Friday, July 13, 2018

What Residency Looks Like XXXVI: Karaoke

Photo of KBOX Karaoke House - Pittsburgh, PA, United States. Sweeeeet Caroline!!!!!

Sometimes residency looks like a bunch of residents in what amounts to a private living room with a glowing coffee table and neon lights sharing drinks and mics as they sing their way through an extensive song list to celebrate several of their birthdays.


Tuesday, July 10, 2018

What Residency Looks Like XXXV: Bodily Fluids

Sometimes residency looks like spinning down a sample of urine so you can look at it under the microscope. The colorful strip is a urine dipstick for estimating blood, ketones, protein, glucose, etc. I learned these skills on my renal (kidney) elective.


Saturday, July 7, 2018

What Residency Looks Like XXXIV: Hot Chicken

Sometimes residency looks like a backyard potluck with Nashville-style hot chicken. Our host and hostess (above) did their school in Nashville, where they swear by Hattie B's hot chicken. They are foodies--check out the edible garden behind them--and happy to share their passion and fun toys, namely a deep fryer. So a bunch of us residents brought salads and desserts and drinks and significant others and babies to try their three spice levels: mild, medium, and why-are-there-taste-buds-there? I brought Luby's shredded carrot salad. The recipe is pretty simple once you grate the carrots: mix and chill.

2 pounds whole carrots (or a 1.6-pound bag of peeled and shredded carrots)
1 can crushed pineapple (or cubed, then diced)
1 cup mayo (or substitute)
1 cup raisins ("plumped" in the pineapple juice)
1/2 cup powdered sugar
Optional: 1/4 cup chopped nuts (pecans or walnuts)


Wednesday, July 4, 2018

A NAFTA Fourth of July

Today I planned to make us burgers from the leftover tourtière (French Canadian meat pie) filling that was such a misadventure to make (I'd forgotten about asking the housing inspector to fix the wiring so that we could actually use the oven that day!). Unfortunately, even with an extra egg, the (partially thawed) mixture of ground meat, celery, and oats wouldn't clump together to form patties, so I changed the menu from burgers with pickles and Old Bay popcorn to what amounted to Canadian tacos with peppers (and wine coolers bottled in Rochester, NY). It was truly a NAFTA Fourth of July.

The experience reminded me of other (mis)happy Independence Days we've had, from the year we struggled with the grill and watched fireworks from behind the Steak N Shake to the year we tried to bike 12 miles (including nearly straight up the last mile to our destination), and I got a flat tire 3.5 miles from the end.

Friday, June 29, 2018

What Residency Looks Like XXXIII: Call Rooms

Sometimes residency looks like spending the night in a hospital call room of questionable cleanliness  in which only half the lights and showers work, all so that you don't have to hike up the hill to the parking garage at 11pm, drive home, go to bed, and then turn around and do it all again in less than 8 hours. Thank goodness my bestie J.R. gifted me a sleeping bag liner for cool sleep and sweet dreams, as all of the beds had what looked like old, used linens on them. It is the only time I have slept in a call room in two years, and only because I was not actually "on call." In my experience, overnight shifts are typically too busy, or the call room is too far away, to get any rest in the hospital. What sleep I got would have been improved if the person in the suite nextdoor hadn't turned on the television AT FULL VOLUME in the room on the other side of the wall as the bed at 2AM and left it on for the rest of the night.


Tuesday, June 26, 2018

What Residency Looks Like XXXII: All Wet

Perhaps this should have gone in the bloopers list: one night I finished an emergency department shift at 10pm and had to hike up the hill to the garage in pouring rain. I got soaked from the knees down, despite an umbrella. The next morning my sneakers had not dried by the time I had to leave the house again for lecture, so I wore other shoes and brought the sneakers with me. After lecture, I attempted to go for a swim, but the gym had unexpectedly closed the pool. Closed pool = no towels. I hadn't showered and a shift for the rest of the day...and because the locker room was unlocked but empty, I ended up taking a shower and drying off in front of this mega fan au natural. Thankfully, my sneakers were dry by then, too.


