PCP: Day Two

Today in Dr. E's clinic, I got to see a few patients on my own, which was nice. It was a slow morning, so I was looking forward to getting to Dr. P's clinic in the afternoon (it promised to be busy). Busy was an understatement; we saw 23 patients in 5 hours; I didn't leave the clinic until 6:30. It was still cool, b/c I got to see several baby checkups, Fifth's disease (again) and appendicitis. The Fifth's disease and appendicitis patients, I got to interview on my own. But tomorrow is a new month, and Ann (intern from 6th floor) will be rotating with Dr. P so I won't be going back to Dr. P's clinic for the rest of the week. Probably means I'll be with Dr. E then.

PCP: Day One

This entire week I'll be working in outpatient clinics: mornings will be spent with Dr. E at Driscoll, and afternoons will be spent with Dr. P at Robstown, a small town 20 miles west of Corpus. Delip and an intern from Bay Area, Kyle (a KCUMB grad), were in Dr. E's office with me today. At one point Delip got a patient who had back pain, so Kyle and I went to see her. Kyle did some OMM on her (soft tissue, JSCS, muscle energy), which was pretty cool. He's going to specialize in PM&R, so OMM will come in handy for him in the future.

The drive to Dr. P's clinic was boring (grass everywhere) but peaceful. Dr. P's clinic (which looks like a train from outside) was very busy today and we got to see several baby checkups. I think today was also the first day I got to actually hold a baby on my rotation, which was pretty cool. And the good thing about doing PCP: I'm on my feet all day, therefore, I can't fall asleep on the job. =)

PICU: Day Two, AJ's Story

In the middle of rounds in the PICU today, a 2 year old boy bleeding from the nose and mouth (possibly septic shock, even though he was afebrile) was brought into PICU from the ER. The boy, AJ (short for Armando Julian), had a history of ALL and had both neutropenia and thrombocytopenia. After rounds, I saw one of the attendings, Dr. S, inserting a central line into his femoral vein, so I asked if I could observe. He said it was fine and proceeded to pimp me about the layout of the femoral vessels and all the landmarks involved. The boy's eyes were open, but they were unblinking and unseeing, which scared me because there were no signs of life in those eyes. Eventually his eyes had to be taped shut before his parents came in to see him.

Grand Rounds was on an interesting topic today: Munchausen syndrome. When it was over, I arrived at PICU at the same time as AJ's dad, who looked very frantic. I soon found out why: AJ was hemorrhaging again (blood was oozing out of his nose into the ventilator) and the doctors were trying to stabilize the bleeding. They gave him a blood transfusion, a platelet infusion, epinephrine, and more. I remained hopeful that he would be okay until his mother ran out of his room screaming, "HE'S DEAD!" AJ had coded, and his nurse was giving him chest compressions. Dr. S saw me and Dingding (the 2nd year resident) standing on the sidelines and said, "Come on, time to get dirty" and motioned us into the room. I stood where I was, unable to believe that he wanted me, a lowly med student, to jump right in, but Dingding immediately gloved up and got in line to do compressions. All the while, AJ's parents held on tightly to each other, with his mother crying and praying to God to save her baby. It was heartwrenching, very hard to watch. Eventually, AJ's heart started beating on its own again, and Dr. S called his parents over to the conference room so he could talk to them. As they left, I heard one of AJ's relatives tell his mother, "He's a fighter."

Once the family was gone, I learned how dire the situation was from Dr. S. AJ's blood was not clotting and he was hemorrhaging into his lungs, so unless the bleeding could be stopped, death was imminent. Sure enough, about thirty minutes later, AJ's heart rate started falling again. Dr. S asked the nurses to administer a dose of epi while he contacted the family. A minute later, his mother runs in asking, "Is he going?" Dr. S explained that they were going to do chest compressions again, and his mother shook her head. "He wants to go. Let him go." Dr. S yelled, "Stop!" and all hands left the baby. I watched as AJ's heart rate dropped from 80 to 30, and then his time of death appeared in large numbers: 15:19. He was gone.

When the finality of death set in, AJ's mother started screaming, and curtains were drawn around the crib to give the parents some privacy with their child. The nurses removed all of AJ's tubes, wrapped him in a blanket, and laid him in his mother's arms while her husband stood beside her. Through the crack in the curtain, I watched his parents rocking him, stroking his hair, and I walked away to give them some space. But I could still hear them talking, and I heard AJ's mother telling him that he was so brave, so beautiful, and most of all, that she loved him and that she was sorry. I felt awkward just standing around, so I asked Dingding if I could leave and he said sure. Before I left, I had a talk with Dr. S about how he deals with all the death and dying in the PICU. His answer: One day at a time. When I left, I had to pass by many of AJ's relatives who were crying in the hallway, and that only made me sadder. This is the saddest day I've ever experienced on my peds rotation.

