- I'm off of Ob/Gyn and on to pediatric surgery. I love pediatric surgery and always have. And when the residents compliment my pretty sewing, my heart twinges just a little thinking about my future of stapling, rather than suturing, abdominal incisions. If only you didn't have to do general surgery to do pediatric surgery...
- I've been on two interviews so far, with another on Halloween and another two the following week. They've both gone really well, although the traveling is already exhausting. I have a carryon-sized suitcase half-packed at all times. All I need to add is my suit, a clean blouse, and my toothbrush and deodorant, pretty much, and I'm ready to go.
- In order to go on interviews that require plane trips (which all but one of mine do), I take overnight call, then schedule my flight for the next day when I'm post-call, and have my interview the following day and fly back that night. That way, I only skip one day of work, but I also lose out on a lot of that post-call sleep. I'm pretty good about being able to sleep on planes, especially with my handy-dandy travel pillow, but it's still not quite the same. This led to me interviewing with a splitting headache at Washington Hospital Center last week. Not good. Am going to have to figure out a better combination of sleep/caffeine/pain meds.
- Another article that pisses me off. The part that pisses me off? The thing about mandating the doctor's script. Describing fingers and toes in a first-trimester ultrasound? I'm not really so sure that's really so plausible.
- Doctors prescribe placebos, apparently, even though I have always been taught they are unethical. But seriously, I can think of a number of situations in which they would be useful....
- The Phillies are in the World Series! Woohoo! A potential final game is tonight!
- More healthcare articles:
- AIDS treatment should start sooner. This is a big, big deal. It means patients will be treated much differently than they are now, and hopefully it will be for the better, with more patients surviving longer.
- Rotavirus vaccine cuts diarrheal illness. Another big deal for preventing major illness. I did my master's research using data from Merck's rotavirus vaccine, so I have a soft spot in my heart for it.
- New fetal DNA tests trigger debate. I think it's a good thing to keep offering testing to parents. The thing is, a lot of people don't even want prenatal testing, and that's fine. We ask our patients, "If the result were positive (meaning there's a problem with the fetus), would it change your plans for this pregnancy?" In Kentucky, especially, a lot of women say, "No," and therefore don't even bother with the test. If you would change your plans for the pregnancy based on test results, I and most physicians don't think that's a bad thing. We don't tell people to terminate; they have to make their own decisions. At this point, it's all an ethical debate, which, don't get me wrong, is good to have, but the reality is that things don't work that way. I think equating termination of fetuses with known major, severe abnormalities with eugenics or the Nazis is a little extreme. Spend a day or two in the NICU and watch those horribly sick babies slowly dying day after day and you might have a different opinion about what a quality life consists of.
Monday, October 27, 2008
Bulleted thoughts
Friday, October 17, 2008
Commuting Fail
see more pwn and owned pictures
I submitted this, and it got on the main page! Go me!
I took it in Nottingham, Pa., on the way to Downingtown from Maryland. After passing the Herr's Factory and the giant Wawa, I was supposed to get on Route 1 north from Route 272. I missed the exit, though, and pulled into this park and ride lot to turn around. And right there in front of me was this ridiculous sign. And I happened to have my camera with me. The end, by Holly.
Wednesday, October 15, 2008
Nothing makes me boiling mad like pregnancy termination
and the threat of removing a woman's right to access it.
Project Runway is over (Congrats, Leanne, although I think I would have picked Korto), the Phillies are beating the Dodgers 5-0 and the game went to commercial, and I flipped to the debate.
Just in time to hear John McCain say he believes abortion rights should be left to the states.
I firmly, strongly, adamantly, 100% DISAGREE.
Terminating a pregnancy is a decision between a woman and her physician, and no one else. States' rights are fine for some things, like how you're going to handle road repairs, but this is a fundamental right to privacy and a situation in which we need a country of United states, not of 50 states with 50 different opinions. Or, god forbid, 50 South Dakotas. A politician cannot tell me what my opinions about a treatment are and force me to repeat lies to patients.
