glad to be on the other side

My chief resident called me the other day to ask if I'd be on the selection committee for the this year's interviewees. I'm interested to see who we'll get next year, but at the same time, I hate to be blamed if my top picks end up being real duds. I hope I can "read" these people and weed out all the full-of-themselves, lazy, or hard to work with people.

There was this 4th year med student who did a sub-internship with us who I liked and another who I couldn't stand. The latter was older than most the residents and because of that she probably thought she didn't need to "respect" her upper levels including the attending. She annoyed me. Sub-internships can make or break a person. If you think you have a bad personality, don't do a sub-internship at the program where you want to be accepted.

giving up boxing for ballet

I FINALLY saw Billy Elliot tonight and LOVED it! I knew I would, but just never got around to seeing it. I find the boy who plays Billy, Jamie Bell, adorable. I just about cried and laughed throughout the whole thing. The scene where Billy dances out his frustration was reminiscent of Kevin Bacon's dance sequence to Bonnie Tyler's "Hero" in the old farmhouse in Footloose. I actually just saw that last week on VH-1 and my husband, who had never seen the movie, laughed in embarrassment. Men, can be so insecure. But the thing is, that type of movie would have never survived today. When men dance w/o the leotard, I don't see it as too effeminate though. I honestly believe they can get away with it like Kevin Bacon did in Footloose. Afterall, dancing didn't hurt his or John Travolta's movie career now did it?

But the true question remains. will I allow my male child to become a ballet dancer? I wouldn't push it on him, but if he chose it and felt drawn to it by some preternatural force, then so be it.

making time to be social

One of my chief residents is always dogging me on how I don't hang out enough. I hang out, I just don't hang out with them . . .
I have gone out with them several times, but sitting around drinking is not for me. I usually just get a diet coke. Last night, as I had proposed weeks before, we went out to eat at a place that has great magaritas (so we could at least eat). My husband and I had a magarita and pina colada respectively and talked about nothing for about an hour (talking about nothing can be very relaxing). Soon, the people I know a little more than the others left and we were stuck with some very buzzed residents. Now, I think these residents are extremely intelligent and fun people, but I just don't have much in common with them. I was a little embarrassed that they laughed at EVERYTHING. call me a stick in the mud, but I don't care.

I am not against drinking alcohol as long as the people who drink it CONTROL themselves and aren't trying to drink themselves into another person. There are just some people who I don't feel comfortable drinking alcohol with--people who are fake, who need alcohol to feel good about themselves or feel "loose," or drink alcohol for the mere effect of getting drunk. And why is it that so many doctors are alcoholics? Anyway, I'd rather be dancing, but again, why are there no more classy places to go dancing here?

When I watch TV I see all these actors go to some place to have dinner and then all of sudden they get up and dance to a live band. Are there real places like that? Not here. In this town, we have hardly any classy places. I haven't gone to a club in ages b/c I hate the crowd. One resident from Puerto Rico went to one of our clubs and reported that people showed up in jeans/jean shorts. In Puerto Rico, apparently, it is a fashion faux paux to show up in casual clothes and I felt so bad that this city is so out of the loop and non-classy. Come on people, show some class! What is up with all the thugs who wear their jeans so their gluteal clefts are out there for all to see?! I see so many girls who wear hootchie momma (HM) clothes from forever 21 (there are tons of tasteful clothes there but some real HM clothes too). Where is the class?

can't sleep . . . .again

For some reason, the rain has been pouring down only at night these past few days. I'm kept up by the noise, my thoughts, and this "scardy" cat who keeps on purring.

This SAME patient is on my mind particularly b/c there is something going on that I can do nothing about till maybe tomorrow. STILL, she has so many other issues going on w/c I can't mention. Problems for which I can't find the source and others she won't let me find b/c she remains so reticent & mysterious.

I'm frustrated AGAIN b/c this patient's son is sooo "with it" and helpful, but he doesn't live in town. Her daughter is helpful, but she doesn't have the pull with this patient that the son has. why is this patient like this?

I have spent hours looking through this patient's thick chart and now find myself reading through all her hospital stay progress notes. I am irked b/c some of the discharge summaries are terrible and so I must read the progress notes to figure out what went on during her actual hospital admission (5 this year!).

i CAN'T SLEEP.

pilates

I couldn't sleep till 2 am last night and ended up watching an info-mercial on pilates. I started doing some of the exercises they showed and my stomach muscles actually ache right now.. Anyway, I ended up filling in for another resident today b/c she was out sick. All I can say is that I love my clinic compared to the downtown clinic. For one thing, we are much more organized and our charts have good flow sheets. When you open up a patient chart that is about 2 inches thick, you will find it much easier to get a gist of what is going on if there's a problem list, med list, and a flow sheet with common labs in the front. I found it extremely frustrating having to dig through charts today and am relieved to go back to my own clinic tomorrow.

what are you doing in my dreams?

