Spinning baby

it turns out i'm not the only Reza who LOVES spinning. REza's representin everywhere baby

It's Residency Interview Time people!

Wow, it's almost been a year since my last post. well i stopped posting at the end of resident and surgery was too painful on a daily basis due to some crazy resident abuse. but here i am back in gear though no one is probably still following my blog anymore, it's okay though because i still love it.
so my love affair with internal medicine and peds is over. and i absolutely don't like anything cardiology any more. it's all about cardiac surgery now and i'm about to embark on Monday on a three week frenzied tour of the east coast for interviews. here's a little sample:
baltimore, then to pittsburgh, then to massachussetts, then back to pittsburgh (i know, crazy ain't it) then to new york and then back to massachussetts and then back home. wow i got tired just thinking about that.

checking in

it's been a while since i've updated my page, some new stories:
well i've come to know the crazies in my neighborhood pretty well:
1) gym OCD dude: there's this strange looking freak who practically lives at the locker room in my gym. He's there all day and constantly goes back n forth between the gym and the lockers staying there for like three hours. Then one day i noticed he hoarded all sorts of crazy shit like newspapers into his locker and that it would take him an hour to leave because he would clear out the locker and and allt he lockers adjacent to it about a hundred times before he would leave. classic OCD. poor fella, i almost wanted to be go up to him and tell him to get some help.

2)tatoo head: every day at the coffee shop next to my home there 's this fella whose completely bald-headed and he has this crazy ass floral arrangement tatooed on his head in lieu of hair. who does that shit?

3) Did i mention my patients are all crazy too? i'm not kidding.

On medicine

well, internal medicine, the most important rotation, started today. what a mess. i show up in la jolla in the morning. then drive to hillcrest twenty miles away for hospice only to find out i'm actually supposed to be in la jolla for cardiology so i go to la jolla but by the time i get there there are no more pateints and i shadow a doc for an hour and leave and go back to hillcrest for clinic where i saw a whooping single patient who had asthma, and then also turned out to have a wierd rash, and oh yeah, some pre-diabetes, plus hypertension, and then of course like always, some psych history. a simple asthma visited took FOREVER, by the end i was just exhausted because damn, get your ass in shape, get a job, and take care of your body people! anyways, after clinic i again returned to la jolla for lectures, which is where i am as i write this, and in ten minutes i go back to hillcrest to go home meaning i drove over two hours today! yay!

vegas

so my family again participated in the persian invasion of vegas during christmas season because well, that's just how we do. the new fall Diesel jeans line up I must say is quite impressive.

the rash

well, that mean dermatologist should be thanking me now. it turned out my kid had an extremely rare fatal fungal infection. in fact, it's so rare, they're still not absolutely sure which species of fungus it was and every old skool wrinkled up dermatologist came to look at this 2x3 rash because they'd never seen it before and they'd probably never see it again. there's like a handful of these cases reported in immunocompetent patients and my little kiddo got it and if that dermatologist is motivated enough, he could even write it up and get published.

Consults

They say that board scores are inversely related to social skills, this has actually been proven in several studies. Dermatologists have among the highest board scores because it's a high paying lifestyle specialty and well, many dermatologists just are plain assholes. point being:
today:
attending: Let's get a consult on this rash, I'm not comfortable with it
my chief: Reza, we want you to learn to be an intern, you're gonna practice and get comfortable doing consults, checking labs, all that
me: great, i'm on it.

later on that day... calling the derm consult.

