Home Sweet Home

It's great being back here, finally. I've seen all the fam. The kids are so big. It's been a joy just watching them play, and playing with them. The snow it pretty crazy. The tiny rental car that I have is a death trap in the snow, so that's putting a wee bit of a damper on the travel/social schedule. But really, it's been nice to just hang out with family. Patrick arrived yesterday am, on schedule. He's beginning to realize that there really are Bost traits.. I don't think he should be allowed to hang out with Nikki and Janice, they have too much inside scoop on how to manipulate Bost men...

Final Countdown

Thank god, only 3 more days to go til vacation. Honestly, I don't think I could work more than 3 more days. . . Last week really wasn't much fun. I think I'd rather stick my tongue on a frozen metal pole, repeatedly, than work this much. Looking back, I certainly can say that for the first time, I felt that I was less than professional at times. I hit a cynical low point, and at one point had to bite my tongue (I don't know why I keep coming up with ways to hurt my tongue) so that I didn't call a patient by a term normally only heard on navy vessels and at truckstops. But seriously, I had taken care of this drug seeker for a few days, and then he disrespected me. I wasn't too thrilled. . . It's been interesting to see how I deal with these times of extreme fatigue. Part of me wishes I could re-do last week to see if I could shed some of the bitterness and irritability that was pervasive.

What's keeping me going. Honestly, I can't wait to see Jordan and Ryan and Haley. It kills me that it will have been a year since I saw them. A year. A fucking year. Give me the kiddos, piper and bailey, and let me spend the days with them.

So, it's Christmas eve.. I spent a good chunk of time this evening telling a 21 year old that the reason she couldn't breathe wasn't, in fact, due to pneumonia, but rather because she has a mass in her lungs. A mass. Not a good thing. She, and her family, will wake up in the ICU on christmas day, and the ONLY THING they will be able to think is, "IS THIS CANCER?" Cancer. Is it cancer? Merry Christmas.

Jesus, it is Christmas in 30 minutes. It doesn't seem possible. I haven't seen snow this fall/winter. What's up with that? I know that you people in Denver have seen plenty of it, but I'm dying to see some of it. Snow.

I guess that's about it really. My contacts are stickying to my eyeballs. My mind wants to stay up, maybe do some work, some xmas cards, call people on the west coast. But sadly, in 7 hours I'll be headed back to work.

Honestly though, waking up on Christmas morning, alone in my apartment, isn't bad. I'm waking up healthy, maybe suffering from fatigue, but my friends, my family, and my boyfriend are all waking up healthy, and hopefully happy. Really, what else could one want for christmas??

Half Way

-one day off in the past 15 days
-one day off in the next 15 days
-an empty fridge
-topics to review
-phone calls to make
-emails to write
-a stack of unopened mail
-no time to take shirts to the dry cleaner
-why hasn't it snowed yet?
-Ireland seems like 6 months ago
-what kind of medicine do I really want to practice
-a big city, or small mountain town

I started rounding at 6am.
I am going to bed.

-B

Fucking Bitter

This is bullshit. I'm working 29 out of 31 days. I am off today, and have one day off in the next 24. What the fuck kind of bullshit is this? I went to bed at 8:30 pm last night, fucking exhausted after putting in 30 hours in 2 days. What the fuck is the purpose of having a day off? It's not enough time to do laundry, grocery shop, make calls, emails, study, let alone spend time with Patrick.

Argh! I am not a happy camper today.

Now I'm getting on-line to finish discharge summaries from the past 2 days.
b

End of November...

Which means time for a change at the hospital. I am wrapping up Adult in-patient endocrinology, and will be starting Adult General Medicine Wards. It's going to be a busy month, but am looking forward to it in a masochistic way. Going to be lots of work, but should be good learning. Sadly, I only have 2 days off until I head home, so am not going to really have much contact with the outside world. I will be in Denver Dec 28th, until the 7th.

Cheers,
Brian

Happy Thanksgiving

It's my favorite holiday. Forget all the bullshit that comes with most holidays, TG (thanksgiving) is about being with family and friends (and sadly, sometimes about working). I hate to admit it, but I'm sadly disappointed that it won't be with my family. I'll be spending with Patrick at his Dad's house in West Hartford, along with his sisters who will arrive from DC and New York, and a few other family members (totaling about 9). I'm looking forward to meeting his dad, and the one sister whom I have yet to meet, but at the same time I know that Jason and Nikki will be having their family TG in Colorado, Kevin and Karena will be having their TG in Thailand, Dad and Janice with the Bost Clan in Lockport, and that I'll be here, with Patrick and his family. Don't get me wrong, I'm excited to be with Patrick, but in my mind, I would be spending my TG meal in the company of assorted friends who don't have family here... Kind of weird, I can't really explain it. Suffice to say, that if you are reading this, then you are part of the group that I wish could all be together on TG. May you have a wonderful thanksgiving.
-Brian

Back Home

Back from Dublin. Had a grand time. Aside from reading 3 books, drinking endless coffee, tea, wine, and the savory pints of Guinness, having lunch and dinners with friends, walking aimlessly among the old stomping grounds, I didn't do much. And that's the best part. The week flew by. It was exactly what I needed, and wanted. It was great to be able to catch up in person with friends. It was great to be in the buzz of a city again. Lots of people. Lots of cafes etc...

Anyway, now back to the real world. Enjoying a bit of a slower pace at work, learning about diabetes, and other endocrine stuff. Am doing medicine night float this weekend, and that's going to be interesting..

Am keeping this brief, trying to wrap up some studying before crashing for the night.

Cheers,
B

Outta Here!

I am packed, and thrilled to be heading out of dodge for a while. More thrilled, with the thought of visiting friends whom I haven't seen in ages, and also thrilled with the thought of having down time. Time to just sit and chill, walk around an reminisce. It's going to be good..
-B

Reading Time

I just want time to read. That's the thing that I crave the most these days. I have a huge stack of magazines, a new cook book, the new Mitch Albom book plus 3 other books that I've read a few pages of, all overflowing on my night stand and the side table by my reading table. I'm making time to read. That's a lie. I'm taking a vacation to read. All I'm going to pack for my trip to Ireland next week are things to read. "What are you going to do in Ireland?" people ask with regularity. Well, honest to god I plan to spend the days in cafes reading, and the nights in pubs socializing. It'll be nice to go back to a surrogate home where there's nothing touristy to do, but really it's forced relaxation, down time to read, to chill out. Giving my brain time to recoup. Take a break from the medical world, take a break from reading about patient conditions, about ICU management (not that I ever feel like I have read enough for work), and just relax with good books. I can't wait...

Low Point...

I hit the low point on-call last night.

Things just didn't go right. I had an hour-long family meeting with hyper-attentive adult children of a 70 year old lady (I don't want to go into details, ask me in person why I NEVER WANT TO WORK WITH WHITE UPPER CLASS FUCKERS), and then got nickled-and-dimed all night long 3 pain-in-the-ass nurses (the other 7 nurses were awesome as usual) . Sorry, I usually don't speak un-highly of nurses, but last night the surgery ICU resident and myself were starting to plot revenge on a couple of nurses who were the cause of misery.

The good part: while this was the low point of the month, my initial response was not to consider quitting residency, not to throw anything, not to punch, hit, spit, nor kick, but rather to realize that I am FUCKING exhausted. Mental Fatigue. Physical Fatigue. Emotional Fatigue. And the best part is that there is this one-week mentality. When you're down to the final stretch, it's all manageable. Had I hit the low point a week ago, you can bet I would have resorted to some less than mature coping mechanisms...

Know what I can't figure out. I work "80" hours a week. I know how residents in past worked 100+ hours a week (I did work 96 hours one week last year), what kind of quality of life was there back then. What kind of lack of balance was there... Jesus, I'd be a miserable SOB if I had to work those hours for more than a month, shit more than a week or two..

So, it's almost midnight. I came home this afternoon, slept about 2 hours, then went to see the Bare Naked Ladies concert with Patrick. What a great show. We had a good time.

Ok, getting up in less than 6 hours...
Cheers,
Brian

Random Thoughts

1-End of the Golden Weekend. Been relatively relaxing. Got very intoxicated Friday night. Was worth it. Thursday night on-call was somewhat painful, with only maybe 20-30 minutes of sleep, so going out and hitting it hard on Friday was a nice release. I'm sure there are plenty of red flags in there, but... Just chilled out most of yesterday. Had dinner with some friends. Spending today trying to stay on the low-down... Have been to the gym, and am going to get outside for a while this afternoon to enjoy the gorgeous New England fall colours, but then will plan on staying in my flat chilling out..

2-ICU Month. Coming to an end. Just over a week and a half to go, 3 more calls. It's been a really good month. I think I've learned quite a bit as well. If I were going to go into a fellowship, it would be a tough competition between infectious disease and critical care. Have been taking care of two very interesting patients for most of the past week. I've spent a lot of time thinking about how aggressive I'd want to be treated if I were critically unwell. It's kind of tough to know exactly what I'd want done. I'd encourage people to think about this.

3-JP. Back on the pedi ward. Saw her briefly before I left Friday. She didn't look as bad as I'd seen her before. Her mom has made her DNR/DNI (no resuscitation), which is a decision I agree with completely.

