Merry Christmas!

I'm in Maryland with my mom, brother, and one of my sisters. My other sister and my dad are in Belgium. My Christmas present to my mom was cleaning our hallway bathroom -- it got a top-to-bottom scrubbing like it's never seen before. And I've been washing all the bedclothes in all the bedrooms, which is a non-stop dance of washer and dryer cycles and re-making beds -- but totally necessary because the whole house smells like dogs. And cat.

No one ever put up a tree here, which is kind of sad, but totally understandable, because no one has really been around, with work and school and such. But we do have a poinsettia. It's a totally Charlie Brown Christmas here.


After we open presents tomorrow, I'm going to make roast pork loin and some green bean casserole, and then I'm sure there will be lots of Wii playing -- my brother got one from his girlfriend for Christmas, which they celebrated 3 days early. My arm is already sore from Wii tennis this morning!

On Wednesday I'm headed to PA for the rest of the week, to meet up with Eric (who had to work today and has to work tomorrow) and hang out with his family. It will probably be much more traditional as far as Christmases go, but I do get a nice sense of satisfaction from scrubbing tubs and pulling hot, fresh comforters out of the dryer :)

Happy Holidays to you and yours!

December out of the hospital

Here's the biggest difference between surgery and pediatrics: hours on and days off. On surgery, I was showing up between 4:30 and 5:00 a.m. and staying until 5:00 or 6:00 pm. I was on call every fourth night and had one full day off per week. On pediatrics, the first four weeks I worked 9-5 Monday through Friday, period. On in-patient pediatrics, I showed up around 7:30 and worked until sometime between noon and 4 pm, depending on the day. I was on call every fourth night and had no guaranteed days off -- it just depended on the whole team's schedule. So that meant Sunday, December 2 was my last day off until the rotation ended on the 14th. Now, I certainly didn't work long hour each day from the 2nd to the 14th, but not having a day off really eats into your ability to plan your outside life. I was perpetually exhausted on surgery, but at least I knew I had one day off to look forward to each week. Anyway, all of that is only to say that at the beginning of the month, I siezed the rare day-off opportunity to do some Christmas decorating.

We discussed getting a tree, but with me working every day until the 14th, then leaving for home on the 18th, we decided it wasn't worth it. So instead I made this:
Ingredients:

• 2 bunches of evergreen branches from Lowe's, about $8
• Branches of red berries and blue and red Christmas ornaments, 1 metal tray (intended for serving Christmas cookies on) and 1 block of floral foam from Hobby Lobby, about $6
• 2 candles and some flower food that we already had
• Wire cutters, floral cutters, and a glue gun to assemble

That's a centerpiece any florist would be proud of. It's sitting on our windowsill, and we hung a single strand of lights:

It's not quite the same as a tree, but it will do. Especially considering I've already left to come east for the rest of the month!

Last year we hung cards in the office, where the tree was, but this year I thought we should make the living room the focal point, so I hung up a bulletin board and dressed it up a bit:
You can see our messy entry table, complete with mini-pumpkin left over from Thanksgiving. We've made some progress on clearing it up since then. On the left of the bulletin board I hung all the engagement cards we've gotten that had just been sitting in a pile on the table, and I left the right empty for Christmas cards. We got our first one the very next day! It's now full of cards on both sides, and the snowflakes and angels have only been pulled down a couple times by Mojo.

Speaking of cats, they've been acting weird lately. First, they've returned to their former couch-end selves:
To explain, a long time ago they took up residence on the back of the couch, Mojo always on his side and Moxie always on hers (like book-ends on a couch = couch-ends). A few months ago, Mojo stopped napping there, although Moxie has always stayed at her end. A couple weeks ago, Mojo was back! I like it when they do this; it balances the living room nicely.

One evening when I was putting things away in the sewing/liquor/linen closet (the plaid curtain usually hangs down to hide the first two things), I turned away for a minute, then turned back to find Moxie hanging out on top of the towels as if it was the most normal place to be. I don't even know how she got up there, because the shelf above has an overhang that almost reached the level of the top towel below, and the entire shelf is a pretty high jump for what she normally does. Wacky.

Mojo's turn to be wacky. The other day I looked up and found him on top of the kitchen cabinet -- that's above the refrigerator, in case you don't also keep your rice pot and cookbooks on top of your refrigerator, also. It's not unusual for him to jump up onto the fridge, but he usually knocks a bunch of stuff over, gets bored, then jumps back down. I've never seen him sleep up there before -- on a box holding our electric griddle, no less.


Monday night we cooked, for the very first time:
Lobster! I just learned from Louisville HotBytes that Clearwater Seafoods has a distribution center in Louisville, and they sell lobster (and other stuff) fresh to the public. Their "retail grade" lobster is only $8/lb! So after a day of Christmas shopping, we stopped by and picked up two 1.4-lb lobsters, and introduced them to the kitties.

