Sunday, July 6, 2008

The One Question

I have been informed that I need to write more frequently so I'm trying. I am adjusting to life as an intern. I am learning that I need to learn A LOT. Everytime my pager goes off, my heart stops and restarts going about twice as fast and as hard as before. I've decided that the baby will have to have a strong drum beat in its nightly lullabye to be able to sleep because that will be what it has been used to for its last 3 months in my belly.

Along with the pager terror as I like to call it has been the emotional turmoil of dealing with patients as they are at the end of their life and trying to be there for families. One family in particular struck a chord in my heart. The patient had been admitted when I was on call waking me in the very early hours of the morning. I was surprisingly in an okay mood when I came in to talk to both the patient and family. I gathered my information to write my note and get my orders ready. As I was leaving the room, a family member pointed at my belly and said, "What's that? Is it what I think it is?" I told them that I was expecting and was due in October and how it was a significant surprise, but I am now excited about it. They laughed and said, "Aren't they all surprises?" The family then apologized for waking me up- I told them, no need to apologize, this is my job:)

I ended up taking care of the patient for a while and it was a blessing to visit with the family. Everyday, the family member would ask me, "How are you doing with your condition?" With honest concern in their eyes and tone of voice. It was really nice to be asked the one question, "How are you doing?" I told them I was good, but I wanted to know how they were doing.
I didn't really stop to think about it until now, but with most patients the first question I ask is, "How are you doing?" So when the question was asked of me, I realized how much of a blessing it was to have someone care about my well being.

My way of adjusting to intern life means taking in the daily blessings and truly being thankful for them because the hard stuff will always be there . . .

Tuesday, June 24, 2008

Adjusting . . .

Well, I'm back I guess. I've been avoiding writing as I've been adjusting to the idea of new things to come. Avoiding with the thought that maybe if I did not digest what was starting this June 24th, then maybe, it would delay the inevitable feeling of inadequacy.

You may think I sound pretty down at this point. I wouldn't say down, just flat- a little deflated. I had my first day as a doctor in charge of my own patients. I was terrified and I wasn't the only one because all the other interns had this glazed over look, jaws clenched, and trembling hands just as I did. No one tells you that giving Tylenol to a patient for the first time would be a big deal- but it is. Everything we learn in pathology and how Tylenol-at the wrong dose, in the wrong person- is toxic to the liver. This knowledge puts a twinge of fear in the heart because of the possibility that though the patient merely wants relief from a headache- I'm terrified I'll put them in liver failure.

So why am I deflated? Ah, maybe its because I spent 4 years busting my butt (pardon the french if Grandma's reading this;) and trying to learn as much as possible for all of it to fly out the window on the way to work. This left me with a great big vacant space to draw upon when I was asked any question today. I guess we all want to be excellent physicians but they make us do at least 3 years of residency so we actually feel confident in doing so and so that our vacant space gets filled up again.

I hope my next post is positive- in the meantime pray that the great black hole called my brain will remember something the next time AND that my hands would stop trembling at the idea of giving Tylenol:)

Monday, March 24, 2008

The Carew Curse - passing out

After a discussion this weekend about funny passing out stories, I decided to look up a little information to pass along to those who have a similar problem. The current thought is that the Carew side is made up primarily of people who cannot stand the sight of gruesome pictures, have their blood drawn, or anything remotely painful looking (i.e. my dad turning green when I had to get stitches in my leg). While these are common stimuli for passing out, there is more to add:)

Another thought is that we have a chronic problem with low blood sugar. This is also a known trigger, however, I have passed out 2 or 3 times after just eating a whole meal so it doesn't always hold true. So there has to be something else.

This something else is called a heightened "vasovagal response" or neurocardiogenic syncope. Syncope is another word for passing out. This is a problem that can be common and is non-life threatening. The nerves seem to be the problem. It tends to follow a "classic" history with a certain trigger. Common triggers include: prolonged standing, blood drawing, a hot environment, something painful, fear of pain or overworking. After one of these events people begin to feel nauseated, really warm, lightheaded, get sweaty, and pale. Yes, I know it's hard to judge if one of us Carew's can get pale:).

In general terms, there are two nerve circuits in our body. One serves us during periods of relaxation: slows our heart rate down, lowers our blood pressure, slows our breathing, and actually allows our guts to move (this is important for later). The other serves us during periods of exertion or stress: brings our heart rate up, our blood pressure gets elevated, dilates our airways so we can breath deeper better, and slows our guts down. So the problem with vasovagal response is that there is too much activity of the relaxation nerve circuit and this decreases the blood flow to our brain by slowing the heart rate and lowering our blood pressure. The body then responds by wanting to bring the blood back to the brain by gravity i.e. pull the body down to get the head filled with blood. So this why people pass out.

What do we do if we have this problem? A couple of suggestions I've read about if you start to feel this way:
1. First of all, if you feel like you're going down- lay on the ground. No just crouching and hoping the feeling passes. You've got to get blood to your brain. It's better to look silly lying on the ground and awake, then to be on the ground out cold to the world:)
2. Flex your arms and squeeze your hands together- this increases your blood pressure.
3. Using a handgrip ball and squeeze tightly.

For people on their feet a lot, try support stockings. Hahaha! I laughed when I heard this, but this July, I'll be up and about a lot so I plan on buying a pair.