Sunday, June 24, 2018

What Residency Looks Like XXXI: Second-Year Blooper Edition

I have a tradition of sharing bloopers from my clinical training in the summer (for old links see below). This time is no different. I just completed my second year of combined Internal Medicine and Pediatrics residency. I started in the pediatric emergency department and ended in the adult ED. In between I went to the juvenile detention center, saw infectious disease and neurology consults, spent a month improving my teaching skills, rounded in both the pediatric and adult intensive care units, and took care of patients of all ages in clinic and in the hospital. I share these lighter moments as a reminder that we are all human, and humans have the propensity to say or do some funny things sometimes.

Gordy Orange got his head scanned.

Resident Bloopers

10. Every time I had a 24-hour (or longer!) shift and forgot to turn off my bedside alarm. (Sorry, Dear Husband!)

9. The morning I had to run back to the house to retrieve the expensive reflex hammer I had accidentally dropped in the garbage can with the bag of trash I was taking out.

8. The time a clinic patient asked me if I had sent her prescription to the pharmacy and I replied, "Oh shit, sorry, I forgot" in front of the 5-year-old girl she was babysitting and had brought with her.

7. When I tried to make a joke but got the punchline wrong:
Me: I have the patients in rooms 6, 7, 8, 9, 10. Full house: I win!
Attending: That's a straight.
Fellow: Have you ever played poker before?
Me: Once?
6. That night shift when I followed my sign-out instructions and paged the special pharmacist, at home, at 3:30 in the morning, about a medication that didn’t need to be given until 11:30am.

"Smarty Pants"
5. The day in clinic I tried to order a medication (Depo Provera) to the pharmacy but only succeeded in placing the nursing order to have it given. The attending ordered the medication, so I deleted the nursing order. The attending wondered why it was taking so long for the patient to get the medication, and only much later did the nurse come back to ask why I had deleted the administration order, and did I still want the patient to receive the medication she had picked up from the pharmacy?

4. The morning I spent a frantic fifteen minutes looking for my hospital badge in our house and both cars before realizing...I was wearing it on my sweater underneath all my winter gear.

3. When I was seeing a gentleman in the ED who was complaining of pain when he peed and he yelled when I palpated his scrotum. I asked if it hurt there and he replied, "No, but you touched my kids. That's what I call them, 'the kids.'" He wasn't having pain there, he was just surprised.

2. The time in the pediatric emergency room that I guessed that the mother of a newborn baby with jaundice was East Asian and included that as a risk factor on the discharge paperwork I gave them and the father asked me, "Who told you the baby was Asian...?"

1. Once, in the middle of re-sewing a large-bore IV in the ICU, I realized that the suture I had grabbed from the supply room was attached to a straight, 3-inch needle. I had to stand there holding gauze over the opening in the patient's neck while Central Supply sent up suture packets with curved needles. For some reason they only stock straight needles in the unit, so it's not like I had grabbed the wrong package. I have never used a straight needle to place stitches on a human being before and didn't even realize this was a way in which I could screw up. And if that doesn't sum up the ridiculousness of residency, I don't know what does.

Wellness Week = Karaoke

Editor's Note: Nostalgic or new readers can look back on Med School Bloopers 1 and 2, as well as Intern Bloopers.


Friday, June 22, 2018

What Residency Looks Like XXX: Diagnostic Referral Codes

I have just completed a month-long rotation in the Emergency Department (pro tip: no one in medicine calls it the ER) at an urban, academic, tertiary-care center. I didn't see any traumas--the surgeons ran those. I saw some real emergencies--like heart attacks and strokes--but the attendings actually ran those. Most of what I did was basic primary care medicine. In fact, it reminded me of a joke on a Twitter thread by @GruntDoc, responding to the prompt, "Anger your entire speciality in one sentence":
(Walks up to podium at major Emergency Medicine conference)
(Taps mic)
Me: Really we’re all just glorified Family Practitioners with a CT scanner.
(Beaten to death with personally owned handheld sono probes)*
As a way to try to grasp what I actually did that whole month I was in the ED, I decided to tabulate the different kinds of problems I saw during one warm-weather month. The numbers don't add up to the total number of patients seen at the bottom, because some had multiple complaints. If my math is correct (and I'm not sure it is), then I admitted just over 1/3 of the patients I screened in the ED to the hospital.

