Friday, September 21, 2018

What Residency Looks Look XXXXII: Showing (Off) Your Work

Sometimes residency looks like showing (off) your work with a friend and colleague at the local medical education conference. We're trying to bring medical education to social media and invite you to follow Teaching Rounds on Facebook or Tumblr and @MedEdPGH on Twitter.


Tuesday, September 18, 2018

What Residency Looks Like XXXXI: Study Time

Sometimes residency looks like participating in a women's health research study. This is the mobile in the exam room. I don't mind putting my body to the uses of the advancement of science, and the extra cash didn't hurt either.


Thursday, September 6, 2018

That's So Pittsburgh: Hipster Food Scene

That's so Pittsburgh: the up-and-coming hipster foodie scene. For the last two years I have been a Elite Yelper. After the first year, I discovered this meant I was invited to free tasting events. As it happens, these rarely work with my and Dear Husband's schedules, but Thursday night I made it out to a Yelper-only coffee/cocktail shop in the Strip District called De Fer. After a long day at work (I spent 3 hours with my last patient), alcohol and hors d'oeuvres sounded like a great idea. I met a few other foodie types in town and enjoyed getting to know a new establishment on a part of the city I do not visit often enough. Check out the Alphonse Mucha-inspired mural on the brick wall (above). The menu includes waffles, panini, and meat & cheese platters. I could totally see bringing DH here if we happen to be in the area. I will also bookmark it as a potential workspace, if I have time out of the hospital and want to sit on my laptop for a couple of hours and (pay to*) get some work done. Bonus: they have a lending library and small play area for children.

See also: my blog posts on Pittsburgh Bits and Bites tours in the Strip District and the Allentown neighborhood.

*I generally prefer free places to work, namely libraries, especially if they will let me eat/drink. Thank you, Hillman Library!

Monday, September 3, 2018

What Residency Looks Like XXXX: Laboring

Sometimes residency looks like holing up in the university library with a friend, updating your curriculum vitae on your day off. This Labor Day I am laboring, but on my own terms, which is so important to feeling fulfilled with one's work. Adding items to my CV reminds me how much I have in fact accomplished, although there are so many things yet to do. Not pictured: the excellent leafy green view over the plaza.


Sunday, September 2, 2018

The Art of the Brick: Pittsburgh Edition

This year I had a three-day weekend for Labor Day. On Saturday I picked up a hospital shift to help out some colleagues. Although I made a little "mad money," it meant that I was working a six-day week for the sixth week in a row (if you count Camp CAMP), and I was sorry I had given up the chance to lie on the couch all day. On Sunday old friend A.S. came to visit, so Dear Husband and I took him to church for Klondike Sunday (ice cream bars after the service!) and out to lunch with church peeps at a Peruvian cafe called La Feria. Then we piled into the car and headed for the Carnegie Science Center on the North Side.

Our goal: The Art of the Brick, a special exhibit DH and I had tried to see when we visited Tampa earlier in the year, but TAOB is a traveling exhibit, and the advertising campaign had reached Tampa well before the objects d'arte. In 2004, Nathan Sawaya (1973- ) quit corporate law to become a full-time brickartist. Wikipedia tells me, "He is the only person ever to be recognized as both a LEGO Master Builder and a LEGO Certified Professional." His first solo exhibit was in 2007, and now he has a slick website and two studios, one in Manhattan and the other in Los Angeles.


The first room of the exhibit consisted of replicas of two-dimensional artworks--mostly paintings, but also the Sistine Chapel ceiling, and a cathedral rose window made out of translucent Legos so that a spotlight shone the colored pattern on the floor. Sawaya makes a conscientious effort to sample from a variety of artistic traditions, so while DH pointed out the Gustav Klimt "The Kiss" (we saw the original on our second trip to Vienna), I gravitated toward "The Great Wave off Kanagawa" by Katsushika Hokusai (2,877 blocks).

My favorite hall was the next one, for three-dimension pieces. For instance, Degas' "Little Dancer." I chose to pose with that one, because Degas and I share a birthday (July 19).

