Thursday, September 16, 2004

Get Some

All I knew before going in to see my fourth patient of the day was that she "desires change in birth control," and that she has been receiving Depo-Provera shots since she gave birth in 2003. The following dialogue (or one close to it) ensued:
Me: Good morning, my name is Emily, I am the student working in the clinic today.
Patient: I seen you before. (She had, in fact, six weeks ago at a pediatrician's office whre she had taken her older child for a kindergarten physical. At that time she informed me that she didn't like students, and that she didn't really care for her children, either).
Me: Oh, yes, hello. So, you want to switch from the Depo shot to another form of birth control, right?
Patient: Hell yes.
Me: What is it about the Depo shot that makes you want to switch?
Patient: I be bleedin' all the damn time, girl, and I can't get no ass when I be bleedin'. I ain't gonna got his whole winter without no ass.
Me: So you are bleeding in between periods?
Patient: Damn straight.
(We continue the conversation to get more info about the nature of the bleeding)
Me: Have you been having any weight gain or mood changes since you've been on Depo?
Patient: No weight gain. I maybe been in a bad mood, though, but probably because I can't get no head and no ass and that make me crabby.
Me: What kind of birth control do you think you would like to switch to?
Patient: Whatever don't make me bleed, but I ain't puttin' nothin' in my coochie.
Me: So you wouldn't be interested in the Nuva Ring? You just insert it in the vagine once a month and leave it there, then you don't have to take a pill every day, and you only have to think about it every four weeks.
Patient: Hell no, ain't nothin' goin' in my coochie. You know how it be when a man got a big ol' dick and you don't know how it be rockin' around in there movin' shit around.
Me: Do you want to try oral birth control pills?
Patient: Yeah, I'll do those. I been on 'em before, but this time I'll remember to take them everyday because before I forgot and that's how I ended up with him (pointing to her 13 month old running around the room).
Me: So you know how important it is to take it every day at the same time?
Patient: Every morning when he wakes me up at 7:30 the first thing I'm gonna do is take that pill. Also, can you look down there and check everything out and make sure I don't got no infections or diseases? It been a few months since a doctor checked me.
(We wrap things up and I go to wait for my attending to come in so we cn complete the physical exam and counseling. Before we go in, I let the doctor know about the patient's concern over her lack of ability to get any ass or head)
Doctor: So, Emily has been talking to you about some birth control and I hear you aren't happy with the Depo and want to try the Pill again?
Patient: Doctor, like I told her, I be bleedin' all the time and can't any. I got a birthday comin' up and the holidays and you know how we be, I don't wanna go without.
(Most of the conversation I just had with the patient is then repeated with the doctor. I am then instructed by the doctor to do the genital exam, which I am really looking forward to connsidering the lovely things I may be about to find.)
Me: Have you had any increase in discharge? (There is a plentiful amount.)
Patient: There been a little more discharge. I think it stinks, too.
(As I am in the prime location, I can verify the odor)
Me: How long have you had the increased discharge and odor?
Patient: I don't know. I just think it smell like a dead racoon.
(I have heard those "female odors" compared to many things, but this is the first time road kill has been used as a descriptor. I do the pap smear and then take specimens I need for the STD testing. That concludes the physical exam.)
Once the doctor and I finish the exam, write the prescription for a drug to treat the bacterial vaginosis (source of dead racoon smell), and give her a sample of Seasonale (the Pill you take for three months in a row without any placebo weeks so you only have you period once every three months), and a prescription to have the birth control refilled (please please please let her get this prescription refilled and use it, daily, for a very long time), we send our lovely patient on her way, off to merrily begin her pursuit of ass.









Monday, September 13, 2004

Yuzpe

I am sure there is something borderline illegal about my dispensing of medical advice on the internet, but there are just some things I need to share with people. Also, I was recently told by one of my attendings that he thinks all sexually active women need to know the following info, and that if they don't know it, the medical community has failed them.
Since I don't want to contribute to that failure, today I will share a recipe for emergency contraception, known as the Yutzpe Method.
This recipe uses your basic birth control pills to prevent pregnancy after unprotected or unplanned sex.
There are just a few rules you need to follow:
1. You have to do this within 72 hours of sex to have the best effect
2. You have to take the second dose promptly 12 hours after the first dose for maximum effect.
So, here you go.
Each dose is either:
2 pills of Ovral or Ogestrel, OR
4 pills of Cryselle, Levlen, Levora, Lo/Ovral, Nordette, Tri-Levlen, Tri-Phasil, Trivora, Lo-Ogestrel, OR
5 pills of Alesse, Aviane, Lessina, or Levlite.
Take the first dose ASAP after the sex. Then take the second dose (identical in quantity to the first) 12 hours later.
The most likely side effect will be nausea and vomiting (due to all the estrogen you just swallowed).
If you throw up, take something for nausea (dramamine is available over the counter) and then repeat the dose an hour after taking the anti-nausea meds.

