Back to the grind

I am back from my one glorious week of vacation. I flew to southern Virginia, where my parents live. I enjoyed 7 full days of sleeping in, eating home-cooked food, and vegging on the couch. It was fantastic. I was so sad to fly back on Sunday night. I have never dreaded going back to work so much. Not that work is BAD... it's just the hours were wiping me out, and so the thought of returning for another 6 months of intern year was depressing. But I suppose that's a glass-half-empty attitude. A glass-half-full person would say, "Wow, I'm halfway done with intern year!" I am trying to be more optimistic. Affirmative thinking, right? I can do it!! 6 more months!

Last night I worked on the ward. We had a 3 month old baby come in that seriously looked like a little Michelin man (hence the picture above). It was hilarious. I walked in and almost started laughing (thankfully my social tact kicked in and I laughed on the inside). Then I wondered to myself if that's what doctors thought when they saw me as a baby. I was also a really fat baby. My mom says my Korean grandmother thought babies should eat as much as possible so every time I cried she stuck a bottle in my mouth. There are pictures and home movies of me looking almost like the little Michelin baby I saw last night. So I guess I shouldn't poke too much fun at this kid. It just cracked me up, though.

Happy New Year! :)

Dry spell?

Today was so frustrating. I woke up late, as usual. Got to work late, as usual. My senior resident said, "You're gonna be one of THOSE residents, aren't you?" He was just teasing, but I didn't laugh. It was 6:00 in the morning and I hadn't had my coffee yet. I was slow rounding on patients. Physically slow, mentally slow. I didn't even get all of their information before rounds, so I sounded like an idiot when I presented to my attending. Then we were called to a scheduled C-section. The baby was 37 weeks gestational age, a bit premature. He appeared to be doing fine at first, but had some increased work of breathing. We watched him for awhile and decided to take him to the NICU for observation and diagnostic work-up. He needed some interventions, including an IV line, arterial stick, and intubation to give surfactant (a medicine we give to premature babies with immature lungs). As the intern, I was permitted to try all of these procedures first.

IV - tried three times, missed it. The nurses and techs made fun of me. "Have you put IV's in many patients? Maybe you should practice on an adult." I tried to laugh along, and replied "Yes I've put lots of IV's in adults AND babies, and I've gotten many of them. I'm just not having much luck lately."

Arterial stick - tried two times, missed it. At this point I can feel my blood pressure rising and my frustration increasing. But decided to get back on the horse and keep trying procedures.

Intubation - tried three times, missed it. Are you kidding??? I've gotten the last several intubations I've tried. This kid is KILLING my self-esteem!!

A little background info - I've been missing IV after IV, blood-draw after blood-draw... for the last 3 weeks. So today was just the icing on the cake. I felt so completely incompetent. The teasing got old. I was hungry and cranky. I snapped. My senior resident tried to make me feel better. He told me I'm probably just in a "dry spell" and that I need to keep trying until I start getting successful procedures again. I'm not so convinced that this is a dry spell. I think I'm getting tired of intern year. It's wearing me down. I've been working 12-14 hours a day for the last 3 months and I'm exhausted. I need a break. Thank goodness Christmas is just around the corner. I can't wait!!

Circumcision gone bad

Don't be fooled by the title of this blog. I didn't cut off a little boy's penis. He is still a boy, thank goodness. I'm on my nursery month right now so I've been doing lots of circumcisions. And if I say so myself, I've gotten pretty good at them. I think I'm down to about 10-15 minutes per circ, and I have had very good results. HOWEVER, yesterday I had a small complication. Not for the baby, but for ME. I was injecting lidocaine to numb up the baby's penis - something I've done many many times before. I was feeling confident, chatting with my resident and working quickly. I withdrew the needle in order to inject more lidocaine on the other side... and whaddya know, I stuck myself. A small poke in my finger, but I saw a little drop of blood. Nobody saw it happen, and for a millisecond I thought about not saying anything. But I knew I had to. So I told my resident, and I had to stop the procedure and go through the whole needlestick protocol. It can be quite painful. They took 5 tubes of blood from me (it was a lab tech who I was rude to once, so I think maybe he took more blood than he needed as revenge). They checked the baby's mom for diseases. Everything is negative so far. But I felt like such an idiot. I guess that's what I get for being too confident, and being careless with my needle. Lesson learned. And intern year continues...

Kids and their stupid germs...

