Half full or half empty?

I'm writing this from the far side of 6 months of internship. It seems so crazy that it is half over. It sort of begs the question: am I half-way to the amount of knowledge I am supposed to know at the end of this or am I half-way done with the hazing process called internship. Having spent every about 4th night in the hospital for the last 6 months, I know that some of what I say comes from pure fatigue. The funny thing is the way things change that I don't even notice because I am so focused on work, learning new things and not actively (or passively) killing people. Nine-thirty is my new bed-time, meals are rarely sought for enjoyment but simple necessity, I somehow haven't worked out in months and my weight has certainly ballooned to the largest ever....in my life. My tolerance for alcohol has all but disappeared -- now, I was a pretty cheap date before this adventure began but now one good drink and I'm good for hours....until I fall asleep that is!

Other things have changed too. In the last week, I "ran" two codes, meaning I was the first doc to the dying patient and I ordered 10-15 people around to give drugs, put in lines, get an airway and generally try to save the patient. Now, 6 months ago I didn't even KNOW how to do that and now, I wouldn't say I'm comfortable with it, but other residents have said that I "handled myself well". Procedures don't intimidate me as much; I can often help sick patients before calling for help. There are still moments of terror, but they are less constant.

As for knowledge, that feels different. It is not conceivable that I haven't learned anything in the last six months, but I have become so much more aware of what I don't know. Six months ago it felt like a vast and nondescript abyss. It's still a vast abyss but it has acquired some definition that some days make me hopeful that I'm making progress and some days feels so profoundly overwhelming. The knowledge required to be a good doctor is truly infinite: from how to treat a heart attack, to intubating and putting in a giant IV to the cheapest drugs to prescribe patients with no health insurance. I haven't quite grasp how to lasso in the infinite.

Emotionally challenges have gotten a little easier, although I don't know if its better or worse that I don't cry every time a patient dies. I know it makes it a little smoother to get through my days. No matter what your brain says about someone dying, it's always sad. There is always someone hurting over it and it always makes you face your own mortality, with which I'm not that comfortable with. I haven't really had a pediatric patient die yet, but the time is coming. I think that will be a whole other challenge. (Trust me, as it is you don't want to be in my dreams most nights.) As time passes, I just take these moments to be thankful, thankful for my health, the health of my parents and family, the love of those around me and all the luck I've had in my life. I'm thankful now to be taking off for a week with my loved ones and especially thankful that my significant other, Andy, will be moving to Alabama after the first of the year to share even more of this adventure with me. And I'm thankful for another six months to figure all this other stuff out!

Weirdness and Strangeness

October was the month that I switched over to the Internal Medicine (adults) side of my combined program. It's been quite a culture shock not to mention having to a learn a whole new hospital and 3 new computer programs. To make it even more intense, my first rotation in adult medicine is the MICU (Medical Intensive Care Unit). UAB is a large intensive care center and so the patients we have in the ICU are often described as the sickest in 3 states (Alabama, Mississippi and parts of Georgia), which is great for learning but a little intimidating when you haven't seen an adult patients in 6 months. The month has included learning many scary new skills, such as putting great big IV into large veins of the body (central venous lines) and sticking large needles into other body parts (i.e. the chest, abdomen). When on call, in addition to taking care of new patients coming to the ICU and taking care of the really sick ones already in the ICU, we are also part of the "code team" for the hospital. What does that mean? If anyone in the whole hospital codes (i.e. stops breathing, heart stops, generally trying to die) we have to run to the bedside and be part of the team that does CPR, give drugs, shock fatal heart rhythms, etc. With hospital that is spread over 3 city blocks, you can really get a good work-out in on call! The downside is that most codes don't end well. I've dealt with a lot of death this month. I've helped 3 families come to the incredibly difficult decision to withdraw medical care on their loved one to allow them to die peacefully. Many other families eventually make their loved one DNR (do not resusitate) when their heart stops. While a lot of these patients are elderly, I have had many young adults as well, several of whom I found that my greatest accomplishment was helping them go home on hospice. Thankfully, now I'm on to the next rotation. The one saving grace (and pitfall) of internship is that things change frequently!

Outside of work, Andy came to visit and we took a great trip....to Cullman, Alabama, the home of the Ave Maria Grotto.

The Grotto is located in the St. Bernard Abbey, the only Benedictine abbey in Alabama and is composed of the work of the one of the monks that lived in the Abbey. It's tough to describe this feat of folk art: Brother Joseph made miniaturized replicas of religious landmarks.....