Barack Obama has sidestepped the question somewhat, but I can't blame him.
It's 10 pm and I need to go sleep, because I wake up at 6 am for my first interview! And I am completely ready to answer any and all questions about my stance on pregnancy termination with regards to my future career as an obstetrician/gynecologist.
By the way, in case you're wondering, there is no medical procedure called a "partial-birth abortion."
OHMYGOD, I can't listen to this debate any more. I'm about to scream.
Project Runway is over (Congrats, Leanne, although I think I would have picked Korto), the Phillies are beating the Dodgers 5-0 and the game went to commercial, and I flipped to the debate.
Just in time to hear John McCain say he believes abortion rights should be left to the states.
I firmly, strongly, adamantly, 100% DISAGREE.
Terminating a pregnancy is a decision between a woman and her physician, and no one else. States' rights are fine for some things, like how you're going to handle road repairs, but this is a fundamental right to privacy and a situation in which we need a country of United states, not of 50 states with 50 different opinions. Or, god forbid, 50 South Dakotas. A politician cannot tell me what my opinions about a treatment are and force me to repeat lies to patients.
Barack Obama has sidestepped the question somewhat, but I can't blame him.
It's 10 pm and I need to go sleep, because I wake up at 6 am for my first interview! And I am completely ready to answer any and all questions about my stance on pregnancy termination with regards to my future career as an obstetrician/gynecologist.
By the way, in case you're wondering, there is no medical procedure called a "partial-birth abortion."
OHMYGOD, I can't listen to this debate any more. I'm about to scream.
I am a 13-year-old boy
A patient came in tonight (21 years old, my sister's age, aka, TOO YOUNG to be having children!) 33 weeks pregnant, with a chief complaint of post-coital bleeding. Bleeding after intercourse, while you're pregnant, is very common and not something generally to be worried about, but then she said she was also having some contractions (can also happen after sex) and may have been leaking some fluid (OK, now you've got our attention).
To check for ruptured membranes, you can do a few things. First, you do a sterile speculum exam without using any lubricating jelly. You look for:
The patient had some pooling, but the fluid was tinged pink from some blood. Knowing that the pooling itself was not definitive and that nitrazine was useless due to the blood, we swiped some fluid onto a slide to see if, by chance, there was any ferning.
There wasn't.
But guess what there was.
Sperm.
Heehee!
I've never seen sperm under the microscope before, so that was fun to add to my list of things-I've-come-across-in-real-life. It also explained the pooling: Semen, duh.
Oh yeah, and gross. Definitely gross. I've seen lots of stuff under the microscope: trichomonas, bacterial vaginosis, and all sorts of nasty vaginal discharge. But sperm... that's gross in a different way.
But heehee, they just had seee-eex.
To check for ruptured membranes, you can do a few things. First, you do a sterile speculum exam without using any lubricating jelly. You look for:
- pooling -- fluid will collect on the bottom half of the speculum; if it's clear, that's a strong indicator for amniotic fluid. If you push on the abdomen and simultaneously see more fluid flow out the cervix, that's a pretty good indicator too.
- nitrazine test -- stick a qtip in the fluid and swipe it on a piece of nitrazine paper, which is a pH paper. If it changes from yellowish to blue, it has come into contact with a basic substance, and while the vagina is normally acidic, amniotic fluid is not. Things that will give false positive results include water, lubricating jelly, blood, and semen, so the test is useless if any of those are present.
- ferning -- you swipe the qtip on a microscope slide, let it air dry, and look at it under a microscope. Amniotic fluid will produce a pattern that looks like the fronds of a fern, or like snowflakes.
The patient had some pooling, but the fluid was tinged pink from some blood. Knowing that the pooling itself was not definitive and that nitrazine was useless due to the blood, we swiped some fluid onto a slide to see if, by chance, there was any ferning.
