A Week of J2 & Neonatology

I'm on pedi second jeopardy. For a week, which started at 8am on Friday. So far, so good. I'd be surprised if I get jeopardized this time of year. It's quiet in pedi-land. That being said, the head neonatologist said he was going to try and jeopardize me this weekend for a transport. He was, of course, kidding. They would essentially need to have 3 transports going at the same time for the second jeopardy person to get called in. Usually the NICU team can cover a transport, and if needed, they call in the Jeopardy resident to go on a transport if the NICU is busy. Or, if there is an intern working overnight in the NICU, then a senior resident will get called in to go with the intern on the transport.

I've been in the NICU a lot this month, more or less hanging out since the transitional nursery is next to the NICU, and there is a resident call room in the NICU. I've also been hanging out in the afternoons trying to improve my neonatal IV skills. (I suspect that next year in Johannesburg I will be responsible for doing a lot more procedures than we do here).

The NICU staff have been asking when I will be back in the NICU. (It won't be until January). A few have asked if I'm considering a NICU fellowship. I guess after everything that happened in February, I have a bit of a fan club in the NICU. I have actually pondered a NICU fellowship, more than once. From an international perspective, infant mortality is a significant issue and neonatology would be a great skill to take abroad. But, the idea of adding three more years of training is not appealing. Maybe if there were a combined NICU/Pedi ICU/Adult ICU fellowship, I could be tempted to consider it...

If you hear me talk about applying for a fellowship, knock some sense in me. I can easily see myself applying for a fellowship to defer figuring out what I want to do after residency...

The right start to the day

The nice thing about this month: I get to spend the better part of my morning holding newborns.

There is something inherently calming about cradling newborns, and just watching them. I find myself often wondering what will come of them. I know my nomadic tendencies will keep me from taking care of kids for long enough periods to watch them grow up, and see who they become. (Although, my niece and nephews will give me that joy). So, I just hold them and try to imagine them growing up, and hopefully living happy, healthy lives.

More Bats

This is the most recent Bat sighted in my apartment. Granted, this one arrived from a twisted (though dearly twisted) friend, via Fed Ex.

Good thing I have my rabies shots.

Failing Teens vs Failing Systems

"You look like a smart kid, what's really going on with school." And the tough 17 year old started to cry. I felt my visit grind to a halt. I was consciously aware that this would add on an extra 10 minutes to my visit with him. And in that 10 minutes I was scheduled for another "Well Child Exam." I moonlight (sort of) in this evening clinic every now and then (or as much as possible given my future year of poverty), and we're booked 10-15 minutes for well child visits. (Thankfully with a no-show rate of 25% or so, we usually have a bit more time).. You just can't provide good care when in the middle of a jammed pack schedule you have neat teenager, with little support, who at the age of 17 thinks his future hopes are diminished cause he's been screwing up in school. No father figure. No mentor. In a school system that could care less about his future. And he sits in front of me, finally at his breaking point, finally having the courage to admit that he has this inner turmoil. Some of my colleagues wouldn't have gone there. They have the mentality of divide an conquer. And I am learning to do that more and more, that I can't really solve every problem for every person at every visit.. But most days I think that is a pathetic approach to taking care of people. To make a profit, a primary care physicians must see a ridiculous number of patients & triage complaints... They are sorely missing out on the Art of Medicine, and that is tragic. Outpatient primary care is not for me. I can't operate on a schedule mentality. Knowing that somebody needs an extra 5 or 10 minutes of my time should not jeopardize a schedule. And since when does a "schedule" have more priority than taking care of "people."

Hmmm.

Boston and Life...

A friend of mine and I made an impromptu break for Boston on Friday night. I really (no, really) needed to get out of dodge and have some drinks and be around some gay men. Well, gay men with taste. Sometimes it is just so suffocating living here. I can't believe after 5 years of hating the scene in Dublin I moved to somewhere with even less of a scene. Well, not that there is even less of a scene here, in fact there is no scene. (I have to remind myself I came here because I'm in a great residency program). We had a lovely (albeit expensive) dinner, and then plucked ourselves down in a lounge and enjoyed a night of catching up and enjoying some strong Jack and Cokes. (Jason would be proud)! I think I got home about 4am. I think of it as a night of being on call. Being awake fore 22 hours is really no big deal anymore. We made a pact to make it a point to go to Boston (or NYC) monthly. Life is too short to not take advantage of getting out of Dodge more often...

The rest of the weekend was mellow. I spent a few hours working on my application for South Africa. I loathe paperwork. Sadly, work email has been down all weekend, and one of the documents I need to fill out is trapped in my work email. Fingers crossed, I think it will probably take about 2 months for all the paperwork to be completed. Once I get registered with the Licensing Board and the Foreign Workforce Management Program, it should be mostly smooth sailing from there. And then it will feel real.

As for dates, I should be flying to Johannesburg at the end of June (2008), and will return to complete my final year of residency in June 2009, and will finally be finished with formal medical training on June 30th, 2010.

Wow, I just had to sit for a few minutes and look at that date. June 30th, 2010. Wow. It still seems so far away. Ironically, one of the nurses asked me on Wednesday if I was already an attending. I laughed out loud. "No, it just feels like I have been here forever."

Anyway...

I am really looking forward to seeing the family next weekend. We're meeting in Illinois for the grandparents 90th and 85th birthday celebration. I'm really looking forward to seeing my niece and nephews!

Alright, time to go for a bit of a run. I'm trying to run outdoors once a week...

Cheers,
B

Newborn Nursry

Newborn nursery has to be one of the most delightful months of residency. It's a happy day, every day. Well, more or less. It's nice to be in the nursery again. Now that I've had 2 year of pedi under my belt. I finally know what's normal, and what's not. I finally feel like I have a little authority/insight when talking to new parents about how to parent.

