Rockstar moment

On my last night in the Pedi ED (Wednesday, I think), I had a Rockstar moment. And it all has to do with the ultrasound from above (from the net, this isn't the real ultrasound from the patient I took care of). What you're looking at is the ultrasounds of the stomach, that bulge is called Pyloric Stenosis. An idiopathic condition where the pylorus becomes enlarged and obstructs the stomach from emptying, which results in vomiting. Or projectile vomiting, which is what we're taught in med school and residency. This kid didn't have classic projectile vomiting after every feed. But, while I was examining him, there were some forceful perstaltic waves, which were easily palpable. Right time, right place, the kiddo had just taken some pedialyte before I saw him. And that "palpable olive" that is classically described wasn't really appreciated. (Although after my exam, he did have a nice forceful vomit). I was hoping that this kiddo would have simple gastro (the story wasn't the classical version), but it was just unusual enough that my gut (pardon the intended pun) felt the need to get the ultrasound and rule out pyloric stenosis. The Rockstar moment was sticking to my history and physical and writing down pyloric stenosis as my first differential, and then gastro. The real Rockstar feeling is knowing that taking a good history and performing a good physical examination helped this kid get the right diagnosis early on--he had perfectly normal lytes, not even enough time to develop the classic hypokalemic hypochloremic metabolic alkalosis...

Shopping in Soweto

Looks like shopping in Soweto has moved up a notch. I must confess, that the only shopping I did when I was in Bara was on the bridge that crossed the road and lead into the hospital complex. I was able to buy some fruit and chips there when I was on-call.

Shared Experiences

Last night I was in Burlington, VT, chatting with Seamus (training for General Practice in Ireland), Nathaniel (Internal Medicine), and Jean (Family Practice), and it was interesting how common the experience is, regardless of where/what we were studying. I think the common thread was that residency is tough, regardless of where or what you're studying.

Seamus arrived Wednesday. Thursday we left early, ate breakfast in Woodstock, Vt, and then made our way to Mt Washington (NH), drove to the top, and then made our way to Burlington.

Just a plug for Burlington... While I think Telluride is, perhaps, the most perfect place on earth, I think Burlington is a close number two. If I ever disappear, and you want to find me, I'm sure I'll be hiding out in one of those two towns.

Anyway. Then yesterday we took the ferry across the lake, and went to Lake Placid and around the Adirondacks.

Last night, we cooked outside, and ended up having a lovely feast outside, in the dark. It was stellar.

Back to the grind now. Need to cram a bit for the exam Friday and Saturday.

First Snow (In Colorado)

Looks lovely, doesn't it.

Not much going on. Working again tonight in the Pedi ED. Clinic tomorrow. Then headed to Burlington, VT Thursday and Friday. The month is cruising by, can't believe Step 3 is going to be here so quickly. Oye.

PJ

I suspect a majority of the pedi residents will know about PJ in the coming days. That's not a good thing. He will be added to the list of kids with cancer. Kids, who we residents know well, who we happily take care of, who we protect when we see them in the ED. He will be in and out of the hospital. He will be the kid that when he dies, we'll stop and recall when we first met him. And for me, that was last night when he was in the ED. Giving his parents the CT report, and trying to maintain some optimism about not having a final diagnosis was difficult-it's obviously going to be a horrible cancer. I can't even fathom how a parent would be able to deal with this news.

It's been a bit brutal the past few nights. We've seen sick kids. Not much in the way of snotty noses and coughs. Admitted a kid to the Pedi ICU last night with a bad pneumonia, and admitted a kid with meningitis recently as well.

Overall, aside from finishing work at 1-2am, (which means not getting to bed til 3 or so, and not getting up til 10 or so) it's a great month. It's nice to have that immediate gratification of making kids feel better, or giving guidance to parents about their sick kids, and sending them home (even if I have to pay for the taxi myself-like last night).

I'm suppose to be at my second site in 6 hours, so should probably hit the sack...

"Doctor, promise me one thing,

"Doctor, promise me one thing, don't drink alcohol out of a plastic bottle."

This is a quote that I heard tonight from:
A) a patient in clinic
B) a random stranger at the bar
C) my attending in clinic
D) the voices in my head


Yes, C!

Dr G is my hero. She was my first attending physician on July 1 2005 when I stepped foot on the pedi ward, and was convinced that the only thing I knew was my name. And tonight she was my attending in the moonlighting-pedi clinic. I can't even describe her to you. Long gray hair in a pony tail. She has the respect and love of all the residents. She is the definition of liberal, but married to a guy who owns a gun store. And, she drinks her Jameson neat. That's where this all began. After the miserable experience last week, we decided that there would be post-clinic liver rounds tonight to help detoxify the mood after clinic, and we tried to convince Dr G to join us.

"What do young doctors like you drink these days, beer or hard stuff?"

"Beer, tonight. Maybe whiskey at home."

"Well Doctor, promise me one thing..."

No Water

Just for fun, check this out. No Water at Bara.

 

It reminds me of then I was at Mosvold Hospital, and occasionally the hospital, and all the staff who lived on the hospital grounds, wouldn't have running water. We had water stored in the apartment so at least we would have drinking water. In fact, I recall scrubbing for surgery with one of the OR tech pouring running water from a bucket over my hands as I washed...

Feeling Fall

Leaves are changing.

Albeit slowly.

Air is crisp today.

Sweatshirts are back out.

The evening is spectacular.

 

I'm taking a study break, and happened to come across these two clips, which make me very happy.

1- Coffee's Holy Grail

2- To Burundi and Beyond

 

Am off tonight. It was nice and mellow last night at work, to make up for the somewhat crazy Monday night. Checked up on the kids I admitted on Monday, and they were doing well, should have been discharged today.

 

Back to the books.

