Patience

Patience is not something I have a lot of, but is unfortunately something you need a lot of throughout the miscarriage/TTCAL process.

I was supposed to get a follow-up appointment with my doctor 4 weeks post-loss. Apparently somewhere along the way, this fell between the cracks and I didn't get an appointment. So I have to wait another few months until I can see my doctor. But I talked to her on the phone today because I wanted to plan for my operative hysteroscopy. First she was like oh yes, I'll start that process right away. But then she was like, actually, to be completely honest with you, you should go to this other hospital and see if this other doctor will do it. He's the best in Stockholm. I'm obviously grateful for her humility and her recommendation, but couldn't she have mentioned this A MONTH ago?!

Of course when I called, the office had already closed. But I'm going to call again in the morning. I hope I can get in to see this man, this King of Hysteroscopies, soon. This waiting is torture. If we didn't have to do all this testing, we could start TTC again after my first post-loss AF, which hopefully will be arriving some time soon. But instead, we have to wait. And wait. And wait. And wait some more. I'm not good at waiting.

I'm so ready to get this party started!

Monday Randoms

1. Spring might finally be coming to Stockholm, after a long, long, LONG winter.

2. The Pediatric Neurology ward is a tough place. The kids are so sick, but they're so brave. And the parents are unbelievably strong.

3. I went for a run yesterday, which was the first not-cold day since like October. It wasn't a long run, due to my current physical restrictions, but it was amazing.

4. My permanent retainer is broken. I've tried to get it fixed twice but both times the glue has broken. So I went to a new orthodontist, hoping she would tell me I could get a removable one instead. But she thinks I should keep the permanent wire. Navigating this system in Swedish has been such a challenge! My orthodontics vocabulary is limited, to say the least.

5. I went to a Michelin-star restaurant for the first time two weeks ago. The food was delicious, and it was so much fun. The restaurant actually had 2 stars. (I'm hoping to write a separate post about this soon).

6. This website: http://whatshouldwecallmedschool.tumblr.com/ is the best website ever.

7. In less than 2 months, I will be working as a physician. On a ward. With real patients. Just a summer job, but still. Exciting, and terrifying.

8. After my day today, I decided I need to choose a specialty in which you don't have to do rounds. Unfortunately, this strategy is not very feasible since it would eliminate like 99% of specialties.

9. I can't believe people think it's ok to throw themselves a baby shower. Yes, a friend of mine sent an email saying she was going to do this (but it turns out another friend was already going to throw her one, so it was, as Joey says, a moo point.)

10. Friends is the best TV show ever.

Nothing wrong with the patient

On Monday, I was cleared to exercise and have sex. So what did we do? Have sex, of course. It had been almost 2 months, after all. After a few minutes, there was blood on the sheets. Cue freak out.

The bleeding was worse the next morning, so I called the office. They told me that as long as it slowed down by the end of the day, I didn't need to come in. It did, so I didn't. But this morning, I was bleeding a lot again.

Now, I have learned in school that bleeding after a pregnancy has ended (whether it's from delivery, abortion, or miscarriage) can mean 2 things: retained tissue or infection. So naturally, I tried to figure out which one I had, but my symptoms didn't really match up well with either one.

Fortunately, miraculously, everything looks ok. Blood tests are good, hCG is down to 237 from 1120 a week ago. She couldn't see anything in my uterus, and my endometrium was thin (4mm). No signs of infection.

Wait....what?  So you're telling me I don't have either of those 2 differential diagnoses? That's not possible. Every time we go through cases in a seminar, it's always one of those 2 things. How could it be nothing?

And then it hit me. In med school seminars, the patient is always sick. There's always a diagnosis, otherwise, what's the point? IN REAL LIFE, some people are fine. Not everyone is sick. Some patients are actually completely fine and there's nothing wrong with them.

They think the bleeding must've been caused by the "trauma" of sex, but they do think it was strange that I am still bleeding so much. They couldn't find any other explanation though, and couldn't find any evidence whatsoever that there is a problem, so that's great news. I just have to hang tight until my next hCG draw next Wednesday.

So the moral of the story is - there is not always something wrong with the patient!

Med student vs. scrub nurse

As a med student, I come in contact with all different types of medical professionals. It's challenging to constantly be moving from rotation to rotation and have to meet new people all the time. You feel like you're constantly surrounded by people you don't know, and you're always trying to make a good impression, while obviously trying to learn as much as possible. I usually spend a lot of time with residents and attendings (obviously), and nurses. Although there are some exceptions, most nurses are very nice, and understanding of the fact that I don't know everything.

Scrub nurses, however, are an entirely different breed. Now, if you're reading this and happen to be a scrub nurse, please don't take offense. I'm sure you're a Type 1. And if, by some chance, you're not, please remember to give us poor med students a break once in a while!

(Side note: For those of you who don't know, a scrub nurse is a nurse who works in the operating room. He/she (but usually it's a she) is, among other things, responsible for maintaining the sterile field, and for all the instruments involved in the surgery.)

