"Buenas dias senorita, my siestas are getting shorter and shorter." - Jose, Tropical Serenade

A bit of a different quote this time - direct from Walt Disney World's Tropical Serenade (formerly known as the Tiki Room). Jump start to the exciting parts of the last month that can finally all be blogged:

1 - My sister and brother in law are expecting! I'm finally going to be an aunt in July!! As you can tell, I'm not excited AT ALL about this prospect.

2 - Another really good friend from college is also expecting, due in late April. Babies everywhere... I can't wait.

3 - Walt Disney World will be happening at the end of May/early June with my best med school buddies as we celebrate the end of an era/error (the culmination of two CRAZY years) and have some fun before wards start.

4 - Christmas, of course. I love spending time with my family :)

It continues to be a wild ride. I have set a date for the fourletterword - May 23. The only thing getting me there is what's coming after.... Disney, M3, and baby. In comes the quote of the title - my siestas must get shorter and shorter, and my study hours longer and longer. As usual, there's only One who can get me through the next few months. I rely fully and honestly on His grace, assurance, and comfort.

"When was the last time a stranger took off her clothes in front of you, pointed to a purple splotch on her back, and asked,"what the hell is this?"

"Question- when was the last time a complete stranger took off her clothes in front of you, pointed to a big purple splotch on her back, and asked,"what the hell is this thing?" If you're a normal person,the answer is hopefully never. If you're a doctor the answer is probably about five minutes ago." - Meredith Grey

So I haven't fallen off the face of the planet. In fact, I haven't even fallen out of the state. It's just been busy enough, and boring enough, that I've found myself with little to document. However, assuming the role of a true historian, I must break the silence and catch up - primarily with this week's events.

Thanksgiving at home was wonderful, I really enjoyed the family time and catching up with M and S. I miss her a lot some days... okay, most days. Having a sister, whether by blood or heart, is one of the best things that has ever happened to me.

As far as school goes, it's basically one and the same. I'm entering a period of extreme "M2-itis" (extreme loathing of the classroom, studying, and the fourletterword coupled with intense procrastination, lack of motivation, and lots of dreaming about being on wards). Thankfully, it's almost Christmas break - which means a few extra days away, and one more test block down. Leaving us with only three to go before M3. :D

In other school related news, I'm pretty sure M and I got THE best preceptor on the planet. We've had a good time with her both times we've met, felt very at ease and stress-less over the situation, and are learning bits and pieces to incorporate into our own clinical practices. With that said, yesterday I did my first completely solo H&P (emphasis on the "H") - as in, grabbed the chart and walked in the patient's room on my own. Dr. M had previously informed the patient I was coming, but there's a first time for everything right? I'd done history-taking before, but announcing my own arrival was a new step... and it still amazes me what the White Coat does. The experience went well (except for the fact that I've yet to actually write up the final) and I'm looking forward to next week :)

Last night I went to my first Christian concert - Chris Tomlin and Louis Giglio. It was fabulous. Definitely helped me stay in the Christmas spirit with the reason for the season.

Tomorrow's going to be pretty crazy - Mississippi Children's Museum is opening, and I (and several PIG members/officers) am slotted to help with some of Batson's activities there. Should be a fun day. Tomorrow night is the Claus Ball, if I've got one iota of energy left. And then it's almost time to do it all again.

Lord, hold me... and help me cherish these (stressful) days before Christmas in the midst of the craziness.

"There are days that make the sacrifices seem worthwhile. And then there are the days where everything feels like a sacrifice.."

The key to being successful is what we give up: sleep, friends, a normal life. We sacrifice it all for that one amazing moment, that moment when you can legally call yourself a doctor. There are days that make the sacrifices seem worthwhile. And then there are the days where everything feels like a sacrifice. And then there are the sacrifices that you can’t even figure out why you're making. - Meredith

Test block two is complete. On average, this one was a little more stressful than the last. I'm not sure if that's because of the way the material was arranged (lots of classes didn't overlap very well, so it was literally like studying five weeks of material for five different tests in five days), the way the tests were arranged (with the big ones spaced out MWF), or that I just didn't pace myself quite as well during the block - but as usual, M and I made it through together, and I'm fairly happy with the results.

