Subaqua Sternal Rubs

I survived the first set of midterm exams in St. Vincent, getting a rather decent grade in one… Everyone says the first exams are the hardest, since no one knows what to expect, so now that I know what the exams are like, I should be able to refine my study habits and do even better on the next ones. Anyways, it's off to Pharm Small Groups. (They just don't give us a break, do they?)

And the award for the most appropriate acronym goes to: (Drumroll)

Diarrhea of Obscure Origin = DOO

Who thinks up these things?

Anyways, I finished the Pharm Midterm 1 yesterday. Hopefully it went alright. As you can tell, I am now studying for the Pathophysiology exam (and GI to be exact) on Monday… Close to 700 pages of notes to memorize and/or synthesize. Yippee!

After numerous complaint regarding this term's exam schedule (usually they get a week between exams, and we have a weekend), our Emergency Medicine rotation was canceled today. More time to study Not going to the ED, and having to reschedule the rotation So in short, no interesting posts for a few days. (Other than the obligatory notice that I failed Pharm.)

Update: Sorry for the confusion, but no, I did not fail Pharm (yet), as the first exam is tomorrow. I was just trying to say I feel like I am going to fail it as a result of the disingenious exam schedule this term. We'll see how it actually goes.

I finally bit the bullet and upgraded the software running this site to WordPress 2.0. And then I found out that 2.0.1 had been released a few days ago. Doh! So, I upgraded again. In any case, I think everything is working, but let me know if anything is out of whack, especially if you can not read locked posts when logged in to your Friends Only account. (I had to do some "tweaking," and I think I got everyone, but I am not sure.)

Having been a productive member of society (well, I guess I wouldn't go that far. Let's just say I showed up to a job 5 times a week or more for almost 2 years), I can definitely relate to wanting to get out of work on time on Friday… However, I never left an hour early just because I felt like it. When I showed up at 4:30PM at a mercantile establishment, I met the last employee who was just locking up the door, despite the sign that said "opening hours" were until 5:30PM. It wouldn't be that bad, except I wasted and hour with the driving, etc, and the employee showed absolutely no remorse for her dereliction of duty. Unfortunately, that is rather typical around here. Like the entire Financial Aid department that wasn't in their office at 12:45PM, and 3:30PM today, despite a sign that announced "opening hours" were 9a-5p M-F. Grr. I guess I'll have to wait until Monday to pick up that loan check. Not that I really care (as I wasn't expecting a loan check - so either I miscalculated or it is in fact a check from teaching CPR a couple of weekends ago), but it is just the principle of the thing. And I do feel bad for people that have not been able to pay their rent/other necessities because they haven't been able to pick up their loan checks…

This afternoon was the much anticipated first rotation (out of 5) in the Accident and Emergency Department. I was impressed with A&E starting with the waiting room, mostly because of the huge sign that said:

What I wouldn't have given to put up a sign like that in the ED where I work(ed), though I would make it 4AM instead.

Other than that, we didn't get to see much of the A&E (other than the fact that it had about 10 rooms, 2 resuscitation rooms, and an "asthma bay," where two kids were happily sucking on nebulizers), as we were whisked off to do guess what? Yup, another history and physical. Our patient was a 45yo male salesman who c/o lower abdominal pain which radiated to both flanks, accompanied with nausea and vomiting. Unfortunately, it was not anywhere near the critical care level the adrenaline junkie side of me hoped to see in A&E, but still a learning experience. Though the physical exam less so, as the pt had been drugged up with pain relievers, and the abdominal exam revealed absolutely nothing. As laboratory and imaging studies were not back yet, we didn't have a diagnosis more definitive than rule out kidney stones or rule out appendicitis.

After reviewing our history and the differential diagnoses with us, our precepting physician was signing our "green cards" (hospital rotation cards to prove we actually attended), the adrenaline junkie once again got the better of me, and I asked if it were possible to do an EMS rotation. His reply?

"Aren't you here to learn the history and physical? I don't think they do that on the ambulance."

Ok, so while some people who abuse the EMS system think it is a taxi service, it is in fact not. Seriously, does he think that EMS just throws the patient in the back of the rig and drives them to the hospital without saying a word in the 30 or so minutes it takes to get there? Most EMS providers do perform a history and physical to figure out what is wrong with the patient, so they can 1) give appropriate treatment and 2) give report to the hospital. Though to be fair, I don't know what level of training the EMS has in St. Vincent, and they may be just "ambulance drivers."

The precepting physician also added:

"Doctors do not go out on the ambulance, so you would have no supervision."

Of course he did not know that I have been a certified EMT/AEMT for the past 6 years, and haven't killed anyone yet. (Despite trying once or twice.) And to be honest with you, I really wouldn't trust some of the students here, or some of the students that rotated through the ED where I worked back home. Either 1) they know absolutely nothing, or 2) they'll rattle off every possible diagnosis out of Robbin's Pathology without ever mentioning the obvious one.

Oh well, maybe one of the other docs will let me play with the lights and sirens. (And save some lives, of course.)