Inspiration

To be truthful, I have been neglectful of nearly every aspect of my life in the last month or so besides work.  Life as a second year is tough and when I get home, I'm lucky if I don't collapse on my sofa and watch tv for the rest of the night.  I haven't been cooking.  I haven't been swimming.  My apartment was such a mess that I was stressed out when I thought about it.  I hadn't done laundry in a month.  My mail was stacking up.  My "garden" is a mess and in desperate need of repotting (but the lemons are doing wonderfully). 

So, tonight, to get myself out, my friend T and I went to see Julie and Julia.  It was a good movie, kind of light entertainment and upbeat.  What I didn't expect, and maybe should have, was to be inspired.  I was inspired to branch out in my life.  To keep on pursuing those outside interests that keep me, well, me. 

I know that it seems silly, especially to those who haven't gone through residency, but it is hard to maintain a sense of self when you spend 80 hours a week serving others and bending to the will of others. 

My new resolutions: to work out more (which would mean working out at all), to cook more (no more CSA = no more veggies to force me to cook), to get back to exploring the south bay, and last, but not least, to go back to updating the blog. 

Also, to learn how to poach an egg. 

Beyond exhausted

These last few weeks have been beyond exhausting (which explains my lack of blog updates), to say the least. 

Signs that you know you're way too tired:

• You put your underwear on inside out and don't realize it until 3 in the morning. 
  
• You leave the stove on twice in one night.  

No need to worry, though!  I am in a better place (and on a better rotation) now. 

Goodies

Today was a long, hard day at work, so it was nice to be greeted by my brand spanking new CSA box! I'm sharing a CSA (community shared agriculture, courtesy of Two Small Farms) with my friend, C. Fortunately, since I was working til 9PM tonight, she picked up the CSA box and I picked up my share from her apartment.

She was so kind as to take a picture:


This is delightful gift, especially after my very bad day (gross understatement). I plan on using the turnips and parsley roots in a roasted root vegetable side dish. The celery in a fish head soup (with tomatoes and lemon). The dill in roasted salmon. The orach (purple spinach) sauteed. I already ate the baby carrots. The leeks, I'm not sure of. And the broccoli is easy - so many options!

That's it for tonight. Another long day tomorrow.

Road trip

On Friday, I took a half day road trip down to Monterey/Carmel and had a blast. We ate wonderful sandwiches at a place in Carmel. We took lots of funny photos. It was a beautiful, sun-shiny day. Who knew I could enjoy intern year so much?

Match Day!

Today is Match Day!  Boy, am I glad that it's not me this time around.  On the other hand, it's hard to imagine that it was a year ago that I was sitting in Vietnam, at a hotel computer, with my crutches by my side, and wondering where I was going to spend the next four years of my life. 

Just another day...

...in the ED with one guy screaming his head off the the drunk guy next to him complaining, "that guy is crazy."

Repetition is key

I just realized, as I finish my glass of Bailey's, that I tend to
drink Bailey's when I'm studying for the boards. When I was studying
for step 2 of my boards in medical school, I finished a whole bottle
of Bailey's (granted, it was over a month). I hope I don't repeat
that this time (especially given that I take my boards in a week).

Cocktail time

A patient of mine gave me a cocktail recipe today. When I asked him
about his alcohol use, he responded, "Well, a beer every night and
every now and then, I make myself a bloody Mary. Have you ever had a
Bloody Mary? Well, they're great and easy to make. You know V8
tomato juice? Well, they make a spicy one. Mix that with some vodka
and you have a great drink."

It's sad that I get drink recipes from my alcoholic patients, but I
admit, I'm curious to try it out.

In lieu of a Bloody Mary, I poured myself a glass of Bailey's on the
rocks. I haven't had a drink in awhile and was craving it. And yes,
every now and then, I like to pretend I'm an old white man.

As seen on TV

I started working in the emergency department this week and it
definitely hasn't been as exciting as you would think an ED would be.
It's actually a lot of psychiatry, which I hated while in medical
school and which I still kinda hate out of medical school.

However, I did have a case which still has me thinking, "Could I have
done things differently?" It was a woman who was a few weeks after
delivering her baby and she came in complaining of bleeding. However,
when I saw her, she had minimal bleeding on exam and I discharged her.
Not 30 minutes later, while she was still in the room (thank goodness
discharges take awhile - at least in this case), she just started
hemorrhaging. Blood everywhere. Pale as a ghost. Blood pressure
dropped. Could I have done something differently? If I had, would it
have been any different? She ended up doing fine and the general
consensus was that it was such an odd presentation, but I still think
back on it.

In reflection, I guess it's good that I still think back on the case.
I hope never to be a doctor that doesn't care about the outcome of her
patients. I want to be able to follow up on my patients, realize how I
could have done things better (sometimes realizing that I may or may
not have done something wrong), and learn from the experience. I've
had several cases this year so far that have been me pause and think
back on what I did and if I could have done things differently.
Thankfully, all outcomes have been good.

In becoming a doctor, I am given the awesome privilege to help people,
but with that comes great responsibility.