Things I learned this week: 1) Getting news of any great magnitude - be it good or bad - is not conducive to productive studying. 2) I can't cram for anything except Micro... but I'm an awesome Micro crammer. 3) My best friend and M2 "other half of my brain" is pretty much amazing - and I'm beyond glad that God put us in each other's lives at just the right moment... definitely couldn't make it without her.

The weekend was lovely. Friday night, I went to Mistletoe Marketplace for the first time... so much fun. I see a new annual tradition headed my way! Saturday, Mommy came up and we went shopping (Mistletoe again... and some other places). Yesterday, just football and lots of relaxation... followed by Girls' Night, the Grey's Anatomy we missed Thursday (stupid test block).

There were grand master plans to go to school today, but those fell through when the bed was just waaaaay too comfy. And after looking at the schedule for tomorrow, I'm calling a repeat. Four day weekends? Anytime. Thanks med school. It's nice of you to "play nice" after last week. :)

De Nile. It's not just a river in Egypt, it's a freakin' ocean

Sometimes reality has a way of sneaking up and biting us in the ass. And when the dam bursts, all you can do is swim. The world of pretend is a cage, not a cocoon. We can only lie to ourselves for so long. We are tired, we are scared, denying it doesn't change the truth. Sooner or later we have to put aside our denial and face the world. Head on, guns blazing. De Nile. It's not just a river in Egypt, it's a freakin' ocean. So how do you keep from drowning in it? - Meredith

So it's been two weeks already, eh? The title of this post about sums it up. Finally got to a "non-denial" place about this test block, just in time thank goodness. I had too much fun (is that even possible?) being normal and just had no desire to return to the mundane world of M2 year.

Highlights from the last couple of weeks:
NICU day last Monday - lots of cool cases around right now, also super cool to see some of my last on-call deliveries from the summer "all grown up". A few long-term kiddos have even gone home. It was so nice to be back, but one day is just a tease.

Starry Starry Night - very cool. I'm getting the hang of the Easely Amused experience.. and getting addicted.

FAIR!!! It was my first trip to the fair, and it was lots of fun. Ate a huge turkey leg, a funnel cake (complete with strawberries), and rode 'til I almost (literally) threw up. Thanks M for a fun time, and not laughing at me toooo much when we had to stop that one ride...

"Life As We Know It" - Very very cute, very much a chick flick, very much recommended.

Church- as much as possible. Having a home place of worship is great!

There was, of course, lots of studying in between that and this past week and I'm finally beginning to feel caught up. I'm no where near ready and it's going to be an insane 10 days or so before the next block starts. But I'm totally looking forward to week-after again. This M2 thing? It's pretty cool.

"....To stop thinking like a doctor, and remember what it means to think like a human being."

"They say that practice makes perfect. Theory is– the more you think like a doctor, the more you become like one, the better you get at remaining neutral, clinical, cut, suture, close - the harder it becomes to turn it off. To stop thinking like a doctor, and remember what it means to think like a human being."

It's been a lovely two weeks. Renaissance was AMAZING. I don't know why I waited so long to play that game - I'll definitely be doing some Christmas shopping there. That was Tuesday... after that I guess I went to school for a couple days, it's been a very "non school" type of couple weeks. I needed the break, but I suppose it's time to get back on the horse. I didn't realize how much break I'd need after the test block - the M3's warned, but since I didn't spend 20 hr days studying the week of tests I honestly figured I'd be alright. Guess the exhaustion kicks in no matter what.

This week has been very sluggish. Today we did ENT exams on each other, that was kinda fun. My partner played "kid" since I was the only self-proclaimed pediatrician to be in the room. She whined, moaned , and pulled her ears away from me. Fun times in M2 land. We also had our second PIG meeting today - I think it went great!

