Be Thou My Vision

This morning at church I re-discovered a beautiful hymn called "Be Thou My Vision".  It's been a long time since I heard it and I was pleasantly surprised!  I was at First Baptist Church of San Antonio, inside an old historic building.  The sun was shining through the stained glass windows and the sanctuary looked grand.  The choir and congregation sang it so beautifully and softly.... and for a moment I had a feeling of peace.  It really moved me.  The melody is beautiful but the words also capture my soul.  Here they are:

Be Thou my vision, O Lord of my heart

Naught be all else to me, save that Thou art

Thou my best thought, by day and by night

Waking or sleeping, Thy presence my light

Be Thou my wisdom, and Thou my true Word

I ever with Thee and Thou with me Lord

Thou my great Father, I thy true son

Thou in me dwelling, and I with Thee one

Be Thou my battle shield, sword for the fight

Be Thou my dignity, Thou my delight

Thou my Soul's shelter, Thou my high tower

Raise Thou me heavenward, O power of my power

Riches I heed not, nor man's empty praise

Thou mine inheritance, now and always

Thou and Thou only, first in my heart

High King of heaven, my treasure Thou art

High King of Heaven my victory won

May I reach heaven's joys, O bright heaven's sun!

Heart of my own heart, whatever befall

Still be my vision, O ruler of all

Adult medicine? What's that??

I'm at Ft. Hood in the great little city of Killeen, Texas.  I was here a year ago for my nursery rotation.  This year I am rotating in the ER.  Which means I have to see kids AND adults.  Weird!  I don't remember how to do adult medicine.  I haven't taken care of adults in a long time.  It's all foreign to me.  Fortunately the people I'm working with are really cool and they don't mind letting me see the kids that come in.  No crazy stories just yet.  I had two patients walk out on me, which was kind of funny.  People seem to think the ER is like Burger King - "Have it your way."  Um, sorry to disappoint, but NO.  It just doesn't work like that.  It's so hard to provide compassionate care to people who are so entitled and ungrateful.  Drives me crazy.  But I guess that's what I signed up for.  The good, the bad, AND the annoying.

The calm before the storm

It's a beautiful Saturday morning and I am enjoying a nice warm cup of chai tea, enjoying these last few moments of peace.  In 3 days I will be starting my second year of residency as the senior resident in the NICU.  I'm a little nervous about this new level of responsibility.  It's just so strange... one night you go to bed a clueless intern, the next day you wake up as the all-knowing senior resident.  Yikes!  I'll have three interns to be responsible for.  I will be their direct supervisor, as well as their teacher.  I'm kind of excited about this job, but also somewhat anxious.  I want to do a really good job.  I had excellent second year residents last year.  I have big shoes to fill.

But there's no sense in sitting here worrying about it.  Worrying doesn't add a single hour to the day, as it says in the Bible.  So for now I will enjoy the sunny weekend and get rested before the craziness begins!  :)

17 days and counting...

I'm almost done with my intern year!!!  I can't believe it!  It went by fast.  I'm super excited, and a little nervous too.  I'm not sure if I'm ready to be a second year resident.  But I don't really have a choice because they passed me on all of my rotations this year so apparently somebody important thinks I'm ready.  :)  I still feel like I have SO MUCH to learn.  I think I'm going to be reading a lot more this year.  I feel like intern year was kind of just a time to get my feet wet, to get accustomed to Pediatrics, and to learn the system.  NOW I need to learn the art of medicine.  It's a lot to squeeze into a 3-year residency.  But I know being a doctor will involve lifelong learning.  I'll never be done learning or taking tests.

Top ten memories of intern year:

10. Walking into my first continuity clinic ever and looking at my first patient's chart - former 22 week premie with cerebral palsy, hearing loss, blindness, hypothyroidism, etc., etc., etc.  AHHHH!!!

9. Circumcising a little African-American baby boy who was so large we nicknamed him "Big Dog Duckett".

8. Rounding on patients with the ward team dressed up as the Flintstones on Halloween.

7. Walking with our leukemia patients on the annual Light the Night walk.

6. Telling off a lab tech only to come face-to-face with him several weeks later when I had a needle-stick injury and he had to draw blood from me.  KARMA.

5. Having a ward spelling bee because all the guys on our team were so bad at spelling - taking home the winning ribbon!!

