“XII If the radiology resident and the BMS [Best Medical School Student] both see a lesion on the chest X ray, there can be no lesion there”

I was reluctant to read the novel, House of God by Samuel Shem (Dr. Steve Bergman) mostly because one day during medical school I opened the cover and read the words “Except for her sunglasses, Berry was naked.” Uh… I’m all for art and free expression but I figured the book held the words of a male chauvinist-surgeon type and I was already annoyed with half of the male population in my medical school class. But as fate would have it, I ended up with a copy a few weeks ago and just finished it today.

It was written in the 70’s, before the ACGME insisted upon humane treatment of residents, when residents took q3 or q2 call without going home at noon post-call. Good Lord, I cannot imagine what that must have been like. It’s bad enough as it is. After having completed an emotionally draining adult neurology year, I can relate. I think everyone can. The calls alone put my pediatrics intern year to shame. And I can’t complain because I know my surgeon friends work even more.

I’m so grateful to all my sane medical and non-medical friends who kept me somewhat normal. Because after reading this book, I saw how easily I could've fallen off the deep end taking care of Neuro ICU patients. I’m already worried that I know residents who have. I mentioned once to a non-medical friend about a recent call I had, when the ER paged me on two patients who arrived with large brain bleeds. I had to tell their families about the imaging results, likely poor outcomes and consoled one of the families with a Spanish translator at 3am which felt wrong somehow. When I told my friend this, maybe I didn't realize how easily I laughed off the coincidence of having not one, but two horribly critical patients roll in the ER, my comment ‘man that really makes you feel helpless every time.' or how quickly I changed the subject afterwards. I don’t think I’ll forget the next question he asked, after a long pause: “Um, did you ever think of therapy?”

We probably all need therapy as residents, and The House of God highlights that. It’s an amazingly honest book about internship year that demanded change from the medical system. And it worked! In fact, there’s a rumor floating around that the 80 hour workweek limit will be shortened to 60 hours and interns will no longer do 24 hour shifts in the hospital. Hallelujah!

For me, my therapy was the ocean, friends and family who remind me that there IS life outside the hospital and it is wonderful. And my patients- those really sweet old ladies who'd tell me stories every morning when I’d check on them. And one ridiculously cute old gentleman with a fisherman’s cap who’d always ask me about Texas and talk about dancing. He wanted to learn how to incorporate his new cane into his dance moves. :)

It's nice to finally get all those House of God references people throw around. I’m also grateful to be a pediatrician again. It’s so much happier here. :)

PICU Playa'

I was a little surprised at the pain meds neurosurgery ordered for a kid they admitted to the PICU last night. He had just had his skull opened and grids placed to help figure out the location of his seizures. Our ICU team was consulted to help with pain management overnight. I figured it was probably just me not being used to adult doses—he was 16—so I thought I’d try it out and follow their plan. It was this combination of frequently scheduled Toredol and Valium… and if he still had pain he could have 5mg of Morphine (big adult dose!) or Tylenol with Codeine. Neurosurgery does not mess around!

Turns out, they worked a little too well… I woke him up before examining him and saw him looking at me kind of funny while I was introducing myself. I asked him to follow my light… but instead, he just said “Woah… doc! You’re beautiful!” His mom started laughing pretty hard while I just went on with my exam, but he was like “no really—you’re really beautiful!” Nice. I had to cut back on his meds a bit. The best part was watching the reactions of any female nurse or resident who came out of his room… they all had smiles on their faces!

Countdown to California… 25 days!

Woah.

It’s been a year and I’m about to have my last call of Intern year Monday… there are definitely things I’m frightened about as a second year, but all the more motivation to crack the books open again. I’ve gotten lazier about studying over the past few months so it’s payback time.

My schedule seems pretty fun. Not only do I have almost two weeks off in September (ACL music festival! Who’s with me??), but I have all the rotations I wanted: Genetics, Cardiology and even some I don't so much (Endocrine... eeeek. I had enough Endo as a med student!). I start off as a supervisor resident at the county hospital… I’m not sure which genius is responsible for this decision-- I have to oversee four interns and six medical students! But, it comes along with a nice q7 call schedule so I’ll put up with the madness gladly. :-)

Just the other day I was thinking of all the kids I’ve known who have died this year, and I was thinking how nice Pedi was that I could actually fit everyone on one hand… my medicine friends tell me about least one person a night passing away on some services. But then my friend calls me to tell me she had to call time of death on a patient I knew at MD Anderson. That makes six.

I was at an M&M (morbidity and mortality) conference of another patient I knew who had died from complications following heart surgery to remove an enormous abscess. Most of the people in the room knew him; one of my friends was giving the talk since she took care of him on the floor when he coded. (Way to stay strong Di! You didn’t see me tearing up in the back row…) Was it a diseased heart that was inevitably going to fail? Was it the telemetry monitors that didn’t make his arrhythmias clear? Was it us? These are all such hard questions with no answers. But, it seems to have resulted in the hospital completely changing the way it cares for post-op heart patients on monitors.

