years. Mr. A, any nausea or vom-
Ms. X: Are you married?
Rabs: Er, no...So, any naus-
Ms. X: Where are you from originally?
Rabs: Um, I was born in Pakistan, but grew up in England and the US...Mr. A-
Ms. X: Oh, we're Lebanese!
Mr. A (groggily): Where are you from again?
Ms. X: She's from Pakistan.
Mr. A: Hmm...close enough!
Rabs (bright red): Errrr...um... (smile?)
Ms. X (also embarrassed): Ahem, don't worry dear, he just likes it when people are from the same region as us...

The conversation quickly returned to Mr. A's condition, although I did later run into his daughter. She had heard about our little chat and wanted to apologize for her father and his, um, girlfriend's behavior.

Apparently, he was just looking for a nice girl for his grandson.

Things that make me go AARRGGHH!!!

2007-11-05T20:57:00.000-05:00

Why can't I get motivated to study???

I only have to do about an hour of work each day right now, and I should be doing another 6-8 hours of studying per day. It's.not.happening.

Why do Desis and/or Muslims insist on making other people's lives their own business?

Why is she standing so close to him? Did you see him looking at her for more than five seconds? Do you think there's something going on between them? Should we say something to their parents? I think we should, they'd want to know, right?

For God's sake, mind your own damn business people!

Why am I so pathetic?

Right now, the last thing I need is a man in my life. Of course, that's the one thing I would love to have. The brain knows better than the heart.

I'm in what seems like a permanent "transitional" stage. I won't know where I'm going to be living for the next few years until match day in March. So, even if I do meet someone, there's not much point developing a relationship - six months from now, I could be anywhere from Portland, Oregon to Portland, Maine.

Then, I'll be committing myself to 5-7 years of indentured servitude, basically resigning myself to having no life for that time. Therefore, no time to meet anyone. Besides, I'm choosing this torture - why would I want to subject anyone else to it?!

If I'm lucky, I'll be 34 by the time I'm done with training, making me far too old for any respectable (according to my parents) gentleman to want to marry me. I'll be left with the scraps, to put it delicately.

My two (realistic) choices at this point are both pretty, um, sad. I could

-have my parents find me "a suitable boy"; have a quick wedding; have an unhappy marriage because I'm never there or too tired to work on having a meaningful relationship; get divorced by the time I'm 35; live with my cats until I die

or

-stay single; skip the drama of the above option; live with my cats until I die

Sigh. I suppose I could get dogs.

Inertia: the reason I am a lazy ass

2007-11-02T14:51:00.000-04:00

I hate reading EKGs. Yet I signed up for a two week class on it. WHY?!?!?!

Oh, I remember, because I don't actually have to do much. We go in every day, arrive around 11am, we each read one EKG, then we go through some lecture notes for a few minutes. And after that, we go home.

Now, I'm not complaining (well, I am really, but nevermind). It's certainly more relaxed than getting to the hospital at 4:30 every morning, running around like a crazy lady all day, and then going home at 7pm. But at least I felt like I was doing something semi-productive. With this, I just feel like I'm vegetating. I wake up late, rush to get ready, use my brain for an hour, then pretty much go back to vegetating.

The sad thing is, I should be studying. I have Step 2 CK (the written part) of the boards coming up in two weeks. A nine hour exam, designed to make sure you know just enough to be unleashed on unsuspecting patients. And I haven't started studying yet!!! OK, yes, I just proved myself to be a typical compulsive med student with that last sentence.

With apologies to Newton: a medical student in procrastination will stay in procrastination until an external force applies to it.

I need my own personal butt kicker to get myself into gear. :p

I will never understand men...

2007-10-29T15:27:00.000-04:00

Actually, there's one man in particular who I'll never understand. My ex, of course.

We broke up around the end of June/beginning of July, although our relationship had been in trouble for a long time before then. I gave him plenty of notice before ending things. I told him the problems I had with our relationship. I gave him many opportunities to change. And it became very clear that things were not going to be different, that I could not spend the rest of my life with him - or, rather, that I could not spend the rest of my life with him and still be happy.

I knew that the breakup would be more difficult for him than it would be for me. I was ready for it. Or so I thought.

