The most wonderful day of the year! (and I couldn't resist skipping school to get a taste at the 24th annual Chocolate Fat Tuesday!)
This is the Empire State Building. Made of chocolate. With a few thousand white Hershey's chocolate squares as windows. Now look at the top - a solid chocolate King Kong. And it's hard to see, but there is a mechanical airplane circling him.
My dad's creativity is amazing.
Matt and I jumped back in the car at 5pm on Monday, and 
made it to Olean by 10:30 -just in time to help Dad pull out all of his chocolate treasures: the chocolate train, candy jars, chocolate champagne, chocolate covered football, a 7 tier chocolate wedding cake, a giant copper bowl full of melted chocolate to dip strawberries and pineapples, a chocolate waterfall to send oreos and marshmallows through, a chocolate dolphin spouting chocolate sauce... and more chocolate cakes, pies, tortes and desserts you could ever sample.
450 people enjoyed the feast of chocolate at The Old Library - I wonder how many then gave it up for Lent...
Well done Mom and Dad :)
When I googled "trauma" this was the first image that came up. I'm pretty sure it's not real, but it is funny.
Last Friday night I was at the hospital from 7pm - 7am doing "trauma shadowing." The Emergency Medicine Interest Group arranged for two first year students to follow around the second year resident for a 12 hour night shift to start learning what trauma, surgery and emergency medicine are all about. We carried a beeper all night and in addition to going to see the post-surgical patients the resident was taking care of (to remove tubes, draw blood or prescribe pain killers), we met down in the trauma bay whenever someone was on their way to the hospital in an ambulance.
First of all, it is really hard to stay up all night. Thankfully the "sleeping rooms" have very comfortable beds (but no pillows), personal bathrooms, and allow for naps between traumas.
Our first case was a "chest stabbing" that the other student and I decided to demote to a "chest poking." The man was "minding his own business" ("one of the most dangerous things to do in Baltimore," in the words of one of his nurses) and didn't know who or what stabbed him. After a chest x-ray and CT scan he got 3 staples to hold the wound together and was released.
The second case was a man who tried to commit suicide and had a very deep rope burn around his neck. He had a history of psychiatric disorders and came in to the emergency room on his own actually. A CT scan showed no soft tissue damage and the blood vessels in his neck were not torn. I believe he was taken to another area of the hospital after it was determined he would be ok.
Our final patient was brought in around 2:30am (the bars close at 2am) after he got in a bar fight. He was in rough shape and the attending physician wanted to get a CT scan to make sure he didn't have any head or brain injuries. Unfortunately, an hour later the we still had no scan to look at because the man kept climbing out of the CT machine. He was NOT happy to be in the hospital (which he referred to as the bar several times, while asking for his boys) and did not want an IV in his arm (which he ripped out twice).
Overall, it was interesting to see the approach to taking care of a patient with possible trauma. Lots of people were completing many tasks - and I was able to identify who was doing what and why they were doing it. Getting a history, age, drug and alcohol use, and allergies. Hooking up the finger pulse oximeter and blood pressure cuff to monitor vital signs. Understanding when to get a chest x-ray and CT scan. Then as the situation gets under control, people start to thin out and the patient is given the care and support necessary for his specific situation. Which makes sense :)
I'm terrible at consistent blogging.
Other than that, we've learned almost 100 different bugs (bacteria, viruses, fungi, protozoa that infect the human body) and more than 50 drugs (antibiotics, antivirals, antifungals....) to treat those infections.
If you have a UTI, it's either E. coli, E. coli or E. coli. If you have a fever and you are a returned traveler, it's malaria until further testing is done. If your infant eats natural honey or home canned fruits or veggies, they are at risk for botulism. (This is because the spore of the bacteria is found in nature, accidentally put into the honey jars and ingested.. The still developing immune system of the baby can't deal with it like adult immune systems can.)
Last night 4 of us went across town to the other med school to participate in their Family Medicine Interest Group Procedures Night. We don't have a Family Medicine department, which is strange, so the awesome group across town includes us in their activities. I learned how to put on splints and casts and draw blood. We practiced on each other. :) I was all ready to break out my plaster of Paris, rip up some newspaper strips and dip them in the paper mache goop, and practice my pinata making skills from 3rd grade... but you should know, as I learned last night, this is not at all how you make a cast. Instead, you use this nifty foam/mesh product that hardens as it is exposed to air. It comes like an ace bandage and after positioning the joint and bones, you just start wrapping. Ok, it's a little more complicated than that, but I assure you, there are no liquid glues involved.