There wasn't.
But guess what there was.
Sperm.
Heehee!
I've never seen sperm under the microscope before, so that was fun to add to my list of things-I've-come-across-in-real-life. It also explained the pooling: Semen, duh.
Oh yeah, and gross. Definitely gross. I've seen lots of stuff under the microscope: trichomonas, bacterial vaginosis, and all sorts of nasty vaginal discharge. But sperm... that's gross in a different way.
But heehee,
Tuesday, October 14, 2008
Triplets!!!
Two nights ago, a woman came into triage complaining of spotting at 8 weeks. So we stuck the transvaginal ultrasound probe in and started probing. And I saw something weird... it was a black space on top of another black space. One black space should be the open (pregnant) uterine cavity, and if you saw another, triangular, black space to the anterior and inferior side of it, that would be a full bladder. But this black space was to the anterior and superior side of it, so it definitely wasn't bladder.
Then I saw two yolk sacs, one in (what turned out to be) each amnionic sac.
TWINS!
The patient was completely shocked, but in a good way. She told us that her 4-year-old had just recently told her that he thought she was carrying twins, and she had blown it off as a 4-year-old being silly.
Then, we kept looking around, and we realized in the anterior amniotic sac, there were TWO yolk sacs. More scanning confirmed it: THREE HEARTBEATS!
Those little round blobs were so adorable, with their little heart flutters. And the parents were totally and completely in shock.
No infertility treatments, and no history of twins or triplets on either side of the family.
1. It was crazy to see, and so nice to see a happy reaction to pregnancy news (our patient population isn't always that thrilled)
2. It was nice to know that I immediately could see and interpret the ultrasound evidence, because that means I'm getting better at my ultrasound technique!
Then I saw two yolk sacs, one in (what turned out to be) each amnionic sac.
TWINS!
The patient was completely shocked, but in a good way. She told us that her 4-year-old had just recently told her that he thought she was carrying twins, and she had blown it off as a 4-year-old being silly.
Then, we kept looking around, and we realized in the anterior amniotic sac, there were TWO yolk sacs. More scanning confirmed it: THREE HEARTBEATS!
Those little round blobs were so adorable, with their little heart flutters. And the parents were totally and completely in shock.
No infertility treatments, and no history of twins or triplets on either side of the family.
1. It was crazy to see, and so nice to see a happy reaction to pregnancy news (our patient population isn't always that thrilled)
2. It was nice to know that I immediately could see and interpret the ultrasound evidence, because that means I'm getting better at my ultrasound technique!
Sunday, October 05, 2008
Ben Folds
Last night we went to see Ben Folds with the Louisville Orchestra. It was a really cool show. The orchestra started out with 5 pieces in the first half, and they were all fairly friendly to an audience that bought tickets to see Ben Folds and not the orchestra. Tchaikovsky, Aaron Copland, a medley of Star Trek themes. But that didn't stop the high schoolers sitting next to us from talking and being generally obnoxious during the whole thing. Look at your programs, people; that's what they're there for. If you don't want to sit through the first half, go out to the lobby and wait.
Geez, I feel like an old geezer. But seriously, I was about to slap them.
Then Ben Folds came out, and he was really good, as was expected. At first, his piano wasn't miked enough, so he blended with the orchestra too much, but after the first song, that was resolved. He played lots of favorites, and one song from his new album. With an entire orchestra to accompany him, I hoped he would play "Steven's Last Night in Town," and he did. Since it's my favorite song, I hoped he would play "One Down," and he did -- all by himself, with no orchestral accompaniment. It was better that way. I totally love that song.
(By the way, I just Googled "one down three point six" and the first hit was Transmogrification. Small world!)
The low part of the concert was "The Ascent of Stan," for which the orchestra was dragging a bit.
