Sunday, September 16, 2012



     Every person in the medical field knows the sound. It is the dreaded pager. More importantly, nearly every person in the medical field shudders when they hear it. Usually, it means that some menial paperwork needs to be completed. Or that Mrs. Smith, the 45 year old woman who just had a ruptured appendix removed the day before wants to know if she can get up and walk around. *Yes, for the love of all that is Holy, yes! Please walk around and jump start your bowels again. You need to eat so we can send you home. We want to send you home as bad as you want to go home. Rarely is the extended hospital stay a good one for a patient. There are just too many complications that arise from merely being in the building.* But on the trauma service, that sound can mean something entirely different. As a medical student on the trauma service, one finds themselves to be an accessory when it comes to traumas. Thank goodness.

     At our institution, the chief resident runs the traumas as they arrive in the trauma bay. The attending physician is typically just outside or watching from the door, depending on the chief resident and the attending. The midlevel tends to find themselves at the head of the bed to manage airways, and the the interns fill in as needed. One intern usually starts documenting the encounter so that the history and physical exam can be documented and the rest of the team can focus on evaluation and stabilization of the patient. And the students find themselves cutting off clothes, putting in foley catheters, and  just fill-in as we are told. Don't get me wrong, we are given that much responsibility and I think are generally thankful for it but sometimes you realize you are doing the job nobody else wants to do.

     Back on track, one rainy morning in the last several weeks, as the trauma team was gathering for rounds, the familiar beep sounded. In unison, almost as though we were all tethered together, we reached for our pagers. Ped vs. MVC, 28 y/o male, LLE injury, L shoulder disloc, L elbow lac, VSS. ETA 17 mins. All of that tells us approximately what will be coming through the door. In this case, it was a 28 year old male with an injury to his left leg, a dislocated left shoulder, a laceration on his left elbow, and his vital signs (heart rate, blood pressure, respiratory rate, temperature, and his oxygen saturation) were all stable. When the patient arrived, the paramedics who flew him in told his story. He was running and was hit by a car. A moment of pause ensued in my brain. I thought "This guy was hit by a car! How is he doing this well? He should be in much worse shape!" Not that I was wishing that on him, but I expected him to have been looking much rougher after being on the receiving end of a Buick doing 40 mph. And thankfully, he was not. As the paramedic told more of his story, he mentioned that in the helicopter, he was given some ketamine. A collective "What the hell?" was given by the chief resident and mid-level resident. Ketamine, or Special K as it is sometimes known, has a nasty habit of producing visual and  auditory hallucinations. And just generally giving patients a touch of the cray-cray. I don't mean to make light of psychiatric illness, but ketamine can make a person whose mental function is perfect just lose their minds. And lose his mind this guy did. He was screaming nonsense. He was asking why he was so fucked. He wanted to know if he would lose his leg. He wanted to know why we had taken his leg. The funniest part was while he was being evaluated by the mid-level resident, an attractive young female, sticks his tongue out. And in sticking his tongue out, he starts flicking his tongue up and down. Repeatedly. Yep, this guy was laying on the stretcher, broken leg and dislocated shoulder still very much present, mimicking oral sex. And after 25 or 30 seconds, he screams at the top of his lungs "DO YOU LIKE THAT?" Oh yeah, that happened. And in the middle of a very tense time, like say evaluation a patient for a traumatic injury, it can really cut through the tension. And it did. We were to the point that we were pretty sure that he was going to be okay. And this just put the icing on the cake.

     When we went back to rounds, after having made sure this guy was okay, the attending asked what we'd learned. Several answers popped up. Someone said they had put in their first foley. Another said that they learned something about the FAST exam. I said I learned two things. One, don't give ketamine if you don't want the PACU nurses to hate you, and two, remember to have a chat with your air medics and find out what makes them happy. And do it.


Gotta run!

- The Anesthetized Student

Saturday, September 15, 2012

Why TAS is a bad person...

So if I was really going to list the reasons that I am a bad person, I'd spend all night writing this post. And tomorrow. And the better part of Monday. And then I'd have a short nap and get back to listing the reasons that I'm a bad person. Suffice it to say that if there is a crass thought, "dirty" joke, or generally a comment you'd expect to be made by an ass, you can bet that I have done or am about to do one of those things. Enough jokes, now on to the story. I need to get this out and I hope you are willing to listen (read?) to my story. I apologize in advance, but I've left a lot of details out to maintain anonymity and to help keep this close to SFW. If you are concerned, treat this post as NSFW. I appreciate your time.