Challenges

Residency is full of challenges and we all know how fun it can be to grin and bear it through everything. This week has been a week full of challenges. I have had to grin and bear it through difficult patients, difficult social situations, difficult nurses, difficult bureaucracy, and difficult diagnoses.

Example of today: Patient A has abdominal pain and chest pain, for which we are literally doing nothing but refusing to let him eat. He has been infinitely patient, but we continue to challenge him. We poke him repeatedly for blood and got none. We lost his belongings, including his house keys and his wallet. Yet, he continues to tell me, "Doctor, I just want to get better." At the end of the day, literally as I have my keys in my hand, his blood gets drawn and he gets a critical lab value - and I put my keys back in my pocket and proceed to poke and prod him further. To add to it, I get calls from physical therapy and social work that there are issues with him - even though I had consulted them early in the day, knowing that he would be discharged.

Patient B is incarcerated and presents with chest pain and weakness. We rule him out for any real cardiac pain. We rule him out for a stroke. Yet, he says he has continual chest pain. Convinces the nurse, as he is about to go back to jail, that he has the classic substernal chest pain radiating down the arm to the jaw and feels like an elephant sitting on his chest. So, there I am, again with keys in hand and they go back in the pocket, as I sit and wait for an EKG - which arrives an hour later. Nice to know "stat" means something resembling "in the next lifetime."

And of course, this does not include the dozens and dozens of pages I get a day. Half the time, they're worth it. Half the time, I answer them and sit on hold for 5, 6, or 10 minutes until someone answers the phone and then is disappointed that I'm not the person they're looking for.

This week has been challenging, to say the least. I guess it's all a part of my life that is intern year. That doesn't make it any easier, especially knowing that intern year is almost over, meaning that I will be a second year with twice as much responsibility.

Do you like your work? Oh, that's too bad.

That's what my 8-year old cousin emailed to me. That's the entire email. How did she know the answer to the question and then so succinctly put her response in the second sentence? Amazing, my cousin, she is.

Sleepy head

I'm so proud of myself - I stayed awake for the entire day today!  This is quite a feat given that I had slept for about 16 hours for the last 3 days (12+ hours overnight, and a few naps thrown in).  Let's keep my fingers crossed that I can stay awake for my in-service exam tomorrow (yeah, I still have to take tests) and then last a night on call. 

Sick.

I'm sitting at my parents' house feeling sick.  Sick like I haven't felt in a long time. 

1. My lymph node is still huge and still hurts.  As the doctor I saw put it: "Yeah, that's a big lymph node.  Gosh, that's the size of a golf ball!  That can't be normal... [then scribble something down]... it could be scrofula! You know, where you have TB in your lymph node. That'd be cool."  Cool, yes, if it weren't happening to me and it weren't one of the most painful things I have ever felt. 
2. I've got a fever!  Yeah, how does one get a fever after being on big gun antibiotics for nearly two weeks?  Clearly, can't be good. Nonetheless, I'm on Tylenol around the clock.
   
3. And a rash to boot.  Turns out I'm allergic to the big gun antibiotics that I've been getting, with proof in the pudding - the pudding being my skin mottled with a nice rash. 
   

Yeah, let's just say it's been fun.  And I was on call yesterday.  I made it in, did some rounding, then realized that maybe I shouldn't stay around, in pain, with a fever, delivering babies. So, that's when I decided to drive to my parents' house before taking my Tylenol #3, which was a questionable decision given I don't know which is worse - driving with a high fever (every time I get a fever, I get the same crazy thoughts, like weird puzzles that recycle over and over in my head - yeah, I may be crazy) versus driving under the influence of narcotics.  Oh well. 

Fortunately, I do have my spiked Tylenol and my dad has some Vicodin to help me sleep at night.  Thank god for pain medicine.

Oh, did I mention that the CREOGs are this week?  For those not medically-inclined (I can't blame you), CREOGs are the in-service exam for Ob/Gyn residents - basically like a yearly SAT to see how you compare to everyone else in the country.  Let's hope my fever stops by then.

All play and little work

I have to say that my life on ambulatory has been really really nice.  I don't have to be in the hospital until 8, which is like a vacation!  And I usually get out by 5, which is like a vacation, times two!  That means that I have time to cook, watch a little bit of Project Runway, season 2 (which I got in a white elephant gift exchange), and sleep - in other words, I get to live a normal life.  I've actually been sleeping a lot more than usual, which is nice and concerning (especially given my hypochondriasis about my lymph node - which is still here, albeit nontender and a little smaller).

 

On another note, I'm continuing my reading trend.  A few months ago, I tried reading Oblivion by David Foster Wallace, but didn't understand half the stories that I read, so got bored. Now, I'm back onto reading a classic (I alternate between modern fiction and literary classics - really, it's whatever I can find at the used book store or bargain rack).  My latest kick is Little Women and I'm liking it much more than I thought I would.  The old-fashioned ways of courtship and such still confuse me (I mean, being asked for my hand in marriage after a smile and professing of undying love?  I think not), but it's a nice escape.

