First Night Shift...*cries*

Yesterday Anita and I reported to L&D at 8:00 pm and found Chris and Aaron still there, waiting for their team to check out and my team to check in. My team has one fourth year, one second year, and one intern, all of whom seem like cool, friendly people. One of the first things we got to do was observe a C-section. Anita was supposed to get scrubbed in and see the surgery up close, but when she did get scrubbed in, there was no gown for her b/c no one told the surgical nurse she was scrubbing in. So we had to watch the C-section from afar, and wow, there was lots of blood. When they pulled the baby out, her skin was a dusky purple color but she started crying and moving around immediately, which was good =)

Things went downhill after that. I was sent to do an H&P but ran into a language hurdle when the patients couldn't speak English. After that Anita and I just hung out in the doctors' lounge practicing tying knots on a "giant vagina" (really a towel folded so that it looked like one), reading our lecture notes, or just talking. There were two IUFD (intrauterine fetal deaths) mothers in L&D, and we got to see one fetus after it was delivered. At 24 weeks old, it was less than one foot long and looked as though it was made of Jell-O. Its facial features were indistinguishable, and some docs thought it may have been Trisomy 13. Either way, it was sad.

Around 3:30 a.m., Anita took a nap while I did Qbank questions online. Yes, it was that boring on L&D; the babies just weren't coming out. Around 4:00 a.m. we followed one of the family residents, Dr. B, into one room to watch him insert a catheter into a cervix. In the room across from ours, one woman was in the process of giving birth. Over and over, we heard, "1, 2, 3, 4, 5, 6, 7, 8, 9, 10, all right, push push push! You're doing great! 1, 2, 3..." and so on and so forth. Dr. B said it was like a rodeo in there. It took a while, but that baby was born at 4:15 a.m. Then it was dead until 5:00 a.m. when we went on rounds with Dr. B and learned to write progress notes. We saw Marcus and Jedd at 6:00 a.m. and the other girls around 7:00 a.m, when we left. By then I was starving since the last meal I had was at midnight, so Anita and I grabbed breakfast at McDonalds. Normally we'd go home after that, but no, we had a 2 hr lecture that ended up lasting until 9:45 a.m. Anita and I were taking turns falling asleep throughout the lecture, and it was such a relief when we were allowed to go home. Even better was when the shuttle bus (with Jon onboard; he's doing surgery now) stopped on the side of the road to pick us up so we didn't have to walk all the way back to the garage

So now it's past 10:30 am and I am blogging when I should be sleeping. My priorities do suck. Hopefully I can get at least 5 hrs of sleep before the hell begins again at 6:00 pm

*edit* Nope...I got two hours of nap-sleep, and 2 hours of true REM sleep. Four hours ain't gonna be enough to keep me awake tonight...

ObGyn Orientation

Today was my first day of ob-gyn at JPS. I didn't realize there was a long walk from the parking garage to the hospital, but luckily a shuttle driver stopped by me and asked if I needed a ride. There are nine of us doing ob-gyn at JPS for the next weeks, and as it turned out, we were all paired up nicely. I'm with Anita, Chris is with Aaron, Marcus is with Jedd (of course), and Sharon, Blakely, and Kimberly make the lone three-person team. Anita and I will have night shift for the rest of the week, meaning I'll have to sleep all afternoon tomorrow if I want to stay awake to deliver placentas (or whatever happens during night shift)

I haven't met the rest of my team yet, but the residents we did meet seemed nice. "It's a white thrombus," one guy joked when we all entered the L&D (labor and delivery) ward, since we were all clad in white coats. We spent the morning in lecture about important things to know in ob-gyn, and when the midwife started talking about the birthing process, Jedd kept nodding his head (having witnessed his wife giving birth back in May), and Marcus told him to stop.

At lunch everyone except Marcus and Jedd went to Junsuree, and we ran into Ryan D and Jeremy there (post-call surgery). We all sat together and exchanged small talk about surgery and pediatrics (which we all just finished). Aaron and Chris were at Odessa together for peds, and Aaron got sick on several occasions (thank goodness none of the kids got me sick...) After lunch, we filled out paperwork, got our IDs made, picked up parking permits, and picked up scrubs. The worst part of it all: the heat. Imagine walking around in 100+ weather wearing a white coat and carrying tons of books (the ob-gyn department gave us a stack of materials at least 6 inches tall and heavy)...yeah. I was getting a headache from all the heat. Maybe working at night won't be so bad after all; at least the sun will be down. Now I just have to adapt to being nocturnal for a week.

