Sunday, November 29, 2009

thanksgiving was awesome

four days in a row of not having to be at the hospital. wonderful. however, that bubble will be busted tomorrow at 4:30 am when my alarm goes off. pediatric surgery has been going well so far, all 2 days of it. i'm bringing my leftover carrot cake tomorrow for the surgery residents, and if i can get my butt off the couch i will be making some bread today as well. i should also gym since i ate an obscene amount of food the last few days. i just want to nap.

tomorrow is the last day that i will have M4s on my service. starting tuesday (december 1), i will be the only med student. aak. that means i scrub in on everything, or close to everything, and have more work to do. but that's ok. i think i can survive? only 3 weeks until christmas break! woo!

i suppose i should resist the nap urge and get up and do stuff. ugh. i want a couple more days off!

Saturday, November 21, 2009

golden weekend

just chilling. it's kind of nice. reading for fun. sleeping in. tomorrow me and H are going to a food festival a few hours away. i plan on plumping up as much as i can. woo!

some of my friends have given me excellent advice for surgery. another friend gave me some sutures and needle drivers so i can practice. i got some books too. just overall kind of nervous.

it's weird, i'm not really missing peds. maybe i will once i get into surgery more, ha, but i don't feel like i'm missing out on the fun stuff like i did once ob/gyn was over. we toured the NICU on thursday, and that is a very sad and strange place. it's weird, when i was in high school i thought i would like to be a neonatologist, but after seeing all those tiny babies and hearing that "necrotizing enterocolitis is par the course", i'm like, PASS. is it really worth it? i know i'm not a mom, and maybe that will all change if i ever have kids, but i just don't know. alas...

i saw some ob/gyn residents the other day and they remembered me and asked when i was coming back. that made me really happy. i don't think the peds residents would have been the same way with me. it just seemed like on peds the students were more of a nuisance or something. at least to me. i dunno. blah!

i'm reading "delivering doctor amelia". so far, it's interesting.

OH, the "spirit catches you and you fall down" book club meeting was really cool. the attending who is our "leader" or sponsor or whatever, she went to medical school with some of the residents depicted in the novel. she was able to give us some excellent insight. that book really just stirred a bunch of emotions in me. i found myself at various times so upset and angry, and especially angry at the two pediatric attendings at the hospital that this took place. turns out they are "awesome" people, but i dunno. it made me really angry at the medical people, and especially doctors. i guess it just made me realize that i personally need to watch myself and my thoughts because i do not want to end up being a doctor that patronizes my patients and whatnot. and i can already tell that i have to catch myself from having really jaded thoughts towards certain types of people. alas. it just all makes me confused sometimes. people in the world say that being a doctor is like being on top of the world because doctors are "rich" and "powerful" and whatever, well, there's so much pressure because you can get sued at any moment or what if you make the wrong decision or what if the patient just hates you and sabotages themselves...what then. alas. too much thinking.

i'm excited about thanksgiving. it's my favoritest holiday of the year. i'm making pumpkin pie and carrot cake for my family's house. and some cranberry shortbread cookie bars if they turn out better. prototype 1.0 turned out ok, but not to my liking. too tart, needs to be more sweet. then it will be time for mucho gymming afterwards. hope my stomach doesn't pop.

Wednesday, November 18, 2009

nursery week

this week i get to stare at babies who lay in cribs. some of them are cute. some have weirdo freakazoid parents. alas. such is life.

i saw a boy get circumcised this week. OUCH! but i will say that they did a nerve block and everything, but it did look brutal. i'm still going to circumcise all my future sons if i have any! better to do it younger rather than older, and it really does have good health benefits. but still, ouch!

today i sat through a nearly 3 hour lecture on breast feeding. it was quite informative, but maybe a bit too informative? and long? ha. i will say breast is best. the vacuum pumps though, i pumped my arm to just feel how it feels and it is WEIRD. kudos to all those breast pumping moms because to have things sucking on your boobs has got to feel very odd. but i fully recommend breast feeding over bottle, or at least trying. no bad feelings for those that breast feed and supplement with formula, because i can imagine that it is hard to keep up. if i ever have kids, i'll certainly try my darndest to breast feed for the first 6 months (what is recommended, ideally up to 1 year).

only 2 more days of peds then surgery! aah! and i have a test on friday! aaaak!