By June, he'd had several months to get used to the idea of being without me. Still, he wanted to be involved in my life. Even after things were "officially" over, he was intrusive, calling and trying to keep me on the phone, sending multiple emails a day, showing up unannounced at my apartment "just to talk". OK, so he was having trouble adjusting.

This went on even while we were both travelling for rotations. We spent several weeks at the same away hospital. I deliberately tried to avoid him, even changing my cell phone number. Unfortunately, I made the mistake of checking my messages while he was around. Since we were in a public situation where I couldn't just tell him to buzz off, he took advantage of the situation, asking to borrow my phone. He called his own phone, and immediately saved the number. I was powerless to stop him, but if looks could kill... And yet, he saw nothing wrong with his behavior.

Even after we were truly apart, he continued to email and call me incessantly. A simple response telling him to stop was countered with a barrage of replies. I couldn't win. Once I stopped contacting him altogether, I thought that perhaps he finally understood that harassing me wouldn't help his already pathetic case.

Again, surprise surprise, I was wrong.

He started sending me unwanted gifts. It started off with expensive jewelry. Then things from my amazon.com wishlist showed up on my doorstep. If I wasn't already freaked out, this did it. He was seriously stalking me now.

Then, suddenly, everything stopped. No contact at all for a couple of weeks. Bliss. Even when we did happen to run into each other, he completely ignored me. Fine by me!

Alas, it ended all too soon. We started the same rotation today. It seemed pretty good at first. We were civil to each other. We spoke like normal people. He wasn't intrusive. I wasn't enraged or in tears by the end of the encounter.

Then I got home. Within minutes, there was a ringing of the doorbell. I opened the door to find (drumroll please): two bags of kitchen items. Things we had shared when we were together, things that I had told him to keep when we broke up.

Chopping boards and a full knife block. Always the best thing to leave at the doorstep of someone who has accused you harassing them on multiple occasions. That type of thing always gets the girls.

Boy, I really have the warm-fuzzies now. :shiver:

They like me, they really like me...I think

2007-10-26T18:44:00.000-04:00

Right now, I'm going through the process of applying for residency training. It's a time which can be fun, scary, and exhausting.

Fun: you finally see years of hard work paying off - this is when you (hopefully) find out that programs want you, and that there is a light at the end of the tunnel. Of course, that light is several years of 80 hour work weeks ahead (train!), but who's really thinking about that.

Scary: there's always the fear and reality of rejection, coupled with the realization that all your training will culminate with real responsibility. Once residency starts, you can no longer hide behind your team and say "I dunno, I'll ask my resident" when decisions need to be made.

Exhausting: you have to schedule interviews, hotels, flights, then actually do all that traveling, talk ad nauseum about your strengths/weaknesses/how your spilt lip at the age of seven inspired you to become a plastic surgeon. And then you enter the mind warp which is the match.

Fun stuff.

The good news is that I've had ten interview invites so far. At least I can be pretty sure I'll match somewhere.

The bad news is that by the time I'm done, I'll be even more broke than I am right now. :p

Hello everyone

2007-10-25T19:26:00.000-04:00

This blog is mainly a way to let me talk about what's happening in my life. If people read it, great. If not...well, you know what they say about people who talk to themselves. ;)

Here are a few things that I hope to explore:

Work stuff: I'm in med school, and I'm planning on going into surgery. For those unfamiliar with medicine, surgery has it's own culture, one which seems odd, often harsh, even to others in medicine. Surgeons are the jocks of medicine in many ways, so you can imagine how well a petite Pakistani-America girl fits in. But I have a secret weapon - I was a tomboy growing up and I still have the sense of humor of a 14 year old boy.

Personal stuff: I recently got out of a bad 4.5 year relationship, and I live across the street from my ex, who didn't want to break up. Couple this with a somewhat traditional Muslim family and a mother who believes that girls "expire" at 30 (I'm almost 28 now) and you have a recipe for disaster. Hopefully I can at least make my futility entertaining.

Random stuff: Hmm, the interplay of work and personal issues. Politics. Religion. Randomness (that's what boredom does to me). Hot guys - now that I can look without guilt. Whatever's on the news or on TV.

Right now, I'm going to watch the World Series. GO SOX!!!