4-Patrick. It's been a bit tough this past week or two, I've certainly had a full plate, and work is keeping him busy. I'm not sure I've been the most pleasant person to be around. We're definitely looking forward to my schedule next month when things will resemble a bit of a more normal person's schedule. I certainly am learning that relationships require a fair amount of work as well. Thankfully, we're pretty good at communicating.

That's really the bulk of my life right now. Me. Work. Dating.
B

Motions...

Some days you just feel yourself going through the motions. Not really paying attention to the finer details. You're there, but not present. Running on autopilot. That's me lately. Running on autopilot. It's the second time I have been stuck on autopilot, the last time was back in March. March was way worse though. I remember so badly needing to get away from it all then, and that's the weekend I went away, found a nice B&B and spent my golden weekend enjoying solitude. Golden weekend is when you're post-call on Friday (meaning work ends around noonish), and then you're free Saturday and Sunday. A golden weekend is GOLD. A prized possession. GOLD. Fantasies about how to spend the golden weekend crop up weeks before it arrives. Am I going away again? I fantasize about driving away, and spending Friday night in a B&B in the mountains, or on the coast. Or flying somewhere. Escaping from my current over-worked life. But then, as the time draws nearer, the work required to find a place to go, to pack, to drive all seem almost insurmountable. It's also tough to justify the cost, given that I have a real vacation in 3 weeks..

Blah. That's the scoop. It's almost 8pm, and I may be going to bed in a few minutes. Not to mention that I dozed on and off all day today while we were in the car. I've even avoided caffeine to make sure I sleep soundly tonight.

That's my story.

FALL (pt 2)

I know I already gushed about fall.. but really, it's so beautiful out. I was post call yesterday so pick up Patrick and we went for a drive to some of the smaller towns around here, and enjoyed the changing colors. The weather was just wonderful. Able to just sit outside on benches, watching people, enjoying the cloudless skies. Then today, we met a few other residents for brekky, and then went hiking, and then went for ice-cream. It's not anything like "Grey's Anatomy." Don't let them fool you, our lives are MUCH MORE BORING than on the TV show. We talk more about sleep than we do about sex. We enjoy getting a free minute and getting outdoors. Don't get me wrong, we're happy to hang out in the pub too. Anyway, I do miss Colorado.. Something about seeing the Aspens change...

ICU is not too bad. Feel like there is so much to learn, and I'm not good at making time right now to sit down and read. For example, I really haven't been home since Friday night. Here I am, home, and am exhausted. Feel like there are a ton of things to do: email, phone calls, laundry, clean, READ READ READ. I've had a movie at my apartment from BLockbuster for a MONTH NOW and haven't read it. The stack of magazines are outdated as well. Blah blah blah....

I guess that's about it really. Thinking of all the things I want to get done, I all of a sudden feel motivated to get off the computer and get some work done.

Cheers. B

ICU & JP

ICU:
I had my first overnight call in the ICU last night. Similar to my first call in the CCU last year, there was no break, up for 30 hours. Although, it wasn't really that bad, and the only thing I didn't like was being so freaking tired.. I dare even say it was nice to be able to think for myself a bit, and then be able to page my senior resident when I needed help. I'm working with a resident in my med-peds class, and we're committed to having some fun at work. Yes, it is possible to have fun in the ICU.

JP:
Ready for some fucking depressing news? We have a diagnosis. It took 5 months for this horrible disease process to wreak enough damage in her brain to show some changes on MRI, and now the disease entity has a name, JP has a diagnosis to explain what's been going on. A disease which carries a fatal prognosis-in 2-5 years. And NO QUALITY OF LIFE til then. Dear god help this mom who will lose one child tomorrow and another one in the near future.

-B

FALL

Last night was the real first fall night. Driving back from looking at the changing colors, the air was crisp. It got dark early. There was just that fall feeling in the air. A day spent buying warm clothes at the factory outlets. Having soup for dinner. Seeing the pumpkins out for sale. It all screams fall. I think everybody should do a little happy fall dance, crunch some leaves, buy a pumpkin.

Out of the PICU now. JP ended up in the PICU a few nights before I left. Not good. Diagnosis, which seemed so close, is now elusive, again. I dunno. I just don't know.

Am starting in the adult ICU. Another month of every 4th night overnight call. I'm looking forward to the month cause I am hoping to really learn a lot, and it'll be nice to have this month over in the sense that I think it will help me be better at managing certain problems when I am back on medicine wards in December.

I am definitely looking forward to November 4th, when it's off to Ireland... Going to be great to be back and see people. It's forced vacation. No touristy stuff, just hanging out, reading for pleasure, evenings in the pub catching up. The pleasure of walking places, and not being in a car..

Ok, going to do something totally unheard of, and be in BED by 10 PM!
Cheers,
B

PICU & JP

PICU-SLAMMED yesterday. Crawled into bed at 330 am, out of bed at 4am, and never made it back. Had breakfast with Amy (The Pedi Ward Senior who got us dinner at 11pm!), and the Pedi Surgery resident, who kept rubbing it in that she had gone to bed at 9pm! So, it was really hectic, a few sick kids, but overall it was a great day for learning. At one point the PICU was closed to admission cause we FILLED IT UP! Kids with trachs with chronic respiratory problems, 2 head injury kids (one who kept me up all night), hemopericardium for unknown causes, aplastic anemia and sick, lupus nephritis and hypertension. Honestly, it doesn't get better. But know what was great, at about 5am, a sense of calm settled over the PICU. The guy with the really bad head injury started to settle down, the girl with the really bad fever started to look a bit better, the girl with really bad hypertension seemed to finally settle down, the kid who had the stroke was awake and talking (although he has lost his vision). And at 5am, there was a little joy, in knowing that kids were better. A few would be transferred out of the PICU, a few would go home. It was also good cause I got to finally think on my own, learned quite a bit as well..

JP... JP is a kid slightly less than a year old whom I have taken care of in July on the pedi ward and again earlier this month in the PICU. She is "my girl." I know this kid well, think about her regularly when she's not in the hospital, get updates regularly from her specialists. She is chronically unwell. If you saw her in the grocery store, you'd think she was maybe 3 months old. When I was in the ED last night I saw her down there , and my heart sunk. (She almost came to the PICU, but ended up on the floor where she was almost constantly observed by us neurotic residents and nurses who care about this precious girl). I can't even describe how shitty this situation is. Nobody knows why this kids is sick, some metabolic/genetic/endocrine disorder. Talking to mom last night (who just learned that her pregnancy is going to be terminated due to a non-viable fetus) she broke down and has finally realized that JP is not going to make it. My gut feeling changed yesterday too, and I don't think JP is going to make it. I'm convinced that we're slowly watching her die. And while I think it is horrible for me to watch her die, it breaks my fucking heart to watch her mom who knows that she's losing 2 kids. I can't even imagine...

PICU Part Two

2:30 am. just finished tucking in the kid I just admitted. interesting day. Like running a neurosurgical service. broken heads today. bleeds in the brains. two 20 y/o girls, and now a 2 year old boy. girls were preventable. bike helmets are a good thing. not driving drunk is a good thing. having a 2 year old with a brain mass is not a good thing. nice people today. great nurses. It's been a pretty decent month. I hate to complain cause on the one hand i know that next month is going to kick my ass (when I'm in the Adult ICU working more hours than any human should), whereas this month the work has been actually mellow, but I don't think I'm learning as much as I had hoped. partly my fully, of course, haven't really had the time/motivation to read much outside of work.

Anyway, life is really good right now. It's going to be a crazy few month (on-call 3 of the next 4 months), with a vacation to Ireland, and then home for New Years.

Ok, going to get some much needed precious sleep now. Oh, funny thing, we had a lecture on sleep deprivation earlier in the week, would have been nice had they allowed us to take a nap instead of going to a conference on sleep deprivation.

Neurotic Friends

First of all, I'm the neurotic friend. Well, that's a total lie, cause "birds of a feather..." yeah, you know the rest of the saying. However, as of late, I'd just like to thank my friends for putting up with my neurotic issues (life, love, and the pursuit of happiness), cause god love the people who I have called multiple times to hash out a few things going on in my life recently. You know who you are, and all I can say is thanks. And I might add that I listened, for once. This post won't make sense to many of you at this time. C'est La Vie.
-BPB

Mountains Beyond Mountains

I had the chance tonight to hear one of my heroes speak. Maybe "Mentor-By-Proxy" is a better term. If I've never tried to convince you to read the book Mountains Beyond Mountains about the work of Paul Farmer, have a look at THIS SITE on the group Partners in Health and find a copy of the book (or come visit me and read mine). It's a medically oriented book, but everybody I know who is non-medical has been inspired. So really, drop the smut novel, and read some real chicken soup for mankind kind of book. Really, trust me on this one... PICU is good. My favorite kiddo got transferred to the pedi ward today. Will miss seeing her, but will keep tabs on her.

g'night, it's very late.
B

PICU Part One

So, had my first overnight PICU call (they are all going to be overnight by the way) last night, and, um, I hate to admit it, but I wore the lucky socks, AND THEY WORKED! I actually didn't have a single admission, and went to bed and didn't get called til 0530! Amazing. Granted, I'm sure that means I'm going to get nailed on the next call, but that's ok.. It's certainly nice to be engaging my brain again.

