D11 – 17

D11

Clinic. I listen to heart and lungs for each patient and the attending writes the results before I finish. I learn staging of tests in pregnancy. One woman is adhered and the speculum is blocked. One woman is younger than me and blushes as I listen to her heart and it pounds but I say nothing.

 

D12

Lectures. Back to back to back after rounds. Apparently orcas undergo menopause.

 

D13

Lab BBQ and my only alcohol of the rotation. Feeling much sharper. Play catch in the pool as children attack with spray guns and foam footballs.

 

D14

World cup final my sister and her boyfriend. They cubed old potatoes planted them in dirt and they sprouted green. All dug from the ground as new miniatures. Vegetarians are merciless with their plants. I study and make muffins for future breakfasts. A long walk in the sun as I talk to my dad, lamenting using a translator to take a history. He says good students figure out ways to get things done.

 

D15 L&D. New residents, familiar attendings. A baby is delivered and I try to learn how to take care of a neonate from the pediatricians. The baby seems floppy but gets a perfect score on muscle tone. I am tasked with taking a history but told to get the resident if she only speaks Spanish. She does and I get nervous and go get him and he takes most of the history for me. For shame.

 

D16 L&D. I learn to ultrasound a gravid uterus. Finding head, heart, abdomen, and femur with some guidance. My hand slides without feeling it. I go to take a history and she only speaks Spanish and I use the translator with confidence and my history is complete. I am renewed. Use every opportunity to practice and improve.

D17 L&D. More histories. Forget much and learn much. A baby pops out before I gown.

Tubal ligation

framed umbilicus

lasso looped salpinx, cut, tuck

bind separation

Feel tinge of irritation as the day recedes.

 

ObGyn D9 D10

D9

A clinic in the east. Outer walls mosaic, inside wood and tile. The coat and a fast walk make some think I’ve come to bring them change. I can only pass. The doctor shows me how to use the speculum. The plastic ratchets and glows. The metal, smooth, supple. Lo siento lo siento. In my head but I am unable to speak. A woman repeats it, embarrassed. Some must get nipped. 6 o’clock, 9 o’clock. One writhes, her foot shakes. Tembloroso. One is stone, testing the ceiling’s courage. Blood pools and spills down the handle. I see it was designed for that.

 

D10

A day off. E-mails to coordinate the next rotation, two weeks into this one. I learn in three words that the two days of OR time next week have no cases scheduled. Efficiency is so cold. I try to do write ups and realize how incomplete and incoherent my notes have been. Something to improve on  one self reassures the other. That other’s anxiety builds as I do more cases. Get questions wrong and the splinter in the windshield that is my confidence begins. We’ve hit a saturation point, now everything begins to get jumbled. Only ten days in! Maybe we just accept being a shitty doctor, scrambling through our notes, not have the simplest of answers. How easily I’m pushed off course. Plod along, plod along. We’ll get somewhere.

ObGyn D4-8

D4

A drive north. A tall thin doctor, very flat, except that he smiles and laughs when talking about his test taking habits. A nurse brings a folder into his office and gurgles a sentence of acronyms.  He looks at the folder, we stand up and walk next door.  There is almost always a man and a woman on the exam table. He introduces me and turns out the lights and becomes a wizard. Left hand on glowing emeralds and diamonds, right hand a wand. Coalesced static forms a skull, abdomen; the sharp line of a femur to be measured. He can make a 3D image of the face, and the parents are transfixed. One man repeatedly asks for a picture of the babies foot. One solo woman with short curly hair learns that she has a currently healthy 13 week old boy. When the lights come on she wipes tears, grabs a styrofoam cup and her bag and leaves.

It is beginning to get warm.

D5

Walking from my car at 0645 I begin to sweat through my clothes. Rounds and lectures with the department. A break with a friend and more lectures. Contraception methods. Abnormal pap smear management, which consists of looking up the plan online and following the algorithm. After, I try to go to the lab and switch to research. Instead, I look at away rotation applications and requirements, tormenting myself with schools who require minimum step 1 scores that I don’t meet. I’m really in the lab to use the a/c. Walking outside is like opening an oven to check on dinner. The wind is warmer than still air and carries a faint odor of smoke. I check my phone to rule out inclement firestorm and it dies. I sleep on my couch to be near the a/c.

 

D6

Morning is still 80. L&D day two. I help deliver two babies. Another c-section to scrub in to, and I get to practice suturing fascia. The resident is impressed with the fascia opportunity. My notes on patients become chaos. They get moved from a room and room numbers become worthless. Last names don’t help. All the G’s and P’s meld into either G1 or Gmultiple. Which page is who? I’m asked to take a history and she speaks only Spanish. A bright blue phone holds a translator. I talk to her she talks to the wall. I can hear the translators judgement of my questions. I’m told she says 39 weeks and first pregnancy. The attending gets 41 weeks and 3rd pregnancy, confirmed in prior records. I forget to ask many questions. I’m told the attending is impressed with me. Remind myself to keep trying despite fear, the only way to improve. Home at eight and eating dinner close to nine. Perpetual sweat. Sleep on the couch again.

 

D7

Day off. Sleep in until my dampness becomes unbearable.  Make a seran wrap green house for one of the orchids I repotted. Pack things to go to gym and lab to get a/c. Realize I lost my student ID. Drive to the hospital to look. Can’t find it.  Make an office in  front of the a/c for a few hours, then go for a run outside. Warm air at dusk is delightful. Can’t stop sweating in the apartment, make banana breakfast muffins anyway.

