Rotation Memorable Moments

Memorable moments from my rotation and the rotations of my friends:

• Psych
• Early teen's high functioning asperger's kid who's been drawing ideas for horror tv shows since age 4. Plots include murder, rape, violence, etc.
• Manic patient runs out of room saying "they're trying to get me," gets stopped/calmed down by a nurse, and ensues to hug the nurse and me.
• Manic patient repeatedly cries out, "I'm ready to talk"
• Manic patient pulls out imaginary string from my pants and coils it in her hands.
• The attending was speaking to the mother about her son.  All of a sudden, the son gets up, asks his mom if he could tell her a secret.  The kid whispers something to his mom, and sits back down.  The mom turns to me, and says her son wanted to say something to me.  The kid smiles widely and says, "Konichiwa."
• My patient asked me to button up my white coat (apparently I was dressed too provocatively - note the sarcasm)
• A patient refused to talk to me because, my bangs were in my eyes.
• A guy getting anesthesia before ECT got stuck in both arms, both feet, and both sides of neck to put in an IV line.  Ultimately they still didn't get a line and he had to go home to return to get a port placed on another day.
• Patient believes Eminem fathers her children, Eminem's songs were written by her, and he had left a letter in the wall of her building, so she tore up the wall with a sledge hammer.
• Patient believed the FBI had tapped his house and listens to him, wife's friends are after him, wife had put shards in child's hands, and wife is dating a teenager.
• Interviewed a patient for almost 2 hrs because he had latency of 5-10sec, and kept being distracted by dots.
• Almost 100yo cute old lady who thinks she's engaged to Tom Brokaw
• Twin autistic kids. One of them has a tic of bending at the waste when watching something on iphone/computer.
• Trazadone guy: "trazadone?! do you have any trazadone?! doctor can you give me some trazadone?!"
• Lady who shouts obscenities in low, monstrous, husky voice.  And believed someone had shot her in the leg and back, that people were coming after her from her closet, and that she was pregnant.
• Guy who burst into rage, obsenities, and threats while a lot of residents/students watched from a corner.
• Being told by ob/consult that it's not appropriate for a medical student to call consult.  It's alright, the resident backed me up :D
• Neuro:
• 14 yo's response when asked about anxiety and mood: "some anxiety, but not clinically significant" - turns out a parent is a psychiatrist.
• Discussing neuro exam on kids: "well there isn't really much you can assess for in terms of higher cognitive function - they eat, they sleep, they cry, and they make baby movements." (so cute!)
• Achondroplasia baby with hydrocephale - enormous head, very happy baby
• Neurofibromatosis 1: neurofibromas all over - some really soft
• Von Hippel Lindau syndrome: many hemangioblastomas in brain
• Cushing's: striae, gynecomastia, weight gain, moon face, renal failure from ibuprofen for headaches
• Left ICA, right ACA infarction - didn't know had stroke b/c under sedation
• Radiation induced meningiomas; hemiparesis, dysphasia, many things...
• Pilocytic astrocytoma in young adult, spinal ependymoma, HIV + meningioma surgeries.
• Na of 203 b/c of paraneoplastic syndrome!
• 4 patients started seizing within one hour and one coded.
• Attempting an LP on BMI of 70
• Leptomeningeal carcinoma - sarcoid? meningioma? ???
• Melanoma brain metastasis + lung cancer
• Huge list of PMH + ESRD/HD + endocarditis + bacteremia + delirium + no pupil constriction
• ADEM vs. MS + unresponsive/no blink to corneal reflex
• Guillain Barre vs. DM
• ER:
• Finally got to do an LP (successful too!) after watching a bijillion and not allowed to do them b/c the patient was too difficult (let's just say the needle had to be long).
• Pelvic exam, check anal tone, all that good stuff
• Dude with 5 fingers lacerated b/c of band saw - finger krooked, see tendon, etc.
• Reducing a dislocated shoulder - oh man, people under some sedation are pretty amusing.
• Suture laceration on arm and face - I love suturing!
• Held a live, beating heart between my two hands. 
• Stapled it, made it go into fibrillation with a battery, and then pumped it with two hands.
• Started an IV while patient screamed "Ahhhhh" and "Heeeeelp."
• Peds:
• Epidermolysis bullosa - fingers fused together, whole body wrapped up, can't talk clearly because corners of mouth fused, skin was so fragile that rubbing it would cause it to slough off and blister.
• Little guy with optoclonus/myoclonus + ganglioside neuroblastoma
• Girl with GVHD (MDS txp): white skin patches, hair loss, tear duct
• Hurler syndrome, BMT, hypogammaglobulinemia: gargoylism, large tongue, corneal clouding, HSM, contractures, running nose, heart/lung issues
• Fanconi Anemia: short, cartilage/finger thumb, skin, horseshoe kidney, AA/AML, BRCA gene
• Unknown: hard nodules all over + fibrosarcoma + contractures + unknown brain tumor + cafe au lait spots (not NF1 or mismatch repair deletion)
• Pilocytic astrocytoma on optic chiasm resected led to DI treated with DDAVP
• Little boy that kept on saying no, then said yes when I asked if he wanted to get out of that room
• Chubby little baby who finished his chemo and got to ring the bell and got balloons + a present
• TAR (thrombocytopenia with absent radii) - no forearm!
• Duchenne muscular dystrophy (completely atrophied legs)
• FAP + hepatoblastoma + desmoid tumor + b-catenin + fx
• Langerhans Histiocytosis (face); Hemophagocytic lymphohistiocytosis; Alveoli rhabodmyosarcoma; Adrenal cortical carcinoma (cushing)
• ALL (extramedullary - renal), NHL, HL, Wilms
• Sickle, SC, C w/persistent F, Bthal trait adopted girl, hereditary elliptocytosis (smear looked really cool)
• Branchial cyst
• When asked about funny moments in peds, friend says, "They don't really do funny things because they can't talk.  They just wriggle around a lot and sleep or cry."
• Nursery
• Catching babies!
• Watching a very tired mom take a peek at her child, smile, and say, "please take care of him!" as he's rolled away in isolation.
• 24+ hrs of labor!
• Baby delivery into the toilet!
• Others:
• Sitting in a car with an attending and an intern hearing about each of them talking about how their patient died.