As I was examining a kiddo yesterday, it dawned on me that I was the first physician to ever examine this new human. I was the first physician to listen to his heart. I was the first physician to look in his eyes (not that you can see much at this age). The first to feel his femoral pulses. The first to make sure his hips were normal. The first to make sure his back was straight. There's a sense of responsibility that goes along with being the first physician to examine a patient. And then, when I told the mom that his exam was completely normal, I had this sense of responsibility wondering what would it mean if I had missed something on my exam... Who would catch it? (Well, likely the attending)...

I almost did battle with a nurse yesterday. I find L&D nurses can be extremely judgemental-passing judgements left and right about parents and their capabilities to raise children. It's pretty gross really. I almost feel like unless the parents are middle-upper class, English speaking caucasians who kiss ass to the fucking nurses, the nurses tend to have less than favourable opinions about the parents. Don't get me wrong, I'm not a (total) saint, I don't believe that just because you have a pulse means that you will be a decent parent, but I'm all for giving the benefit of the doubt. It's my job as a pediatrician to help these new parents (and all parents) be as successful as possible in raising happy, healthy children. Being a good parent has nothing to do with money, or with the ability to speak the national language. I looked at this nurse, and thought of how my brothers and I were raised, and I think we turned out ok. (Certain sister-in-laws may feel different). I was embarrassed for this nurse. She doesn't have a fucking clue. And she doesn't deserve to be in the L&D ward.

B

Rabies Shots...

HURT! All 6 of them. I have new found sympathy for the kiddos when I order up the 3 or 4 shots at a time. I started the Rabies vaccine series (4 more shots to go) and also go the immunoglobulin today, and that was what made it 6 lovely shots. I referred to it as the mackerena of immunizations.. Shoulder, shoulder, butt, butt, thigh, thigh, oomph!

Fucking Bats.

More Bats

Bat #2 just made a guest appearance. I'm annoyed. And now am DAMN WIDE AWAKE. How am I suppose to save lives tomorrow given the lack of sleep? Oh wait, it's adolescent clinic... don't need much sleep for that..

The answering service didn't consider "bats" to be an emergency... It will be an emergency when I go ballistic if I get a third visitor tonight. I called MS, who suggested that they may be coming from the vent in the bathroom.. which doesn't work, and never has, and may be providing a nice one way ticket into MY DAMN APARTMENT. Retrospectively, the noise from the ceiling, which I always assumed was from a squirrel, may have been, in fact, FROM BATS. Holy Bat Shit! (is that guano?).

So, what does the CDC say about bats??

Q: How can I tell if a bat has rabies?
A: Rabies can be confirmed only in a laboratory. However, any bat that is active by day, is found in a place where bats are not usually seen (for example, in a room in your home or on the lawn), or is unable to fly, is far more likely than others to be rabid. Such bats are often the most easily approached. Therefore, it is best never to handle any bat.

Q: What should I do if I come in contact with a bat?
A: If you are bitten by a bat -- or if infectious material (such as saliva) from a bat gets into your eyes, nose, mouth, or a wound -- wash the affected area thoroughly and get medical advice immediately. Whenever possible, the bat should be captured and sent to a laboratory for rabies testing (see: How can I safely capture a bat in my home?).
People usually know when they have been bitten by a bat. However, because bats have small teeth which may leave marks that are not easily seen, there are situations in which you should seek medical advice even in the absence of an obvious bite wound. For example, if you awaken and find a bat in your room, see a bat in the room of an unattended child, or see a bat near a mentally impaired or intoxicated person (NOT ME TONIGHT), seek medical advice and have the bat tested.

Bat #2 is currently flying in the hallway of the apartments (ie, not my fucking problem right now).. thank god other tenants are leaving for work before me tomorrow..

Argh,
B

Bats

I came home, and there was a bat flying in my room. From where, I cannot tell. It freaks me out. I may sleep in the living room. Where the hell did it come from?

Stacking Stones: A Year Off... Going to South Africa

I've read my post from April 14th, numerous times... There was nostalgia. And then I remembered thinking one day how I wanted to return to Bara to learn at some point as a resident. I had been debating if I would go to South Africa or Peru for my away elective in my 4th year.. And then I began to entertain the notion of going to Baragwanath, but not for a month.. what about going for a year. Yes, what about taking a year off of my residency to go train at Bara for a year... and I got excited... and ran the crazy idea by a few friends, who didn't think it was so crazy...

Here's the deal:
I was offered a 6 month pediatric training post, and a 6 month medicine training post. My program director supported my idea. And today, the chair of academic affairs granted approval for a year leave of absence from my residency program.

I'm going back to Johannesburg, for a year, to train in the most amazing hospital. I am lucky.

I took the stones and re-stacked them, and to my amazement, they didn't fall this time.

Wow.
Brian

EBM is bullshit...

I have to present a patient at pedi morning report on Wednesday am. It has to be an adolescent topic. This is what kills me... I wanted to talk on some relevant topic. Something, oh say, big picture. Something that applied to many adolescents. I wanted to do some teaching about choosing appropriate contraceptive methods, (and review Plan B). Some simple spoon feeding. There are a lot of choices.. pills, patches, injections, rings, all with pros and cons, some with contraindications... My preceptor wanted it focused, and, and wanted something that was topical in the current literature, ie, bullshit "Evidence-Based Medicine" (EBM).

EBM should be renamed boring mental masturbation. What the fuck is the purpose of looking up minutia bullshit when people don't even understand the damn basics. I asked around earlier this month, and realized that we residents (both internal medicine and pediatric residents), had a weak grasp of the basics on contraception. And some spoon feeding (oh sure, I would have done it in a case-based format so it was applicable and interesting), would have really helped to increase knowledge. But instead, I have to talk about some fucking random question that most of us won't have to deal with when we talk about contraceptive methods, and to top it off, there is no official consensus on the question that I am presenting on Wednesday morning.

