fever dream

You know those last few pages of Into The Wild where Chris McCandless is deliriously scribbling his final, dying thoughts into his journal before taking his last, raspy breath? Yeah well that's what it's been like around here the last couple of days. I can't say for certain, but I highly suspect that yesterday's fever was the equivalent of seventeen full length Grateful Dead shows in terms of brain damage sustained and not only is it now confirmed that I will be waddling around in enormous Adult Diapers by the time I'm 80 but I'm also going to be on dialysis because I straight up blew out my kidneys with Nyquil. 

So, for the record, Dengue/Scarlet/Small Pox/Yellow Fever sucks and I highly recommend not getting it. Really. Much like Meth, it's retarded to even try. It's probably better to put your head in a blender, I can promise you it would feel better.

And! AND. While I was probably going to stay home today anyway, milking the phenomenal level of sympathy and kindness of my preceptors for all it was worth, as it turns out today is an official snow day and we were given the day off. Officially, and shit. Because New Yorkers are unbelievably woosey and can't negotiate life in the city with 4 inches of snow. And hur-friggen-ray.

So now I'm going to bake a cake. Because tacking at a body temperature of 103.2 F for 96 hours burns you some calories, yo. 

So apparently I have EBOLA and had to stagger desperately home this morning after trying to crawl into someone's locker to get a little shut-eye already because the 3rd year med student I'm on team with this week is such a fucking incompetent retard pansy special person and acted like I'd just thrown her grandmother into moving traffic at the mere suggestion that I might go home because the last time I checked, spreading your Meningitis/Hanta/Nipah viral slime all over the greater parts of large urban hospitals is pretty much frowned upon. 

And then some kindly attending took one look at me and promptly told me to "get the fuck out of here before you infect all of us you $#@*% idiot". So that was awesome and reassuring and about as warm fuzzy inducing as a dinner date with Mao Tse-tun. 

But I did go home, after passing out on the subway and being kicked awake by some drunk bum who was angry because I was sleeping in his urinal and have a little decorum, please. And went immediately to bed where I slept for nine hours straight and you know the craziest thing of all? Cats can sleep forever. I got home at 9:00 am, slept until 6:00 pm, straight, and when I finally stumbled up and out to drink some fluids or eat some chicken soup or whatever it is people are supposed to do when they're dying a slow and feverish death both of the cats are all, "jesus lady, you don't have to be so fucking aggressive about it". 

surgical work ups

Thursday was a @#$%^$ ass kicker of a day. Surgical people are such strange, sadomasochistic, single-minded, abusive, abused, unrealistic freaks. To start, I wake up at 3:45 am. My clinical day doesn't begin officially until 5:45 am, but my day officially, officially, officially begins at 3:45 am, when my eyeballs are open.

And that sucks.

Second, I'm still not better. I'm not hallucinating, I'm no longer channeling satanic forces through a massively febrile state of altered mental status, but I'm not better. My throat is quite seriously threatening to expel itself from my body in what would certainly be an impressive display of blood and gross stuff and some really cool and previously unknown mechanics of auto-amputation. I'm almost certain it would get me top spot on the roster for Friday afternoon Morbidity and Mortality. And, I'm a fucked up and curious enough human that, if I could, I would almost goad it on. 

Third, surgeons habitually disregard reality as we know it. They're kind of like Jersey Used Car Salesmen, only, not at all. Oh, you've been cut into five different, unequal pieces? No problem, we can totally fix that. And thank god, you know. Because Krishna knows that whenever I'm cut up into five different, unequal pieces, I really appreciate their optimism. At 5:45 in the morning, though, the optimism that I actually can gather up all the labs, CT/MRCP/ERCP/MRI/XRAY results, pathology reports and over night vitals on 15 different patients spread out over 6 different floors in a hospital that has centrally organized ABSOLUTELY NOTHING onto a conveniently located computer system, in 15 minutes? 

Not so much.

Because 7 minutes into sprinting up and down the stairs to all sixty million different areas of the hospital where the information is separately and surreptitiously squirreled away in esoteric and poorly labeled locations and scribbled by hand in sanscrit and then lorded over by nurses who will fuck you up if you even think about moving anything from its clearly obvious place, I basically want to shove a scalpel into my own eyeball and wash it down with a shot of rubbing alcohol. 

And then. AND THEN. After failing this "pathetically rudimentary" and "simplest of tasks", the surgical residents take prolonged and bowel-hurl-inducing exquisite glee in determining who, based on our abilities to perform ingratiating an illegal tasks in exchange for vital information such as, say, the blood pressure on patient A in Bed ___ of the SICU on Floor __ (really people, I don't even want to know what CIA agents have to endure to find out information any more covert than that), who gets to scrub in on what surgeries, and when.

And I can't even tell you what a hungry, future surgeon, 3rd year medical student will voluntarily do to themselves and others, for the divine privilege of watching someone's gallbladder come out. It's unfuckingbelievable. 