Sunday, November 15, 2009

the best book ever, or at least a very good one

the spirit catches you and you fall down. by anne fadiman.

seriously, read this book. it's about a hmong family in merced, ca, and how they interact with the local doctors, community, and also about all the warfare they've had to endure. a cultural book, very striking. the author does a terrific job conveying everything.

i just finished reading it, and wow.

just had to post this so i would remember to talk more about it later. the ethics book club meets tomorrow to talk about it, so hopefully i'll make some more comments.

now i think i'll make an apple cranberry pie.

Friday, November 13, 2009

week recap

wow, have i not really blogged in over a week?

my bad.

i've really enjoyed this week...i've been on hem/onc clinic in the mornings and in continuity clinic in the afternoons. continuity basically means well baby checks and whatnot. hem/onc is great...say what you will about it being "so sad" and whatever, but the patients are so interesting. i've seen a kid with TAR syndrome (thrombocytopenia and bilateral absent radii...basically low platelets and missing arm bones), neurofibromatosis type 1, various sickle cells, and the best yet...one of my patients that i followed post-operatively on gyn! she had a tumor removed, i followed her for a few days after her surgery, and now's she's getting chemo at the hem/onc clinic. it was so nice to be able to see how she's been doing, and she looked so good. not that she ever looked bad, but being all bundled up in a hospital bed to dressed all trendy and whatnot, it was nice. and she remembered me. that really made my day.

also, i've gotten to do 2 LUMBAR PUNCTURES this week! and they were both clear champagne taps! woo! they were on kids getting chemo in their csf due to cns relapses, sadness. but i guess for the positive spin, i LOVED doing the procedures. yesterday i did my first one, and today the second. one of the nurses in the OR commented that yesterday she couldn't believe it was my first LP since i was able to do it so quickly and smoothly. well, today i got the needle in the right spot almost immediately, the attending was surprised and was like "i gotta hurry up and draw up my meds!" and the nurse had a look of shock on her face. a "good shock" look, but it made me have the biggest shit-eating grin ever. ha. not to brag on myself, but i was so very happy that everything went so well (times two!). i may not say the right things, but i guess i make up for it with my skillzzzz...ha! but i must say, it helps when the patient is sedated and of normal weight. so i had some advantages. i can't wait to do another one! who knows when that will be, alas. you just find your bony landmarks, angle your needle correctly, and go on in...if you hit bone, pull back and just angle your needle a bit more, take out the stylet and see if you have csf flowing out, if not, push a little deeper, and BAM! there you go. simple as pie.

so yeah, this week was really good. and i got to do some procedures and look in microscopes. maybe peds hem/onc is the way to go...ha! (but i wouldn't want to steal tiny letter's specialty!) regardless, i just find myself really enjoying the hands on stuff...surgery starts in a week so who knows, maybe i'll love it.

now it's time to go get some awesome frozen yogurt! woo!

Monday, November 02, 2009

evals and f$&@ RSV!!!

so i believe i have caught a delightful case of RSV...it is the season, after all. first it started off as the "feeling of impending doom", and then a slight sore throat, then after all sorts of halloween party exposures over the weekend, the doo-doo hit the fan and BAM i was sick. i was on call sunday and you know you're sick when every time you sit down you fall asleep if not otherwise occupied with important M3-like duties. today is better...i have more energy, but the sickness has evolved into the more classic upper respiratory gunky sinus one nostril is plugged at any given time phase. i am also sneezing. and coughing. i live for those brief moments where BOTH nares are PATENT! yes. also, it sucks to have to climb up and down stairs...the children's hospital elevators are the major suck so it's quicker to just climb 4-5 flights of stairs than wait. so i've been getting my gym on at school. this is also my last week of wards, and i'm kind of excited. because that means moving on to clinic. which means no more wards. which means no CALL. which means i am happy.