Mental Masturbation without a climax. Isn't that worth it?!

I'm calling it BEBM from now on... Yep, you guessed it. Bullshit Evidence Based Medicine.

The more I train in the US system, the more I am beginning to think that I'm not being prepared to really take care of patients. I'm being trained to look shit up constantly and to fill out fucking forms.

Back to BEBM.

Brian

HtoTD

How to of The Day:

How to stop being a people pleaser.

Just for fun.
B

View of the East River & Stacking Stones II

On the 33rd floor of a friends flat here in Manhattan looking out over the East River. Walking the city today. Walking through the West Village and Chelsea. People everywhere. Street festivals. dIvErSitY. People of all colors. Admiring the men in the city. The view is addictive. Watching barges, boats go up the river. Looking out to Brooklyn.

Tomorrow at this time, back home. But it's temporary. Finally, I'm coming to terms with the decision I made before residency. I decided to choose the best med-peds program for me, knowing I wouldn't like where I lived. I tried to like the place. I explored the mountains. I looked for good coffee shops. I looked for a solid base of friends. I looked for love. I looked for a group of gay friends. I looked, I looked, I looked. And didn't find these things. I am sitting here in my friends flat, which has a couch, a table, some chairs. It is one bedroom. It is simple. I fell into the trap of accumulating a ton of shit in my apartment, and in truth, what I needed was a simple space.

I am stacking stones (see July 4th entry). I am going to keep stacking stones; I am stubborn and will persevere. But stupidly, I couldn't use my imagination when re-stacking stones. I kept placing them in the same order, looking for the same things, and watching it all crumble. I've started the re-stacking. I think I finally have some peace about my decision about where I live, and quite honestly, I'm done complaining about it.

I have gotten past this unhappy hurdle which kept tripping me up.

Now, I am going to read here in my friends flat, and watch the view.

Cheers,
Brian

1) Shattering ones own confidence 2) Reading

I had been feeling pretty confident lately. In fact, recently I've had a few conversations on how a few of us in our program have hit that stage where we begin to feel like we do, in fact, know a few thingsThat's the tough part about acquiring knowledge, especially medical knowledge. It's impossible to explain what you know. Sure, you can recall some stuff off the top of your head. But in a larger sense, a large part is the application of knowledge. We residents tend to spend a fair amount of time looking things up. And not just looking up, but also printing up stuff to read "later." Like later when I'm bedridden in a nursing home, because that's likely about to be the next time I have leisure time to read.

Tonight, I have decided to throw away all the stuff I haven't read in the last 2 years. (It's a fucking shame there is no recycling in my area. I'm killing trees here)! It's haunting to see the vastness of knowledge I am throwing away. I feel like, OH MY GOD, I DON'T KNOW JACK SHIT LOOK AT ALL THIS STUFF I HAVE NEVER READ, I AM DOOOOOOMED! (The corrolary to this is: OH MY GOD, I DON'T KNOW JACK SHIT LOOK AT ALL THIS STUFF I HAVE NEVER READ, MY PATIENTS ARE DOOOOOOMED!)!

Sometimes I want to gag when I hear the term "Lifelong-learning." I thought I was signing up to learn the bulk of stuff during residency and then do some little learning here and there, preferable at medical conferences in nice hotels, surrounded by ski slopes or warm sandy beaches.. but the closer I get to the end of my residency, the more I realize that residency is preparing me to 1) Not kill people 2) be able to treat the bulk of patients, and treat to a minimal-moderate standard 3) know when to call in backup.

As for reading... between the 4-6 journals a month that I feel compelled to try and read, plus the shit I print regularly, plus the books/study guides for that months rotation, plus the few pedi books that we recommend to parents, plus the stack of books that have nothing to do with medicine, but are a nice escape, I need about 5 more hours in a day to read. Remember when you read a book and had to do a book report in junior high. You wanted to mention some small specific details from the middle of the book so that the teacher knew that you actually read the book. That's how I use to feel about journal articles.. now I read the beginning and the ends.. the boring shit is in the middle... who cares what the delta co-efficient raised to the sputum power of the random blah blah blah... I need to now the level of detail so that I 1) Don't prescribe a drug that will kill somebody 2) can stay current on treatment guidelines so that I can give the best care possible to patients, and 3) what what drugs the back-up docs are using so that when the patient comes back to me from the specialist, I don't look like a fool.

No wonder I almost need bifocals.

Cheers,
I'm off to read.

Brian

Mentorship

Starting this month, I'm spending one half day a week in a separate pediatric practice. I have chosen to spend these half days with a local pediatrician who has become my mentor. Dr. N is not only a great pediatrician, but he has lots of experience abroad and understands my interest in international health. He actually works with a group which has done overseas medical relief work. So, today I went to their private practice office, and spent a half day with him. It was quite a shock to see what and efficient outpatient practice looks like. It was even better to spend half the day with the pediatrician whom I idolized the most. Ironically, there are two other pediatricians in the private practice group who like Dr. N. and myself, along with a few others, all are in charge of overseeing the International health and global medicine track at our hospital. (This is the track that I wrote a proposal for a year ago, which is being implemented this year).

The rest of the day was rather bland.
Maybe I need some Yemen.

Blah,
Brian

Normalcy

The past few days I have actually been done with work by 4pm. It's almost a sense of normalcy. It just feels weird to actually come home from clinic, grab a bite to eat, putz around the flat for a bit, and then either go to read at the library or Barnes and Noble, and then pop into the gym. Sadly, this is going to most likely be the only real month of normalcy this month. I doubt I'll have this much down time in clinic again..