We took turns guessing how many Legos comprised the Moai "Easter Island head": A.S. and I were way over (by a factor of 5-10); DH nearly hit the nail on the head with 75,000 (actual answer: 75,450).

My next favorite pieces were his humanoid forms. This one is "Doorway": "Excuse me. I've just got to step outside of myself for a few minutes. But don't worry, I'll be back." (6,988 blocks) The person is executed so sensitively, and then there's the "back" with a working hinged door.

This is probably the apogee of his inspirational messages: "Step-ladder." "Sometimes when you're looking for a step up, you don't have to look any further than yourself. We're all capable of more than we think." (4,054 blocks)

This one is called "Please Do Not Touch." No wait, that's the instruction to parents when they realize their small children have grabbed handfuls of loose blue Legos from the display. Actually, it's a woman swimming. You can see there were light effects with this one. Altogether the exhibit was very nicely put together, except for the model of the globe that was rotating the wrong direction (east to west).

Ladies and gentlemen, a complete Tyrannosaurus rex skeleton, made out of Lego bricks. It took him an entire summer to build and requires 19 cables to steady it. After this was a shared gallery of digital photographs edited to include Lego objects in otherwise melancholy American landscapes made with an Australian artist.

All that standing and walking and snapping photos wore out your trusty blogger, so we stopped for a break on some benches. Upstairs A.S. and I scrabbled through shallow trays of Lego pieces to construct arched buildings before finally calling it a day. Originally DH and I had thought to use the excuse of accompanying some visiting kiddos to the exhibit, but honestly they probably would have wanted to speed through while we tried to revel in the mastery before indulging in a favorite (but not exclusively childhood) past time. I'm glad we took ourselves.

Sunday, August 26, 2018

That's So Pittsburgh: Music to my ears

Today is a rare day off in my residency schedule, so we had planned to meet up with friends of ours from out of town for lunch and a visit to the Carnegie Science Center. However, they had had an over full day the day before and were not ready to leave Hershey until after lunchime. Luckily, a friend of Dear Husband's texted at the last minute, inviting us to hang out with her and her wife at a local watering hole, Friendship Perk and Brews. From there we carpooled into downtown for the Piano Day Pittsburgh open-air music festival. Organizers had placed four pianos around the Cultural and Arts District. Local musicians volunteered to be scheduled to play at three of them, and one was reserved for the public to showcase their talents. We started there, at PPG Place, where Dear Husband accompanied while the friend sang a couple of pieces from their concert the previous night.

Next we bypassed the singer-songwriter set up in Market Square and headed to the classical music station at Heinz Hall, where we watched a succession of tykes play on a Steinway as if at a recital. We ended up at the jazz station, where we took up residence on a shady bench in front of a fountain to chat and enjoy the music. Along the way we bumped into some familiar faces, one of whom asked whether I had been working very much and whether we getting to spend any time together. "Yes," I answered, because despite my crazy schedule we have managed to find time for dinner, or walks. Or even just some silly texting during a slow moment.

Then we perambulated across the Roberto Clemente Bridge and along the River Front Walk, where I pointed out the trees we had planted a year ago, Gandalf, Galadriel, and Waldo. We had enough time for me to visit the Fred Rogers Memorial overlooking the river confluence across from the Point, where the fountain was gushing in its full glory. We sat in the shade to listen to the recording of Rogers singing songs and reading stories before finally heading to the Jerome Bettis Grille for a leisurely 2-hour dinner and conversation. As we walked back across the river to our car, we enjoyed the lights and a gentle breeze after the heat of the day.

Who still takes photographs with their fingers over the lense?!? Any way, this was me trying to set the scene through the Doomsday portal, with one of Pittsburgh yellow bridges, the Point Park fountain, and the Fred Rogers statue in the center.