PICU: Day One

Today was my first day in the PICU. I was with two interns, a third year, and one attending as we rounded on the patients. In the beginning, we were accompanied by a cardiologist and rounded on the patients who had cardiac defects. Among the cases I saw were Ebstein's anomaly, TGA, hypoplastic left heart, and Tetralogy of Fallot; pretty cool stuff. Well, good for studying, not for the babies and their families. I did see the little boy who presented with a brain tumor about two weeks ago (turns out he had an astrocytoma); he's currently on a trach but doing better. His mother didn't recognize me when I asked how he was doing, but maybe it's just as well.

We had a noon lecture on what I thought would be behavior science, but instead the lecturer showed us pictures of skin disorders with little stories for each of them (shingles, scarlet fever, herpangina, chicken pox, etc). He liked to talk and made us laugh for nearly 2 hours; we went overtime and were late to our respective clinics but no one really cared.

One thing I noticed about this hospital (and probably most hospitals) is that a lot of the mothers here are young. And because they are young, they tend to give their kids ridiculous names without thinking about the ramifications for those kids later on. There was a "Justin Case" in PICU, I think, and one of the interns said he heard someone named their girl "Placenta Previa" because it "sounded cool" (I hope that girl doesn't become a doctor or else she'll want a name change...) But the one that topped it all was when Enrique, one of the senior residents, said he knew a girl who was named Jenny Talia. Say that one fast....ugh.

ER: Day Five

After two days at NICU, it was back to the ER today for me. The first case of the morning: a teenage girl with what looked like a cellulitis on her elbow, except when Dr. C touched her arm she started crying. Turns out her entire arm was tender to the touch, and Dr. C called it a "cellulitis, lymphangitis, and abscess all in one." Yikes. She was supposed to see her PCP tomorrow but Dr. C said, "This can't wait that long." The girl had to be admitted and receive IV antibiotics (clindamycin) for her infection, but the veins in her hand kept rolling so they had to insert the IV in her cubital fossa. Thank goodness my veins never give me trouble. Getting pricked once is bad enough; getting pricked twice is torture.

We had two lectures today: the first was at lunchtime and covered different types of anemias, and the second one at 4:00 pm covered fluids (which I still have trouble with). Right before the fluid lecture, a 4 year old boy came in with a Nike-shaped laceration to his knee. Yesterday Arash got to assist in doing subQ stitches in one girl's leg in the ER (the girl had needed 70 stitches total), so when Gina said she'd let me put in a few stitches of my own, I was excited. However, when it was my turn to do a stitch, the boy's grandmother told Gina to keep going. "He's the one who's going to have to live with it. I don't want to put him in any more pain than he's already in," was what she said. Meaning, of course, that she did not want a lowly medical student to suture her grandson's leg. I was disappointed, but I understood her reasoning perfectly.

Later an infant was brought in with a history of general seizures. He was crying bigtime as the nurses tried to find a vein in his leg to insert an IV, and then he went into another seizure. It lasted about 45 minutes, and all the while, his mother was holding his shoulders and crying, "Mijo, mijo..." I felt so bad for her; it cannot be easy for any mother to watch their child have a seizure and be helpless to do anything about it. The pediatric neurologist, Dr. D, was called to the ER for a consult. I had to leave around then, but had I stayed around, maybe I would have seen the docs do an IO on the baby. And so concludes my time in the ER. Next stop: PICU

*Zzzzzzz*

Nothing much happened today. Spent 2 hours in the NICU, then went home and took a nap before a lecture on jaundice. Hard to believe this is week 4. Two more weeks in Corpus, and then...home

NICU and USMLE scores

Today I went on rounds at the NICU with two interns, a pharmacy student, and an attending who didn't seem to be very interested in teaching. Many times I'd be looking at babies that I had no clue what was wrong with them, and I'd have to ask one of the interns for more info. We saw several preemies, two babies with trachoesophageal fistulas, one baby with a PDA (I got to listen to the machine murmur), etc. On the fifth floor, where the "larger" infants were, I saw a baby girl with Trisomy 18. She had the wide-set eyes, pointy occiput, and overlapping fingers, but she was bundled up so I couldn't see her feet. Her mother was with her, and I felt sad knowing that the poor baby will most likely not live to see her 1st birthday.

