Thanks everyone for the well wishes. :)
I went to occupational health this morning to have baseline labs drawn and consented to have a "student phlebotomist" draw my blood. hey, we all gotta learn somehow (although most of the time in med school phlebotomy class, the learning is mutual). the student phlebotomist was nervous, but pretty fast. after the blood draw, the nurse supervising her growled, "you have to make sure that the whole needle is in the sharps bin." we looked at the table and realized that the entire butterfly needle was still hanging outside the bin. Hm. The sight of such a needlestick hazard made me wince (on the inside).
on the bright side, i've recently gone into a skin care "phase," where i took a good look at my skin and realized that an entire year of neglect cannot be good for you. i have subsequently resolved to 1) exfoliate and 2) moisturize more often, even daily if time permits! adding SPF might also be a great idea.
Friday, July 10, 2009
Wednesday, July 08, 2009
"Stuck" in the ED
Yesterday was my first day in the SFGH ED as a sub-intern. I really enjoy the fast pace of the emergency room and the ability to triage and decide on preliminary tests for my patients. By the end of five hours, my head was pounding from the chaos and competing interests of different patients (next time, carry tylenol in my pocket).
Another nice thing about the ED is the number of procedures that you can do. By the end of my shift (7/7, 9:10 pm), I was attempting a lumbar puncture on a woman suspected to have meningitis. After inserting a 20-something gauge needle filled with lidocaine to anesthetize her back, I capped the needle using the one-handed scoop method. Then I tried to unscrew the needle to replace it with a longer needle in the LP kit. But the needle would not unscrew from the syringe. I made a twisting motion, which in retrospect only loosened the cap from the needle, and subsequently felt a familiar sting (after being phlebotomized by classmates so many times). I had stuck myself in the tip of my left index finger with a dirty needle.
"I think I stuck myself," I told the resident calmly, setting the syringe down and walking away from the patient while watching the blood welling underneath my glove tip. My first thought was, "Good thing we got a rapid HIV test before doing the LP." The resident was incredibly considerate and advised me to run my finger under running water for five minutes before calling the needlestick hotline (in retrospect, I would recommend washing with soap and water, running your wound under a faucet for 5 minutes, and maybe splashing some alcohol or betadine if you're extra paranoid).
While holding my finger under running water, I stared at the clock and began rapidly running through the patient's medical history again in my mind. 35 F c/o 3 days of fever and headache. 10/10 occipital headache with pain on neck flexion. no trauma. T 38.7 on arrival. What were her serologies? Is this an acute primary HIV infection? What is the NPV of a rapid HIV test in the SFGH ED? I felt unnaturally detached.
I was also extremely peeved at myself for making this mistake, because I usually pride myself on being careful during procedures. In fact, the smoldering annoyance has not faded today, and I still feel like an idiot. In retrospect, most needlestick injuries occur when you are recapping a needle (hence the scoop method) or disposing sharps, and the injury occured probably because I was attempting to unconsciously recap the needle before the needlepoint was exposed after seeing the cap slipping. Unfortunately, the lidocaine needle is a lot shorter than the IV needles that I have grown accustomed to using. When speaking to the ID fellow, he advised me that one of the most common needlestick injuries occur after screwing the needle too tightly into the syringe.
Needlesticks are extremely common in the hospital, but in the SFGH ED, it was especially scary. Most of my patients have HIV, HCV, or both, and this patient was a black box. It was also concerning for me to realize that we still had no idea what her diagnosis was.
Since today was my day off, I was able to read some personal accounts of other doctors and nurses who have joined the Private Misery Club and some of them are quite moving, funny, thoughtful, and some just depressing. Many talk about mortality, or the sensation of a lost future. Some of my first thoughts after the needlestick involved my future...what am i going to do now? can i practice medicine in the future? what about unprotected sex? and then maybe a few times I mentally uttered my favorite curse word of all time: fuck.
It is not a good time right now to wax philosophical about mortality or medicine; I have an appointment on Friday for some baseline labs. The patient's rapid oral HIV was negative, and I have been told today that her serologies were negative, but that doesn't ease my concern that this patient has acute primary HIV infection given her suspected meningitis (which can follow the prodromal flu-like illness) and considering our ED population enriched with blood-borne diseases. Argh. If there is one thing that I hate more than uncertainty or regret, it is having the patience and attention span required for surveillance serologies. The ED requires neither patience nor an attention span longer than 24 hours, which might still be ideal for me.