Still doing adolescent medicine this month. It's picking up a bit. Still miss the buzz of the hospital.

B

Spicing Things Up

Bland was the flavor of the day. In fact, bland was the flavor of the past few days. This month is already dragging. I'm outpatient, again, this month. And am really realizing that I need to buzz buzz buzz of the hospital to keep me interested.

I ditched the co-workers last night, was feeling anti-social (really just tired of ending up with co-workers always talking medicine) and needed to just get out and have a laugh and enjoy the craic. So, Kian (my pal who is a manager at Starbucks and a coffee whiz) and I went for sushi, and then ice-cream. I know what you're thinking.. and when we went for ice-cream, they had Jalapeno Ice Cream. Seriously, I know it sounds yucky gross. And I kind of figured it would be, but what the hell, like there is anything else interesting going on in my bland life... So I tried it. And not only did I try it, i LIKED it enough, that I got some to eat :) I literally tried to spice up my evening. And the craic was good, we hung out having coffee people watching and laughing the whole time.

Ya gotta get you some of that Jalapeno Ice Cream!!

Spicely,
B

Stacking Stones

From Free Will Astrology:

[Aquarius Horoscope for week of July 5, 2007

Nature artist Andy Goldsworthy is a skilled rock balancer. With infinite patience, he arranges stacks of them in seemingly impossible arrangements. Though he has a highly developed sensitivity to the heft and shape of his raw materials, his work still requires him to persist through frustration. While building one particularly intricate structure, he said, "The moment it collapses is disappointing. But since it has collapsed four times I'm beginning to understand the stones better." From what I can determine, Aquarius, you're at a stage in your own labor of love that's equivalent to Goldsworthy's third collapse. Keep at it. ]

Hmmm... Kind of scary how horoscopes just kind of make sense once and a while. Guess it's time to pick up the stones and start re-stacking..

4th here was wet and soggy, a day which would have been better had I stayed in PJs, drinking tea and reading a good book.

Start of 3rd Year

Amazingly, I'm starting my third year. I looked back on the post from last year at this time, and after speaking with some of the new second years today, realized that the transition from second to third year is less exciting that the transition from intern to second year resident. That may be a good thing, though. Unlike last year, when I had to suddenly be a responsible intern on July 1, this year I was off.

I had a fabulous (a word that is not used often enough) weekend. Friday night I went to New York City. I regret to say that it is, in fact, only my SECOND trip down there in the time I have been here. I think that is un-fabulous. A dear friend of mine is starting a family practice residency in the city, so I went to visit her. We had a great time catching up, had a lovely dinner outside on the patio of some swank-ish restaurant, and chatted forever about future dreams and plans. I think NYC is really one of the forbidden fruits. Denver is the other. I found myself feeling slightly regretful at where I am living at the moment. FACT: I love the hospital I work in. I think it is an AMAZING hospital (maybe I'll make a separate post about that later), I have great co-residents, lots of wonderful attendings, and think I am becoming a good doctor (as slow and painful as the process seems, at times). FACT: I am not meant to live here. NYC is forbidden fruit because, people there run in the city. People are everywhere. There is a buzz to the city. There is social awareness. What's really important right now? My training. But it's kind of tough when life can feel so painfully boring here.

The rest of the weekend was spent getting caught up on organizing my life. Sat night had a somewhat impromptu going away party for our former med-peds chief. Sunday Patrick and I went for a lovely hike. He's starting a blog, and I've threatened to put a link to his blog here.

That's about it really. I'm doing adolescent medicine this month... kind of a lighter month.

Cheers,
Brian

On a lighter note...

Makes ya laugh out loud, right?

B

Working Abroad...

Last week I found myself on the defensive. I was kind of caught off guard. How, I was asked, can I justify wanting to work outside of the US when there are people in America who lack healthcare. To me, this isn't an "either-or" situation, but a both. I was pretty annoyed at the time. And today, I read this passage from the book "Not On Our Watch: The Mission to end Genocide in Darfur and Beyond." It's graphic, and very disturbing.

". . .we met a woman, Amina, cooking on the ground. She had fled her village during an attack. Her husband had been shot as soon as he left their hut. She had two of her children on her back and the other two in her arms as about twenty Janjaweed chased her on camels. First they ripped her five-year-old, Adom [sic], from her, and when she stopped running and begged for her child, they told her they would shoot her. So she continued running away from her village that was up in flames. The Janjaweed then tossed Adom into the fire. He was screaming and calling her name, but she just kept running. Despite her speed, her seven-year-old, Asam Mohamed, was then taken and shot, once in his side and once in his back. She was never able to bury her children."

I wish I could have had that passage on hand when I needed to defend my desires to work in these environments. We have healthcare, and basic rights in this country. There are people who have neither. Tell me they don't need some help from us...

Argh!
Brian

Doing "Research"

I'm going to play hooky today. Technically I have a "research day." So I'm going to run to clinic, drop off the project I've been working on-making reference binders, and then am going to go to Pediatric Grand Rounds, and then I'm calling it quits for the day. Well, I mean I am going to do "research." I'm going to research what's been going on with a friend, while we have ice-cream this afternoon. I'm also going to research which coffee shop has the best java-this is actually on-going research, I know which ones I like best thus far...

By the way, this is my horoscope today:
Is your career growing the way you want it to grow? Or is it taking away from the rest of your life? It's time to re-examine your priorities. If your career has been taking too much of your attention, then today you need to schedule a day off or take a long lunch. If you haven't been giving it enough attention, then today you should investigate new ways to jazz up your office routine. You won't be able to change everything, so focus on the things that you can change.