I'm taking care of one of the kiddos I took care of in July. It's tough cause I was pretty worried about this kiddo in July, she's failing to grow, failing to reach milestones, has had a pretty thorough work up this far, and nothing is coming up. It's tough. And let me tell you, her mom is a Saint. It kills me each day when I have to tell her that we still don't know what's going on. FOR TWO MONTHS!

Ok, I need to get some reading done...

Cheers,
B

End of the Month

Tomorrow is switch day. I'll be starting in the Pediatric ICU in the morning. I will miss the slack pace of this month, but at the same time am looking forward to using my brain a bit more. Should be a good month for learning...

Roller coaster and forbidden fruit...

The past week has been a series of ups and downs, regarding one issue. Where I live. I am going to go on record and finally just plain admit that I do not love living here. It's not bad, well all that bad. In fact, many people are happy living here. The forbidden fruit was my trip to Seattle, where I spent the past four or five days for a friend's wedding, and also to visit another friend. Seattle, Ahhh. Coffee- everywhere! Healthy people running! CULTURE! Open and welcoming people! Fashion. Shopping. Everything that I seem to be missing from here, I was able to find in Seattle. It was heaven, but also painful cause I realized what I miss...

I'm not sure where I would be happy living right now. Maybe a big city. Maybe a smaller city with good mountains at my doorstep. Definitely somewhere with places to hang out-chilling having coffee.

I've come up with various strategies to keep me happy for the duration of my time here, or at least for the meantime. One strategy has been a bit of a make-over of the apartment. Bought some plants today, a few odds and ends (courtesy of a pottery barn gift certificate-thanks J&N), and some photo frames to mount on the wall. Part of this is philosophical, getting myself to believe that I will, in fact, be living here for 3 more years, and that actually coming to terms with the fact that my apartment is way more comfortable to hang out in than the lame-ass coffee places around hear, so am taking some time to make this a Home. Big "H" noted.

September and October are going to fly by, I start in the Pedi ICU on Friday, call on Sunday. It's going to be time to get back to the books, and I'm going to be ready for it.

Ok-time to hit the gym.
B

Tea Time & Driving

One of the things that I realized tonight that I miss about living in Dublin is having people over for tea. Pretty simple. Come over, brew some tea, and chat. It was easy in Dublin because people lived so close to one another. There was no need to spend half an hour driving to get to someone's flat. That brings up the other issue: Driving. I dropped off the liberty to the auto body shop this morning (to fix the dent that I made while four wheeling back in May). So, I've been without a car for the whole day, which has actually been kind of liberating. Liberating not having the liberty-pun kind of intended. I'm kind of sick a driving everywhere. Want to know what's gross, I have almost 21000 miles on the liberty, ALREADY. Where to feck have I driven? Sure, some long trips here and there, but most of that driving has been just driving around finding places to have coffee or to meet up with friends. When really,I am sure it would be more pleasurable to hang out in my own flat, drinking my own coffee with friends, and saving a few bob here and there... Just a passing thought.

Vacation starts Saturday morning. Thank God!

The Speed of Trees and Johnny K

The Speed of Trees: Ellis Paul is a musician that I have been recently listening to. I highly recommend that you check out his CD “The Speed of Trees .” It was suggested to me by a friend who lives in a small Colorado mountain in town. Johnny K is a through hiker on the Appalachian Trail (AT), That I met a little over a week ago during an overnight backpack trip.

How do these two things relate? I decided that I desperately needed to get into the mountains for a little down time. I was still trying to recover from the insanity of July. So I took a Friday afternoon off, packed up my backpack, and hit the AT. I hiked 9 miles (a fucking tough 9 miles I might add) and camped at a backcountry campground that was populated with AT through hikers. I was listening to Ellis Paul on the way to the trailhead and as I was hiking along I kept thinking of the title of the CD, “The Speed of Trees,” and how I have been so caught up in my daily resident life that I was missing out on the speed of the trees. Meaning, that in the blink of an eye, I realize that it was already mid August and I had yet to go backpacking/camping or even hiking. And that if I didn't make it a priority to spend some more time outdoors, before I know it, I would miss seeing the trees change colors in the fall. And let me tell you about Johnny K. 45, ex-Marine, decided he would hike the entire Appalachian trail this summer. Johnny K didn't just give me pieces of lightweight backpacking advice, but also suggested I slow down and spend more time hiking. Of course I gave him some advice to basically to take care of the healing wound on his ankle.

Daily Grind: it has taken me a bit of time to recover from July. Looking back, I think that July was much more difficult than I had anticipated it would be. The transition from intern to “senior” resident was a bit of a bigger jump than I thought it would be. So I was responsible for supervising both an intern and a medical student. It was pleasurable teaching for the first few weeks but when things were busy teaching was the first thing that was dropped, and it probably should not have it. Also, I realized that I am not good at delegating. I often found it easier to just to do the work myself than to delegate it to the intern or medical student. When my team was on call, I was also the pediatric admit resident which meant that all pediatric patients admitted to the wards came through me. Which means that more than once I found myself stuck on the phone for insane periods of time trying to coordinate admissions to the hospital. This month, I am doing pediatric outpatient surgery clinic. It is fairly relaxed. I have a week of vacation starting Saturday and am looking forward to my time off, as well as looking forward to seeing dad and Janice. September and October will be fairly busy as I am in the pediatric ICU in September and then the adult ICU in October.

My Home: I don't think that I am settling in here as well as I thought I would. I find that I really wish there were better (taller, more mountanous) mountains close by (part of why I don't go hiking as much as I could/should). At this point, I feel fairly certain that I will be leaving this area after residency.

After Residency… kind of the million-dollar question, or the future job du jour. Some days I see myself spending a year or two in the Indian health service, some days I see myself settling down in a bigger city (Denver, Chicago, New York, Seattle, San Francisco), some days I see myself doing three month locum tenems jobs. All I know at this point is that I am fairly certain I will be staying in primary care, providing care for both children and adults (and the occasional geriatric patients, ie, dad and Janice).

So, there you have it for now. I leave you with this quote to think about:

“Everyone who is born holds dual citizenship, in the kingdom of the well and the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place."-Susan Sontag-

Rocky Mountain High

I'm missing Colorado. More than I have previously, when I was even farther away. Perhaps it is because I had thought that once I was back in the US, it would be easy to make weekend trips back to Colorado. I mean really, Dublin to Denver was a long commute, so surely from where I am now to Denver should be quick. But sadly, there is no non-stop flight, and the length of travel (plus the outrageous ticket prices) has kept me from making a quick trip home. And it's killing me that when I get pictures from home I can't tell which nephew is which. I also really miss being able to make a quick day trip up to Georgetown, Breck, wherever. This morning I was surfing on the web looking at maybe trying to do a month elective in a small Colorado town ( I won't tell you which, but it is perhaps the most perfect place on earth), and it didn't look like there was a pediatrician in the town. A few fam pracs, but no pedi doc?? Outrageous!

So, I don't know what I'm going to do. I don't think I can wait til New Years to make it back. Anybody got a leer jet I can borrow?

On another note, I was on call Friday night. My first full call shift (there is an overnight float senior resident except for Friday and Saturday night). It was pretty decent, busy. 7 admission or so. Cool kids, cool parents. I didn't even seen the call room, but that didn't bother me.

In some ways, it has been a weird month. We've seen 2 incredibly rare cancers in kids, both kids should be ok. Both are likely to end up as published case reports, especially since one kiddo is the youngest patient ever to receive this certain chemo drug. Again, cool kids, cool parents.

Anyway, should be going to bed. Slept on and off yesterday post call, and took a nice nap this evening, so my sleep schedule is all off... c'est la vie.

By the Numbers

3-the number of e-mails I have received today from people I haven't heard from in years.

9-the number of admissions I had last Thursday to the pediatric team which I am managing.

2- the number on interns I was over-seeing last week.

8.5-the number of extra hours I worked due to the nine admissions

1-the number of brilliant diagnoses I was able to make the last week purely by accident

2-the number of naps I took on Saturday because I was so tired

0-the number of miles I hike last weekend, the weekend I was going to go for a two night backpack trip

3-the number of nieces and nephews I haven't seen in six months

635-the amount of money it would have cost me to fly to Denver last weekend had I booked my ticket on Tuesday

2-the number of discharge summaries I have not completed from this month

5-the number of cups of coffee I had today

2-the number of alcoholic drinks I had last week

5.5-the number of hours of sleep I would to get if I fell asleep right now until I need to get up for work in the morning

24-the rough estimate of the number of people I wish I could get around to e-mailing

7-the number of unscheduled vacation days that I have available

73-the number of times I was paged last Thursday

374-the number of days I have been a doctor

2-the number of times I seriously considered moving to a small mountain town and changing my identity

3-the number of hours worth of work I feel I would like to get done tonight

5-the number of conditions I listed that I wanted to read about

Fresh Coffee...

I had the freshest cup of coffee about an hour ago. Not fresh meaning that it was brewed this morning (which it was), but fresh meeting that I roasted the beans myself last night. It's like when speed addicts start making their own methamphetamines in their own kitchen... I roasted some Bolivian beans which were imported by a Bolivian company with offices in Bolivia and Massachusetts. (The beans are certified fair trade and organic). Good stuff. This is the start of a lovely new experiment in life.

The doc's advice: do something near and exciting this weekend.

Alive and Well & "What do I know now that I didn't know a year ago?"