My favorite personal account of a needlestick injury is from Buckeye: http://ohiosurgery.blogspot.com/2008/10/needle-stick.html.
There's a nice one from an ED physician: http://gruntdoc.com/2005/05/needlestick.html
And a blithe one from an MS2: http://www.boston.com/yourlife/health/blog/2007/10/ill_have_what_s.html
Another nice thing about the ED is the number of procedures that you can do. By the end of my shift (7/7, 9:10 pm), I was attempting a lumbar puncture on a woman suspected to have meningitis. After inserting a 20-something gauge needle filled with lidocaine to anesthetize her back, I capped the needle using the one-handed scoop method. Then I tried to unscrew the needle to replace it with a longer needle in the LP kit. But the needle would not unscrew from the syringe. I made a twisting motion, which in retrospect only loosened the cap from the needle, and subsequently felt a familiar sting (after being phlebotomized by classmates so many times). I had stuck myself in the tip of my left index finger with a dirty needle.
"I think I stuck myself," I told the resident calmly, setting the syringe down and walking away from the patient while watching the blood welling underneath my glove tip. My first thought was, "Good thing we got a rapid HIV test before doing the LP." The resident was incredibly considerate and advised me to run my finger under running water for five minutes before calling the needlestick hotline (in retrospect, I would recommend washing with soap and water, running your wound under a faucet for 5 minutes, and maybe splashing some alcohol or betadine if you're extra paranoid).
While holding my finger under running water, I stared at the clock and began rapidly running through the patient's medical history again in my mind. 35 F c/o 3 days of fever and headache. 10/10 occipital headache with pain on neck flexion. no trauma. T 38.7 on arrival. What were her serologies? Is this an acute primary HIV infection? What is the NPV of a rapid HIV test in the SFGH ED? I felt unnaturally detached.
I was also extremely peeved at myself for making this mistake, because I usually pride myself on being careful during procedures. In fact, the smoldering annoyance has not faded today, and I still feel like an idiot. In retrospect, most needlestick injuries occur when you are recapping a needle (hence the scoop method) or disposing sharps, and the injury occured probably because I was attempting to unconsciously recap the needle before the needlepoint was exposed after seeing the cap slipping. Unfortunately, the lidocaine needle is a lot shorter than the IV needles that I have grown accustomed to using. When speaking to the ID fellow, he advised me that one of the most common needlestick injuries occur after screwing the needle too tightly into the syringe.
Needlesticks are extremely common in the hospital, but in the SFGH ED, it was especially scary. Most of my patients have HIV, HCV, or both, and this patient was a black box. It was also concerning for me to realize that we still had no idea what her diagnosis was.
Since today was my day off, I was able to read some personal accounts of other doctors and nurses who have joined the Private Misery Club and some of them are quite moving, funny, thoughtful, and some just depressing. Many talk about mortality, or the sensation of a lost future. Some of my first thoughts after the needlestick involved my future...what am i going to do now? can i practice medicine in the future? what about unprotected sex? and then maybe a few times I mentally uttered my favorite curse word of all time: fuck.
It is not a good time right now to wax philosophical about mortality or medicine; I have an appointment on Friday for some baseline labs. The patient's rapid oral HIV was negative, and I have been told today that her serologies were negative, but that doesn't ease my concern that this patient has acute primary HIV infection given her suspected meningitis (which can follow the prodromal flu-like illness) and considering our ED population enriched with blood-borne diseases. Argh. If there is one thing that I hate more than uncertainty or regret, it is having the patience and attention span required for surveillance serologies. The ED requires neither patience nor an attention span longer than 24 hours, which might still be ideal for me.
My favorite personal account of a needlestick injury is from Buckeye: http://ohiosurgery.blogspot.com/2008/10/needle-stick.html.