I was done with rounds before noon conference, so I finished my second H&P and turned it in. My mom called during dinner and told me the news about my USMLE score: I passed. It wasn't an outstanding score, but given how I took it early (and was falling asleep during the exam), it could have been much worse. If I had higher aspirations (radiology, derm), then my score would have shot my dreams to pieces, but since I'm interested in IM, I might be okay.

Harry Potter and the Deathly Hallows

Harry Potter and the Deathly Hallows came out last night, and I went to Barnes and Noble a little past midnight to pick up my (reserved) copy. The good thing about Corpus is that there's not a lot of people so the wait to the checkout line was not horrifically long; I only had to wait 30 minutes. My plan was to start reading the book in the morning after breakfast, and hopefully finish by dinnertime.

It took about 6-7 hours total, but I did it, I finished the book. It was an awesome read, so if you haven't read this book yet, go do so now! =)

ER: Day Four

The ER started out slow once again, but I bounced around from Martel to Gina depending on who had a more interesting case. One was a nine-year-old boy who had a 3cm deep laceration on his leg; I got to watch Martel suture him (it took 8 stitches). Another was a 3 year old girl with an abscess being raised by a single dad, and she had lots of questions about mommies. She asked me if I had a mommy, where my mommy lived, and whether or not my rabbit (I showed her a picture of Pearl) had a mommy. For some reason that just made me sad.

We had two lectures today: one at noon about sepsis and fever with the chief residents, and one at four with the pediatric neurologist about ethics in medicine. The ethics cases we discussed were lots more interesting than the ethics we discussed back in school. Sam, the 3rd year resident who supervised me once during call, stopped by to see who Sharon was (she's on call today), and he regretted not staying and listening to Dr. D's lecture as well.

The ER was empty at 4:00 when I left for lecture, but when I got back at 6:00 (after dinner), there were five charts along the wall waiting to be seen and lots more to come. Time to put the med student to work! I had time to see two patients before my shift ended: an earache (pretty common these days) and a sore throat (lots of ulcers in the mouth; possibly herpangina). The girl with the herpangina also had a yeast infection so we had to get that cultured; I'm just glad the attending didn't have to do a pelvic on her. All the attendings today were female, which was a nice change since they tend to be friendlier. Especially since one of them was another graduate from my school =)

I have the day off tomorrow! Hopefully it'll be put to studying.

ER: Day Three

Another day in the ER. Only a few notable cases were seen today: a toddler with Fifth's disease, a 15-year-old with HPV (Dr. C wouldn't let me in the room during the pelvic exam, but afterwards he said he ripped her a good one for having unprotected sex at her age), a teenager with a lacerated eyelid, and a 10-year-old with hyperventilation syndrome. When we had some downtime, Martel pimped Delip and me on cardiovascular disease, and that was helpful.

For the teenager, Dr. C got the pediatric plastic surgeon to come down and sew up the eyelid, and let me tell you, that was painful to watch. This kid was trying so hard to be brave (he's still not an adult, after all), but once the needle containing anesthetic hit his eyelid (I don't know about you, but I'd be terrified to have a needle stuck anywhere near my eye), it took me a while to realize that the sounds I was hearing were his moans and cries. His parents were there beside him, holding his hand and telling him it was going to be all right, but it did nothing to calm him down. Only later, once the Versed set in and the plastic surgeon was almost done sewing the lac, did he whisper, "Thank you."

As for the 10-year-old, he started hyperventilating after witnessing his parents arguing, so Dr. C pulled them into a family room to talk to them about getting their lives together for their children. "The most important thing in a relationship is not marriage, it's respect. If you don't respect each other, love dies." Definitely some deep words of wisdom there. The father was all for getting counseling and putting his family back together, but the mother just smiled slightly and said nothing. Bottom line: don't argue in front of your kids.

Dr. C is really an amazing fountain of knowledge (has been in practice for almost 40 years). When the ER was dead, I just sat in the attendings' office listening to him talk to 2 residents about medicine back in his day and medicine the way it is today. In his day, he had 36 hr shifts, then 12 hrs off; no ACGME to regulate the number of hours residents work, and nothing about "balancing life and work." The residents, of course, think medicine today is just as tough as it was then, and it was a good thing to discuss and think about. I think I can learn a lot just from hearing Dr. C talk. Everything had a story. When he learned my name, he said he knew a woman with the same name as me whose baby almost died of a intusseption, but he (Dr. C) was able to save the baby. That baby is now a recent high school grad and he still gets Christmas cards from the family. One of the best rewards of being a doctor, I think =)

