Oh rrrrrrly?

Overheard on rounds:

"Mrs. F has had two live births and seven elective abortions. She uses no method of birth control."

Perks of the profession

The doctor I've been following this week, a high risk obstetrician, received a sack of just-picked tomatoes from a very satisfied Bedouin couple the other day.

He's also received, in addition to lots of yummy produce, more than fifteen chickens and ducks. (And a goat, which he politely declined). His kids are raising them in the backyard.

Yay for rural health care!

People are special

A middle aged woman with three children came in for pre-op rounds one afternoon last week. These rounds are pretty simple: we talk to the patient about why we feel they need surgery, explain the procedure to them, answer any questions, and then they sign the release forms.

This case was clear: she had had an operation a few months ago for an ovarian mass that was suspicious for cancer. During the operation they removed most of the tumor (which did turn out to be cancerous). But the lab reports showed that the surgical margins were not clear, some tumor had been left in her body.

They called her in immediately to schedule a second operation. When she arrived, her doctor explained everything to her, and told her that he wanted her to have surgery the next day.

"Oh, no." She replied, "tomorrow doesn't work for me."

We asked if the next week was better for her.

Nope, next week didn't work for her either. Couldn't we wait until April?

Her doctor explained to her beautifully how important this surgery was. That ovarian cancer can be aggressive, can spread quickly, that putting off her surgery could be really dangerous for her.

She was unmoved. This month just really wasn't convenient for her.

It took about twenty minutes of cajoling to get the reason out of her. And the reason?

She wants to lose weight and look amazing for her nephew's bar mitzva next month. And she gained weight and didn't look good after her last operation. So, long story short, there is absolutely no way to convince her to have the surgery before the bar mitzva.

Now because Israel is socialized, it's nearly impossible to schedule elective surgeries in a timely manner. This means that if she doesn't have the urgent surgery now, we might not be able to schedule it again until June.

She understood all this and still left without scheduling the surgery.

And I feel like we failed. And I feel that she let down her family, let down her body, let down the team of doctors that put a lot of thought and energy into her well-being.

It was disappointing.

But there you go.

On a side note. . .

I may or may not have just been exposed to avian flu.

Overseen in the ER

"More money is spent on breast enlargements and Viagra than on Alzheimer's research. This means that in the year 2020, much of the population will have huge breast and huge erections and be entirely unable to remember what to do with them."

I am ashamed. . .

Embarrassed. (<-- curse you extraneous consonants.) Abashed. Chagrined.
Humbled even.
I have become that which I scorned.
I have become an American who lives abroad.
And drinks. . . americanos.

What's an americano? Basically a shot of espresso diluted in a cup of hot water.

Wikipedia elaborates: One popular explanation for the name is that it was originally intended as an insult to Americans, who wanted their espresso diluted. During the Second World War, American occupational forces in Italy searched for the "cup of joe" they were accustomed to at home, which local baristas tried to emulate for them.[1] If this is the case, many American coffee drinkers are either unaware of or unfazed by the derogatory nature of the name, even in some cases going so far as to misinterpret americano as being a uniquely American way to drink espresso

Except that Wikipedia errs. I am fazed by the derogatory nature of the name. When I worked at Starbucks, I was horrified to discover that the drink named after our country was in fact basically espresso tea. I almost spit it out the first time I had a sip. It's everything that's bitter and harsh about espresso combined with everything that's boring and pointless about hot water. It nowhere near approaches the happiness that is a cup of actual coffee.

I quickly put two and two together and figured that the name probably arose from some European hotel barrista trying to approximate drip coffee for picky American tourists. And I swore that I would not perpetuate this slander, this myth that an americano bears even a passing resemblance to actual coffee. And, even worse, that my weak American taste buds can't handle real coffee unless it's diluted tenfold. And it just seems so lame, so typical to be an American ordering an americano.


And then it happened. I had been on-call the night before, delivering babies, saving lives, the usual. Okay, actually just delivering babies. I was too tired for tea. Couldn't handle the thought of another capuccino or nescafe (Israeli instant coffee) and my friend in line in front of me ordered an Americano. And against all better judgment, when it was my turn I found myself saying, "I'll have the same."

And I put a teeny bit of milk in, pretending it was normal coffee. And then, to my shock and horror. It actually kind of did taste a little bit like actual coffee. Bear in mind that I have not had actual coffee in about ten months, so my sense memory may be moderately distorted at this point. But it was kind of yummy. Not too milky, not too strong.

And this has become my drink of choice. And I cringe a bit inside every time I order it and try to use my best Israeli accent which doesn't fool anybody.

My name is T. I am an American. I am an americano drinker.
Sad.