So I've discovered one of the sucky things about working in Pediatrics - getting sick from the little disease vectors! Oh yes, they're cute. But they are loaded with all kinds of nasty viruses. I got to experience one myself this weekend. Late Friday night I woke up feeling nauseous. I thought maybe it was just something I had eaten, so I rolled over and tried to sleep it off. A couple hours later I was making a mad dash for the bathroom... and just barely made it. I ended up spending all day Saturday either in bed moaning or hanging over the toilet wretching. I managed to keep a few saltine crackers down, but otherwise didn't eat all day. I felt so weak I could barely walk to the kitchen to get water.

The thing that sucked the most about getting sick was that this was my last full weekend off for awhile. And it was Kimberly's last weekend here in San Antonio. We had big plans to go to Austin Saturday night, to enjoy one last night out together. Oh well. I guess I should be thankful that Kimberly WAS still here when I got sick. It would've sucked being all by myself and sick.

So that was my weekend. Tomorrow it's back to work. My month on the ward is over. I start Nursery next. Should be fun. I'll be sure to share interesting stories.

My 33-hour day

Yesterday (which really started the day before yesterday) was one of the longest days I've had yet. I'm working in the NICU this month and I'm extremely sleep-deprived, so I'm going to be brief. In fact, I think bullet format will suffice.

- Monday, 0530: Woke up late, threw on my clothes, packed my lunch, and grabbed the trash to place on the curb. Halfway to the hospital, realized I had accidentally left my lunch with the trash. Not a great start to the day.
- 0615: Arrived fashionably late for sign-out (that's when residents change shifts). Apologized profusely and sank in my shoes, feeling like the worst intern ever.
- 0700-1230: Rounded on patients, hurriedly wrote notes, ran to the call room to change into my uniform for continuity clinic.
- 1245: Left late for continuity clinic, which is across town at a different hospital. Drove my little Civic Si like a race car and STILL got to clinic late. Had enough time to grab a corndog for lunch. It was disgusting.
- 1300-1600: Had continuity clinic. One no-show, one left without being seen because as always I was running late. Again felt like the worst intern ever.
- 1615: Headed back to Wilford Hall for call. Grabbed snacks and Red Bull from the BX. Ran to the call room and changed out of uniform back into scrubs (now on clothing change #3 of the day). Got to sign-out JUST in time.
- 1700: Began my wonderful night of call. Attempted to work on discharge stuff for one of my babies, but kept being interrupted by my pager.
- 1800-midnight: Don't even remember what I did, but I was busy.
- Now Tuesday, 0200: Decided to try to get a quick nap; went to the call room and fell into the bed. Set my alarm for 0400 thinking that would be plenty of time to gather numbers, write notes, etc.
- 0400: Stumbled back to the NICU and starting writing down vital signs.
- 0430: Paged for twin delivery. Headed to the delivery room, felt like absolute crap. Head was hurting, mind was still asleep, stomach writhing a little from all the candy I ate on call.
- 0530: Finished writing notes and orders for new twin babies; returned to NICU to collect data. Started putting data into computer for day team.
- 0600: Day team arrived; NOT done with my work. Gave a crappy sign-out, and ran off to see my patients before rounds. Again, worst intern ever.
- 0715: Informed that we had the ferret lab. Went to the call room to change out of scrubs and into PT gear (you can't walk to the lab in scrubs). Note: this is clothing change #4. Walked to the lab with coffee in hand... running on adrenaline and Seattle's Best at this point. Changed out of PT gear and into another set of scrubs (change #5). Lab was pretty cool, despite the fact that I had now been awake for almost 24 hours straight. I got to intubate two ferrets, and I was succesful on my first attempt on each. Not bad, if I say so myself. Hehe. Changed back into PT gear (change #6) and walked briskly back to the hospital.
- 0900: Changed back into original set of scrubs (change #7) and headed to the NICU to finish seeing patients/writing notes.
-0930-1200: Rounded on patients, finished work. Drank more coffee. Tried to finish up work, but was told to leave (after 30 hours we "turn into pumpkins" - we have to leave in order to avoid breaking work hour regulations).
- 1215: Changed back into PT gear (change #8) and headed to the library to kill time before my dental appointment. Almost fell asleep at the keyboard.
- 1330: Went to dental clinic. Had probably the most painful filling placed EVER. Almost gagged on my saliva as the dental assistant sat there with the suction device stuck to the inside of my cheek instead of suctioning the back of my throat. Tried to say "I'm gagging" but it came out "I hahheen".
- 1430: Left the dental clinic wanting to cry from the pain. Called my sister and complained. Went home and sat on the couch moaning. Spent the rest of the day feeling sorry for myself.

And that was my 33-hour day. I didn't eat breakfast or lunch (unless you can count a nasty corndog). I changed 8 times. I resuscitated 2 babies, intubated 2 ferrets, and had a cavity filled. Did I mention I feel like the worst intern ever?