(Andy will you give you a perspective on size of the buildings)

(and here's one to give you perspective the extent of Brother Joseph's work)
including the birthplace of Jesus,

shrines,

and non-religious landmarks....and random things, like Hansel and Gretel visiting the fairy castle with a "scary" dragon guarding the gates....

our personal favorite:
I think that sums it up. Oh! Except for the range of creativity and thriftiness Brother Joseph used in his art. Lacking traditional artist supplies, he used cold cream jars, concrete, broken glass, old flashlights and any number of scraps to create his pieces:

We tried hard to be respectful, but there was a certain amount of uncontrollable laughing...

and a little uncontrollable Beatles impersonation

at the chipmunk crossing, of course.

Stay tuned for the next unique Alabama adventure!

August, September, October...oh my!

I hate to be the one to say it, but time flies when you're working your tail off (what, you've never heard that one before?). Needless to say, I survived August taking care of teeny tiny bitsy babies and then took the Pediatric Emergency Room by storm....well, I worked there for a few weeks anyway. September was spent working wacky hours (those doors never close!), doing more lumbar punctures except on bigger kids who are much harder to hold down, suturing many a facial wound incurred while being a kid and seeing A LOT of kids with vomiting, diarrhea, snotty noses and coughs (including the kid that actually managed to cough directly into my mouth, YUCK). I was continuously surprised how a kid with a raging fever will still be bouncing around like nothing's wrong (because my last experience with fever had me conclude that fever=yucky). Miraculously, I stayed fairly well for the month and was even released for AN ENTIRE WEEK to spend with Andy cruising around New England.

First stop, wedding of one of his oldest friends, Jay:

Now, meeting family of your significant other is always nerve-racking (yep, we did that too) but meeting childhood friends?!?! Yikes. I mean anyone can fake being a nice girl for his mom (just kidding, honey) but winning the approval of friends is much more complex.

But, here's the payoff: Andy in a tux....

and Andy dancing! (Can't tell you how exciting it was when I learned that he liked to dance. I didn't know men like that existed.)

I was similarly relieved to discover that he, like most sane human beings, does refuse to dance the Macarena.


After the wedding, we headed to the best city on earth, NYC! Although our GPS really, really, really wanted us to end up in Brooklyn, we eventually made our way to our hotel room in Manhattan and spent several days walking, eating, visiting museums, going to a Broadway show and enjoying the city life.

The first night we stayed very close to the UN building, so we headed over to check it out. There was an assembly in progress and we even got to see some UN protestors (it was great, their protest area was about 5'X5', or aproximately the size of an NYC apartment).

We also made it through Central Park to the Met, where we saw many cool things and this, one of Jeff Koon's sculptures in the sculpture garden on the roof of the Met.

I don't get it.

And what would a visit to New York be without a Broadway show and a stroll through Times' Square (actually, I hate Times Sq but Andy was mesmerized).

After NYC, we headed back to the Boston area to spend some time with Andy's folks in his home town. This is the house where he grew up:


and this is his favorite spot on the north shore (if you squint, you can see the Boston skyline)....


and we really need to figure out the automatic photo-taking thingy on our cameras....

and Continental airlines needs to figure out how to spell.


On a final note, I am recently saddened by the passage of the bailout package. Didn't we used to pretend that the rich guys didn't ACTUALLY run everything? Anyway, it just makes it more poignant to me the importance of an administration change in this year's election. However, sadly, in Birmingham, I feel intimidated and somewhat reluctant to display my Obama support. A friend of mine had an Obama sign stolen out of his yard and it just make me wonder. But, I have resolved to put that sticker on my card and be damned, maybe it will get someone to the polls.

Firsts

Intern year is full of firsts. Primarily, the first time one is called Dr, asked to make an important decision, called to a patient's bedside when they are ill or simply signing your own orders for the first time (in med school someone has to "co-sign" them for you).

