Friday, April 23, 2010

Half Eaten By Wild Dogs

All right. I finally did it. Faced with the realities of being a single woman working 80 hours a week on the hospital wards, I joined the online dating scene.

said reality

However, I don’t know how realistic it is to expect to find love via the internet. I mean, it’s a great place to buy shoes, order books, browse clothing – but can the wonders of modern technology really bring you a head-over-heels, butterflies-in-the-stomach experience? Friends tell me yes, but I have my doubts.

I started trolling over some of these sites this morning. Whether any of this will translate into actual dates remains to be seen. Maybe it’s because, as with everything else in my life, I am too damn picky. (Wait! Strike that! I have some friends who might beg to differ based on my dating history…) Anyway, my morning peruse went something like this:

Profiles that don’t say very much = either you’re really boring OR you just don’t care who the cat drags in.

Profiles that say too much = wow, you really think highly of yourself. A little too highly? Will you wake me when the monologue is over?

Profiles without a picture = This tells me you’re hiding something… or from someone…

Profiles with pictures of scenery = I mean, really. Really? You think your appreciation for a sunset is going to make me date you?

Profiles with potential suitor who is shirtless, flexing, or in any other way showing off their muscles = just, ew.

And with that my new adventure begins! If nothing else, this latest endeavor will serve as my own little sociological experiment. And hey, maybe I’ll get a couple of free dinners out of it.

P.S. To my two loyal readers (a.k.a. Mom and Dad), don’t worry. I promise to stay away from all the weirdoes, serial killers, and unemployed men out there.

Monday, April 19, 2010

A Bad Kind of Itch

For better or worse, I get very attached to my clinic patients.

Maybe it is because patient continuity is so hard to come by as a resident. Every five weeks, you are shuttled off to a different rotation. Unless you happen to be on the labor floor when your clinic patient shows up in labor, the chances are that someone else will deliver them.

Y.S. is one of my dearest clinic patients to date. She is a lovely young woman from Guatemala expecting her first baby. It’s a boy. She’s going to name him Jack after her equally lovely husband. Y.S. was an unusual clinic patient. First off, her pregnancy was actually planned. She was healthy. She had a supportive family. She had no substance abuse or psychiatric issues. (Gives you an idea of what our resident clinic is usually like, no?)

One day, Y.S. came to me for her usual prenatal visit. Her only complaint was some relentless itching that had developed around her 34th week of pregnancy. She had no rash. The itching was worse at night. For my non-OB readers, this presentation is concerning for a disease known as Cholestasis of Pregnancy. It’s a rare disease which, for reasons that are not clearly understood, can result in an IUFD, or fetal demise. It is so rare that I doubted my patient had this. But being a responsible resident means ruling out “badness”, so I sent her to the lab to have her bile acids (a liver product) checked.

Normal bile acids are less than 40. Hers came back at 82. Dammit. We sent her to Gastroenterology and started her on a medication called Ursodiol. Despite our best efforts, by her 36th week, her bile acids were >180 (read: beyond what our lab could calculate).

My last day at work before vacation, Y.S. was brought in for an amniocentesis, a test for fetal lung maturity. The plan was to confirm that her baby’s lungs were developed and start an early induction of labor. We wanted to bring this baby into the world before Cholestasis had a chance to take him out of it. Unfortunately, things rarely go as planned. Little Jack’s lungs were NOT yet developed. Now what were we to do? Deliver a baby with the risk of breathing problems due to immature lungs? Or let him cook a little longer and risk his life to do it?

* UPDATE: As I returned to the hospital today, I made a beeline straight for Y.S.'s room. I found her - glowing, smiling, as happy a new mother as they come. Little Jack is fantastic. He is a healthy, bouncing, 6lbs 7oz bundle of joy. After a 2 day induction of labor, Jack was welcomed into the world around noon yesterday. Successful vaginal delivery - check. Healthy mom - check. Healthy baby - check. Now this folks, is a happy ending.

Throwing Out the Alarm Clock

Ahhh… I am officially on vacation! Phew… This is not my first vacation this year, but it has been by far my most-needed one to date. Over the last three months , I have rotated through the Surgical ICU, Medical ICU, OB Days, and now Gyn Surgery – with tons of call in between. Boy, have I been beat.