It’s wild to think that in two weeks, interns will come to me with questions. Like, how do you write for Tylenol? What do I do if my pager falls in the toilet? (this has almost happened to me once while I was carrying four different pagers) Why do the nurses call me at 2am with normal lab values? Why does pharmacy never trust what I write for?* Why does this lack of trust always happen during nighttime hours? Why do I have dreams of rounding on my patients when I’m not on call and why do I start answering my regular phone as “Hello, this is Dr. _____"?

While I can't quite help with these (well, ok I can help with the Tylenol...), I can offer four very helpful pieces of advice: trust no one, know what you don't know, know who to ask for help, and when in doubt use Google. I too shall heed by this.

Welcome new interns! THANK YOU for being here. :-)


(*disclaimer- pharmacy has definitely prevented me from accidentally hurting patients on more than one occasion, and for that I am grateful. But, the ratio of good phone calls to useless phone calls at Hermann is <<<1, and this fact is universally agreed upon by most residents.)

Surviving the Petri Dish

Yay! My ER month is over. It was really cool and inspired many a' ponderings:

1. It's impossible to work more than two 12-hour shifts in a row without getting sick! I bet I'm colonized with a nice variety of bugs now... luckily they're the "upper" kind and not the "lower" kind.

2. Completely well children in the ER are really fun to see, despite the trees killed to meet their paperwork requirements.

3. Completely well children who listen to people's bottoms with stethoscopes cause they're not tall enough to reach your lungs are even more fun!

4. Teaching med students how to suture is AWESOME. I feel so useful now! Want me to suture you??

5. When you pick up a chart, and it says "vaginal bleeder" it's ok to put the chart back and walk away slowly. You can even use the speculums in self defense!

6. Working nights is kind of strange, because halfway through at midnight you have to switch the dates. So, when I'm there during days I start switching the date at noon which stirs up all kinds of trouble. Although, it makes time move twice as fast. :-)

7. Splinting is totally cool and fuels the part of me that always wanted to do Ortho. (I think it's a small part. Can we splint and cast brains?)

8. All ER attendings are crazy. I think you really kind of have to be, and admittedly some are crazy in more endearing ways than others. My favorite is the attending who writes "Stop using Drugs or You'll DIE!!!"on her discharge papers for kids who come in with drug overdoses. She'll underline the "DIE!!" too, and write it really big. And under the 'home meds' section she'll put "None-- you have already had too much!"

9. This same attending did a throat swab on me after I asked her how to do one. Good thing I didn't ask for a refresher on a Gonococcal/ Chlamydia probe...

10. Mia Bella's (off Lexington and Shepard) has half priced drinks and appetizers all day Wednesday and free dessert coupons on Citysearch.com. AND the food is delish! This doesn't have so much to do with the ER, but it's my new favorite restaurant in Houston! MMM!

I'd like to thank my asthmatic patients on the Hermann floors for once again allowing me to update my blog. I can't really sleep since I have to check on two of them every hour or so, so this is great. I will miss not having call, but it's nice being back here... these kids are so cute! One patient who looked like the girl from little miss sunshine kept making pooping noises at me. (She really wanted to poop because she hadn't in a while.) And another toddler who had two butt abscesses drained was still running around her room laughing.

Bye bye pregnant teenagers! :-)

Santa's big helpers!

I really should sleep now (since I'm on call) but I feel a little guilty. There are only two of us interns covering the entire pedi service tonight on Christmas eve/morn, one of us admits (not me) and the other one is available for questions/concerns/emergencies the other patients in the hospital might have. Right now I've gotten called on a few easy things (tylenol for fever!) a few confusing things (why IS this patient in the hospital, really?) and one sad thing (boooo yeast line infections in kids!) The admitting intern, Jaime, is hard at work seeing kids, saving lives... and then here I am blogging! well, I could be sleeping. I'm already caught up on my discharge summaries!!

So I've kind of been bad keeping up with these hospital stories... I had this whole "ode to pumkins" theme I was going to use for my little NICU babies. but alas, that was a month ago. My pumpkins are doing well from what I hear, I heard one little baby (who was really fat too! AWWW!) was recently extubated and feeding well! and my other one who started looking like a glow-worm when I met him might actually be gaining weight. He was cute. If I could describe my entire NICU experience by one patient, that would be little baby A. He'd just be rocking in his little chair like a bobble head... with his big eyes wide open, tounge sticking out of his mouth and a serious look on his face (sometimes he'd smile though!) Soooo cute.

Last month (december... gasp!) I was in a chronic care facilty for kids who needed rehab, long term med therapy or kids too sick to go home but not sick enough to be in the hospital. That was pretty fun, only one kid I got really attached to (as did everyone since she'd been in and out of hospitals for the past few years) decide she had enough of her war against Pompe's disease (and the experimental enzyme replacement therapy she was getting for it) and left for a better world. Poor kiddo. She will be missed... with her cute little smiles, head bobbing and arm waving... but I'm sure she won't miss the crazy amount of meds and breathing devices keeping her alive. The room was so quiet though, it was eerie. If I were a braver intern, I woulda held her while they withdrew care, but I think I'm not quite ready yet. I have so much admiration for hospice workers and people in general who are at peace with the idea of death, and being with people as they go. I, on the other hand, have a severe fight-or-flight response. So I flew... out the door. Meh.

