Resolutions, Version 27.0

After a year of being knocked out by sleep deprivation (did I even have resolutions last year?) I thought I’d try this resolution business again. This time I’ve had more sleep, and more time to soak in the world around me. So much, that even though my call this month in the NICU is every five nights instead of the standard four, I still feel like I’m being run to the ground.

But, as self-improvement is an adventure in itself, I have some great ideas brewing. Some of my resident friends here may join me in my most ingenious idea. If it works, I shall blog about it in a year, if it ends disastrously (Wikepedia says I have an 88% chance of failure) it will still be worth writing about, as it will surely be an ingenious disaster. :-)

Here are a few other ones I came up with: (Hold me accountable!)

1. Take time to read more often. For example, for the past year our clinic has had a shortage of the Hib (Haemophilus influenza B) vaccine. This vaccine was a breakthrough in preventing one of the most common potentially deadly illnesses and reason for hospital admission in children. Never really questioned the shortage, but after reading this, I know that Merck made a mistake, kids ARE getting sick again, and if anything this may help parents understand the importance of childhood vaccinations.

2. Get the flu vaccine. (I hope my chief residents aren't reading this... I'm gonna get it soon!)

3. Try not to suck so badly at Kareoke again. The uncomfortable silence and nervous laughter after my version of "Mr. Jones" during my friend's new year's party comes to mind...

4. Do something kid-like at least once a week. Yesterday I played basketball for the first time in years. It was with a group of men and women with an average height of like, 5’3". I know... I know... but man it felt good. ;-)

5. Stay updated on current events. Despite the instability surrounding us now, I’ve never felt so patriotic or proud of our country before for the version of leadership we’ve chosen. In the past it’s usually been an apathetic detachment, or disappointment that issues I supported (or cared enough to form opinions for) were in the minority. It’s a humbling, wonderful thing, this witnessing of who we are slowly becoming.

The NICU is a crazy place. Crazy, but always interesting. A baby with a sacrococcygeal teratoma was born today, there's a giant mass coming out of her lower back/rectal area. I wonder if there's teeth in it. Extra eyeball? :-) Ew... ok subject change... another resolution maybe?




6. Celebrate Bunnies more often! AWWWWWWW!! :-)

I am an Idiot

Note to self: do not walk into no-parking signs.

This morning after seeing patients at the JDC (Juvenile Detention Center) I was having trouble finding my parking lot. We have free resident parking a block away behind a building by some gas pumps and I think I starting walking towards the wrong set of pumps. After studying the street signs for a while I finally realized where I was and turned around… knocking the right side of my face into a metal sign. I do this kind of thing pretty frequently (accidents) but have never injured myself enough to seek medical attention.

After grabbing my eye, I realized there was some blood on my hands. It didn’t feel bad, I felt like I might have had a cut on my eyebrow so I ducked into a nearby Court building to find a bathroom and clean it off. Four guards inside graciously asked me if I needed help. Without thinking, I uncovered my eye and asked if I could find a bathroom or some gauze. After seeing my wound, one guy started shaking, asked me if I was ok and said that I should sit down. Another ran to find a first aid kit, and a third offered to call an ambulance. A woman said she saw me hit the sign and was worried about me.

So, I’m thinking “Good God, I think my eyebrow must be hanging off my face.” I put pressure on it with napkins and wondered if I could talk a colleague at the hospital into “borrowing” some Dermabond (superglue for your skin!) so I wouldn’t have to get stitches… or if it was possible to suture it closed myself. That’d actually rock.

Despite protests to move, I broke away to the bathroom to look at the damage. One of the women followed me in. I had a fairly large red mark on my cheek and a half-centimeter abrasion on my right eyebrow only worthy of a band-aid. More embarrassing if anything… I felt bad inflicting panic among such nice people, especially when one of the men said “What can I get you, Doc?” I also felt bad for having to tell them that the hydrocortisone cream in their first aid kit wasn’t the same thing as antibiotic ointment. Now that I think about it… could putting a steroid cream on an open wound possibly increase the likelihood of infection?