I hopped on a plane home last night right after coming off a 24 hour shift (gotta make each non-work hour count!). I slept on the plane, landed, and went out for some dinner and dancing to celebrate the birthday of a dear friend. By the time I got home, I was so sleep deprived that I fell face first into my childhood bed and into REM sleep. It was a lovely 10 straight hours of snoozing. Once I mustered myself out of my bed and onto the couch, I snuggled up to another dear friend: My parents’ big screen HD TV.

Yes, I am one of those self-righteous liberals who brags about not having television. “It helps me to be more productive!” I often gloat. The secret is that we are the ones who salivate over TV the most. Hotels, friends’ houses, my parents’ home – what do these things have in common? Cable TV! And boy did I get my fill today. I learned all about Extreme Cake Decorating, The Fabulous Lives of Heiresses, Mystery Diagnoses, and being 16 and Pregnant (though I think my work teaches me more about this last one than MTV could).

my aspiration for this vacation is simple!

Of course, now that I am recharged, the Type A personality in me is already thinking of ways to make my vacation week productive… I should kick up my running schedule, hit up my old yoga studio, hit up the beach, learn some of my mom’s recipes for home cooking, do some non-medical reading, see my college friends, see my med school friends...


Or maybe I can just lie on this couch here for the next seven days.

Sunday, April 11, 2010

Who, Me?

Ten months into my intern year and I have gotten used to a lot of things: the labor room, the operating room, the wards, the intensive care unit. I’ve gotten to know both birth and death. I’ve been covered in probably every bodily fluid imaginable. To top it off, I’ve become BFFs with the vagina.  

What I still haven’t quite gotten used to is being called “Doctor”.

The issue doesn't come up with my patients. In fact, looking as young as I do, I’ve had to get over that one pretty darn fast. I couldn’t tell you the number of times I’ve heard, “Aren’t you kind of young to be a doctor?” Then there are those split seconds after I introduce myself as Doctor when patients quickly glance down at my ID badge to make sure it really does say MD. I often feel like shouting "No, I didn't buy this white coat at the costume store! It has my name on it and everything!"

It is with hospital staff that being addressed as “Doctor” makes me feel like I'm playing dress-up. Sure I went to medical school. Sure I learned about the pathophysiology of the human body and the pharmacokinetics of drugs we use. But textbook learning doesn’t hold a candle to the years of experience in patient care that the nurses and OR staff have. In fact, I’ve learned just as much about operating from the scrub techs as I have from my attendings. I’ve learned just as much about patient care from the nurses as I have from my senior residents and fellows. The first issue I have is that the title implies that I know more than them. And frankly, I still rely on them way too much to believe that I do. The second issue is the age difference. Many of these people, from the housekeeping staff to pharmacists, are my parent's and grandparent's age. Maybe it's the Asian persuasion in me, but I feel like if any one is going to be addressed with a title of respect, it should be them.

Who you calling Doctor?
A Scenario: The OR. A scrub tech who has 20 years of experience regularly gives me advice on how to improve my surgical skills. She knows the steps of each surgery down to a T. She hands me the instruments I need before I even ask for them, saving me the embarrassment of revealing I can’t remember the name of the instrument that comes next. Is it Metzenbaum scissors? Or curved Mayos?  I call her by her first name. She calls me Doctor. Trying to buck the system, I tell her “You know you can call me by my first name”. “I can’t do that,” she replies. “I’m old school”. I sigh. Back to square one.

Tuesday, April 6, 2010

Woman vs. Wild

Gynecology is filled with fun and satisfying procedures. Of course, there are those cases that are technically difficult, (i.e. tumor debulkings, vaginal hysterectomies) that make you embrace the title of surgeon. But gynecology is also a land mine of small procedures that are fun in the same way as zit popping. Quick and satisfying.

Today was an OR day of hysteroscopy. This is a procedure in which a patient is put to sleep and a special camera is placed inside her uterus to look for any abnormalities. Simple enough. My second case of the day, however, was no simple hysteroscopy. The patient was a 54 year old female with a history of postmenopausal bleeding. There are many causes for this: atrophic endometrium (aka thin and fragile lining of the uterus), endometrial polyps, pre-cancer and cancer of the uterus. As I placed the hysteroscope into her uterine cavity, I saw it, projected on the OR television screen: the polyp of all polyps, spanning from the top of her uterus to the top of her cervix. It was an endometrial polyp on steroids.

