Tuesday, November 20, 2007

Something about modified expectations

There is no sleep so sweet as post-call sleep. You drag yourself through rounds all morning, waiting for the senior resident or attending to look your way and say, "You're post-call? You can go home now." And then you go home, shower for much longer than you should because you feel so dirty with hospital, and crawl into bed.

And the sleep is so warm, so uninterrupted. Sure, I usually get to sleep a few hours in the on-call room, but this is so much better. No pagers waiting to go off. No sounds of the hospital's tubing system coming through the walls, sounding like a surprised inhalation. Just sweet, perfect sleep.

It almost makes being on call worth it.

Sunday, November 18, 2007

Oh, right...knitting

In case everyone thinks I've changed my needle preference from size US 6 circs to 20 gauge angiocaths, have faith that I am still working on the robe. It's all knit, and I sewed the shoulder seams and one sleeve on tonight. Since we do get Thursday (and maybe Friday...fingers crossed) off this week, I'm hoping to finish this sucker up by the end of next weekend. You know, just in time to put it in a drawer and wait until May to wear it.

Friday, November 16, 2007

Time for the morbid hospital post

Last week was my Pediatric Intensive Care Unit (PICU) week. For the most part, I really enjoyed it. I got some interesting patients, and I really like the feel of an ICU. Nursing is better, and there's more information at your fingertips to play with. Vitals are charted meticulously, labs are drawn frequently, and rounds happen twice a day. It's an OCD dream.


It also makes you think about children and death and maybe living but not really living. One patient was an infant born at 24 weeks. She essentially had no brain, just a bit of brainstem, thalamus, and cerebellum. But no actual, thinking brain. And she was in foster care, because whoever her parents were didn't have the abilities to take care of her. She also had problems with just about every other organ system, but the brain thing was what really bothered me. She couldn't interact, and she was the age where she should at least be smiling and making eye contact and cuddling. But she didn't. She showed distress when we tried to draw blood (she was very obese, so that made it extra difficult), but even that was not really emotion, just being agitated. Taking care of her was frustrating for everyone. At one point, one of the doctors on the team said, "The NICU [Neonatal ICU] made her; they should take her back."

It sounds callous, but it pointed to something I've been thinking about. Sometimes, maybe, the NICU doesn't really do good by saving these early, early preemies. Sometimes, you're just prolonging suffering. Sometimes you're creating a being that has no consciousness, essentially a baby Terry Schiavo. But sometimes, the baby you're trying to save grows up to be a person who has thoughts and interactions, and thank goodness you fought for that life. And you don't know, at 24 weeks, which sort of situation you're dealing with.

So what do you do? I have to admit that I'm glad I won't have to make that decision. I can help with genetic counseling in the prenatal period, but I won't have to deal with the aftermath of whatever my patients decide. And I can work to deliver those 22, 23, 24 weekers as safely as possible. But then I get to pass them off to the NICU folks and focus on making sure the mom is okay. For me, it's just an ethical argument to contemplate when I'm post-call. But for many, it's a real, practical decision.

Sunday, November 11, 2007

Wooo Cleveland! Represent!

Michael Symon is the Next Iron Chef!

I wasn't sure he'd make it. His competition (John Besh) was very respectable. I would have been okay if he had won. But he didn't. Because Chef Symon did. Because he is awesome.

Michael Symon is a Cleveland chef who owns both Lola, one of the best restaurants in Cleveland, and Lolita, it's more casual, cheaper little sister. Lola is where B and I spent both our first and second anniversary dinners. Both meals were remarkable. I could talk about the perfection of the vanilla infused salad dressing or the perfectly crisped arctic char skin or the amazing pineapple panna cotta concoction for quite a while, but I won't. (We also visited Lola the night after taking Step I of the United States Medical Licensing Exam, aka "The Boards," but I honestly don't remember that much about that meal. I was too stunned and sleep deprived to appreciate it. After we take Step II, we'll be ordering pizza and watching a low-brow movie. Anyway.)

Cleveland doesn't get much glory. We tend to choke in the final round(s) (I'm looking at you, Cavs and Indians...), so I was kind of surprised to see Cleveland come through this time. Congratulations, Chef Symon. Rock on.

Thursday, November 8, 2007

Oh, the cute

Today was my day in the newborn nursery. It basically entailed doing little, repetitive exams on perfectly healthy babies all day. Cute, but a little dull after awhile.

The cutest was this: on one baby's crib, there was a little piece of paper with child-like handwriting that said, "Hi, [baby's name]. Happy Birthday!"

That's pretty freakin' cute.

Tuesday, November 6, 2007

Day 2

I'm happy to be back. My first week is peds clinic and one day of nursery. Then on to the PICU for a week, then two weeks of peds inpatient. I felt so without purpose during research. There is nothing like a way overbooked rapid access peds clinic to cure you of that. Granted, those kids are sick, so that's not fun. Not deathly sick, but covered in germs sick. If I make it through this rotation without getting a URI or gastroenteritis, it will be amazing.

I think I'm doing a good job. It helps that I like babies (most of my patients are between 3 and 14 months) and that I'm not afraid to look in a poopy diaper. Also, it helps that the expectations are low. Basically, I'm taking lots of histories, trying to get the babies to hold still long enough to look in their ears, and handing out amoxicillin like candy. Also hydrocortisone cream. This rotation is going to teach me when to bring my own kids in to the pediatrician and when to stay far, far away. Useful.

We finally got our clinical grades today from the block that ended four months ago. I'm happy. I'm in a position where I'm still going to have to up my NBME grades (the test based part of the final grade), but I have a shot to be where I want to be. I was actually kind of scared that I might not get the grade in surgery that I thought I deserved (based on feedback I received). UH surgery has a reputation of grading people down. Anyway, either they didn't, or the powers that be scaled grades back up. So, phew... B also did very well, so we're happy.

That's about it for now. I don't really have any hilarious stories yet. And I do actually have work to do. Time to read about peds hematology. You know you're jealous.