off-service notes

Tradition has it that your last day on service, you write a comprehensive note with a summary of the hospital course to date. So last night, while I wasn't busy with a misbehaving 28weeker who was on maximal pressors and inotropes, I sat dutifully in front of the computer and wrote detailed descriptions of what has happened during the last month.

Of course, the intern who is taking over my list on Monday likely won't even read these notes. Plus, everything will change over the weekend.

The weekend...my golden weekend...the first since the holidays. It stretches out blissfully in front of me. 2 whole days of sleeping in, seeing friends, skiing (only if there's been enough snow), and staying up past 10pm (something I try not to do when I have to get up at 5am).

Definitely no misbehaving 28wkrs. they're not allowed to be out past 10pm.

on the bright side

I recently heard that Jason Lee is taking a break from filming his t.v. series, My Name is Earl, because he has "adult chickenpox". It's a good excuse for missing work. I'm wondering whether he has shingles or primary varicella, but that's really not the point of this post.
The point of this post is that I, too, have a good reason for not blogging over the last week or so. I mean, besides the obvious/lame "I've been really busy with work" sort of thing. I have been busy, but the real reason is that I've been struggling with how to set the tone for this blog. We've had a very sad week here in the ICN. I could have posted about the death of this beautiful baby boy who struggled for months after having a very severe meconium ileus (and cystic fibrosis) and how sad AND relieved it makes me that he's not suffering anymore. I wasn't sure, though, that this was the best forum for processing all of that grief.
I see a lot of horrible things in my line of work. What I try to take from it, though, is that, given how miserable things can turn out, isn't it a wonderful occurence when it all works out? As a for instance, we got a transport from a small, community hospital of a 26 week baby. His mom had had an abruption after a fairly uneventful early pregnancy. The initial story was that he was very depressed at birth and was being transferred to our hospital essentially to die. When he got here, however, he looked a million times better than we thought he would. He's now several weeks old and doing wonderfully. Not out of the woods by any means, but doing so very well for a baby of that extreme prematurity. His parents are the sweetest people in the world and have nothing but faith in their "fiesty" little boy. For them, the cup is always going to be half-full. I'd love to always have that optimism.

things that go pop in the night

there's a beautiful baby here in our nursery who almost died a few nights ago. she developed one of the worst complications you can get in this age group...necrotizing enterocolitis, aka NEC. our resident was called at 3am by the nursing staff, reporting that she had some blood in her stool. in his sleepy wisdom, he decided that he needed to get up and examine her, instead of just attributing her symptoms to something common, like a fissure (which, incidentally, she did have). her belly was very firm and she looked extrememly uncomfortable, so he ordered the first of many films that showed one of the worst cases of NEC that we've ever seen. her whole bowel, from duodenum to sigmoid, was filled with pneumatosis intestinalis (air in the bowel wall). i think if the resident had not examined her and gotten that film, she would have perforated her bowel, the consequences of which are dreadful.
well, she did not perf. 4 days later, she looks like a peach. i sit up tonight waiting for a belly film on another baby with NEC. it's written for 2am, but i wait without bitterness, the lessons from this other baby fresh in my mind. we are human...we have to take the lessons whenever and wherever they come along. these babies are so fragile and depend upon us entirely. that kind of responsibility is hard to sleep through.

fyi

just an fyi...for the few who have seen this blog over the past week or so, you might notice that the name has changed. used to be "girl friday", which i thought was a very cute title for a blog.

funny thing...if you google "girl friday" you don't just get links to the very cute cary grant movie. you also get lots of x-rated sites. so i decided that i'd prefer not to attract that kind of reader. just g-rated...well, maybe pg-13 and an occasional R for language. but definitely not x.

saturday call

ok. so saturday call sounds like complete drudgery. you come in on the weekend, have a skeleton crew of staff and have the same number of patients with the same amount of work.

