Delayed Gratification...Delivered

Medicine is about a lot of things: service to humanity, life-long learning, ... and delayed gratification. Academia too. How many life experiences or projects have been put off "until I finish the dissertation," "once I land a permanent job," or "after I achieve tenure"? I've been blogging here for about a decade (actually 11 or 12 years, depending on whether you count the place-holding post I put up once I had decided on the name for my blog-to-be). I feel that I know a thing or three about delayed gratification. This is the story of gratification delivered.

Dear Husband designed this "Dr. Kristen Ehrenberger, PhD" nameplate
when I was still an intern. He presented this vision of the future to me as
a pick-me-up during a particularly grueling rotation. Hot/cold tumbler
from my mother; hand-drawn mug from my older niece and nephew.

Premedical college students study subjects that are not-quite-medicine: biology, genetics, general and organic chemistry, physics (!). Maybe the geneticists, pathologists, and radiologists can more directly apply what they learned in those classes to their final careers, but for most aspiring physicians, those are the lists we have to joust in order to pass the MCAT, in order to go medical school, in order to land a good residency, in order to get a fellowship, in order to become >>duhn-duhn<< AN ATTENDING PHYSICIAN.

In medical school it starts over again with anatomy and physiology, microbiology and immunology, histology and epidemiology, pathology and pharmacology. At the time, these basic science courses seemed so far from the clinic that motivation to hang on to what we were learning was hard to come by. Each exam seemed like just another hoop to jump through in order to get to the promised land of "clinical rotations." 

Like many medical schools, mine tried to get us excited for patient contact during the first two years by having us shadow practicing physicians. We didn't really know much in the way of useful knowledge or skills yet, however. While we sat in the corner, observing, it was difficult to look ahead to realize what use anatomical landmarks would be for the musculoskeletal physical exam, or that a significant portion of general medical practice involves diagnosing and treating infectious diseases. (I wish I had studied harder in microbio, and immunology really only made sense after we had finished the class.)

I of course chose a path less traveled that simultaneously made this problem of delayed gratification harder and easier. Pursuing an MD-PhD added 8 years to my medical training. It became harder to wear the label "student" the further into my 30s I got. (Don't get me started on the short white med student jacket.) However, the other discipline(s) I was learning--academic history, body scholarship, interdisciplinary science studies, medical humanities--also allowed me do the thing I was studying. I've been a practicing historian since I delivered my first conference paper in my second semester grad school, just over 15 years ago. Not only did I co-author a monograph at MIT Press while still in graduate school, but I am now being asked to organize groups and to edit publications as an early-to-mid-career academic.

By contrast, I have only been practicing medicine since I started internship, 5 years ago. And even then, a lot of what I did as a resident was still observing, or "pretending" to be a specialist on various rotations (ID, cardiology, pulmonology, neurology, etc.). Because internal medicine residency produces general internists (and pediatrics residency yields general pediatricians) who have a little bit of knowledge in a lot of different things, I had to wait until my first attending position to actually do full time the thing for which I had been studying: practicing primary care medicine for adults with and without disabilities. Well, part-time, since my faculty position gives me promotional credit for my medical humanities scholarship but not the protected time in which to do it. I grew tired of squeezing my scholarship into nights, weekends, and vacations, so I took a pay cut to get to do it all of those times and also one day during the work week.

The waiting "to arrive" wasn't over with graduation from residency a year ago today, because we still had 3 weeks of service left before the end of our contracts. And I waited 2 months to start my job because I wanted a break from 20 years of continuous higher education to relax and travel (::sigh:: pandemic). And even when I did start at the beginning of September, I still felt like a resident, because my attending credentials had not been entered in the computer system, so I couldn't do my own billing and had to sign my notes over to a colleague for 2 weeks. And for 2 months I was still studying (for the second of 2 board exams).

After I passed my boards, I finally felt like I might have arrived. Except that no one had made provisions for me to have an office, or even a desk in a shared space, so I squatted in empty conference rooms or used one of the fellows' shared desks. (When I pointed this out rather piquedly to the senior attending who had taken over the computer I was using while I was in clinic because his was farther down the hallway, he retorted, "Do you have a job? Have you been receiving a paycheck all this time?" Yes and yes, on the very last day of the month, thank you for reminding me how precarious it was to go 3 months without income last summer.)

