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