To give you an idea of what this is like, I thought I'd make a lists of my firsts since intern year started (as you might guess, I'm working so much I haven't had any fun trips with exciting pictures, so a work-related post is the only option):

first night on call (usually means I spend the whole night in the hospital taking care of new patients that come in and all the patients in the hospital that night)

first "champagne" tap (this refers to doing a lumbar puncture, where you stick a needle in to the space between the vertebrae and the spinal cord to get spinal fluid to test for meningitis, and get no red blood cells in the fluid)

first patient with typhoid fever (really! she was 4 and had never been outside of Alabama, but mama was from the Philippines...there were a few typhoid mary jokes among the residents)

first night on call in the NICU (neonatal intensive care unit), which involves attending all high risk deliveries in the hospital and "resusitating" the babies, which can involve anything from smacking the feet (not the bum!) to sucking goop out of their airway (suctioning) to putting a tube down the throat to help them breathe. Lots of times it also involves showing the baby to mom for the first time....those are good ones!

first tap (lumbar puncture, see above) on a patient on a ventilator (breathing machine)

first tap on a patient on a ventilator (breathing machine) AND with a chest tube (tube place through the skin into the space between the chest wall and the lung...a little delicate)

first intubation (putting a tube down the throat to help a patient breathe)....on a baby that weighs 500g (0.5 kilograms or ~1 lb)

first fever while working 30 hours straight (not fun, but I'm sure it won't be the last)

Well, that's just a few of 'em, but you get the idea. I promise the next post will be more colorful and less full of medical speak.

The Big Easy

Someone dear to my heart recently told me that my blog has been sucking a little....and if he weren't so right, I might have got my feelings hurt. But, as it turns out, working 80 hours a week takes up a lot more time than I thought.

Residency is going well, or as well to be expected, I think. Days seem to drag a little, but that could be that my ignorance is just so painful at this stage. I keep telling myself that someday I WILL memorize the dosing for Tylenol not to mention other important things but until then, I will need a trusty guide.

Anyway, I finally got 2 whole days off in a row off (this is a small miracle in my world) and Andy and I decided to make an exotic rondevouz in New Orleans to hang out with my brother, Chris (yes, the Crawdad King) and his girlfriend, Lisa. It was like an extended double date but totally 100x more fun than you have ever had on a double date. The only down side? In order to get a whole weekend off, I had to work a 30 hour shift prior to flying to NOLA and then work another one pretty much as soon as I got back. Whew! It was a whirlwind but so much fun!

Friday night was pretty chill but early Saturday morning we arose to observe the running of the bulls, New Orleans style. What does that mean, you say? Well, here are the bulls:AKA the roller derby girls of New Orleans.This bull was the sound system. He also occasionally blew steam out his nose.

They chase the worthy citizens of the city down the streets of the Quarter with their trusty bats.....kinda a rough way to start the weekend, if you ask me.The Rolling Elvi, a group of Elvis impersonators on bikes, were also a highlight of the running.

By the time the running was over, it was almost 8am and clearly time to start the drinking with a walking beer. Oh yeah, the lack of an open container law in N.O. is brilliant in terms of promoting partying.

After a long morning stroll throughout the Quarter,one of the beautifully painted doors in the French Quarter

we decided to try to get out of the sun and the heat with a little steam boat tour along the Mississippi.

paddles of the paddle boat

In addition to seeing some of the historic sites of New Orleans, we also got a much better sense of the path and aftermath of Katrina. And, of course, there was drinking (can't you tell?!).

After the steamboat ride came more walking and then FANTASTIC po'boys.....I love me some oyster po'boys. Andy, the infamous Yankee, had never had such a sandwich before and I'm fairly sure we successfully converted him. Saturday we caught some live music from Johnny Sketch and the Dirty Notes .... which was a great band and had some very devote groupies.

Next morning, up early again and out crabbing....which is amazingly straightforward. The high tech equipment required is raw chicken parts and string. Yup, highly technical. It does require some skill of snatching up crabs with a net, but all that takes is a little time.

Chris also was coronated as the Red Fish King after snagging this beautiful red fish with the same limited equipment:
Ok, maybe that's not exactly how it happened, but what's the difference?!?!
The bayou was beautiful..but somehow I still couldn't help thinking about an alligator lurking in these waters.

The real rewards of our day of slaving in the sun with Bloody Marys......
Sadly, before the crab juice was even dry on my chin, it was off to the airport, back to Bham and then shortly back to the Children's Hospital. Now, time to plan the next fun trip.

Stay tuned for more NOLA pics....they are currently being held hostage in my camera.

Andy's First Visit

So, my boyfriend Andy is a Yankee....yes, a real-live Yankee doodle boy. Ok, that might be a little much, but his only trip to the South involves Georgia, an excess of peaches and intense memories of the subsequent gastrointestinal experience. Despite this, he braced himself and flew to Alabama for his first adult deep South experience.