ER: Day Two

As long as I'm in the ER, I don't have to attend 7 a.m. morning reports, so this week I get to sleep in...sort of (wake at 7:30 instead of 6:20). I turned in my long overdue paper on asthma exacerbations to the med student coordinator before going to the ER. Today was a very slow day. Yesterday there were too many patients and not enough rooms or attendings; today there weren't many patients and too many residents (including 3 family residents from Memorial, another hospital). I also missed out on a chance to help reduce a nursemaid's elbow, though Gina, a third year resident who also graduated from my school. showed me how to do it. "This is all OMM," she said. Other notable patients: an infant who presented with crying but had a viral infection, a six year old with a deep laceration who needed stitches, and another infant who had a labial MRSA abscess.

I'm starting to think peds is not the specialty for me. With the crying infant, it took me, the intern, and the mom to pin her down while the doctor tried to clean her ears. I had to hold her head down, and through it all I couldn't stop thinking about how delicate a baby's skull was, whether or not her fontanelle had closed, whether I was messing up her flexion-extension cycles (cranial anyone?), etc. With the six year old, he had to have his arms put in a pillowcase (kiddie straightjacket) so he wouldn't move during the procedure, but he still got scared and started screaming about how he couldn't breathe and had to go to the bathroom. As I watched, I couldn't help but remember something similar that happened to me. When I was 4, I lacerated my head falling into the corner of a coffee table, and I had to get three stitches. I remember the doctors covered my eyes so I couldn't see what was going on, and I remember screaming and crying because the stitches hurt (they say they give you lidocaine, but you still feel some pain) and I wanted my mom, but at the time I don't think they allowed parents in the room. This is one of the more vivid memories from my early childhood (people tend to remember traumatic events, after all), and when I saw that poor kid with a towel over his eyes and asking what's going on every other second, I couldn't help but feel sorry for him. After all, I've been there before, and it wasn't fun.

Noon lecture was at the diabetes center (we talked about growth), and afterwards Amy, Elizabeth, and I found a scale so we could see how fat we've gotten at Corpus =P. At dinner, the mother of the little boy with a tumor came up to me and said that he had his operation earlier today to remove the tumor. The doctors will do a CT scan tomorrow and see if it's all gone, and they'll go from there. I was glad to hear the surgery was a success and thanked her for letting me know. That poor mom has been through so much already; I hope her son will be ok.

The attending in the ER today, Dr. C, was the type of doctor who looked intimidating (I saw him my first day of inpatient and got scared), but in reality was very kind and full of experience and knowledge. Toward the end of my shift, when patients were few, he told me and one of the Memorial residents, Alicia, examples about a few bad doctors and the things that go wrong when bad doctors are allowed to practice medicine. He also talked about one of his residents, whose husband left her 6 months into residency, and how she persevered to do succeed but had too much hesitancy in her procedures. "If you're not aggressive, the ER is not the place for you. There's no room for you to be a wimp," he said. Alicia, who's considering a peds-ER fellowship, agreed with him. Looks like I have lots to learn about being aggressive in the ER.

ER: Day One

Today was my last day to present at morning report (since Elizabeth and I are finished with inpatient care), and I talked about the little boy with the brain tumor. Arash later told me that he had seen the same little boy at the PCP office last week, and we both agreed he was a cute kid. At Ortho Clinic, Dr. T taught us about knee disorders briefly before the first of his patients came in. ER didn't start for another hour, so I went to the library while Elizabeth went to pathology.

ER had a very slow morning, with the first cases coming shortly before lunch. One was a toddler who presented with seizures because his glucose levels were 31, which was way too low. When we arrived at the ER after lunch, it was packed. The patients' charts are color-coded green (non-urgent) and orange (more urgent), and all orange cases are seen before green cases. My first case was a kid with asthma, but I got nervous when one of the residents followed me into the room to supervise. My next patient was a toddler with fever; she started screaming and crying during the exam and was inconsolable until after I left the room. My last patient was a teenage boy who broke/sprained his ankle after landing on it wrong on a trampoline. I actually found myself able to relate to him since I'd sprained my ankle before. As a result, I was able to come up with an acceptable treatment plan for him =)

The way the ER is run: charts are placed along the wall, we take them and get an H&P on the patients, present our case to any of the attendings, and then accompany our attendings to talk to the patients again. The problem: too many patients, not enough attendings. There were only two attendings this afternoon, and with two medical students, at least three or four residents, and many nurses lining up to present cases to them, they were totally swamped. Not to mention there were more patients than rooms available, so many patients had to wait hours before being seen. I still have to learn how ER H&Ps differ from IP H&Ps, but I'll be in the ER all week so I think I'll get the hang of it.