B

I Wanted Ice Cream

And she wanted to pee.

I ran up from the Pedi ER to the pedi floor to help Amy (the night resident) do a LP (spinal tap) on a kiddo that I had taken care of in the ED. I felt a little guilty cause I didn't tap the kid in the ER, and then the admitting attending (who has the luxury of hearing the story from home, not seeing the kid) wanted a tap done (even though this kid has been on antibiotics for 14 days), which defaulted to Amy. She was going to need some holding help. And, I was starving, and the pedi floor has those cute small ice-cream-in-a-small-styrofoam-cup with wooden spoon that make you feel like a kid again, so I offered to run up and help her. I grabbed an ice-cream, and she realized that in the time it would take me to eat that small container, she could zip to the bathroom. It's going to be a long night for her!

Tonight was a good warm up to the upcoming Pedi ER Winter Season. We admitted at least 7 kids this evening. Sick kids too..

Say a little Prayer

M is a 12 year old whom I took care of tonight. He dislocated his pinky, at the proximal interphalangeal joint. (The joint closest to the knuckle). He was a tough kid, but even with with a digital block (numbing the finger) reducing the dislocation was proving difficult. I tried twice, the attending tried twice, and we were about to place a call to the orthopedic team to have them do it. We pleaded for one more attempt, and that's when M turned his back to us and said a very soft prayer, and viola-it went back in place.

I sutured another kid, those skills are coming back, albeit slowly. I haven't sutured since I was in South Africa back in 2003, but this is the second time I've sutured in the pedi ED. It's like riding a bike.

That's my Joya for today. Praying put joints back in place, and suturing kids.

Way past time for bed.

B

Joya Del Dia

Translation: Jewel of the Day.

Joya is a happy coffee. I don't really know how else to describe it. It's snappy. It jumps in your mouth. It is nice and simple. Simplicity has been woefully deficient in my life recently. Well, for probably a bit longer than "recently."

It was nice to be away and to have time to do nothing but study and relax. No TV. No Internet. No old journals/newspapers begging to be read. It was a jewel really. A retreat. A chance to just escape from life and take time out to get some much needed studying done for Step 3 (USMLE) and a chance to review for CCU (October).

I had the Ubora blend (at Starbucks) on Wednesday, and thought it was delicious. On Friday, I ran out of coffee and picked up the Joya blend by accident. I'm a bold guy-not a big fan of medium blends. But as I settled down Friday night with a new pot of Joya and a practice test in surgery, overlooking the East River, in a contemplative mood, free from distractions, I was pleasantly surprised when I sipped the Joya. It was simple. There was nothing to analyze-no hidden agenda.

And that was when I realized that I dearly miss simplicity (maybe that's what I like best about pediatrics). Don't get me wrong, I like the complexity of a nice cup of Yemen, but in my personal life right now, I'm moving toward "Joya." Correction-I can hear people already protesting that I don't know how to simplify life. I should learn how to move to Joya.

Walking back to Starbucks today, I felt relaxed for the first time in a while. I had a productive jam session of studying, while being removed from the world (yet, in the center of the world at the same time), and felt that I had shed some accumulated layers of aggression and frustration that had built up recently.

This afternoon, I hit the wall (to borrow a running term) while studying... so, I went for a nice long walk in the city. I just walked aimlessly... Watching people mostly.

While I learned and reviewed a plethora of medical knowledge, I also learned that there should be a little "Joya" in every day.

$4315.05, Hiding Out, Compromise

$4315.05:
That's my bill from the ER. For my rabies immunoglobulin and vaccine. Outrageous, isn't it. But really, given that rabies is universally fatal, I guess it is worth it. And thank god for the $50 co-pay only!

Hiding Out:
Finally, my pager is off. I have NO clinical responsibilities. I feel like I am on a mini-vacation. I'm catching the train to New York tomorrow. I think it's going to be the perfect few days away. Will have my books with me, and will enjoy some serious down time. Am looking forward to coffee breaks walking around the city, hanging out studying in busy coffee shops. I'm looking forward to some anonymity. I'm pretty tempted to go out Friday night too :)

Compromise:
In the evening moonlighting well child clinic I saw 10 kids in the span of a few hours. Not my kind of medicine. Decided that while the moonlighting money is nice (and each shift will cover half a month of rent next year in Jo'burgh), it's not the kind of medicine I want to practice, so have decided that my shift next week will be the last of the moonlighting shifts for me. Can't put a price (or roof?) on the quality of medical care I want to deliver to my patients.

So, don't plan on being back until Sunday, and then it's back to work on Sunday afternoon...

Day #12

It's finally here. This is day # 12 in a row (or day #19 if you consider the fact that I was on-call over the weekend a few weekends ago).

I'm escaping tomorrow morning. I'm going to head down to New York for the weekend and hide out in Lucia's flat while she is away-and hopefully have a very productive study session.

Not much else...

Ian and Emily

Pamper Hats!

Adorable. Ian (on the left) decided to wear his diaper in a bit of an unusual way, and then decided that his sister needed to join in his new fashion statement. I had brekky this am with a good friend from work (who is in anaesthesia) and we made french toast. Nice relaxing morning, and nice to take a break off from studying.

Pedi ED

Past two nights were pretty busy. We're seeing a fair bit of enteroviral infections, with a fair bit of dehydration. Think pedialyte people. Keep those kids hydrated. Also took care of a infant yesterday, who had intussusception. It's the third kid for me. And none of them have had any resemblance of the classical presentation. The money is in the history. Sad how each time others had passed-over what were seen as trivial parts of the history. The infant should do well.

Back tonight. Am sure that on a holiday Monday, it's going to be FUN FUN FUN, and busy busy busy.

Am seriously looking forward to my day off (starting on Thursday). Am pretty tired by now.