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!

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...