heart attack  1
low blood pressure  4
high blood pressure  2
low heart rate 1
high heart rate  2

breathing problem  2
community acquired pneumonia  1
aspiration pneumonia  1
needs lung transplant  1
post lung transplant  1
pleural effusion  1

abdominal pain  3 (1 of these turned out later to be cancer)
nausea/vomiting  4
acute diarrhea  1 (probably typhoid acquired abroad)
chronic diarrhea 1
constipation  2
acute pancreatitis  2
perforated viscus  1
pooping blood  1
rectal prolapse  1
diverticulitis  1
proctitis  1

Lyme Disease 1
viral syndrome 2
Practicing foreign body removal.
strep throat  1
Sickle Cell pain crisis  2

allergies/allergic reaction  4
low blood sugar  4
high blood sugar  3
hepatic encephalopathy  1
medical problem unspecified  4

fluid overload  2
UTI  4
peeing blood  1

bloody nose  1
rash  2
cut  2
beaten up  1
burst varicose vein  1
accidental needlestick/blood exposure  2
dental abscess  3
other abscess  4
kicked in the chest  1
muscle strain  2
tendon sprain  4
broken bone  4 (femur, finger, skull, lumbar vertebra)
post-surgical complications  4
arterial thrombus  1

headache (migraine, IIH, post-LP)  3
VP shunt malfunction  1
head bleed  2
seizure  2
seizure-like event  1
pseudoseizure  1
stroke  1
near syncope  2
fall  4
spinal cord compression  1
unknown neurological condition  2
   (1 turned out later to have Creutzfeldt-Jakob Disease)
whiplash  1
pain  12
sciatica  1

psychosis  5
?panic attack/anxiety  2
accidental drug overdose  2
intentional drug overdose  3
alcohol or drug intoxication  5

corneal ulceration  4
conjunctival ulceration  1
subconjunctival hemorrhage  1
acute angle glaucoma  1
anterior uveitis  2
retinal hemorrhage  1
vitreous hemorrhage  1
optic disc edema  1
anisocoria  1

Procedures I did:
cardioversion  1.5
  (the second guy converted into normal sinus while my attending was consenting him)
opened an abscess  1
reduced a rectal prolapse  1
ocular lavage (I rinsed this guy's eye out)  1
suturing  0  (much to my dismay)

Patients admitted: 49/131

*My contribution to the Twitter prompt was this:
(Walks up to the podium at a major Internal Medicine-Pediatrics conference.)
(Taps mic.)
Me: It's true that MedsPeds docs are jills of all trades and mistresses of none.
(Cacophony of boos and jeers ensues.)


Sunday, June 17, 2018

Annals of Bad Housekeeping: Bathroom Edition

1st Folio: Dear Husband and I adopted a cat from the humane society a month ago (introductory post with photos coming soon!). She spent most of her first week hiding in our semi-finished basement, either behind some boxes or up in the rafters. One of the first clues that she had ventured to the first floor of the house was these dirty paw prints on the 1/2-bath sink, presumably leading to the fragrant bar of lavender soap. I thought our furry friends were supposed to leave paw prints on our hearts, not our porcelain fixtures.

2nd Folio: The upstairs bathtub faucet has dripped since we moved in two years ago. We immediately asked the landlord to send a plumber, who pronounced the situation hopeless, since the pipes are encased in the wall. About a month ago I decided to try to measure how much water was coming out of the faucet: about 2 gallons per day! I have tried to capture the water and re-use it around the house: in the Brita filter, for washing produce, and especially for watering the plants. Unfortunately, the aloe plant took offense to suddenly living in a tropical jungle rather than in an arid desert of benign neglect and promptly rotted at the stem.

Wednesday, June 13, 2018

What Residency Looks Like XXIX: Family

Since before we started residency, it's been rare to get all four of us in my cohort together in one place at one time. Thanks to J.P., M.K., and J.T. for humoring me in taking this cheesy "family portrait" in the ENT conference room after a lecture about mechanical ventilation. We may look like mater and pater familias with two spunky daughters, but we function more like cousins who value all the time we can steal to spend together.


Saturday, June 9, 2018

What Residency Looks Like XXVIII: Dirty Scrubs

Sometimes residency looks like starting your Emergency Department shift with pre-splattered scrubs. Is it blood? sh**? No, it's chocolate ice cream I tried to eat in the car on the way to the hospital on a hot day. Lesson (probably) learned.