COMLEX scores revealed

Elizabeth, Sharon, and I have been trying to access the NBOME website all weekend to find out our COMLEX scores, but up until yesterday we got a message that read, "Scores not available." On a whim, I decided to log on to NBOME this morning, while I was on call (and hiding in the medical library). The first thing I saw:

COMLEX Level 1, Status: Passed

While I never really doubted that I would pass (my COMLEX was easier than my USMLE), it was still a relief to see that word, "Passed," with my own eyes. Next was the actual score itself. I still don't really know what makes a good COMLEX score, but from what I could interpret, my scores are all right. But now I'm really scared about my USMLE score...but knowing my COMLEX score is a bit reassuring.

Bubble Tea and Harry Potter

Last night Anita went stir-crazy and wanted to go watch the latest Harry Potter movie, so Sharon and I decided to join her. We wanted to see the 8:45 pm show but it was sold out, so our next best time was 9:30. We had one hour to kill before the movie, so I suggested that we go get some bubble tea. I went to the local Asian market two days ago and asked the manager where to get bubble tea, and he directed me to a restaurant that was, luckily, only a 5 min drive from the theater. The drinks cost $3.75, and I thought, "The tea had better be good if I'm spending this much on it." Of course, this being Corpus, I didn't have high hopes for delicious pearl milk tea. But I was pleasantly surprise. The drink size was HUGE, the tea was good, and after a night of being in the fridge, the pearls were still soft and chewy. So yeah, I'll be going there again =)

We got to the theater by 9:00 for the movie and got excellent seats. Overall, the movie was excellent! I had my fair share of gripes with the 4th movie, but the 5th one, I had no complaints about. Sure, lots of scenes were cut, but everything was edited in a way to make the plot flow. So yeah, 5 out of 5 stars. Go see it if you haven't already!

Friday 13th anyone?

This morning Dr. B met with Elizabeth and me separately after morning report. Dr. B told me that I did very well these past two weeks, which of course made me very happy. So I know I'll get at least one good evaluation for peds. Let's hope the other peds attendings I work with will like me too.

We had to attend a lecture on evidence based medicine taught by Dr. VJ, and then we had grand rounds at 12:30. Today's topic was on birthing and breast feeding, which would have been more interesting if the lecturer didn't spend most of her time quoting tatistics and meta-analyses. We get the hard facts, so how about more personal details about mother-child bonding during breast feeding? Halfway through the talk Delip motioned that Amy had fallen asleep. It wasn't too obvious, but we could tell. So much for mastering the art of sleeping in lecture. I tried not to say too much though; hell, I still get teased for my penchant for dozing off in lecture.

My pneumonia patient was discharged last night after a 1 week hospital stay, so I'm glad she could go home. Our senior attending was post-call and got to leave in the afternoon, so it was just me, Elizabeth, and one of the residents. I had one new admission so I took it while Elizabeth went to the pathology department. This girl had a history of pulmonary hemosiderosis (I still don't really understand what that is) and has to be admitted once a month for a weekend regimen of steroid, IVIg, and chemo treatment. She's been hospitalized so many times that she's become resigned to being here; poor girl.

It's Friday the 13th, and the end of inpatient service for me. Next stop: peds ER!

*snore*

This morning I checked on my pneumonia patient, who is doing a lot better. Once again she cried an awful lot when her mother wasn't in the room with her, so whenever I had time, I'd go into her room and talk to her. She was very interested when I showed her a picture of Pearl that I keep in my PDA, so that was cute =) One of the chief residents went over my progress notes with me today, ranging from lousy (Monday's report) to much better (today's report). I've been seeing the same patient all week now; hopefully she'll be able to go home tonight or tomorrow.

Today was a very tiring day for me. I couldn't stay awake during lecture (again) and ate some chocolate-covered coffee beans hoping they'd wake me up (and knowing they'd give me a stomachache later), but it didn't work. I ate a little too much, and felt a bit nauseated before and during dinner. Needless to say I didn't feel too much like laughing and joking with the others and later took a drive to clear my head. Everyone needs some alone time once in a while.

