Instant Partner Notification

Second rotation as an intern: ED
Lesson learned: Some of us need no prompting to talk to our partners

Patient in the emergency department: a young woman with RUQ pain, normal labs, normal ultrasound, and trichomonas found incidentally on UA. After explaining that she has trichomonas, that trich is an STI, and that she should tell her sexual partner so he can get treated too, I'm about to do a pelvic exam when she suddenly gets up, walks over to the phone with her IV trailing behind her, and starts dialing with murderous jabs of her index finger.

"Pick up the phone RIGHT NOW!!!!" she says emphatically into the receiver. "WHERE are you???"

Then apparently the person on the other end answers.

The patient says, "I just got the biggest shock of my life. They told me I have a sexually transmitted infection and there's no way I got it from anyone else but YOU."

Pause as the person on the other end speaks.

Then the patient interjects, "No, you SAW my test results. I showed YOU mine and you KNOW I was clean. I haven't been with anyone but you in the last 2 years. WHERE did I get it from? From YOUR contaminated ass!"

Tell it to him, girl! Notify his contaminated ass!

Never Turn Your Back on a Multip in Labor!

First rotation as an intern: OB
Lesson learned: Beware of precipitous deliveries from multiparous women!

Example 1: Woman, G4P3, being wheeled to L & D with intense contractions. Alarm goes off in her room, and I sprint over, only to discover 50,000 nurses crowded around her. The woman is still in the wheelchair and a head is coming out of her vagina! The nurses ease the woman onto the floor, the baby is delivered. Thirty minutes later, after we deliver the placenta and stitch up a second degree perineal laceration, the woman's chart is located. Under obstetrical history, it states the patient has a "history of precipitous deliveries x3". Ha! Make that x4.

Example 2: Woman, G2P1, with didelphys uterus and double cervix, arrives with her right cervix dilated 5 cm. After she has been registered and settled into a room, I leave for a few minutes. During the short span of my absence, her cervix has completely dilated and the baby starts to emerge--it's a footling breech! A nurse who happens to be walking by, notices what's going on, runs in and delivers the baby.

Example 3: Woman, G3P2, arrives in OB triage, moaning with intense contractions Q2-3 min. I check her cervix. She is complete/complete/+2. We wheel her bed immediately to L & D. She doesn't speak English but seems to understand my half-baked Cantonese. The OB fellow comes in and wants me to coach the woman through labor. I'm trying to tell her to "push like you're having a bowel movement" in Cantonese but I have a feeling that one syllable is off and I am mistakenly imploring her to "push like you have a big nose". Baby delivered quickly after 10 minutes of pushing, and luckily the real Cantonese interpreter appears. God knows I might have accidentally asked the father if he wanted to "cut the Empire State Building" instead of the umbilical cord.

For Everything Else, There's Mastercard

Total amount received in Stafford loans during medical school: $92,000
Amount spent on industrial size bottles of ibuprofen to ease the pain of being a medical student: $95.60
Having Arnold Schwarzennegar's signature on your University of California M.D. diploma: priceless

Of Pills and Pie

Wrapped in a protective gown with a mask obscuring half my face, I entered the isolation room. The patient was a frail 78-year-old man with marked temporal wasting and a worrisome cough. He had been transferred from another unit, labeled uncooperative and irritable. His sputum had tested positive for acid-fast bacteria, but he insisted he was not sick and refused to take any medication. Realizing that the patient resented being treated as if his illness was his one defining feature, I sat down and spoke with him about his life outside the hospital. He was a retired postal worker who had been widowed for 5 years. His favorite pastime was baking, and sweet potato pie was his specialty.

It was then that we struck a bargain: if I was able to bake a sweet potato pie that was as flavorful as his, he would take the cocktail of isoniazid, rifampin, ethambutol, and pyrazinamide.

When I went home that evening, I researched pie recipes with the same fervor ordinarily reserved for obscure medical conditions. With a combination of two different recipes and some improvisation, my pie was produced. The next day, I presented the sweet potato pie. The patient lifted a spoonful to his mouth. “Lemon juice… vanilla… cinnamon,” he murmured as he chewed. He closed his eyes and smiled. “I’ll take the medicine now.”