i'm of two minds about saturday call. on the one hand, it means you get no sleep-in day for the whole week. however, it's the only time you really have a straight, 24-hour shift. so, being the polly-anna that i am determined to be this month, i am looking on the bright side. i get to go home tomorrow morning at 8AM.
my plan is to sleep all day, then, as is our weekly social activity, watch desperate housewives and grey's anatomy with 2 other peds interns. it's silly, we know. we just sit there and are constantly amazed at the improbably turn of events that occur in fictional seattle. but, hey, you can't go wrong with patrick dempsey.

back to the grind...still have several notes to write and feeding advances to start, not to mention all the phototherapy! seems like every baby has hyperbilirubinemia.

the grant

every year on martin luther king weekend for the past decade, my boyfriend and a bunch of his friends take this trip up to
the grant, officially known as the 2nd college grant. what happened to the first one, you ask? well...follow the link for the history. it's basically acres upon acres of land up in northeastern new hampshire with some old, rustic cabins. in the winter, it's freezing cold and the only heat source are the woodstoves, the culprits in many a cabin burning to the ground. they all go up there and x-country ski or snowshoe. i went last year, as "the new girlfriend". it was actually kind of fun, albeit cold. but i got to use my new snowshoes, which was awesome. we had zip-together sleeping bags, too.
so i'm on call this weekend (saturday call...ugh) and cannot go this year. of course, this year, for the first time in the grant history, it's supposed to rain. wooops. i think the plan at this point is to get really sloshed on mudslides (made with kahlua, snow and Silk soy milk) and "snowgharitas" (sorry, don't know the ingredients for that one, but assume tequila). i've never been a big drinker, but the mudslides are pretty tasty.

makes me wanna holler

so, today i had to do one of the hardest things there is to do when you are a pediatrician. call dcf. i'm on this crazy rotation in the ICN and i get a call from my continuity clinic secretary. she says there's a department of health worker on the line about a patient of mine whom she had seen in her WIC office. turns out (details spared to spare the innocent), this baby was well below the 3rd percentile for weight (formally called "failure to thrive"). this is a family that i desperately wanted to succeed. an older child had been removed from the home for a similar problem, but this time, the parents professed a great desire to be better parents. at their last visit with me, i was optimistic that they would succeed. however, you can't argue with the numbers, especially numbers like these.

so i did what i am mandated to do...i picked up the phone and called my local department of children and families and made a report. what they do with the information is up to them, but based on the family history, my money is on removal and foster care. hopefully before there's too much developmental delay from malnutrition.

it just breaks my heart to see these kids and families in such turmoil. really, if you think about it, they're set up to fail. they have no positive role-modeling. if you grow up in a family where it's normal to have babies at 15 or do the bare minimum to get through high school or huff until your brain is numb...how are you supposed to want anything different for yourself or your child? i remember this kid i had as a student once (in my former life, i wanted to be a teacher)...his dad had taught him how to huff and he did it every morning before school. it also happened that he had a visual impairment that prevented him from focusing on one point (so doing math problems, he would mix numbers up from different problems), but he'd been told his whole life that he was stupid. no one figured out that he had a learning disability until he was 16 and already addicted to toxic chemicals.

what's up with that???

it all just makes me want to scream at the tragedy of it all. it's such a waste.

bow ties

i've been leaving the hospital late a lot, usually around 7 or 8pm. my record thus far this year came in november during the middle of a very busy in-patient month when i stayed, working solidly, until 10:30pm. 15 and a half hours. truth be told, i really love what i do and usually don't mind the late hours, particularly since my boyfriend lives 2 hours away. sometimes, though, i stay late for the free hi-speed internet access. i only have dial-up at home, which is really just not worth the money.

well, for the last few weeks, i keep seeing the same man every night as i walk through the empty hallways...this grey-haired, wizened attending, of what specialty i'm not sure, who is always dressed impeccably, right down to his polished shoes, tweed jacket and bow tie.

this is the detail that first caught my eye.

the bow tie.

no one wears bowties anymore, right, except your grandfather who smells faintly of pipe tobacco? wrong. there appears to be a resurgence in the popularity of the bow tie...i've seen some young(er) men wearing them lately,too. like today, for example, my attending in the ICN was wearing a bow tie...dark navy blue with hunter green frogs and little black flies. very cool, if you ask me. it's also quite practical if you think about it. they don't hang down into your tomato soup and they can't be used to hang anyone so people in psychiatric facilities could wear them without fearing for their lives or the lives of others.

