Tuesday, September 29, 2015

September Snippets


yes, of actual story this time. XD I haven't done any in a while. 





   “You’re him…” she whispered, feeling blackness swallow her voice, her thoughts, her very soul. 
   “You’re the angel from my nightmares.”
Contract to Time Travel II

____________________________


   
We chose you...we chose you...answer us....
   Fire-flashing eyes, faces at once fierce and beautiful, and their voices...ah, their voices...even as they tore at him, they filled him with a consuming hunger he could scarcely bear.
   We'll tell you a secret! a secret! a secret!
   The echoes rang within his head and he gasped at the hurt within. Yet the glory they promised was greater even than the pain they brought. 
Imperfecta

____________________________


"I don't care, you know," he said, glancing up at me from beneath that mess of pale, turquoise tinged hair.
More Than Houses Can Be Haunted
[novel inspired by a picture. and 11 weeks of working in a hospital. and a need to work through ethical problems by writing]

____________________________


   Forgive me, for I have sinned. 
   Nay, I cannot say father. Does this make my confession null and void? For then I need say no more. And yet…I think you must hear the whole of it before you pass judgment upon me. 
[King Arthur Rewritten, from Mordred's POV. Possibly set in China.]

____________________________

   No. He was screaming it, and yet all that could be heard was the chains rattling against the plexi. 
   The chimera was looking at the mirage,  directly through to the camera, aching resignation slowly passing over his face. 
   That look he had seen in a thousand dreams since.
   No!
Contract to Time Travel II

____________________________


   "He's dying, you know." The Fae King's voice was as insidiously beautiful as ever, only deeper, richer now. The body he had borrowed was shuddering, straining at the seams in its attempt to hold him within. 
   "It was his choice." And yet, he could be saved from the consequences of that choice. If the Westmoore heir wanted to save him. To save him, and to lose himself and the rest of the world beside. 
Imperfecta

____________________________


   “Maybe it’s normal growing up.”
   “Did you actually just use the world normal in talking about me?”
   He looked at her, a laughing smile twisting his lips. “You are one of the most normal things in my life, Fae.”  

Contract to Time Travel II


Monday, September 28, 2015

in honor of editing

which I should be doing more of.  ;)




   “That!” Echo cried and he snatched up a syringe he had missed the first time through. 
   “What does it do?” he demanded, looking in vain for any sort of labeling as he started back towards the cot.
   “It’s for overdoses…” she started, then stopped, as if realizing at the same time he did that the how didn’t exactly matter. Assuming it worked at all.
   “Just tell me where do I stick it,” he said, pulling the cap off. 
   “Warning.” 
   The robotic voice nearly made him drop the syringe. 
   “Full dosage for two hundred pounds. Twist plunger two clicks to the right for every twenty-five pounds below this weight.”
   “I don’t know what it weighs!” Ellian snapped, as if the talking medicine was going to answer him.
   “You carried him—” Echo started, and Ellian started twisting it to the right.    The creature weighed nothing near two hundred pounds, and he could always give more later, right? He hoped. But who made a talking syringe that couldn’t dose itself!
   “If this is an emergency, inject immediately into any large muscle group.”
   “What defines large?” Ellian growled, as the syringe continued, “This injection is active against the following drug classes:”
   “Just inject it!” Echo half cried. “His leg or his shoulder…it can’t be that different from insulin injections.”
    “Which I know absolutely nothing about!” he couldn’t help answering. “This is seriously something I never thought I’d do,” he added, pulling the left side of the jacket out of the way and shoving the  thin shirt up so the muscle of the angel’s upper arm was visible. 

   He steadied the syringe in his hand and glanced over at Echo. Silent, motionless, not breathing, no heartbeat… “It’s not like I’m gonna hurt him more,” he said aloud, then wished she hadn’t flinched.


~Contract to Time Travel

Wednesday, September 23, 2015

snippets

like is there ever a time I shouldn't add a picture from my window to a post? XD

snippets.
not of my writing, but of my story. of the stories that intersect my story. pieces of the people I have seen. pieces of myself. things have been changed if necessary to protect patient privacy, of course.