Bipolar Mania

Psychiatry is very, very, very interesting! I got assigned to a few patients, including bipolar patients!  It's so difficult to interview them because they just talk 100 mph!  Initially I felt bad interrupting them, but if I didn't, I'd still be there interviewing them!  In the end, I just let them ramble, until I thought of a new question to ask.  The human brain is truly amazing.  I could be asking about how they slept, and they would respond well, then talk about how they slept in Iowa, and how they could get me a good deal at the hotel next door - things that are completely unconnected and untrue.  When the patient got worse, I couldn't even understand them because they were trying to speak so fast they'd end up mumbling.

Another patient had psychosis and apparently pulled a long piece of string from the side of my pants, and started raveling it.  All the while, they were doing the motion, and there was definitely no string.  Then the patient talked about how everyone in the hospital is acting and out to get them.  They would switch from being very nice and smiling to being completely guarded and suspicious and say things like "you're one of them, I'm not going to tell you anymore things" to admiring how our shoes are similar - all in 10 seconds.  In the meantime, they get distracted so easily that they couldn't even remember where they were or what year it is.  Perhaps they do know, but they just get distracted too quickly to be able to think of the right answer and respond.

Meanwhile, someone else didn't sleep at all the night before, yet still had an insane amount of energy.  Every time I said "okay, can we talk about...." they would get ready to get out of their seats and do something.  Apparently they were so restless they reorganized all the games in the activity center and drew on the walls.  The patient also kept on saying for me and my husband to go visit them, even though I told them that I didn't have a husband.  Then they said they could find me a nice doctor to marry.  Later on, they gave me a hug - kinda sweet, kinda nice, but also kind of sad b/c who knows if they really meant to give that hug.

One patient was such a nice patient.  When I first med them, they were so friendly and said they saw a sparkle in my eye.  They later said they were afraid I was going to leave, and gave me a hug.  It's so sad because I'm sure the patient was a great person, but this psychiatric problem has left them so dysfunctional.  They've been refractory to a lot of treatments, and their current treatment hasn't started to work yet.  I really hope they get better!

Paintballing!

So much fun! Paintballs are A LOT smaller than I expected!  I was thinking of something from...10 things I hate about you.  If those were the sun, then these paintballs today were like the earth.  Many of us (girls) were slightly concerned about the painful report we received from previous ballers, and warning was well heeded.  I was fortunate - did not get hit that often, or at close range, but others on my team were not so lucky.  One teammate was hit TWICE, by a friend too!  Oh man, she got welts that look like a ring of blood-filled blisters.  It looks pretty gruesome for sure.

We had played 3 games.  The first game consisted of mostly running around the forest.  I was so nervous initially, I could feel my heart beating and I think I might have even been shaking.  I was just kind of sitting on some sand bags behind a tree, and afraid to move to see the opposite team.  After seeing I wasn't getting anywhere, I decided to move to a ditch.  Lucky for me, people didn't really see me there in the corner, so I got lucky and shot 3 people or so.  Each round is single elimination, so if the paintball bursts on you, then you're out.  I think everyone was lucky then, so time ran out and it was a draw.  It was funny to see where people got hit: skidding the arm, right smack between the eyes (we got masks), and even in the "man area"(apparently he didn't feel it).

For the second game, our group of friends had to split up because the other team only had 3 people.  Right away, I tried to advance far so I could get a good angle and good hiding spot.  It was so muddy I could barely move, so I moved even farther forward.  After the game, a friend on the opposite team complained that I pelted him a million times while he was a bush, another friend said I hit him in the face and on his bare head, and I hit someone else on the head.  Oops...maybe I should be less vicious.   But turns out one of them got hit, but the ball didn't burst, and so she later got me back when there was maybe 1 minute left.  Sighs.

The last round was pretty disastrous.  We had planned to have some people go right, some left, and one up in the tower, but it turns out we had no idea how far left the field went.  I also got too impatient (progressively more so each game), didn't realize there were people on my right, and easily got pelted by 3 paintballs.  Yikes.  Meanwhile, the other team, completely flanked us by going through a trail on the left - while we thought we had reached the border.  Yup, 5 min and we were goners.

Anyhow, it was a lot of fun, and I'd love to go again! (if it weren't so expensive...)