Annual Thanksgiving photoshoot

With Christmas coming up in 3 days, I'm a bad blogger and am a month overdue in uploading pictures, but here are some of my favorite snaps from Thanksgiving. I'll aim to get Christmas pictures up, oh sometime before Valentine's Day. This year's theme: taking Charlie and his friend Lucky out for a walk!

Doctor

Warning: humblebrag post.

I've been lucky on my medicine service to have really grateful patients. You get so used to hearing the stories of the drug-addicted, narcotic seeking, alcoholic patients who threaten to leave AMA and can't wait to bust out of the hospital, but I've been lucky enough to have the mostly really kind, patient patients who take the time to know my name, ask me questions, always say thank you. Even the grumpy ones turn around in the end (One patient who would always give me one word answers in the two weeks I was following her, was sobbing when we discharged her because she was so happy that I rescued her daughter's picture from a fire!). It won't last, so I should just revel in this naivety for the time being, but I've also starting feeling like my patients have started thinking of me as "their doctor." Sometimes I don't bother to correct them when they refer to me as a doctor because to them, it doesn't really matter.

Today, I was so flattered when one of a patient's daughter's asked for me, by name, to talk to me about her father's condition. Another patient's daughter, of a 92 year old lady who was bleeding internally and had to receive 16 units of blood (she's stable now), always seeks me out to ask me about how her mother's doing and asks for my recommendations. She asks me questions like I'm her mother's doctor. In the beginning of the school year, I was also intimidated by a lot of the nurses, but now I'm much more comfortable talking to them and asking them to do things for me (get vitals, give meds, etc) and they update me and ask me questions about the patients too. As a medical student, it's not often (or sometimes never) you get to assume full responsibility for a patient, so it was just flattering to be recognized for it today, for the first time by having a family member want to talk to me. I'm on my way!

Black weekend

This past weekend was my "black weekend" on Internal Medicine, i.e. I had to work both Saturday and Sunday. This means by the next time I get a day off, I will have worked 10-12 hours days for 12 days straight. 12 days in a row doesn't sound too bad initially. But just not having ONE day to sleep in, take care of errands, go grocery shopping, go to the gym, or cook something, just kills you for the rest of the week. You work 5 days and then get a two day break. I work 12 days and I get one day off (this Saturday!!). I try not to complain too much, but this morning, after working the entire weekend, and having to admit 3 new patients this morning, running to wheel a patient down to do a stat MRI because she was acting funny and we were afraid she threw a septic embolus into her brain, and then launching straight into attending rounds made me want to go curl up in a ball and cry. To make things worse, there was a fire in the hospital this weekend.

http://abcnews.go.com/Health/hospital-fire-patients-room-sparks-smoking-rumors/story?id=20852594

To make things even worse, the patient's room was the room next to our Med I team room. Literally next door. And so when we showed up at 7 am Saturday morning, our entire floor was closed off and security officers weren't letting anyone onto the floor, not even the nurses or doctors that work there, so we were without our stethoscopes, pens, papers, white coats, everything that we needed to do our jobs in the morning. During a break in the morning, K and I actually snuck up to the floor through another stairwell, I ran into the room, and I grabbed all of our white coats, pens, and papers (all covered in ash) while he served as the decoy and distracted the security guard and then ran our belongings down to my team members. Pretty sure I trespassed on a crime scene, but I saved our white coats and stethoscopes! And so that was my secret agent moment of the day.

Since Saturday, we've basically been squatting in other teams' team rooms. It was easier on the weekend when not all of the teams were there, but today, all of the team rooms were occupied so we talk about all of our patients and go over their plans in a tiny back corridor/cubby area behind the nursing station for 2 hours. There weren't even enough stools for us so we literally sat on the floor. The cherry on top was that these past few days have been our busiest days when we've started on this service. We have upwards of 15 patients (we started off with 6), so we're frantically working on discharges, taking care of belligerent patients who won't leave, losing track of patients who just bounce without telling us, and generally stumbling bumbling tumbling traveling through. It's been a crazy 3 days. We also seem to be breaking some of our more stable patients. The hospital is a dangerous place, people. Every single morning, it seems like someone who we are ready to discharge catches a new bug (multidrug resistant, mmhmm) or decompensates overnight because we were too aggressive on their meds. Now that I've worked there, I wouldn't recommend staying in a hospital unless you absolutely need to, e.g. you were actually dying.

But I actually love it (if I weren't so tired all of the time)! In addition to being in charge of a patient's care when they're on the general medicine service (encompassing all different specialties, including GI, hematology/oncology, neuro, psych, pulmonary, surgery), you learn a lot about the logistics (some would say bureaucracies) of working in a hospital. It's all part of the job. After all of this, I would still be happy to go into Internal Medicine!

Apple picking

After battling 90 degree highs the first week of October, I finally celebrated the arrival of fall with R & J and R's family by picking pumpkins and apples! I don't remember the last time I went to a pumpkin patch and I don't think I've ever picked apples, but I'm going to start making it a tradition every fall. After a productive morning shopping and gorging ourselves at Indian buffet (I miss you, Indian donuts), we made our way to the boonies to Homestead Farms. Not too busy, not over the top with monsters/scarecrows/Halloween stuff, it was still rustic and homey and had reasonable prices. I highly recommend it!