My fellow student ends a call, starts laughing as she looks at me. That was our attending; he has a patient for me. When I answered, he wanted to know if I was the tall med student.
I look down at my high heeled boots and laugh with her. We've already discussed how we're both girls, we're both blonde-ish, our names both start with the same letter, we both have white coats, and we both carry the exact same white and blue bag stuffed full of study materials over our shoulder. He has found the distinguishing characteristic to keep us straight.


Do you have a magic wand? I've got a patient dying, and there's nothing I can do. The young surgeon shuts the folder with a bang and gets heavily to his feet. It's 9am and he's already done all he can.


What do you mean? The woman narrows her eyes at me, and my words stumble, trying to explain a machine I don't fully understand. At this point in my studies, patient care remains unaffected whether or not I can eloquently explain the inner workings of magnetic resonance imaging, but someone she loves is sick, and I fully understand the inflection of her voice. Knowing or not knowing makes no difference...but I wish I knew it all. 


A little melody comes abruptly over the hospital intercom, and I look up from my studies to meet the blue eyes of my fellow student. We smile at each other, sharing a moment of joy that no matter what is happening in the rest of the hospital, someone on the floor below us is taking their first breath in this strange world of ours.


My patient is a seventy-three year old woman with a past medical history pertinent for hypertension and atrial fibrillation diagnosed in 2013, for which she is on heparin. She comes in today with a two day history of melena and - A crackling voice on the loudspeakers interrupts me and an instant later my attending is on her feet. 
Code in rehab, she says, and then we're both running for the stairs. 
Please let whoever it is be all right; please let whoever it is be all right; please let whoever it is be all right.
My silent prayer tangles with the clatter of my shoes inside my head.


My attending runs down the hallway, see me through the open staff room door, catches himself long enough to call in I'll be with you in a moment! That slowing is long enough for the lake to catch his eye and he stops fully, staring past me at our seventh story view of sun on water, shimmering glory just beyond the glass. That's beautiful, he says, and there's awe in his voice. 


Is there a chance the cancer has spread to my brain? I hear the question amid a small flurry of activity in the room and freeze inside. Of course there's a chance. We're all wondering it, but no one knows yet. I don't know how to answer - I have no idea of percentages or likelihoods, only that this is my patient and recurrent cancer with new-onset neurological symptoms is not a good sign. I let the question slip by under cover of the busyness.
The patient does not ask again, and I realize my silence was also an answer. 
May I learn how to do all these things I must do the way I should do them soon.


Thirteen years of higher education, and I can't find the on button. 
I smother my laughter in a corner of the physician dining room, watching three doctors attempting to turn on a computer in the corner. How many neurosurgeons does it take to turn on a computer? I still don't know, because they never did find that button.




Saturday, September 19, 2015

what has it got in its pocketses



It's time for the weekly washing of my white coat 
{white + me has never been a good combination...this white coat is going to be a rag by the time I graduate}
and as I emptied my pockets, I thought it might be fun to show you what a 3rd year medical student carries around all the time.


1) Stethoscope {with little helicopter ID tag, of course}
This is basically guaranteed to be unneeded, and to tangle up everything you're trying to put in or pull out of your pockets, catch on door handles, drop onto patients' laps, and generally get in the way of anything you try to do.
If, however, you leave your stethoscope in your bag three stories down in a locked room, there is a 100% chance your attending* will call you into a room to hear a heart murmur or lung mass.
That is just how it works.
{*attending, by the way, is short for attending physician - the doctor in charge of the patient, overseeing students and residents, who may be doing most or all of the actual care, depending on what level they are at in their training}

2) Reflex Hammer
Used to remind you every time you do a physical exam that you stink at checking reflexes, in my case because every time I take something called a hammer to my patient's kneecap, I cringe. I am learning to hit harder. Otherwise my patients tend to fake reflexes just so I don't keep tapping them. {The brachioradialis reflex is genuinely hard to find...I can get it on myself, though, which is always the first step when it comes to me finding reflexes.}

3) Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine
The brain book: the short version of everything you need to know as a student and resident. {And which you'll hopefully have down by the time you're an attending.} The new version is purple. And more expensive. And otherwise basically the same. 
The print is so small and the number of abbreviations so large it's somewhat difficult to find what you're looking for in it, or understand what it's saying when you do find it. But I'm getting more used to it. 