"Hmm. We think you smell interesting, and possibly delicious, but we're not sure..."
"You're lucky our claws are banded, you jerks."

Don't worry, I put the lobsters in the fridge after that.

But only until the water came to a boil.
I even made clarified butter! And it turned out perfectly fine in a regular pot, not that that doesn't make me want an All-Clad butter warmer any less.

Twenty minutes later, we had a feast fit for royalty (frozen corn instead of corn on the cob, but remember that it's December, not July):
You can see my flat-leaf parsley and basil growing in the window.

And thirty minutes after that:
Sorry, I know that's gross. But it was sooooo delicious! And now I have "The Walrus and the Carpenter" going through my head, substituting "lobster" for "oyster."


Instead of leaving you with that picture of lobster destruction, here's a picture to put you in the holiday mood:
Meowy Christmas!
(Looks an awful lot like this picture, doesn't it?)

December in the hospital

Pediatrics is over and I'm pretty neutral on it any way you look at it. The kids are cute, the parents aren't always as annoying as I had anticipated, and it's not hard work (especially not compared to surgery, ha!). But it's just not for me, I fear -- unless I could magically become a Peds ID or surgery attending without doing general pediatrics or (even worse) general surgery first.

Some highlights:

• -Crazy little Ruby R., 2 years old and with probably no well-child-checkup in her life. She got her shots at the health department and went to her Passport-assigned family practice clinic for sick visits (Passport is KY 's Medicaid, essentially). But when she rolled into Kosair with bronchiolitis, she had a palpable liver and a crazy-ass heart murmur, and it was obvious no one had ever listened to her heart before. And she had the CRAZIEST parents -- they were definitely what we call a "social nightmare." We suspected Marfan's, so I was sent to take all her measurements (a wingspan-to-torso ratio of > 1.2 is usually what you find), but it turned out she instead had Williams syndrome (supra-valvular aortic stenosis -- take THAT, shelf test!). She was a cutie pie, jumping up and down in her hospital crib/cage like a little monkey (a cocktail party monkey!), and even though it was sad that she wasn't talking or walking yet -- instead, scooting herself around on her butt, again like a monkey -- it was adorably sad. I meant to call the cardiologist to see if she ever made it to her follow-up appointment, because I'd be willing to bet she didn't.
• -Room 513's mom, who had been in the hospital with her 2-month-old son for 3 weeks straight. He had had pneumonia (actual, bacterial pneumonia, not viral or atypical, yay for me!) and had been intubated in the PICU for over a week. Now he was back on the floor, and being weaned off his morphine. One night, we figured out the wean was going to quickly, because his withdrawal symptoms were pretty bad, so we stepped back and started the wean over, with much begging from mom. The next morning I checked in and asked mom how he was doing. "Oh, much better, he does much better with that morphine. And so do I." And that's how addicts are born, I thought to myself. Just kidding. The kiddo did fine, and so did mom, although she actually was planning to have a hysterectomy the day after we discharged them, and refused to believe that should would have any problems getting out of bed to take care of her son the same day!
• -L.J., who was 3 years old and weighed 120 pounds. And did not have Prader-Willi or any other type of genetic problem. And what did "L.J." stand for? Little James. I shit you not.
• -A little girl at my outpatient clinic who declared that her "pooket" was itching. I didn't actually see her myself, but that story was spread far and wide immediately after the resident got out of the room. Her "pooket"? Where do parents come up with these names for genitalia? And of course, I was picturing that she was saying "Phuket" and thinking of the "What happens in Thailand stays in Thailand" SNL skit with Ben Affleck. Sure, maybe "vagina" is a little much for a 3-year-old, but where does "pooket" come from?

It's nice to be home, although the stress of splitting holidays among two families and trying to see as many friends as possible means it's going to be a tiring week and a half. Happy December!

My new obsession

I need these! All of them!

I heart guts

I still want the rest of the Giant Microbes, too, in case you're wondering (hey, they've added more to their collection!)



Look! What a cute uterus! And I love the little pancreas and gallbladder, too.

Get your flu shot! New Jersey insists!

I've been pretty convinced that I'm going to become an Ob/Gyn lately. Then I attended pediatric grand rounds last Friday, where who was presenting but none other than Dr. Gary Marshall, of pediatric infectious diseases, who is by far one of the best lecturers I have ever heard. Last year he gave the closing lecture in our microbiology course, about vaccines and vaccine-preventable illnesses, and I my love for infectious disease (as a field, not an ailment) was reinforced. Of course, that was before I found out that I was a cutter (not myself -- other people!). Since August, I've been busy thinking about how Ob/Gyn is the perfect fit for me. Surgery, babies, a little primary care, and a little infectious disease.

Then I heard Dr. Marshall talk again last week and I was back to square one. "Didn't I get my MPH to work in infectious disease epidemiology?" "Don't I have a bizarre love of vaccines and vaccine-preventable illnesses?" Argh. But, there's still hope.