Off to do some research

Random Dream #1

I wish I could take a year off to travel the world. Part of this desire is biased in light of having just read "Three Weeks with my Brother," where Nicholas Sparks and his brother spend 3 weeks on a package tour around the world seeing the great sites. Sure, obviously I wish I could spend 3 weeks traveling with my brothers. But in my fantasy of a year off, I would spend that year traveling from friend/family-to-friend/family.

Somehow I have managed to amass this beautiful collection of friends, and somehow they have become scattered all over the world. 5 continents. Too many states to count. I wish I could leave tomorrow, drive up to Burlington, Vermont and start there. No specific plan, just a goal to move from there and work my way across the US & Canada, end up in Hawaii/Alaska, and then board a plane and go from there. Maybe spend a few days with some people, weeks with others.

I've hit that point in residency where my day-to-day existence passes by, and I know that I'm moving, but it happens so fast that it actually seems slow, and seems like nothing changes. Every day poses new things to learn and new challenges, but the overall day-to-day is the same. And I don't even know where I'm going in the long run. I'm tired of guessing where I'll end up in 2 years--those plans change regularly. And then I catch myself wishing that I could just meet up with old friends, drink coffee in Denver, or grab a pint in Dublin, and discuss dreams for the future.

Holy shit, that future is rapidly approaching, and it's going to be time to make a decision about what I want to do when I grow up. And that's when I wish I could escape from my life for a year, re-connect with the people whom I have known since those days when the "future" was so far off in the distance, that it seemed like it would never get here.

"Not all those who wander are lost." -JRR Tolkien

I may wander for a while...

Cheers,
Brian

Back Home

Falling off the grid meant a quick, under-the-radar trip to Colorado. Spent a somewhat-lavish-but-modest weekend in Aspen with a great friend, then hung out with the family for a few days. I'm telling you, being in Maroon Bells, the only thing that kept coming to mind was how I was ever able to leave such a great place...

It's kind of good to be back now. I've got a few projects to get cracking on...

Cheers,

Brian

You know you're a resident when...

...when being awake for 24 hours doesn't seem like a big deal. The other morning I got up at 9am, knowing that I wouldn't nap before working the overnight shift, and that it would be well past 9am the next day when I went to bed, and the thought of being up 24 hours seemed REASONABLE? Is that normal? 30 hours make me cringe a bit, but 24 hours...

I have finished my long 6 week stretch. I'm a bit shattered, I must confess. I enjoyed the work, and would have to say that I am definitely leaning toward a hospitalist position down the road. Looking back, the hours were long, but the hospitalists at our hospital work 40 hours a week. Residents hit 80/week. Hospitalists make more than triple what we make. I think I'd maybe prefer a week on, and then a week off. Ideal would be a week of adult hospitalist, a week of pedi hospitalist, and then a week of walk-in/urgent/inner-city clinic, followed by a week off...

My brain isn't functioning, my sleep cycle is out of whack (it's almost 1:30 and I'm wide awake), and I have let a ton of things slide in the past month. I'm going to "drop off the grid" for a bit to relax. Am looking forward to getting out of dodge for some serious R&R.

Cheers,
Brian

Best for Last

I saved the best for last today. At my 86th hour of work this week, I walked into Ms Js room, flopped down in a chair by her bed, and just listened...

I expected to coast through today. But then I had a ridiculous number of admission overnight, and realized that my plan for finishing work by noon, or even two was fucked, and I was pissed. Couldn't even fake a smile, so I saw intoxicated and demented patients first. They wouldn't know I was in a foul mood, or, at the very least, wouldn't remember.

A few hours later I peeked in on Ms J. "I'll be by in a few hours, just wanted to make sure you were doing ok." I had already looked at her labs, talked to the night nurse when I got to work and knew that she was doing well, but I knew she would expect to see me in the morning. I hoped I had been able to pull off a half-decent fake smile for her...

I went about the day. And then settled myself in Ms. Js room. For a hour I just listened. This woman is amazing. Hearing her stories, listening to her talk about raising her children; I sit there and look at her and get caught up in her life. I believe her. She isn't going to die. But then I am snapped back to reality, and I know that best case is she makes it til Thanksgiving-Christmas would be a miracle. Does she really know that. Just when I think she doesn't she says something like, "when I'm gone.." or how easily and comfortable she uses the C work. I am drawn to this woman and her family, and I don't know entirely why. Or maybe I do...

It has been a long week. I think it has been rewarding. I think I have probably learned a fair bit. But I am spiteful of the long hours I have had to work. Tomorrow is my day off. And then I work 8 days in a row... what the hell?

Grumpy Point

I've hit that grumpy point of the month. I hit 40 hours today. I have 4 more days to go til a day off, which includes being on call on saturday. I worked 86 hours last week. I'm annoyed with a few of the residents I am working with, but then again am working with a few (sadly fewer) stellar residents. I'm just tired. Coffee doesn't even make me feel happy right now, and it barely gives me the buzz I need to keep moving along.

Blah.
B

Palliative week

Mrs O died last night at midnight. That pretty much summarizes the week.

It was a long, grueling week, but probably one of the most rewarding weeks thus far. This week was essentially a learning experience in palliative medicine. I had one patient go home with home hospice. Took another person off of supportive care and started comfort measures (meaning controlling pain, taking them off of the ventilator, stopping dialysis and medical care), and then the bombshell was making Mrs O comfort measures yesterday. I spent hours with these families each day, and it was such a privilege to watch them go through the process of accepting the terminality of their family members... I realized, in the process, that a few of the docs I work with, suck at helping families in this process.

I'm starting a 7 day stretch, have one day off then have a 9 day stretch..