There's a nice one from an ED physician: http://gruntdoc.com/2005/05/needlestick.html
And a blithe one from an MS2: http://www.boston.com/yourlife/health/blog/2007/10/ill_have_what_s.html
Monday, June 15, 2009
perfect weekend
i'm not sure yet what "living the dream" means in medicine jargon, but just finished a perfect weekend (thanks to paul and costco):
saturday: philz coffee, driving over golden gate bridge to napa (mondavi, stag's leap -- cask 23 is uhmazing), napa outlets, spicy dinner in berkeley
sunday: philz coffee, casual walk to SF Giants game for $10 seats in the view box behind home plate, 9-hole game of golf at Golden Gate Park, and watching the movie "Up" in 3D using $7.50 costco tickets.
saturday: philz coffee, driving over golden gate bridge to napa (mondavi, stag's leap -- cask 23 is uhmazing), napa outlets, spicy dinner in berkeley
sunday: philz coffee, casual walk to SF Giants game for $10 seats in the view box behind home plate, 9-hole game of golf at Golden Gate Park, and watching the movie "Up" in 3D using $7.50 costco tickets.
most people do not know where the heart is
recent study in BMC Family Practice showing that less than half of 722 Britons surveyed can identify where the heart is on a diagram.
http://www.cnn.com/2009/HEALTH/06/15/body.knowledge.survey/index.html
reminder to self: draw more pictures for patients
http://www.cnn.com/2009/HEALTH/06/15/body.knowledge.survey/index.html
reminder to self: draw more pictures for patients
Tuesday, June 09, 2009
Radiology
Currently on a didactic radiology rotation for the next month. Medicine at SFGH was great, and I look forward to working in the ED next month (read: avoid the ED next month).
Currently watching basketball.
Currently watching basketball.
Thursday, June 04, 2009
osborne wave!
Craig showed me the coooooolest EKG this morning of a 58 M "found down" in the tenderloin. rectal temp 24 degrees celsius. he had very large and distinct osborne waves!
It was very exciting to see real osborne waves for the first time, like reading someone's biography and then meeting them in person for the first time. Do people still read biographies?
Thanks, Craig!
It was very exciting to see real osborne waves for the first time, like reading someone's biography and then meeting them in person for the first time. Do people still read biographies?
Thanks, Craig!
Wednesday, June 03, 2009
reflections on a "stabbiversary"
extremely well-written reflection on near-death experiences from NYT blog. curiously, this author was stabbed in the neck with a stiletto 14 years ago...
"You can’t feel grateful to be alive your whole life any more than you can stay passionately in love forever — or grieve forever, for that matter. Time forces us all to betray ourselves and get back to the busywork of living in the world. Before a year had gone by the same dumb everyday anxieties and frustrations began creeping back. I’d be disgusted to catch myself yelling in traffic, pounding on my computer, lying awake at night wondering what was going to become of me."
http://happydays.blogs.nytimes.com/2009/06/02/reprieve/?em
"You can’t feel grateful to be alive your whole life any more than you can stay passionately in love forever — or grieve forever, for that matter. Time forces us all to betray ourselves and get back to the busywork of living in the world. Before a year had gone by the same dumb everyday anxieties and frustrations began creeping back. I’d be disgusted to catch myself yelling in traffic, pounding on my computer, lying awake at night wondering what was going to become of me."
http://happydays.blogs.nytimes.com/2009/06/02/reprieve/?em
Monday, June 01, 2009
"Winning the Game"
In medicine, "winning the game" means that a team or person has discharged all of their patients before the next call night, which means that they have no work until the next call. Clinical medicine is an interesting culture, with slang and neologisms that can roll off your tongue before you can think, "wait, that was incomprehensible to a normal person." For instance, you can say, "CBC q 6 hours, goal crit 30" or "cycle the trops" or "wean the nebs" and most people around you in the hospital will nod knowingly.
But i often digress. Medicine at el general has been great, I really enjoy working with my team and treating patients who are often underprivileged and have complex psychosocial situtations. The residents and attendings at SFGH are fantastic, and provide top notch care to patients who can easily fall between the cracks.
But i often digress. Medicine at el general has been great, I really enjoy working with my team and treating patients who are often underprivileged and have complex psychosocial situtations. The residents and attendings at SFGH are fantastic, and provide top notch care to patients who can easily fall between the cracks.
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