The low part for me was when he performed "Gracie," the first line of which goes, "You can't fool me, I saw you when you came out." He had told us about watching his twins be born, and used the phrase "saw them come out" a couple times while talking, and I guess the third time, in the actual lyrics, was too much for me. Remember that very, very sad thing I mentioned before, that I hadn't had any time to process?
Well, my subconscious sent it flying up into my consciousness, and I processed it right there in Whitney Hall, while Ben Folds sang "Gracie." And I mean tears were running down my face uncontrollably. That's how emotionally exhausted I am from this month.
The very, very sad thing involves a baby dying last week. I don't think I want to tell the whole story any more, so please forgive me. Let's just say that in obstetrics, there are a few different types of "fetal demise," but I think I've concluded that for obstetricians, there are only two types: expected/unsurprising, and unexpected/surprising.
This one was out-of-left-field unexpected and very, very surprising and upsetting. Not least of all for the mother, of course, but also for the rest of the team. I barely met the mother, she wasn't my patient, but there I was, crying uncontrollably at a Ben Folds concert last night for a baby whose father didn't get to watch it come out.
Two weeks down, two weeks to go.
Geez, I feel like an old geezer. But seriously, I was about to slap them.
Then Ben Folds came out, and he was really good, as was expected. At first, his piano wasn't miked enough, so he blended with the orchestra too much, but after the first song, that was resolved. He played lots of favorites, and one song from his new album. With an entire orchestra to accompany him, I hoped he would play "Steven's Last Night in Town," and he did. Since it's my favorite song, I hoped he would play "One Down," and he did -- all by himself, with no orchestral accompaniment. It was better that way. I totally love that song.
(By the way, I just Googled "one down three point six" and the first hit was Transmogrification. Small world!)
The low part of the concert was "The Ascent of Stan," for which the orchestra was dragging a bit.
The low part for me was when he performed "Gracie," the first line of which goes, "You can't fool me, I saw you when you came out." He had told us about watching his twins be born, and used the phrase "saw them come out" a couple times while talking, and I guess the third time, in the actual lyrics, was too much for me. Remember that very, very sad thing I mentioned before, that I hadn't had any time to process?
Well, my subconscious sent it flying up into my consciousness, and I processed it right there in Whitney Hall, while Ben Folds sang "Gracie." And I mean tears were running down my face uncontrollably. That's how emotionally exhausted I am from this month.
The very, very sad thing involves a baby dying last week. I don't think I want to tell the whole story any more, so please forgive me. Let's just say that in obstetrics, there are a few different types of "fetal demise," but I think I've concluded that for obstetricians, there are only two types: expected/unsurprising, and unexpected/surprising.
This one was out-of-left-field unexpected and very, very surprising and upsetting. Not least of all for the mother, of course, but also for the rest of the team. I barely met the mother, she wasn't my patient, but there I was, crying uncontrollably at a Ben Folds concert last night for a baby whose father didn't get to watch it come out.
Two weeks down, two weeks to go.
Pine Mountain, revisited
Remember when I did this?
Well, now the NY Times has done it, too.
(OK, he hiked and I drove. But still -- driving alone up there is JUST as scary as hiking, I promise!)
(And, sniff, I kind of miss Whitesburg now. Until I think of that Super 8 I lived in for a month. No "stately Salyer House Bed and Breakfast" for me, unfortunately.)
Well, now the NY Times has done it, too.
(OK, he hiked and I drove. But still -- driving alone up there is JUST as scary as hiking, I promise!)
(And, sniff, I kind of miss Whitesburg now. Until I think of that Super 8 I lived in for a month. No "stately Salyer House Bed and Breakfast" for me, unfortunately.)
Friday, October 03, 2008
Labor and Delivery
I'm at the end of my second week of four of these overnight shifts. It's 5:00 in the morning, and I don't get to go home for another 3 hours. I've seen a lot of things, some very happy, some very, very sad, and a lot in between. I wanted to write about the very, very sad things, but my brain doesn't function properly anymore -- that's due to the whole overnight thing. It's easier to be sad for 5 minutes, process it as quickly as I can, and move on to the next thing. Frankly, I just don't have the energy to spend any more brain power on it, and that in itself does make me sad. Maybe once it's all said and done, I can find the energy to process it correctly and come up with emotions that will allow me to tell you about it.