-Hi, I'm Reza from the peds team, I'm calling to ask for a consult.
- Who are you? he replies
-I'm the med student on the peds team
-Why are they having a med student call me? he replies angrily. sounding insulted.
-Well, the intern on the case is sitting next to me, I'm just helping out
-Give the phone to the doctor.

great... never mind I know the patient inside out and I know what's going on. I wanted to say:
listen man, I'm a good student and I know what's going on here and you need to get over yourself and just hear me give you a one minute consult it's not that big a deal, this is a teaching hospital after all and further more, your ass should be thanking me, how often do we even get a derm consult? no one dies from skin diseases, well very rarely do they, and even then we usually get a infectious disease consult because you guys are too wimpy to even handle mrsa most of the time so if anything i'm kinda doing you a favor here and get over your damn self, i mean are you so important in derm land that you can't talk to a student when the bad ass cardiologist can? it's not like you're so stressed out running around not saving lives and popping pimples and prescribing hydrocortisone that you can't at least be polite about it.

but i didn't say that, i just gave the phone to the intern and got ticked off deep down inside and here i'm venting
c'est la vie
the kids gave me some obnoxious cold that everyone in med school seems to be getting.
only 25 days till winter break!

i did it

so last night i went out with a black girl. i tried that once in paris but this man never lets one experience spoil him. i liked her too but i didn't pick up a chemistry between us. we went to a concert, and afterwards i treated her to some hooka during which she started pulling the "i don't date" line on me, when i turned it around on her "do you feel like you're not worth anyone dating?" kind of thing. i think this quickly triggered some defensive reflex in her and next thing i know, we're talking about all her problems and insecurities. by the end of the night, i knew that a second date was well within my grasp. we had mentioned doing something on saturday but i was kind of turned off by her attitude so after we went home, she said "call me if you want to hang out next saturday" and i thought to myself, "not so much" but instead nodded and dubiously replied "ok," but anyways, my point is, she had a ghetto booty and let me tell you, the ghetto booty is way too over idealized. it ain't all that.

Just a wonderful day

I'm on neurology right now which means hours upon hours of "where is the lesion?" my professors are kind of unrelenting.
Pt has a foot drop, where is the lesion?
The common peroneal nerve, it's very vulnerable i repeat
ok... he says, where else could it be?
great.... never mind that we hardly ever ever see it anywhere else, but i take a stab
well, the spinal root
which?
s2-s3 i say
"l1 and l2" a kind intern whispers to me, so i correct myself,
which nerve?
sciatic, oh oh , he 's not nodding, femoral i quickly correct myself,
and on and on and on trying to guess where the fucking lesion is, i'm just ready to lose my mind. a human being can only tolerate so much neuroanatomy in one day. hell, in most med schools, this isn't even a required clerkship.

so my first chief told me i sucked, never mind that she threw me in there with five patients the first week plusp presenting all new patients, making it impossible for me to do well. thank God she left. the next one came in, he was more reasonable, thought i did a great job, circled honors on my eval, and just signed. you could say i was lucky there was a shift in power but that is the nature of this random thing called third year of med school

neurologists are dorks, and i mean that sincerely.even the cool ones. well, a couple of them were cool but if er docs are cowboys and pediatricians are sensitive and family med people are boring, then neurologists are just the class computer dorks, you know, the type that is currently at a coffeeshop near you playing the wonderful world of warcraft or whatever that lame game is called.
thank God i got outpatient assigned to a pediatric neuro unit where the kids keep me busy and the pediatricians have a bit more personality and aren't so concerned about the lesion. "the MRI is the lesion!" as one of my new attendings told me today, now that's an answer i like, a lot, oh, and he has long hair, need i say more?

it looks like my people took the House by storm and most likely the Senate too. that's another thing to be happy about

weird ass parents

so today this four monther comes in for vaccines and as part of his physical exam i have to check his package, you know, make sure the inguinal nodes are there and that his nutsack isn't empty. the sucker kept crying until i noticed him stop and smile and suddenly... tada, urine all over my shirt. little *(E*$&#)#!! so i walked around all day smelling of baby urine

but it gets better
later on in the day, another mom thought that the sight of her 6monther's penis might traumatize me and covered it up with her hand to protect his privacy or maybe her innocence or maybe my innocence, i don't know but i was like "ma'am i just need to make sure he has good peripheral pusles and there isn 't a problem with his descending aorta." i mean, come on people. the kids three days old. you'd think a grown woman with a baby would be more mature.

