Grand Rounds is up!

Please check out the wonderful job that Sam at Blog, MD did with Grand Rounds. Thanks for including my submission!

TB with a side of pi

First off, happy pi day. (My geek is showing).

Next, I did something in clinic today I did not expect I would have to do...treat a 25 year old for TB. Granted it was latent TB, but it scares me because she's a recently graduated nurse, and had negative PPDs. However, her quantiferon gold test was positive, and a nodule showed up on xray. And while she's been asymptomatic, and working (!!!) per the employee health recommendations, I have now sentenced her to 4 months of fairly hardcore antibiotics. It makes me wonder what I have been exposed to.....

Thirdly, I am having so much fun buying things for my Yarn Pron Swap pal! I need to be careful to stop buying things for myself too.... :) Etsy has so many good things, how's a girl to decide?
My Cozy lace shawl is driving me nuts. I've frogged a row about 5 times, and I cannot figure out why it looks like it's in pattern at the beginning, and then towards the end, the pattern is off, and I have an extra stitch. WTF??? I think it's back to the soothing ribbing on my sock for awhile.

Toys in the Attic

I had an incredible breakthrough in one of my own biases today, and it made me feel really good about some of the personal work I've been doing this year.

A little background....

I've had an eating disorder for the past ten years or so, and recently reached the decision that I could not live that life anymore. I have been in treatment for about 8 months. Part of that treatment was the determination that I have had a low-level depression for the past few years, through which I have been functional, but not optimal (a dysthymia, if you will). I was advised that an antidepressant could be very helpful to me.

While my logical, medical brain told me that this made sense, my gut put on the brakes. I came to recognize that when I see patients who are taking psych medications/have psychiatric history, I tend to conceptualize them differently in my own mind. At least in the inpatient setting where I spend most of my time lately, it often means that those patients are more difficult to treat. They often have accompanying social issues (I swear I have learned as much social work in my intern year as I have medicine). They may be less likely to take their meds, and keep their follow-up appointments. And now, I was going to be ONE OF THEM.

To clarify, my greatest fear was that, in reviewing my "med list" someone would see that I take an antidepressant medication, and would form the same opinion about ME. That's when my bias stood up and slapped me in the face.

I have tried to keep this in mind as I have carried on through the wards the past few months, and have been able to see things through different eyes to a certain degree. Another facet of this which emerged is that I was often reluctant to talk about psychiatric disorders frankly with patients....as if they didn't know they had it, or something? I think it's mostly because it's not a field that I see frequently/am comfortable treating.

In any case, I am on an outpatient month now, and while in my preceptor's clinic this afternoon, had the opportunity to meet a 70-something lady with bipolar disorder. It wasn't something I could pussyfoot around - the reason she came in to the internal medicine clinic was to talk about her current manic episode. Ok.

The patient was there with her daughter, and both spoke frankly about it as soon as I walked in:

Dr. Raygungirl: "Tell me what brings you in today."

Patient: "Well, I'm having a manic episode. I'm not sleeping, I'm spending more money, and I have 15 projects going on at home right now. And I want to remodel my kitchen." (She meant remodel it herself, not hire someone, FYI.)

And so it went. I found I was incredibly comfortable talking to the patient about her symptoms, explaining why she was experiencing what she was, and even guiding her and her daughter in the best way to navigate the god-awful insurance coverage for mental health. I called it a disease, and the patient stopped, faced me directly, and said, "I never thought of it that way!" So I went on to explain that it was a disease, no different from diabetes or hypertension except that it was happening in her brain. And then she shared with me that forty years ago, after she had her "nervous breakdown," she and her husband moved their family to a different town because they were so embarrassed about her "problem." It felt really good to reassure her, and in doing so, reassure myself. Mental health diseases are diseases, and they can be treated and managed in a similar manner to blood pressure, as long as we are not too hung up on stereotypes or limited experience (me).

I was frank, upfront, and I was helpful. I feel today that I've been more helpful to that one patient than I've been to all the patients I did blood pressure checks and well-woman exams on all month so far. And she, in turn, has helped me. I know that mental health issues are still stigmatized in our culture, but now, I'm not going to be part of the stereotyping and stigmatization. Next time I see a chart with psych meds or diagnoses, I won't jump to my previous conclusions. And maybe, next time someone sees my chart, they'll show me the same respect.

Yarn Pron Survey

Late with this, but just got back from Vegas (see upcoming post)....

1. What kind of fibers do you prefer? Anything natural, although I do love merino lots

2. What kind of weight do you prefer (sock, worsted, bulky)? sock through worsted

3. Do you spin? Nope

4. Do you crochet? Nope

5. Are there any books, patterns, magazines would you like to own that you don't? Oh, lets see: SNB nation, anything Interweave, Wicked and Rusted Root from Zephyrstyle, Fitted Knits

6. Are you participating in any themed a-longs like the Project Spectrum? Nope.

7. Do you have a wishlist on Amazon.com or Half.com? (provide a link) Mostly doctor-related books, so not really relevant.

8. Any Etsy stores that you would love to get something from? Hmm, Ruby 297, Yarn Botanika,
and not necessarily etsy, but I love Lisa Souza, and would love to try socks that rock, yarn pirate, tofutsies or yarntini.

9. What other crafty things are you involved in (quilting, drawing, painting)? Beading/Jewelry making.

10. What is your favorite sort of scent? My absolute favorite scent if my eucalyptus spearmint BnBW line of stuff, but I'm also a big fan of Ralph Lauren Style.