Other milestones have been delayed. Dear Husband and I have been trying to try to buy a house almost since we moved to Pittsburgh. We had planned to find a home equidistant between our places of employment between the first and second year of residency, but it took him all that time to find a job. Then we promised ourselves we would buy after five years of renting, but the housing market was too hot for us this spring. And I've been dreaming of a Greek second honeymoon to celebrate 15 years of marriage for at least 2 years (::sigh:: pandemic).

Nevertheless, things are looking up. I am no longer studying in all of my free time, now using it to work on a variety of projects (including TeachingRounds, the ultimate study project). With some promotions and retirements, I finally have my own desk (in a shared space). My name is even on the door! The backboard is a green-brown bulletin board, so I splurged on designer pushpins from Etsy: one set of woodland creatures, and another set of beach glass from Maine. A goal that will hopefully be reached is getting my residency research project published soon (that had to wait until facultyhood, because residents don't have access to the kind of statistical help I needed.) And even though we don't quite have the room for a full-sized LaZBoy, I decided I didn't want to wait for us to move to have a more comfortable armchair than the wooden, second-hand, twice-recovered rocking chair I have been using for the last 13 years.

This is what gratification looks like. It was delivered on Thursday. Now Rosamunda, DH, and I don't have to jockey for dibs on his comfy chair, and I can kick back with my feet up to "attend" lectures, review charts, and write. Ahhhhh...it feels so good.

Oh, The Places I've Been!

“Things may happen and often do to people as brainy and footsy as you”― Dr. Seuss, Oh, the Places You'll Go!

How many of us received Dr. Seuss's Oh, The Places You'll Go! as a graduation gift? I got mine after high school, I think. For graduation from residency, My Awesome Parents (MAP) gifted me a piece of personalized artwork with each state in which I got my education: Maryland (K-12), Missouri (BA), Illinois (MD PhD), and Pennsylvania (residency). Each state is made of words about the state written in a different primary color. So Maryland has crabs, Missouri has the Ozarks, Illinois has deep dish pizza, and Pennsylvania has the Liberty Bell. When I opened, I knew exactly what I wanted to do to personalize it further. I hopped on RedBubble and found transparent stickers with objects associated with each state. I actually ordered more than would fit so that I would have options; the leftovers will probably end up on travel mugs (then maybe I won't lose them as easily!). Below you can see the work in progress. For Maryland, a black-eyed Susan with the Maryland flag at the center and a crab with the state glad didn't make the cut; I chose the Old Bay spice box from McCormick's and a fancy, mosaic blue crab. I thought about fried ravioli or the Washington University in St. Louis seal but settled on the facade of Brookings Building (looks like a castle) and the silhouettes of two lindyhoppers. For Illinois, I left off the Block I for the University of Illinois in favor of the Alma Mater statue; and I put a painting of Louis Armstrong up in Lake Michigan for Chicago and the blues. And for Pennsylvania, I put a golden Cathedral of Learning for the University of Pittsburgh at the center and made the difficult decision to leave off the Mr. Rogers trolley in favor of the Duquesne incline, for reasons of space. Oh! And I ordered a "Made in Texas" QPC code, for obvious reasons. I was momentarily stymied when I discovered it was *exactly* the same size as the frame I picked up at Michael's, but a few trims with scissors cut it down to fit nicely. I'll hang the finished product either in our bedroom or, when I get one, my office.

What Residency Looks Like C: Final Bloopers Edition

Now that I have exited the relatively sheltered realm of training and entered The Real World(TM) of practicing medicine as an attending physician, this will likely be my last bloopers post. Far be it from me to maintain that only medical trainees make funny mistakes--I'm sure every nurse and therapist of any kind has at least one tale of a seasoned physician bungling something that would leave you in stitches. But I have decided to relieve myself, at least for now, of the responsibility of enumerating my own faults (there must be 10 per year, no more, no fewer!). Everyone says the steepest learning curve in medical training is the first year as an attending, when you sometimes look around for "the attendier attending." No doubt for the first couple of years I will continue to feel like a "pre-tending," the term we used for ourselves as senior residents when we ran a service with less supervision than usual. Yet I hope to keep my sense of humor about myself, medicine, and the human body, so if I collect (good) enough anecdotes, I will post them here. For now, it seems right to conclude the series with its 100th post.

Top 10 Bloopers of a Fourth-Year Medical Resident

10. There's the time I made Dear Husband carry my pager: I was on call 24/7 but didn't want to be housebound, so I ventured out to the gym...and forgot my pager. He had to take it on his run just in case it went off! (It didn't.)

