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.