Now I gotta get to bed so the craziness can continue tomorrow.

The next hurdle

During residency, we are constantly moving from one training environment to the next. We have month-long rotations through the different departments in Pediatrics: clinic, ward, nursery, intensive care units, specialties like Cardiology or Heme-Onc, and so forth. My first three rotations this year were pretty easy, despite all my whining about being tired and working hard. I've actually had it kinda nice. But starting next Monday, I will be entering a tougher phase of my intern year. I have three inpatient rotations in a row. First I have my NICU rotation (Neonatal Intensive Care Unit), then the pediatric ward, and then nursery. All of these rotations require long hours, sometimes working 2 weeks straight before having a day off. I will be pulling regular call, most likely every three to five nights. I'll be responsible for some very sick kids. I'm a bit nervous about it.

And the thing about these month-long rotations is that by the time you've kinda figured out what you're doing and feel comfortable, that's when it's time to move on to the next rotation. Today was the first day in my clinic month where I felt almost like a doctor. I was relatively on time for all my patients, I made some good management decisions, and I even had time to call some patients at home and follow up on stuff. It was a much-needed ego boost.

Oh, and I found out I passed my boards! So, one hurdle cleared... many more to go. (And yes, that's a picture of me jumping a hurdle - many, many years ago in high school. Ah, my days of track glory. Hahaha.)

It's all about the benjamins

I had my 26th birthday this weekend, woohoo!! I know 26 isn't really a landmark birthday, but I wanted to have a big celebration anyway because 1) It's my intern year and there are rarely occasions to go out and let loose, and 2) It's the one time of year when you can act like a kid and demand that the world revolve around you. Just kidding about that last part. Well, not really. But anyway, Friday night I had a birthday dinner at a really nice restaurant downtown. A few residents were there, as well as my good friends Kimberly and Jenn (Kimberly's my old roomie and a medical student, here on a rotation; Jenn's a friend from Maryland who had flown in to visit for a few days). After our fantastic dinner, we headed to a club across the street called Suede. I had never been there before, but one of my friends said it was supposed to be a great place to go dancing. So we walked into this place and headed to the bar for some birthday drinks. I had a buttery nipple, one of my favorite shots (despite the naughty name, haha). We stood and chatted for awhile, then the ladies started gettin our groove on. We were probably the only people dancing in the room, but I didn't care because - it was my birthday! Then, in the middle of a Justin Timberlake song, something really strange and random happened. I heard some noise from the balcony above and I looked over at Jenn and saw that she had stopped dancing and was staring up at the balcony with a confused look. There was a blonde guy standing there smiling, and it might have been construed as harmless flirtation had it not been for his entourage of beautiful young women with implants and low-cut dresses. Then he dropped a small paper object, and I watched as Jenn reached out for it. It slipped through her fingers and fell to the floor and everybody seemed to freeze as she reached down and picked it up. Then I saw it - Benjamin Franklin's face. "Jenn, is that a hundred dollar bill???" She looked up, dazed, and said, "Yeah, I think it is." I was stunned. "Did that really just happen??" I asked. She nodded and we both looked back up to the balcony. The blonde man and his entourage were smiling at us and giving us the thumbs up. I looked around and everyone was staring at the hundred dollar bill, mouths wide open. Jenn stuffed the bill in her pocket and said, "I'm going to the bathroom." So we ran off to the bathroom and once inside, we inspected the bill more closely. It looked genuine. We continued to be amazed for the remainder of the night, and the bill stayed in Jenn's pocket until we got home. Then I took the picture of Jenn that's posted here, just to prove that it really happened. Who was that guy? And why did he throw a hundred bucks at us? I'll never know. But for one night, it was all about the benjamins baby. Hahahah.

Ear day -- a.k.a. Kill-Linda's-self-esteem-day

Today started out as a normal day in clinic. I had a well-baby visit, which went smoothly. I was actually ON TIME for once, so I was feeling pretty good about myself. Then the ear visits started. First it was a little boy with fever and congestion - sounded like a viral respiratory infection to me. I strolled off to my preceptor's office feeling confident, presented the case, and said "He looks great. Tympanic membranes are clear, so I don't think there's an ear infection causing his fever. This is probably viral - we'll treat him symptomatically". My preceptor walks with me to the office, takes one look in the baby's ears and says, "He's got an ear infection." Great. Moving on. Next patient has similar complaints: fever, congestion, cough, loose stools... so again I'm thinking viral infection. But this time I wanted to be sure, so I attempted to get a good look at the kid's ears. FULL of wax. I tried cleaning it out with my little ear pick, and I guess I was too aggressive because the kid started screaming and I noticed blood coming out. CRAP. I ran to my preceptor's office in a panic, thinking I perforated this patient's eardrum... but he assured me that it's not uncommon for ears to sometimes bleed when being probed. So I sent the baby to get his ears flushed (I figured I had tortured him enough with my little instrument of death). When I was finally able to see his ears, they were bright red - as expected, since he had been screaming his head off. So I couldn't figure out if he had an ear infection or not. Turns out he didn't. (Again, my preceptor took one look and said, "No ear infection. Just red from crying." Of course, his ears didn't look any different to me than the previous kid's ears, but apparently it was obvious).

