The Countdown...

Has begun.

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

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

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

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

One more week...

Keeping a low profile..

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

Lots to get done tonight.

b

More shit you can't make up...

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

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

I shit you not. Verbatim.

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

Not Much Fun..

This job definitely sucks today.

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

Peru 21 days.

The shit you can't make up...

Ok, just a funny story.

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

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

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

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

Priceless.
Priceless!

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

When Things Click

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

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

Cheers,
B

Moving On..

Moving On #1

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

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

Moving On #2

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

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

Cheers,
B

T minus 7 Hours

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

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

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

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

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

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

Cheers,
B

Free Will Astrology & Black Clouds

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

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

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

Where do the Children Play?

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

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

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

Not Going to be a Neonatologist

Why I’m not going to be a Neonatologist.

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

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

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

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

Post-Call Mania (PCM for short)

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

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

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

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

Cheers,
PS, I just realized today is TUESDAY!

Moving

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

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

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

NICU Black Cloud

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

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

Cheers,
B

Running, Skiing, NICU

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

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

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

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

Cheers,
B

Starbucks Philosophy

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

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

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

Grocery Store

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

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

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

Cheers,
B

Back in MA

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

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

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

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

Chicago

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

Snow and HIV

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

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