Archive for Medical

Excuses excuses

No, I don’t actually have any excuses for my lack of posting lately. We got back from Ireland at the end of June and I ran a very disappointing half marathon, finishing 2 seconds slower than my previous half. Of course, as Eddie points out, I had been quite sick for the week prior, and it was a ridiculously hilly course so he thinks I should be quite pleased with my finish. If I really think about it, given the course and the bad bronchitis I had, my finishing time is not bad. But given how much I trained for it (and how little I trained for my first half), I remain quite disappointed. So, I’ve decided enough with these long distance races, I’m going to train for a 5K. My husband has been trying to break 20 minutes in the 5K for a while now, and he’s been making excellent progress so I’m excited to start training for mine. My previous 5K PR is 28:19 in 2004, followed by 28:34 this past March. So my current goal is sub-28 which I think should be pretty easy, and maybe even sub-27. We’ll see. To accomplish this, I’ve been running about 20 miles a week with a 9 mile long run and 1 day a week of intervals. I’ve had some trouble with my left foot for the past few months, and I was worried that intervals would exacerbate it, but it seems to be holding up fine.

Enough about running. As of July 1st, I am now officially a 3rd year resident. I started off the year with the wards, which is probably our toughest rotation. Thankfully, I had a fabulous intern and managed to survive a very busy month with a significant amount of anxiety but also a good amount of learning and fun. I followed that with a 2 week away rotation in pediatric oncology because I’ll soon be applying for a fellowship, and I’m trying to get a sense of the different programs. I’m not looking forward to writing yet another personal statement…

I survived the exciting milestone of turning 30 and celebrated with a fabulous barbecue at our place. As a sign of my age, about half the people at the party brought babies with them. Soon, everyone I know will have kids!

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Death

I would like to write about a child who recently died, but it’s difficult to express myself well. It was a very difficult and surreal experience. Part of this was because when I first met him, he was intubated and unresponsive, so I never knew him as a person. The other part is that I didn’t have time to mourn him or even think about what happened because there were other kids that needed to be taken care of.

One of the definitions for surreal that come up on Google described it well: “characterized by fantastic imagery and incongruous juxtapositions.”

It felt very unreal to me to go from doing chest compressions one minute to mundane unimportant tasks the next. I feel my life should somehow be inextricably liked with his, but I never even met his parents. I want them to know that I am thinking of them and mourning him with them. I wish they could have held him before he died.

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Long hours

As many people are aware, there are now work hour restrictions for residents which means we get to upload our hours to a website on a regular basis. I just did that and realized that I worked 84 hours this past week. No wonder I’m feeling tired. And this 84 hours was during a week where I had a golden weekend (2 entire days off in a row), which means I basically crammed all those hours into 5 days. phew. Despite that, I still managed to run 16 miles this week. Of course, most of this was over the past two days (7 miles on Satuday, 5.5 today), but I’m still pretty pleased. Nonetheless, I’m really not looking forward to going back to work tomorrow. This rotation is very high stress and very emotionally exhausting.

On the plus side, I had a fabulous golden weekend. Got home post call on Friday around 2 pm and slept until 6:45 pm when my husband called to let me know we had friends coming over and they would be there in 15 minutes. Gotta love it. Managed to drag myself out of bed for some all-you-can-eat brazilian barbeque. Delicious. Fell asleep at 10 pm and didn’t wake up until noon the next day when my husband dragged me out of bed. silly boy. Had a lovely run in the balmy 40 degree weather and then enjoyed looking at all the strange food at Super 88. Then we celebrated a belated Valentine’s Day by making some authentic Thai food (Tom Yum soup and Chiang Mai noodles). Delicious. Today I woke up and met some friends to go running and then headed over to Sound Bites for a tasty brunch. Watched O Brother Where Art Thou and then had a lovely afternoon nap before heading over the Formaggio’s for a BBQ, cheese and beer tasting. Now I’m getting ready for bed as I prepare for another difficult week.

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Boredom vs. sheer terror

As a second year resident, I spend a lot of time by myself at community hospitals. These nights on call vary greatly. For example, last night was composed of many hours of pure boredom. I’m sure that I could have been doing something very productive with my time, but mostly I tried to figure out how I could screw around. I wasn’t wholly unproductive, though. I did manage to do two physicals on kids in the psych unit, place an IV in a kid on the floor, help out the intern in the ED, read through two issues of Peds in Review, send lots of work-related emails and even take a nap. Guess I really can’t complain.

On the other hand, some nights on call consist of me running around like a chicken with its head cut off. Not a pretty image. I think I would really prefer a happy medium…

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Impact

Lately I’ve been thinking a lot about the patients I’ve taken care of during my 1.5 years of residency.  I don’t think they’re aware of how much they affect me.  As an intern, I often spent nights wondering if I treated my patients correctly–was it right to not prescribe antibiotics, could I have a done better job putting in an IV, was it okay to send that person home from the emergency room or should they have been admitted to the hospital…  Lately I feel a little more confident in my management so instead I spend my time wondering how my patients are doing.  And it’s funny, even if I’ve seem them only once, I still tend to think of them as “my patients.”  It’s hard because I know most of them don’t even remember me.  I’m simply one of the million random faces they encountered in the hospital.  As cheesy as it sounds, there stories really stick with me.  And I wish I could post about them here without violating confidentiality.  Here’s my attempt to explain what I feel without infringing on patients’ rights.