They say the third time's a charm... and that's about how my technique drawing blood went. :( I felt so very bad for my partner, but she assured me that skilled professionals have trouble finding her veins. She found my vein on the first try... and we both decided that was because I'm so white my skin in see though.
To Do: Get outside into the sun.
I really love my clerkship experience because, as I've pointed out, it puts what I'm learning in the classroom into practice. For example: Group B Strep and pregnancy.Last week I saw a patient with Bell's Palsy affecting the left side of her face. As it turns out, this facial paralysis is thought to be the result of latent herpes viruses reactivating in the immunosuppressed mom. Pregnancy causes a reduced cellular immunity system (so the mom's body won't reject the baby) and latent viruses, such as Herpes Simplex 1, take this opportunity to do their thing. The virus in this case causes inflammation of the facial nerve leading to the symptoms.
Patient's with Bell's Palsy complain of weakness or complete paralysis of the muscles on one, or both, sides of their face. The
y can't blink their eye or smile on that side. The corner of their mouth droops a little. Eye irritation from a constantly opened eyelid tends to result. Interestingly, facial sensation is preserved. I touched both sides of the patient's face and asked if she felt the sensation equally. She said yes.
Bell's Palsy can occur in anyone at any time, but is seen more in patients who's immune system is not as strong and therefore allows the facial nerve to inflame. It resolves on it's own in 3 weeks to 3 months, but drugs to reduce inflammation of the nerve or antiviral drugs against the herpes virus should be used.
On a completely different note, I wanted to share a quick story about a couple who brought up adding something to their family medical history. The mom-to-be's brother was just diagnosed with leukemia last week. Dr. R. very kindly offered sympathy for the brother and said that the diagnosis of leukemia wasn't something that would impact the pregnancy, but would be something that might come into play in thirty years or so when the child is grown. A family history is always very important. But then the couple offered the real reason they were asking, "We've rethought our decision and we want to bank the umbilical cord-blood."
I'm not sure if they were considering the possibility of helping the woman's brother, or the baby's future medical needs, but I'm interested to learn more about the advantages and reasons to bank your newborn's cord-blood. Seeing patients is really great!
14 patients in 4 hours! Wow. But time flies when you're learning more than you can possibly absorb, understand, or make connections to your classwork! It was a whirlwind of an afternoon with Dr. R, my preceptor for my outpatient rotation. He is a fast walking and fast talking short man who mixes up his 'v' and 'b' sounds because his first language is Spanish. (Which actually reminds me of my Pap-pap, so that's kind of nice!)
We saw women for their yearly exam and Pap smear, women who were 16 weeks or 24 weeks or 36 weeks pregnant, a woman who gave birth 6 weeks ago and was in for her postpartum exam, a 74 year old woman with lower right abdominal pain, and two women in their early 30s who each had constant heavy bleeding and were there to ask Dr. R for a hysterectomy. I need to take a notepad with me this week to take notes on things I need to look up, questions to ask Dr. R after the patient leaves, and tidbits I learn along the way.
Tidbits from last week:
- Starting in the second trimester, fundal height, the distance from the pubic bone to the top of the uterus, in centimeters generally equals the number of weeks along in the pregnancy... 32 weeks along means a 32 cm belly!
- 10% to 30% of pregnant women are colonized (but not sick) with group B strep in the genital tract - not really a problem for healthy adults. But this does put the baby at risk for sepsis (infection of the bloodstream) and meningitis (infection of the lining and fluid surrounding the brain) and a common cause of pneumonia if this bacteria is passed on during the birthing process. Dr. R, and most other doctors in the US, test all pregnant women for group B strep at some point in their pregnancy and treat both the mom and the baby with antibiotics at the time of delivery if the culture is positive.
... and it just so happens we learned about this very thing in Infectious Disease class today! Med school does work :)
The most wonderful day of the year! (and I couldn't resist skipping school to get a taste at the 24th annual Chocolate Fat Tuesday!)
made it to Olean by 10:30 -just in time to help Dad pull out all of his chocolate treasures: the chocolate train, candy jars, chocolate champagne, chocolate covered football, a 7 tier chocolate wedding cake, a giant copper bowl full of melted chocolate to dip strawberries and pineapples, a chocolate waterfall to send oreos and marshmallows through, a chocolate dolphin spouting chocolate sauce... and more chocolate cakes, pies, tortes and desserts you could ever sample.
450 people enjoyed the feast of chocolate at The Old Library - I wonder how many then gave it up for Lent...