9. How about after attending the endocrine fellows' morning lecture, I got myself and an intern stuck in an elevator lobby in one of the fancy research buildings that requires a badge to get in, out, and move around it. We had to call the fellow to stop his elevator on our floor so we could get back on and go to the correct floor.

Last day of 32nd grade!

8. Or when I dropped the rest of my donut on the floor of the residency office, picked it up, ... and after thinking about the three long hours of rounding between me and lunch at noon conference, finished it anyway.

7. Repeatedly diagnosing and treating myself for a skin infection around my mouth that I thought I was contracting from my chapstick, only to finally realize that I had developed contact dermatitis (aka an allergic reaction) to my chapstick (that sometimes damaged the skin so badly that it DID get infected).

6. When I held my hands out to a patient in the hospital and asked her to "Give me a big squeeze," intending that she make a fist around my fingers. Instead, she threw her arms around my neck and hugged me.

5. The morning I got on an elevator after an overnight shift in the emergency room and pressed the button for "1." "You're already on the first floor," said the cafeteria worker in the elevator.

4. When I agreed to cover a resident's patients in clinic so she could travel to see her hubby...I didn't put it on my calendar...and she forgot to remind me...so I didn't know why she hadn't shown up and texted around until it suddenly dawned on me that she wasn't even in the state anymore, much less running very late. I very sheepishly saw her patients.

3. The time I logged in to record my last week of duty hours and discovered 44 requests for faculty evaluations. I had worked a single 10-hour shift in the pediatric emergency room, and rather than ask me with whom I had worked, the residency office sent me a request to evaluate every single attending and fellow in the department.

2. Every resident's nightmare finally came true: I didn't read my schedule correctly and slept in on a Saturday when I was supposed to be starting a 24-hour shift. Thankfully I didn't sleep in that much, realized my mistake when the night resident texted the group WhatsApp, and was ultimately less than an hour late. Good thing the she was understanding; a manslaughter charge wouldn't have stood up in court after making her stay an extra hour after a 12-hour overnight shift.

1. When I offered to heat a patient's homemade "hot pack" made of dried rice in a sock and accidentally put it in the microwave on high for too long, which cooked the rice, which expanded and burned through the sock. The microwave, family kitchen, and my scrubs all smelled like burned rice. I hurriedly turned the end of the sock over the rice that was still in the foot, retied it, and hoped the patient didn't notice...

Older

What Residency Looks Like XCIX: All Gone!

At the conclusion of residency, I went to the children's hospital to run some errands:

• Filled out yet another check-out form (3 programs = 4x the forms!)

• Dropped off my "pickle phone" and charger for one of the in-coming MedPeds interns (it's the ciiiiircle of technology!); happy to be keeping my pager with its winning number (#5050)

• Took my final portrait (below)

• Purchased $42.50-worth of food with the last of my meal tickets: sushi and a boxed salad for lunches, 2 pints of ice cream (chocolate for me, chocolate chip cookie dough for him), 1/2 dozen bagels, and 1 dozen fizzy drinks

Older

Newer

What Residency Looks Like XCVIII: Tea cups

This tea set--a gift from my in-laws--accurately represents my residency class: four different cups and saucers that are equally good for serving hot beverages, and even though they don't match, they still go together. I think I'm the one on the far left. (With two cups in the background for the two significant others.) I will always remember that one time we decided to teach ourselves how to play bridge, and how--briefly--I was Lord of Catan.

Older

Newer

What Residency Looks Like CXVII: COVID fashion

Sometimes residency in the time of COVID looks like "business on the top" and "comfort underneath."

Exhibit A: Comfy solid tee with a statement necklace that will look good on Zoom/Team meetings, with shorts because the room with the plain background gets hot from the morning sun.

Exhibit B: Cover your comfy tee with a scarf, cargo pants on the bottom; very busy domestic background.

Older

Newer

What Residency Looks Like CXVI: Med Peds Picnic

What can I say? We're just so photogenic! Which makes it all the more a shame that the Graduate Medical Education office didn't post pictures of us in its online graduation announcement, although almost all the other residents and fellows had at least a head shot, if not a group pic. That may be because when they redesigned the Internal Medicine Residency Program website, they left off the fourth-year residents (!). It's not that *none* of the Med Peds residents were included, just that the *four* of us were nowhere to be found. One of the rising third-years mentioned it in a meeting earlier this month, and I emailed the IM Chiefs about it before we were even off the call, because, come on. Who wouldn't want to look at these mugs? And the class behind us is even more camera ready (they're matching-outfit adorable).