Whew. Now this holiday schedule is so confusing. let me expain. there are four teams of interns at our hospital, we've combined two of the teams so that Team A is former Teams B and D, and Team B is former Teams A and C. There are three interns on each team, and two supers on one team, we admit tonight and tomorrow, and the other team admits the day after Christmas. I'm taking call tonight for Team B, but I'm really on Team A. Or something like that. Anyway we have the original Team A pager (since it says team A on it) but the real team A patients are on Team B... so you can see what kind of fun we've had today. :-) But the nurses are feeding me goodies tonight and digging my Santa hat, so I can't get annoyed. It's almost Christmas!

Speaking of which, I wish you all a merry one! I'm going to have a fantastic one tomorrow... in my bed all snug and warm... with my pager OFF! :-) Good night to all!

Awesome.

This woman is my hero!

That's all for now... I slept 13 hours straight after my NICU (neonatal intensive care unit) call the other day. And... I think I'm going to sleep some more now.

But first a story. I intubated today!! It sort of counted, the NICU fellow had to hold the blade in place to expose the chords after my own failed attempt. So all I really had to do was put the tube in between the chords, and wooooo! It was in! You remember how when we were kids we put blocks through holes and thought we were geniouses? It was sort of like that. Maybe next time, I can do the whole thing myself!

I should write more about my babies. They're all champs, they're so cute and are starting to fix themselves. Its amazing how many babies are born broken, and even more amazing how they can sometimes self-correct. I'll leave that to my next post. I already have a fun title in my mind. (wouldn't you like to know!) :-)

Mmmm I need a run. Tomorrow. OK I'm out!

Disc On!

I've discovered a group of people who play ultimate! One of them even played with us at uthscsa before going off to Baylor to do a Pedi residency three years ago. So it was a fun reunion of sorts! It seems that people have played at Hermann Park for the past 10 years, but for the past four weeks or so thunderstorms have stopped a lot of people from coming out. This time the sky was clear, with 2/3 of the muddy field resembling the wetlands. As it should be.


I saw a little surprise peeking out over the bushes looking at the players on my way back. I can't believe he didnt notice me sneaking up on him. Bunnies and Frisbee!! That's kind of like the royal flush of cuteness. or awesomeness. why didn't we have bunnies at uthscsa? :-)

Back on call tomorrow! On a fun (and slightly nerdy) note, the other day I diagnosed my first case of Viral Meningitis!! With a crystal clear LP on the first try! Oh sweet success! The little boy will be fine... this particular type of viral meningitis gets better on its own. But it felt really nice telling his mom the diagnosis and freeing her from other worries... this whole doctor thing is awesome!!

Taco Supreme!

Thank goodness for cute young things in blankets.

I was going to write some things about call but then I realized something. I can't remember! I can't remember anything! Sleep deprivation subtracts things from my memory. This frightens me. The first thing I heard when I walked into our break room was "thou shalt not fear!" Apparently someone left the TV on from the night before and this tele-evangelist lady was on. I had to smile... you kind of do get that feeling that you're an actor in some really strange tv show sometimes around here.

I've discovered something though, I think you may need a little fear. I might need a little fear... just a tiny bit so that I STAY AWAKE. I was so high on adrenaline last night that not only did I not really sleep the entire 5 hours that there were no pages and nothing to do, but I wasn't sleepy at at in morning report or noon conference the next day. And seeing the three patients admitted at 3am? No problem. Only I was kinda in this weird hazy awake-yet-forgetful-spazzed out state. Some people look great when they spazz (like Di!) but me, I look like Einstein. With the hair, without the brains.

I hope I didn't scare my med student. Med students are awesome! They just started their clinical year, and keep wanting to do really nice things for us. I think they feel bad for us with our sometimes-overwhelming scutwork and not knowing where anything is all the time. I wanted to tell them "we're fine, you should wait till your surgery rotation, we peds residents are spoiled!!" I also have this urge to shower them with positive feedback and tell them everything i know all the time. I have PTSD issues from my first third year rotation (CT Surgery) where we were pimped (questioned about our medical knowledge) mercilessly, yelled at, and made to feel like we really WERE scum. And it was true that our time was constantly wasted. My evaluation/grade from that rotation was great, but was the psychological abuse necessary? I hope I never make a med student cry. Here, our pediatrics chief resident has chocolate and hugs in her office when things get tough! :-)

What's better than chocolate and hugs? I leaned how to feed a baby last night!! It was so theraputic. Next time I freak out, I'll just drop everything and go feed babies. YAY FOR CUTE YOUNG THINGS IN BLANKETS!