Catskills

Friday morning, Mrs O asked me what I was going to do with my weekend off. I wanted her to know I wouldn't see her again until Monday. "I hope you are doing something enjoyable." To me, sleeping all weekend sounded enjoyable. Sure, I had been planning on going for an overnight backpack trip on Saturday. My 2 day trip was squashed due to a work retreat on friday evening. But on Friday, I was wiped out. The thought of packing my bag, and hiking seemed like too much work. Maybe a day trip instead. And looking at Mrs O, I felt this urge to enjoy myself this weekend. No responsibility. No Errands. This is my golden weekend, damn right it should be enjoyable. Almost exactly a week ago at this time, the medicine service was asked to provide care for Mrs O. Her attending is an oncologist, and she was unwell, and wanted the residents to cover her, meaning we would coordinate her medical care at all hours. After an hour trying to sort through her complex medical history, talking to her family (Mrs O was barely conscious then), I explained that I expected Mrs O would end up in the ICU, on a ventilator, and that I wasn't sure how this would play out. I re-visited the expectations for medical care, which were to "do everything possible." The oncologist had been trying to get the patient and family to consider Do Not Resuscitate and I wasn't going to get them to change their mind at this moment. I thought it our care was bordering on frivolous that night. I was pessimistic, at best. 2 hours later I transferred her to the intermediate level ICU, aggressively treated her issues. And on Friday (she is back on the regular ward, and doing well, albeit with still undiagnosed/pressing medical issues), when she told me to "do something enjoyable," it dawned on me that she was living on borrowed time. How could I even fathom letting a free weekend pass without getting into the mountains and going for an overnight trip. In 30 years, I'm not going to regret sitting around doing nothing on free weekends, but I will regret not making use of free time to get out and enjoy life. This is the view from my tent last night. I sat here and pondered many things, but kept thinking about Mrs O. She may not be alive in 1 month, or 6 months, or 1 year, but she has been able to enjoy 7 more days of life, so far, with her family. And today, she is celebrating mother's day.

So often it seems we press code status with families. There's a slight sense of relief when complicated, or sick patients are Do Not Resuscitate. But maybe sometimes we're wrong, and not really wanting to face the challenge, the fight to help keep people live. I have thought long and hard about my own wishes if I became unwell, and it's not even clear cut to me, and I think I have good insight into the issues.

I think I'm rambling at this point.

A weekend away, hiking in gorgeous mountains, driving through small mountain towns, it's been an enjoyable weekend.

Cheers,

Brian

Med Wards

Week one: not too bad of a week. Pretty long hours though, just taking some extra time to get acquainted to my new patients earlier in the week. Kind of nice to be taking care of adults, in the sense that the medicine is a bit more complex. After my month in the emergency department, medicine is beginning to feel a bit more comfortable.

Not much going on aside from work. I am off next weekend, and am thinking about making a overnight or tonight backpacking trip to the Catskills. Would it be nice to explore some real mountains. Cheers!
Brian

My Day Off, and Green Eggs

So, I had yesterday and today off. Made a break for the mountains yesterday. Packed about 8-9 miles and camped over night. Weather was perfect. Hot yesterday (sunburned arms), and perfectly overcast and cool today. Was nice to get away, and the trail was mostly empty. I realized that I really need to move somewhere that had good mountains.

On my way back home I stopped at a brew pub. I was sitting next to the owner at the bar. People kept coming in and saying hi to the guy. Nice local place. And no shit, this guys brings a carton of eggs (god love a local place), and opens them up, and they are, in fact, GREEN EGGS! I guess they come from some kind of Peruvian hen.

Back to clinic tomorrow. And then I'm back to the ER this weekend. Tuesday will be starting back on Medicine wards. May is going to be a busy month...

Cheers,

Brian

Trauma: A Spectator Sport

I was a spectator, today. My patients were stable, it was too close to shift change to start seeing new patients. We'd had 7 "trauma" patients in 2 hours, and 3 more (all of whom had been shot), were rolling in the door, so I decided to go in the trauma room to be a spectator. I wanted to take in some coffee and popcorn, maybe heckle from the back of the room ("Hey Doc, ya gonna stop the bleeding sometime today?"). . . but didn't think it would go over well...

What a mess... I think every ER resident was there, plus god knows how many surgeons/surgical residents, plus 2 ER attendings, a dozen nurses, and some xray people, security guards, police, and us gawkers at the back. In fact, I think at one point the hospital operators put on the answering machine and popped by to watch the action. Needless to say, it wasn't pretty.

While I watched the trauma-drama unfold, all I could do was think back to the surgical pit at Bara (South Africa). Simplicity. Good care. People lived. 3 guys in Bara, showing up at the same time who had been shot, taken care of by a grand total of 5, maybe 6 docs/nurses. Surgeons without ego. People who had seen so many trauma patients that they could do their job in their sleep (In fact, I fell asleep standing up in surgery there). This "third world" hospital was delivering superior care to what I was watching.

I am closeted in the ER. I don't let them know that I worked in an ER during college. I don't let them know that I probably saw more people shot in my month at Bara than these residents will see in their entire residency. Instead, I'll happily tend to the patients that the ER residents find boring. I like the elderly folks who have fallen. I like the kids with coughs. I like the suicidal teens. I like the guy with HIV and kidney failure.

I like being an internist and a pediatrician.

Going to work, knowing that I am in my ideal profession (even when residency makes me fatigued, depressed, angry), makes me feel damn lucky.

That's what ran though my mind as I watched the trauma team. And then I left, I had better things to do than be a spectator.

I may not enter the trauma room again.
Been there, done that.

Life and Death in the ER

Not in the dramatic sense.. but last night was really life and death in the ER. One minute I'm telling a 19 year old that she is pregnant (surprise!) and then 30 minutes later I'm asking two women if they want us to continue doing CPR on their father. That was the spectrum of my night last night. You might be picturing lots of tears and hysterics, but in reality the 19 year old took the news well, as did her parents, and the sisters had been expecting their dad to pass away soon, and they were well prepared.