Older

Newer

What Residency Looks Like CXV: Accomplishments

Monday: 

Graduated from Internal Medicine Residency (no more shifts!). I dressed up for the live-stream, although no one could see me except in the selfie I posted on Facebook. Even Dear Husband was on a different Zoom meeting.

Earned a Certificate in Medical Education. Was "voted" most likely to give a history of medicine lesson on rounds. Sore that the foodie award went to someone who isn't even a Yelp Elite.

Friday: 

Took a knee against white supremacy, racism, and police brutality. Medical professionals around the city gathered at noon to reflect and kneel for 8 minutes and 46 seconds, but I was not on campus due to graduation. So I had my own one-woman protest on the busy street corner in scrubs, a white coat, a refurbished version of the "White Coats 4 Black Lives" poster that has lived in my rear car window since medical school. I didn't do it for likes on social media, so I didn't have Dear Husband come take pictures or video or anything. I did it for the white man who started crossing the street, turned around, and came back to ask what I was doing. I did it for the black city bus driver who honked and waved. I did it for the black woman who asked to take my picture. I learned that 8 minutes and 46 seconds is a long time to support my weight on one thigh, and that the pavement is very hard when the soft neck of a Black person isn't underneath.

Graduated from Pediatrics Residency (1 Emergency Department shift, 12 more hours of jeopardy, and 3 weeks of out-patient elective to go!). DH, my parents, and I gathered at my colleague's house for a graduation party. Since Allegheny County had moved to Green that very day and there were still fewer than 10 of us, we figured it was safe. I confess that sitting on a friend's couch to watch a pre-recorded ceremony with an adult beverage in your hand is absolutely a superior way to experience a graduation. Big surprise: I was awarded the American Academy of Pediatrics Med-Peds Resident Recognition Award for my advocacy work, and the program director read my poem, "In the Trenches."

Provided by-stander aid to an older gentleman who fell off his motorcycle due to a near-miss with a car. Good thing there was a house full of doctors on the corner, and good thing he didn't really need us!

The ambulance driver who came to pick up the biker was definitely
laughing at us as she drove down the street after the accident...

Saturday:

Repaired a closet shelf that had collapsed when we moved in and I tried to store too many boxes of books on it. (Credit: Father Man)

Acquired a blister from a lovely walk in Frick Park in inappropriate footwear.

BBQ shish-kabobs (Credit: Father Man, who wore his new "My Favorite Doctor Calls Me DAD" tshirt)

Games after dinner included the tallest-ever Tier auf Tier tower (Credit: DH). We also made up rules for Gluecksferkel, because the instructions were missing from the box (I acquired 3 German children's games for free back in grad school).

Sunday:

Adult Forum finished talking about Barbara Brown Taylor's Holy Envy: Finding God in the Faith of Others; Zoom church went off more or less without a hitch; and DH had very thoughtfully picked up Klondike bars with which to mark the start of "summer church" (we're still meeting at the same time, however, since we don't have to move to the cooler worship area at an earlier time due to the lack of AC).

Re-upholstering my rocking chair. It was 10 years old when we got it with the dining room table and chairs from another history graduate student; at that time I replaced the stained blue-and-white coverings with green-and-brown stripes. 10 years and 2 cats later, however, it was time to replace the fabric. Mother brought a beautiful dark blue cotton with light blue flowers that remind me of blueberries and Maine for the front and ottoman, which we paired with a sturdy light blue polyester for the back.

45-minute hike in North Park (Mother and I are wearing matching face masks that she sewed)

Successfully ordered burgers to go (it only took two tries in three days, as the first time we accidentally landed on the site for a burger joint 30 minutes out of town!); watched Top Gun; chilled

Monday:

Had second breakfast together and said our good-byes until...mid-August for family vacation?

Older

Newer

What Residency Looks Like XCIV: Lesson on Friendship

Sometimes residency during COVID looks like snuggling up with the kitty, your notebook, and a lecture on social outcomes for kids with severe and/or chronic medical stressors like cancer or sickle cell disease. She got lots of scratches, accidentally knocked me out of the meeting once, and then fell fast asleep.

Older

Newer

What Residency Looks Like XCIII: Back porch oasis

Sometimes residency looks like studying for board exams in a lounge chair on your back porch. The "garden" bed is a riot of green weeds and Queen Anne's Lace that I don't see a need to do anything about because it thrives so wondrously without me. Above me hang the wind chimes: a piano keyboard from Aunt B., a copper spinner from Uncle M. and Aunt C., and a tubular chime left by the prior occupants.