     But this post is going to have a darker, more ominous tone. I wanted to follow up on my initial post and talk about my struggle with vaginismus. But you might ask, "TAS, how do you struggle with vaginismus? What with the lack of a vagina and whatnot." Well dear friends, I struggle with it because SAHA (TAS's beautiful wife, ;) ) is battling vaginismus. Truth be told, my portion of the struggle stems from my inability to talk about the things that are bothering me. I started bottling up my emotions quite some time ago. I thought I had beaten that, but somewhere along the way I slipped back into my "old" ways. Before I started medical school (that seems like an eternity ago!) SAHA and I were trying to start a family. We found out where I was going to school, bought a house, and eight days after closing on the house, we moved all of our crap in and she told me that she was pregnant. I was ELATED! Everything was moving in our direction. It felt like we sat down to play a game of cards with Life and we were holding all aces. And 7 weeks into that feeling, we went for a follow-up dating ultrasound. And we found out that our baby, whom we had already named and for whom we'd started laying out the future, did not have a heart beat. And we found out in the shittiest way possible. The ultrasound technologist, before confirming the imaging with a physician, awkwardly half-smiled and said "Your baby doesn't have a heartbeat." She didn't seem bothered by the news she had to deliver. More than anything she seemed disturbed by delivering the news. And who wouldn't be bothered by that. But she shouldn't have done it at all. Sorry, I digress. After that loss, SAHA wanted to get right back into the business of making a baby, thinking that the pain of one lost pregnancy could be eased by a successful one. I was reluctant, but I can't say that I had a better answer. So we started to try again. And again. And again. And well, you get the idea. We tried, unsuccessfully for quite some time. We crossed the 6 month sans baby mark. For those of you in the field, you'll know that infertility is defined by 1 year without a successful pregnancy, however some practioners don't like to wait a full year because the biological clock, she be a tickin'. SAHA was finally referred to a reproductive endocrinologist and many invasive tests were performed. She had several appointments with her primary obstetrician and the RE. And many pelvic exams. And she continued to feel like a failure because she couldn't get pregnant. Worse yet, she would go on to get 3 consecutive cycles with a positive at-home pregnancy test only to have her period start the next day. She was crushed. Repeatedly.

     All the meanwhile, she wanted a baby. We were fine. I was busy with school, she was working and focused on making a baby, but our relationship was good. Probably even better. Okay, maybe it wasn't as good as I thought at the time. But during this time, our intimacy had dropped off. In an effort to increase the likelihood of pregnancy, SAHA was taking basal temps and using ovulation prediction tests. The only way more sticks could have been peed upon in our house would have been to let the nearest humane society loose in a lumber yard. She also refused to have sex 2-3 days before she expected to ovulate and asked me (politely, but firmly) to abstain from taking care of the problem myself during that time. And it seems, as the months dragged on, that instead of not having sex a few days before ovulation we were only able to make love around the time of ovulation. And it felt forced and robotic. I know, I know. I'm a guy, what do I care how sex feels so long as it feels like it is happening. Well, I'm hear to tell you that it wasn't great. In retrospect, I felt sort of used. And the sex was very mechanical. Like there was a clear objective that didn't involve love, pleasure, or intimacy. The point was to make a baby. And it hurt. I am complicit in that, however, because I allowed it to go on. For months. And just after another ovulation spike, I expected SAHA to tearily tell me that, once again, she had her period. But, as I lie face down on my pillow at 0830 in the morning, she came back to our bedroom and told me to snuggle her and "Carlos." Because we had named our first baby that was subsequently lost, we felt like we couldn't use the names we had selected. And that sucked because they were great names for our child. At that time, we agreed that our next baby would be "Carlos" until arrival. And yes, our inspiration was Carlos of The Hangover. And life was grand. Except that she was worried that we would literally "shake the baby loose." And yes, she knows how crazy that sounds. And so sex was out. And then she was nauseated. And sex was out. And then sex was possible. Her nausea had subsided and she felt (and looked) GREAT! Side note, there are few things that can make a beautiful woman more beautiful than knowing she is carrying your child. Or maybe that was just my experience. And so we tried. And then we stopped. She was in pain. I would imagine that the increase in blood flow to the region combined with her constant worry made for a less than pleasurable few moments and seeing the pain in her face she was trying to hide, I stopped "the act" and sulked off. And after a few more attempts, we realized that the pain was too much. So we halted attempts until post baby. We tried a few other things to stay intimate, but they weren't cutting the mustard. The frequency of these other acts (some sexual in nature, some not) would wane and I would get mad and after a few weeks of sulking I would get mad, shut-down to the point of not talking, argue with SAHA, tell her I was unhappy and things would get better. And then back to nothing. And then, the littlest Pizzle arrived. And things were great.

