First time Blood Donor

I donated blood for the first time today. I'm not sure what to expect so I kinda just follow my resident and the other student in. I've wanted to donate blood for a while but just haven't gotten the courage to do it. Today, I was like what the heck, just go for it. That's what I did.

It wasn't bad at all. The room that the drive was in today was cold and of course, they couldn't find a good obvious vein on my arms, so they have pick the best one. The pinch when the needle went it hurts, it was more painful than when the draw blood for lab work. If that's how an IV line feels, I can see why patients absolutely hate them. I didn't feel anything when the phlebotomist took it out. It took be about 10 min to fill the bag up with my blood. By the end of the time, my hand was tired from squeezing the stress ball that they had us squeezing. After that I just got a sore arm.

I didn't feel dizzy when I got up but I laid down for a couple of minutes before that. By the time I finished, they had catered lunch brought in, so I sat down the staff and basically had lunch with them. They gave me a Christmas mugful of candies and random things. I also got 2 auto show tickets and a BP gas card of $15. I gave the autos how tickets to my residents since I have no intention of going. I think I'll do it again the next time they have a drive.

Now I just feel extra tired. I wasn't tired before this but I feel like it's already 8 or 9pm. ::yawn::

It's all for a good cause. And I also get to find out my exact blood type.

First Code Death

What an experience. I'm sure because it's my first one that I'm feeling like this. I'm pretty sure that I'll see and experience plenty more codes whether the patient comes back or gone. I'm not quite sure what I'm feeling about what just happened. The patient was at end stage with his lung disease and the family was outside of the ICU watching all of us running off the elevator and into the ICU. By the time I got there with my resident, only the daughter was there and she wanted everything to be done.

The team did 45 min of rescue with CPR and medications. Halfway through it, we all thought the patient was going to make it because he had a pulse and good rhythm. But finally it just wasn't enough and went pulseless again. Finally enough was enough and called time of death.

It was a grim reality check of our life. When I saw the white feet, I had a gut feeling that the patient wasn't going to make it but you can't say that when the family wants everything done. Life is just too short and there's no guarantee that it will be a set number of years that we get. I'm glad that I know where I'm going to be after death, with God in heaven. The death on earth is our sleeping time. I also know that even though I'm leaving my friends and family behind, I'm in comfort knowing that they know where I'm going to be and that we'll all meet again in the golden heaven.

Another that I got started to think about is DNR and organ donation. There are many forms of DNR, but I know for sure I don't want to be on a machine when my brain is dead. Intubation is questionable. All I know for sure is that I want the intubation but only till a certain point. Being on the machine without any brain function might be comforting to the family but I don't see how it could benefit the patient. Anyhoo, these are my thoughts.

Taro and Tapioca Dessert

This is one of my favorite desserts when we go to restaurants. But the restaurants have a tendency to make it too sweet. Now that I've found the recipe for it, may be I'll make it myself so it won't be too sweet. Haha.

Ingredients:
0.70 lb taro diced
1/2 cup tapioca pearls
1 1/2 cup coconut milk, to taste
rock sugar, to tast
4 1/4 cup water

1. Soak tapioca pearls over 3 hours. Add to the boiling water on medium heat. Stir them frequently and make sure that they don’t stick together. After cooking for 20 minutes, remove the pot from heat, cover and let sit for another 30 minutes. The tapioca pearls should be translucent, without any white dots in the middle. They are done. If they are not ready, turn on the heat again and cook for a few minutes more. And then let sit for a while again.
2. Drain tapioca pearls and rinse under cold water. All tapioca pearls should be cool to the touch.
3. Bring water and coconut to the boil, add diced taro. When the taro cubes are cooked half through, add rock sugar until melted, to your taste. Lastly, add cooked tapioca pearls. Done.

Serve hot or cold.

Medicine Floor

I started on my Medicine rotation. The residents and the interns are great. They are super smart and more than willing to teach. My first week was uneventful. Had a patient with angioedema from ACE Inhibitor and another patient with chest pains that wanted to be in the hospital for the holiday. Then I had the Thanksgiving and the Friday off. So really not much.

Just finished the second week and had a new team of the resident and intern because of the new month. They are chilled and fun to be around. I'm definitely enjoying my time on the floors with them. They are very efficient so a lot of the times we would all finish our rounding by 10am. They assign the students about 2-3 patients at a time. And a lot of the time, whenever there's a fairly simple procedures, they would let us do most of it. Pretty neat.