I'm off today. And sadly I need to finish a presentation that I have to give tomorrow. Nothing worse than having a "day off" and spending all day doing stuff for work.

B

Unlucky Socks

I wore my unlucky socks yesterday...

You see, I was on Jeopardy call yesterday. And Friday I knew I would be on the pedi ward in the morning. But I figured I would be done by noon, or 1 at the latest. I figured wearing my unlucky socks, which are these striped multi-blue socks and are fun to wear with scrubs, would be harmless.

So, at 5:45 when I finally was able to leave the hospital, I was 5 minutes out the door when I got paged back to go on a NICU transport. And of course, what should have been a simple scoop and go transport took way too long, and I finally left the hospital at 9:15 pm.

I don't mind that I spent most of my jeopardy day working. Sure, the selfish part of me really wanted to have the day free to run errands, maybe socialize, and sadly I work at 3pm today so don't really have much of a weekend at all. I took care of cool kids and nice parents yesterday, got to work with a good friend during the day, and even went to dinner in Amherst (dinner at 10pm?) and got to see some friends (work/non-work) whom I hadn't seen in AGES! What I do mind, though, is what to do about socks that I like, which are unlucky? I hadn't worn them since July, when I had an ugly on-call shift on the pedi ward... I'm guessing that they will live, forever, in my sock drawer, but it'll be a while before I wear them again.

Today is April 1st. Am starting in the Adult ER tonight at 3pm. I'm looking forward to the educational opportunity to brush up on some adult medicine topics, but have a serious mental block when it comes to thinking good thoughts about the ED in general..

Cheers,
Brian

Balcony Day

Balcony Day. Number One.

Today was quite possibly the first official balcony day of the year. A few Sundays ago might have counted as a balcony day, but you can't really have a balcony day on a weekend, or vacation day. You know the days I am talking about...

I'm walking down the hall, and I look outside and I can see the beautiful blue sky, and I just know that the weather outside is perfect. And the day is going great. Things make sense. I'm taking care of neat kids, caring parents, my attending is in clinic in the morning, so I get to round on all the kids, see a new kid, and have a little autonomy in the morning, before he comes for afternoon rounds, agrees with my plans from my morning notes, and then he even takes the time to take me down to the hematology lab and review some slides under the microscope. I still manage to sneak away from work at a decent time, and all of a sudden I feel like a kid who has a half day. And all I want to do is sit on my balcony, send a text message to my flatmate saying this is a balcony afternoon, which mandates that we will take our kitchen chairs and sit out on the balcony drinking beer and listening to our balcony CD. Of course, I don't have a balcony anymore. I don't have that cool flatmate anymore. But that's ok... The important thing is realizing that sometimes, ya just gotta stop and admire the moment.

I know, you're wondering why can't you have a balcony day on a weekend. Think about it...

Ok, it's way late, and I have to finish up a presentation for tomorrow.

Cheers,
B

PS-Hope you have a balcony day soon.

Dinner for 20

I went to see family in Chicago this weekend. (Not Chicago proper, about an hour south of the city). It was really a much needed trip. It was great to see my grandparents (who will turn 85 and 90 this summer), and the rest of the gang. "What are you going to do?" Nothing I told people. Absolutely nothing. Spend the day with my grandparents, the afternoon with my godfather in the bar, and then dinner with whomever shows up. It was exactly what I needed. 48 hours away from my life. Away from Springfield. Away from my apartment. Away from the cold. Away from work.

I had been in a bit of a rut. Just kind of going through the motions. Complacent. Status Quo. I've just been a bit unsettled. But things were brought back into focus recently. And my trip to Chicago solidified that. There was something special about sitting down to dinner with 20 family members last night to remind me that I have great family in Chicago (and Denver). And of course, great friends, from coast-to-coast, and sprinkled around the world. And while I do have good friends here, it's just not the same. And recently, that's what I miss the most. The people who I've known for ages, aren't here.

Anyway, just some recent thoughts.. I should clean up the kitchen now. I've cooked enough food (lentil soup, sweet potato samosas) to have wonderful dinners all week long.

I'm wrapping up pedi heme/oncology this week. I'm switching back to Adult-land after that, and will be in the Adult ER in April. I have really enjoyed my past 3 months in pediatrics, and it's going to be a bit of a transition back to adults...

Cheers,
Brian

Yemen Week...

Like the good cup of Yemen coffee I posted about on Sunday, this week has been the shake-up I really needed.

I've been in the pedi heme/onc clinic most of this week. Have seen a bunch of really cool kids (and parents). It's really nice to be in unfamiliar territory. I know very little about the heme/onc world. As a future practitioner in rural areas, I don't want to be the guy who misses the kiddo with leukemia, or the guy who has to send a family to a specialist 5 hours away if I can get the work up done myself.

What's made this week really good though, have been some simple reminders of how wonderful it is to be a doctor.

I volunteered in a free clinic Wednesday night (now that I have some free time this month). It's ENTIRELY volunteer. This clinic is getting meds to people who would otherwise not have access to meds. The crowd falls mostly into the under-insured category. It runs out of a private Ob-Gyn office. Very cool. Very simple. It's my cup of tea.

Then, today in clinic I saw 2 of my favorite patients, and one of my most complicated patients who is non-compliant-generally-drives-me-crazy-but-has-really-grown-on-me patients. I also saw 1 really cool kid, and one of my cool teens who we're starting on ADHD treatment. It was one of those days where I didn't care about running on time (and my patients didn't care either). It was just great to take the extra time to talk to patients. Amazing what you can learn in a few minutes. One patient and I talked about what his life was like before his health deteriorated, and for the first time I saw how much his life has really changed. One patient and I talked about his recent cruise with his partner, and their evolving plans to retire to Florida. One patient (a woman in her 80s) told me about one of her trips to London, and how having grown up in Jamaica she was able to visit all the places she had learned about as a school girl, and how one afternoon as she was taking the escalator out of the tube station one of the security guards stopped her, and it turned out to be a classmate from primary school some 30 years previous. Is that cool or what!