 

Well, no reading for me tonight.  I'm on call - so I guess this month isn't entirely like being on vacation.

 

Argh!

It's funny how I cannot stay awake while studying, despite the fact that I, a) slept 10 hours last night, b) just had a cup of caramel macchiato (albeit decaf), and c) the Christmas music is playing right by my head. 

Did I mention how depressed I am that I'm still in California?  I want to go sledding!! 

Fatigued, exhausted, worn out

There are many ways to put it, but that's what I've been since starting residency.  Would I be less so if my hours were better?  If I had a 5 hour nap overnight while on call?  If I was guaranteed one day off every week?  If I could not be on call more than once every three days?  It's hard to tell, but it will be interesting to find out. 

Soon enough, we will all find out if the new resident work hour recommendations made by the Institute of Medicine are put into effect. 

On my toes

My last call night, I realized how important it is to be on my toes, even at 4am.  I did a c-section at 4am and it went fine, except for some excess bleeding secondary to uterine atony.  We had controlled the bleeding, but she had lost a good amount of blood during the operation.  As I was in the recovery room, dictating the case, the nurse called me over. 

Nurse: "Her blood pressure has dropped."
Me: "How low is it?"
Nurse: "Right now, it's 70/40."
Me:  [Right now, I'm thinking, "Crap!"] "Ok, bolus 1 liter normal saline, get another large bore IV, draw labs, and let me examine her." 
[I then proceed to see if she's bleeding and get a fist-sized clot out, but otherwise it's ok.] 
"Ok, let me get the attending."

Yeah, that's me on my toes.  They may be short little toes and it may have been 5am, but yeah, I did things right.  Of course, that was my first time where a patient needed my immediate attention.  And I was alone, at least in the room.  It was scary, exhilarating, and pretty awesome all at the same time.  In the end, it helped me have faith in my own abilities and, yeah, I really am a doctor. 

Duh

This article just came out in the New England Journal of Medicine and it states the obvious - that medical students are graduating from medical school with a mountain of debt.  Upon looking at that mountain of debt, some people who went to medical school to work in primary care or in underserved areas may be swayed to choose more lucrative careers. 

In short, I am one of those quarter of people who graduate from medical school with more than $200,000 in debt.  Yes, you read that right, $200,000.  I think it's a touchy subject because a lot of people don't like talking about money, especially debt money.  However, I think that it's important to consider.  That's enough money to buy a house.  That's enough money to start a small business.  With the interest and eventual pay back, I will have paid back nearly half a million dollars.  Half a million dollars.  Sometimes it's unbelievable to myself.  Sometimes I stop looking at the monthly interest statements that come to my mailbox, in hopes that maybe all of that debt will go away. 

With the mountains and mountains of debt that I have, I am definitely not one of those doctors that laments the "pitiful" income that doctors make.  I think we forget that, even as a resident, I get paid more than the average American.  Granted, I have gone through much more school and training than the average American, but that doesn't make me more privy to a decent income than the next person.  More often than not, I find myself grateful that I can make a more than comfortable income doing something that I love doing. 

I was also fortunate enough to have fallen in love with a medical specialty that pays more than the average primary care income.  With my debt, I am looking at monthly payments of $5,000, or annual payments of $60,000.  If I went into internal medicine or family medicine, that would be more than half of my take home income.  That's downright crazy.  There have to be better ways of going about doing this.  I understand that debt is something that is inevitable, but when is too much too much? 

Nights like these

Last night, I did a c-section where the lady lost almost two liters of blood (maybe due to the fact that she had been in labor for two days, or the fact that her baby was 9 pounds plus, or maybe due to the fact she had an infection, or due to the fact that I have bad luck) and needed a transfusion. 

The board (what we call the list of patients on Labor and Delivery at any point in time) was packed full and every patient was complicated - with diabetes, drug use, placental abruption, placental previa (where the placenta covers the cervix), pre-term labor, etc etc.  Lots of fun stuff to be had. 

Unfortunately, with all the excitement, I get no sleep and I only racked up two deliveries (including the c-section).  Oh, to top it off, as I'm rounding this morning, I slip and fall flat on my butt and bang my knee against the ground.  Just what I needed. 

Er, I just want to curl up into a ball. 

Aches of all sorts

(Image courtesy of Wikipedia)

Two quotes from an article I'm reading right now:

"Sensible sun exposure can provide an adequate amount of vitamin D3, which is stored in body fat and released during the winter, when vitamin D3 cannot be produced. Exposure of arms and legs for 5 to 30 minutes (depending on time of day, season, latitude, and skin pigmentation) between the hours of 10 a.m. and 3 p.m. twice a week is often adequate."

and

"32% of healthy students, physicians, and residents at a Boston hospital were found to be vitamin D–deficient, despite drinking a glass of milk and taking a multivitamin daily and eating salmon at least once a week."

Now, I'm convinced that my joint pain is secondary to rickets. I'm getting rickets. Or maybe it's just that I'm getting older. Either way, it's no fun.