And then there was the finale of ear drama. My last kid of the day, chief complaint of hearing loss. Mom seemed friendly enough; she didn't even seem to mind that I was an hour behind. We chatted for a little while, I got the medical history, and then it was time for the exam. I looked in his ears and whadya know... full of wax. Perfect. It's the end of the day, I just want to go home. So I decided to try to get the wax out so I can see his eardrums. After my previous experience just hours earlier, making a kid's ear bleed, I decided to be extra gentle. So I got my little probe, pulled my patient's ear slightly to open up the canal, and started moving the wax out of the way. He seemed to be doing really well. Then all of a sudden I heard a sniffle. I looked at his face and he looked like he was ready to burst into tears. And a second later he did. Of course that made his mom get all upset, and so whatever rapport I had established with her went out the window. She went off on me. Big time. She said, "I want someone to look in his ears to see if you damaged anything. He never cries, and you stuck that thing in his ear and made him cry." I said, "I apologize, ma'am, but sometimes kids do cry when we try to get wax out." "NO, my son never cries. I want a REAL doctor to look at him. I'm just not comfortable with some intern sticking stuff in his ears." "Again, ma'am, I'm sorry. I AM a real doctor, but if you'd like to see my staff, that's fine." I maintained my composure long enough to leave the room and go to my preceptor's office. Then I lost it. I don't know why, but I started crying. And when my preceptor asked what was wrong, it was like when you're little and you've hurt yourself and you're totally fine until you hear your mom's voice, then you break down. I just felt so frustrated and incompetent. It's so hard being an intern. You've worked four hard years in medical school and you have an M.D. after your name, but you still feel so inexperienced. The nurses seem to know more, even the techs seem more capable. I've tried so many procedures and failed... I can't seem to remember any of the basic skills I should've learned as a med student... I'm tired and defenseless... and now a patient's mother has questioned my competency. It was enough to send me over the edge. But just for today. I won't let her shake my confidence for good. Tomorrow is another day. Fresh, with no mistakes in it yet. :)

And now I'm gonna go take my frustration out on my weeds. Later!

New hobby

I've discovered a new way to release my stress: gardening! My mom has always been into gardening, and she used to try to share her hobby with me when I was younger, but at the time I had no interest. Now that I have my own house, it's a little more appealing. Also because I spend so much time inside the hospital, it's nice to be outside and enjoy some fresh air and sunlight. But man, it's hard work! I spent two hours weeding today and barely made a dent in my backyard. It's FULL of weeds. My back is hurting, my neck is sore, and I have itchy red marks all over my legs. But it was rewarding. I have a vision for my yard. It will be my oasis.

Meanwhile work goes on. I'm now fully immersed in internship. No longer can I say, "Well it's only my first week!" I'm working in the clinic this month, which is fairly low stress. Next month I'll be in the NICU... which scares me. I did a rotation in the NICU last year as a med student, but it's going to be a very different experience as an intern. But I suppose I will get through it, just as everyone before me has. I cleared another obstacle last week - Step 3! It's over, yay!! Now I have to play the waiting game. It will be 3 or 4 weeks before I find out if I passed. PRAY!

Now it's time for well-deserved sleep. Goodnight! :)

You're a slacker, McFly!!

For anyone who doesn't get the title of my post, it's from one of my favorite movies ever, "Back to the Future". I'm feeling like such a slacker right now. I'm three days away from my board exam, and I can't bring myself to study anymore. And it's not like I've been studying very hard to begin with. I'm so easily distracted, and even when I do study it's only half-heartedly. I just don't have it in me anymore. I'm tired of tests. I'm horrible at standardized tests. And I get really anxious about them, which probably makes me perform even worse. My second year of med school when I was getting ready to take Step 1 of the USMLE, one of our advisors did this thing where he figured out who was "at risk" for failing the boards. He used this equation that he made up, which included our MCAT scores, cumulative GPA and so on. Anyway, I ended up being calculated as high risk. I had to go talk to the advisor and he told me I needed to study extra hard. Duh. Like I wasn't gonna study before he told me that. I ended up scoring 20 points above what he had predicted. Boo-yah.