I don't know how doctors see 20-30 patients a day. What's the point? If you don't know who your patients are, why bother?

Maybe I'll write a few scripts for a good cup of Yemen Coffee. Free Refills, of course.

Cheers,
Brian.

Not Settling...

I was deathly low on coffee beans. Tomorrow is Monday morning. Obviously, you see the problem. I swore I wasn't going to spend any more money once I got home from brunch this morning, but this coffee bean thing was an issue.

I decided to take my pediatric heme/onc book to Barnes and Nobble and read and get some coffee beans. I'm a huge Sumatra fan. It's my go-to. In a pinch, I can count on it. But I was saddened to see that they only had ground Sumatra. I really wanted Sumatra, but I wanted whole beans. I couldn't settle. So I decided, what the hell, might as well go get some freshly roasted coffee beans (which made me realize I really need to start roasting my own regularly) and went to Rao's Coffee in Amherst. Yeah, it's half an hour away, but it's one of the best coffee shops in these parts... and I got me a pound of Yemen coffee. This stuff ain't no Folgers.

My most favorite coffee in the world is the Yemen roast from Bluebottle Coffee Company. This is how Bluebottle describes their Yemen: "One more thing: you might not like it. Lovers of clean, snappy Costa Ricans, or Colombians might consider drinking a cup of Yemen uncomfortably similar to being picked up by the lapels, shaken, then tossed into a grimy Manhattan snow bank. But for some of us, this is the most complex and desirable cup in town." And this is what Rao's has to say about their Yemen: "Yemen has not, for the most part, modernized it methods of coffee cultivation. The result is an unwashed coffee with subtle complexity: wild and exotic with flavors of berries, nuts and chocolate. Yemen’s simultaneous characteristics may take a whole cup to really grasp. "


In life, some things are worth settling for. But other times, ya just gotta go out of your way to get what's really important. Tonight, it was good coffee.

Shaken. Desirable. Unwashed. Wild. Exotic. Grasp. Sounds like the swift kick in the ass I need after recent events, and the perfect way to start a new week, a new rotation, a fresh outlook. I'm not going to settle...

A month to forget...

This month started out well, but has crashed over the past 2 weeks. . .

One of my rocks-(a stable NICU kiddo) started to get sick on presidents day, and just tanked. He died 2 days later. It was a tough few days, and in the end we withdrew care so that he could die in his parents arms--the first and only time that they would ever hold him while he was alive.

Patrick and I also decided to stop dating. This has been the most difficult decision I have had to make in years. He is a wonderful guy, and I am hopeful that we will remain very good friends for a long time.

I'm looking forward to March. . .

B

Midas Touch in the NICU

Intubation in the NICU has been my nemesis. The art of taking a tiny tube and sneaking it past the vocal cords with goal of rescuing a tiny human who can't breathe and giving them the vital capacity to get oxygen has been the bane of my NICU confidence. I was ZERO for three. Until yesterday, when I was able to finally find a bit of confidence and was able to intubate 3 kids, all were emergent intubations too... It was one of those beautiful days at work where things made sense, I knew what to do. I've had some sick kiddos and yesterday they were turning the corner. I literally watched them get better in the 24 hours I was there. That is job satisfaction. At 3am I just walked through the NICU (I had one really sick kid and knew I wasn't going to sleep all night) and peeked in on a few kids, watching them breathe. It was very calming. These kids are going to make it. (I knew I was delirious from exhaustion when I was looking into NICU fellowships at 4am)... Not headed that route..

B

NICU, again

So, I am back in the NICU. NICU is an interesting place... But better the second time around. I have had two nights on call so far, and an amazingly, have only admitted one kiddo.

Not much else exciting going on. It has been damn cold here. The good news is I have an incredible sale at GAP and Banana Republic, and have new wool sweaters to add to my wardrobe.

Things are going well with Patrick...

Not much else exciting to report. Things are very good overall. I have some free weekends in March if anybody fancies a visit to Western Massachusetts, and am scouting some ticket prices various locations, but haven't found any great deals so far.

Cheers,

Brian

Blah(g)

Blah.

That's really about all I have to say. It's freaking COLD here. COLD. Miserable cold. Seriously, I can't get warm. I'm contemplating going to the doctor, I think my internal thermostat is broken. Trust me, it's NOT my thyroid. If I hear one more person tell me to have it checked, I'll scream. Ya know how old women always seem so bundled, shawls and all, that's me!

Developmental Peds is good. I'm learning about Autism, ADD/ADHD, growth, nutrition, speech delay etc. So that means, every time I see a kid I scrutinize them. Are they hitting their developmental milestones. Do they talk enough. Are they interacting appropriately? I must say, having spent an afternoon with speech pathologists, these people are SAINTS...

As usual, the month is coming to a close, and even though this is day #12 of the rotation (I had a few vacation days at the beginning of the month), I feel like I am behind in learning for this month. Where does the time go? Seriously folks?

I took off Friday afternoon to read for pleasure. How goofy is that? I had to make time to just read. It wasn't so much reading, but rather I escaped to an old mill located by a creek, where you can hear the water inside the book mill/coffee house and just chill. This place is kind of magical. Any guess what, I had perhaps the best cup of joe in months at this place. The first sip was magical. Sitting at an old wooden table, wrapped in my shawl, listening to the water, reading. Seriously folks, that was liquid crack.

Patrick and I saw the movie "The Queen" last night. It was good. Better than I had expected it to be.

Alrighty, I need to get some work done.

Hope your 2007 is off to a good start.
-B

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-