Summer 2020 was supposed to be a mix of hot sunny days as a healthcare volunteer at Camp CAMP down in Central Texas; a week that would go by too quickly with my family at Smith Mountain Lake; and studying. Probably we would have squeezed in at least one trip to Cincinnati for Fourth of July or birthdays. But CAMP has been shuttered for the summer, and the rental house canceled our reservations, so we're left with the calculus between how many hours a day I can effectively study...and when we will feel ready to travel.

By this point we are Zoom pros and proud of our custom backgrounds, so if you haven't seen our faces for too long and want to, please reach out to set up a session! You'll know where to find me with my textbooks and practice questions...

Older

Newer

What Residency Looks Like XCII: Caricatures

"He's gorgeous," I say to a first-time mom.

"I bet you say that to all the parents," she replies, wryly.

"I do, but it's also true," I admit.

"I agree with her," says the OB, who is fixing a tear. "They're all so stinking cute!"


COVID-19 has upended the end of residency, which was supposed to consist of a couple weeks of night shifts and inpatient pediatrics interspersed with electives and history of medicine conferences. Instead, for the last 6 weeks, I have either been quarantined at home for my protection or else working at the women's hospital, attending high-risk births as the pediatrician who checks out the newborn baby. For this reason, my life hasn't been all that terribly different under COVID. When I'm home, I keep myself busy writing and studying (and tuning in to live-streamed lectures), and when I'm at work, the women's hospital functions much like it always has, since people still have babies in the middle of a pandemic. We are not entirely sure why adults _seem to be_ having fewer heart attacks and strokes than before, but some awestruck relatives will still take flash photographs while you resuscitate a blue baby...

I am not a fan of the long hours and the uncertain schedule (example: 5 hours of waiting, followed by 5 babies born within 30 minutes). But I do like being a cheerleader for new parents, reassuring them that their babies are cute despite the blood, meconium, cranial molding or swelling, extra digits, and/or weird swelling in the groin that is either a hernia or a lipoma but either way is really just cosmetic, and General Surgery can take it off when the baby is old enough for anesthesia in a couple of months. I enjoy announcing the baby's weight, since everyone has a guess (and sometimes money riding on it). And I particularly like introducing babies to their fathers. Although I have a good relationship with my own father, I think it's a cultural thing I have unfortunately absorbed that suggests it's unusual for dads to be emotionally invested in their children. Which may be why the video of Anderson Cooper choking up while announcing the birth of his son, Wyatt, got me right in the feels this week.

Anyway, I had already completed this required rotation a year and a half ago and wasn't expected to be back, which is why there was no head shot to go on the whiteboard for tracking which procedures we had done. So I drew my own "COVID portrait," hospital-issued paper mask and all. But I had to "break quarantine" to document it: the blur in the bottom left corner is the edge of the plastic bag around my cellphone. It's not very environmentally friendly, but I've been using one a day to reduce the burden of germs on my phone. When I get home from the hospital I remove the bag and clean my phone with an alcohol wipe. Then it just has "home germs" on it.

Next week we will resume something that approximates our "normal" schedules, although patient volumes are expected to remain low, and some visits will take place via video chat rather than in person. It is all so similar, yet different, a caricature of what used to be.

Older

Newer

What Residency Looks Like XCI: Food on the Run

Sometimes residency looks like meal prep in the morning before a 12-hour shift. If I get up before 7am, I typically need "2 carbs" to make it to lunch. This photo shows first breakfast (oatmeal with raisins, walnuts, cinnamon, and brown sugar); second breakfast (homemade oatmeal blackberry coffee cake and a hard-boiled egg); a mango-flavored bubbly water in case I couldn't make it to the water fountain to refill my big blue flask; and afternoon snack (homemade chocolate chip cookies and a sliced apple). I used meal tickets to buy lunch at the cafeteria, and I ate leftovers for dinner when I got home.

What I ate while on service: 3 pieces of veggie pizza (free), 6 squares of blackberry oatmeal coffee cake, 7 hard boiled eggs, 7 apples, 5-6 bananas, 1 orange, 3 bowls of oatmeal, 2 bowls of yogurt and granola, 15 homemade chocolate chip cookies, 1 piece of chocolate, 1 freezer-burnt pre-boxed salad from the cafeteria, 1 salad that was not frozen, 2 bags BBQ potato chips, 1 crab cake sandwich consumed 30 minutes after it was reheated for me, 1 large plate of very salty pasta with Swedish meatballs, 1 slightly soggy cookies and cream ice cream cone (free), 1 bag of Chex Mix party mix, 2 chicken tenders, 2 small salads, part of a high-protein cookie, tortellini soup that was salty from having cooked down, a 100-calorie baggie of Lorna Doone cookies, a bag of white cheddar popcorn. There definitely would have been more chocolate if I knew what had happened to the stash that used to live in the left-hand bottom drawer, but oh well.

