Week 3: Part 1

Lots of significant updates over the past couple days, so I'm a little early posting...

COMPS
My excuses
I submitted my Comps rewrite Monday at 6:12pm. Yes, I did not fully pass all my questions that fateful day. It was about speech/language/auditory development pre- and post-cochlear implant, and in my defense, I've had very little experience in this area (my FOCUS kid was a 2x no show) and had only one class in my early undergrad career about AR. That textbook has long since disappeared. And this was back when CIs were not all-the-rage yet (you know, around the same time cell phones only came in black and couldn't fit in your purse). I know I'm not the only one with the same background. So all I'm saying is, when your Comps time comes, study EVERYTHING.
Timing
I was told my results 12 days after Comps via email, which included instructions on completing my rewrite to be submitted (via email) by April 3rd, about 10 days. I wouldn't call it a "rewrite", because they didn't give me the same question again to "rewrite" a better answer. Instead, I was given a prompt to write about some important information that I did not include in my original answer, which was appropriate except for that (again in my defense, the question could've been more clear about what they wanted!). I didn't start it till last weekend, mainly because I had been sick. I'd say it took me a total of about 5 hours, which was 4 hours longer than I expected.
I wanted to finish by Sunday night, but I couldn't, and my supervisors here were super nice about it. As usual! They said it's going to be a slow day (though I saw 6 people! 30-45 minutes each!), and I could leave early if I finished early. Well that didnt' happen. Anyway, I got an email from Mary Jo today (4-5-06, 1.5 days after submission) saying I passed!

Scary stuff
Interrogation
At the end of the day on Monday, I was called to Caroline's office, where she and Kim were both waiting for me. They pulled up a CT scan of one of my patients, and asked me what her diagnosis was. Well, I didnt' have my notes with me, but luckily I knew most of my patients had anterior-communicating artery aneurysms clipped, so that's what I said. Kim says students usually need to have everything written down and get freaked out when they are asked that question. Lucky me!
We looked at the CT scan, and below are the proceedings (C=Caroline, K=Kim, M=Me)
C: So they scan the person, and find that there is a sub-arachnoid hemorrhage. What do they do next?
M: Uh... they drain the blood?
C: Yes, but how do they know where it was coming from?
M: *thought for ages* I honestly don't know.
C: Arteriography. (opens the images)
M: Oh, that's where they inject something into the artery and follow it's path!
C: That's right. (points out the aneurysm) What do they do after they find it?
M: Well they clip it (didn't really know exactly how that works, but I said it cuz of the diagnoses I've had)
C: That's one option; what's the other?
M: Uh.. Bend... they bend... something to do with turning or bending... (nervous laugh)
K: You're on the right track. They can coil it.

In my mind, I thought that meant literally twisting the artery around like a coil, but I didn't say that. Caroline explains what they both mean, and even draws me a diagram, which was very helpful! I even drew the same thing for a patient the next day who was wondering why she was there. The rest of the session involved me asking a lot of stupid questions, and them patiently explaining the MRI images and etc. I especially liked learning how surgeons got to the anterior communicating artery by lifting the frontal lobe and reaching from underneath, which explains the huge scar along the top of my patients' heads.

Anyway, this anecdote was just to exmplify that even though I was caught WAY off guard, and kind of intimidated by these blunt knowledge-check questions, I still felt free to be wrong and even continue to embarass myself by asking questions that would make anyone wonder how I got past high school bio. My supervisors really know their stuff in terms of anatomy and procedures, and I fully appreciate them trying to help me undersatnd what I'm doing, too.

Death
I saw a patient with Caroline last week as she did an impromptu bedside swallow with her. She and her family were super nice and appreciative of our services. I later saw her again for a full cognitive-linguistic eval, taking about a half hour. Near the end, she said she was really tired. I explained the results to her and her sister who was there at the time. Still great people.
Yesterday, I learned that overnight, she developed hypertension, cardiac problems, and a PE (pulmonary embolism, where a clot forms in the lower extremities, and travels to the lungs, causing lots of harm). So I was told I didnt' need to see her for followup that day.
Walking by the hallway yesterday, I noticed commotion in the room, family members crying by her door, and a male voice crying out in a trembling voice, "Oh my God Oh my God..."
She passed away.
I couldn't help but cry. I didnt' know her well, except those two incidences, but enough to feel personally saddened by the loss. Please keep her family in your prayers.

Escape attempts
I've been seeing this other guy for the past couple weeks. He's the typical ACOM aneurysm; confabulatory, tangential, poor recall of information... Except he scares me. He often tries to get out of bed, which is NOT good when he has tubes coming out of his head to drain the excess cerebralspinal fluid. He also tries to pull things off of him, including his IV, the staples and stiches in his head, etc.
He nearly got the best of me once last week, when he was trying to get off the bed and wouldn't listen to me. I was also physically trying to keep him down. No nurses came to answer the nurse call button that I kept pressing, and the door was nearly shut to his room so that people couldn't hear me calling for help! After about 10 minutes of debating with him that he needed to stay down and his physically resisting, I was also afraid of all the struggle causing somethign to come loose on him, AND I didn't want to alarm him by REALLY calling outloud for help. I finally made the huge mistake of a decision to run outside to get the nurse's attention. First thing I said was XX's trying to get out of bed, I need help. First thing the nurse said was I should never ever leave him alone in the room.
For pete's sake! No one was coming to help! Guess shouting outloud and risking him getting alarmed (and his blood pressure up, etc.) would be better than me leaving the room and risking him falling over and getting things yanked out of his skin. Sheesh, I couldnt' think straight at the time!
Since then, they have strapped his arms down to the sides of the bed. He still manages to twist around and strain the flow of his IV and things, but I've felt less anxious going into his room. Every time I go in (which is every day for the past couple weeks), he still attempts to get up and/or pull stuff off. He just doesn't understand right now.
Today, he has a new restraint. Yesterday (fortunately, when I wasnt' there), he fell off his bed and hurt his nose. His new restraint covers his upper body and looks like a small shirt. Four straps are tied to the back and side of his bed, so he can't even sit up. "Whew" i say.

I should stop complaining
When I was sick, I had to take 2 Tylenol pills every 4 hours. I hated it! I find swallowing pills really difficult. Before Tylenol, I took the liquid Nyquil at night before bed -nasty taste! I complained in my head all the time.
And then I get well enough to return, and I happen to be doing tx while several patients in that day are getting their medicine. They have to take like 7 pills at a time, drink little individual containers of nasty liquid medicines, and get one or two shots to boot! Twice a day, every day! Talk about a wake-up call, Linda.
And today, I was completing another cognitive-linguistic evaluation when a nurse came in to shave a guy's head in the area surrounding the scar. Now, I naively thought that didnt' sound so bad. Well, razer to scalp, the guy was shouting in pain, begging for her to stop (I need to never complain about my job again). I clearly forgot that the area was still swollen, sore with stitches and staples, and super sensitive. Plus, all my patients complain of itchiness in that area, and are always picking, pulling, scratching, or rubbing at the scar. All I need to do with them usually is pull the hand down and tell them to stop, since it was more out of subconsious reaction to the itchiness. I only worry about my escape artist patient.