Today was. . .

chock full of fetuses.

Which is to be expected from my obstetrics/gynecology rotation, I suppose.

We are currently 30 students rotating in two gynecology wards, two high-risk pregnancy wards, post-delivery care, multiple outpatient clinics, one emergency room, surgical day care, and labor and delivery. Each of those venues can accommodate between one and six students on a given day. We are paired with different students every day. We are also each on-call in labor and delivery or the women's ER 3-5 nights during the rotation. Our schedule approaches the complexity of most moderately sized military operation.

Today I accidentally ended up in the outpatient OR dedicated to abortions when I was scheduled to be in the gynecology ward. This led to a different kind of day than I had first anticipated.

Israel has relatively liberal abortion policies and extensive prenatal screening programs so this OR is a busy one. To be honest, I don't find it all that upsetting. Well, that's not true. I find all surgery vaguely upsetting and violent and unnatural. Especially the ones where we take internal organs out and throw them away and/or place foreign objects, such as giant plastic intestine snaps, in. I appreciate the results, ie survival, but something about it feels so wrong to me. And I didn't go through all of our clinical days, communication skills afternoons, and empathetic body language role-play weekends to poke sleeping people all day.

Moral of the story, I don't find the abortions disturbing. But it was a downer of a day anyway. Our population here is largely Bedouin, and the entire focus of their culture is children. And they're very quiet and stoic. But you can feel the desperation for a healthy pregnancy. There was a women there today, exactly my age, with six children. (What have I been doing with my life?!) This was her first pregnancy loss. She wasn't visibly upset, but right before the procedure she looked so scared, and my Arabic isn't remotely good enough to say anything comforting. Meh, it was one of those days.

I obsessively watch Scrubs to cheer myself up. I vaguely consider this time educational. Sadly, like all medical students, I tend towards the obsessive and refuse to just watch my favorite episodes. I have to watch them in order. From season 1 episode 1. This means sitting through the annoying "extra special" Scrubs(es?) where they get all serious for no justifiable reason.

So that's today. Tomorrow promises a long night of vaginal bleeding in the women's ER. Till then. . .

Overheard in the women's ER

Chief Attending to a group of students on a hospital tour: "This ER serves as the gynecologic trash can of Southern Israel."

Overseen in the gynecologic ER

The doctor pointed out the word "Virgo" written in bold across the top of an 18 year old patient's chart and asked me why it was important. I should have realized that we probably had a translation/spelling error at play, but it was the middle of the night and I wasn't thinking at my brightest, so I sat for a good ten minutes trying to figure what a zodiac sign could possibly have to do with women's health.

The answer of course is that the doctor just doesn't know how to spell virgin and he guessed. (They write it in English on the charts in order to not embarrass the patients. Despite all the other equally if not more embarrassing personal medical information also written in the chart). And the clinical significance is that we don't do transvaginal ultrasound on virgins because we'd have to break the hymen.

This is not as exciting as finding out that Virgos are more susceptible to, I don't know, ruptured ovarian cysts when the moon is in Capricorn. But reassuring to find out that my sign is not, in fact, of medical significance.

Highlights of my Israeli wedding- a cautionary tale

After explicit and vaguely violent assertions that yes he absolutely, positively had years and years of experience with American wedding cakes and he understood exactly what I wanted and I definitely, assuredly did not need to bring him pictures or check on the cake myself because he is the world expert on wedding cakes, this is what our Israeli wedding planner came up with:



My guess is that he googled "American wedding cake" about two hours before the wedding, pasted together four cakes he happened to have back in the kitchen, tried to hide the icing mistakes with ribbons, put it on the giant roll-y thing in an effort to disguise the fact that it's about 1/16th the size a wedding cake is actually supposed to be, then remembered as he was rolling it out that I had requested flowers, so he grabbed a giant pink plastic flower most likely left over from a bar mitzah the previous day and threw it on top. Very creative, actually.
(Note: this is actually the way the cake looked when it was first wheeled out. This is our wedding cake at it's very best. This is not, as it may appear, our wedding cake after a long night of drinking tequila, making out with strippers, and dancing on bars.)

And then, the ceremony itself. . .
Our actual conversation with the DJ:
DJ: When do you want the sparklers?
Husband and I: No. No sparklers. We do not want sparklers.
DJ: They're included in the price.
Husband and I: We don't want sparklers at our wedding.
DJ: I was thinking just when the bride walks in.
Me: ::As emphatically no as possible:: No no no no no no no. (I even had my husband repeat this is better Hebrew for emphasis)
DJ: Oh, so you don't want sparklers?
Us: Correct, no sparklers.