Still, I get nervous. If my old advisor were to come up with an equation for predicting Step 3 success, I wonder if I would be high risk again. And if so, would I be able to beat his prediction again? I hope so. I really don't want to have to take this test more than once. It's incredibly painful. My brain hurts just thinking about it. This is cruel and unusual punishment.

Okay so maybe I'm being a little bit dramatic. But I just had to vent. Please pray for me to pass my board exam. It's on Thursday and Friday. Now I suppose I should try and study. Next time I write, I will be DONE with the exam!

So, what IS the What?

I just finished reading "What is the What" by Dave Eggers. It's an autobiography about a young Sudanese refugee named Valentino Achak Deng, and it was an AMAZING book. Sad, moving, even funny. I still don't know what "the What" is, though. If you want to try to figure it out, pick up this incredible book at your local library or bookstore. It's a great way to get an insider's perspective of the conflict in Sudan. There's also a website, http://www.valentinoachakdeng.org. If you're interested, there's lots of great information, pictures, and links. Oh, and by the way... when you purchase "What is the What", the proceeds go towards aiding Sudanese refugees. Pretty cool.

Now that I've finished, it's time to start reading the final Harry Potter, woohoo!! I love J.K. Rowling. She's such a genius.

For all you coffee lovers out there...

I saw this article on Yahoo today. It made me happy. And it made me want to say "Told you so!!" to all those people who try to say drinking coffee everyday is bad for you. I love my coffee. It's more than just a drink, or even a caffeine buzz (although those are both nice) - it's the ritual of drinking coffee that I enjoy. It's my morning routine. It's sitting in a quaint little shop with a good friend, chatting over white chocolate mochas and caramel macchiatos. Or cozying up in a big loveseat with a mug in one hand and a book in the other. It got me through those all-nighters in college, med school, and now residency. Not to mention, it keeps me regular. Haha. :)

Anyway, here's the article:


Good News About Coffee: Filtering the Facts

Coffee lovers may be raising their cups—and perhaps eyebrows—at the recent news (in the Journal of Agricultural and Food Chemistry) that the drink contains soluble fiber, the type that can help lower cholesterol. With about 1 gram per cup, coffee’s fiber impact is modest. But the report is the latest in a growing stream of positive news about coffee.



Some of the most promising findings come from studies of diabetes. When Harvard researchers combined data from nine studies involving more than 193,000 people, they found that regular coffee drinkers had a significantly lower risk of type 2 diabetes than those who abstained. The more they drank, the lower their risk.

And, despite coffee’s reputation for being bad for the heart, recent epidemiologic studies haven’t found a connection; some even suggest coffee can be protective. A study in February’s American Journal of Clinical Nutrition reported that healthy people 65 and over who drank four or more cups of caffeinated beverages daily (primarily coffee) had a 53 percent lower risk of heart disease than non-coffee-drinkers.

It’s even more beguiling when you consider that the immediate effects of drinking coffee tend to go in the opposite direction, raising heart rate and blood pressure and temporarily making cells more resistant to insulin. “But those effects are probably short-lived, as people develop a tolerance,” explains Frank Hu, M.D., Ph.D., associate professor of nutrition and epidemiology at Harvard School of Public Health, who has studied coffee extensively. “In the long term, beneficial components in coffee may have stronger, more lasting effects.”

How coffee might work isn’t clear; the studies weren’t designed to identify cause-and-effect relationships. Antioxidants, such as chlorogenic acid (related to polyphenols in grapes), are likely players: coffee has more of them per serving than blueberries do, making it the top source of antioxidants in our diets. Antioxidants help quell inflammation, which might explain coffee’s effect in inflammation-related diseases like diabetes and heart disease. Magnesium in coffee might help make cells more sensitive to insulin. And caffeine seems to have its own beneficial effects; the diabetes studies found that those who drank regular coffee had lower risks of the disease than decaf drinkers. Caffeinated-coffee drinking has also been linked with reduced risk of Parkinson’s disease, gallstones, cirrhosis and liver cancer.

Bottom Line: For healthy adults, having two or three cups of joe daily generally isn’t harmful and it may have health perks.