My day starts at 5:30 pm and ends at 8 am, and that leaves me just enough time in between to sleep like a rock for just long enough to function for the next 5:30p-8a shift.
Every night I eat breakfast/dinner somewhere between 9-11pm, and it's usually a cheeseburger and fries. Or a turkey cheeseburger and fries. There are no vegetables at the late-night grill other than the lettuce and tomato that goes on my burger. Fries don't count. I'm craving broccoli hardcore. Sometime in the middle of the night, I inevitably eat a snack, like chips -- tonight it was an oreo-and-vanilla frozen yogurt blendy dessert thing, which was delicious. Most mornings, I run back down to the early-morning grill and get breakfast -- bacon, egg, and cheese sandwich. Yesterday I caved and got a Krispy Kreme donut IN ADDITION TO the sandwich. I ate all my groceries at home last week, and didn't go grocery shopping last weekend, and I'm paying for it this week, for sure. There's no way my wedding dress is going to fit when it arrives in 8-10 weeks. Oh well.
I'm so behind in everything involving the rest of my life, it isn't even funny. In residency, I'll do this for 8 weeks in a row. Can it really be too late for my backup plan of a career in public health? Or my backup backup plan of becoming a florist? If only I didn't have $300,000 of student loans to pay back.
Speaking of loans, I found out there's a Residency and Relocation loan I can apply for -- up to $15,000 to be used toward the cost of applying to, interviewing for, and relocating for my residency. I think I'm going to need it -- as of today I've gotten 12 (12!) interview invitations (of 31 applications), and almost none of them can be scheduled back to back. So that means I'm booking plane tickets back east once a week for most of October, November, and December, at a cost of at least $200 a trip. Yikes! Plus hotels, rental cars, you name it. It was exciting at first, but now it's just stressful. And I found out that one of the biggest lenders for these relocation loans is going to quit lending in a couple weeks, due to the credit crisis. Two weeks ago, I blew off the credit crisis as being serious for the country and for other people, but not for me in particular, since I have no assets whatsoever. Today, I see how it is going to affect me. Blah. So I guess I'd better sign up for an additional $15K of debt while I still can. The "perk" is that since I'm going to be a doctor, I can get special doctor rates for things like this relocation loan, and for mortgages. A better perk would be if I could crawl into bed at a normal time and sleep for a normal number of hours. Why do I have to like Ob/Gyn so much? I could be a dermatologist. Or an ophthomologist. Or an anesthesiologist. Except rashes give me the heebie-jeebies, I think eyeballs are the most disgusting part of the human body, and the thought of having to suction phlegm out of someone's throat makes me gag. So vaginas and a horrible lifestyle it is. Sigh.
So far, I've accepted all the interview invitations that have been extended to me, even though most of them are for smaller programs, because I feel like I need to. I may not hear from the bigger programs, so I need to take what I can get. I still want to interview at as many places as possible, because I still don't believe my chances can be very good (mostly, that's just me being cautious. But it's possible!). But the scheduling is starting to get to me. A lot of places interview on the same days, so I'm having trouble fitting them all in. Plus, I have to take time off from school to interview, and officially, there is a limit to how many days I'm allowed to be gone. So if one school in Pennsylvania interviews on a Wednesday, and another interviews on that Friday, my grades can't afford for me to take Tuesday (to get there the night before) - Friday off, but my wallet can't afford for me to fly out Tuesday night, fly back Wednesday night, and fly out again Thursay night to interview Friday. What to do?
I don't know what the answer is. All I know is, it's the weekend, and I'm going to sleep as much as possible, which may not be much, because:
Did I mention that Eric's here? And that we're going to see Ben Folds this weekend? And having our tasting with the caterer? And going to a wine tasting with some friends?