     We were both so wrapped up in being parents that all of our problems fell to the wayside. Along with sleep. You know, sleep? I seem to remember doing it once, but it has been nearly a year since Sleep, SAHA, and I all had an uninterrupted visit. But that baby is damn cute and worth every second of it. Again, I digress. 10 weeks after our little one showed up, we decided to try sex again. SAHA seemed apprehensive, but she could see how withdrawn I was becoming. So we tried. A few short moments into "the act" and SAHA looked like she could cry. She would later describe the pain as burning and searing. From my point of view, that couldn't be a better descriptor. Despite her encouraging me to continue (I think she hoped it would get better in a few moments), I couldn't do it. She was trying to make it better and the only thing I could do was stop, roll over on to my side of the bed and withdraw emotionally.

     And withdrawn I was. A whole bunch of thoughts would race through my head. None of them pleasant. None of them I am particularly comfortable with. Mostly, I wondered if I was even still attractive to my wife. She would say it, but after enough months without physical reinforcement, I began to wonder. And I discovered that "taking care" of the problem myself had its limitations. Mostly, I was ashamed that as a married man, I was left to masturbate in the shower. Like a teenager hiding his burgeoning development, I was hiding in shame while I satisfied my sex drive. And I hated it. I became resentful. I started to withdraw from SAHA. And I didn't say a word about it. She was make a joke, sometimes one overtly sexual (Remember that part about dirty jokes and whatnot? It turns out that SAHA and I were made for each other. ;) ) and sometimes an innocent joke that would remind me of the fact that I was in a sexless marriage. And I would shut down. Sometimes to the tune of not talking to her for a few days at a time. I was so hurt and so lost inside that I couldn't think of doing anything else to do. And it made me an asshole. And it worried my wife. After several episodes of me being drug into this empty abyss, SAHA and I finally had it out. She told me that she was worried that our marriage wouldn't survive. Not because she was planning to leave, but because she thought I was going to leave. I didn't realize that I had shut down so much that she was worried about our love. We are a team, we are close, and she's telling me that she was worried I'd ask for a divorce. I was lost. I had no idea things had gotten quite that bad. I was miserable. But I didn't know what to do. Anytime I started to hint at the situation, SAHA would tell me that she had tried her treatments previously prescribed and that she was doing what she could do to get better. And I didn't believe her. Deep down, I wondered if she really was. Those creeping doubts about whether or not she found me attractive were accompanied by questions about how much she wanted to get better. I had lived for ~20 months (longer if we include the robotic sex for conception) in a sexless marriage. Doubts happen. I thought and wondered things that I never imagined I would. And I hated myself for it. I became resentful of my wife. Thankfully, I could not and would not allow myself to feel that way about our baby. But SAHA had no saving grace. And truth be told, I was just angry. Angry with her for not getting better. Angry because we couldn't have sex. Angry because I couldn't fix the problem. Angry because I was angry.

     I was angry. And sad. Sadly, I couldn't cry. Many nights I would be up, too angry and bitter to go to bed with SAHA and as I thought about "our situation," I realized that I could not cry. I felt like I needed to cry. But the tears wouldn't flow. There would be no relief for me. Not through crying. Backed into a wall, when we finally had a blow-up, I finally let out what I was feeling. I told SAHA I was sad and hurt. I told her that I hated feeling like a roommate. And mostly, I told her I was sorry. I had bottled up for 20+ months all of the thoughts and resentment and I had slowly tortured her because of it. Sorry didn't begin to describe me. And I'm not just talking about apologetic. I was a shitty husband. Not because I needed physical intimacy and the release of sex. Hell, the fact that I needed those things and only wanted them from my wife and didn't deviate from that makes me a decent husband. At least I think so. I was sorry because I withheld from my best friend that I had basic needs that were unmet. That I was sad and hurting and I didn't trust her enough to share that with her. That made me sorry. A sorry individual and an even sorrier husband. That is why TAS is a bad person. I withheld my basic wants and desires from the one person with whom I'd always promised to share them. And I managed to make her feel like shit in the meantime.