Hey there, I am alive and well. I don't know what I have been up to recently but just haven't really felt motivated to jump on here to give any exciting updates...

I finished up my medicine ward month on June 3rd. It was nice to finish up on the wards, however, it is always bittersweet because when I left, I was giving up the right to continue taking care of three patients whom I greatly enjoyed. That doesn't mean that I have not poked in to say hi to them, and in fact, the one patient who I diagnosed with septic pulmonary emboli will actually be getting me as her primary care physician. It's exciting because she has done remarkably well. And by remarkably well, I mean being hospitalized has given her a chance to get off of heroin and to reconnect with some of her family. I am actually quite excited for her because she is doing so well. The other patient was one of my most favorite to patients so far. She was discharged to a rehab facility, and I have plans to go meet up with her and her husband for tea at some point. The last patient was discharged out of the hospital yesterday, and should have an uneventful course from here.

I have also just recently finished two weeks of geriatric medicine. (No, dad, not so that I can take care of you some day). It was pretty helpful, but, two weeks was not enough. It's kind of like pediatrics in a way. People fall and get hurt. People lose control of their bowels and bladder. Drugs which do well for adults cannot be used as easily in the elderly. It was also interesting going to a rehab facility for two afternoons, and to see the amazing work that is done on that end. My interest in the geriatric/rehab aspect is that I'm sure some day I will not have the luxury of having a geriatrician or rehab Doc to help me manage these patients.

I'm in clinic for the next two weeks. I have mixed feelings about clinic. I enjoy the patients we take care of, but the clinic itself can be a bit of a pain in the ass!

I have a few projects working at this point and was hoping to use this weekend to get caught up on them. I'm working on getting my international health track going at hospital, with the target date too start July 1st, 2007. I'm also trying to organize the immense amount of paperwork and articles and reading materials that I seem to have accumulated over the past year. I was half tempted to just throw the stack away and start all over.

Speaking of starting all over, I cannot believe that a year of residency is almost over!!!!!!!!!! HOLY SHIT! What do I know now that I didn't know a year ago? I'm sure I have learned a lot, but ask me to name one specific detail and my mind goes utterly blank. Utterly blank. Utterly blank! You see, when I try to think about what I have learned in the past year, all that comes to mind is how much I still need to learn. For example, this July 1, I find myself again on the pediatric ward. Last July 1, anytime I had a question, I was able to ask my senior resident and get the answer. This July 1, I am that senior resident. What is really different from a year ago? I guess what is really different days that this year I am more confident. I suspect I do know a hell of a lot more than I did a year ago...

Three Days and Counting...

Three days left. Including call tomorrow. It's kind of the home stretch now. I've hit that point where it does not matter how tired I am because the end is in sight, and no matter how bad call could be tomorrow, come Friday afternoon, I am a free man! I kind of dreaded seeing my attending today. I knew that after the way things ended on Friday, I was not going to have warm fuzzy feelings for her. But again, the end is in sight. And I didn't have warm fuzzy feelings for her. It kind of sucks, because I think she's a good doctor, and I know she wants us to become a doctors, but her constant criticisms have just left me a bit annoyed with the entire month.

Miserable fucking day, Part 2

So, I have this bad habit of logging in to the hospital computer from home to check up on my patients. Before I left this afternoon, my attending was grilling me on why I ordered a CT angiogram on a patient of mine this morning. I defended my actions to her, but could tell that she wasn't too impressed that I had ordered a test which will probably cost the hospital a few thousand dollars. At 7 a.m., when I ordered the test, I knew I would have to defend my actions. This patient, has been complaining of a pain, and we haven't found and the source. The pain is not due to kidney stones, nor due to a kidney infection, so based on the fact that she uses injection drugs, I was worried about disease in the lung. I figured she had a lung infection which hadn't shown up on a normal chest x-ray. So I ordered the CT angiogram, cognizant of the fact that this patient doesn't have insurance.

And guess what, it shows that she has multiple tiny infections in the lung. The best part, is that they called my attending with the results. I wish I could have been there to seen her face when she found out that the test, which she criticized, had proven exactly what I was looking for.

Intern =1, Attending =0

And like that, all of a sudden, my confidence is right back to where it was before this downward spiral began.

A miserable fucking day

It's just been one of those days. Where the work is good, but the overall experience has just fucking sucked. Actually, this all began yesterday. Yesterday, my co-intern said "this could be the day I quit residency." I thought he was being a bit dramatic. Today, I said "this could be the day I quit residency or rather this residency." I know I was being dramatic. But is it funny, how when you're just stressed out, quitting seems like a good option. Let me explain...

At five o'clock last night, I met with my attending doctor. It had already been a trying day. First off, by five o'clock I should have already signed out and been at home. At 5 p.m., my attending gave me about another hour's worth of tasks that she felt needed to be done. So of course, I did them. Even though they could have waited till today. At six o'clock, I signed out to my co-intern (who thankfully hadn't quit). I then spent two hours with a patient and his family trying to figure out why he wasn't getting better. I left at eight. Four hours past when I should have left.

This morning I started at 6 a.m. By 8 a.m., Molly (our medical student), and I were telling a patient that he has esophageal cancer. A few minutes later, I ran into my attending doctor, and that is when the day began to turn sour. She hasn't been happy lately, and made it clear that today wasn't going to be an exception. To make matters worse, she informed me we would meet this afternoon. To make matters even more worse, she wasn't pleased to hear that my senior resident was getting me out early this afternoon. And so, knowing that in the afternoon we would have a confrontation, I spent most of the morning trying to figure out what the fuck her problem is. Our team has been working well over the number of hours we should be working, discharging patients quicker than other teams, and still she constantly has issues for me and my co-intern. Which is why, I had a miserable fucking day thinking about where I'd rather be than where I was.

How did my day end? Instead of leaving at one, I left at three. Surprise. Surprise. Surprise. And, that was after being berated for 20 minutes about things that happened yesterday, and things that hadn't been done today. Being a resident can just fucking suck.

Thank God, only one more week of medicine wards

More thoughts on the liberty

Today is my day off. I've decided to use these days off this month (all four of them) to have some fun in life. So today I was going to go hiking. Unfortunately, it's been passing rain for days now. Rain brings mud, a chance for dirtying up the liberty. So instead of going hiking, I went four-wheeling. My goal was to get mud on the top of the liberty. I was successful. Unfortunately, the liberty now has a wee bit of a scratch. Well, not a scratch really. Actually, after the bump I took I'm pretty happy that it's just a scratch. Some of the moulding is a little bit looser, that was earlier in the day. I'm pretty sure it's something that can be fixed fairly easily. I'm proud of the liberty, she handled like a charm...

anyways, it's probably time to go ahead and get busy on the things I really need to get done on my one day off this week. Grocery shopping laundry, etc. etc. etc.

hope you had a nice weekend!

Cheers,

Brian

New toys...

So, it's pretty amazing what you can do to justify buying a things. Let me explain. The thing I really dislike most about my job, it's all the damn paperwork. So, in my quest to reduce the amount of paperwork that have to do on a regular basis, or at least to make it more fun and interesting, I've decided to buy new toys. For example, tonight instead of using the boring keyboard to put this in I'm using my voice recognition software. How did I justify this purchase? Let me tell you..

Whenever someone leaves the hospital, we do this painful process of documenting their entire stay of the hospital with the premise that someone actually reads the pages long of babble that write. So, since I've been spending in oh at least an hour every night working on these summaries, and while I'm not the slowest type or the world, nor the fastest, I've justified buying some voice recognition software. And basically, you are my guinea pigs. Kidding!

So, tonight I'm working on my discharge summaries by dictating them at home. I'm hoping that, while it may not speed up the process, it will at least distract me from the pain associated with doing these damn discharge summaries. There's more though. Did you also know that they make SD cards, which are also jump drives? What this means, essentially, is that the discharge summaries that I start tonight, I will carry around in my palm pilot tomorrow, and update them periodically throughout the day. And as patients get discharged. I merely take the S D card of my palm pilot, plug it into a computer and boom I can get the patient discharged.

Tomorrow is my day to round. It should be a short day, theoretically. In at 8 a.m., and if all goes well, out the door by 2 p.m. That being said, realistically, I know will probably be 3 or 4 p.m.

Anyways, now it's time to put this new toy to work, and crank out some of those damn discharge summaries.

Cheers, Brian

A Million Thoughts...

Are running through my mind. It's monday night, 9:15 and I'm basically sitting here paralyzed. I want to go to the gym. I want to go grocery shopping. I want to read about my patient's conditions. I need to start writing the discharge summaries for my patients. I want to get caught up on email. I want to get caught up on talking to family. I really want to get caught up on sleep!

I hoped that a cup of coffee would start a nuclear reaction of energy and that somehow, I'd find the energy to do something from the above list. And nada..

Work is busy. Busy, blah blah blah. But it's good. I find I set myself up for this dilemma every day. We're suppose to work 7am to 4pm. "suppose to." Today was 6:30 am. I was hoping to make it out of there by 4pm today (so I could get some of the above errands done). Realistically I knew it would be 6pm. But shit, again there was a patient to be discharge at the last minute. And then I wanted to go check up on 2 patients before I left for then night. I left late.

It's not really a big deal, except that I had expectations to get some stuff done this evening. Which is why it is now 9:30, and I can't even figure out where to start.