The first night he got to meet some of my resident classmates, which is good because they will basically be my hospital family for the next 4 years. He entertained them so well with his story of carrying a moon rock through airport security (ask him sometime, it's a good story) that they are still talking about it! We also checked out my local pub, which is approximately 100 ft from my apartment, which boasts the largest draft beer selection in town.

The next day we explored Sloss Furnaces. Birmingham is a relatively new Southern city; it basically exists because this area has the highest concentration of the 3 ingredients of iron (iron ore, coal and limestone) in the world.

This giant thing brought huge amounts of raw ingredients from the railroad at the bottom to the top of the furnace.

Sloss was one of the largest producers of iron in Birmingham in their heyday and remains a very prominent part of the Birmingham landscape. We never quite figured out what these were, but likely related to huge amount of gas and steam that was created, and used, by the furnace.

Subsequently it became a historical landmark and also has an art focus, with classes, studio space for artists and a yearly iron pour.

Sculptures near the first stage of the water treatment part of the furnaces.

That's one big wrench!

What is it about boys and trains?

The next day we visited another prominent Birmingham landmark, The Vulcan. Vulcan is the Roman god of "beneficial and hindering fire, whether helpful or harmful, including the fire of volcanoes" (dontcha just love Wikipedia?!). The statue of Vulcan in Birmingham was made for the St. Louis World Fair to commemorate the productivity of the area's iron industry.
Vulcan has had quite an eventful life in terms of traveling to St. Louis for the fair and has resided in several spots in Birmingham. It now lives high atop Red Mountain, which is about 1/2 a mile from my place and you can get a great view of the city from the observation deck (which you can see at the bottom of the above picture) if the heights don't terrify you.


Speaking of bottoms, Andy really wanted to visit the Vulcan. Why? Well, the most recent renovation to Vulcan required a large fund raiser, part of which involved making numerous bronze replicas of the famous guy. Andy worked at the foundry that made the replicas....small world, eh? Anyway, his strongest memory of this task was the time he spent shaping a particular portion of the statue.

I'll leave it to you to figure out which portion. This is also a story worth asking him about, but if your time is limited, go for the moon rock one.

All too quickly it was back to the airport, but I'm sure we will have some more fun in B'ham together.

Small Victories

Some large tasks are best thought of in small steps....no, I'm not talking about becoming a doctor, I'm talking about setting up one's home. This week I had several exciting small victories:

After two weeks of phone calls, some requiring syrupy sweetness and all requiring undying persistence, I finally have fully functioning appliances in my home:


I made mac n' cheese to celebrate.

Some of my favorite art pieces are finally hanging on the wall.

And the pièce de résistance....drumroll....a dining room table!

(yes, I put the whole thing in my little car!)

It is a steal from the Salvation Army and needs a small amount of cosmetic work, but it is very useful, you know, like for eating a meal I have cooked....on my new stove!

I also started another large endeavor this week, residency. For those of you who are still confused, residency is post-graduate training for medical graduates so we can actually learn how to be a doctor (which does beg the question...what have I been doing for the last 5 years? It's better just not to ask). Most residency training is fairly general and you can continue on after residency to do fellowship in more specialized fields. ANYWAY, I'm doing my residency in Internal Medicine AND Pediatrics, which means I will be trained to be an internist and a pediatrician. Sort of being a double major in college, after this is over, I hope to be board certified in both fields. The way we accomplish that is by alternatively rotating for 3 months on Pediatrics and Medicine.....for 4 years (straight Internal Medicine or Pediatrics residencies are 3 years).

BUT to start residency, you must be trained to resuscitate patients who are having trouble breathing or getting their heart to pump. Due to my combined program, I had to get certified to resuscitate neonates (newborns), children aged 1 mo-18 years and adults....whew! PLUS there is a ton of paperwork, logistics and social functions. I've been busy!

My favorite activity this week?!? Well, beyond being served BBQ about 12 times (a little tough for the veggies), I intubated (put a tube down the trachea of) a ferret. Yes, a ferret. They are actually a very good replica of the neonate respiratory system, so it was pretty cool. (they were sedated, no animal cruelty, promise)

My least favorite activity of orientation? Thinking about June 24th, my first day of working as a real doctor AND my first night on call, when I will spend all night in the hospital, admitting patients and answering nurses call (and hopefully not using ANY of that advanced life-support training).

Andy also made his venture into the South this past weekend....and that will be the next post! Come back soon to see it!