Monday, August 20, 2018

What Residency Looks Like XXXIX: A Screw Loose

While working at the hospital over the weekend, my pager fell out of its holder onto the floor--again. The loose screw popped out, and the corner button got stuck in the "on" position (a compression fracture?). Despite performing emergency surgery on it with a suture removal kit and an eyeglasses repair kit, I had to declare its condition terminal. Today I made the long trek to the pager office and exchanged it for a new one--good thing we don't do that when our loved ones get sick!


Saturday, August 18, 2018

Reading The Handmaid's Tale

I'm a pretty passive reader. Even when reading for research, it takes more mental energy to engage critically with the author's ideas than to simply let them wash over me until I turn the last page. Margaret Atwood's The Handmaid's Tale (1985) is different. Not only did it transform me back into the kind of bookworm I was as a kid--reading while walking, getting dressed, or brushing my teeth--but it also inspired me to lie in bed on my one day off in seven, just thinking about it. Atwood herself observed once that The Handmaid's Tale has "haunted" her in the thirty years since the book was published, although at the time it was an intensely productive but not self-reflective period. Funnily enough, it was the historian's talk at the end that really got my juices flowing. The result is a blog review a whole four months in advance of my annual Books I Read This Year list.

Although I had loved Atwood's short story "Bluebeard's Egg" as an undergraduate, I had gotten all the way through college AND graduate school without reading The Handmaid's Tale in either a feminist studies class or on my own. I really only knew the premise from the promos around the current Hulu series (now confirmed for a third season), of a dystopian future in which a violent theocracy uses women as reproductive vessels. I was enthralled with this book from the first few pages. I was struck initially by two things: 1) the narrating character's word play, which I assume came from Atwood herself and which is so prominent throughout the book that I can't pull out a single favorite passage, and 2) the way that the reader's view is blinkered, the environment and context revealed piecemeal, much like the main character's point of view is physically limited by her headdress and practically limited by the regime's control of (mis)information. Fragmentation comes up repeatedly in the story, from the flashbacks set between action "in the present" to the body parts mailed to defectors to the bits of recording scattered among dozens of cassette tapes.

I found the characters nuanced but not entirely knowable, which fits the setting in an oppressive society wrought with spies (::cough:: DDR, USSR), as well the style of writing with a narrator who is not omniscient. I particularly appreciated that Atwood had Offred tell Moira's story in Moira's voice, letting this female figure speak as herself in a culture that sought to silence women. I found Offred's reflection that she had responded to Finally, I thought about the passage of time. The table of contents contains seven "Nights," suggesting one week--of creation? By the narrator's description, the events in the present tense take place from early spring to late summer of one year. It was harder to tell how many years had elapsed since the Sons of Judah had taken over the country--perhaps three? And of course Offred's memories stretch back to her childhood in what sounded like the mid- to late twentieth century. Atwood's critiques of American culture and politics made me wonder what it would be like to read this book alongside Rachel Carson's Silent Spring, for its expose of physical and chemical danger to the environment.

Sunday, August 12, 2018

What Residency Looks Like XXXVIII: Gratitude

Sometimes residency looks like patients' gratitude. This last week was long and emotionally fraught, but it was made a little lighter by the patient who sent everyone baked goods, and by the family who was so appreciative that they dropped off this lovely bouquet. Other things patients have given me: fresh pizza, hugs, and a leather tag for a keychain he had stamped "KRISTINE."


Sunday, August 5, 2018

TSPGH: Bridges

That's so Pittsburgh: I laughed out loud the night I realized this crosswalk downtown near The Point was patterned like the famous bridges over the Allegheny River.

You know what else is "so Pittsburgh"? Random reminders of the city's industrial past. The way the airport celebrates its multicultural past/present. Hipster coffee houses that serve cocktails. Okay, maybe that last one isn't unique to the Steel City, but they do an excellent job representing the type!

Friday, July 27, 2018

Stars Burning Brightly in the Night

What does it take for you to achieve your maximum potential? The chance to try without repercussions if you fail? Friends who cheer you on? What about a working manual wheelchair and someone to push it? Anti-seizure medications three times a day? A pump to run special formula into your stomach at night? Or a respiratory therapist to clear your lungs of secretions around the clock?