they're also pretty cute and somewhat stylish...even J crew is selling them this year. i asked my boyfriend if he liked them. he indicated that he did, but that he did not own any. nor does he know how to tie them. this is the problem, as i see it: what happens when there's no one left who knows how to tie a bow tie? this would be tragic. so, you see, we must encourage this bow-tie-wearing resurgence.

i'm going to learn how to tie them, just in case.

word of the day

here's the word of the day...

anachronism (uh-NAK-ruh-niz-uhm) noun
1. The error of placing a person, object, custom, or event in the wrong historical period.
2. A person, thing, or practice that does not belong in a time period.
[From French anachronisme, from Latin anachronismus, from Greek anakhronismos, from ana-, (backwards) + khronos (time).]

sometimes i feel like an anachronism. sometimes i don't.

today was a good day

today was a good day, although my version of a good day might be different from ice cube's.
my goal for the day was to not cry. not once. i just signed out my list of patients to the night team and, lo and behold, not a tear.
for those of you who know me, you know that i'm not an easy cry-er. i just happen to be on a particularly difficult month in the intensive care nursery (ICN, NICU, what-have-you). i just had a wonderful holiday break with my family, whom i have not seen since september, and my boyfriend. then this.
it's been something i've been dreading ever since starting in the ICN in july, my first month of internship. now, july would have been a difficult month, no matter what i was doing, just by virtue of the fact that being a new intern is incredibly overwhelming...as much as you wanted your signature to count, all of a sudden it does and you really wish there was someone still looking over your shoulder checking those drug doses...but starting in the ICN was beyond overwhelming.
it's not that i don't like the babies. i love the babies. they are actually really amazing. the medicine is challenging, which i love. it's really only when you do it every day that you truly understand how to interpret a blood gas or manage someone on a ventilator.
it's just the toxic work environment that drives me to the brink of madness.
why is it that when you get a bunch of women together, there's just no end to the drama and passive-aggressive behavior???
well, i'm back for a second month. my goal is humble, modest even. just don't cry. whatever you do, don't let them see you cry.
of course, on tuesday, i snuck into the staff bathroom and lost it.
but not today. today was a good day.

non-profit?

this is quite perplexing. while attempting to create my profile, i scrolled down through the list of options and found...every occupation except my own, which i thought was rather commonplace. or, at the very least, worthy of a spot on the scroll-down list of occupations.

healthcare. i mean, how many hundreds of thousands of people are employed in the health professions, not to mention the allied health professions? well, stymied as i was, i finally chose "non-profit", as at this point in my career, that's actually true.

i once worked with a surgeon who claimed that, "there are three professions in this world...law, clergy and medicine." i was a fourth year med student at the time and would have been inspired by that sentiment had he not been using it as justification why we should NOT have rules about excessive work hours as residents. now, half-way through my intern year, i am the beneficiary (?) of those work hour rules, but find myself actually aspiring to become the sort of doctor he was talking about, the kind of doctor who is not ruled by shifts and billing and reimbursement, the kind of doctor who retains that bit of altruism that struggles up through the cynicism that pervades modern medicine.

but, truth be told, i wish i had a dime for every time some old-school attending started a sentence with the phrase, "well, when i was a resident..."

introductions

Greetings one and all.
I've thought long and hard about starting a blog, what with all the spying that's going on without our knowledge. What if i end up on some FBI/CIA black list? Well, a girl can aspire to greatness, can't she? Suffice to say, I had the usual reservations about privacy, what's the point, will anyone read it, etc, etc. I'll spare you the list, as I'm sure if you blog, you've had similar questions and must have made similar rationalizations. In the end, I decided that, at the very least, it's a way for me to keep track of my albeit boring life. Maybe boring is too strong a word, a bit harsh and overly judgemental. I guess I should say that I lead a small life, not known on the broader stage of tabloids or notorious criminals. However small, it's mine and, henceforth, the details (some, anyway) will reside herein.
Please feel free to comment, make requests, etc. I encourage conversation and debate.