Pediatric Shelf Exam

To prepare for the shelf, I did all the Qbank questions, read all of Case Files, and answered all the questions in Pretest. I also looked through notes and handouts that I'd received during my time in Corpus. I'd be lying if I said I studied my butt off for this shelf (ask any of the girls who were in Corpus with me; they can tell you how little I opened the books until the last week or two), but in a way, I wasn't too worried. We'd just taken the boards two months ago; a lot of the diseases covered in the peds shelf are also covered in First Aid or the Kaplan pathology book (Kawasaki dz, HSP, intusseptions, etc.) Additional material that was not covered in board study included immunization schedules, developmental milestones, and some other kid-focused topics, but you get to learn those pretty well after a week or two of doing well-child exams.

The only people taking their shelfs today were Group C classmates, so there were about thirty-something of us in Everett today. It was good seeing other familiar faces again for sure. I listened to a few people talk about their obgyn experiences at JPS, and while they said that the schedule was busy, it was also a lot of fun. We'll see how I feel about it in a week or two.

All the shelf exams have 100 questions and we get 2 hrs 10 min to do them. My biggest enemy on the shelf: not enough time. Some question stems were long and I'd have to read and reread them multiple times before I could figure out what they were asking. After I went through all the questions once, I think I had about 10-15 minutes left to go over the ones I'd skipped. By the time I'd filled in all the bubbles, I was too tired (and hungry) to double-check and turned my exam in with about 7 minutes to spare. Overall I'd say the peds shelf was pretty do-able. I don't know how many I missed, but I'm fairly sure I didn't fail. At least...I hope not.

Pulmonology. Old Friends. Home

The date should read Wednesday, not Thursday, but I got home late (11:35 pm) so here goes. Today was my last day at Driscoll, and my final subspecialty was pulmonology with Dr. W, who was also the attending in charge of grading all med students. He let me interview several patients on my own before going to see them with me. One little boy (I think his name was Fernie?) was a CF patient who was hospitalized on 6T (sixth floor) the week that Elizabeth and I were doing inpatient care; I think Elizabeth may have seen him. Another patient I saw, a handicapped 10-year-old nicknamed Deedee, made me really sad because she had status encephalopathy along with left torticollis and severe scoliosis. Her spine was so curved that she essentially has no function of her left lung (compressed by the spine), and her limbs are rigid and spastic. Her nurse could tell I was a newbie and said, "Never seen a patient like her, have you." Nope. But it was a good learning experience.

Dr. W went overtime with patients (we didn't stop until just past 12:30), and then he called me into his office for my evaluation. He said that I got good reviews from the other doctors and residents and said that as far as he knew, I did very well. He asked me if I was thinking about pediatrics as a potential specialty, and I hesitated because I wasn't sure. I haven't ruled it out, but it's not jumping out at me, either. After the meeting, I got lunch, packed some more, then turned in my Harriet Lane book (which I barely touched), scrubs, and badge to Dedie, who gave me a hug before I left. I'm glad she made us all feel so welcome here.

I didn't leave Corpus Christi until 2:15 pm, and I drove almost non-stop to Austin, where I got dinner at Cocos, picked up a few things at the Coop, and stopped by the Starbucks where Alyssa works. Fortunately I got there just as she got off work, so we (along with Jeff, who was also at Starbucks) got together and chatted for a while. Andrew was still at work; otherwise I'd have liked to see him, too. After Austin, I stopped in Round Rock to meet up with Randy, a friend of mine getting his PhD at Scott and White, and we talked about medicine and research. We saw a group of three MS I students studying (starting this year, A&M lets some of its students stay in Temple for all four years of med school), and Randy knew one of them, so we talked to them for a while. They were studying anatomy; glad I'm done with that.