This week we've got a couple interesting ones. We had a Ludwig's angina, Steven Johnson Syndrome, Ascites due to Schistosomiasis and another due to alcohol. I was also able to observe a bone marrow biopsy. St Mikes definitely is not lacking in any interesting diagnosis.

The biopsy and aspiration has pretty much turn me off on Heme/Onc. The biopsy wasn't too bad but I don't think I can handle the painful melodramatic screaming. That's not the worst part for me. Just thinking about how the whole patient population is dying from cancer of some form and the point is to prolong their lives, even though we know it's hopeless. I know that the whole profession is like this but Heme/Onc was more obvious.

As more and more I think about my choice for the rest of my life, I working more and more to set myself up for anesthesiology. Hopefully that will pan out for 4th year rotations. It's still a little too early for it, but there's a lot of leg work since I'm going to go the allopathic route.

I finally settled on the COMLEX Step 2 dates.
July 7 - PE
July 16 - CE
USMLE Step 2 CK will depend on how the studying goes. If I do take it, it will be late July/early Aug.

Thanksgiving on the East

This is the first Thanksgiving away from home. I'm spent it with Kirstin's family. She is my closest friend in med school. Her family is very much like mine so it was very comfortable. I definitely enjoyed it and had 2 thanksgiving dinners, one at her brother's place and the second one at her home. It was yummy. My favorite was the Pumpkin Gingerbread. I found the recipe that her mom used and I'm going to try it one of these days.

We also did the Black Friday shopping but we did it at 9am. It was all girls, her mom and her sister (Katie), Kirstin and I, so we did the usual stops, NY&Co, Express, Victoria's Secrets and Bath and Body Works, JC Penny. I have bought sweaters, enough to last me for a long while. I was able to buy the gift for the girl I picked from the inner city organization. So all in all, it's been a good couple days of break away from the hospital. The weather was good until I had to drive back from Saugerties. That day started off with flurries, then raining then icy rain. The road wasn't bad at all but the drivers were kind crazy. 3 accidents along the Thruway which took me 3 hours to get back when it should've taken me 1.5-2 hours. Oh well.

I'm just glad that I didn't have to spend Thanksgiving by myself and in Newark. Thank God for giving me a friend in med school when I didn't think I would find a good Christian girlfriend.

Pumpkin Gingerbread

The yummy pumpkin gingerbread that I didn't think I would fall in love with. I had it over Thanksgiving at Kirstin's place.

Ingredients:
3 cups sugar
1 cup vegetable oil (applesauce substitute)
4 eggs
2/3 cup water
1 (15 ounce) can pumpkin puree
2 teaspoons ground ginger
1 teaspoon ground allspice
1 teaspoon ground cinnamon
1 teaspoon ground cloves
3 1/2 cups all-purpose flour
2 teaspoons baking soda
1 1/2 teaspoons salt
1/2 teaspoon baking powder

Directions
1. Preheat oven to 350 degrees F (175 degrees C). Lightly grease two 9x5 inch loaf pans.
2. In a large mixing, combine sugar, oil and eggs; beat until smooth. Add water and beat until well blended. Stir in pumpkin, ginger, allspice and cinnamon.
3. In medium bowl, combine flour, soda, salt, and baking powder. Add dry ingredients to pumpkin mixture and blend just until all ingredients are mixed. Divide batter between prepared pans.
4. Bake in preheated oven until toothpick comes out clean, about 1 hour.

can use pumpkin pie spice to substitute all other spices

Surgery Rotation

Long hours on Surgery rotation. Leave my apartment when it's still dark and come back after sundown. I don't think I have seen the sun for the month of surgery.

There was definitely a lot of learning for the month but it was a lot abuse from the political turf war in the OR and the pimping. Starting with the turf war, because I wasn't an UNE student and that this is the first year that we are doing surgery at St Mike's. They still haven't figure out where Kirksville and Kansas City kids fit in. We are the step kids while the UNE kids are their real ones. Oh well, we are bascially getting screwed politically both ways. I just wish our school would quickly figure out what's going on.

The learning part was awesome though. It was mostly from the residents, Drs. Sub, Wr and Mwan. They are very willing to teach and tell us their crazy stories. They tried to help us during the rounds of pimping too. They are the ones that I'll miss after the month, not the actually surgeries. From the past month, I definitely learn that I can't physically do the surgery. I can't stand up for long hours and the worst part is that my skin just about react to anything randomly. My hands reacted to a pair of latex free gloves, partly I think it's also from those aweful gowns too.