I hope you enjoy this info!

Thursday, March 13, 2008

constipation of all things:)

Well, I go in spurts with writing so I apologize for any delay. I just thought I would pass on the education that I received during our noon conference lecture while we all ate lunch.

The topic was constipation and some of you may think this is a boring process, but not so with children. Constipation can be an active process for some but definitely not all children or adults.

First of all, there is the poop dance best described as a child walking on their tip toes and squeezing both of their gluteus maximus muscles together to withhold from pooping until the urge to defecate has passed. Sometimes, a child will hold onto furniture with their arms, stand on their tip toes, and stay in that position until the urge passes.

We learned that after a long stent of holding feces, there can be something that forms called a "fecolith" A.K.A. "poop rock" that sits near the rear exit and prevents passage of stool, until there is such a large build up and the anal sphincter muscle is stretched and nerve endings are stretched beyond working that stool is passed unknown to the child. This is called encoparesis.

Some of you may be wondering "why would someone try to withhold stool when it can get so bad?" Well, it could be that there was something that had made passing stool painful in the past and many other problems. The important thing is that there is treatment and it is not the fault of the child regarding constipation.

So interesting notes: I learned a very interesting term "ileal brake ". There are three parts to the small intestine: 1st- duodenum, 2nd- jejunem, 3rd- ileum. The ileum is the last place where nutrients are largely absorbed especially fat! (Interestingly about 99% of fat is absorbed from food!!) So when a person eats a meal high in fat content, the food gets to the ileum and the transit of the food slows down remarkably to increase absorption, therefore causing an "ileal brake". They recommend eating diets low in fat if constipation is a problem. They also recommend drinking plenty of fluids and once regularity isn't as large of an obstacle, high fiber foods can be implemented.

I hope you feel enlightened and to quote our speaker "have the scoop on poop"!

Tuesday, February 26, 2008


Something has happened in the process of doing a month of autopsies that has disturbed me. Let me explain my schedule a little. In the mornings, I always check in the autopsy suite to see if there are any bodies for autopsy. If not, then I am assigned to either looking at slides most of the day, dissecting organs that have been removed from live people a day prior, or taking a small piece of an organ that has just been removed from a person mainly to see if all the cancer was removed.

Most of the mornings I have had an autopsy and the bodies were cold to preserve the tissue. Well, one day I went from an autopsy TO helping out with the organ staining to see if the cancer was removed. The staining happens in the same hallway as the surgeries are taking place. This is so we can report back to the surgeon to let them know if they got it all or not. Then, the surgeon knows how to proceed with the surgery.

Well, I think I got used to the "cold" autopsy organs so when I was looking at the organs fresh from surgery it was really alarming because they were warm! I think the warmth brought back the reality that the organ was from a live patient and made things a little too real. During the process of medical school, it becomes kind of like second nature to do examinations and to become a little disconnected so that a body part is a body part and not attached to a person.

Anyways, through this whole process I was disturbed because I realized that I've become rewired in my thinking- good or bad?

Monday, February 11, 2008

slightly serious note

Well, it is the season of Lent and in previous years I have given up pop, desserts, and any combination thereof. After a convincing sermon on Sunday, Ryan and I decided that we would try and give something up this year for Lent. Our goal is to stop complaining and to stop criticizing others. In the less than 24 hours that we have had to attempt these two tasks, it has been a great challenge.

I had a wonderful argument in my head as I drove to work this morning with the lady who cut me off and then drove so slowly in front of me. I thought of all the ways I could help her improve her driving and then was gently reminded that I was to give mercy and not critique in these next days. So instead of laying on my horn as I is my usual response, I gripped the steering wheel a little tighter and prayed that I would remember all the times I drove like an idiot and needed mercy.

That's it for now, I'll keep you updated. There were more challenges throughout the day, but in light of not complaining, I'll keep them to myself and be grateful for another day:)

Sunday, February 10, 2008

The Carew Side

It's been an incredibly long time since I've posted so here it goes:

I started a pathology elective this past week which involves autopsies for at least half of the month. I didn't know how I would do, but was willing to try to be brave. The first case didn't actually happen until Tuesday and with my luck we had to wear masks for tuberculosis protection. These are not regular masks because it felt like I couldn't exchange any air because the mask was so thick. So knowing the morning was going to be rough, I ate an extra snack, but it wasn't enough.

I started to feel hot, a little suffocated from the mask, and a slight nausea- all symptoms I have had for previous passing out episodes so I quickly excused myself and sat in the hallway . . . removed the mask, cooled down, and felt better. Being the stubborn person I am, I went back, I lasted about 15 minutes, and then the same hot, suffocated, and nauseated, went back to the hall sat down, got a little sweaty, but regained control and went back. I should have given up honestly. So the last time I observed for only 5 minutes before the hotness and suffocating feeling swept over me. I practically ran out, ripped off the mask, tore off the surgical gown hoping to get cool, and laid flat on the floor. I was drenched with sweat, unable to talk for fear opening my mouth would allow vomit to escape, and was passed by 2 separate people in the hallway who didn't ask if I was okay. I laid there for about 5 minutes and then decided I had a rough morning and went home for the day:)

Oh the joys of medical school! I figured the Carews will truly appreciate the same feelings I had that day.