4) Templates
Extremely helpful guides written out by various attendings on the phraseology and order they want for oral presentations of patients or for admission write-ups. 
And several more off the internet to use when I'm interviewing patients and doing exams. Some students see template use as evidence of lack of knowledge...I come at it from the airplane pilot school of thought, where nobody cares how many years you've been flying, you pull out the checklist and you make sure you didn't forget a single thing before you take off. Atul Gawande, the physician-author who has "achieved rock-star status" among his peers, agrees with me. {See The Checklist Manifesto: How to get Things Right.} {I keep meaning to read his books, but I haven't had money to buy them.}

5) Maxwell Quick Medical Reference
Normal lab values, quick overview of history and physical, neurological exam steps, etc. This will probably be shredded before I graduate, but by then I should have it all down. 

6) Pager
ie completely useless object that gets in my way, pulls my waistband down, or takes up space in my pocket and bangs my hip all day. I was paged exactly 1 time while on OB/GYN rotation, and that was while I was sitting at a lecture and therefore could not go anyway. And I have been paged 1 time in 4 weeks of my MED 1 rotation. Yet there is always the off chance that I might be paged. Therefore I continue carrying it around with me.
It is, in a word, annoying. 

7) Assorted Pens
3 is a leeetle overkill...I try to have 1 black and 1 colored with me all the time, though. And I have about 10 in my bag: colored, because that's how I study and also how I take notes when our attendings give us lectures, and black, because I always have extras in case attendings or fellow students need a pen. Which they at times do.

8) Chapstick
This might just be me. But when I don't have it my lips are not happy. 

9) Phone
Because pagers are outdated and this is actually how attendings get a hold of me. Also how the other student on rotation with me and I keep track of each other. And also what my mother uses to text me when she's worried over how late I'm staying at the hospital. Or what my siblings use to text me story ideas when I'm in the middle of work. {'cause clearly I don't have enough of those, and that's totally what I need when I'm trying to concentrate. guysssss... XD}

10) Watch
It's in my pocket because it's not terribly comfortable, and I've gotten used to not wearing one. But you never know when you'll need to check somebody's pulse, and clocks are not always where you'd think they should be.

11) Name Tag
So attendings know which student is which when they're yelling at us 
{heheh actually so far all my attendings have been like If you do this/say this/write this/sound like this/don't know this, your attendings will chew you out/yell at you/rip you apart. All of which I extremely appreciate, especially the part when they're not actually being nasty to me while they tell me how to improve.} and so patients know I'm official and so I can access locked wards and so I can get free lunch.
All good things.

Not Shown: 
ipad
 Which I used to take the picture...used alllllllll the time for looking up diseases, tests, random things I don't know, to write up notes when necessary, and for study materials when I'm not otherwise occupied. 
{also email and facebook, because sometimes brains require study breaks}

pocket-sized notebook
I go through them very fast {pocket notebooks are literally always a good present for medical students}, but I always have extra paper with me for emergencies. 
{assignments from attendings, notes on patients, lists of tasks I have to accomplish, random story ideas...}


It doesn't actually look like much, but my coat feels like it weighs 15 pounds. And then there's my bag, which I carry around all the time...that weighs about three times as much. But that's a set of items for another day. :D




Ooh, something else that sometimes fits in my pockets...
 My new favorite drink. 
Peach is the absolute best...dragonfruit is good...clementine is good...lemon tastes like expensive lemonade without having the ridiculous sugar content...blueberry is good, but I don't particularly like blueberry...pomegranate is pretty good too, but not as sweet as the others. 
I've been drinking between 1 and 3 a day, so I really hope they're as good as their label says they are. 
{I'm just waiting for a study to come out saying stevia actually causes cancer...}



And I feel like I'd be remiss if I didn't include at least 1 picture of the view from the student room where I usually am when not running after my attending. 


{ipad again, so poor quality. but that view is high quality, let me tell you. when the sun hits the water right it's like the whole world is sparkling.}

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