4. Walking into one of the Labor & Delivery rooms with a newborn in his bassinet, giving my discharge instructions and realizing halfway through I'm in the wrong room - receiving blank stares from parents who have not had their child yet.  Oops.

3. Running my first mock code ever on the ward, not just as practice but as the "official" pediatric ward mock code - failing miserably and crying in front of two attendings (including the department chief).

2. Causing a raucous in Fredericksburg during our resident retreat - Sue throwing a bottle of Worcestershire sauce and me dropping and shattering a bottle of beer.

1. Making some great new friends.  :)

There's no place like home

I wish it were as easy as tapping ruby red slippers together and chanting "There's no place like home."  I wish I could be with my family whenever I'm feeling homesick.  Unfortunately it took a very long plane ride and months of planning.  Also money, Air Force leave request, and much preparation.  I spent the last 10 days on the East Coast, and it was wonderful.  I spent the first part of my visit up in Maryland, where I got to see my good friend Kimberly graduate from med school.  I also reunited with some old friends and even went to my old church.  Then I headed to the Outer Banks in North Carolina for some much-needed R&R and girl bonding time with my mom and sister.  Lisa had flown in from Las Vegas.  She is almost 6 months pregnant with a little girl, and definitely has the "glow" of pregnancy.  She has always been beautiful, and is even more so now.  We went to a lesser known area of the Outer Banks called Ocracoke Island.  It's a very small island that is accessible only by ferry, private boat or plane.  It has a population of less than 1000 and has miles and miles of untouched beaches.  Most of the Outer Banks has been built up and commercialized.  But not Ocracoke.  As soon as we drove off the ferry there was a sense of old-town comfort and quiet.  People ride bikes around the small island.  There are no familiar chain restaurants or stores - no Wal-Mart, no CVS, no McDonald's.  Instead there are quaint privately-owned shops, such as "Sweet Tooth" candy store, "The Back Porch" restaurant, and of course the General Store.  We stayed at a lovely B&B called The Cove.  Our deck looked out at the water.  After 3 glorious days at the beach, the girls headed back home to Virginia and I spent the rest of the week catching up with family and preparing for Lisa's baby shower.  We had a mini family reunion for her shower - almost all of the 12 cousins were there.  My last night at home I walked around the farm taking pictures with my new camera, marveling at what a peaceful night it was.  My parents have built their retirement home on a farm and there's a little pond in front that sparkles at night when the sun is setting.  It couldn't be more picturesque.  The next morning was filled with tearful goodbyes - particularly when my sister left.  I almost always cry when we part.  I miss her so much.  And I miss the rest of my family, too.  Coming home from vacation is always hard.  Especially when you've gone home to visit family.  Hence the title of the blog.  Despite the friends I've made here in Texas and the exciting new adventures I've had here, I still feel like a part of my heart is missing because it's with my friends and family in Virginia.  There truly is no place like home.

Constructive vs. destructive criticism

I finished my ward rotation at University Hospital today.  This is the one civilian rotation we have all year.  The purpose is to expose us to another medical system, particularly one like UH that has a lot of pediatric trauma and high-acuity patients.  I was actually pretty excited about it.  A new hospital, new people to meet, interesting patients, and I got to dress like a girl instead of wearing my very unattractive BDU's everyday.  

I'm sorry to say I was somewhat disappointed with the rotation.  Don't get me wrong - I did enjoy the medicine I learned, and I enjoyed getting to know some of the people there.  Unfortunately, my senior resident and I didn't really click.  She's a very serious, smart, efficient resident.  I'm more laid-back, which I think can be perceived as laziness.  I'm not lazy, though.  I work hard.  Granted I have my off days where I'd rather not be there and I probably don't give 100%.  But for the most part, I consider myself to have a very good work ethic.

Unfortunately, this is not what my senior resident thought of me.  I asked for feedback halfway through the rotation and again today at the end of the rotation... and I have to say, it was probably the most negative, unhelpful feedback I've ever gotten.  And I'm not just being defensive when I say I don't agree with it.  I really do think I did a better job than she gave me credit for.  She totally focused on the few things I did wrong and didn't mention any of the things I did right.  It was really quite destructive to my ego, and not constructive in any way.  Apparently this girl did not attend leadership courses like I did in ROTC at good old Virginia Tech.  Hasn't she heard of the "feedback sandwich"?  Positive critique, followed by negative critique with suggestions for improvement, wrapped up with positive critique.  You can give constructive criticism without making someone feel like a piece of crap... which is what she made me feel like.