Today was a pretty good reality check. Just when things seem to be clicking along great, feeling pretty confident that I've learned a lot so far, wham-O! Very complicated patient. A fantastic patient who I totally adore, who is a bit sick. I admitted her last night. At first it seemed kind of straight forward when the call came from the ED. Pneumonia. Simple stuff. But then when I met the patient and got the story and looked at her preliminary labs, the simplicity quickly faded. My current reference frame for seeing patients is "in 3 years and 2 months (yikes), I may very well be working out in the boonies and what would I do in this situation." Usually that forces me to think things through and things start falling into place. Last night, though, ll I could come up with was: Better get the hematologist to tell me what the hell is going on! And as I headed home last night, I was determined to put on my detective hat look up some of the abnormalities, and figure out what was going on... But I was just too tired to muster the strength to open my "Harrison's Principles of Internal Medicine." I'm not going to read tonight either...

B

March of the Jeep Liberty

Have you seen March of the Penguins? There's this part where the penguins essentially call out for their mates and kids. Last night in the parking lot, when I could not for the life of me remember where I parked, I had to walk around pushing my automatic lock button waiting to hear the Liberty beckon me to her!

Back on med wards.. I think I had forgotten how busy med wards is.. But, that's not necessarily a bad thing. I no longer get that "oh God, now what" feeling when my pager goes off. It doesn't freak me out that I have patients to discharge and at the same time others waiting to be admitted. I think this is going to be a great month to learn and improve my skills.

So the earliest we can sign out on non-call days is 4pm. I think I'm just going to resign myself to planning on leaving at 6pm every night (which actually means It'll be more like 7pm). I had a discussion with a co-intern in my program today. We both have a reputation for being there late. And we discussed how it seems to be that other interns leave at 4pm. Granted, it is quite possible that we're both just slow. Rather, we concluded that enjoying the best part of our job (actually talking with patients and families), means that we're in the hospital later. I'm pretty sure I could have dodged out of there at 6pm (instead of 7:30), but that would have meant not going around to peek in on everybody this evening, and leaving a few loose ends for the on-call intern to deal with.. As we were getting ready to leave, there were 2 senior residents who, likewise, were not on call, and who were leaving damn late. They are in our program. What do I like best about the residents in our program? We care for our patients. This brings me back to the Time article (see previous post). Personally, their fucking slant against residents pisses me off, and quite frankly, they can fuck off. (Although I did sign out for a subscription to fight my cultural ignorance). So, it's almost 10 pm, I had a quick bite after popping in to the gym briefly, and now I'm going to spend at least an hour on the computer working on discharge summaries for patients who are hopefully going to go home tomorrow. (Again, fuck off Time).

I suspect I'll be Marching for the Jeep Liberty again soon.

Cheers,
B

Prilosec (Omeprazole)... Taco Bell... Med Wards... Time Magazine...

So, Saturday was our monthly intern gathering. (Once a month we have an intern retreat, so we get together as a group and socialize). On the way to our hiking destination the 3 of us in the car were chatting. This is the summary of part of the conversation. One of my peers has recently started taking omeprazole as well! Here I am, trying to hide the fact that I'm self-treating some GI upset issues and come to find out that 3 of the 7 of us are all on PPIs, as well as quite a few other residents in our program! Even more shocking, this intern has also had to QUIT COFFEE!! Woah there, lets not get all crazy! Come on, I pop those little pills in the morning so my stomach can tolerate the coffee!

Anyway, Saturday was outstanding. Amazingly, we were all off on Saturday. So we had a lovely hike, followed by dinner, followed by dessert, followed by drinks in this tiny bar with 2 guys playing what I learned was Americana music. Good times. We have a great intern group!

This is my last free weekend til sometime in June, so it's been a nice lazy weekend. I was also out Friday night, which, ended up at Taco Bell at 3am. Wow, haven't been to Taco Bell in prob 2 year?? Suspect it'll be another 2 years as well.

Blah blah blah, blah blah blah.

Oh, so this is cool. When I was having dinner with J&J on Friday, they had this great candle burning, that sounds like a "crackling fire." So, I had to get one of those today as well. Cool stuff.

That's really about it for now. I'm starting med wards on Wednesday. Aside from the 6 days a week, I'm actually kind of looking forward to it this time around... Speaking of medicine, the new issue of TIME has an article about medicine, and I'm not the biggest fan of time, but a part of this story caught my eye, and that part was a slam against residents.. I have only read the first part of the article, so I'm deferring final comments til later...

Alright, should probably get some sleep...

How I spent my morning...

I wish it was laying in bed, reading the paper and listening to NPR while my servant brought me a french press and fresh fruit and a warm scone. Really, that would have been preferable.

When, in reality, this is how it went... I was laying in bed, wondering if the woman who paged me at 11:30 last night was in fact having a heart attack, or was in just indigestion. While eating my oatmeal for brekky, I logged on to work and decided to do some follow-up. I had told her to go to the ER to be seen. Shockingly, there was no record of her being in the ED last night. Well, maybe she went to the private hospital down the street. While I was there at the computer, I decided to follow up on another patient...

So I got a call from a mom at 6:30 last night. She was concerned that her child may have been harmed, intentionally. I was concerned that her child was harmed, intentionally. We talked for probably 10 minutes on why she needed to take her child to the ED to be seen by a pediatrician, and she was in complete agreement. So, shockingly, that child also wasn't seen in the ED last night. ARGH! So, had she gone to the ED last night, at bare minimum, the child would have been evaluated by the pedi res/doc, who could have gotten the story better than I did over the phone, and they would have all the info needed to involve social services, and maybe the police. However, since she didn't show up to the ED, and since I'm a "mandatory reporter" the fact that I have concerns about the welfare of this child means that this morning I had to try to reach this mother, and when I failed at doing that, I had to call social services and pass on what paltry information I did have. 2 hours of phone calls and forms. The mom isn't answering her phone... And all I can think about is if this kid is ok...

Cruising on autopilot & Next Year's Schedule

Kind of going through the motions more than anything these days. Which I think is ok. There really isn't that much going on, and try as I might, I can't bring myself to get extra projects done.. I'm suppose to be doing this 2 week elective in radiology, interventional radiology. 2 days would have been plenty, 2 weeks is just damn painful. I kind of just float around the radiology department popping in here and there to observe. Well, ok, not just the radiology department. I did manage to pop into Costco and then the grocery store yesterday, and then popped home and to the gym. I justified it on the basis that after 39 hours of work responsibility, I was free to go...

So, I had these grandiose plans to come home and read up on some nagging topics (what is the outcome in lichen planus), do some practice questions for my next board exam, read a few journals. Yeah, I took a nice nap, instead...

This is my free weekend, the last one til June. Does it seem ridiculous that I was going to go away this weekend? I was torn between driving somewhere (Philly, Burlington, Montreal, NY), or backpacking. Instead I'm going to chill out this weekend and get caught up on social engagements.

My Schedule (including vacations)

May-medicine wards (6 days a week, don't expect to see much of me)
June-2 weeks geriatrics, 2 weeks ambulatory (2 weeks of jeopardy call)
July-Pedi Ward (as a senior resident-pretty crazy)
August-Pedi Surg (vacation #1 to HG's wedding)
Sept-Pedi ICU
Oct-Adult ICU (hence, long stretch!!!!)
Nov-Going to Ireland the first week
Nov-Elective
Dec-Medicine Wards (prob home new years)
Jan-Pedi development
Feb-Neonatal ICU
March-Indian Health Service (Arizona/New Mexico Border)
April-first week vacation in Denver
April-Adult ED
May-Medicine Wards
June-1 week night float, 3 weeks community medicine

Subject to change at will...

Cheers,
B

Married to my pager...

I've been married to my pager since 9pm last night, and am married to it until at least 8am. Lemme think.. so that's like 37 hours. Let me explain...

So last night and Friday night I was the overnight intern, which means I went to work at 9pm and then the other medicine residents signed out their patients to me. I was covering somewhere around 70 to 80 patients. Those night went well. Even managed to get a bit of sleep Friday during the night.. I finished at 8:30 this am.

But, since 8 am I have been the on-call doc for clinic patients. Pretty chill today as well, but means I need to be available to call people back..


Things I miss about Dublin (yes, there are some things).
-It is raining today. It's the perfect day to spend it indoors (obviously) having friends over for tea and conversation. I don't know why that doesn't really happen here. Maybe it's because aside from J & J, my friends are co-residents. When you're working gobs, it's kind of tough to make spontaneous coffee hanging out things happen. Maybe that's a bullshit excuse. I dunno.

What I do know, is that since I'm on call today, and when I found out it was going to rain all day, I decided that this would be the perfect day to stay home and finish some house chores, including organizing my books so I can hopefully start being a bit more productive in my study habits..

I'm more inclined to sip coffee and think about tea with friends in Dublin.

Speaking of Dublin.. possible trip to Dublin in November.. shhh! I'm keeping it quiet til I know for sure.

Cheers,
B

Springtime...

Nice day today. Amazingly got out of clinic by 5:30 pm. A record! I even cleared out all the charts and mounting paperwork in my box. Form. Refills. The part of my job that I loathe! Paperwork.

The days are getting longer. Green is making a comeback in the outside world...