Polypectomies are fun. You see one, you grab it, you pull it, and you’re done. And you have a neat product to show off afterwards. I told you, it’s like zit popping.

polypectomy, however, was not your average procedure. I placed my little graspers through the hysteroscope and lined it up with the big, fat stalk of this polyp. I bit into it. I twisted. I pulled. When I looked again, I saw only the tiniest bite out of the polyp stalk. The polyp held its ground. This happened over and over again, for about 5 full minutes. Meanwhile, my attending and chief in the background are cheering me on. “Come on grab it! You got it! Twist! Pull! Pull! ...(silence)... Did you get it? Ohhh…(sigh)” The polyp remained there proudly, laughing at us.

I took out the hysteroscope. I needed a bigger instrument. I was determined to show this polyp who was boss. I inserted a polyp grasper through the cervix into the uterine cavity. Blindly, I felt around with my tool and tried to grab on to something. The little mofo kept escaping my grasp. My chief resident stepped into try. Finally something. She pulled out a nice 1cm polyp! That was it! We got it!

We replaced the hysteroscope to take a final look. Once inside, lo and behold, what do we see? The mother effing polyp was still there, it all its glory (minus a tiny bit from its end), taunting us. I pulled the hysteroscope out again. I went in again with the graspers even more determined this time. I felt something. I tugged. And tugged. Finally, another 1cm piece came out. “Yay!” we shoutedd! We must have gotten it this time! For good measure, I curettaged the endometrium (I inserted a sharp instrument to scrape out the lining of the uterus). I did this to make sure we got every last bit of polyp. When I finished, I reintroduced the hysteroscope. You can guess what happened. Polly the Persistent Polyp was still waving back and forth at us! “How’s it going suckas???” it seemed to say. I was fuming – and laughing at the same time. We all were. At this point, the entire OR staff (my attending, my chief resident, the scrub tech, the circulating nurse, and the anesthesiologist) was cheering me on to take this pesky polyp down.

Again I remove the hysteroscope. I picked up the granddaddy of graspers – the myoma graspers (meant for fibroids). It barely fit through the cervix. When I fully inserted the instrument, I felt it bite. I twisted. I turned. As I pulled the remainder of the polyp out, I swear I heard it curse at me. “I’ll be baaaaack….”

Whatever. Round 5 and I’m the winner.

Monday, April 5, 2010

Love in the Dirty Thirties

The business of love was much easier in my younger days. The goal was simple - find someone you like and spend time with them. When things stop being fun, you end it. There was no stressing about long-term compatibility, matching family values, or similar parenting philosophies. I didn't have anxiety about religious or cultural differences. I didn’t freak out at conversational lulls, the lack of/or presence of chivalry, or the way we split the check on a date. Dating was simply more lighthearted back then.

I always envisioned my 30s as a time when I would know exactly who I was and exactly what qualities I wanted in a life partner. In many respects, that is true. However, what I haven’t learned yet are which qualities (and how many) are okay to compromise on. I am not so idealistic to think that one day I will meet a Mr. Perfect. I’ve never believed that exists. But I would like to believe there is a mind-blowing Mr. Almost Perfect out there. And I hope that I am still lighthearted enough to be swept off my feet by him. These days I’m not so sure.

So let me break it down.

The Good: I’m smart, pretty cute, and got a rock-solid future ahead of me. I think of myself as a darn good catch (pats self on back).
The Bad: I work at a hospital, 60 to 80 hours per week, where every man I encounter is either old, taken, or gay. Slim pickins’ I say. I’m in my early, early 30s (yes, that’s TWO earlies!) and while my biological clock isn’t quite ticking yet, my eggs are not as fresh as they were 10 years ago.
The Ugly?: I’ve met some lovely men in the last 6 months of my newfound singlehood. There’s one quite special one, in fact, that shall be known as New York. He is HOT and smart and thoughtful and funny and ambitious. Did I mention he’s HOT? In my lighthearted days of youth, this is someone that would’ve “had me at hello”. These days, however, I’ve got major security detail working round the clock to protect my heart. My brain is on overdrive calculating the likelihood of relationship success given our very different backgrounds. I’m exhausted from overthinking it. In the end, I think it all boils down to one thing – after a bruising heartbreak, I’m just not ready for another go at this.

When did falling in love become so much gosh-darn work? Where are those intoxicating endorphins when you need them? Have I grown out of that exhilarating kind of falling in love? Is it all rational and thought-out and controlled from here? And if that’s how it’s going to be, should I revert back to my college dreams of being eternally single with a rotating schedule of lovers throughout the world?