Another day in paradise

Well it was another lovely night of call. I slept about 45 minutes, and found myself falling asleep while sipping coffee this morning. How does that happen?? Anyway, it was a pretty busy night. There was a 27-week premie born around 1:00 in the morning (WHY is it always in the middle of the night??). Unfortunately because I'm an intern, I don't really matter (not dissing myself, it's just the truth)... so I wasn't called to the delivery. I was examining another new baby. But when I got back to the NICU I saw a whole mob of people around this teeny little baby, hooking him up to the ventilator. Then they noticed I was there and invited me to help. I attempted to put an umbilical arterial line in, but was not successful. It's a lot harder than it looks! Those vessels are so small, and the catheter is stiff and gets caught at every bend or valve. I also attempted an IV last night, but was not able to get that either. I blew a couple veins and decided to stop using the baby as a pin cushion. So all in all, it was not the best night for my self-esteem. But at least I got to try.

Sometimes I wonder what I would've done if I hadn't gone down the doctor route. A couple of residents were joking about that the other night at my friend's party. This lifestyle is just very demanding. And work is continually challenging. Especially intern year, when you have so much to learn. So I guess I better get to it - time to hit the books.

I am NOT a radiologist

I haven't written in awhile because, well there's just not much to write about. I've been hanging out with the Pediatric Radiology department this week, as part of my elective rotation. After 4 days in a dark room looking at X-ray after X-ray, I can say with certainty that I was not meant to be a radiologist. I mean, it's an interesting job and all... and I'm glad someone likes to do it. But it's just not for me. I think I'm too ADD. I get bored sitting in one spot and staring at the computer screen.

I can't complain, though, because the hours have been great. I left at noon today. I'm supposed to be taking advantage of these hours to study for my boards. But instead I went to see "Transformers" with one of my friends tonight. It was fantastic. I had forgotten all about Megatron and the Decepticons. Brings back memories. :)

Camp CAMP

I spent the last week at an incredible summer camp called Camp CAMP. CAMP stands for Children's Association for Maximum Potential, which is a non-profit organization that "enables children with disabilities to thrive in a recreational environment where safety and nurturing are primary." I found out about it from my residency program - they encourage residents to attend camp as medical staff if our schedules permit. Fortunately, my schedule did allow me to attend, and I'm SO glad I had the experience. I've never been around severely handicapped children before. At least not in this sort of setting. I learned about them in medical school. I've seen them in hospitals. But I've never had daily encounters with them in a laid-back, non-medical environment. It was like a little taste of what life must be like for these kids and their families. Everyday we drew up their meds, distributed them (which could be very challenging!), and assessed the kids to make sure they were staying hydrated and not having any medical problems. The job of being a camp doctor wasn't really that hard. What was difficult was trying to find time to get to know the kids and their counselors. We had lectures every morning and I had to work in the infirmary a couple times, so between those responsibilities and managing meds, it was hard to really feel like I was part of the tribe (the kids were divided into four "tribes": Cherokee, Apache, Mohawk, and Pawnee... notice the initials are C, A, M, and P?). But I tried to attend activities when I could. They had typical camp activities, like swimming, horseback riding, and archery. Every child had a counselor, which I thought was really neat. It makes sense, though, since most of these children are so medically complicated that they need constant supervision. But here's the amazing thing - the counselors were all teenagers! They were aged 14 and up, and each one was paired with a disabled child. They were responsible for their child 24 hrs a day, for the entire week (they got a few breaks, but not many). They fed them, bathed them, changed their diapers, pushed their wheelchairs, and soothed them when they were homesick. They had to put up with all kinds of nasty bodily fluids, temper tantrums, hair-pulling, biting... and they did it with such grace and patience. I was so impressed with the counselors. I don't think I was nearly as mature or selfless when I was their age.

If I had to tell you about one camper that stood out in my mind, it would have to be a little boy who was about 8 years old, and I'll just call him Danny (he's a foster child, so I have to be careful about giving too much information... I can't put his picture on here, which is too bad because he has the CUTEST smile). He has a disease called Duchenne's muscular dystrophy, which is an inherited, progressive, muscular disease. These children are missing a muscle protein called dystrophin, and have weakness of certain muscle groups (initially in the lower half of the body, but eventually affecting the upper half as well). Many children end up in wheelchairs by adolescence, and death occurs in the second decade of life (usually from lung problems). They are usually intellectually normal, but may have some mental delay. I believe Danny was only slightly delayed. It is a devastating disease because it's progressive, and there's no cure. Anyway, Danny just had the sweetest disposition and the brightest smile! He was still able to walk, but his gait was abnormal because of his leg weakness. The last night at camp, there was a dance held in the outdoor pavilion (the traditional "prom night" for the campers, held every year). Danny was so enthusiastic about dancing and so popular amongst the other campers and counselors, and he ended up being crowned Prom King! It was so cute. He was very proud of his "crown" (a baseball cap decorated with puff paint and glitter). The med staff went crazy taking pictures. We called ourselves the camp paparazzi.