Thank you employees of the random courthouse I park behind! I’m sorry that I stole your only package of gauze and I hope you’re not traumatized. Thank you mostly for not laughing at me. Perhaps this election's result has inspired even more good will in us all! :-)

Thank you Colin Powell!

Colin Powell officially endorsed Obama recently and commented on a frequent belief held by some voters that Obama is Muslim:

"He's always been a Christian. But the really right answer is, what if he is? Is there something wrong with being a Muslim in this country? The answer's no, that's not America," Powell said. "Is there something wrong with some 7-year-old Muslim-American kid believing that he or she could be president?"

This makes me want to stand up and cheer. Why haven't I heard this before from either side?

Here's a link to the article, from the AP

Despite occasional frustrations with people who are racist or... um, lets just call them "hesitant to trust others perceived as unlike themselves," I am ridiculously excited about how this race has been unfolding and the possible outcome of this election. Obama is a politician to whom I can actually relate, he comes across as polished--even professor-like--with the clarity of his explanations and encouragement thrown into his speeches. And his wife is so inspiring! She might be my new hero. Can she be president too?

McCain's family memoir, Faith of My Fathers, was actually really good. I respected McCain before I read the book, but now I'm humbled by him. It helped me understand the "pro-war" side (or, the anthesisis of an anti-war stance) and made me think twice about my instinct to dismiss the necessity of any war. (Unfortunately for McCain, I still hold that instinct.) It's a shame that his campaign has gone in the direction that it has.

On to Obama's book, this should be great... another one about a Father. Makes me really want to call my Dad. :-)

Ode to Water, Power, and Music.

Holy goodness... a lot has happened. Galveston was pretty much annihilated from Ike. Boo Ike... BOO! But now I know my neighbors since we were powerless for a week afterwards. The older man who lives next door to me is a professional violinist in the Houston orchestra and in a band that plays “a kind of Egyptian Jazz music.” He says that in this awesome European accent... I totally love that I can hear him practicing through my walls.

It is kind of neat that despite camping out for so long the atmosphere in houston and the hospitals was pretty upbeat the whole time, even with all the Galveston residents relocated here who lost their homes. I guess such a strange/sad situation can be pretty uniting! Apparently I qualify for some sort of government reimbursement but it’d kinda be lame to ask for it since my place was fine, I was stranded in LA of all places (yay!!), and this gave me an excuse to mooch of my friends in Houston with apartments much nicer than mine. But now a lot has changed--all the stoplights work and I don't need to leave for work an hour early anymore! I have POWER and WATER!

The music festival in Austin was awesome! There was so much good music, and much of it was new to me. The most impressive thing about ACL this year was that they really improved the sound leak between stages—that was very annoying in years past. Outside water was allowed in, and there was plenty of power... so much that my Sprint cell phone kept switching between eastern and central time! It was political at times with many artists giving shout-outs to both candidates. I was surprised when bands who mentioned their support for McCain were rewarded by silence (given that I was supposed to still be in TX) but I have to admit it was pretty funny. I do think they need to sell fewer tickets as there was very little space between crowds around stages at opposite ends of Zilker. Also, the Frisbees we threw around seemed to hit people more often. Unless you're a Russian guy with superior aim whose discs only go to Siri.

My fav: The Swell Season, with Glen Hassard and Marketa Irglova from the move ‘Once,’ who played Friday. I still can’t believe I got to see them... they sounded beautiful. I think what made the night was Glen Hassard’s attempts at philosophizing. His speeches/song explanations were usually accompanied by wild guesturing, and while some of it might be over my head he did say one profound thought. I am paraphrasing, with hopefully less rambling. "Sometimes when you have an obstacle in front of you that’s like an endless wall… and you can’t go around or over it, I've learned sometimes you can walk away from it... and keep walking so that eventually you walk around the whole f*ing world and find yourself where you wanted to be in the first place!" Genius.