"Heaven's Very Special Child,"
a poem by John & Edna
Massamilla associated with
the special-needs community.
These are all things that happen at Camp CAMP (Children’s Association for Maximum Potential) in Center Point, TX. CAMP offers week-long summer camps for kids and adults with special needs—and their families—during the summer, as well as respite days during the rest of the year. I first volunteered at CAMP as a junior medical student, spending a week as a 1:1 counselor for a teen-aged girl with tuberous sclerosis who loved dress-up and tickling and also needed help dressing and showering. I came back a few years later as a senior medical student to be a healthcare volunteer, administering medications and staffing the infirmary for two weeks. (You can read my blog posts about those adventures here and here.) During the second trip I learned about transitional care, a subspecialty of adolescent medicine that helps young people with special needs transition from pediatric to adult care. (Later I found out about complex care, a related niche of medicine that takes care of such patients across their whole life spans; it’s the reason I chose to train in a combined Internal Medicine-Pediatrics residency program.) The chief residents helped me squeeze a week of vacation between hospital rotations this summer so I could return as a healthcare volunteer for a medically complex week.

My campers this week loved dogs, the color pink, Justin Bieber, Good Night Moon, swimming, and karaoke. They also carried diagnoses like cerebral palsy, spina bifida, holoprosencephaly, and spinocerebellar ataxia. My job was to work with their counselors, lead staff, and other healthcare volunteers to enable them to have a blast by giving their meds (by mouth or G tube), monitoring their hydration status in 100+-degree heat, and assessing their bumps, bruises, vomiting, and seizures. I (re)learned how to catheterize for urine, paddled a canoe, gave a lecture on cerebral palsy, and did a lot of singing, dancing, and laughing. I also did a fair amount of apologizing for getting something wrong, from forgetting supplies, to taking too long to find the right place to put the catheter, to getting the already flexible schedule wrong and showing up early or late, to being perceived as talking down to a camper. “Camp is for the campers.” That’s what/whom we’re here for.

Sunday: Hot. A 1-hour drive to the camp was followed by a 3-hour orientation outside, where shade was increasingly insufficient to keep us comfortable. A quick lunch in the AC was followed by 4 hours in a pavilion, checking in campers, learning about them and their medications, and sweating. This was immediately followed by prepping and giving dinner medications, eating dinner, prepping and giving night medications, and (re)cathing one camper. Another of my campers was already sick with a fever. Then there was “grand rounds” in the infirmary. When I got off duty at midnight, I still needed a shower to feel human enough to go to bed. When I told my bunkmates I didn’t mind if they used the toilet while I was in the shower--I believe the actual words that came out of my mouth were "I'm not squeamish"--one promptly came in and threw up (she’s pregnant in her first trimester).

Monday:  Stupid hot. Missed “Tribe Pride Day” because I didn’t pack anything in Cherokee red; wore an old CAMP shirt instead. Had lecture in the morning and staffed the infirmary in the afternoon. That camper with the elevated temperature went home, and another departed to the ED via ambulance after multiple seizures from the heat. Code brown in the pool.

Photo courtesy DG.
Tuesday:  Hotter than stink. Forgot I had to both prep my morning meds and cath a camper in her cabin before breakfast, so I set my phone alarm for 7:15. At 7:13, I woke with the sudden realization that I was already running 15 minutes behind. Good thing the day’s theme was “pajama day”; my unwashed face and uncombed hair were authentic. Successfully cathed the camper with my left hand. Paddled a canoe for 1.5 hours on a shallow part of the Guadalupe River (right). We could see fish in the water and birds flying while the breeze blew through the trees. A dragonfly sat on my finger. This is always one of my favorite parts of CAMP. Code brown in the pool.