Thursday, May 24, 2018

What Residency Looks Like XXVI: Trees of Green, Skies of Blue

Sometimes your attending lets you out early, and even though it takes 45 minutes to drive home, there is still warm sunshine outside. So you and Dear Husband change into shorts to walk to the ice cream store to fortify yourselves for the descent into Frick Park to lie on the grass in the shade and study nephrology or read about Mozart.


Tuesday, May 22, 2018

What Residency Looks Like XXV: Sunshine on a Cloudy Day

Sometimes residency looks like a bit of sun on the sculpture garden at the hospice center in the middle of a rainy day, when your attending lets you out early, and you decide to spend the afternoon adopting a cat (pics when she gets brave enough to come out of the basement!).


Sunday, May 20, 2018

You Can't Go Home Again

It's true what they say: you can't go home again. I recently flew back to where I did graduate and medical school after two years away, in order to visit old friends--at least, the ones who were still there. As it so happened, one of my dissertation advisors and our church's long-time choir director were retiring that weekend, so I was able to celebrate with them in person. It was bitter sweet to drive those gridded streets again. They were so familiar: I can remember listening to the radio while driving down that one on Saturday errands; this is the route I used to bike to the farmer's market; I always liked the Christmas lights on that house over there. Of course some things had changed: new apartment buildings that are depressing the rental market, for instance, and new restaurants, a few old buildings torn down. What hurt the most was that I spent a dozen formative years there, and it cannot be "home" again, because I needed to complete my training elsewhere. We knew that when we came, and yes, those years were sometimes difficult: more studying than socializing, far from family, regrets about opportunities missed, cancer. But the place was comfortable and nurturing, as evidenced by the number of meet-ups I tried to cram into a few short days.

I ate lunch with a friend at the new Broadway Food Hall; took a walk on the park path near our old house; patronized the Steak N Shake because the Krekel's hasn't opened yet; worked at the public library; ate outside downtown with friends; got breakfast at the farmer's market with Bible Study folks; tried a new Indian restaurant with an old union colleague; hung around with a church lady and her fur-children; caught up with old swing-dance partners; attended two retirement parties; ran into dear acquaintances on the street; worshipped twice on Sunday morning; and met up with former professors and still mentors. When Dear Husband and I moved away in 2016, I definitely felt as if I had grown tired of the physical landscape but was only just starting to get to know the human landscape. With any luck we will have knitted bonds that will stretch across the country with us as we move from one home to another.

Flower-like butterflies fill the air in the entranceway of the public library.

Wednesday, May 2, 2018

What Residency Looks Like XXIV: Simulated Patients

Sometimes residency involves simulated procedures. Over lunch today we had a lecture about removing foreign bodies from one of the ED fellows. Here I've just successfully dug a bead out of this spaghetti squash's "ear."

We in medicine apparently like to play with our food: I've sewn up pig feet a number of times, and I've injected a grape "bursa" hidden in a chicken breast "shoulder."


Saturday, April 21, 2018

That's So Pittsburgh: Planting Community

Six months ago, Dear Husband and I joined dozens of volunteers with the Western Pennsylvania Conservancy and the Pittsburgh Redbud Project to plant trees on the North Shore. Last night I realized Saturday was Earth Day and that I could use part of my day off to plant native species in the new bioswale I've been watching them construct near my parking garage at work. A bioswale is basically a rain garden with storage tanks underneath. The idea is to capture rain water so that it nourishes plant life that cleans the air and protects critters rather than going into the city's drainage system. Pittsburgh's storm drains and sewer system run together such that after a particularly hard rain or large snow melt, the runoff causes the sewers to overflow into the three rivers. Gross.

A good crowd of all ages, including representatives from a couple local Target stores, quickly put a couple dozen hydrangeas and nine tail bushes into the fresh dirt. Then we wrestled a number of juvenile hornbeams and redbuds into the ground. Dave, Sue, Kristen, and I planted a redbud we named Emily (after the project director) at the foot of the hill. At the top of the hill, Wes and I eventually got another redbud into a muddy hole while I told him about the 16 new redbuds that beavers had gnawed off on the North Shore. Beavers and redbuds are both native to these parts, although hunting and pollution had killed off the original Pennsylvania beavers such that transplants were brought in from Wisconsin and Canada. Wes asked what beavers didn't like, and we settled on predators such as wolves, so I named the second tree Lobos to ward off any water rodents that might be lurking in the Hill District!