Work hasn't been too shabby the past few days. I'm bopping around in the radiology department trying to get a bit of a scoop on what really goes on when we sent people down for special tests...

I'm on "night float" this weekend. Maybe I have mentioned this elsewhere... Night Float, so when I show up Friday and Saturday night, I get to be the lucky intern to cover all the house medical patients... Should be fun fun fun. So, will be sleeping all day Saturday.. And then Sunday during the day I am on clinic call, so will be available by phone to the clinic patients.

Can't believe only 2 months left of internship...

Cheers,
B

Lima Taxi

Taxi #1: from the airport. the hotel was suppose to send me a taxi to pick me up. it never showed. got my own taxi. haggled a price to what the hotel said they would charge. taxi driver wants to take me to another hotel. no thanks i say, i have a reservation at this place. he keeps pestering me to change hotels. i suspect he has a connection at the other place. end up at the hotel i booked.

Taxi #2: going into central lima yesterday. young looking kid driving. i get his life story in a matter of minutes. married 8 months and hating married life. he has "a few" other girlfriends on the side. reading between the lines i think he´s trying to find out if i want a hooker. when he points out the hookers on the steet 5 minutes later, i confirm my suspicions.

Taxi #3: leaving central lima yesterday. almost get into a minor fender bender. will, it may have not been all that minor since the taxi i was in would have held up as great as aluminum foil. traxi drier races ahead and yells obscenities at the other taxi driver. this goes on for 5 minutes over the couse of a few stop lights.

Wanna have fun in lima? take a taxi.

Holy Friday... most things are closed. i was crushed to find out that the starbucks where i was going to spend most of the day is closed. damn.

back to the us tonight.

from lima,
B

Hi From Lima!

Wow, lots to mention ..

arriving in lima. sleeping in the airport. flying to puno the next morning. walking around that day in puno, trying like mad to remember basic spanish, taking in all the sights, smells. feeling great to be somewhere new and exciting. walking around getting lost. taking an afternoon tour to the burial area of sillustani. back to trown. finding the local market and walking around at dusk buying local fruits. waking at 6am for desayuna, bread and jam, yoghurt with quinoa (this awesome grain with huge protein content). taking the boat out on lago titicaca (lake titicaca) to Los Islas Flotantes (the Uros Islands). amazed that these FLOATING islands are man-made, last 30 years, and some 2000 people live on the 35 islands. continuing on to the island of taquilli. nice hike in the sun, boat back to puno. spening the evening eating at one of the local food stalls (dinner cost me 60 CENTS) chatting with random stranges, not seeing any other tourists. Taking a 6 hour bus ride to Cuzco the next day, stopping along the way at local markets. Arriving in cuzco, meeting up with susanna. cuzco is much pretier than puno, but far more touristy as well. no blending in here, look non-peruvian and you´re approached constantly. spending the next day walking to 4 inca rouins, including ¨sexy woman¨among others. meeting that night with the tour group for the inca trail. the inca trail. what to say about the inca trail. i´ll summarize the inca trail in a separate blog to do it justice. beautiful. hard. amazing. diverted through aguas caliente due to mud slide, waking at 4 am to head to Machu Picchu. i´ve seen it in pictures, but in person, it´s just amazing. back to cuzco last night. had been fighting some kind of GI upset on and off for days, thought it was related to food, not sure. finally started cipro last night, didn´t eat for 24 hours, and can finally eat today. i am officially giving up beef for life. in lima today. exhausted. have been getting up anywhere from 4am to 6 am the entire trip. wandered around miraflores section on lima a it today. found 2 starbucks!! sick, i know. along the beach, elevated on a cliff, starting to read ¨The spirit catches you and you fall down.¨ last too tired to go into central lima and be a tourist today. just need a bit more down time. . .

Impressions:
1) poverty sucks
2) i like being outside of america, and i can´t explain why, and am not sure i need to
3) when on the inca trail, don´t look at how steep the trail is, just focus on the next step
4) i have a lot more material shit than i need in life
5) manners have gone by the wayside in the US.


i´m too tired to proof this, the web page is in spanish, and i don´t want to delete the thing by trying the spellcheck...

From Lima,
Brian

Leaving...

I am headed for the airport. Yesterday was beautiful! Sunny. Went running outside. Had coffee at Starbucks. And then finally got around to packing last night..

Will try to drop a blog or two from Peru.

Til Then-

Cheers

The Countdown...

Has begun.

All day long, I kept thinking: One week from now. One week from now. On a plane to Peru. I don't think I'm going on vacation so much as I think I am escaping my current situation.

I don't mean to make it sounds all bad, but the past 2 weeks have just fucking sucked. I can't even sugar coat it for myself, let alone for you. Every 4th night for the past 2 months I have been on call. I have not worked less than 90 hours a week the past month.

I don't recall the last time I cooked an actual meal (I live off of oatmeal, yoghurt, cottage cheese, fruit, and a ton of fucking coffee!). I haven't written a proper email in months. Sometimes I can't even remember what I did 2 days ago.

I knew this was going to be the worst part of this year. I knew that 2 months of back-to-back call, let alone pediatrics in the busy season, was going to be tough. What has made this unbelievably tough was the recent death of my closest friend in residency. And that fucking sucks!

One more week...

Keeping a low profile..

Lots of things going on these days, and I'm just doing what I can to keep a wee bit of sanity about me til I leave for Peru in 11 days. This month got wickedly long on Sunday, and I can say that it will be memorable; for the wrong reasons.

Lots to get done tonight.

b

More shit you can't make up...

A few of us were in clinic way too late tonight trying to get caught up on mounds of paperwork, when a fellow resident called a patient. This in the conversation, as I overheard it.

"Hi, Mr. Smith? It's Doctor Bob. You left your blood pressure prescription in the clinic today. I know, but like I said in clinic, there are many ways to lower your blood pressure without medications. You could eat better, get some exercise, stop smoking crack, or take the prescription..."

I shit you not. Verbatim.

It' been a long month so far. Can't wait for peru.
Cheers,
B

Not Much Fun..

This job definitely sucks today.

I came to work 18 hours ago, and I have 12 hours left in my shift. This is the first time I have sat down since I showed up. I definitely have not had fun today. There's no point in even going to bed. I'm waiting for lab results in an hour...

Peru 21 days.

The shit you can't make up...

Ok, just a funny story.

Early last week my final patient of the night shows up very late to clinic. I was about to walk out the door at 4:30 to an afternoon of freedom when I get the page that the guy showed up 40 minutes late. What to do. Leave. He's WAY LATE, not my problem. I review his chart, the guy hasn't seen me in 6 months, and missed a few appts. What the hell, I think, simple blood pressure check, adjust some meds, out the clinic in 20 minutes. I left at 6:30. The guy was kind of ill. Details not important. I specifically told him, in fact, wrote on his instruction sheet "DO NOT DRINK ALCOHOL" (it wasn't helping his liver disease or his bleeding gut or his blood pressure), made him a few urgent appointments, and told him to take his blood pressure medication..

So, I see the guy back tonight. Can't for the life of me figure out why he's not taking the damn pills (actually, I know why, but it's not relevant), so I tell my preceptor the story, and he comes in to see the guy so we figure out why he's not taking his meds, discuss his alcohol use etc..

Punchline: we're talking about detox, high blood pressure, and NO SHIT THE GUY SAYS AS SERIOUS AS CAN BE:

"So, Doc, I can't take my blood pressure pills with beer?"

Priceless.
Priceless!

This guy presses the auto-destruct button regularly, but I'm determined to keep him going.

When Things Click

5 am.
20 hours down.
3 to go.
Wait, that math doesn't add up. I'm guessing it is 21 hours down, cause I know it's at least 3 to go. Saturday on-call on the pedi ward. And things clicked today. Somewhere, a magical switch was flipped, and things made sense. I didn't get that twinge in my stomach when the pager went off while my senior resident is asleep. I told the attending what I wanted to do for the kids I am taking care of. I had 11 kids to round on today, and have admitted 5 more. I didn't view the admission as "more work" or bullshit dumps from the ED, but as a chance for more fun. What the hell, I'm up to 13 kiddos on my team. I kind of like the idea of having a ward full of kids. So far, they are all cool kids, nice parents. Lots of bread a butter admits-it's RSV bronchiolitis season. But also a few kids on chemo. When I had a sick 5 day old to admit, it was nuttin after a month in the NICU. Just been one of those days where being a resident is fun...

I had grandiose plans to finish my move after work this morning, go for a run, unpack at my new place, get groceries, but all I can think about it crawling into bed. Oh wait.. my bed is still in the old flat. Damn.

Cheers,
B

Moving On..

Moving On #1

So, I'm back on the pedi ward as of today. It's like a homecoming. This is where I started my residency, back in July. JULY. Holy Shit! That was 8 months ago. EIGHT MONTHS AGO. Where did January go? Blink. Gone. February? Blink. Gone. Lots of thoughts. First, I can remember back to what July was like. The uncertainty constantly. Can I stop this patients IV fluids? The nurse wants more pain meds. This kid has a fever. Asking my senior resident what I should do. Today, telling my senior resident I was going to stop IV fluids, telling my senior that I didn't want a kiddo sent home in the morning, that I wanted to wait til afternoon. Finally, a familiarity to my job.