I think about the girl I admitted with a severe asthma exacerbation.  I remember walking into the room, taking one look at her and pulling out my code card so I could figure out what size endotracheal tube I might need.

I think a lot about the boy I took care of who remained intubated the entire time I knew him.  I remember wondering what he was like as a person and whether I would ever finally get to “meet” him.  Do his parents know that I still think about him and about them and wonder how they’re doing?

I don’t know.  They’re so many more stories (new diagnosis of leukemia, transplant patient, cystic fibrosis clean outs, unknown diagnosis …) but I can’t really give justice to their stories and their effects on me without violating confidentiality.

I also feel a little bad for the patients that I only think about in terms of their disease.  It’s a little embarassing when I get excited that I’m about to see a patient with some rare disease or who accidentally amputated their finger.  Not good from a human perspective, but probably good that I still possess medical curiosity.

I feel I did a bad job of explaining all this.  I guess what I’m trying to convey is that I hope the patients I see know how much they mean to me and how much time I spend thinking about them and wondering how they’re doing.

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Saving lives

Despite what TV would have you believe, residency rarely involves saving lives. In fact, sometimes I feel like a large part of pediatric residency is treating viral URIs.

However, on my current rotation, my job is to go to deliveries and resuscitate babies. Often, babies really don’t need any help at all. But a few days ago, a baby came out limp and blue with a low heart rate, and I had the privilege of giving positive pressure ventilation and (amazingly, to me) the baby came around perfectly and was being held by mom a few minutes later. Although I obviously understand the physiology behind this, it’s amazing to watch a limp, blue baby become pink and crying thanks to something I did. Ridiculous.

Other exciting news:
1. Got my first intubation
2. Halfway through Step 3 (taking second half of test tomorrow)
3. Start 8 days of vacation on July 1
4. Last call of intern year will be this Sunday!!!

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High stress level

I started a ridiculously busy rotation today at a different hospital with a new set of residents, and it’s a little bit stressful to say the least. Add to this the fact that I haven’t run in over a week, that I’m taking Step 3 (yet another big medical test) in a few weeks, working on several projects for my residency and trying to decide what to do with the rest of my life, and you might start to get an idea of my stress level. Apparently my husband has even noticed (and perhaps subtly hinted) that I’m slightly grumpier than usual…

I’ve finally decided that it’s time to take a true break from running and let my plantar fasciitis heal. It must be more serious than I thought because even without running for a week, it’s still pretty painful at the end of each day. In place of running, I’ve decided to start training for a triathlon by working on my biking and swimming. I used to be a pretty good swimmer as a child, but I’ve certainly lost any swimming fitness that I once had because I found swimming for 20 minutes completely exhausting the other day. I guess I need to work on my upper body strength a little. I’m kind of excited for the new challenge that a triathlon will present.

Unfortunately, I find swimming and biking are a little more difficult to fit in than running. So far I’ve found two pools that I can use. The hours of one are 7 am to 5 pm and the other is 11 am to 8 pm, which isn’t too bad, but it’s still a challenge if I end up working 7:30 am to 7:30 pm. I also get a little nervous about biking in the dark or in the pouring rain so I find that I have to plan out my workouts more than previously.

I was going to write more about my new rotation, but I find myself drifting off to sleep even as I try to type this… Time for bed.

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Relaxing

I’m currently sitting on our front deck enjoying the beautiful weather with my cat and drinking a delicious (if overly sugared) ice coffee. I love that we have a deck so that I can sit outside and admire the very green leaves on the trees, listen to the birds chirping, and watch various neighbors as they go about their business. I spent much of my childhood playing outside, and as a result, I love the feeling of the breeze on my skin and the smell of the trees. It definitely brings me a sense of peace. Perhaps this is partly why I love running so much. I love being outside, even in the cold of winter. The only thing I don’t enjoy so much is the heat, which is why I definitely prefer running in the winter to running in the summer.

Speaking of running, today is certainly a perfect day for it. I’ve been slowly ramping back up on the mileaage (am aiming for a whopping 10 this week!), and my foot seems to be doing okay. I continue to ice several times a day, wear my silly sock at night, and do various exercises with stretching. I’m hoping my foot stays okay because I’m really hoping to run another half marathon this fall, and I need to get back to a good 20-25 mile/week base before I can really start training for that. Please continue to send healing thoughts my way.