But I am not a hungry future surgical third year medical student. Which is an amazing, exceptional place to be, because I am quickly learning that people can only abuse you if you let them. And if you don't actually give a furry little rodent bottom about inguinal hernias and the vastly astonishing ways that we repair them, it's hard to get beat up. And this, my friends, is truly amazing. Because nothing infuriates a Czar Surgeon fourth year surgical resident more than not being able to distribute sweet, sweet torture. 

Resident: Okay children, listen up! If you don't get all your vitals and labs and results and reports prior to morning report, and by prior I mean 5 MINUTES BEFORE WE START, morning report you will not be able to scrub into surgery. And you will have to stay on the floors, see all the patients in recovery, you will have to talk to them, you will have to examine them, you will have to write progress notes in the charts and you will have to follow up on their recoveries, their pathology reports and their pain management. DO YOU UNDERSTAND????

So my punishment, if you will, was to stay on the floors, with sweet fourth year resident Dr. P, who cares way too much about people and I have no idea why he's completely sacrificed his life (really, literally, sacrificed. Life? Gone. Nada. Zip. Four am to eight pm. Six days a week. Forever.) to cut up unconscious people. It friggen baffles me. 

And all we did, all day long, was run (not figuratively) around the hospital, checking on this or that, consulting on a patient here, arranging surgery on a patient there, trying to determine why patient A is bleeding out on floor C and why surgeon X won't take him any sooner than, hmm, next week, by which time he will be exactly 6 days expired. He sent me to do a number of different consults on my own (which scared the CRAP out of me because what if, oh, I don't know, I'm WRONG and they actually do need surgery, like, this instant) and I can organize the hell out of anything, so it felt better to be useful. And honestly, even though it would get old after a while, existing in a vast world of spinning micro-management, I rather do that all day than just standing in a sterile room under scorching lights for seventeen hours, not being able to scratch your own nose or pick your wedgie, looking at people's shiny pink insides. 

nuchal rigity

You know those days when you get on a plane to go to California from New York, watch 6 1/2 hours of Animal Planet straight, openly sob into your Taro Blue Potato Chips when the Pedigree commercials come on that get you right in the fucking solar plexus (and don't even SAY THE WORDS "that ASPCA commercial" because I friggen lose it just thinking about it so just stop it right now) and every rerun of Animal Precinct makes you realize that ALL YOU WANT TO DO is pack heat and save dogs and then you spend just enough hours in California to get fat on huevos rancheros and margaritas, come to terms with the fact that you miss the ocean like it was a kidney, get back on a plane from California to New York, watch five more hours of Animals (in peril) Planet, get out of the plane, it's -17 degrees, the cab line is fifty million people deep and you didn't bring a hat and by the time you make it home all the take out restaurants are closed and you don't even have cheesy mac in a box and you have to get up the next morning at 6am to get on another plane to New Hampshire to look at the house you bought and hopefully still really really really like many hundreds of thousands of dollars really love, almost get kicked out of school for shirking off on your clinical training and escaping only by the grace of god or someone who just works for him, getting back on another plane back to New York, spike a 102 temperature, start hallucinating, begin your first day of surgery a day late at 5:00am with a core body temperature of 101.7 F (despite 5,000,000 mg of Dayquil) and active rigors, make nice with the residents, literally FLEE during afternoon rounds by running down the back stairs because the whole light/end of tunnel/angel of death thing is going on in front of you and for once its not your patients and so you crawl home on all fours through the snow to get into the bath and there's no hot water and by the time your husband comes home you are speaking in tongues and have swallowed half the bottle of Nyquil and thank god he's there because lord knows the cats can't pick you up out of the bath tub because they have no thumbs and then you proceed to sleep sweat profusely for 11 hours straight only to wake up 99% convinced that, dude, you have meningitis?

Man I hate when that happens.

letter d

So it occurred to me today that we throw a lot of d words around in medicine. For instance, during the course of reviewing hyponatremia (a DEFICIENCY of sodium) alone I came up with ten --deca-- different ways to say "shit's fucked up" using, exclusively, words that start with d:

defect

deficit

deficiency

depletion

disorder

disregulation

damaged

decompensated

deformity

degenerative

Then there's the standard, garden variety disorganized, disproportionate, debilitated, debris (debride), decapitation, decay, decerebrate, delirium, as well the more exotic and alluring:

1. Decipara ~ a woman who has given birth for the tenth time to infants, alive or dead. Notice that they have to CLARIFY that she's given birth to infants, and not, say, kittens. 

2. Dactolysis ~ the spontaneous amputation of fingers or toes. As seen in leprosy, ainhum and produced in utero. Holyfriggencrap. 

3. Deutromycotina ~ the phylum of imperfect fungi. 

And then, my personal, all-time favorite:

Defecography ~ Radiography of the ano-rectal region after instilling barium paste into the rectum. The defecation process is [then] imaged by direct filming (fluroscopy) or video recording. No way.