A friend of mine who I haven't seen in 7 years and only e-mail about once every 2 years wrote an e-mail to me out of the blue. He said he had a dream about me marrying Andre Rison. For one thing, I'm married, and another, I had no idea who Andre Rison was. I ended up looking him up on the internet--some football player. I wrote back my friend asking him how he matched me up with that dude. He said he didn't even know if Rison played football anymore but that perhaps I got into his dream b/c he's going to do another stint with YWAM (youth with a mission, a mission organization I did some mission work with and met this friend at years ago.)

ah, the memories of YWAM ("why-wam") . . .I had so much fun and received such great teaching on the character of God. What an experience. I met so many people from all over the world and got to travel. B/c of my experience, I think I'll have to urge my kids to do some mission work in the future.
anyway, my husband is laughing hysterically at the TV right now. gotta check it out.

Natures Way of Cleansing

As I drove home the other day, I saw an adverstisement on the side of a bus for colonic hydrotherapy, i.e. "Natures Way of Cleansing." What genius thought of that and what weirdos would pay a spa to give them an enema?

pus filled-dreams

I had to visit my nursing home Saturday just to check on her sebaceous cyst on her back. As soon as I touched it pus starting coming out. I'm looking forward to I & D'ing it (incision and draining) tomorrow. Thing about being an intern the first 6 months, you have to see all your clinic patients with an attending , and all procedures must be precepted by an upper level. PLUS, I never got to 'pop' a cyst before. I only got to pack them afterwards-- and this as a med student. Where is the excitement in that?

weekend

I had a good time this weekend. plenty of R& R otherwise.

frustration station

I'm frustrated that I get calls from the nursing home and home health practically everyday. why can't these patients get well? Is it so hard for a 90 plus year old to get well? The resident who had this patient was lucky b/c the patient made it through. Again, there goes my fear again. i don't want anything to be my fault.

breather

Okay, big deep breath in and out . . .I can do this. This is my life. I can handle this.

Loans

I'm consolidating my loans now and we figured most of my paycheck will be going towards these loans. I won't be contributing much to the bills and so my husbands says,"No more shoes for you!" aacckkk. There goes my extra-curricular activity, but fortunately , I'm still in the grace period.

What can I say about loans? Well, even though I lived in a cheap place my first year in med school ($200/mo), I still managed to use the money for a lot of other things. I thought I was saving, and felt I could use the money saved for other things. Some of the money went to tuition, books, supplies, more books( I couldn't get enough of em), and then clothes, car, gas, the wedding (gifts for the party, fabric, pics, tips),etc. My parents didn't pay for anything in med school (except of course the bulk of the wedding!). I basically borrowed from my future income.

And now I have to pay BIG TIME!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

home visit

so i visited my little patient at her house yesterday. Some of the houses around hers showed their age, but she kept hers nicely painted. Some of the things I do at home visits include making sure areas have good lighting, have stable rugs, and that one can easily access the bathroom. Basically, you try to ensure the house is fall proof. When the elderly fall and break a bone, hip etc, their health deteriorates pretty quickly b/c they don't rebound as quickly or even totally as younger people do.

Home visits also allow me to see the patient on his/her home turf. I saw pictures of her family, her late husband, and her grown children. I saw her bed and found that she kept a pretty clean house. I also got to perform tests and talk to her longer than I would have during her regular visit. One of the exams included a geriatric depression scale as well as the mini-mental and clock drawing exams.

She amazingly scored well on the depression scale w/c made me think she's either not depressed or faking it. My patient can carry on a conversation well, but her mini-mental showed moderate dementia (she couldn't recall the state or country, couldn't copy a drawing and had a deficit in her short term memory.) I found her drawing of a clock which supposedly read "2:45" interesting as well b/c she appears to be very "with it" otherwise. She drew her clock with all 12 numbers practically all on the right side of the clock and then when she proceeded to draw the small and large hands, she made one hand go to the 2, another to the 4, and another to the 5.

Try this on your parents and you'll see whether they're demented or not.

frequent flyer

my patient has become a frequent flyer to the inpatient service. I was planning on doing a home visit last week but ended up admitting her to the hospital instead. I felt bad for my colleagues cuz you never want to overload them with more patients. I tried to breif them on my patient as much as possible, wrote the admit orders ,and brought the CXR over to the hospital myself. The pain of having a train wreck of an admit or someone who doesn't give a good history (my patient is one of those) is trying to do all the detective work quickly and accurately. This is even worse when you have a list of other chores to do. I didn't want that to happen to my patient b/c I wanted her to get good care and I didn't want to trouble the inpatient team too much. I couldn't even sleep that night b/c I couldn't help but think my little patient was freezing in the ER waiting room. I kept track of my patient's care from home (we can dial in and do our notes, look up labs on the internet) and made sure I could answer any questions that came up concerning my patient's care. Anyway, the team discharged my patient today and I pray there will be no more visits to the hospital for a while.

