The Price IS Right!!!

Okay, this is my first attempt at a post, and it's an exciting one....
-Ashley

My college roommate Michelle and I left San Diego today at 5:15am to head to the CBS studio in LA for the taping of The Price is Right! Michelle was heading to Anaheim for an Uppercase Living convention, and some of the ladies got group tickets for TPIR, so we jumped at the opportunity. After LOTS and LOTS of waiting in line (5 hours!), we finally made it to the front of the line to be interviewed by the show's producer. For those of you who have not had the privilege of attending a taping, this is how they choose the contestants for the day's gameshow. Michelle must have impressed the producer with her good looks, quick wit, and charm... they really seemed to love her!

Around noon, we finally got shuffled over to the waiting area for the studio. [Let me warn you, if you ever go to TPIR (which I highly recommend -- it was a lot of fun!), be sure to bring snacks! You are there for a very long time, and there is really no time to leave to get anything to eat. Needless to say, we were starving by around 10am without any options for food.] So, after relinquishing all electronics outside (I hoped to see my iPhone again), we made our way into the studio. A-maze-ing! It was incredible to walk into the studio and see the set of the TV show I had watched all these years. The studio is actually much smaller than you might expect -- not a bad seat in the house. It was very exciting!

After we got to our seats, we were given a brief overview of how the taping was going to work. Before we knew it, the bright lights came on, the "Applause" lights illuminated, and they started the show introductions with Drew Carey (Bob Barker's replacement). Wow - everything happened so quickly! The first step was to select the first four contestants. One by one, Rich Fields (he's the "Come on down" guy) read off their names, the assistants held up signs with the names (since we really couldn't hear much in the audience over all the clapping), and the contestants chosen ran down to their places.

Michelle was called as the second contestant!!! We were super excited, we stood up and cheered, and she ran down to the front of the studio. They filled the rest of the places, and then the show really started. During the bidding stage, Michelle kindly decided to let her competition take on the first two prizes (she was waiting for the really good stuff). I'm sure she didn't want the surfboard and snowboard package, or the set of crystal stemware. It was definitely time to act, however, when the chaise lounge shaped like a shoe was up for bid. She outbid all the other contestants (retail value was $1500!) and ran up on stage to play Bonus Game with Drew. Michelle did really well! She won 3 of the 4 smaller prizes (TPIR video game, toothbrush sanitizer -- everyone needs one!, and waterproof iPod speakers), and then won the bonus prize! You will have to watch The Price is Right on October 27th to see what bonus prize Michelle won (we're sworn to secrecy). Let's just say it starts with dune, ends with buggy, and might look something like this. I'm not sure where she's going to use that thing in Seattle, but it sure makes for a cool story! The only bad part - all winners have to pay taxes on their winnings. Michelle almost made it to the Showcase Showdown - she spun $1.05 (so close!) on the big wheel. The winner (a nursing student from Tennessee) ended up winning a Lexus SUV among other things.

It was an exhausting day, but it was so much fun to cheer for Michelle and just be there to experience the show. I would love to go back - it really pays to go in a group (then you're pretty much guaranteed a spot) - so let me know if you're interested! It ended up being about a 12 hour trip for a one-hour show, but well worth it -- except for the ants in the rootbeer on the way home. Gross. Other than that, it was super fun!

Be sure to watch The Price is Right on CBS on October 27!

1/13th Through

Today is the last day of our first rotation (we switch rotations every month). Since the rotations are 4 weeks each (not actually 1 calendar month), there are 13 rotations total for the year. It so happens that I have the luck of being the last person on call for the block. Presently I am at the hospital in my call room. It has been an uncharacteristically slow day so far (keeping my fingers crossed that it holds out), so I thought it was about time that I start a new blog entry. I'll try and summarize the last few weeks as best as I can.

By way of update to my last blog, the guy who we diagnosed with a brain tumor ended up getting surgery and is doing quite well. He went to the ICU after surgery (standard for neurosurgery), but I was able to go visit him pretty much everyday even though I wasn't responsible for taking care of him while he was in "the Unit." We've developed a really good relationship through all of this. On Thursday, he came out of the ICU and back to the regular medical floor, so I'm taking care of him again. He was really weak right before he had his surgery, but he's recovering a lot now and I'm really happy to see him progress so much. He has definitely been the most interesting, and my favorite, patient so far (... don't tell my other patients, though).

