Driving the Differential Diagnosis Strugglebus

I have no idea what I could possibly write about tonight. But that title is just too good. I'll think of something.

...

Still haven't thought of anything. In other news. I went climbing on Friday night, and my fingers are only now slowly responding to mental commands. One of my patients has C. diff, and if you've never smelled that, well, consider yourself blessed among men. I just did a late-night run to Taco Bell, which is funny since it's not even 9 pm yet. I have the occasional awkwardness meter of a high-school nerd. My senior resident is making me work on Thanksgiving. I have a dream of me all fit and sexily defeating bad guys and whatnot and tried to start running against last night to make it come true...suffice to say that the dream died at about a mile when my lungs felt like they were icing over and caving in. Now I'm defeating test questions from the comfort of my own couch, in my tee shirt and sweats. I will try and be a superhero again tomorrow.

knotted

I'm not sure how I got pulled into it--heaven knows there are so many things I should be studying--but before I knew it, 40 minutes had passed and I was still lost in clips of various Disney movie ending scenes. It sounds ridiculous even in my head, being a grown woman and all, but somewhere halfway through the dance at the end of Enchanted, where Patrick Dempsey starts singing "So Close", I completely lost it.

Such stories just seem to set us all up for heartbreak, don't they? It's the sheer perfection of it. Both people always have, of course, obstacles that stand between them. They have to fight for each other, be the hand outstretched when everything is falling apart, and balance the other's weakness--and maybe they don't know how, at first, maybe they have to learn--but in the end, it works, because they are right for each other. At the core, they fit. They match. They learn how to love each other best. And because they do, it doesn't matter what life throws at them--they can handle it.

Nothing in any of these movies sets you up for the reality of two people who fall in love anyway before realizing that they don't fit in ways they must. Nothing in any of the stories I've ever heard gives any idea of the unbearable decisions that have to be made when this happens. They don't talk about hyperventilating in the shower or nights spent alone or the loss of futures and dreams. They don't prepare you for how difficult it is to find hope again. I don't think anything can.

The Fat Entitled Whiner

I was talking to dad today during a leisurely breakfast here at the hospital--both things are sadly far too rare, and so I was thoroughly enjoying myself as we talked about interesting cases I have seen here in LA. He works with other medical students as well, in his practice, and so I get to hear stories about interesting people he comes across.

He was telling me about a young female resident that reminded him of me, and her experience with a patient. A young illegal immigrant from Mexico was hit by a car and came into the hospital with bleeding in his brain, eventually requiring surgeries to place a mesh and several months in the hospital. The mesh became infected, but not all problems can be fixed, and the danger of him having it removed was greater than the danger if it stayed--and so he was placed on expensive antibiotics to control the chronic infection in his brain, and would have to be on them for the rest of his life.

But he was illegal--no citizenship, no insurance--and so the authorities contacted the mayor of the small mountain village where he came from to determine how to get him home. It turns out that the mayor had a burro, and so he would travel down to the city and collect the man from the airport when they shipped him back. All the resident could do was send the man to the airport with 6 months worth of antibiotics, and let him go home to die.

I was telling dad about the dichotomy that exists in my mind when I hear these stories. On one hand, the little girl in me wants to save everyone--on the other, I have paid thousands and thousands of dollars for the right and ability to save people, and in uninsured cases like this, the rest of the hundreds of thousands of dollars it takes to do so are also coming out of my pocket. That's not right, any way you look at it.

And then there are patients like the one upstairs, who has been here for almost a week for "chest pain," weakness, more chest pain, back pain, neck pain, nut pain, paralysis, brain pain, trouble breathing--you name it, he has it. Oh, and he's "allergic" to Tylenol and Motrin--only Dilaudid and morphine will work, Doc, I'm in so much pain, can we increase my dose? I just wanna feel better, Doc, I'll stay here as long as it takes. I'll do whatever it takes. Including eating on the days we schedule his testing, twice, so that we have to reschedule them for the next day. We all know he's full of crap; of course he wants to stay here. Here is where the medicines are, here is where the nurses are at his beck and call--here is a several-thousand-dollars-a-night hotel is his for the asking. So every day he comes up with new excuses, and threatens to sue us if we send him home with all the "symptoms" he's having--and policy being what it is, we're not allowed to tell him how easy it is to test if people are faking, and that he's failing miserably. If I had my choice, I'd've kick him out on his butt yesterday, with pleasure.

If money is just lying around to be wasted on lardy, unhealthy, duplicitous people like this man--and it's not, but for the sake of argument, let's assume--then I'd much rather spend it on the man who is going to die alone in his village while the man upstairs eats himself to death.

Arrhythmias and Surly Black Men

My resident was explaining EKGs to me tonight, taking advantage of the first slow on-call night we've had since I've been in LA. After several successive calls with over 12 patients admitted, today was a deep breath in the middle of a hectic week. The most exciting thing that happened was our first admit, a large and angry black man who (after questioning whether my residents did anything useful besides paperwork) answered most of our questions with surly and progressively louder "I don't know! It doesn't matter!" exclamations, and who also decided while in the ED that he was hungry, and promptly left against staff instructions, dragging his IV pole and his partially hospital-gown covered bare cheeks behind him to find the cafeteria. The last I heard, security was searching for him. Seriously. I have no idea where he is. I hope he eventually comes back and reclaims his underwear.