Friday, April 20, 2018

What Residency Looks Like XXIII: Clinical Pearls

I recently had the honor of presenting the pre-intervention survey results of my research group's project on medical education on social media. This was our title slide. You can find us on Facebook and Tumblr at Teaching Rounds, and on Instagram and Twitter at Med Ed Pittsburgh. More pics on Twitter @MedEdPGH.


Monday, April 16, 2018

What Residency Looks Like XXII: The view from the top

Sometimes residency looks like interrupting the conversation in your team room on the twelfth floor of the hospital so everyone can take pictures of the beautiful hawk perched outside the window.


Saturday, April 7, 2018

Spring Sprang at Phipps Conservatory

Dear Husband and I took advantage of the last month of our membership at the Phipps Conservatory and Botanical Gardens by joining half of Pittsburgh to ogle at and take photographs of their spring show dedicated to colors and scents. I thought it was one of the most beautiful they have done, with gorgeous hues of orange and purple and pink and red like those in the potted flowers to the left. The skunk sculptures were adorable in the bright sunlight, and I really liked the tall white Grecian columns and figure of a woman with a water jug (below). Their Congo forest exhibit has been changed out for one on Cuba...although with the exception of more and different kinds of palm trees, it looked a lot the same to us. Happily we stumbled upon a docent giving a tour of (one of) the greenest buildings in the country, the educational and office building behind the main conservatory. In just half an hour, he told us about the zero-runoff water collecting system, the greenhouses with roofs that open in the summer to equalize the temperature, and the water-cooling system under the rainforest. Phipps has so many solar panels and such eco-conscious design that this greenest building produces more electricity than it uses. There were dozens more interesting factoids about the water filtration system, the windows that catch sunlight, the lawn that only needs to be mowed once a year, and the smart heating/cooling system that directs its energy toward only those parts of the building where people actually are. He wanted to go on for another half hour, but we excused ourselves to finish with the exhibit rooms. However, they were so full that we decided we had seen enough and went home to enjoy what had started as a snowy day but become a warm and sunny one.


Bonsai azalea!

Tuesday, April 3, 2018

What Residency Looks Like XXI: Occasional Indulgences

Sometimes residency looks like a box of specially cupcakes the med student ordered by Uber delivery because his sweet tooth was acting up. The carrot cake cupcake in the rear left was suh-WEET. I'll be hepped up on sugar for the rest of my shift.


Friday, March 30, 2018

Eating our way through Allentown

Over Easter, My Awesome Parents (MAP) came to visit us, so we took them on a 'Burgh Bits and Bites tour of the Allentown neighborhood. No, not Allentown in eastern Pennsylvania, but the up-and-coming (maybe gentrifying) Hilltop community in southern Pittsburgh. It's currently marked by little plaster penguins by artist James Simon (Hilltop Waddle, below). The tour combined stops at food establishments as well as small businesses. It started at Breakfast at Shelly's, where we enjoyed kielbasa with sauerkraut. The little Black Market deli shares the space and provided excellent meats. I would happily drive across town to eat here again.

We also visited Work Hard Pittsburgh, a cooperative where independent artists and professionals can buy desk or conference room time, with a media studio in the basement. And an independent media organization whose name escapes me. These are the kinds of employment that are driving housing and the food industry along the main drag in the neighborhood. 

Next stop was the Black Forge heavy-metal-themed coffee shop, where they have an assortment of teas and coffees, and the blondie brownies were large and to-die-for. Then we doubled back to Leon's Caribbean Restaurant, where we admired the art on the walls but packed away the meat hot pockets for later, because we were getting full. After that was Paisano's for pizza, pizza rolls, and the curliest herb fries that no one could stop eating. On top of all that, the owner--to whom our tour guide referred as the Pizza Soup Nazi--pulled out a jar of Maraschino cherries in homemade moonshine: bam!

Because the guitar guy has gotten married and moved his shop out to his new farm, last stop was at Onion Maiden, a punk-rock vegan restaurant with an extensive menu and the most tongue-in-cheek names: we were served a bit of Kimmy Gibbler Dawg with in-house kimchi that was (I'm sorry to say) not that flavorful. However, I am looking forward to coming back for Kale 'Em All salad, Emperor Palpatots tater tot nachos, and Terrormisu (you read that right).