 

D8

I learn from an intern and a midwife for half of a day. The intern has many of the same questions I do, which is reassuring. Gym at lunch time, food truck for lunch. An Arizona Iced Tea wards off heat anxiety. I study at the lab, and discover how helpful Case Files are. I must go through them all as quickly as possible. I’ll take a few notes by hand, but only Anki the questions from each case I get wrong. I’ll finish cases before UWorld.

I’ve been reading Eye Level by Jenny Xie.  When I used to write poetry I used words like she does. You feel them in your mouth as you read/write them, pair them together based on mouthfeel, flavor, texture. A new line is to swallow.

Xie-Eye-Level

Listening to Future’s BEASTMODE 2. Intricate bass heavy beats, hardship and pain next to triumph, confidence and persistence.

ObGyn D3

First day on labor and delivery and scrubbed in to an emergent c section and helped deliver a meat raisin. They laid it in her lap and it squawked and tears hit my eyes and someone lifted it away and I kept retracting. At first I couldn’t get the scissors to cut suture but by the end I cut crisp.

ObGyn D2

Had time to eat at home and still be early.  Proactive for a badge.

First day in the clinic. A place to sit and read the textbook. Until permission is given, and I enter the room. Everyone sits while I stand, with little to say. Following along but not much to learn. Then a thrash of phrases and letter clusters to be sorted and stored to look up later while I watch and try to remember. Where is the wand? Back up. How did she put on the gel? Back up. How did she get the patient in this vulnerable position so gracefully? All done ok schedule your next appointment for two weeks see you then. Door shut. Any questions? A million. None that I can’t look up. Ask a weak one. Sit again and learn and learn.

A man who stares at the ground. He had to turn off the Cup. She says she exercises because she works in the field. Instruction on the importance of sustained heart rate.

Another man who stares at the ground when I’m learning how to swab for GBS. He fiddles with his patriotic sailboat socks. Ultrasound head is a circle, abdomen an oval. A femur from nowhere.

I listen to pulm and card, knowing  I’m supposed to ask for the removal of the shirt, waiting to be scolded. When I finally ask she says no need to be so thorough and I realize it was just something for me to do. We check the suture from a leiomyoma removal.  Leio mean smooth. But I think of a lions mane every time.

Other patients. At 10 weeks the entire uterus fits on the screen. A placenta and small heart rate.

I get good at guessing the heart rate on doppler. Nobody asks for my parlor trick.

At home I read this

Screenshot_20180703-165743~2
Zuihitsu by Jenny Xie

 

and think of my standing, quiet, in each room, tunneling. Internal language recursively burrows.

I run to the end of Drake’s Scorpion and start of Florence’s High As Hope. It is hot and the air, exhaust.

 

Zuihitsu by Jenny Xie

ObGyn D1

Minutiae of schedules. Expectations and assignments.

A worm burrowed through a woman’s umbilicus. What do we see? Soon everything the size of a fist might be a uterus. Everything the size of a thumb, an ovary. Adnexa, fimbrae, salpinx. The terms come back.  Everyone who just took step is quick to say their buzzwords. A small burst of panic, a distant firework in the evening, because I didn’t know them then and I don’t know them now. It fades because we are quickly moving beyond.

The worm turns its head. A patch of turmeric colored mesenteric fat. The liver, a shadow, looming over us.

I’ve never felt queasy viewing surgeries. A colpotomy brings me close.

We practice manual exams with bare hands in rubber. It is hard to be delicate. During an instructor explanation, someone near me is ramming his fingers to try and find the ovary. It is not commonly palpated if normal. This is why we practice.

Lunch with the lab and my figures and results are good. Time to write it up.

Four P’s needed before a patient can be discharged post-op. They are straightforward and I doodle; graph paper biases my hand towards square shapes.

Nine something causes of abnormal uterine bleeds. I remember to look for clues in presentation to differentiate. I take notes. I’ve reviewed those notes. Good little ninja.

We practice knots that I’ve already learned. I try not to show off. I try to help other people but I find it hard to instruct how to move their hands; chirality is a mind-bender. A needle slides through a banana so smoothly. The suture rubs.

I moved my computer out of the main lab space. End of the year. Very few goals accomplished. But much learning, progress, and fun. And growth, much much growth. And another year of growth lies ahead. With pain, exhaustion, disappointment, and  inadequacy for sure. But learning and exhilaration and accomplishment more so.  I view myself as a mercenary of medical learning. Mercenaries are viewed as disloyal and unscrupulous, but they live as nomads, untethered, willing to do what others aren’t. Usually for the offer of payment. My currency is knowledge. Teach me show me explain. From teachers and patients. Roam between hospitals, clinics, east then north, west and back east. Serve different residents and attendings, care for humans you will never see again. And devour all that those offer in knowledge.

Trolley Tracks

 

He saw a spot and hooked a left tires bumping over the trolley tracks and then parked.

He thought about the dream where he watched the whole city slide down a hill into the water; an egg in a frying pan the streets were rubber and flopped underneath the buildings as it all slipped into the gray water. He got out, door squeaking, and from five feet away smelled the homeless guy sleeping in the entrance of the apartment building and it smelled like feet, just feet all over.

As he stepped by, the man stirred amidst the blankets and asked, “You got any change?” And he looked away and said, “No, sorry” even though he felt some bounce in his pocket and he looked back at the homeless man who stared at the street both of them tired of seeing the other one’s face during that lie.

 

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