Of course, there are some other handy products, such as Plan B, that are "available," but that lots of chain drug stores have decided not to carry, so they may be hard to find. If you can get it, though, then the advantage is that you only take one pill in each dose, and the pills have no estrogen, so you won't get nauseated. For more info, go to www.go2planb.com

These methods are 80-90% effective in preventing pregnancy. They will NOT end an already established pregnancy, and if you happen to have conceived from the unplanned sex, then this won't affect that, either. This is why you want to take the pills as soon as possible.

Also, my attending recommended that we ask all our patients if they would like a prescription for PLan B so they can get it filled and have it around for the "just in case." If your doc hasn't offered it, and you are interested, then demand your Plan B, ladies! If you can't find Plan B in your area pharmacies, then ask to have an extra pack of pills so you can do the Yutzpe (your doc can also prescribe you a more powerful medicine to prevent the nausea that might come from taking the regular birth control pills).

Let me know if you have any questions!

Thursday, August 26, 2004

INFP

When I was a sophomore in high school, I took my very first Myers-Briggs Personality test, and at that time was an INFP (introverted, intuituve, feeling, perceiving).
When I was given the test again toward the end of my first year of medical school, things had changed and I tested as more of an INTJ (introverted, intuituve, thinking, judging).
Happily, I can now report that I am back to my more INFP ways.
This may just sound like a bunch of blah blah blah, but it is cool to ttake the test and then to see what other "famous" people share your personality type.
So, I am pleased to say that as an INFP, I now join the ranks of none other than:
Mary, the Virgin Mother of Jesus.

To take you own Myers-Briggs test, go to:
http://similarminds.com/myers-briggs-jung.html
enter your gender, and on the box for mbti type, select "unknown"
This is a real test that is used by psychologists, counselors, and lots of other people who try to figure other people out, so it isn't just a hoax.

Again, I repeat, I am just like the Virgin Mary.
The question is: how did they manage to give Mary this personality test?


Wednesday, August 25, 2004

Slippery When Born

Yes, it has been some time.
For the past three weeks, I have been on my obstetrics rotation, which means I have been seeing lots of 7 pound humans coming out of lots of 10 centimeter holes. Tomorrow being the last day I have in this rotation, I thought I could soend some time reflecting on what I have seen and learned this month.

1. We all start off slippery
I don't think i have ever held anything more slippery than a brand new human being. Last Monday, I had the distinct honor of actually catching a baby (Sidebar: We say "catch" now instead of "deliver," which I think is a change for the better because when that baby comes shooting out of its mom, you just have to grab it an hold on tight). I could write pages about that experience, but suffice it to say that it was once of the coolest and scariest things I have ever been a part of. I am not sure of there is anywhere in nature or made by man a more slippery substance than that stuff that covers babies when they are born. It makes sense: you want the watermelon well-lubed before you send it down the pipes. If small town fairs wanted to have real entertainment, they would skip the greased pig contest, and instead oil up some babies and start tossing them back and forth, like a water balloon contest.

2. Wear Disposable Shoes
Birth is a beautiful thing. Birth is also one of the bloodiest, gunkiest, poopiest, water-shooting-out-of-orifices-est things that happens. No, I will go ahead and say it is THE bloodiest, gunkiest, poopiest, water-shooting-out-of-orifices-est thing that happens on this planet. Since each birth is different, you never know just what is going to come flying out, or just what is going to land on the floor. So, always put on the prtective gown and mask, always cover your shoes with the throw-away booties, and never wear a apair of shoes you wouldn't be willing to throw away in case you don't have time to put the dispoable booties on over your shoes.

3. Placenta is Gross
Ys it is responsible for noursishing the baby for its 9 months in the womb, but once that thing has served its purpose, it is nothing but a big old nast bloody mess that no woman needs to witness being expelled from her body. Ew.

4. No Matter How Mature You Think You Are...
It is still weird to be within 6 inches of someone else's vagina when you only met them 10 minutes ago.

5. Moms Rule
Anyone who gives birth is my hero. I don't think there is a grown man alive who would endure what every mother has gone through to birth her children. They just couldn't handle it. I have been shocked and awed time and time again at the strength that women have, and their amazing ability to love the little crying creature that just caused them hours of agonizing pain.