Other favorites: Tristan Prettyman, Erykah Badu (this woman is phenomenal. she's also very pregnant!), Jose Gonzales, Jenny Lewis, Okerville River, Beck (yay!), and Manu Chao mostly because I figured that anyone new I saw after the Swell Season wouldn't be able to hold my attention, but I was wrong--Manu Chao was freakin amazing.. yo yo yo! I also loved a three minute moment during the Foo Fighter’s encore where they busted out with ‘Big Me,’ only after butchering my favorite Foo Fighter song ‘Monkey Wrench.’ And let's talk about this Monkey Wrench thing. I was SO looking forward to rocking out to that fun yelling thing he does at the end of the song... but where was it? Oh after the false ending and weird creative drumming and... lets pretend we're stopping the song again... oh wait no here's the rest of it.... and yes, here is that fun yelling part only I'm not going to yell with the music... and I'm going to cut the stage lights again. Not that I'm bitter. :-)

But then they played Big Me... it's the sweetest song of all time! My love is regained!

Turkey? Provolone?

I think my subconscious wanted to be a doctor more than I did. For the past several weeks, the medical world keeps finding a way to creep into my dreams. Two days ago I dreamt vividly of a four month old baby on the wards with feeding issues and that I happened to have a friend who specialized in feeding problems. (Is there really such a sub-specialty? At four months?) I decided I immediately needed to transfer care to my friend. This meant I should pick up the phone at once and call her… which I did… until I realized it was 3am and the friend that I was calling was the last person who had text paged me. Thankfully I realized this after hearing it ring on her end, so I hung up quickly. She’s actually an internal medicine resident so my dream-mind was WAY off. Does this happen when I’m on call too??

Today, in dreamland I had to undergo special training for resident leadership skills. This meant running a sandwich shop. (I think I may have been a little hungry too while dreaming this.) The nurses from the ER were my coaches. They told me that my job was to “be their friend” but to put on my “sandwich gloves” and be stern when I need to direct them to do something. So, they had me behind the counter and I had to direct the sandwich-making. One female elderly doctor had approached the table, and she had an easy request, but before we could get to it (there was a more experienced sandwich maker at the counter too since in my dream I could not make sandwiches) two older male doctors came and demanded sandwiches. They said they had to go to the OR. What did I do? I told them to go back in line! And they did. My supervisors told me I did a great job. And then… then I woke up before I got my sandwich reward!! Blast.

My floor supervisor month in July rocked. The interns are all so nice... and smart! ER has been awesome too. Foreign bodies were pulled from all kinds of orifices (my favorite… sponge up nose! that one was a surprise), friendships were maintained despite consulting pediatric surgery every five minutes, violence was avoided from angry parents (but one nurse got hit!) On the downside, babies were beaten at home, twelve year olds found out they were pregnant, and I went through two other pagers after my beloved/hated electronic companion of a year broke. But I learned more this month than I think I’ve learned in a long time, simply from the volume and diversity of patients we saw. Next month I have to do some ER shifts at the county hospital (shudder!) and work as floor supervisor at night for a week. More stories I'm sure, I may have to try and stay awake more so my real stories outnumber my dream stories! Next month will also bring two vacations, my birthday, and a possible hurricane evacuation.

Stop Gustav!

Who knew?

According to CNNMoney.com, my parents are set! No need to move anywhere else to retire in style. Check it out... my hometown is famous!

#7 America's best small cities: Round Rock, TX

I was a little disappointed that there was no mention of the world famous (I like to think) Round Rock Donuts... so I am going to mention them now. I even stole this pic off the internet, where any good world famous donut picture would be located:

Mmm! The address (if you'd like to GPS it from your respective starting points) is 106 West Liberty, Round Rock, TX, 78664. The cherry bismarks are delicious!

Also, it was an even nicer surprise to see where my new home for 2009 and beyond was ranked:

#4 America's best small cities: Irvine, CA

Score! (Ignore the fact that I am going to be very, very broke for quite some time) :-)

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.)