Recipe for Match Day

1. Alarm goes off at 07:00
2. Mix equal parts champagne and freshly squeezed orange juice into a 40 ounce industrial strength thermos. Pack 20 dainty Disney Dixie cups so that:
a) to the untrained eye, I will appear to be harmlessly sipping orange juice
b) I can share my homemade mimosas with classmates who are in close physical proximity and we can all appear to be harmlessly sipping orange juice
3. Arrive at our Match Day venue at 08:00
4. Pick up my pre-ordered personalized Graduation Announcements. Having been forced to purchase a minimum packet of 25 when I really only needed 10, will try to convince more popular classmates they can be ghetto-fabulous by taking my extra announcements, crossing out my name, and inserting theirs.
5. Pretend to listen politely while our endearing taskmaster of a Dean gives his rah-rah inspirational speech to 150 soon-to-be graduating medical students, all chomping at the bit to find out where we matched. We need ativan 1 mg IM Q1-2h prn agitation.
6. At 09:00, the Match Day envelopes are distributed; a wave of frenzied ripping-envelope-open noises reverberates throughout the room, accompanied by shrieks of excitement and/or dismay…
7. …and I got my top choice!!!!! Goodbye La-La Land, hello Emerald City!

My Life As a Dictator

There's nothing like being in a room full of attendings and residents who are all on the phone reciting succinct dictations that recount the clinic visits of their patients. Imagine people in white coats speaking quickly, crisply sotto voce into phone receivers as if it were the most natural activity.

I, on the other hand, feel like I'm having a coronary every time I start a dictation: face flushed, difficulty breathing, palpitations, chest pain, and the inability to form the simplest of words. My dictations are full of awkward pauses as I try to persuade the frozen peas of my 4th year med student brain to thaw out and justify my medical decision-making. I drop multiple apologies to the poor sap who has to listen to my stumbling dictation and transcribe it into a legible document. I live in fear that the transcriber will hunt me down in the middle of the night and swiftly dispatch a poison dart into my larynx as punishment for my sub-par dictating skills.

Report from the Battle of Normandy

The Interviews
15 total, about 2/3 family medicine and 1/3 emergency medicine with one combined FM/EM program. The two specialties are more similar than most would suspect. Both require a very broad spectrum of knowledge gleaned from multiple fields and the ability to quickly develop rapport with patients of all ages. With rising numbers of uninsured patients, a growing proportion of visits to the emergency department involve primary care related issues.

Hands-Down Most Bizarre Interview Question: What is the glue that holds you together?
Answer:….um….Elmer’s..?
[in a Monty Python world, the rest of the exchange would go like this:
Interviewer: Elmer’s School Glue or Elmer’s Wood Glue?
Applicant: School Glue
Interviewer: Wrong, it’s Wood Glue!!!!
Applicant: (screams while being jettisoned off the bridge into the misty swamp below)]

Toward the end of interview season, attention deficit disorder emerges and your mind starts to wander, fluttering around frivolous trivialities: Why is the Applicant from New Jersey so distractingly tan in midwinter? or Where can I score some tater tots and a gin & tonic?

The Travel
6 flights, 5 rental cars, numerous road trips in my trusty Honda Civic, 7 hotel rooms, and several episodes of bittersweet chocolate intoxication. On the flight home from my final interview, while I drifted in and out of sleep in a haze of Sudafed (phenylephrine formula, not the good stuff with pseudoephedrine) and Halls menthol cough drops, the plane hit a patch of turbulence and was vigorously tossed in multiple directions.
Other people on the plane: Are we going to crash?
Me: Am I going to sustain a head injury and fall into a coma without submitting my rank order list?!

The Rank Order List
Medicine, being full of obsessive-compulsive types, loves lists. Applicants submit a list ranking the programs they have visited. Residency programs submit a list ranking the applicants they have interviewed. While creating the rank order list, applicants can omit programs they don’t want to attend; residency programs can omit applicants who are unacceptable to them. Everything goes into a giant centralized computer that runs a complicated algorithm multiple times during the 3 weeks between the rank order list deadline and Match Day. Why? They say it’s for quality assurance; I say it’s for pure, unadulterated torture. On Match Day, we each get an envelope with a sheet of paper that tells us what residency program we’ll be attending. And yes, it’s a binding contract, people. Run for your lives!