But I only felt that way for a little while.  Then I decided I'm not going to let her get to me.  I know how hard I worked.  I know the good things I did.  I don't need her recognition to know that.  I'll be honest, I'm still a little frustrated by the whole thing - but I'll get over it.  I'll put a smile on my face and keep trying my hardest.  Only 2 more months of intern year, and then I'm no longer at the bottom of the totem pole.  Yay!!

And I'm BACK!... with a Mac!!

So about a month ago my 5-year old HP laptop decided to die.  It's been a pretty slow inevitable process... little things kept breaking here and there.  Then I got a nasty virus and everything shut down.  I decided it was time to buy a new computer.  My laptop was extremely outdated and worked better as a doorstop than it did as a computer (it weighs about 20 pounds, haha... no seriously, it's ridiculously heavy).  

In the meantime I've been disconnected from the outside world.  No Facebook, no MySpace, no blog, no YouTube.  In other words, I had loads of time to do more productive things.  Like watch American Idol.  Hahah.  But I also spent a great deal of time researching what I would buy to replace my old laptop.  I seriously spent HOURS comparing all the different PC's.  I learned more than I ever want to know about processors, frontside bus (still don't really know what that means), gigabytes, RAM... I had narrowed it down to either a Dell or Sony Vaio.

And then I talked to some friends who made the leap from PC to Mac.  One friend told me, "I will never buy a PC again."  She let me play with her Mac.  It was pretty sweet.  So today - one month after the death of my HP - I bought a Macbook.  It's a pretty big change for me.  I've never been an Apple girl.  Macs always kinda scared me.  And they seem to be for people who are members of some sort of secret elite club.  But so far I'm happy with my purchase.  My Macbook is so pretty and fancy!  I have hours of nerdy enjoyment ahead of me.  And now I'm back in the internet world.  I'll still be watching American Idol, though.  :) 

Back in the NICU

I'm working in the Neonatal Intensive Care Unit (NICU) again this month, so I probably won't be writing on this blog too much. Not that I write much as it is. I have become too busy and too tired to bother writing on here. I cherish my spare time to sleep or attempt to lead a normal life. Last night I actually got away from the hospital and did something fun. I went to see "The Phantom of the Opera" with one of my good friends who was in town. It was the Broadway show - they are on tour here in San Antonio at the Majestic Theater. It was amazing!!! I absolutely loved it. I've been singing songs from the show all day. What a beautiful, tragic love story. I want to see it again.

And now I'm off to bed, hoping to dream of my own Phantom who's madly in love with me. Haha. :)

Holy cow!!

Yesterday I was on call. It started off with a painful social admission (noun: 1. patient admission to hospital NOT due to medical problems but because of social reasons; 2. administrative nightmare, whereby intern spends ridiculous amounts of time making phone calls, sending faxes, and NOT practicing medical skills). Yes, I spent about 6 hours on ONE patient who was admitted for reported abuse. I know, I know... I should be more more compassionate. It is sad. Don't get me wrong, there's nothing that ruffles my feathers more than the topic of child abuse. But these cases take so much time, you end up neglecting your other patients who have real medical issues. Which was what I did half the day yesterday.

But that's not what the holy cow is about. So around 9:00 pm I got a call from the ER saying they had a kid they wanted to admit. 7 year old with fever and chest pain, concern for pericarditis (noun: 1. inflammation of the pericardium, which is the sac that encloses your heart). We go down to see this kid and he's sitting in bed looking kind of miserable. Cute kid! Reddish hair, sweet little voice. He originally had a temperature of 105 and a heart rate of 170 (very fast for his age). When we got there his temperature and heart rate were normal, as well as the rest of his vital signs. He said his chest hurt a little, but otherwise felt okay. We chatted with our supervisor and ended up sending him to the pediatric ICU for observation.

Two hours later, the kid ended up decompensating. His blood pressure dropped, his heart rate went back up, and he seemed to be going downhill fast. It turns out he had developed a pericardial effusion (fluid around the heart) and was going into early cardiac tamponade (a condition where the fluid is compressing the heart to the extent where it can't pump efficiently anymore). He ended up being intubated and they had to go in with a needle and drain the fluid from around his heart ("they" did, not me... stick a needle in a kid's chest, are you kidding??). He's now stable but has a tube coming out of his chest and could very well have died.