Dr. Marshall talked about thimerosal and vaccines, and it was a wonderful lecture. He gave some background on thimerosal and mercury, reviewed the research that shows no link between vaccines and autism, and reviewed and debunked the research that supporters of the link try to claim as evidence. It was all in all a great talk, especially because Dr. Marshall is such a great speaker. *Note: I am not here to start a debate with anyone on the vaccine-autism bullshit. Vaccines do not cause autism. Period. End of story. I think not vaccinating your children is a form of parental neglect.

One of the questions that came up was why, if all the evidence points to the contrary, does this misinformation keep spreading? One answer is that parent groups are very proactive in bringing in people who keep spreading the misinformation, and physicians are notoriously poor at organizing and fighting back in a people-friendly way (true). It's very easy to stand there in your white coat and say, "Your child needs this vaccine because it's the best thing for him," but very difficult to go in front of a group of educated-but-misinformed parents and try to fight the crazy head on. So we were challenged to do just that.

And then it hit me. That's why I can still do good things (vaccine-related, that is) with Ob/Gyn: Because maternal attitudes are formed during pregnancy, not afterward. It is well known among pediatricians that obstetricians need to push breastfeeding, because once the baby meets the pediatrician for the first time, even if it's at a mere 2 days of age, it's too late to change maternal attitudes, and that baby is going to be bottlefed. Things might not be that dire when it comes to vaccines, but I really think obstetricians can play a large role in directing attitudes toward vaccination. And I really love a good dose of crazy, so I've decided my job is to infiltrate, infect (with wisdom!), and fix this craziness. Beliefs cannot continue to trump facts! So watch for me at your next PTA meeting. In five years.

And on that note, check out why New Jersey is awesome (Seriously, people! I keep telling you it's not all the Turnpike and jughandles!): N.J. first in nation to mandate flu vaccine for preschoolers.

Talk about continuity!

You probably remember my excitement at being able to provide continuity of care on my Ob/Gyn rotation to a woman (OK, girl) who I saw at my clinic, then saw again in labor and delivery. Well, Dr. HWong14's continuity of care just got bigger and better. This week, we had a little 4-month-old baby with RSV bronchiolitis, and on morning rounds I could not stop staring at his mom. I noticed that she had really thin, stringy hair and looked "older than her stated age" (though not by much). Then I had a really strong sense of deja vu, which isn't unusual for me, but this time I realized it was real! I had seen her before! And thought the same thing about her hair! But where? In clinic? On surgery? No -- on Ob/Gyn! I asked mom where she delivered, and she said at University. I checked the baby's birthdate on his chart -- July 24. I was at private practice then, so I couldn't have delivered her. It took another day, but I finally figured it out -- when I was manning L&D triage, she came back in a week after her C-section to have her staples removed, and I removed her staples. I saw that little baby when he was just a week old, and now I was taking care of him four months later. So cool!

I've had another sort-of continuity experience as well -- at the beginning of last week, we rounded with the other half of our team, and when we entered this little boy Jacob's room, I knew I had seen him before. And the woman with him looked very familiar, too. All of a sudden, it hit us at the same time and we interrupted rounds to exclaim that we had seen each other just two weeks prior in outpatient clinic! She was Jacob's grandmother, who took care of him and his sister because his mom had been diagnosed with a brain tumor right after the daughter was born earlier this year. It's a really sad story, but that family is so amazing. Well, Jacob was diagnosed with adenovirus pneumonia, and by the end of the week, his sister was admitted for RSV. Talk about social stressors. It was nice to see Jacob again (I had seen him in clinic for a well-child checkup) even though it was under such difficult circumstances. Plus, he was absolutely the cutest boy in the entire world.

So I guess since I get excited by continuity, that I'm more cut out for primary care than I thought. Plus, it turns out I HATE hospital medicine. I hate rounding every day. I hate the "wait and see" of long-term illnesses. Especially when there are no more labs or radiology tests to perform on a daily basis. You mean we just have to wait for the patient to get well enough to go home?? It drives me crazy! And rounding is so boring -- walking around to every patient's room every morning takes hours! I don't get to actually start on the day's work until after lunch! I mentioned this to Eric the other day and he asked what I would rather be doing during the time we spend rounding. My answer? "Cutting people open." Yeah, I know, I have problems.

Surgery isn't the only thing I like. I like clinic better than outpatient medicine because there's an immediate goal: discharging the patient. I see the patient, figure out what's wrong, figure out what I'm going to do about it, and send the patient on his or her way. Sure, some things need referrals and further workup, but I resolve the issue at hand and grab the next chart. Keep the line moving, get everyone seen. No wonder I've always been drawn to emergency medicine, too. If only emergency medicine wasn't, as one anesthesiology resident put it, "clinic for crackheads."