Anyway, I digress. I was learning EKGs in prelude to questions I know are coming, courtesy of my attending, who is ever so excited when I have at least one question to ask him about each patient. He likes to know that I am invested and curious, and he's also feeling out his teaching style for students and likes to have conversations stimulated by inquiries. He is very sweet and makes me laugh, like yesterday when he was telling me about a research project he did while in medical school. Apparently, there were large rats that he and his colleagues used for experiments, and he was frankly creeped out by them. "The rats, you see, the rats are very large and I do not like to handle them," he told me in his heavy spanish accent, "but you have to, you know. They are very smart, and so you must caress the rat, yes, caress it like this, and then, yah! You must grab it very quickly! So I got on my big leather gloves, and I was caressing, caressing the rat like so, and then I grabbed it (with a violent motion) and I grabbed it so hard that I damaged one of its lungs. We discovered that when we opened it up later." Horrifying, yes, but ridiculously funny to watch.

 The EKG session, though, was the highlight of my day. Compliments from residents are not a daily occurrence for me, and so they mean a great deal. While Ben, my senior, was explaining how to determine results from the strips, I answered one of his questions with clarification from something we'd discussed last week. He laughed, looked at me and exclaimed, "God, that's why I love you! You're just like a sponge. You remember every single thing I teach you." And that's what makes him such a good person to learn with--not only does he rock at teaching clearly and concisely, but he encourages and doesn't make a big deal out of my mistakes. He and Andie are about the best thing I could wish for on this rotation.

Heroic Nudity

She's called the Veiled Virgin by Giovanni Strazza. This is what I love about how marble flows.

Finally, after over a week, I have had an adventure in LA. Let me sum up for you the highlight of my evening at the Getty Villa Museum's college night. 

"In this funeral fresco, added white paint accents the figure's heroic nudity." 

I did a double take. Wait, what? Sure enough, the figure in the Greek and Roman museum exhibit fairly glowed moon-bright with all of his painted glory, he was certainly nude, and...I suppose if you looked out of the corner of your eye and squinted a bit, he did look potentially hero-esque. His abs were very chiseled, and he had a strong profile and wavy hair, but his languid reclining position sort of killed the strong hero-image for me...and I kept getting distracted by trying to imagine a situation where a naked stranger coming to my rescue wouldn't have overwhelmingly awkward overtones.

What if it really were that simple? What if all you had to do was slather yourself in white paint, run stark naked into the middle of the city and strike a pose, and passersby would stop, point, and scream, "Look! There goes a true hero!" Everybody would get all excited, and that was all it took--you and your accented heroic nudity were an instant big deal. Ross informs me that, if we replace the paint with gold, I've basically described the premise of Immortals. Nowadays, the pointing and screaming would end with a shiny pair of handcuff accenting your heroic wrists.

The Villa was an excellent adventure and very good for the beauty-loving part of my soul...although I can't think there's a part of my soul that doesn't crave lovely things. I wandered through the halls fairly in awe of the intricacy of artistry from all those thousands of years ago, some rivaling anything you could find today for their lifelike depictions of those long dead. I loved the gallery of full-sized statues--it's amazing how marble seems to flow and come alive, how the illusion of transparency comes from solid stone. There was a carved girl with a slight smile on her face, about my height, and it was easy to look at the marble and see the individual that the artist took such pains to replicate--how he delineated the individual strands and curls in her hair, curved the pattern on her drapes, and how he made the stone of her skin shine. It was lovely.

Also, we exited through the Herb Garden--130 feet of every herb known to man. I was so excited that I couldn't decide which way to go first. I assumed that the true enjoyment of such a place was through the olfactory senses, so I picked sprigs of almost everything and was perfectly happy.

LA

The city of angels isn't quite what I expected--probably to be expected, since I haven't seen much of it past the skyline from my temporary apartment. I'd like to go down into it, explore, talk to people before I make up my mind, but the chances aren't as readily available as I'd thought, and I don't quite feel up to the task of wandering solo and keeping myself in one piece.

White Memorial is proving to be enjoyable, for the most part. The most noticeable difference so far is how the residents interact with me. Back at LLUMC the species can, at best, be described as pleasant but detached and aloof. We address them as "Dr. White" and "Dr. Shuminahumina", and it's all very correct and such even though the only difference between us is sometimes barely a year and a half. Here, my residents quite emphatically told me that they are to be addressed as Ben and Andie, and that the abandoned wing they use as a clubhouse is now the "Ben, Andie, and Alyssa" hideout. They're encouraging and they laugh with me when I mess up and then tell me how they've done worse. The other residents I run across actually make it a point to introduce themselves, and they always use their first names. They assume me into their world. It takes a graceful spirit to do that, and I'm grateful.

There are more of us here than I thought there would be, as well. Last night was such fun! I wanted to cook, so with Ben acting as bodyguard we made our first foray out into the world to find a grocery store, a pot, and some cooking utensils. There ended up being seven of us in this small apartment...Debbie, who scared the bejeezus out of me when she stumbled into my room on the third night, after I'd gone to sleep, to take up residence in the other bed; Alicia, who I'd never really met before and who has the most lovely head of hair; Zach, who has fantastic taste in girlfriends; Ben, who warded off all the scary LA people; Jonathan, who has a kind spirit and great kitchen ethics; and Jessica, who just joined out class and whom I like very much. That's always so much fun for me, to be able to feed people and just be surrounded by goodness and contentment.

The only downside is that I have to work tomorrow...after this, I get my Sabbaths off, so I'm resigned to sucking it up and doing my best. But most everyone has gone back to LLU for the weekend, and this little apartment is very quiet. Not so, unfortunately, the street band playing outside. Oy vey. Sleeping will be difficult tonight!