Anita's Birthday

Today was a pure teaching day. There were about 17 patients presented in morning report. After that, Elizabeth and I had teaching rounds with one of the attendings and the former med student coordinator, Dr. VJ. He was a very talkative man, and when he asked me to present my 7 month old pneumonia patient and pointed out some mistakes I'd made, he was quick to assure me that he wasn't trying to put me down. That was nice of him to say so. After Dr. VJ left, the pulmonologist, Dr. B, stopped by to teach the interns (and us) how to read CXRs. He had many CXRs of tension pneumothorax and had a story to tell with each X-ray. The important thing to remember was that when teenagers present in the ER with chest pain, it's a good chance it's tension pneumo, yet ER docs are quick to order an EKG as well.

We had our lecture during lunch today with a forensic pediatrician who deals with child abuse. She showed us pictures of burns, sexual assault, and more, each patient with a story to tell. Amy and I were able to contribute to her presentation when we discussed coining and cupping. We even got to find out the whole story behind the father who ran over his own son (see previous post) It was a very interesting lecture, but I was exhausted since Elizabeth and I both stayed up later than usual last night working on our papers. I had chocolate covered Kona coffee beans to keep me awake in the afternoon, though =) Ann gave me a free retractable ID holder that she had, so I have a retractable one now. Elizabeth wanted a monkey ID holder from the gift shop but didn't have cash on her, so I got one of the last ones (monkeys are very popular at the hospital) for her.

Elizabeth and Anita talked me into walking to the bay with them (in the hot humid weather no less), and it was a short 10 minute walk, but the beaches along Ocean Drive were private, not to mention cluttered with litter, so it was a disappointing trip. Afterwards the four of us and Amy went to Utopia again for sushi before stopping at Coldstone for dessert later (I passed on dessert). At Utopia we had to wait 40 min just to get a table, but the food was good; I was happy. Sharon had a headache so Amy drove us home. Needless to say it wasn't the best moment for Amy to tell us that she has lousy night vision (aftereffects of Lasik surgery), so I kept a watchful eye throughout our entire ride home. Next time we go anywhere, I'll drive.

And now what everyone wants to see...pictures from our evening =)

A view of the Gulf of Mexico from Ocean Drive

The TCOM ladies =)

Amy and me

My housemates and me

Not Really Good

The morning did not start out good. Although I was on call yesterday and expected to present my case at morning report, my housemates told me that there was no morning report today because almost all the residents had an inpatient exam to take (therefore, no one would be there) I listened to them and got breakfast with Anita and Elizabeth, but I kept having a nagging feeling that I should be at the conference room. Finally I couldn't take it anymore and ran to the conference room to see if there was morning report. Sure enough, my worst fears were confirmed: morning report was happening, and I was to present my case in a few minutes!

The worst part of it (for me) was that I had left my notes on the inpatient floors and had not brought them to breakfast with me, so I was empty-handed and expected to present! So when my turn came, I took a deep breath and recited what I remembered from the chart, and though I covered a few major details, I knew I'd left out more. When it was over, the attendings didn't ask questions except for the dimensions of the stenosis, and I sat down feeling very upset with myself. Later I apologized to my Sam, my senior resident, and the attending for being late and unprepared, but they assured me that I did very well. Sam said that he was impressed that I was able to remember so much from memory, but he did say that if I ever felt uncomfortable presenting, he'd do it for me (nice offer, except I won't be on call with him again). Myriah was the only med student who attended morning report, and she said I did great. The attending even said that my presentation was one of the better ones that morning. That made me feel better, because he's not the type of person who'd give false praise.

The floors were dead in the afternoon (only one new patient, whom the residents took care of). I kept tabs on my pneumonia patient from yesterday. Her parents were nowhere to be found for most of the afternoon so she was crying nonstop for a while. I ended up visiting her twice, giving her toys or letting her listen to classical music from my PDA (yes, I'm a dork, but why else would I choose a name like crescendo?) to calm her down. After check-out, I went to see my pyloric stenosis baby; his PFO (patent foramen ovale) murmur was cleared as harmless and he was scheduled for surgery 30 minutes after my visit. I wished the grandmother a good outcome with the surgery. "I have faith," was her simple reply.

The Lousy Father and more

I had some time to play my violin yesterday, and Anita came in to listen for a while. She said I sounded really good and encouraged me not to stop playing. I don't intend to anytime soon =)

This morning we had Arash and Myriah join us in morning report. Elizabeth was on call yesterday so she got to present a case. There was one case that got our attention: a drunk father accidentally backed his truck over his 5 year old son, fracturing his femur. He then chose NOT to take his son to the hospital, instead dropping him off at his ex-wife's place the next morning with no explanation of why their son was screaming in pain. He'd apparently threatened the boy not to tell his mother what really happened, but when the mother took her son to the hospital, the boy told the doctors everything. Good for him. As for that father...some people should not be parents. He shouldn't be allowed anywhere near his kids.