Older

Newer

What Residency Looks Like XC: Random thoughts

What residency looks like:
1st breakfast: scrambled egg with Old Bay, two warm pumpkin cookies, peppermint milk tea
2nd breakfast: two homemade chocolate chip cookies, yogurt with kiwi and craisins
Lunch: ham sandwich, pretzels
Snack: apple, white cheddar popcorn
Dinner: lentil soup

Yes, I had 4 cookies for breakfasts this morning: brain food! That's me ensconced in an enormous rocking easy chair in the Neurology lounge, where I frequently put my feet up while reviewing charts or writing notes.

Scenes from social distancing: The in-hospital eatery is closed down, and the tables and chairs have been replaced by a cooler with 1/2 gallons of milk and shelves with loaves of bread. Is this an invitation for panic purchasing as if a snowstorm were on its way?

All of the couches, chairs, and end tables have been pushed into a corner in the lobby to prevent visitors or patients from lingering. The entrance is now cordoned off, and security guards check badges in order to keep the number of visitors low.

Older

Newer

What Residency Looks Like LXXXX: Happy St. Patrick's Day!

We're ready for St. Patrick's Day at our outpatient clinic! These goofy dinosaur and zebra greet everyone who comes through the waiting room. Did you put on something green, eat your Lucky Charms, and follow the rainbow to its lucky destination this morning? Actually, not many people are out and about, thanks to the COVID-19 pandemic. Schools and restaurants have been closed, and our schedules have been frozen, either to make room for patients who are acutely ill, or in case we get pulled for coverage at the hospital. I'll leave you with a couple Irish blessings for these...interest times:

May good luck be with you wherever you go,
and your blessings outnumber the shamrocks that grow.

May the Good Lord take a liking to you--but not too soon! 

Older

Newer

What Residency Looks Like LXXXIX: Packing my bags

With the heightened concern about transmissability of SARS-CoV-2, the Corona virus that causes COVID-19, many of us have stopped wearing white coats and are lobbying our programs to let us change into scrubs at the hospital so that we're not wearing clothes to and from that could carry infectious particles (of that or anything else). This is all well and good, except for the increase in laundry (time, detergent, electricity) if you can't access hospital scrubs, and the loss of all those glorious POCKETS, which is one of the main reasons I wear a white coat. Also, because I get cold. I have a slick residency program windbreaker with pockets, but I figure that falls into the category of wearable fomites, so I left that at home. Instead I decided to go back to carrying a "medical bag," an experiment I tried a few years ago and then gave up because I figured the bag itself was an infection risk. But I'm trying it again, leaving the bag at the hospital and laundering it weekly (which is as often as I wash my white coats, when I'm wearing them).

I packed my stethoscope (always cleaned before each use), reflex hammer because I'm on Neurology Consults (now cleaned after each use), a couple of pens, a penlight, my pager, some lip gloss, extra hand sanitizer, and alcohol wipes. The detachable wallet purse has my driver's license, debit card, meal tickets, and some cash. I can tuck my cell phone (wiped down a couple times a day now) into one of the outer pockets.

Maybe this is premature, but just in case we get to the place at which physician cannot or should not go home from the hospital to non-medical cohabitants, I have also packed an overnight bag with two sets of scrubs, two tshirts to wear underneath (hospitals get cold at night!), extra socks and underwear (not pictured), grubby sneakers, shampoo and toothpaste, a hair barrette, silicon ear plugs for sleeping at night, sanitary supplies, arch supports, key medical references, green tea, granola bars, M&Ms, and dried apricots. (Meal tickets are no go if the cafeteria is closed!) Hopefully I end up pulling this bag from my trunk once the pandemic blows over, but until then, I'll be prepared like the Girl Scout I am.

Older

Newer

What Residency Looks Like LXXXVIII: The Final Countdown

Sometimes residency sounds like listening to 1980s synthesizer pop songs while studying neurology over breakfast in the hospital cafeteria before a moonlighting shift in the Neonatal ICU. It was a bold choice for 6:30 on a Saturday morning, and I salute whomever decided we needed Bonnie Tyler and Duran Duran to jump-start our day.