Needless to say, we were all stuffed and skipped dinner. Although the weather could have been nicer, this was a neat way to spend an afternoon getting to know the city better. Also, I almost lost my phone but recovered it, so there's that. We really like this tour company--having eaten our way through the Strip District--and plan to sign up for another food excursion when it warms up.

Monday, March 26, 2018

What Residency Looks Like XX: Four for Four

My residency program accepts four trainees each year, and since it's a four-year program, there are sixteen of us at any one time, plus or minus partners, children, and pets. Each June we take a "class picture" at the summer picnic. For Christmas this year I asked My Awesome Parents for a custom frame from an Etsy shop called Rustic Springs. I requested Pitt/UPMC colors of weathered navy blue on the outer frame and rustic weathered gold on the inner frame. (The Children's Hospital color is purple, which I thought would look over the top.) It's sort of like an Advent calendar for my time in residency: when I receive the final photo, we will have started our final year together. I finally got around to hanging it up and think it looks great!


Sunday, March 25, 2018

That's So Pittsburgh: Voices Raised Together

Image may contain: one or more people, people standing, crowd and outdoorIsaiah 11:6 "...and a little child shall lead them."

Saturday, tens of thousands of us gathered in downtown Pittsburgh to rally for better gun control. It paralleled the March for Our Lives happening at the same time in Washington, D.C. We marched though the streets carrying signs and shouting slogans. Local high school students led us to Market Square, where there were speeches from politicians, teenagers, and family members of persons killed by guns. The organizers had expected 3,000 people, but news outlets estimated 30,000 activists, teachers, and families showed up to encourage each other and to make a statement with their bodies and their voices.

Here are some of the signs Dear Husband and I saw and the slogans we heard: Arms are for hugging. Tell me what democracy looks like; this is what democracy looks like. No more silence, end gun violence. Am I next? Vote them out! I thought you were pro-life. Dodge ball not dodge bullets. Thoughts and prayers are not enough. Guns are not school supplies. We stand with Parkland. Make our schools safe again. Make Assault Guns Abolished. "There is no trust more sacred than the one the world holds with children." ~Kofi Annan

"All Glory Laud and Honor"
All glory, laud, and honor
to you, Redeemer, King,
to whom the lips of children
made sweet hosannas ring.
You are the King of Israel
and David's royal Son,
now in the Lord's name coming,
the King and Blessed One.

Sunday was Palm/Passion Sunday, when we remembered Jesus' triumphal entrance into Jerusalem at the end of his ministry and beginning of Holy Week. Although ours did not, many churches stage processions of palms (led) by the children of the Sunday School​. They are supposed to demonstrate the faith like a child. We held palms and sang "All Glory, Laud, and Honor," whose chorus impressed me today in a way I hadn't noticed before: "to whom the lips of children made sweet hosannas ring." I couldn't help but compare the clogged streets yesterday with the throngs who are said to have greeted the Messiah. We waved paper and cardboard signs, they had palm fronds and cloaks. We shouted, "No more silence"; they cried, "Hosanna!" and "Blessed is the One who comes in the name of the Lord!" Both were seeking to change society: the one for less violence in homes and schools, the other for a violent rebellion against the Roman empire. We now know that the Son of God and the Son of Man--against all expectations--suffered at the hands of the oppressor and rose again to new life. It was an entirely different revolution than what had been anticipated. Maybe when we pray today for an end to mass shootings, the answer will be different than what we had expected, too:

No automatic alt text available.
The sign reads: "What if these kids are the answer to your thoughts & prayers? Are you listening??"
(We did not see this sign at our march, but it has been making the rounds on the interwebs.)

Wednesday, March 21, 2018

What Residency Looks Like XIX: Sweet Moments

Sometimes residency looks like an ice cream sundae made with whatever ice cream hasn't melted by the time you arrive to the good-bye party after long call and sign out. It's been a busy three days, what with a new team on Monday morning, outpatient clinic Monday afternoon, >1 hour of note writing Monday evening, and two long, busy days in the short-stay unit at the children's hospital complicated by snow delays and personal crises affecting team members. Tuesday I needed help, waited too long to ask for it, and felt like I needed a drink by the time I got home. Wednesday I asked for help early, got it, and felt like celebrating when I got off.