In the morning we all had an hour of "Ortho Clinic" during which an orthopedic surgeon taught us how to read cervical x-rays and all the things that can go wrong with the cervical spine. He was a good teacher and I look forward to whatever he's going to teach us next week. Back on the IP floors, I was assigned to check in on a 9 month old girl with pneumonia and atelectasis, and I heard both wheezes and rhonchi. My SOAPnote, however, was a total bust since I didn't really differentiate between the S and O components. Our attending, Dr. W, was on vacation, but the chief residents came to our floor in his place to read our notes and make sure they're all right. I'd never seen the chief residents before, and when one of them read over my note and pointed out my mistakes, I could see how she earned that position. There was an air of authority about her that wasn't present in the interns or even some of the senior residents.

At dinnertime, Delip and I had a lot to chat about regarding Hawaii since he went there for his honeymoon shortly before I got there. Later I was on call with Ann, another intern, a 2nd year resident, and a 3rd year resident who also graduated from our school. At first he was like, "Oh, another TCOMer..." making Ann laugh, and I wondered what the joke was, and then he showed me his badge that read DO. He was really cool though; after letting me see a month-old baby with pyloric stenosis, he let me off for the rest of the evening. Hopefully I can finish my asthma paper now.

Looking back...the first few days

Monday: The drive to Corpus wasn't too bad; I stopped in Round Rock Outlets for some shopping (Esprit was having a huge sale), then stopped in Austin for lunch at Coco's. I was in no rush to get to Corpus, so I walked around the Drag and the north part of campus for a while. The new Duren Hall has opened across from Kinsolving and from the outside it looks even better than SanJac. I bought a few items at the Annex and then rode the FA to the parking garage for old time's sake (not to mention it was burning hot outside) I'll probably stop by again on my way back home.

I managed to get out of Austin before traffic hit, and I made it to Corpus at exactly 6:00 pm. Anita and Sharon had already arrived, so we went to Driscoll (right behind the backyard, pretty short walk!) for dinner. There, we met Amy, a third year from A&M who's sharing a house with us. The house where we're staying at has four bedrooms, two with one full sized bed, two with two twin beds each. Anita and Amy each claimed a room with a full bed. Sharon has her own room with two beds, and I'm sharing with Elizabeth. Our room is pretty large, so we still have our own privacy.

Tuesday: The four of us got breakfast together and then went to 7:00 a.m. morning report, where cases that were seen in the last 24 hrs were discussed (with minor pimpage from a few attendings), and then the four of us reported to Dedie, the med student coordinator, for a tour and discussion of our schedules and stuff. My schedule looks all right; we get weekends off except when we're on call (I have one weekend call and two weekday calls), and each week is different. I have 2 weeks of inpatient, then 1 week of ER, 1 week of primary care, 1 week of specialty, and 1 week of NICU/PICU (not in that order necessarily). The order of our rotations is staggered, so we won't be seeing each other much except at home.

Elizabeth and I are both assigned to inpatient for the 1st two weeks (so it's a good thing we're rooming together; we have to wake up at the same time) There were no senior residents on the floor today, so we followed two PGY-1 residents who just started their own rotation on Monday, so there were times when neither of us knew what we were doing. My intern, Ann, graduated from TCOM this past spring, and she'd done her peds rotation here too, so she was a big help. In the morning we did rounds. My one patient of the day was a 4 year old who was hospitalized for asthma exacerbation. He was in a hurry to get us out of his room so he would watch the MMPR movie. I asked him which Ranger was his favorite; he said red.

Afterwards I had no idea what to do. I struggled with the H&P, and writing it up was even harder. We were allowed to leave at 4, but Elizabeth and I didn't get out until 5:50 because we had trouble with what we had to do. I was sooo tired.

Wednesday: It was Fourth of July, so I slept in...to 10:45 a.m. =D I decided to explore Corpus and found some important stores (Sams, B&N, the mall) along the way. In the evening, Sharon and I went to Sue's July 4th bbq at her house (it was located across the bay so it was a 30 min drive), and we brought Amy along with us. Luckily Amy got along well with the other TCOMers, until we started discussing OMM and then she had no clue what we were talking about =P It was cool hanging out with Jennifer, Liza, Myriah, etc., again, even though we'd just seen each other last week. Jen and Venessa didn't come. Even though most of us did not talk to each other during the school year, everyone was mingling tonight. Afterwards, we all went to some Indian Point Park (or something like it) to watch fireworks, but it was rainy so we only got to see a few sparklers. After that we went our separate ways.

