Home for the holidays

After working my butt off without a full week off since July, I'm looking forward to just hanging out with the fam and being a normal, non-medical student person for a little while.

I almost always enjoy my ride home...until I'm stuck driving on the "clear" day between two snowstorms (it snowed the entire way) on the same day when people from the southern states are all of a sudden trying to drive in the snow for the first time in who knows how many years. I only saw 4 accidents on the way and they only added 45 minutes to the ride, so it could have been alot worse...

I actually miss the Massachusetts winters. There's a routine that happens around a snowstorm, life slows down a little bit and there's a clear priority to the days affairs: get the snow out of the way and go about life. It's almost automatic, ingrained on my soul from my formative years. It could be 3 inches or 3 feet...life goes on as normal. In NY, life pretty much stops for a few inches of snow, everyone on the roads looses their mind. In DC, it takes about half an inch of the white stuff to cripple the nation's seat of power. I came home to about 6 inches on the ground and then we had about 10 more that fell on top of that...so it's a nice wintery change of pace up here. I've already hit the local ski resort up once which was great, though there's something that seems wrong about skiing corduroy the day after 10" of snow fell (but it's the east coast...I can count the number of days I've skiied powder on one hand).

I haven't really been in my usual holiday spirit this year. I think it's the all consuming nature of school coupled with the girlfriend and family being far away, my classmates being spread all over the tri-state area and my roomate being depressed because his girlfriend moved back home for the forseeable future. Despite my case of the Bah-Humbug's, I spent 6 hours of yesterday shopping for everyone with my youngest brother. I'm almost finished, just the girlfriend's mom and niece to shop for. I have to head up for their traditional Christmas Eve Party, which is always interesting since it's the only time that I interact with her massive extended family. Then it's back home for christmas day and then to upstate NY/Canada for a bachelor weekend including the world famous Dinosaur BBQ, a venture into Canada, the Pats-Bills game...and probably lots of heavy drinking in there too. I imagine we'll probably also end up in a canadian strip club at some point (which is always interesting). Then it's back home for new years in Boston with a few of the college buddies and the GF. Then I have 3 days to recover, ski and get ready for OB/GYN to destroy my sleep cycle/personal life.

Merry Christmas to you all! Until 2009...
~Bostonian

A little too close to home...

I had the lovely opportunity to spend 3 days in the NICU of my hospital. Being an ex-30 weeker with APGAR's below 5, I was a little hesitant to begin this rotation to say the least. It brought up a lot of personal feelings that I didn't know were there...like a deep appreciation for the docs and nurses that worked on me...I would have never known that I was such a giant pain in the ass for so long. There's also a sense that all of that is worth it.

It's also immensely sad to see young familes go through that kind of ordeal...I could never imagine the anguish that my parents went through over 25 years ago watching my pediatrician code me in the delivery room...I guess I turned out all right. I feel a deep attachment to the field and a fondness for everyone in the unit. It's truely a wonderful profession that they practice.

At the same time, I had this weird identity crisis thing going on every time that I would reach into an incubator to examine a baby with tubes coming out of everywhere. It was like looking back 25 years ago onto what my life was, and could have been. Rounds for the past three days have been a little too personal of an experience for me to even consider as a career option. I wouldn't be able to deal with it the first time I lost a kid...which happens. Having to code a kid in the delivery room would probably be just too much for me to handle.

But at the same time it has alot of the benefits of EM (proceedures, good lifestyle, portable practice) that I like. I just don't think I could hang through 3 years of gen peds only to have to deal while being emotionally invested in those kids for the rest of my life. It just hits a little too close to home for me.

The rest of the week the Peds ED

So I've nearly had just about every bodily substance pass by my general direction while torturing the kiddies for the past 6 days. I've seen everything from perfectly behaved children who don't even bat an eye while you poke them with needles to 4 year olds that require 5 full-sized adults to hold them down to look in the ears. I've seen parents who would do anything to make sure that their very sick children get healthy to some of the dumbest, drug addicted DNA donors that I've ever met.

What I've learned:
-A thorough H&P will pretty much give you the right diagnosis 9 times out of 10...be thorough and cautious.
-Parent's ideas of what constitutes an emergency and what is an actual medical emergency are two very different things
-Schools and daycares are germ factories. Wash your hands or you'll catch a stupid URI that will suck the life out of you.
-Kids puke for almost anything at all: Strep- puke, PNA-puke, Cold- puke, Flu- puke, AGE-puking alot, intusceception- puke, bad mood-puke, poor self image- puke,
-Not every
-Eyes are disgusting...conjunctivitis is gross, eye herpes is perhaps the scariest thing in the world.

Finally, I love the ED...undifferentiated patients, procedures, trauma, medicine, primary care, decent pace to keep me from slacking, a good lifestyle, near-instant access to resources, being the floodgates...it's awesome. Yeah, it's a shitty field in many other respects but I'll deflate that baloon full of niave optimism when the time comes.

NICU next week, with exams...should be a fun week.

Peds ED Night 1

First night in the Peds ED with my favorite attending and tolerable peds residents...it was great!