BTW, it is the primary care docs job to keep a patient out of the hospital, but what do you do when the patient doesn't take care of her/himself? You educate them & their family as much as possible, but sometimes that doesn't even work. I am reaching the point where i might be becoming too attached and too concerned with this patient. Just when I think the treatment plan is working, I'm thrown for a loop. i find it so frustrating.

last castle

Last week, we asked my cousins if they wanted to watch Unbreakable at our place. "Are you going to make us dinner?" We had no choice and so we pulled out all our nice wedding plates and had them over along with my aunt. This time they returned the favor. We were kind of using each other as guinea pigs so that we could use all our nice plates and wine (don't worry, s**, they're planning on inviting the other cousins later, this is a just a prelude). "The girls," my cousins, made some panang curry as well as hot and sour soup. For most of us, except my Indian husband, the dish made us sweat b/c of the spice, but we found it to be quite tasty. I'm actually having some reflux though right now and I'll probably have to sleep with several pillows under my head tonight . . .

Anyway, tonight we watched Last Castle with Robert Redford. I don't think I even saw the trailer for the movie during it's run b/c I think Spy Games overshadowed it. 4 out of 4 stars! I found Redford to be quite good looking even in his 60s.

walk-in

Since my inpatient pedi rotation is kaput for now, my attending paged me as I was watching the Cosby Show at home in my sleeping clothes. "Dinah, what are you doing." "uhh . . .studying for my inservice exam (which I was doing AS I was watching TV)."
"If you want, and only if you want to, I'm offering you the chance to do the pedi walk-in clinic." There I was, unshowered and enjoying my favorite 80s sitcom, what to do . . .

OK, so I went. It would be bad form not to go AND I need the pediatric exposure. Well, I thought it was going to be the ole humdrum cough and cold as always, but instead I got an 11 year old c SOB (with shortness of breath) and heart murmur with possible Left ventricular hypertrophy, another child who was all of a sudden blind in her R eye 2/2 (secondary to) being "blindsided" with a cello bow during orchestra/band practice, and 2 lacerations to the hand. It was nice to finally practice my suturing skills again--a little shaky at first, but it turned out ok.

This is the bread and butter. This is what I will be doing in the future--working in the clinic, doing procedures, seeing both acute care and continuity patients and occasionally making home visits (w/c I plan on doing tomorrow). I abhor the hospital where the malodor of the halls waxes and wanes. Or where germs wait for the 5th day of your hospital day to give you some hospital-acquired infection. Or where some doctor who hasn't washed their hands even after seeing 5 different patients comes to accost you at 5:30 in the morning. Yes, there are many of us physicians who hate the hospital. Some are dermatologists, but others are primary care docs who'd rather turn their patient over to the hospital enamored hospitalists who'll gladly look after their patient while in-house.

home visit

I've been planning on doing this for about 2 weeks now--visiting my patient at home, the one that keeps me up at night. There's a new health issue with her and I just discharged her from the hospital last week--and 4 weeks prior to that. But on the whole, I still thinks she's doing better. there is hope I think even though others keep on saying she's a goner or she's toast. I HATE it when my colleagues are so frank about other people's lives just b/c they don't know them.

I certainly hope

the bug that just went up my nose isn't still there and I hope i didn't sniff it up and swallow it.

post-call

I had a fun time during conference today watching one of my colleagues who was post-call try her best not to sleep. I watched her eyelids slowly close then immediatly open over and over again throughout the hour. Finally, the arm that she was resting her head on slipped off the table and the rest of us could no longer pretend we hadn't noticed her falling asleep. I'm so glad I'm not in her shoes right now b/c that was me 3 weeks ago.