My last shift in the NICU (for this year, will be back for a month years 2 and 3), I was writing summary notes for my kiddos. I was reviewing my daily progress notes while doing this. It was approximately mid-February when I seemed to have slightly figured out what the hell I was doing. It shows in my notes. CLUELESS the first week, week-and-a-half. That's the crazy thing about residency so far. Every month, new ward. New team. But this month, am back to the pedi ward. I'm looking forward to it.

Moving On #2

In the new apartment now. Well, still have my bed, couch and cups at the old place. God knows when I'll have time to get those over here. Am missing my coffee mug. It's a starbucks (surprise) mug that I've had since Dublin Days.. It's nice to be in the new apartment. It's warm. Quiet. It's huge.

Aside from work, and moving not much else is going on. March 11th is my next day off, and I'm looking forward to it...

Cheers,
B

T minus 7 Hours

My alarm clock is going off in 7 hours. Decisions. Decisions. At one point this morning (during a somewhat painful lecture) all I could think about was crawling into bed. Which, was a bad idea because I was fighting falling asleep. It's like when you have to pee really bad and you keep thinking of running water, or how good it will feel to finally pee!

Oh, so my decision. I came home from clinic and then had a great chat with a dear friend who is in London, and soon moving to Edinburgh to take up a post in an emergency medicine training program. Then I proceeded to piss away most of the evening thinking about all the things I have to do, and how little time I seem to have right now to get things done. While I was grabbing a box to pack, I decided I needed coffee, which made me think I should go visit a friend of mine who works at Starbucks, and since I was leaving the house, decided I would go to the gym as well.

So, what I've really been doing is procrastinating. "No shit Sherlock!" I heard you think it. But, the real question is why. Well, because in my passive-aggressive nature with the bastards who live next door, I have decided that I will stay up late to finish packing, and getting my desk and tables taken apart, playing some music, and no doubtedly making noise. Pathetic, I know.

The only foolish part of this plan... I'm on call tomorrow night. Oye!

I'm going to rethink this while I make my lunch for tomorrow.. I hope that in the grownup tells the rebellious teenage to go to bed..

PS-this is my last night in the apartment.
The phone number 413-592-.... is history as if March 1.

Cheers,
B

Free Will Astrology & Black Clouds

Aquarius Horoscope for week of February 23, 2006
There was an indignant uproar after revelations that James Frey's bestselling memoir A Million Little Pieces contains fabrications. Hearing about it prompted me to ruminate on whether there's any such thing as a completely accurate account of any person's life. My conclusion: no. In every autobiography and biography ever written, the author imaginatively strings together selectively chosen details to conjure up artificially coherent narratives rather than depict the crazy-quilt ambiguity that actually characterizes everyone's journey. If you and nine writers set out to tell your life story, you'd produce ten wildly different tales, each rife with subjective interpretation, misplaced emphasis, unintentional distortions, and exorbitant extrapolations from insufficient data. Your assignment this week, Aquarius, is to celebrate the malleability of reality. Regale listeners with stories about the time you worked as a pirate in the Indian Ocean, or rode the rails through Kansas as a hobo, or gave Donald Trump sage advice in an elevator.

Get on freewillastrology.com. It's worth the laugh. Scarily, it can be true sometimes. Even though I am post call tonight (and took a 20 minute nap at 6am), I think I need to go out tonight, break some cabin fever. I may spend the night coming up with as many tales as possible..

So, I was a black cloud again last night. 6 admissions! We'd been averaging 1 a day, occasionally 2, and yesterday a whopping 6, 3 of which were transports that I did. So, from 3pm til 1am I was mostly out of the hospital picking up kiddos. People are glad I only have one call left in the NICU!

Where do the Children Play?

I was in clinic this afternoon, talking to one of my favorite 11 year old patients, and her mom. She's bilingual, and mom's english is way better than my spanish. We have a good time chatting, I like to practice my spanish, and mom likes to practice her english. Her english is better than my spanish. When I told them that I needed to improve my spanish quickly for my trip to Peru, she smiled and said that I'd be fine. (Or, at least that's how I was interpreting it. Which reminds me of a funny story from South Africa, which I don't have time to tell right now)...

Anyway, the whole family (mom/dad/bro/sis) are from Puerto Rico, and have had quite a few struggles, but they are so happy, and nice. My pt (pt=patient), is, quite frankly, obese. Her BMI last time I checked was 40 or so. We were exploring how she could be more active. She takes the bus to school. She can't play outside because they live in an unsafe neighborhood. Mom doesn't even want her walking up to the top of the apartment building for exercise because there are some shady characters in the building... I sat there thinking two thoughts. 1) when we were kids we went everywhere outside, how lucky were we. Remember riding bikes to Chatfield Reservoir? 2) What kind of fucking society are we living in where kids can't get outside to play safely. Poverty. That's a fucking societal disease. Obesity is one of its many byproducts. ARGH!

[Where do the Children Play? => Cat Stevens Song]

Not Going to be a Neonatologist

Why I’m not going to be a Neonatologist.

2 years ago, I thought there was a chance I may be interested in neonatology...

Kids are great. I like seeing kids--in clinic, on the pediatric ward, running through departments stores causing holy terror (I was that kid). For me, the best part of working in medicine are the people. That’s what I love about my program, the people here are genuine. American. Polish. Mexican. Russian. Puerto Rican. Somali. White. Black. Male. Female. Infant. Elderly. Teens. Gay. Straight. Homeless. Poor. Middle class. Upper class. And everything in-between. They ALL have a story to tell. My last ward month, the attending would ask, “What the story with your MI rule out in bed 352?” That “MI rule out in bed 352” was a recent Egyptian immigrant who was unemployed, trying to provide for himself, his wife, and his daughter, and was worried sick that this hospital visit was going to further ruin his meager financial picture. My attending didn’t know this. I did, I wanted to know WHO this guy was that I was taking care of. With kids, it’s a short story, and you get the parent’s story as well.

That’s the problem with the NICU. These kids don’t have a story. Well, they do, it just happens to be short. (Hi, I’m bobby. I was conceived 7 months ago after a drunken night on the town, my mom had high blood pressure while pregnant, and I was born way too early. I’ve been in the NICU for 45 days). Granted, the parents have a story, but I find it hard to connect with the parents in the same way that I can connect with the parents of kids on the pediatric ward, or the parents of kids I see in clinic. And for this reason, I’m not going to be a neonatologist, I couldn’t do this stuff daily for the rest of my life. I do, however, want to be a doc who is competent and comfortable stabilizing these kiddos until I can get them to a NICU...

Realizing this issue last night brought quite a bit of clarity.

Post-Call Mania (PCM for short)

I love being post call. It's the best part of being on call. The thought of working 24-30 hour shifts brings to mind images of pain and suffering of junior doctors. And while there may be lots of pain and suffering during those hours (hopefully on the part of the doctors, not the patients), post-call can be pleasant. For instance, I get PCM. I bet people released form prison or a bad evening with their in-laws get the same feeling. FREEDOM! I've suffered for X hours with little contact with the outside world, in an environment, which I may or may not like, but one which restricts my freedom. Now that I'm free, I'm going to make up for "wasted" time. (I say "wasted" cause while I don't consider being on call "wasted" time, it is time at work, and in my mind that's time that I can't be doing all the other things that I could be doing if I were a trustifarian. PS, Dad if you're reading this, I'm not bitter about not being a trustifarian).

So, this is how my mind works. Regardless of how much or how little sleep I get on call, about an hour before freedom, I begin to make a mental list of all the things I can get done as soon I get in my Jeep. This can be difficult when nurses are trying to interrupt me to tell me that some kiddo looks kind of blue, but being a doctor is all about multi-tasking...

So, today this is my list:
1) Run home, get gym bag and first load of stuff to take to new flat
2) Get coffee
3) Drop off stuff in new flat
4) Organize, in my mind, how I'm going to arrange furniture in the new flat
5) Go to the gym
6) Check PO Box
7) Wonder where to get coffee next
8) Back to work (ARGH!) to pick up a box of oranges that I ordered
9) Still thinking about coffee
10) Call Jay and Jen-partners in crime, make plans for coffee, shopping, lunch.
11) Update blog
12) Write down rest of things to do: Buy shoes, clean apartment, make lunch for tomorrow, research peru trip, work on international health project for work, go out for coffee, read all of my 2000 page pediatric text, read all of my 1700 page medicine text book, go out for coffee, clear out my email inboxes, write a few letters, read the 4 books that I've been meaning to read for ages-while having more coffee, develop film, find a marathon to run, write a letter to my former dentist telling him he has no ethics. And this is just the list BEFORE dinner.

See! PCM! What's going to really happen... not much :)

Cheers,
PS, I just realized today is TUESDAY!

Moving

Moving #1:
So, I'm moving out of my flat. It's like a relationship gone bad. Love at first sight, then realized there were a lot of things I can't stand. I can't stand the noise from my neighbors, nor the cost of heating this place (flashbacks of Dublin). So, I'm breaking my lease and have found a top floor apartment with no neighbors, and only one person below me. Moving is going to be a drag.. C'est La Vie. The location is nice, it's about 10 minutes to work, and about 3 minutes to the gym. A bar close by boasts being one of the areas greatest pubs.. I'm a bit skeptical, but what the hell, it serves Guinness!