Seriously, though, a good scrub nurse makes ALL the difference in a surgery. They are excellent at what they do and are often grossly underappreciated by some surgeons. Additionally, they are responsible for maintaining the sterile field, which is an extremely important and difficult job. People often walk in and out of the OR, and they have to constantly make sure no one contaminates anything. It can't be easy, and I really do get that.

In my experience and opinion, there are 2 types of scrub nurses:


1. Type 1: The Nice Ones. These scrub nurses are friendly, and understand the fact that med students can't possibly know all the ins and outs of every type of surgery. They make you feel comfortable, and are open to questions.

Examples of Type 1 (all things that have happened to me):

"Have you seen this type of surgery before? No? Oh, well then let me walk you through all the instruments used, so you can be familiar with them. That will make it easier for you to assist."

"Are you scrubbing in? What size gloves do you wear? Great, I'll get some for you."

"Oh, when you cut that type of suture, you should hold the scissors like this, that'll be easier."


2. Type 2: The Nasty Ones. These scrub nurses are sick and tired of being bossed around by arrogant surgeons and have apparently decided to take their anger and frustration out on poor, innocent med students. What have we ever done to them? Nothing! But, alas, we find ourselves getting yelled at for merely existing. We do our best, honest. We don't know everything and we know we don't, but pleast don't hate on us for trying. We are there for a reason - we have to learn surgery. We're not just there to bother you, I swear.

Examples of Type 2 (again, all things that have happened to me):

Me, after opening the door to an OR where there are already 2 med students : "Hi, my name is C, and I'd like to observe this surgery."
Type 2 scrub nurse (T2SN): *rolls eyes* "Get in line."

While standing at least 3 feet from any table covered in sterile drapes: "You CANNOT touch anything that's blue!!!!"

After a non-sterile person backed into me: "You just contaminated yourself!! You can't touch anyone who's not sterile!! Go re-scrub!!"

I mean, if I had a nickel for every time I've been yelled at by a scrub nurse for something I didn't do, I'd be rich!!


But to all nurses, scrub or otherwise, thank you for all you do. Good nurses are at the core of a good hospital. I know your work doesn't always get recognized.

** This post was inspired by spending the morning with some arrogant surgeons and one of the nicest scrub nurses I've ever come across. She got yelled at by one of the surgeons a few times for stuff she didn't do, but she didn't retaliate. She was friendly, helpful, and very nice to me. **

Fly

This song came up on my phone as I was walking from school to the bus stop. I've heard this song before, since I've had this album since I was a teenager. I've always thought it was a pretty song, but today, the lyrics touched me in a whole new way.



Fly, fly little wing
Fly beyond imagining
The softest cloud, the whitest dove
Upon the wind of heaven's love
Past the planets and the stars
Leave this lonely world of ours
Escape the sorrow and the pain
And fly again


Fly, fly precious one
Your endless journey has begun
Take your gentle happiness
Far too beautiful for this
Cross over to the other shore
There is peace forevermore
But hold this mem'ry bittersweet
Until we meet


Fly, fly do not fear
Don't waste a breath, don't shed a tear
Your heart is pure, your soul is free
Be on your way, don't wait for me
Above the universe you'll climb
On beyond the hands of time
The moon will rise, the sun will set
But I won't forget


Fly, fly little wing
Fly where only angels sing
Fly away, the time is right
Go now, find the light

It's over.

On Tuesday we found out my hCG had gone down a bit. Ultrasound on Wednesday confirmed that. After getting yet another ultrasound yesterday, everyone is in agreement that the pregnancy is in the uterine cavity, which means we can hopefully take care of this with mifepristone and cytotec. I'm hoping to avoid methotrexate or surgery. I'm really scared of the pain, and scared that it won't work.

This meant that I also had to cancel my trip home, which is really just rubbing salt into the wound.

The multiple ultrasounds also led to a more in-depth discussion of the possible role my small (10mm) subseptum may be playing in all this. We are going to look into it more after this is all over, and also do some other testing. So that's good, at least.

I just hope that, someday, we will get our rainbow.

Bad English

In general, Swedes speak excellent English. I am constantly impressed by how good they are. The main exception is adults older than 50-ish. They didn't take English classes in school, and they are definitely not as good.

Today I had to witness some of the worst English I've seen since moving here. I was sitting in the peds outpatient clinic, next to the attending I was spending the day with. He had to write a note explaining why a patient needed to bring special food and asthma medicine onto a plane. I sat there while he typed what must be the most horrendous letter, in terms of grammar and spelling, that I've ever seen! Many of the errors were classic Swedish mistakes (like combining two words into one, as they do all the time in Swedish but we do not do in English), but some of the other things I just can't figure out.

Some examples:
"Certificate of need of specialfood"
"The patient needs to bring hers own food and asthmamedication"
"Consultant Pediatrichian"
"Therefore neither can she be exposed to food with nuts or gluten."

Needless to say, it was painful. It took every ounce of willpower I had not to grab the keyboard out of his hands and type it myself! I faced the dilemma of either a) sitting back and doing nothing, forcing innocent airline and airport employees to try to decipher the code, of b) saying something. I chose to mostly do b) but I did point out a few of the worst offenders, because I couldn't help myself.