This month has definitely crossed surgery off my list. But Anesthesiology is back on my list and very high too. I actually spend a lot of time with the anesthesiologist whenever I'm in the OR watching and not scrubbed in. I'm really leaning towards anesthesiology, not easy especially with my Step 1 scores. Oh well. we'll see where God opens the doors for me.

Psychiatry anecdotes

There are a few stories that are worth sharing.

This patient hears voices but the voices are not violent at all. So the doc try to provoke him by provoking his voices to see how much control the voices have. Doc said, "I'm f**king your mother. She is a prostitute. I'm f**king her." His voices didn't respond to the provocation, only said that the spirits from above will judge on the last day of earth. This was repeated multiple times. This was just not the usual provocation and much more shocking.

Here's another one, this patient first came into the ward very paranoid and doesn't want any students around, but our doc basically said that if she wants to stay, the students are in. At first we didn't know why he did that, but she did eventually talk to us and tell us what's going on with her. The next day, the other male students came and want to talk to her but she refused because she thought they were cops. Once we explained that they weren't, she was more than happy to talk. We got to know her very well and really do wish her well. So on her last day, as her leaving the ward present, we got our doc a cop hat right before we see her. Then we brought her into the office, she just stopped at the door and her jaw just dropped and refused to step into the office. It took her a full 5 seconds to realize that there are no cops, just our doc with a cops hat. Ha Ha. We all had a good laugh.

Being a doc is really what you make of it, fully dependent on relationship with the patient. As our preceptor says it, the best therapy is the physician-patient relationship.

Psychiatric ending

Psych ward out here is mostly for chronically ill patients like schizophrenia, depression or bipolar. The patients here are interesting. I kinda forgot that in the city, "crazy" people like to hit on single gals. In undergrad, I always get hit on by guys on the bus, either crazies or foreigners. So it's been a while for me. It's kind of funny now. For the past 4 weeks, I've had about 5 male patients flirting with me and 2 marriage proposals. What a crazy world since to them, this is all reality but I know that it's only reality in their minds, delusion or hallucinations. Part of me find that it's really frustrating dealing with them day in or day out because it's not something I could understand. But it's actually good for them since they can re-focused by coming into the psych ward and not doing something harmful outside on the streets.

The patients here really know how to play the system. The key phrase they use most often is "I'm thinking about killing myself." That will get them an automatic committed admission to the ward where they don't have to pay for rent (Medicare pays), get 3 meals a day, a bed and people to talk to. But the thing is most of them really do have a pysch problem. It's just that our system is not perfect and can be totally be taken advantage of.

Another thing that they do is the they come in around the 25th of the month when they ran out of money from social security check then they will stay until the 3rd of the next month when they get the next check. This is particularly true for the druggies.

Even though they play the system, our preceptor plays with them too. His reasoning was that it's better for them to be in the ward and trying to get help then get in trouble out on the streets. That does make sense and it seems to be working. To each their own.

Psychiatric start

Finished peds rotation almost 2 weeks ago. The NBME shelf exam, end of rotation exam, wasn't too bad. It was mostly case scenarios and trying to figure out what the diagnosis for each case was. I got the score back and I passed. I didn't really study much, just read the Blueprints and Pretest. Well there goes my first end of rotation exam. One down, 7 more to go.

Now I'm on psychiatric ward. It's an inpatient unit with mostly schizophrenics and depressed patients. So far it's been interesting. Even though some of them has the same diagnosis, they all behave very differently. The best or the funniest part is our preceptor (our doc in charge). He's in his 70s and is from Cuban so his accent is still quite heavy. He likes to lecture us on philosophy and it would be on a tangent topic of what we have asked. Also he talk to us about treatments that slightly far fetched and antiquated. Between him and my psych professor in med school, I feel like most of the psychiatrists are very eccentric and borderline being diagnosed with a psychiatric disorder.

So far the schedule has been morning group session where they talk about their goals for the day and meeting anyone that's new. Then either exercise session or we read then lunch time for us. After lunch, we see the patients with either Dr Gomez, our preceptor, or with Dr. Lizardo, the doc for the involuntary committed patients. It's been a relatively light rotation with lots of time for reading, chatting or taking breaks. I got to know a few students from UNE, Firas, Ryan and Eric. They are funny and very informative. This is the first time since I've been here where I feel like I'm actually meeting people and being able to talk to them.

We'll see how the rest of rotation pan out.