on a more serious note, i have seen many sad things.
there's this obscure disease called leisch nyhan syndrome where kids have HGPRT deficiency leading to abnormal purine metabolism (do you see why it's "obscure" and easy to forget). the kids end up mutilating themselves and being really wierd with cherry red maculas etc. every med student memorizes and forgets about the good ol leisch nyhan right away at least three times in the course of their career. well, no I, for i got to work with THE Dr. Nyhan who immediately pimped me about an obscure metabolic diseae and by sheer luck i remembered that beta glucorerbrosidase deficiency led to nieman-pick disorder. anyways, he was slightly impressed and i was on his good side. i saw SO MANY weird kids. Hurler's syndrome, PKU, Neimann Pick, etc.... the kids were still cute but man, they looked really different and sick with a million problems. sad yet encouraging that someone was taking care of these vulnerable precious kids. the end of the day, the famous doctor even let me dictate, which was awesome except i ended up calling the dictation people and freezing, not sure exactly what to say, so i just winged it. i hope he likes it. all said and done though, i htink i'm going back into a surgery phase again.

Peds

man, peds is fun. these little rugrats are like a barrel of monkeys. half the kids: absolutely innocent and cute as hell, you wish you could play pikaboo all day. sometimes i get so caught up playing and making funny noises with them that I forget I'm there to do a medical exam. But then there's the other half that are, well, cranky as hell. serious: they start crying their heart out over absolutely nothing and then all this snot runs out of their mouth and they freakin piss all over your white coat as you go to make sure their damn testicles have descended appropriately. the best is when they're twins and you do two exams at once. once, one twin was the embodiment of peace and the other was just straight up meaner than dick cheney and who would want to deal with dick cheney? anyways, i'm pretty good with the kids. next week is newborn nursery and that's really gonna be fun. those little kidos don't even really look human. it's like their bodies just took a crash course through evolution, from scales and fishlungs to what they are now and their faces are still settling in, especially because they just got all squished up coming out of the birth canal and uterus and sometimes they have huge distorted heads because of the suction vacuum gizmo we have to use. don't worry, their heads return to a normal oval in like 4-6 weeks. oh, and their cry, man, it is very different, it's not like crying as much as it is just simply screaming with these small airways and vocal cords that sound like those keys all the way on the left side of the piano except the noise doesn't end, the arghh..... just goes on and on and on and on until you get them to suck on your pinky, which they just absolutely love, and that might get them to quiet for like five minutes at which point you better have finished your exam and can let the nurses deal with them.

Crazy Times

Wow, psych is already over.... that was probably the best six weeks of med school yet.
Not a single resident abused me, seriously, it was great.
Psych was crazy, but that was kind of the point, you know? For hipaa reasons i can't be specific about things but let's just say psychotic people are mean at times, and they can be real nasty when they're all upset and literally out of their mind.

The interviews were the best at the psych ward. they go something like this:
"hey there, mr. x, so how are you doing today."
"blah blah blah, a bunch of crazy nonsensical things come out of their mouth, or even better, they'll tell me delusional things concerning aliens or monsters or something.
and there goes my interview; progress report today says: "patient still delusional, we'll continue antipsychotic treatment."
and like that, I could finish a note in fifteen minutes sometimes.

