Almost but not quite the end

Final exams officially start today. The next two weeks are going to be pretty awful. But when I think about it, it's not like my routine is going to change very much. My life is just consumed by studying day in and day out anyway. I have eight exams left in my second-year medical education. Seven of them will be in these next two weeks. When I survive these, I will officially be done with anything class-related. We still have a smattering of lectures throughout the clinical years, but no classes in the traditional sense. So that's what, 19 years of classroom education under my belt? Did I really just spent 19 years of my life sitting around listening to people talk at me? That doesn't even sound rational. Well, it all ends here. It's going to be bittersweet. I can't say I'm going to miss going to classes, but I'll sure miss sleeping through them.

Student Outreach, Part 2

It's common to get a patient who tends to be a little chatty, where every question probing his or her medical history unearths more than we might bargain for. As the dust is kicked up we have to somehow sort out the jewels from the junk. We have to master the art of cutting people off politely. Don't get me wrong. I enjoy talking to patients. But when your time is limited, you have to draw the line somewhere. Unfortunately, spending less time with patients would potentially mean missing out on such great conversational gems as the following...

A patient told me that she once went into a coma from smoking a joint that had been laced with cocaine and heroine and PCP and god knows what else. Interesting, but irrelevant to her current health.

A patient once told me she was "oversexed." Not sure what to make of that. Actually, I do, but I don't need a mental picture.

I once saw a patient who had been hit by a train and a semi and was shot by a cop. Thankfully, not all on the same day. Otherwise, he might be Jack Bauer.

A lady once told me she substituted ground turkey for beef in some burritos she made for her husband, and he didn't even find out, nor did he believe her when she told him!!! I love turkey, too, but irrelevant, and not that exciting.

A patient told me her urine turned orange because of a certain medication (Phenazopyridine Hydrochloride), but it was normal. Now, that's interesting, relevant, and educational, AND I got to see her pee! I mean pee as in the noun, not the verb. That's gross.

I once talked to a patient for a long, long time since her answer to every question rivaled a Homerian epic. I didn't really have a time schedule, so I didn't mind. Finally, one of the doctors in the clinic entered our room to check up on me, fearing that I had dropped off the face of the earth. No, I had simply been lulled into sedation by a siren's song about her diabetes and urinary tract infections. The doctor spoke with her for a bit and managed to sum up in a few minutes what had taken me much longer. As the doctor was writing up some final notes for her files, she said that she just remembered something, which she always forgot to mention on prior visits because she was never around long enough. She pulled off her boots to reveal some pretty bad edema and cellulitis, likely complications from her diabetes. A full physical would have caught this, but those are rare in a free clinic. She was also a returning patient, and logically, we simply ask returning patients about new complaints, how they're doing with their meds, etc. The swelling in her lower extremities developed slowly over time, so it didn't have the urgency that one might expect upon looking at her legs. Thus, it was easy for it to slip her mind. It was just fortunate this time that I had seemingly piddled around when I could have had her in and out of the clinic in a few minutes. Under normal circumstances, that's probably what I would have done. But I was new at the clinic and assumed I was supposed to wait for the doctor. I guess I was supposed to go find him when I was done questioning the patient. Oops, my bad. But then again, maybe not?

Student Outreach, Part 1

I volunteered at the new Student Outreach Clinic today. It's about time our school had a student-run clinic, so kudos to all those working to make this a permanent aspect of our school. It's not an official IU clinic yet because of some legal issues that came up recently, but hopefully those will be resolved soon. That means we can't officially diagnose people or write prescriptions yet, not that I'm personally capable of doing so, anyway. The patient flow is still kind of slow since the clinic is still pretty new, and not that many people in the community know about it. It's in a part of town that is a little rougher than even I'm used to, if you can believe it. It's a bad sign when the clinic organizers tell you to walk in groups to cross the street from the parking lot to the clinic in broad daylight. Regardless, it was an interesting day at the clinic, and it was nice to be able to help some people out who probably wouldn't have gotten the help they needed. There was a kid who sprained his ankle right outside the church where we were, so it was pretty convenient that he was able to hobble right inside to be seen by a doctor. Might have been more convenient for him had he not fallen down some steps, but I think he'll be okay.

I spent a great deal to time talking to a lady who had some arthritis in her hands but was allergic to medications that would otherwise be effective for most people and she also needed a precription refill for another medical condition but wasn't able to get a hold of her primary care physician for the past five months because the scheduled times that were available would get filled too quickly and they wouldn't take walk-ins and she couldn't get through via the pharmacy either but didn't want to switch doctors and she had some really bad arthritis in her hands so much so that she couldn't hold up a plate and she couldn't get refills on her medications because she couldn't get a hold of her doctor and she had some pain in her left hand so she mostly uses her right now and she also needed a precription refilled because her medications were running out and she didn't know what else to do so she needed our help.

So we tried to help her. We couldn't prescribe her what she needed even if we wanted to since she already had prescriptions from her physician, so we tried to counsel her on some other solutions she could try. Everything was either unfeasible or had already been tried to no avail. Finally, our doctor said he would contact her doctor to get her script refilled. It happens a lot where our jobs as doctors and medical students have nothing to do with diagnosing people or prescribing drugs. Sometimes the only remedy that can bring immediate relief is just to have someone listen to you.

Worst Headache of My Life

Somehow, in the course of our medical education, we've come to associate the words "worst headache of my life" with "subarachnoid hemorrhage." I can't imagine it's pathognomonic since it sounds like such a subjective phrase for a patient to say, but if you ever see it on a test, don't even bother reading the rest of the question. The answer is subarachnoid hemorrhage. And if it isn't, the question writer obviously didn't know what he was doing.

You see what the problem is, right? Up until you get your SH, there must have been some other headache that was the worst headache of your life. And who's to tell someone with cluster headaches or metastatic brain cancer that his or her heachache isn't nearly bad enough for the big time?

Migraines, huh? Quit yer bitchin'. As least your brain didn't EXPLODE.

I had the worst headache of my life a couple days ago. I've been fighting something nasty for the past several days, and I swear I wanted rip my head off just so it could suffer alone, away from the rest of my body, which had more important things to do like lift weights and watch trashy TV. But alas, I confined myself to my quarantine chamber (aka my room) to suffer quietly and study for my upcoming exams, like a dying pigeon... who studies. And as I read about such wonders of life like septic shock and glioblastoma multiforme, a brain cancer with a dismal prognosis, I realized things could be a whole lot worse. At least my brain wasn't bleeding into itself, which was good, though it was a bit disconcerting that I could hear the pulsating turbulence of my cranial vessels a little too loudly.

I felt a whole lot better this morning, just in time for my three horrendous exams crammed into 3.5 headache-inducing hours.

I forgot to mention that there was this other time when I also had the worst headache of my life. I was descending from the summit of Mt. Kenya, and my headache was so bad that I died a little with every step, and I'm pretty sure I about overdosed on painkillers that day, to little relief. I think I just had a touch of high altitude cerebral edema that day.