Wednesday: Less hot. Wore my CAMP shirt backward for Wacky-Tacky Day. On time or early for all my medications and procedures. Walked alongside and steadied one of my campers as she conquered her fear and rode a horse for the first time. Watched another teenager with balance and coordination problems repeatedly nail her counselors with soaking sponges in “wet dodgeball”; she managed not to trip over the garden hose and sprayed me too, while laughing gleefully. Napped during “toes up time” but still ready for bed at 11pm.

Thursday: Heat almost bearable in the shade. Decorated my Gilligan’s hat with all the pins (“swag”) off my white coat and backpack—except the copper paraguard IUD, which had fallen off who knows where.  Drank my morning tea while swinging in a hammock and waiting for wake-up time at the camper cabin. Gave a 45-minute long lecture on cerebral palsy using the pediatric physiatrist’s slides, whose fonts and punctuation I had standardized. Gave my business card to a medical student who is interested in complex care. Stayed up late for the star ceremony.* Full moon.

Friday: Still hot. Woke up at the usual time, aka an hour before I had set my alarm. Packed and nursed a mug of tea before giving morning meds in my official pink t-shirt. Spent 4 hours sweltering in the arts & crafts pavilion waiting for parents to retrieve their children’s medications. A couple of interns gave me a ride to San Antonio International Airport, where I enjoyed almost two hours of air conditioning and internet before my flight to Chicago. Touched down in Pittsburgh at 2:30am after delays in the Windy City.

Me and the nursing student with whom I worked this week.

*This is the fourth star ceremony I have attended, and it was the first time it really meant anything to me. After the campers have been put to bed, the counselors and staff sway in a circle on a dark hillside watching kerosene on a metal star shape burn out while a couple of star-themed songs play (listen here). The first couple of times it bothered me that I didn’t know the words. This time the ceremony was dedicated to two campers who had passed away: one who had just attended camp the week before, and the other who was supposed to attend this week. I didn’t know either boy, his diagnoses, or when, where, or why he died. But I imagined the one who had just been to Camp CAMP had decompensated, maybe developed a pneumonia, and died in a PICU. I cried. I cried for the resident who declared his death—it could have been a brand-new intern who has only been a physician for a month. The PICU is often a traumatic place, but especially when a child dies. I cried because that resident only knew him as a patient, a couple of lines on a sign-out sheet, and maybe as a source of frustration, the cause of more paperwork. She didn’t get to know him the way his family and his CAMP counselors did, as a boy with a smile that lit up the cabin. That’s what we’re here for.

Sunday, July 22, 2018

What Residency Looks Like XXXVII: Snack Attack

Sometimes residency looks like stocking up on snack supplies before starting a month-long rotation as a team leader with (relatively new) interns and medical students. This should last us for about a week!


Saturday, July 21, 2018

That's So Pittsburgh: Pittsburgh International Airport

There once was a farm...that became an airport. In 2017, Pittsburgh International Airport was named Airport of the Year, the first US airport to win the distinction, behind Hong Kong, London Heathrow, and Singapore's airports -- for its design and usability, I guess. The little airport that could. Mostly I associate it with running to catch (and sometimes miss) early morning flights. On a recent Saturday afternoon, however, getting through security with quick, even with my usual "full body massage." So I had some time to poke around.

There's this large black and gold medal statue, called Arc, by Glenn Kaino. It was originally installed in downtown Pittsburgh in 2008 for the city's 250th anniversary and was so popular it's stuck around for 3 years instead of 6 months. It was restored and  moved to the check-in counter area at the airport in 2013@. It's supposed to be part transformer, part bridge - I think it looks like a hockey goalie, which would be totally appropriate for a town that loves its Penguins team. That's so Pittsburgh.

Then I had a chance to actually read the signs in the room-sized Western Pennsylvania Tuskegee Airmen Memorial. Apparently 932 men finished the training program, and 355 actually served. A large contingent were from Western Pennsylvania and Pittsburgh, including the only three who died, two on active duty and one in a training accident.

Editor's Note: If you enjoyed this blog post, just search "TSPGH" on this blog to find other entries!

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!).