There were so many other adorable and loveable kids, I could tell a million more stories. Let me just say, I enjoyed it so much that I am planning on going back if I can. If you're interested in learning more about Camp CAMP, check out their website at www.campcamp.org. Now I gotta go to work - I'm on call tonight. Good times!

My first Down's baby

Today was the first time I've seen a newborn with Down syndrome. Well I guess I should correct myself - with suspected Down syndrome. We still have to wait on the chromosomal tests. But my attending is pretty sure that's what it is. This is a baby who pediatricians would lovingly call an FLK (Funny-Looking Kid). With FLKs, we always look at the parents to ensure they aren't FLPs (Funny-Looking Parents) - this baby's parents were not. So we had to consider other reasons, one of them being Down syndrome. She has several of the classic findings: downward-slanting eyes, flattened nasal bridge, protruding tongue, redundant neck tissue... and she is SO cute (well technically being cute is not a classic finding, but I just had to throw that in there). She was wearing this little yellow onesie, and was looking around the room, trying to figure out what was going on. Her parents did not take the news very well. They kept saying things like, "Well she just has a lot of swelling around her eyes" and "She has a lot of fat under her chin, maybe that's why she has all that tissue in the back of her neck, too". This is their first child. I'm sure nobody wants to be told their first child may have Down syndrome. I felt really bad for them. And the worst part is, the chromosomal test won't come back for a month. Can you imagine being a new parent, wondering for 4 long weeks whether or not your child is normal? It must be so frustrating.

The experience made me think of a book I read, called "The Memory Keeper's Daughter" by Kim Edwards. It was an excellent book - I highly recommend it. It's about a doctor who gives his child away because she has Down syndrome. Very sad, and very moving. I hope this family I met can deal with whatever diagnosis ends up being given to their daughter. And if it's Down's, I hope they can manage to be as excited about her as they would be about a healthy "normal" baby girl. I found an interesting video from the Christian Broadcasting Network, interviewing parents of Down's children. I don't know how to post it, so here's the link: http://www.cbn.com/CBNnews/191521.aspx. I really enjoyed the video - it gives you a different perspective. Now if you really want a heart-warming story about Down's children, go buy (or borrow) the book I recommended!

The Pest Western

I just have to say the hotel I'm staying at is disgusting. I will not name the hotel, but I think you can probably guess from my title (I thought it was a pretty clever little pun). I awoke several mornings last week to find extremely large cockroaches running through my bathroom. Imagine being all half-awake, stumbling over to the toilet for your morning pee... and all of a sudden you see this nasty black thing scurrying across the tile. I screamed. And then I threw the shampoo bottle at it. I was so disgusted I couldn't even bring myself to throw the dead bug away, so I left a little surprise for the maid. Oops.

Turns out the cockroaches were coming up through the shower drain. How disgusting is that. Apparently I'm supposed to close the drain when I'm not using it. The hotel owners were really nice, they came and sprayed the room for me. Gosh, I'm such a girl. I get freaked out by bugs. My mom's not girly. She kills bugs with her bare hands. She always said (with her Korean accent), "Why you afraid of bug, Ninda? You bigger than the bug!" I love my mom. She cracks me up.

That's my story for the day. Now it's time to study. :)

2 weeks down, 142 to go...

I can't believe it's only been 2 weeks since I started residency. I feel exhausted already. I was on call last night and I felt like such a zombie. Everything I did was in slow motion. I almost fell asleep walking downstairs to the nursery. And at one point, I thought to myself, "How am I going to do this for THREE YEARS??"

There's something wrong with the medical career field. Whoever thought doctors can pull 24-hour shifts and make good decisions was out of their mind. I can feel myself getting dumber and dumber the later the night gets. And the problem is, there's a whole cohort of doctors who have this philosophy that "because I went through it, everyone else should, too." There are older doctors who would probably be extremely annoyed by this blog because they'd say I have nothing to complain about. We have a new policy now, the so-called "80-hour work week." Old-school doctors scoff at this, thinking they've softened residency too much. But if we break it down, here's what we get. There are 168 hours in a week. If you work 80 of them, that leaves you with 88 hours. Studies have shown that most adults need at least 8 hours of sleep a night in order to be functional and avoid accumulating sleep debt. That means of the remaining 88 hours, 56 hours should be for sleeping. That leaves you with 32 hours to do anything else with your life. That's 4.5 hours a day. Plus if you add commute time to and from work, you probably only have about 3.5 or 4 hours.

There just aren't enough hours in the day. If you ever wonder why your doctor seems so rushed or perhaps isn't giving you the attention you think you deserve... well maybe this will help you understand a little better. It's such a demanding career field. And I'm only 2 weeks into it. Yikes!