peds so far has been a double edged sword in a way...i enjoy being with the kids, i really do. i like the babies, even if they make me sick. however, it really saddens me to see the abused kids, and the ex-preemies who are now trach'ed and feeding tubed and whatnot living out some sort of strange existence. i know, these kids are someone's child and they are loved and have their purpose in this world, but at the same time, on some level it just seems almost wrong. i don't want to start an ideological/philosophical war, because i have never had children or suffered through horrible chronic diseases, etc, but it just seems wrong to try and "beat nature" or surpass "God's will" and prolong life when it seems that the most humane thing would just be to let nature take its course. i have had a couple of ex-preemie kids (like extreme preemie...like 23 weekers) who have such severe neurological devastation (so they are functional vegetables), they have a tracheostomy (so they breathe through a tube, most of the time there is oxygen being pumped into the tube as well), they have feeding tubes (so they are fed through a tube that goes into their stomach or intestines)...it just really makes me sad. these folks are in and out of hospitals for seizures, pneumonias, you name it. i have no idea what that family has gone through, or the decisions they have had to make, but i can't help and think that for me and my future family, i don't know if i'd want to "do everything possible to make life happen" if i happened to deliver a child at extreme prematurity. call me selfish, but i just don't see how that is humane to that child to keep them living when there is really nothing to live for. maybe they do have hopes and dreams, but it's hard to imagine that they do when they can't even interact with the world around them.

just some thoughts i've been having on that topic.

it's kind of hard to not wrestle with those tough topics when you see the patients every day. are we really doing good? for example...kid has some crazy something going on. they can't feed by mouth for whatever reason. ok, well, they need to eat. how will they eat? let's stick in a feeding tube. that tube goes in through the abdominal wall into the stomach. uh oh...now the hole in which the tube is inserted is leaking. oh, it's leaking stomach acid. now there's a ginormous hole in the abdominal wall and all the skin around it is disintegrating because of the acid. how do we fix it? also, how does the kid get nutrition? we got to stick more holes in the body to get to a vein to give some IV fluid nutrition, but that doesn't help out too much in the long run. then all those veins get clogged, and now you have clots that are threatening to go into the heart and lungs and cause some major damage. and you still have the ginormous acid hole in the abdomen...

another example...a kid who is deaf and blind and has a whole host of other neurological problems. why is the kid that way? mom had some sort of infection while she was pregnant, and the infection crossed over the placenta into the baby and now the kid is just a living vegetable. i guess the kid only knows if people are there because of touch. what kind of existence is that? no speaking capacity, can't even move, or see or hear...it's just tough to wrestle in my mind sometimes...

ok, let's move on to something else.

i just checked out my last set of evals from ob/gyn, and i got the nicest, most uplifting evaluations from that rotation. things that said "would make a great house officer" (a.k.a. kickass resident). "above average student". "worked well with others". "hard worker". i guess it's just wonderful and incredibly validating to do your best and for your work to be acknowledged by others in a positive way. when i read some of those comments, it really gave me a good self-esteem boost, because i sure feel like i'm dragging now, and surgery is yet to be done! and i know i'm not the smartest person...i certainly get a lot of questions wrong, which sucks, and i don't know what's supposed to happen next 99% of the time, but at least i'm learning from my mistakes and people recognize that i'm a good worker. that makes me feel good about myself, and sometimes that is hard to come by when everyday in medical school is just another reminder of what you're doing wrong and of how much you just don't know and need to learn. i know, what a fatalistic way to approach life, but that's kind of how it is nowadays.

ok, i think having RSV is making me a bit too philosophical. and it's time to make dinner, which will be pancakes, eggs, and sausage because dammit, breakfast for dinner is awesome!