Moving #2:
I went on my first NICU transport this morning (1 am). Smaller hospitals call us to go pick up sick newborns and take them by ambulance to our hospital. I thought I was just going along for the ride, since it was my first transport. Well, I was a bit freaked to find out (once I was in the ambulance on the way to the other hospital) that I was going to be running the show, and that the senior resident was there for moral support. It was one of those moments that made me remember that I am a doctor. I tend to forget this fact when going about the daily grind. Of course, what you have to realize is that this kiddo was relatively stable (though he did get dopamine when we got back), short transport time (30 minutes), and that the nurse and respiratory therapist are sharp! So it all went smoothly. The rest of the night was steady. I laid down in bed 3 times, but for never more than 5-10 minutes. Ah well..

I think that's about it for now.
Cheers,
B

NICU Black Cloud

So... The NICU staff have determined that I was the black cloud for yesterday. Apparently it's not normal to be called to 11 deliveries in one 24 hour period. That's how the day went. Granted, some of those babies were fine, but quite a few made the trip up to the NICU. It was a long 25 hours, but I did manage to get a tad more than an hour of sleep.

The thing I don't like about being on call on Saturday is that it kind of ruins the weekend. I have a bunch of errands to get done today, not too sure it will be a productive day though. Ah well.. I usually try to stay up on my post-call days, and then just hit the sack early, but can already feel the fatigue setting in.

Cheers,
B

Running, Skiing, NICU

I went running, outside last night. I haven't done that in ages. Couldn't fight traffic to get to the gym, and needed to get out, run, expend energy, clear my mind, get an endorphin release. A while ago I decided I would run outside once a week, and well, this was the fist time that I was did it. It wasn't the same as dublin. I pictured myself running down familiar roads in Dublin. Watching people on buses. Running past people in the rain, knowing they looked at me as if I was crazy. I haven't done much "running" lately. The treadmill at the gym, to me, doesn't count. Sure I can run sprints and nice uphill stretches, but I'd rather be running in a city. Or a trail.

I went skiing Tuesday and Wednesday at Mt. Stowe in Vermont. A friend of mine busted his leg, and needed his condo cleared out, so I was happy to head up there with some friends for a few days of skiing. It was great. Beautiful mountains. Hard skiing. Going to bed exhausted, body still feeling like I was on the slopes...

I started in the NICU today. It's going to take a few days to get use it. Should be interesting. Lots to learn. I'm on call tomorrow, so it may be a bit of a long day.

This is short. I need to get some reading done to hopefully make tomorrow a bit smoother.

Cheers,
B

Starbucks Philosophy

So, I popped into my local buckeys last night, with the intent to do a bit of reading. I caught up with the crowd who works there, and was happy to hear that a big starbucks is being built, which is close to the area that I'm going to move to in June. Convenient, huh? Anyway, I normally get my coffee in a ceramic mug, since I stay there and have my java. But the accidentally gave it to me in a togo cup. Have you looked under the sleeve recently, now that the xmas cups are gone. They've had some quotes recently. And they are pretty cool. This is one:

The Way I See It #61
Imagine we are all the same.
Imagine we agree about politics,
religion and morality. Imagine
we like the same types of music,
art, food and coffee. Imagine we
all look alike. Sound boring?
Differences need not divide us.
Embrace diversity. Dignity is
everyone's human right.
--Bill Brummel (Documentary filmmaker)

Pretty cool stuff, if you ask me.
Cheers,
B

Grocery Store

Ok, I should be committed. I got up way early this am (615) to go to the grocery store. I have a love/hate affair with the grocery store. Heather could give you stories on how I feel about grocery shopping. When I first moved out on my own, it was so exciting to go the the store. Buy my own food etc. Now, I have to be in the right mood to grocery shop. Ideal conditions involve either bopping and shopping with my ipod, sipping coffee, people watching and taking my time. Or, sometimes I decide on a spur to get groceries, get about half way done, decide I'm over it (no ipod on these trips, and usually feel like I have a million and one other things to do), and make a bee line for the check out! (Thus, forgetting important shit like toilet paper). But, my last favourite is to go damn early (like this morning), bopping to tunes and going up and down every aisle :)

I just got back from viewing another apartment, in the complex I have been eyeing. It's half-way between work and my gym. One bedroom, for a bit less than I'm paying now. Space may be a bit tight there. The woman says she will definitely have a place for June 1st, and I'll have to give first months rent when I put in the application. I dunno, seems kind of weird to me, unless she knows that she'll have that much turnover. I called a resident who lives there and she said it sounded legitimate..

I was out with Jay and Jen last night, we went to Spoleto for dinner last night. Food was killer, service was mediocre, but we had a great table. That's about all that's going on. I'm going to pay bills and read a bit for work.

Cheers,
B

Back in MA

I had a great, restful, trip to the Midwest. Forgot how damn nice people are out there. Yeah, that's a slam against the East Coast. What can I say, I had a bunch of random conversations with strangers; at the store this morning with my grandpa, buying a Carhart shirt, at the pubs with my uncle, and at the airport tonight.

It's kind of late, I don't know why I'm up. Everybody in Chicago will comment on how sleep deprived I look, when in fact I was just coffee deficient. One of the pedi ER Docs I worked with has a funny saying about kids with fevers, "Know what that kid's diagnosis is?" No. "Ibuprofen deficiency." I finally got caught up on sleep (more than 8 hours one night), and caught up on email, and even read a little bit for the NICU.

I've included a new link, one for Stop TB.org. They are launching a global campaign to eradicate TB. Of course TB is an issue that is very important to me. I still kind of hate the stigma associated with having had TB. For instance, I went to a new dentist a few weeks ago, and had to fill out one of those medical history forms, which, of course asks about TB. And I always debate checking the box, I mean I'm cured (or so I hope I am). Well, the dentist thought I was mistakenly checked the box saying, "oh, were you exposed to TB?" To which I replied, "Well yeah, I guess I was. And then I had full blown pleural TB." The look on her face was priceless. If I could describe it, it would be: Healthy white boy resident doctor had that disease? Stigma. Stigma. Have a look around on the web site. It has lots of great information. Also, FYI: March 24th is World TB Day.

Well, I really should go unpack now. And get some sleep. I'm in clinic all day tomorrow. I'm eager to see the kiddo I wrote about earlier. I hope he shows up. I have good news for him and his family.

Chicago

Surprise, I made a quick escape to Chicago to visit family. Left one cold place for another, albeit with more wind.. Going to chill for 2 days. Read a bit, catch up with family.. ahh.
B

Snow and HIV

So, I woke to snow this morning. It snowed because I had a bunch of errands to run, including making a special trip to the clinic to fill out a bunch of forms for a patient of mine. Damn, should have done them on Friday! But... My motivation to get out and run errands was knowing that the JEEP is so much fun to drive in the snow... Anyway, the snow should be lightening up a bit as the day goes on. It's a wet snow, I had to resist the urge to throw snowballs :)

At our hospital they run HIV tests on Monday, Wednesday, and Friday. I saw a kiddo recently who had an infection that he shouldn't have at his age. In fact, when I saw this kid, my heart sunk, and I was immediately back in South Africa. I have seen this before, and on those kids we didn't even bother to test for HIV since there wasn't any treatment. So there I was, trying to explain to Dad that while this is most likely not a big deal (I used better terms than that), we needed to check for HIV. And Dad didn't even seem to flinch at the mention. Hmmm. Anyway, when I get to work this afternoon, I'm going to check on the results.

Sunday Brunch

Last night started off pretty mellow in the Pedi ED, and then out of nowhere it got crazy busy, and I realized that I was seeing 5 of 7 patients at one point. That screwed up the rest of my night cause I ended up being at work til 2am, waiting for surgery to come down and see 2 of my kids. Argh.

I'm back in the Pedi ED tonight and Monday. I don't know that I'm enjoying this month as much as I thought I would. Not too sure what I'm meant to accomplish this month. Have seems lots of kids, lots of viral illnesses, lots of head injuries...

Today is going to be kind of busy as well. I'm headed to the gym in a few minutes, and then we're having our monthly Med-Peds intern gathering for brunch. Sunday brunch is my favorite thing in the world! (next to a good cup of coffee and my nieces and nephews)! We're going to Zoe's . They serve a KILLER brunch. With a traditional and a Fish brunch buffet. Hence the gym first :)

Cheers!

White Coats

I've been pondering the need for white coats for docs. Originally, I was against them. But, I do like the pockets. I keep them well loaded with small reference books, which are essentially pacifiers for my lack of knowledge. That being said, I think they kind of set up this power differential. But, I know that a few of my mentors (who are kind of the old school docs, and that's a compliment-really) wear them. I'm in the Pedi ER this month, so am not wearing one this month, and won't be next month when I'm in the NICU. I've bought a fanny pack (or Bum Bag for you across the pond), so that I can hopefully ditch the white coat, and still have the comfort of knowing that my panic guides are close at hand.

Ona!

Ona made me do this. I had to create a profile so I could respond to her Blog. I was so sad to read that she bought one of those coffee makers with a timer to make it before you get up in the morning.. she's selling out. For the record, I had espresso this morning. Worth the wait. Made in my $5 IKEA espresso maker that makes this horrendous sounds as it nears the end. It sounds like it is about to croak as it sputters making the last few drops of my morning gogo juice.

ps, I'm a coffee whore. And proud of it.