Incidentally, there are just 136 days left in my residency program (but who's counting?). I'm hoping to get to an even 100 What Residency Looks Like posts by then. For your nostalgic enjoyment, here's the official music video for Europe's famous song:


Older

Newer

What Residency Looks Like LXXXVII: Doppelgaengerin

Sometimes residency looks like your facecard hanging on the wall when you are the "Clinic Supe" (supervisor) for the month. It's a relatively new position whose duties we're still figuring out, but so far it involves leading the pre-clinic conference lesson, managing the flow of patients, teaching the medical students, handling paperwork for absent residents, answering all manner questions, and blogging about it. I am also doing a small quality improvement project about making referrals for nutrition counseling.




Older

Newer

What Residency Looks Like LXXXVI: On Red Team, we are positive

Over the course of one month, Red Team took care of 102 patients: 64 women and 38 men. They ranged in age from 20 to 95 years old, with an average of 63 years old. While most were admitted for 2-3 days, their length of stay ranged from less than 1 day to 52 days, with a few long admissions pulling the average up to 6 days. There were three codes and two deaths. One patient signed himself out against medical advice. We transferred 2 patients to Family Medicine, 2 to Cardiology, and 1 to Cardiothoracic Surgery.

We learned about such rare diagnoses as Sturge-Weber Syndrome, Castleman Disease, and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). We also took care of patients with common medical conditions: atrial fibrillation, congestive heart failure, pulmonary embolism, and infected foot ulcers, and we practiced managing pain, blood pressure, and blood glucoses in the hospital.

One patient refused dialysis, but his kidney function improved anyway; another patient's kidneys got worse and had to be started on dialysis. Most of the people admitted with chest pain concerning for heart disease were discharged with other diagnosis, but two of them went to the cath lab to get stents for on-going myocardial infarctions, and in the process they reminded us that women's heart attacks can present differently than men. We diagnosed four people with cancer, one of them for the third time.

The team shared lighter moments, such as the patient who asked us to autograph her facecard.* The workroom was often filled with laughter, sometimes with music, and once we smuggled a chocolate candy bar on rounds. Some patients had interesting allergies listed in their electronic medical records: tomatoes (reaction: worsens arthritis^), oral diuretics (but somehow not IV diuretics), and cocaine (!). One woman took a record number of herbal supplements at home (9).

There were difficult moments: The patient who made sexist comments about one of the medical students in the middle of morning rounds. The woman who didn't like the intern who wears a headscarf and speaks with an accent. The patient who insisted against all evidence that the interns had asked the nurses to dilute her pain medication. The family member who complimented "the colored boy," a young African-American patient care technician who helped feed her husband when he couldn't do it himself.

There were moving moments: One man had a peaceful death in the same wing of the hospital in which he had been born. One of our "difficult patients" thanked me for pulling up a chair most afternoons of her month-long hospital stay: "No one else comes to visit me." Another "difficult patient" cried when I told her that I was rotating to a different hospital. We became close with the staff on the floor, too, including one of the nurses, who--having been publicly berated by a patient's family member--tearfully confessed to me, "I feel like I'm a member of your team."

Medicine is a team sport: patients, doctors, families, nurses, consultants, food service, environmental service, operators, therapists, care managers, social workers, secretaries, and ED staff. We don't always agree on the diagnosis or the plan, and sometimes no matter how hard we try, we cannot not fix a patient's problem, but the important part is that we are in it together against pathology and red tape, not each other. This weird and wonderful calling of caring for sick people, often at their worst moments, can sometimes bring out the best in us and others. On Red Team, we are positive.

Older

Newer

*A facecard is just what it sounds like: a piece of card stock with the names and faces of the medical team taking care of the patient.
^This medical myth was promulgated by a 1993 theoretical paper but has never been substantiated by high-quality evidence.

So long, 2019! Hello, 2020!

Happy New Year! As I have for the last 5 years, I collected tickets, photos, and snippets in a decorated jar that I wanted to remember from 2019. Here they are, illustrated and in roughly chronological order. For prior years check out 2015, 2016, 2017, and 2018.

~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*

Starting the year with a trip to the holiday lights display at the Phipps Conservatory in January.

And the fashion show at the Frick Museum. [Blog post pending time to write it.]

When I asked a "difficult patient" to "give me a big squeeze," and she held up her arms for a hug! (I wanted her to squeeze my fingers to check for grip strength but accepted the hug instead that day.)

That my book chapter (right) and poem were finally published!