     Thankfully, that meantime is over now. After our huge blowup, we talked openly and honestly about what was going on. SAHA had recently sought out a referral to a center that diagnosed her with vaginismus and they had begun her treatment regimen. It includes exercises, like the ever-popular Kegel and using a what equates to a TENS machine intravaginally. After our blow-up, she decided that because of her continued anxiety she would see a counselor. And after one meeting with that counselor, things are already looking "up," so to speak. ;) And, in promising to her that I would be more open with my feelings, I am using this place as a test run for my thoughts. And I needed to get this out, despite talking with her. So there you have it. This is my battle with vaginismus and my success over my inherent failures. Now if you'll forgive me, I am going to go spend some time with my beautiful wife. And tell her how writing this post made me feel better. And try to apologize again. Thanks for reading and please drop me comments or emails if you have had a similar experience. Or just something to share. I know I have felt much better after talking about it and maybe you can to. Have a good night reader and I promise to keep things a little lighter next time. And probably shorter.

That's what she said. ;)

- The Anesthetized Student

Sunday, September 9, 2012

Inducing... erm... Introducing!

     Sorry, that's a little medical/anesthesiology humor. One of the things I am sure to discuss is my desire to pursue training as an anesthesiologist. Unfortunately for you, that means you have to endure nerd humor. I suppose that is just a hazard of the job. And it is a terribly appropriate introduction to my dry, crass sense of humor.

     As the "About Me" says, I am in my late twenties, a medical student, a husband to a wife with a professional degree who is making a profession out of being a wife and mother, and daddy to a wonderful little girl. I constantly find myself wearing different hats and praying that each time I put a new one on, it will fit. This blog is being composed in hopes of providing me someplace to vent my frustrations with school, talk about some of the difficulties I have encountered in my young marriage, and discuss the daily adventures of a toddler. At least, that is what I hope to get out of it. My hope for you is to have a better understanding about the training physicians receive, be reminded that doctors are fallible human beings, and hopefully get a few chuckles for your trouble.

     Starting with my hopes for you (yes, I'm looking at you!), I feel like there is a disconnect between the world of medicine/physicians and the people who seek out the counsel of physicians. And I am comfortable placing the blame squarely on physicians. Surprisingly (or not, depending on your personal experiences), physicians aren't always the best communicators. We do a suboptimal job of helping the public to understand the things that we take for granted. Like why you are sitting in the waiting room 35 minutes past your appointment time. When there is radio silence from the physician's office, you are left to wonder if your doctor was enjoying a lunch of lobster, caviar, and 25 year old scotch. But with a little communication, you might find out that a patient came to the office with a list of concerns longer any of Tolstoy's works, another patient walked-in from the street with fever, stiff neck, and pain when looking at the lights, a patient in the hospital's condition has deteriorated, and Mrs. Jones has called four times because pharmacy said she is out of refills on her water pill. And no lunch was had that day by your doctor. That certainly isn't always the case, but a quick word from the nurse or front desk staff that  Dr. Smith is running 30 minutes behind because of some very sick people might make everyone a little happier. And that's the everyday stuff. It is even worse when sensitive topics like physician compensation, end-of-life care, or even breaking bad news leave something to be desired. Thankfully, those in medical education recognize the faults of their colleagues (and themselves!) and are working to change that. Students spend a lot of time in medical school talking about talking. Know that the situation will get better. And when it does, everyone will benefit.

     All of that talk about talking is probably apparent by now. I tend to ramble. And ramble. And ramble. Until it comes time for me to talk about the things in my head and my heart. As I reflect on many of the issues I've encountered in life, I would estimate that 85% were caused by my mouth. Sometimes the problems sprung forth with the words coming out of my mouth, but more recently, the problems have erupted while I lie silent. For the last several years, I have noticed that I have become much more reserved and introverted. I used to be able to talk about anything with anyone, but now I've struggled to talk about the most basic things, like how I feel, what I need from my friends or wife, or even what I hope for in the future. And it has cost me. I have spent hours, neigh days and weeks, being angry and muted toward people closest in my life because I was afraid to talk with them. This blog will hopefully provide me a dry run for my thoughts so that I can have those conversations and that it will be easier to say the words because I've already "said" them before. This has become a necessity recently, as my wife and I have hit a few bumps in the road secondary to vaginismus. And most of those problems sprung from my inability to tell my wife that something was wrong. I can't afford to do that kind of emotional damage to her or myself anymore. I need an outlet for my thoughts and emotions, and I hope that this place can be that. And I would like to thank you for being the ears to which I whisper my thoughts. Understandably, things will likely get very intimate in this space. If I think it is something I wouldn't read sitting in a magazine sitting at Starbucks, I will put some sort of tag in the title so that you can make an informed decision whether or not to read that entry.

     Wow. See, I'm a rambler. I feel like I've been doing that since birth. I think that this is enough of an intro for now. I'm sure there will be more to come fairly soon. Thanks for reading and I look forward to sharing more with you.

- The Anesthetized Student