(no subject)
So just a couple of things. Scrubs usually gets things right, but the target lesion on Lyme disease is only present something like 30% of the time. There is actually a blood test for it, and that would be a better use of time instead of writing off the disease after a skin search failed to reveal a tick bite.
Secondly, Brugada? I've actually seen a patient with Brugada disease, but it's extremely rare, and I know I wouldn't recognize the EKG changes if they lept up and bit me in the nose. I do know the index of suspicision needs to be very high to suspect it, but I know for a fact that as an intern I will not be making that diagnosis (which means I now need to go review that EKG pattern). Anyway, random.
Why are the doctors advocating for a patient to his wife, insisting that he's changed? They've known the patient all of, what, two hours? And they understand what makes him tick? Not to mention that an addict lies as a part of the disease.
Also, I guessed two of the bacteria common in neonatal sepsis. Should have gotten the third one, but that's not bad. Maybe I'll remember all three next time.
Finally, even if a patient has a heartattack due to cocaine abuse, it's still a heartattack. There was tissue damage. They'd need to be observed, at least over night and possibly longer, to make sure no arrythmias develop and to determine the extent of the damage. Streeting anybody who's had a heart attack sounds like you're begging for trouble. On the other hand, simple angina secondary to cocaine abuse, that may be another story.
Anyway, last day of dermatology is tomorrow. I actually got to do two shave biopsies yesterday, which was a lot of fun. I liked drawing up the lidocaine and injecting it. I felt like I was accomplishing something. I haven't been particularly industrious on this rotation, mostly because I have no responsibility whatsoever. No one asks me to make a diagnosis, pick a treatment, or even interview patients. I've frozen a few things, and the biopsies yesterday but that's it. I do feel a lot more comfortable looking at dark lesions and making a call between benign and malignant, although actinic keratoses will just take a while and basal cell carcinomas remain slightly ellusive. But that's okay. I have a better grasp at least of how to perform a biopsy and when it's appropriate to do a shave versus a punch biopsy. I'm satisfied with it. I'm really looking forward to working at the student health center for the next two weeks, though.
Next week there may be a coup. White Coat Company has failed to actually do their job thus far, which consisted of picking a musical. They were supposed to have that meeting a month ago, but never happened. Meera has been pushing for us to take over the troupe since this summer, and I'm ready to listen to her. It's nearly November, and we need to have auditions soon if there's even going to be a musical. I've made renderings of the set and costumes, and I've watched the movie and listened to the songs. I'm prepared to choreograph everything, run auditions, even make it to enough rehearsals to direct, I think. Meera is ready to write a script. We're going to meet with them next week, we think, and make it clear that they either need to get their act together or we will do it for them. There are five of them. I know they're going to say they're busy, but I don't buy it. Meera and I were busy. Chad and Kyla were busy. We all managed to put on a musical. The Lion King was technically even more impressive than The Wizard of Oz. I'll be disappointed if I take over and it kills The White Coat Company's future, but I think I'll be even sadder if there isn't a musical and I'm a fourth year with the time to run it.
Secondly, Brugada? I've actually seen a patient with Brugada disease, but it's extremely rare, and I know I wouldn't recognize the EKG changes if they lept up and bit me in the nose. I do know the index of suspicision needs to be very high to suspect it, but I know for a fact that as an intern I will not be making that diagnosis (which means I now need to go review that EKG pattern). Anyway, random.
Why are the doctors advocating for a patient to his wife, insisting that he's changed? They've known the patient all of, what, two hours? And they understand what makes him tick? Not to mention that an addict lies as a part of the disease.
Also, I guessed two of the bacteria common in neonatal sepsis. Should have gotten the third one, but that's not bad. Maybe I'll remember all three next time.
Finally, even if a patient has a heartattack due to cocaine abuse, it's still a heartattack. There was tissue damage. They'd need to be observed, at least over night and possibly longer, to make sure no arrythmias develop and to determine the extent of the damage. Streeting anybody who's had a heart attack sounds like you're begging for trouble. On the other hand, simple angina secondary to cocaine abuse, that may be another story.
Anyway, last day of dermatology is tomorrow. I actually got to do two shave biopsies yesterday, which was a lot of fun. I liked drawing up the lidocaine and injecting it. I felt like I was accomplishing something. I haven't been particularly industrious on this rotation, mostly because I have no responsibility whatsoever. No one asks me to make a diagnosis, pick a treatment, or even interview patients. I've frozen a few things, and the biopsies yesterday but that's it. I do feel a lot more comfortable looking at dark lesions and making a call between benign and malignant, although actinic keratoses will just take a while and basal cell carcinomas remain slightly ellusive. But that's okay. I have a better grasp at least of how to perform a biopsy and when it's appropriate to do a shave versus a punch biopsy. I'm satisfied with it. I'm really looking forward to working at the student health center for the next two weeks, though.
Next week there may be a coup. White Coat Company has failed to actually do their job thus far, which consisted of picking a musical. They were supposed to have that meeting a month ago, but never happened. Meera has been pushing for us to take over the troupe since this summer, and I'm ready to listen to her. It's nearly November, and we need to have auditions soon if there's even going to be a musical. I've made renderings of the set and costumes, and I've watched the movie and listened to the songs. I'm prepared to choreograph everything, run auditions, even make it to enough rehearsals to direct, I think. Meera is ready to write a script. We're going to meet with them next week, we think, and make it clear that they either need to get their act together or we will do it for them. There are five of them. I know they're going to say they're busy, but I don't buy it. Meera and I were busy. Chad and Kyla were busy. We all managed to put on a musical. The Lion King was technically even more impressive than The Wizard of Oz. I'll be disappointed if I take over and it kills The White Coat Company's future, but I think I'll be even sadder if there isn't a musical and I'm a fourth year with the time to run it.