It's going to be glorious. Sleep be damned.
My day starts at 5:30 pm and ends at 8 am, and that leaves me just enough time in between to sleep like a rock for just long enough to function for the next 5:30p-8a shift.
Every night I eat breakfast/dinner somewhere between 9-11pm, and it's usually a cheeseburger and fries. Or a turkey cheeseburger and fries. There are no vegetables at the late-night grill other than the lettuce and tomato that goes on my burger. Fries don't count. I'm craving broccoli hardcore. Sometime in the middle of the night, I inevitably eat a snack, like chips -- tonight it was an oreo-and-vanilla frozen yogurt blendy dessert thing, which was delicious. Most mornings, I run back down to the early-morning grill and get breakfast -- bacon, egg, and cheese sandwich. Yesterday I caved and got a Krispy Kreme donut IN ADDITION TO the sandwich. I ate all my groceries at home last week, and didn't go grocery shopping last weekend, and I'm paying for it this week, for sure. There's no way my wedding dress is going to fit when it arrives in 8-10 weeks. Oh well.
I'm so behind in everything involving the rest of my life, it isn't even funny. In residency, I'll do this for 8 weeks in a row. Can it really be too late for my backup plan of a career in public health? Or my backup backup plan of becoming a florist? If only I didn't have $300,000 of student loans to pay back.
Speaking of loans, I found out there's a Residency and Relocation loan I can apply for -- up to $15,000 to be used toward the cost of applying to, interviewing for, and relocating for my residency. I think I'm going to need it -- as of today I've gotten 12 (12!) interview invitations (of 31 applications), and almost none of them can be scheduled back to back. So that means I'm booking plane tickets back east once a week for most of October, November, and December, at a cost of at least $200 a trip. Yikes! Plus hotels, rental cars, you name it. It was exciting at first, but now it's just stressful. And I found out that one of the biggest lenders for these relocation loans is going to quit lending in a couple weeks, due to the credit crisis. Two weeks ago, I blew off the credit crisis as being serious for the country and for other people, but not for me in particular, since I have no assets whatsoever. Today, I see how it is going to affect me. Blah. So I guess I'd better sign up for an additional $15K of debt while I still can. The "perk" is that since I'm going to be a doctor, I can get special doctor rates for things like this relocation loan, and for mortgages. A better perk would be if I could crawl into bed at a normal time and sleep for a normal number of hours. Why do I have to like Ob/Gyn so much? I could be a dermatologist. Or an ophthomologist. Or an anesthesiologist. Except rashes give me the heebie-jeebies, I think eyeballs are the most disgusting part of the human body, and the thought of having to suction phlegm out of someone's throat makes me gag. So vaginas and a horrible lifestyle it is. Sigh.
So far, I've accepted all the interview invitations that have been extended to me, even though most of them are for smaller programs, because I feel like I need to. I may not hear from the bigger programs, so I need to take what I can get. I still want to interview at as many places as possible, because I still don't believe my chances can be very good (mostly, that's just me being cautious. But it's possible!). But the scheduling is starting to get to me. A lot of places interview on the same days, so I'm having trouble fitting them all in. Plus, I have to take time off from school to interview, and officially, there is a limit to how many days I'm allowed to be gone. So if one school in Pennsylvania interviews on a Wednesday, and another interviews on that Friday, my grades can't afford for me to take Tuesday (to get there the night before) - Friday off, but my wallet can't afford for me to fly out Tuesday night, fly back Wednesday night, and fly out again Thursay night to interview Friday. What to do?
I don't know what the answer is. All I know is, it's the weekend, and I'm going to sleep as much as possible, which may not be much, because:
Did I mention that Eric's here? And that we're going to see Ben Folds this weekend? And having our tasting with the caterer? And going to a wine tasting with some friends?
It's going to be glorious. Sleep be damned.
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