Needless to say I didn't leave Temple until 9:30 pm, and it was another 2 hours of hellish driving (I was getting a headache, and I was sleepy) before I got home. Still, the trip was worth it. I had a great time in Corpus, I got to catch up with old friends, and now...home sweet home =)

Endocrinology

Today I was scheduled to work with Dr. A in Endocrinology, but not many patients showed up today. We had one girl in the morning, then about 3-4 more kids in the afternoon. Most of them were both diabetic and hypothyroid, so I got to see a lot of acanthosis nigrans. Afterwards Dr. D gave us a lecture on ADHD, which fulfills my final requirement on my pediatrics competency form. It's my last evening in Corpus Christi, so it's time to pack =)

Ortho Clinic

Today I spent the entire day with Dr. T at the Ortho clinic. There were several changes at the clinic this morning. Delip and Amy were gone, replaced by two brand new A&M guys, Dylan and Vu. We learned to put splints on our arms, which was a lot of fun. After that, I followed Dr. T from room to room until noon. A lot of kids were coming in with broken bones, splints, or scoliosis. Dr. T rarely spent more than 5 min with each patient. But no matter how short a time he was there, his manner was always kind and gentle. He shook hands with everyone in the room, always asked the kids if they were okay when he was examining their injured limbs, etc. Definitely made a good impression on everyone he met. One case stood out among the others: a 17 year old girl about to start her senior year came to the office with a history of scoliosis. Five years ago, her pediatrician told her that her scoliosis was mild, nothing to worry about. Today, the angle of her scoliosis was nearly 50 degrees, far too great to be treated with braces (not to mention braces only work in growing children). Surgery is her only option. Dr. T was willing to wait until after she graduates from high school before doing the surgery, but when he started naming the risks of surgery (including paralysis), she broke down and started to cry. Her parents were left wondering if all this could have been avoided if they'd only gotten a second opinion from the pediatrician all those years ago, but it's too late. She has so much to live for, and after the surgery, she'll have a long scar on her back. No one wants that, either.

Dr. W gave us a shelf exam review during lunch that was pretty helpful; maybe it'll motivate me to study harder. Later I met Jen and Sapna for dinner, and boy, did I get an earful. There's been a lot of drama going on in the surgery department at Christus Spohn, most of it consisting of Heather B and maybe Mike E complaining about how they don't get to do enough procedures and basically griping about the way med students are treated at Spohn in general. According to Jen, not only did Heather try to put others down (even going so far as to question why a 4th year got to do more procedures than she did), she was continually butting heads with the attendings. Dr. D and Dr. B came down to Corpus today to talk to the Corpus crew about their thoughts on what was going on, but since Heather was the only one who had complaints (even going so far as to write to Dr. D), she was asked to finish the rest of her rotation in FW. It got even better when Dr. D even said he'd expected something like this to happen, possibly due to the way Heather behaved during post-exam reviews (questioning the profs' answers and all). Now that is pretty bad. We are not in high school anymore; it is not cool to step on your fellow med students and make them look bad, when all the while you're making yourself look bad.

We'll Meet Again

I met Jennifer for lunch today at a Vietnamese restaurant called Hu Dat (when I first heard it I thought she said, "Who dat?" and Elizabeth later said the interpretation would have been funnier if the place called been called "Hu Dat Pho") Hopefully, Jennifer, the next time I see you will not be on Graduation Day in May 2009. =)

Elizabeth also filled me in on the little boy who passed away in PICU last week; he had a Pseudomonas infection that destroyed his lungs, among other things. Apparently two days before his death, he told his dietitian that he wanted to see Jesus and the angels, and that made Elizabeth and me really sad to hear that. Who knew that one little boy could touch our lives so deeply?

14th Annual Pediatrics Conference

There was a pediatrics conference hosted by Driscoll at the Omni Marina this morning, so Elizabeth, Sharon, and I went. We met Ann there and stocked up on free goodies at the exhibition stands. The only lecture we attended was over GI radiology, which was very interesting, but when time came where we were presented with abdominal X-rays and asked to interpret what we saw, I couldn't do it. I later returned to Dr. E's clinic afterwards to see if I could do an ADHD screen (a requirement for the peds rotation), but the psychiatrist had already left the office. I stopped by Dedie's office to ask what I should do, and she said she'll have something for me next week. Hope so.