11. Do you have a sweet tooth and what kind of sweets do you like best? Yes, and dark chocolate is my by-far fav.

12. What kind of music do you like? Everything except country, really. Seriously. (tm) My favorites are Jack Johnson, DMB, Sarah McLachlan, Fiona Apple, etc but I have everything from Grateful Dead to NIN and in between on my iPod.

13. What do you like to knit? And for whom? Everything. And for anyone, mostly. I usually only gift to those who are close ot me and I know will appreciate it, because I knit pretty slowly. FOr that same reason, I will not sell anything I knit, because it takes me so long, the prices would have to be ridiculous.

14. What sort of things do you like to collect? Not a collector type, really. Books, I guess, as my shelves seem to get more packed by the month.

15. Do you want needles? And what kind do you prefer? I can always use needles. I love my KnitPicks options set, but would like some of the smaller circs. I also only have one pair of DPNs, US1s, as I've just started sock knitting. I like metal as I can be hard on needles, but am intrigued by the Lantern Moon needles.

Knitting with the Plague

I've been hit by the plague, othgerwise known as a fabulous little respiratory virus that is not influenza, and therefore not covered by the little shot I got a few months back. It has me down and out for 5 days. I don't think I've been this sick as an adult. Every time I'm feeling better, it starts up again with the fevers and chills, and aches and sore throat. Ugh. This is getting complicated at work, as Healthcare Conglomorate terms any sick time greater than three days a "leave of absence."

Are you kidding me? I took one day as a vacation day, two as sick days, and now I need a NOTE FROM MY DOCTOR to go back to work. Oy vay. It makes me want to just hang a shingle out front of my house when I have my own practice, and keep the linear accelerator in the basement. Or at least remember not to get to close with Healthcare Conglomorate. Too much paperwork.

At least I've finished my Big Bad Baby blanket and a calorimetry to compliment my sister's scarf in time for their various events. Pics to follow.

The Exotic Perfumed Engine Weasel

Sometime last week, I started noticing a faint perfumey smell in my car. Originally I thought it belonged to the baby sweater I had bought my friend and kept in my car for a day, and had a nice little smell to it. But the sweater was gifted last Wednesday, and the smell persisted. It got stronger, and somewhat perfumey, and I thought maybe it was on my scarf. Then, as the temperatures PLUNGED into the depth of frozen hell this week, the heat in my car started to be on more frequently and in greater intensity, I noticed the smell increasing proportionately.

Yesterday, it got to the point that it smelled like a little old lady had crawled up inside my heater and died. It sounds awful, but I Kid. You. Not. It reeked like my grandma's perfume. So as I was driving to our friends' Superbowl party, I asked N if he smelled anything. He did, and I proceeded to see if he knew what it was. I shared my observation about the heat, and we further deduced that it only happened when heat was blowing through the lower vents. I asked if an animal could have gotten up inside there, and N claimed that it would smell much more rank than it did. He then added (totally deadpan)...."Unless it's an exotic perfumed engine weasel."

Hilarity ensued, we arrived at the party, and the car was so damn cold by the time we got back in it, that the weasel was forgotten.

Today driving around, I had no choice but to blast the heat or lose my toes and was nearly asphyxiated by grandma-smell by the time I got to work. By this point, the matter was concerning me ever more greatly, and I called my dad. I described the smell, and he asked whether it was sweet....and then proceeded to freak me out by suggesting that I could potentially have antifreeze fumes leaking into my car.

When N got home today, I sent him outside to the car to smell my coolant to see if it was similar in scent, and approximately ten minutes later he returned, with his hands behind his back and a very smug look on his face. "I present the exotic perfumed engine weasel." He holds out a dryer sheet, which he had found clinging to the under-part of my driver's side dashboard.

It had escaped the apartment on my shoe, and lived on the floor of my car for one very odiferous week. *slaps herself on the forehead*

N offered to nickname me the perfumed engine weasel, but I suggested that it sounds a bit kinky without the backstory.

;)

Ice Princess

Good mother, it's freezing here. My weather.com page tells me it feels like -18 degrees F. I am shivering away in my computer room right now, drooling over lovely wool yarns that I ought not buy, but I want to. I want a stash. N would argue that I already DO have a stash, but it only takes up one little square area in a bookshelf. So not a stash.

If I had a stash, I think I would snuggle up under all the balls of lovely warm wooly yarn goodness tonight, and not come out. That's just how damn cold it is. It is certainly too cold to go traipsing out to see my friend's band tonight, what with the dearth of downtown parking, and the smoky bar, and the cold, cold me. Sorry guys, I'll catch ya next time.

We do have to go out to the Superbowl party tomorrow, not because I'm terribly enamored of the Superbowl, but party because our friends throw this party every year, and next year we'll be in Ohio, and therefore not able to attend, but mostly because I am making an AWESOME black bean dip. It's called a black bean dip, but really it's mounds of melted cheesy goodness with some jalapenos and black beans thrown in for good measure. It's from our favorite hole-in-the-wall restaurant. I shall post it later, after I dig it out. Yum.

I was on call last night, for the first time in the last month that I will ever do general medicine wards. It struck me how much more comfortable I feel doing this now than at the beginning of the year. I think I've learned more in the six months of my intern year than in my last two years of med school, at least as far as amount learned per period of time goes. I can figure out what's wrong with a patient, I uaually have a reasonable idea of how to fix it, and if I don't I know who to call to get a specialty opinion. This does not mean that I have learned all that there is to learn about the art of internal medicine, of course not. But I've become a much better diagnostician and know how to handle patients in the inpatient setting. I suppose that's what this transitional year was all about. Ok, great, so can I be done now? I'm totally ready to move on to RadOnc and start treating cancers, my true interest and career. I'm over pneumonias and diabetes, I tell you.