On another note, I am (amazingly!) nearing the end of my intern year. Wow. Tufts graduation is today which means that I’ve officially been an MD for exactly a year. Wow. It’s amazing how much can happen in a year. Not that a lot has actually changed physically in my life, but mentally I feel very different. I do in fact feel like a doctor now, albeit a very young and inexperienced one. I feel like I’ve learned an amazing amount, but still have an amazing amount more to learn. I think that sense of always needing to learn more is part of what I like about being a doctor. Last year at this point I was completely terrified (and excited!) about starting intern year. And this year, I remain completey terrified of starting second year. But the fear now is a little different. In some ways it’s easier because I know what to expect, but in some ways it’s worse because I know just what can go wrong.

Second year is much different than intern year. My job is now more focused on supervising (!) and teaching and less focused on doing daily scut work. The new interns will be looking to me for advice. On an emotional level I feel that is utterly ridiculous (how can I possibly supervise people!), but an a more rational level, I recognize that I’ve learned an amazing amount, and it’s time I took the next step toward becoming an attending. A year ago, I didn’t know the dosage for amox off the top of my head, or how to do a lumbar puncture, or that constipation can easily mimic appendicitis, or how to manage a seizing child, or how to write TPN, or … the list goes on and on. On the other hand, I still don’t know how to intubate, or how to put in a chest tube, or manage any sort of arrhythmia, or diagnose a murmur… As I said, there’s always more to learn.

Scarily, it’s once again becoming time for me to make yet another decision about the path my career will take. I have to decide fairly soon whether to apply for a fellowship. Much to the perplexity of those around me, I’m currently leaning toward a fellowship in pediatric hematology/oncology. For those not in the medical world, that basically means taking care of kids with cancer or blood diseases (sickle cell, hemophilia etc). I know that probably seems like a very depressing topic, but so far I’ve really enjoyed working with families and helping things go smoothly during such a difficult time. I think it would be a privilege to have a job where you truly feel like you make a difference in someone’s life, whether that be helping a child fight cancer or helping a child have the best death possible. And on a different level, I find the pathophysiology behind cancer very interesting, and I would be excited to do research in that area.

On a more practical note, however, there is unfortunately only one heme/onc fellowship available in Boston, and it’s on the other side of town from where we currently live. I have to say that I LOVE our condo, and would be very sad to move. If I were to match at the Children’s program, that would mean a fairly long commute for me, and if I didn’t match there, then we would have to move to another city. Plus there’s the whole issue of when to have kids…

Another option would be to take an extra year between residency and fellowship, whether it be doing research, or a chief year, or moonlighting. That would give me an extra year to decide about fellowship and possibly a year in which to have a baby. Phew, so much to think about. But enough serious talk, it’s time to find some lunch and do some gardening.

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Sorry

Goodness, more than a month since my last post.  I know you’re all (whoever you are…) anxiously awaiting my amazing words of wisdom.  Sadly, I have none.  Fortunately, my alliteration skills have not waned.

Life has recently been an impressive combination of stress, sleep deprivation, and emotional exhaustion.  Doesn’t that sound pleasant?  I’ve been working long hours and been taking care of a lot of complex and very sick kids.  Sometimes the outcomes are good, which is very satisfying, and sometimes the outcomes are not so good, which is very depressing.  Dealing with this as an intern can be challenging because you’re so focused on getting everything done that you don’t have time to think about the larger issues.  When your day is filled with hounding numerous people to get conscious sedation in place, you forget that the reason you’re doing it is because a 6 year old has incurable cancer.  During the day, it’s easy to keep these thoughts at bay as you run around crazily, but I often find myself thinking about my patients as I drift off to sleep at night, whether it’s reviewing the differential diagnosis and trying to figure out if I missed anything, or trying to remember how loop diuretics work, or wondering what’s going on with the 51a that was filed, or wondering how long they’ll live…  Most of it is unpleasant and my dreams lately are often some strange mishmash of hypothetical medical mistakes.

I feel like I should be able to draw some great and satisfying conclusion from all this misery, but nothing leaps to the eye.  And tomorrow I get to wake up at 5 am, as always, and head in for another day at work.

On the bright side, I have a loving and very supportive husband who’s always happy and willing to listen to my sorrows.  And my cat doesn’t do a bad job either…  My running has picked up a little in recent weeks, as I’ve realized how much I rely on it for stress relief.  Sadly, I’ve gotten impressively out of shape, so I’m having to take it slow.  But as always, I remain convinced that any running is better than none.

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Stress and sleep

The past week and a half has been totally crazy.  I’ve started a new rotation (and not just any new rotation, but pediatric surgery), been on call q2 (on call every 2nd night), been by myself at home because Eddie is visiting his family, AND both my father-in-law and my mother have been in the ICU.  They are both doing okay now, but what a crazy week.  Apparently all this stress (and sleep deprivation) has made me just a little bit tired because I got home yesterday from being on call at around 8:30 am, went to sleep around 9 am, woke up at 5 pm, fell  back asleep on the couch at 7 pm, woke up (very confused) at 3 am, went back to sleep around 4 am, and woke up at 9 am this morning.  That means I slept for 21 of 24 hours.  Pretty impressive, even for me.

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