It was "required" for med students to attend lunch at the conference, so I drove back to the Omni and met everyone else except Elizabeth there. The food was pretty good: pasta, salad, tiramisu. Later we were joined by Dr. D, the residency coordinator at Driscoll, but we weren't intimidated by his presence since he's really laid back. Anita got bored and started making smiley faces with the butter balls, and jokingly asked one of the waiters for another plate of butter balls. To our surprise, he actually brought her another plate, so she started making a stick figure out of butter balls. Everyone thought it was funny, but the other doctors probably thought we were being stupid med students. After that we had the afternoon off. Elizabeth and I picked up dinner at Subways (after almost an hour of driving around trying to find a sandwich place) and then went to Oleander Park to study. It was very windy, but still peaceful. At least I can say I studied with an ocean view. The only problem: we brought our sandwiches to eat and it attracted tons of seagulls. They were circling above our head like freaking vultures, and even I, who rarely get scared by birds, was pretty unnerved. Talk about rats with wings, indeed.

And now, for your viewing pleasure, pictures from the conference:

Sharon and Ann (TCOM Class of 2007)

Elizabeth and I

Myriah, Arash, and Anita checking out what Merck has to offer

Arash, Sharon, me, Myriah, and Anita (with her butter ball man)

Anita, Myriah, and I

PCP: Day Four

Elizabeth and I both overslept for morning report today, but hopefully no one missed. us. It was back to Dr. E's clinic in the morning; most of the patients we saw today needed physicals so I became better at doing well-child exams. Fortunately the babies I examined were all well behaved and didn't cry when I tried to examine them...much. One new patient was a 2 week old preemie with a cleft lip/palate and polydactyly on one hand; it was so sad, and she was so cute. Then there was another family, I don't know if they lived in a homeless shelter or what, but the exam room was filled with the smell of dirty clothes. Even Dr. E commented on it after we'd left the room. One thing about peds, it makes you realize just how lucky you are when you see families that are poor, children that have so many disorders or disabilities, etc.

Tomorrow there's a Pediatrics Conference at the Omni Hotel that we are expected to attend. I'll be there =)

PCP: Day Three

Today was Delip and Amy's last day at Corpus; we saw them briefly at morning report but by the time lunch was over they were en route back to Temple. I didn't get to say goodbye to them, but I'll miss seeing them around the hospital and at mealtimes. I know they're both eager to get back to Scott & White, and I wish them luck on their shelf exams, OSCE, and upcoming OB rotation =)

There were few patients in the clinic today. Most of the kids who come to Dr. E's clinic come as a group (one mom brings 3-4 children), so Kyle and I had our hands full interviewing and examining the kids. Dr. C from ER spoke at noon conference about how to take care of traumas, and we all made sure to pay close attention to his talk. The afternoon at Dr. E's clinic was all right; we were joined by Sam (senior resident, ex TCOM grad) for continuity care. One notable case involved a 4-year-old recently adopted boy whose mother wants to get him circumcised due to "adhesions." Kyle and Sam thought that was the worst thing that could happen to a little boy (probably is, too), so Dr. E and I went to see what was going on. Turns out the kid had a small hypospadias, which needs evaluation by a urologist before they can even think of circumcision. Another family was pretty interesting: they had a 3 year old of normal size, a 2 year old who weighs more than her older sister, and a 7 month old who looks like he's 1 year old. The mom even thought her oldest child was underweight b/c the other two were so pudgy. Dr. E was quick to reassure the mother that her older child was very normal.

One notable thing I got to do was interview and do a physical on a 15 year old. Since she was 15, I had to ask a lot of personal questions about drug use, sex life, etc. Fortunately she was one of the better teenagers; doesn't do drugs, hasn't had sex, fairly sheltered (she's not allowed to drive or talk to boys on the phone until she's 16), and isn't depressed. When Dr. E had to discuss giving her the HPV vaccine, her mother didn't see the point. She said her daughter was going to be pure until marriage and marry a pure man, so there was no chance of HPV transmission. It's definitely a nice thought to have, but in this day and age, more and more people have sex before marriage so Dr. E pushed for the HPV vaccine, and the mother eventually agreed.

Elizabeth and I were both tired after our rotations and crashed until dinnertime, and we got to the cafeteria just before the grill closed. Whew.