Jennifer and I (don't we look tired?)

Thursday: I had one patient this morning, a little 9 month old girl who had viral gastroenteritis. Elizabeth and I got to watch Ann do an LP (lumbar puncture) on an infant, and she got it on the first try! Very impressive; it's all about finding the landmarks. =) Sadly, I dozed off again during noon conference; I need to sleep earlier. At 4:00 we had a lecture on epilepsy and seizures with a pediatric neurologist, but toward the end of lecture I got my first page (I was on evening call) and had to leave early. My job: do an H&P (history and physical) on a 3 year old girl suspected of having child psychosis. According to her mother in a previous doctor's report, the girl reportedly killed her sisters' two pet birds out of spite. But when I saw her, she was all smiles and sunshine. If anything, she was just a normal 3 year old with an ultra short attention span. I presented by findings to the senior resident, and she agreed with my assessment that the girl probably just had a conduct disorder. After that I followed Ann to the procedure room to watch another LP. The problem: it was hard to get any CSF out of this baby. Ann attempted two LPs, one of which was traumatic. The senior resident attempted 3 and fared no better. Since the poor baby got stuck 5 times, they decided to try again tomorrow. I then joined several nurses and a young patient (a girl hospitalized for dehydration) in watching fireworks from an empty hospital room. "Mommy, can I get fireworks spelling out my name for my birthday?" the girl asked. The mom shook her head and declared that she's been watching way too much My Sweet Sixteen. After that I was able to go home, 1 hr early.

Friday: Since I had a patient on call last night, I had to present her case at today's morning report. When it was my turn to present, I was late standing up and stammered a bit. Despite that, people paid attention because a little girl with behavioral disorder was a nice break from all the cellulitis cases and pneumonias that the other residents were talking about, and afterwards one doctor said I did well. I didn't get pimped, either. Sharon later told me that several people came up to her thinking she was me and told her she spoke well, also asking when she'll next be on call. I guess it's a good thing I made a good impression, but people asking when I'll be on call?!

The interns had to take a quiz today, and Elizabeth and I were given a copy too. We were able to answer some questions, like childhood development landmarks and drug reactions (what causes miosis and what causes mydriasis?), but there were others that were harder. We all had to attend Grand Rounds today, in which a doctor talked about how emotions and feelings intertwine and how we can get in better control of our emotions. I didn't really see my own patient today, but I did see a little boy with herpangina and watched two more LP attempts on the little girl from yesterday (both of which failed). The little girl also had thrush, so I got to see my first thrush case. In any case, the best part of today was going home after work knowing I had the weekend free (sort of; still have a paper to write)

Sharon and Amy went drinking tonight with Marco, one of the residents, and a few of the Corpus crew guys, but Anita, Elizabeth, and I chose to stay home. Too tired to party =)

First Saturday in Corpus

Today was a free day, so Elizabeth and I attempted to spend the day writing our H&P reports for Dr. W. Needless to say it was unsuccessful; I barely got done with the differential diagnoses. We had dinner with the A&M peeps, Amy and Delip, before getting ready for Jen's birthday dinner.

Jen's birthday is actually tomorrow, but we celebrated tonight at a restaurant called Utopia. Elizabeth, Anita, Sharon, and I went, along with Corpus crew people Jen, John, Tony, Sapna, Myriah and Ben, and Sue and Kenneth. The day we arrived just happened to have wines for 1/2 off, so most of us decided to partake in EtOH. Anita had two glasses of wine, I had one, Sharon had one. One glass was enough for me =) Jen didn't get wine, but she did get a dessert called a volcano. Several of us ordered sushi, and since Anita's birthday is next week, we're planning to come here when they have their 1/2 off all sushi special =P

Anita and I

Sharon, Jen, and Myriah

Elizabeth, Sue, Kenneth (Sue's husband), and Anita

Myriah and her fiance Ben

Sapna, John, and Tony

Sapna's Veggie Roll (isn't it pretty?)

Anita and I with our wines

Jen being camera shy

...until she decided to show us what she was eating =P

Jen and Myriah

Our group minus Sue, Kenneth, and John (behind the camera)

Sapna, Jen, Tony, and John stopped by our house to hang out for a while and we just sat around the TV chatting for a while. John wanted to watch Silence of the Lambs but the VCR didn't work. After spending time with some of the Corpus crew, it's hit me that I really will miss not seeing some of them again until graduation. They're a cool group.