Holy cow.

Lesson learned: KIDS ARE SCARY!! He looked so stable when we saw him in the ER. That's why they teach us pediatric residents to be aware of how fast kids can "crash". This kid sure did, and I'm just glad he was in the right place when he did.

My happy place

Today was a CRAZY day on the ward. My fellow intern was post-call and my second year resident had clinic, leaving two people to cover the ward - the third year and MOI. We had two discharges, four admissions, a possible child-abuse case, an infant whose IV kept falling out... not to mention my pager went off every 5 minutes. In between admission orders, discharge summaries, talking to the pharmacy, calling Radiology, calling Child Protective Services, Orthopedics, Ophthalmology, Infectious Disease, and every other consultant you can think of... it's no wonder I almost lost my mind. I didn't have time to eat so my empty belly did not help my mood. We had rounds with our new attending, who is much less laid-back than our previous attending. There were multiple medical mishaps that happened last night WHEN I WAS NOT ON SHIFT, but for some reason I got the heat for it. ARRGHH!!!!

At some point during the day I looked up at my computer screen, which has the above pictures as the backdrop. I chose it because I wanted a picture of my "happy place". On one of my past rotations, when things got really crazy my third year would look at me and say, "Go to your happy place." And the first thing that popped into my mind was Kenya. Seems strange to say that now, with all the violence going on there. But my memories of Kenya are happy ones. Almost exactly one year ago, I boarded the plane for the most exciting, moving, life-changing adventures of my life. I met some amazing people, and I felt like I was really living. For two weeks, I didn't have to think about tests, papers, deadlines, graduation requirements, residency fears, heartbreaks, family drama, or ANYTHING! It was just two weeks dedicated to serving God and enjoying Kenya and all its beauty. The people, the place, the circumstances... meeting other sponsors, meeting my sponsor child! It was all so incredible. As it was happening, I remember thinking "I don't want this to end. I want to freeze this moment in time, right here." I think I knew I would need to store those memories in a place where I could retrieve them later.

So today, in the midst of all the craziness on the ward, I glanced up at my computer and for a split second... I was no longer a tired intern trying to write orders and remember milligrams per kilogram dosing. I didn't hear the horrible sound of the beeper going off. I wasn't sitting in a cold flourescent-lit hospital, worrying about how I was going to get all this work done.

For a split second I was sitting on a tour bus in Nairobi, windows down with a warm breeze flowing in. Excited chatter about which project we were going to visit. I felt rested, peaceful, calm, happy, connected. No thoughts about medicine. No worries about being evaluated, judged, or reprimanded. Just enjoying being with other believers. Singing songs on the way to the slums. Looking outside at a foreign world. Laughing with our good friend Fred. Chatting with my dear roomie Allie. Wondering what delicious meal we would eat at the hotel that night by the pool, the cool evening air perfect for lounging and having meaningful discussions. Feeling God's presence like I've never felt it before. For a split second, I was in my happy place.

And then, BEEP-BEEP-BEEP-BEEP!! The nurses paging. Back to reality. Thank God for the small blessings. I was allowed one moment today to be in Kenya. I hope to go back soon. :)

100-hour work week

I worked 100 hours this week. I'm not even kidding. I was on call 3 times. Two of those call nights I didn't sleep AT ALL. I have never felt so tired in my life. On Friday I had about five cups of coffee and I was still struggling to stay awake. This is nuts!

But somehow I'm still enjoying it. I love the kiddies. I respect my colleagues, and feel privileged to be a part of Pediatrics. And I still get excited about interesting diseases and cool procedures. So I guess that's a good sign. Intern year hasn't completely jaded me. :)

Well this tired little intern is going to veg on the couch tonight. More later!

Protest

My body is protesting. It's over the long hours. This weekend I slept about 24 hours. I slept Friday night, almost all day Saturday, and had a little cat nap today. I'm not sick. I haven't been going out partying. So the only explanation is that my body is in protest about residency. I have to agree with it. I'm tired of this. What was I thinking when I decided I wanted to be a doctor? And what was I smoking when I decided to join the military? I am so not military. I don't like wearing boots. I don't starch my uniform. I can't remember ranks. I don't like guns. I believe in love, not war.

How in the world did I get here? I suppose God led me down this path. I just hope He knows what He's doing. :)

Now it's back to... you guessed it, BED!