Random day

So today I had my in-service exam back in San Antonio. I made the two hour drive last night with one of the other residents, and woke up this morning to take a grueling 200-question test covering all topics in Pediatrics. That's right, after 20 years of formal education and graduating from med school in May, the tests STILL aren't over. I have my final board exam (Step 3 of the USMLE) this year, which is two days long. That'll be fun. :)

But I digress. My random day. So after our exam was over, we got in the car to head back up to Killeen. For those of you who aren't familiar with Texas, Killeen is in the middle of nowhere. The drive from San Antonio is pretty boring - lots of farmland, cows munching on grass, and pick-up trucks swerving into your lane when you're trying to drive the speed limit. But about an hour into our drive, I noticed something out of the corner of my eye that made ME almost swerve. It was a zebra!! No kidding, right off this little highway in podunk Texas, there was a real-life zebra just hanging out. I asked the resident, Eshita, if she saw it. She said no, so I said, "Well we have to go back! You have to see this!" So we made a U-turn on the highway and went back to where I saw the zebra so Eshita wouldn't think I was crazy. It was this place called "The Exotic Resort" and apparently they have over 500 animals there. I'm not sure where all the animals are, though, because I pretty much just saw the zebra and some ponies. But anyway, as you can see from the picture, the zebra was very friendly. He walked right up to me. It was really funny.

Only in Texas!

Welcome to internship

On July 2, 2007 I started my Pediatrics residency. I left my new home in San Antonio and headed up to the lovely little town of Killeen, about 2 hours north. For the next month, I'll be working in the nursery at Ft. Hood, Texas. It's one of the largest Army bases in the country, and supposedly has so many deliveries it's known as a "baby factory". So it should be a good experience. This transition to residency is very strange. One day you're a medical student, the next day you're a doctor. You feel like you're somebody important, walking around in your long white coat and stamping orders... but then you realize you know NOTHING. It's very humbling.

Thursday night was my first 24-hour shift. This is what doctors refer to as being "on call". When you're in residency, this means you are physically at the hospital, and usually awake (you can sneek in cat naps if things are slow, but this is only if you're lucky). Staff physicians, who have completed their residencies, usually pull call from home. They have their pagers on and must be within a certain distance of the hospital... but until I finish residency, I will know nothing of "home call". Rather, I will always have "in-house call". Interns are on a regular call schedule, and this can be highly variable. At best, you may have a rotation that doesn't require call at all. At worst, you may end up being on call every three nights (we call this "Q3" in the medical world). Right now I'm on an average of Q5 calls (every five nights).

My first call was quite eventful. In fact, I will probably never forget it. It started off pretty laid-back. There was one new delivery, but it was a healthy term baby so we weren't even called to the delivery. My attending (the staff physician) and I decided to eat dinner and then go do this baby's physical. After seeing the baby, writing notes, and ordering some labs and meds, we decided to try and get some sleep. Then things got crazy. The nursery pager kept going off - one delivery after another. The ICU called me a number of times about our diabetic patient. Our little jaundiced baby had a ridiculously high potassium level - which I assumed was a lab error since she looked great. And then at 3:30 in the morning we got a page for another delivery. "We need Peds in Delivery Room 2 for a 22-weeker." I was blurry-eyed and sleepy, so I said "Okay, we'll be right down." After hanging up the phone, I realized what I had just heard. I immediately called back. "Did you say 22 weeks??" "Yes, 22." WOW. (For non-medical people, 22 weeks gestational age is not considered viable.) Shocked, I hung up the phone, grabbed my attending, and we ran down to the delivery room. There must have been about 20 people in there. I saw this young mother lying there about to have her baby, with a very concerned-looking husband nearby. The nurses were standing by the warmer, ready to receive the baby. She came out quickly, and was immediately placed on the warmer. Her body was lifeless, she didn't utter a single cry. I listened for a heartbeat - my stethescope covered her entire chest - and I heard one, faint and slow. The next 10 minutes were horribly surreal. My attending walked over to the parents and explained the situation to them - the baby was just too young, the outcome would be poor even with the best efforts, and any attempt at a full resuscitation would basically be futile. She told them what the medical opinion was, but reassured them that the ultimate decision was theirs. I can't imagine what that moment must have been like for them. It was agonizing for me just to watch - how much more painful was it for them to go through it?? They ended up deciding to let the baby go. And after some coaxing, they agreed to hold her. The nurses wrapped her up in blankets and placed an oversized knit cap on her head, her tiny face peeking out. Four hours later, her heart finally stopped beating.

My first night on call I saw a baby girl die. Welcome to internship.