My friend kayvon once told me he didn't buy the idea of personality disorders, i mean, if they existed we'd all have one. let me tell you my friends, personality disorders do exist (just walk down the OB/Gyn or surgery floor at any hospital, a lot of cluster B).
I saw SO MANY Borderline personality disorders, and let me tell you, these people are so hard to treat because well, they're just a mess. seriously, they always want to kill themselves or they're happy beyond belief the next minute. You have to keep playing psychological games with them as if they're your three year old brother. But it's still feels good when you can go home at the end of the day and say "I convinced him not to kill himself." and there you have it.
pediatrics is next, man, those kids are gonna be a barrel of monkeys.

long due update

it's been a while since i've updated th is bad boy and i really should be asleep now but i'm being stupid and not and tomorrow's a big day for sure so i'm not sure exactly what i'm doing here.
anyways
psych is well.... crazy, to say the least
but don't get me wrong, i love me the crazies
they're so fun
they get up and do ridiculous things, say ridiculous things and sometimes even piss you off but then you realiize they're just sick and don't know better and in that regard it's kinda like peds but sadder
i can't give details because of hipaa rules but i can give general info that not specific.

psych is sad because these diseases are debilitating and in many ways, the patient's moral being is taken over by the illness and in a way they're pseudo not alive, i can't say dead, because somtimes they've lost too many brain cells to be their normal cell ever again. i've seen drugs fuck up so many people's lives here, turning them into or at least bringing out their normally silent schizophrenia or mania. debilitating illnesses. these poor folks are locked up for their own good and they don't have enough insight to know why.
after we diagnosed the first schizophrenic patient i was assigned to, i went home sad all day and on the verge of tears because in many ways, that kids lives' dreams and hopes are now forever altered. but hey, three weeks later, he got better and went home semi-normal. my attending said we gave him his life back. and i guess that's true but i wonder how long it'll be before the illness gets a hold of him again, i hope never, but the statistics are not on my side. see the problem? it's more like cancer, not like an i nfection. it hardly ever simply goes away.

but i feel like woorking in psych, i'm doing something good and that's what matters the most.
finally, on a happy note: what's the difference between a p sychiatrist and his patients? When the patients leave, they're usually better. budum ching!

In the Navy

My 6week blitz at the naval hospital is over. i must admit, i was treated and taught well there. man, i feel like i've learned SO MUCH ob/gyn. so many triage patients, pap smears, colpos, deliveries, csections. i've amassed so much medical information.
here are some quirks about the naval hospital:
1. cheap ass food at the "galley". i'm talking 30cent scrambeled eggs, dollar sandwiches 15cents a soda, and it's all decent stuff too.
2. the naval language: people are ensigns, not nurses, attendings are commanders, the nurse of the month is Sailor of the Month, you get my drift, oh and labor and delivery deck supervisor is "deck dog"
3. stupid rules: if you talk on your cell while driving in the parking lot, a secuirty guard will harass you. you can't walk the hallways with scrubs without your white coat on. to get a parking permit you need a notarized letter from your parents saying you're allowed to drive their car if it's regisered under their name.
4. the interns are sometimes not so motivated. a favorite quote:
"yeah, i don't really know why i went into medicine, i regret it sometimes."
"what don't you like about it?" i ask
"talking to patients, taking histories, doing physical exams, rounding, yeah, i just hate it all. i think i'm going to be radiologist."
ain't that great
5. the abbreviations are extereme in ob/gyn. an entire note of just abbreviations get you through this. words like TAHBSO are commonly used
6.favorite moment during ultrasound rounds:
would you like to know the sex of the child?
yes
ok, let's see if the med student can do it
I see this between the femurs, so it's a boy
Yes...!says the dad
actually, no, it's a girl... sorry, reza, that's the umbilical cord there, not the penis or scrotum,
sorry.

the stories go on and on and on people but something tells me that psych will be even twice as in teresting.