Favorite Chief Complaint of the night: "Pain in behind" with photographic evidence that I can't make this crap up. Second favorite was "congestion"...mom wanted her kid suctioned for a runny nose...discharged with reassurance.

Snow!

Being a native New Englander, the first snow is something that I've looked forward to every year since I can remember...it always makes me feel like a kid again.

I went out for my weekly long run yesterday on a quiet out-and-back route that takes me by a local pond. There was a decent chop on the pond and it wasn't even frozen over yet. I watched a few ducks diving below the surface and then popping back up into their ripples a few second later. It was a bit windy but overall a quiet December day with the occasional snowflake that would meander out of the sky and land in my eye...always in my freaking eye. I can just see myself now, running next to traffic with my face all contorted into some sort of demented wink to try and melt the snowflake on my cornea. I no longer wonder why passing motorists give me weird looks...though maybe it's the tights.

Anyway, I cruised through the first half of the run without much of a problem through the turn around point. I passed one other runner in too much pink and she let out a quick "hello" between breaths...I smiled and waved. Most runners are a friendly folks and will acknowledge you unless they're in the midst of a full-on tempo run or sprint. I stopped at the end of the path to check my watch and catch my breath for a moment before turning around. Being the friendly runner that I am, I said "good morning" to the lady crossing the street with her yellow lab. She gave me a look of disgust/"why-the-fuck-did-you-just-acknowledge-me" that is quite prevalent in the greater NY area and continued right by me as I tried to get the tightness out of my left calf and get enough oxygen into my brain to calculate my splits (8:29/mi).

All of a sudden I was hit by a C-O-L-D gust of wind and I looked up to see a wall of white absolutely flying down the hill in front of me. I thought to myself, I've never seen a snow squall come out of nowhere like this one.

The white wall enveloped me and I decided that I should get on my way. I felt like the care-free seven-year-old version of me again as I cruised along the path next to the pond, squinting my eyes to keep the snow out and leaving my footprints in the accumulating dust on the path. For those of you that have never experienced a snowfall, the sound of it is amazing. There's a background of white noise from innumerable snowflakes hitting anything in their path, and a muffled quality to the rest of the sounds that you'd normally expect. It's absolutely other-worldly.

I passed the lady with her lab in silence, as is my NY-bound cultural duty, and continued home in the snow with only the syncopated rhythm of my breathing and footfalls to keep me company.

When the hell did I get 16,000 viewings??

The combination of longer hours in the hospital, getting back into running, some peer-advisory stuff, the return of new TV (TopChef and How I Met Your Mother) and Netflix (TM) have conspired to knock the will to blog out of me lately. I've got a few ideas on the brain that might be interesting to share...but I also have my peds shelf coming up in a few weeks.

Apparently people have started to read by blog for some reason or another. I'm not quite sure why...but thank you for looking at the blog 16,000 times. I was playing around with the new gadgets so please note the addition of the followers gadget and my new countdown to the end of medical school...feel free to stick yourself on there and I'll reciprocate!

I've also started using an add-on for Firefox called Scribefire to write my posts and it's been great so far...just thought I'd share a free utility.

Normal Saline Analgesia

I've been working on the floors of a peds hospital for the past month and I finished up my last call the Saturday before Thanksgiving. I had to cover a new admit with the working diagnosis of "Chest Pain" just admitted last night. Seemed like a strange symptom in a tween, but I'm pretty much open to anything after a few months at the major referral center.

Generally, I like to approach these new patients with an open mind and go through my working differential a kind of slowly since I'm still not the brightest crayon in the box. Her symptoms were refractory to a week of antacids/PPI's and had NO identifiable triggers or patterns. Kid had a normal cardiac workup, normal pulmonary work up, clear films of the chest and abdomen, nothing out of the ordinary on labs. So I go out onto the floors to start the day and I hear what sounds like crying coming from her room...great.


Mom comes running out to ask for pain meds. So I eyeball her...and she looks like she's a little uncomfortable, but not in too much distress. She's able to answer my questions clearly through her distress and "8/10" pain. I get the story from mom and it seems like the kid has these paroxisms of stabbing, non-specifically localizable chest pain for about a week. Kid's not in any distress, so I walk away to see the other 10 patients I was covering. Motrin doesn't touch it. Tylenol #3 puts the kid in a comfortable place...problem solved.

So I sit down to write some notes about and about an hour later I hear screaming coming from the room again and mom comes out looking distressed. I stroll on over to check on the kid...10/10 pain, inconsolable, stabbing pain everywhere in her chest. But she still answers my questions and is distractable. Resident writes for some morphine and the nurse goes in a few seconds later to flush the IV and get some fluids running before she pulls the drugs out of the Pyxis.

On the way back over to the room, the nurse notices that it's unusually quiet on that side of the unit...so she palms the morphine while asking the kid how she's feeling. She feels great now, 2/10 pain. Much better!!! I'll file the normal saline analgesia trick away for the finicky attention seekers later in my career.

The difference between kids and adults when they fake:
Adults seek the rush they feel from morphine hitting their neurons,
Kids seek the rush of everyone's attention falling on them for a brief moment

Just an interesting case that I wanted to share.