Tuesday, July 27, 2004

Snip Snip

Circumcision.
Today I learned all I ever need to know about cicumcision, as it was my job to assist with four of them. This week I am in the newborn nursery at the hospital, and one of the fun things we do every day is to remove foreskin.
My official job was to use a dropper to give the babies sugar water right before and then during the procedure. The baby would be strapped onto a special board, legs tied down in spread eagle position, and then I would begin giving them drops of sugar (it was probably the first time these new little humans had ever expereience the sensation of sweetness, and the look of delight on their faces when the drops hit their lips was undeniably adorable). We give them sugar water because it makes the babies release endorphins, the body's "feel good" chemical. After a few drops of sugar and once they get a little of the feeling good, the nurse starts injecting lidocaine into the base of their penises to get them numb. During the rest of the procedure, my job was just to keep giving baby the drops of sugar.
I also liked to say reassuring things like, "Better now than later," and " Don't worry, we won't take off too much," or, "I promise this is the meanest thing two women will ever do to you." I think it made the babies feel better, but it also made the nurse performing the circumcision start to laugh, and I thought the babies would like a steady hand rather than the humor.
The nurse who did the job was so quick and efficient that I barely had time to ever really figure out exactly how the skin got taken off. By the fourth job of the day, though, I was able to adequately aim the dropper at the baby's mouth and watch the entire procedure from start to finish. Does it look rather barbaric? Yes. Does the baby seem to be in pain? Not really. Is there a lot of blood? There can be. What happens to the 1/2 inch of skin that gets snipped of the baby's wiener? That I never found out.
So, as you fall asleep tonight, just think that somewhere in this world, there are babies without their foreskins, and there are foreskins without their babies.
Good night.


Saturday, July 24, 2004

Where to Begin?

Now that I have this blog thing, I have been racking my brain about exactly which part of the story to jump into first. "The story" being how I went from a creative writing major with no idea about what to do with her life to a frenzied medical student with a few definite goals and one chaotic schedule, and how this right-brained lady deals with the left-brained world of science and medicine.
There are two question I hate being asked. The first is "What brought you to Kansas City?" (in reality I still haven't exactly pinned down the answer, but I know that roughly 89% of it had to do with a shaggy-haired fellow named Tommy whose life goals included becoming either a rock star or a ninja, who since has become nearly bald,  my husband and an attorney...)
The second question  is, "Have you always wanted to be a doctor?" The true answer to this question is NO, I have not always wanted to be a doctor. You tell people in the medical profession this, though, and they look at you as if they are just now noticing your second head poking out from your neck.  For some reason, the majority of my classmates, established physicians, etc, just can't seem to fathom not having the desire to be a physicians since the moment the exited the womb. 
Perhaps this has actually been some of the source of my struggle over the past two years . I didn't have that sense with in me that I was finally doing what I had always dreamed of doing, and that there was no obstacle great enough that I wouldn't be willing to overcome it to get to my dream. I lack a certain element of resolve that you can practically see dripping from some medical students. They are like those people we all know who dedicate their lives to a sport, who dream of one day playing college or professional basketball, baseball, or soccer, and who are willing to endure early morning practices, bruised and swollen body parts, and being yelled at to go faster and play harder. They think that kind of thing is fun. I think that kind of thing is torture. 
And I tend to think that the people who put up with this are a little bit crazy.
Anyway, the same dedication that sends some people to the gym or field at 5am also runs through the veins of students who are capable of sitting still, reading books, memorizing lists of info for 12 hours at a time, barely taking a break to eat or drink (which is probably why they never have to break to pee or poop).
Long story short...compared to most of my class, I am a slacker.
So how does this apply to the big picture story of how I ended up in medical school, dealing with these over-achieving people on a daily basis?
Good question.
I don't have a solid answer, except to say that in the past four weeks, I have actually started to feel as if I AM doing what I was always meant to do.
For four weeks now, I have officially been a third year medical student. This means that I no longer sit on my butt in lectures 5 hours a day and then go home and sit on my butt for several more hours. Instead, it means I spend an average of 10 hours a day with real, live patients instead of real, dead books.
Right away, during the first week of this new phase of my education, I started to feel something strange stirring inside me. Yes, much of it had to do with what seems to be recent-onset lactose intolerance, but in addition to the weird things going on in my gut, there was also something weird going on in my head and my heart.
I was having fun.
I was learning.
I was learning and having fun.
And then, before you know it...I was getting up at 5am to be at the hospital by 6:20.
More than that, I was getting up at 5am everyday, and managing to be a pleasant person.
Then one day the thought came into my mind as I was on my way to examine a patient, "I can't believe I actually get to do this everyday."
I stopped in my tracks for a brief second, and it occurred to me that even though I haven't always wanted to be a doctor, that suddenly I am doing exactly what I think I was meant to do, but just never knew that I was meant to do it.
HOLY CRAP.
And so, I guess that gets us pretty much caught up.
Summary:
I spent 25 years wondering what the hell I was supposed to be doing with my life, and within the last 4 weeks realized that even without having a definite goal or any reasonable plan, I somehow ended up exactly where I think I am supposed to be.

This feels better than a bubble bath.

 


Friday, July 23, 2004

Ta-Da

So it begins...
If you made it here, that means you have recently gotten an email from me, had a conversation with me, or have been stalking me. No matter the reason or method, I suppose I am flattered that you have come to read my little takes on the world. Hopefully most of what I have to share will be happy and lighthearted, but I am sure there will also be an ample amount of bitching and perhaps a tad bit of moaning. I will try to keep the bitching and moaning to a minimum, though.
 
And now, please raise your trays to their original upright position, fasten your safety belts, and prepare for take off...

 

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