OB/Gyn

So I'm getting this whole third year thing down and the rotation has picked up. lots of labor triage, ultrasounds, cervical exams, assisting with baby deliveries and c-sections. thank God, hysterectomies were boring procedures to observe. i was assisting with the delivery when the boy popped out and I caught him. the doctor's like, "put the other hand under him and gently stimulate the baby". oh stimulate I did, for as soon as i slightly jiggled my fingers under him a little bit, this 2-minute old was so tittilated that he started urinating all over me. "baby is voiding" yelled the resident to the nurse. yay....! not so much. oh, and i can't' seem to get the stench of amniotic fluid off so i keep changing scrubs but i swear i'm still smelling it when i get home. man, my new air balance shoes have had several close run ins with discharge today. best part is, i no longer have to deal with the mean residents i had on the other service mainly because obstetricians tend to be nice people, i mean, after all, theyr'e constantly delivering bundles of joy. one last epiphany. it's sad seeing the disparity between families here. one room might have a teenager whos confused adolescent boyfriend couldn't be less interested in the newborn or what's going on while the other has the most loving family with the dad doing lamase breathings and kissing the mom the whole time comforting her and sometimes you go from one situation to the other in 10 minutes.

I passed

I walked out of the boards not knowing what had happened or if i passed. well, i passed, in fact, i didn't do bad at all, actually, i got JUST what i was aiming for.

Third year is gonna be long

well, i'm on the wards doing OB/Gyn meaning i'm constantly abused by power hungry residents. yesterday was the greatest example. I'm watching a teratoma get removed in surgery. you guys should have seen this thing, it was so nasty. the tumor had fat, teeth, collagen, and hair. oh man, i can't eat thai food for at least another month.
i digress
anyways, after the surgery, the chief grabs me and takes me to a room to talk to me. apparently my behavior in the OR was not appropriate and I need to adjust better to OR subculture. Now, i'm really curious what i could have possibly done to deserve this, so here it is:

1- don't ask questions during surgery, wait afterwards
2- don't ask or talk about the tumor with the patient in the room, because even though they look like they may be asleep they may not yet be unconscious (um... there was masking tape on her eyes, sorry for the assumption).
4 - don't finish scrubbing up before the resident and don't expect to be scrubbed in or draped before the resident and attending (sorry, i was excited to actually scrub in and didn't see them waiting for the nurse and besides, was it really THAT insulting?)
5- don't ask if someone can show you how to suture, you're supposed to practice that on a slab of meat on your own (i'm sorry, i thought the whole point of this was for doctors to like show me basic procedures.)
6- don't point out that the tumor has a blood supply, the resident can obviously see that and saying that would only make them more nervous (Sorry, i got excited to see my first tumor and it's not like i meant to psych out the resident on purpose)

and really, that was it, all I had done wrong was well.... nothing except maybe trying to learn and being enthusiastic, but i guess it rubbed them the wrong way. and with this little conversation, I realized that this gyn service might not be so interesting after all, it looks like they're just trying to find reasons to be critical instead of teaching me anything. monday, i sat in a room all day for eight hours and there was only one patient the whole day. and let's not forget the best part: the 8 am lecture where all the interns and med students fall asleep because the presenters are talking about esoteric stuff we don't understand anyways.

The Hasselhoff Makes a Comeback

when will he stop making these ridiculous videos?
If you thought "Hooked on a Feeling" was bad, get a load of this.

Med Student Syndrome

I've been pretty good about not developing med student syndrome -- except for that brief 5 seconds when I thought I had Lymphoma back in Fall but then decided it was probably Ebstein Barr Virus but then after the negative mono test figured it was probably CMV or adenovirus -- anyways, all was good til reading BRS pathology like crazy this week. First I thougth maybe I had xanthomas -- surely these little bumps near my eyes were xanthomas, but then i thought, maybe it's molluscum contagiosum, but then that didn't pan out right either, maybe i just have wierd eyes. oh and last night, while i was having,um, REM sleep, I had a nightmare about having cirrhosis. Then I woke up and after five minutes realized, no, there are no caput medusae on my belly, it was only a nightmare.... when will this end?

End of a Diddy Reese Era

How could they raise the price of the ice cream sandwich from $1 to $1.25. is this the first sign of bigger economic troubles to come?
http://www.latimes.com/news/local/la-me-icecream17jun17,0,2668612.story?coll=la-home-headlines