Starting off in the fake pumpkin patch

I match the pumpkins :)

We moved on to pose with the farm animals

And take pictures of brightly colored chickens

After some indecision (apple orchard or pumpkin patch??), we  took off for the apple orchard

And started sampling delicious apples! Braeburn, Fuji, and I think my new favorite, Cameo. "I want to DIE in a field of apples"

I made R laugh so hard she got the D

Things got weird

Mmhmm...Braeburn apples

We found a ladder, so we had to have a photo shoot. 

And traipse through the orchards, pretending we were in a Taylor Swift music video (maybe just me)

I love applesssss

Our spoils...over 20 lbs of apples!

 I made R&J carry our haul back

Thanks to R and her family for the fun time, the apples, and the pictures. Click here to see R's blog post about our day. Next time we'll make sure to have enough time to bake PIES!

Beijing for break

I recently had the luxury to escape to Beijing for our week long fall break. It was a short trip but I managed to squeeze in some quality family time (including my cousin's wedding), sightseeing, pampering, shopping, and of course, eating. 

 Meeting J "right under Mao"

 Lucky to have bright blue skies for our Forbidden City day. I didn't even alter this photo!

"The Big Stone Slab" - apt translation

 Beihai, a lesser known park but a favorite of mine. It's right behind the Forbidden Palace, so it used to be the Emperor's garden/retreat. 

 J came to Beijing! And we ate Peking Duck, naturally. 

 Yang rou chuar

 Qian Men

 Yes, I asked my bathing attendant to take a picture of me in a red wine bath. Not awkward at all. 

 Look, you have your own chicken stand at Tian Yi! 

 Chinese food court. Sweet and sour pork, eggplant, Szechuan cold noodle, some of my favs. 

San Li Tur

Watching them make my favorite breakfast in the world (I'm aware I have a lot of favs)

 Tada, Chinese breakfast taco!

 Zen park right outside my grandparents' house. 

Gynecology

I've officially finished my OB/GYN rotation. My second shelf is over and done with and I'm currently in the Dulles United Club waiting for my flight to Beijing!

In contrast to the labor and delivery portion, I really enjoyed the gynecology half of the rotation. At BWMC, gyn was split into surgery and clinic. I spent most days in the OR, scrubbing in on hysterectomies (removing the uterus +/- ovaries and fallopian tubes), hysteroscopies (the most boring procedure ever - just sticking a long camera scope into the uterus and looking around to find any polyps - takes 10 minutes, tops), tubal ligations (tube tying), and myomectomies (removing fibroids from the uterus). One of the highlights was doing an open myomectomy. Below is all of the 31 fibroids, from pearl size to clementine size, we removed from a woman's uterus! Imagine that all of these firm balls, bening tumors really, infiltrating your uterus, making it grow as big as a pregnant uterus, hindering fertility, causing pain, and bleeding. Pretty unpleasant, but up to 80% of women will develop fibroids at some point in their life. This patient was actually young and still desired children, which is why we decided to do it open (vs. laparoscopic or robotic). We wanted to be more careful to preserve the healthy parts of the uterus, called the myometrium, so she could conceive in future. Digging out these fibroids was like shucking for oysters! After we were done, even the two surgeons remarked that they had never removed so many fibroids.

 One of my favorite parts of this rotation was seeing patients in gyn clinic. Women of all ages came in for various female issues, birth control, pregnancy, abnormal bleeding, menopause, STDs, and well-woman exams (your annual breast and pelvic exam) and it was really rewarding to talk to them about issues and questions all women have. I saw almost 20 patient a day, taking their histories and performing the breast/pelvic exam on them. I even prepped slides and diagnosed yeast infections/STDs sometimes. I'm now an expert vag examiner! On a serious note, I also got to see and diagnose cancer. One of the first days in clinic, I saw a woman who complained of a vaginal tear and I just assumed it was because she was too dry down there. When my attending saw the "tear," she took a step back and immediately ordered a biopsy of it. After we exited the room, she told me she suspected it was late stage cancer. Sure enough, a week later, it came back as Vulvar Intraepithelial Neoplasia Type 3 (VIN 3), which is the most advanced precursor to cancer. It wasn't quite cancer yet, but something like 30% of these will progress to vaginal cancer, which has a horrible prognosis and is very rare. Another day, I was counseling a woman about different birth control options before we did a routine breast and pelvic exam. When she laid back, I noticed some retraction on her left breast and felt a large lump. My attending immediately sobered up when she felt it and afterwards, she told me she suspected it was breast cancer. She ordered a diagnostic mammogram right then and there and ordered the patient to get it. That very same day. I just learned yesterday that it was invasive ductal carcinoma. I liked how the gyn portion of ob/gyn encompassed the whole scope of well woman care, and I think I have it in me to be a gynecologist, but I could never do OB. Flight's boarding, I'll update in Beijing!!