As a matter-of-fact, I should have been on call tonight but my pediatrics rotation is still up in the air. I've been in clinic this week and attended a conference on pediatric oral exams, but no pedi rotation officially yet. There have been some "politics" going on that none of us were aware of till Sunday. We met with the pedi hospitalist on Monday morning but even then the so-called "papers" were still yet to be signed before we could embark on this guinea pig pediatric rotation we are doing with a private pediatrics group. While I'm elated to have some much needed sleeping in time, I can't help but worry (will I ever give up being a type a personality?) that I won't know anything about pedatrics come 2nd year residency. This is the bane of family practice residencies that are university based (you get poor pediatrics exposure). I knew that coming in, but the whole point about starting this new program where we'd be working with this private group at a different hospital separate from the pediatric residency was a big plus and half. Now I'm wondering, "hello? what happened?" we'll see what become of this situation. Nonetheless, anything is better than the pediatric experience the interns got last year (post-transplant pediatrics--your NOT SO bread and butter pediatrics).

job

I don't think people understand that being an intern is not a real job. yes, we are being paid, but not "real" money. We don't have schedules that can be changed just for someone's birthday party or a church retreat. I feel bad that I can not make this big women's retreat at church and i feel like my pastor and some other people think I'm being "non-Christian" for not trying hard enough to go. I hardly even go to church anymore b/c I'm always on -call on the weekends or have to work. If I had done my residency away from home, no one would even know the difference. One con of having your family or church family in town is that you all of a sudden have all these engagements that you feel obligated to attend. and then if you're like me, you have a hard time saying NO and then what's worse is you say you're going to "sing" at the event. ughh.

About every minute or so I have twinges of stress. I do want to go to every event and HATE missing out, but when I feel stressed, I just can't enjoy myself. Even today, our chief resident invited the rest of us to go out for drinks. I don't drink and so for me, it's boring to just sit around and talk in a smoke infested area. I'd rather go to a restaurant where I at least can eat. Again, I felt obligated to go. I just can't say NO! I'd rather avoid the person rather than saying no.

is it wrong

Why do some people feel compelled to like everybody? I understand that you should be tolerant of everyone, but you don't have to be friends with everyone. I have a friend who, everytime she says something slightly derogatory about someone will immediately follow it up with "but she's a nice girl, I like her." All right already. Even I'm not that nice. I told her,"It's okay to be annoyed by someone, it doesn't mean you have to be close friends with everyone!" I also feel like she's trying to "save face" by following her negative statements with positive ones.

Cats
I never thought I'd like cats, but we're babysitting one and it's not so bad. The cat poos in the litter box, doesn't smell, and is clean. I had a dog for 13 years and I must have given him baths and cleaned up his poo about a zillion times. My dog was messy and smelly, but he was so much fun. He was truly a friend. This cat, h/w is MOODY "just like a woman" my husband says. She lets us pet her when she wants to be petted. Occasionally she'll let me pet her, but at times she'll try to bite me. I can't even bribe her with food like I can with a dog. No fun in that respect.

I wouldn't mind having a cat if she were more friendly. What's the point of having a cat if you don't ,as my husband said,"get anything back in return?" She might as well be a fish.

yippee skipee

I got a 5 on one of my evaluations meaning "superior." WHOA! I'm flabbergasted and this from an attending I wasn't sure who liked me or not. I still have to work on my organization and time mgt though (as noted on my evaluation). Three months into my internship and I'm surviving. Pheww.

YES S**, I'm writing a blog finally!

what to say when you don't know what to say

The past 2 weeks we've been inundated with behavioral science. As family physicians we're supposed to be ''touch, feely" but I'm so tired of hearing about all the stuff we have to do. We all are.

One thing we were taught was 3 answers to say when patients are venting. I can't remember the third for some reason, but the 2 I remember:
1. That must have been very difficult for you
2. I understand that you would feel that way (NOT "I understand how you feel" b/c then the patient could off the rebuttal "no you don't!")

I loved the last 2 weeks though simply b/c I had NO CALL. It was so nice and went by way too fast.

baby fever
Everyone in my bible study group either just had a baby, has a baby on the way, or is trying to be pregnant within the next 2 years. Yes, we are included but I don't intend to have one till after internship. As a matter-of-fact, one of the 2nd year residents is about 4 wks pregnant. 3 of our third years were pregnant last year. It's fairly customary for the females to become pregnant during the 3rd year of residency since most of us feel our clocks ticking away by the time we get this far in our education.

responsibility
I have a patient that keeps me up at night. I think about her diagnosis all the time and what I should do and how she is. I call her to see how she's doing at least 2x a week and I KNOW most doctors don't do that. But her condition is worrisome for me. I pray to God she survives the next three years so she doesn't die under my care. It's weirder too b/c her adult children like me and have even bought me a birthday present. I want to do a good job FOR HER AND FOR THEM.

What makes it worse is that I just took a risk mgt course about how you handle medical mistakes or situations where people sue you. We were given tons of scenarios and given options about what to say. Basically, you never apologize for any mistake, but rather tell the truth but not the whole truth.

For example, if you were to hang the wrong blood type and transfuse the patient with this blood and subsequently cause the patient to have an adverse tranfusion reaction you would not say:

"the unit of blood was not checked prior to transfusion which caused a febrile response in the patient" BUT RATHER

"the unit of blood was hung and transfused. The patient had a fever."