In retrospect, this first month has gone by pretty quickly. I'm sure this year will be long gone before I know it. It hasn't been until recently that I've truly felt like I have completely eased into everything, though. The first week or so was pretty rough - I found myself trying to fight back the nearly constant thoughts that maybe I had chosen the wrong career. Stepping into the role of intern, there is a very steep learning curve just with respect to medical knowledge, let alone the fact that being at a new hospital requires that you relearn a bunch of basic stuff on top of that: how to use a new electronic medical record system, who to talk to for discharge planning resources, where records are kept in the ER when admitting patients to the hospital, what the proper procedure is for entering orders for your patients - the list really could go on and on. It was nearly overwhelming.

I think that it wasn't until I had a conversation with my good friend from medical school, Tim, who's also at the beginning of his internship in Ear, Nose, and Throat surgery out in North Carolina (at Wake Forest, where I'll be next year), that I really started to feel better about things. Tim started his internship in the surgical ICU - even more intense than what I'm doing. About a week after we each had started, we caught up with one another and had a short conversation - I think we were both a little surprised to learn that the other had been going through the same sorts of feelings and thoughts. After commiserating a bit, we each left the conversation feeling a little better. I'm sure it is a common experience among interns to go through those feelings of inadequacy and self-doubt. Having friends to go through it with can be quite therapeutic though.

Tomorrow all of the interns will be switching roles since we're starting a new block. Since I'm on call all night tonight through tomorrow, I'm bridging the two blocks - I'm actually the one intern doing two months straight of inpatient medicine from the beginning. Even though it would be nice to have a little break after this somewhat busy month, I'm glad that I can knock out two of my busier months at the very start. And since the interns that are taking over tomorrow have all been doing something else this first month, it will feel nice to be the "experienced" one for a little bit.

* * * * * * * * * * * * * * * *

Ok, my call night is over now. I just thought I'd add one thing to this blog before posting. While I was on call, I was awoken by a phone call from one of the nurses at about 5:30 AM; the conversation went something like this:

Me: "Hi this is Dr. Tower."

Nurse: "Hi, Dr. Tower this is ____ up on the 6th floor. Could you please come up here and pronounce patient so-and-so dead?"

Me: (Long pause) "Ummm ... ok."

Now, this was not an unexpected death - it was a patient who had been really sick and who's family had decided it was his time to go. Regardless of the situation, though, unless you work around death a lot, I think it can still catch you off guard. This patient belonged to one of the other interns, so I was just covering that night - however it was my responsibility to go and perform the death examination. There is a somewhat standard set of things you are supposed to do to determine that a patient is actually dead, and these things comprise the death examination. This was my first experience as a physician performing the examination and declaring, "Time of death - 5:45." I guess officially you haven't really died in a hospital until a doctor declares that you have died. In any event, it was another one of the 'firsts' that I have now gone through since starting internship. I've checked off a lot of those boxes now. I wouldn't be too disappointed if it were also my last.

Mixed Emotions

I find myself already a couple of weeks into my internship now. I meant to devote a special blog to my first night being on call at the hospital, which by the way was pretty crazy and involved me working a 32 hour shift on zero sleep, but that opportunity has passed. In fact, I just finished my second night of being on call with a 30 hour shift. This time was significantly better than the first, though still very busy.

Even more interesting than my experience of being on call, however, is one of the patients I've been taking care of recently. Without revealing personal or identifying information about him, I'll try and give the gist of his story. He is a pretty young guy, somewhere around my age, who has been having progressively more and more problems swallowing for the past several weeks to months. It turns out he has also been feeling sick a lot for the past several months to a year. The swallowing problems have become so bad that he hasn't hardly been able to eat anything for a while and has lost a lot of weight. He had no idea what was going on, and neither did we at first. The more we talked to him, though, the more it sounded to me like it was a neurologic problem that was affecting his swallowing. I wanted to see an MRI of his brain and we ended up ordering one. After a lot of other tests that weren't showing why he was having the problems, the MRI showed that he has a tumor in his brain.

I will say that making that kind of a diagnosis comes with a lot of very mixed feelings - as the guy's doctor, you are happy to finally figure out what the actual problem is, but then you realize that the answer isn't such a great one for the patient. The disappointment in the realization that you have to tell someone that they have a brain tumor quickly overcomes any excitement that comes with solving the case.

This was my first real experience in being the person responsible for relaying some very bad news to my patient. Fortunately I felt I had developed a pretty good rapport with him, which made delivering the news a little easier (and a little harder). Of course, he was completely stunned and in disbelief. Overall, though, I think he handled it very well - a lot better than I'm sure I would have.

The neurosurgeon came to see the patient and is planning an operation soon. We are all hoping for the best. I especially like this guy and feel that in an interesting way we've bonded even more through the experience. I'm trying to stay optimistic - and in the meantime he and his family will be in my prayers.