February #2: Falling Asleep Inappropriately, Or, Radiology

I see how we got here.  In reality all it took were a series of small, logical steps.  Radiologists need to be able to see details in the scans they review, so they darken the room.  They sit down while they work, so it makes sense to have good chairs.  Radiology doesn't require a lot of talking.  And why be cold when you can be warm?  Each piece by itself is perfectly normal.  Consider the sum total, however: a warm, dark, quiet room, where you sit unmoving in a plushy chair for hours.

In short, a nap room.  Except not.  Because you're meant to be working.  Except not, because you are sleeping.

This led to a lot of painful, violent struggles between me and my brain, where it was mashing the POWER button trying to shut me down while I desperately refused to let my background programs close.  Eyelids flickering madly, I always lost.

Brain: ENVIRONMENTAL PARAMETERS MET, INITIATING SLEEP MODE

Me: What?!  No, brain!  No!  Nuuuuuu...

-pause as I fall asleep-

-radiologist suddenly starts teaching-

Radiologist*: ...be worried, not that the mediastinum appears widened here.  But since we're talking about it, what are the main-

Brain: EMERGENCY REBOOT... ONLINE

Radiologist: -causes of a widened mediastinum on a radiograph?

Me: pbbbrthftuhwhat?!  The... of a widened... they are!  Aortic dissection?  And.  Pericardial effusion.  And pneumonia, possibly, in the right middle lobe or the lingula.

Oblivious Or Perhaps Just Kind Radiologist: Good.  Pleural effusion could maybe show up like that too, but it's less likely to be central.  But like I said, we don't see that here. 

I don't think I have ever instantly snapped from sleeping to being fully awake, in a total panic, and on the spot like that before.  It hurts on some connective tissue level.  And it happened almost every day.

Also, right around this time I failed to match into an osteopathic residency.  Not as dire as it sounds, don't worry.  More on that later.

*I made this line up completely.  I have no idea what he said to start the sentence, because I was asleep.  I'm glad I caught as much of his question as I did!

February #1: Ophthpththtpthtpphphththpth- Eyes

So this rotation introduced me to something special and wonderful.  No, not that the inner part of your eyelid and the clear top layer of your eyeball are actually all one continuous layer (although!  how cool is that?! And isn't that also kind of weird?  Because the inside of your eyelid is pink, but that outer part of your eyeball is clear.  And also it's weird that that layer, your conjunctiva, is not made of the same stuff as the clear part that you look through, your cornea.  Crazy.  Anyway).  No, gentle reader, this is the rotation where I learned why spring of fourth year is so vaunted.  It's because you do nothing.

Let me be clear that when I chose my rotations for the spring semester, I was not trying to choose easy rotations.  I wanted to use this time to try to learn about things I'd had very little exposure to.  I chose ophthalmology, radiology, HIV clinic, and anesthesiology.  Sounds legit, right?  Ha!  Wrong!  Because as I found out, once people know you're a fourth year student rather than a third year, they find any number of reasons to send you home early or have you not come in in the first place.  Real examples:

"It might snow today."

"You've been working hard."

"You've already seen this stuff a couple times and you seem to get it."

"Your head hurts; why would I make you work with a headache?"

"You have an appointment scheduled for late morning, so just take the whole morning off."

"If you came in you'd only be working for like two hours anyway."

"I'd like to stay home but I can't, so you do it."

"You're a fourth year."

I felt so weird arguing with people to let me stay and work.  After the first few times, it became easier to just go with it.  And I have discovered something wonderful: having a full life.  I read books.  I watch extra sermons.  I lead study groups for second year students.  I am helping my husband lead our Bible study group.  I exercise, cook, do laundry, talk to my husband, AND I sleep...  is this what all you people with lives get to do all the time?  Surely not; it's too awesome.  If it were possible for people to always live like this the secret would be out, right?  I also love working at medicine, but working all the time doesn't hold a candle to having a balanced, varied life that is full of different sorts of challenges and chances to enjoy people.  I had no idea.  I don't think I have ever had this before.

Despite everything I just said, I did go to work sometimes while I was on my ophthalmology rotation.  It was a whole new totally overwhelming world, actually, which made a two week rotation feel like those impossible multi-site tours people are always inflicting on themselves when they go to other countries.  You take a bunch of pictures of towns you don't catch the names to, you try unsuccessfully to learn a phrase in the local language, you try some weird foods that you're not sure you like, and then you go home.  It's experience with no context to ground it; fun, but with limited return on your investment.

Doctors don't generally learn much about eyes.  They're there.  You see through them.  Don't get stuff in them.  Sometimes they get dry.  You want the jelly part to stay inside.  Go see an eye doctor.  The end.  We learn a fair amount about what leads up to the eyes, i.e. how the brain manages vision and how damage to the brain/ nerves specifically affects sight in different ways, but that's not the same as understanding the eyes themselves.  Eyes are highly complex and fascinating.  They're also quite important in that eyes are the only place in the body where we can directly see blood vessels and nerves without doing surgery or something, because we can shine a light into the eye and see straight through to the back.  That means all diseases that affect blood vessels or nerves systemically (think diabetes, high blood pressure, high cholesterol, some infections, etc.) will show up visibly in the eye somehow.  This is in addition to all of the specific eye conditions that someone can have.  There is a ton of very specific tech and wordage surrounding this, and in two weeks all I got were some basic eye exam skills and a glimpse at a huge body of knowledge that I know nothing about.  I watched a lot of cataract surgeries.  I did not have to watch anyone get their eye surgically removed, and I will always be grateful for that, because ew.

Also I looked at peoples' irises under high magnification a lot.  I was meant to be contemplating the deep mysteries of the pathologic retina at the time, but irises are cooler to look at if you're not an ophthalmologist.  Did you know irises have kind of a black background, and the colour is actually a bunch of fibers radiating out from the pupil?  They stretch out almost flat when your pupils are small, and they curl up when your pupils are dilated.  And a lot of people have little spots of other colours in their irises that aren't visible normally.

Somewhere in there I made P. F. Chang's chicken lettuce wraps from scratch and got all my dry cleaning done and had some work done on my car.

You can tell this was an enormously productive rotation.