Watching the Baltimore Orioles play the Pittsburgh Pirates at LECOM Park during Spring Training. We also enjoyed St. Petersburg's arts and culture [posts 1 and 2], as well as Ybor City [post 3]. However, the in-depth Frank Lloyd Wright tour of Florida Southern College I still need to blog about. (The last day of vacation often gets short shrift.)

Lewis Black's "The Jokes on Us Tour" at Heinz Hall back in April.

When my attending complimented my communication skills on rounds, and every time someone mistook me for a final-year resident while I was still a third-year resident.

A wonderful house concert with terrible angles for photos.

Indecent, the play about Jewish author Sholem Asch and his (in)famous stage play about lesbian love set in a brothel that we attended at the O'Reilly Theater in May on Yelp Elite tickets.

The time on pediatric night shift that theme for our weekly potluck was "RIP Pop Stop," and the menu consisted of "Bieber, milkshakes, snitches get stitches, and quesa-Dallas" (which were delicious, if you're wondering).

Attending a Sherlock Holmes-themed high tea [blog post]. in May Unfortunately, watching Quantum Theater's King Lear outside at the retired Carrie Furnace at the end of the month was a literal wash out from all the rain.

Taking a visitor from Iran to a pro-immigration rally.

"Thank you for being an excellent person." WOS

"Working" 364 hours as first jeopardy and never being called in, which might be a program record [blog post].

Attending our first Picklesburg street fair (sliders with pickles and a stuffed gecko):

Discovering a theater-going partner in a new friend at church; we saw Kinetic Theater's locked-door mystery from Sir Arthur Conan Doyle, The Speckled Band, at the Charity Randall Theater in June, and Spamilton at CLO's Cabaret theater in August, which was hilarious even though none of us had seen the original.

The hottest Pittsburgh Pirates baseball game on a Saturday night in July. Those were free residency tickets, and we almost wished we had just stayed home. [This birthday blog post reminded me of the really delicious strawberry cake I baked and pretty much ate myself.]

Cutting a rug at Jett's Jazz Rally penthouse party:

Learning new games: Settlers of Catan, bridge [blog post], and Ticket to Ride. There was also bowling [blog post].

Pastor John's encouragement/thanking me for making church a priority despite residency: "You are an encouragement."

Everything about our family vacation on Smith Mountain Lake except not being able to sleep.

Being moved by Quantum Theater's world-premier of Looking for Violeta, with a friend in the cast.

Pirates vs Reds. The tickets were free courtesy of the blood bank, and we took new friend Eunice from Ghana to her first baseball game (above).

Saw the Downton Abbey movie at the local Manor Theater with a friend after work. It was fun to watch but not high art by any means; the plot really needed an editor's hand to be tighter.

Wandering the Portland Chinese Garden [blog post] and the Portland Japanese Garden [blog post] while on vacation at the end of September. Visiting the end of the Oregon Trail [post] and hiking Multnomah Falls [post]. Snapping this inadvertent selfie while trying to capture Dear Husband at mile 23-24 of his personal-best marathon.

The satisfaction of a clean team room. Also, referring to myself as a "super senior" since I'm in my fourth year of residency, when most people finish after three years.

The first time Rosamunde climbed up onto my chest for pets while I was lying the cough with my laptop. (This is her from another time.)

I still need to blog about the Japanese garden-themed Fall Show at the Phipps Botanical Garden, where we used the last of the free tickets I won in a photo contest.

The outpouring of concern when my Facebook Messenger was hacked.

Researching and writing a senior talk on Health At Every Size(R) and the anti-dieting movement that was well received. And lots of Med Peds people showed their support!

This quote board from work.

Seeing a really excellent play with a 100% African-American female cast, School Girls; Or, The African Mean Girls Play, at the O'Reilly Theater, with a friend's free tickets.

The patient who wished me "Happy Thanksgiving" across the clinic parking lot, and getting to celebrate with my extended family this year.

Watching a friend's kid star in A Christmas Story at the local middle school.

Eating ice cream for lunch (twice!) at Tom's Ice Cream Bowl, rated best ice cream shop in the country by USA Today in 1998.

That's hardly everything that happened in 2019, but it's more than enough to remember that, personally and professionally, it was a pretty good for me. I haven't decided yet whether I will continue the rememberlutions jar, but here are things I am looking forward to in 2020: teaching history of medicine again, graduating from residency (aka last graduation EVER), starting my first job as an attending, and celebrating 15 years of marriage.

What good will you remember from 2019, and to what are you looking forward in 2020?