Also, M and I have secured a preceptor for ICM, even though the ICM people haven't told us a thing about when this is all going down - which is funny, seeing how it's supposed to happen in less than two weeks. As is med school - we never REALLY know what's going on.

Studying still hasn't come back full force.. but it will tomorrow. I've got a long weekend due to a lucky break on the path/ICM schedules, and I plan on catching up and getting ahead (if possible). Monday I'm playing in the NICU. Can. Not. Wait. It's been a long nine weeks not in there. We have one mandatory at two oclock, but I'll be in baby land until then :). Easely Amused after - where I'm painting "Starry, Starry Night" . I'm sure it'll be WAY better than VanGogh. Hahahaha.

"I like my money where I can see it... hanging in my closet" - Carrie, SATC

I promised I'd update with a non-medical school/fun post eventually, so here goes the epic weekend:

Friday night - Grey's Anatomy, Girls' Night In, and out and out forgetting that school ever existed
Saturday- Starkville! First "live" football game... and it was way too much fun. Melissa thinks she might even turn me into a State fan. Eh, I don't see that one coming any time soon - but I did cheer for them and get excited when they beat the pants off Georgia. My football fandom goes as such: Ole Miss>Mississippi Teams>Bama/Florida>All Other SEC>The rest of the country...
Sunday - church, football (Saints... what more can I say. Don't break our hearts this season boys... it takes an offense AND a defense).
Monday - had a freaking mandatory TBL (team based learning, or more affectionately known as total BS and lies) that was extraordinarily painful, followed by keifer's and writing of test challenges.
Today - it's off to Renaissance with M and N for lots and lots of retail therapy, good food, and laughs.

It's a very happy time in my life. Welcome to it :)

Foreman: "Now all we have to do is read her subconscious and hope that it's completely rational and went to med school."

Test block OVER!!! What a week it has been. The title of this entry, although intended towards a patient in an episode of House totally describes a majority of our professors and their approaches to test questions. I'm just relieved to be on the other side, and super excited about a school free weekend. So far, it holds promises of lots of food, friends, football and fun. Going to my first college game tomorrow night - pretty excited about that. Tonight is going to be low key... I've got about enough energy left to lift my head off the pillow and look at the computer screen (and that's pushing it!) even after a couple hour nap.

I can't say the week was pleasant, but it was much easier considering the fact that M moved in and we muddled through it all together. How you'd do this without a best friend beside you, I have absolutely NO idea.

In personal news, one of my very good friends from home has officially announced her pregnancy - I'm so happy for her and her husband. They are going to make wonderful parents. I was lucky enough to be in the wedding, and if all goes well (and baby stays put til his/her due date), I may be lucky enough to be beside her on this big day too - it falls at the very end of April, so I'm going to have to have a talk with Peanut and convince him/her to wait until after finals, but soon after, so that it isn't close to fourletterword test day.

Looking forward to October. Fall is in the air (somewhere), I'm making another trip to Easely Amused (Starry Starry Night by Meg, the artist...), and there will not be one single test. Much different than Blacktober last year. All my prayers and well wishes are already with the M1's. Other projects for October involve a day or two back in the NICU and some more research on the longitudinal study that Dr. K and I were looking at starting toward the end of the summer. Crazy how quickly the year is passing.

This could quite possibly be the most boring blog post ever. Just wanted to let y'all know I hadn't dropped off the face of the planet... and hopefully I'll have fun things to post about soon!

A patient's history is as important as their symptoms. It's what helps us decide if heart burn's a heart attack... if a head ache's a tumor....

"A patient's history is as important as their symptoms. It's what helps us decide if heart burn's a heart attack... if a head ache's a tumor. Sometimes patients will try to re-write their own histories. They'll claim they don't smoke, or forget to mention certain drugs... which in surgery can be the kiss of death. We can ignore it all we want, but our history eventually always comes back to haunt us." - Meredith

Another wonderful week in the world of med school. I can't believe the test block is right around the corner, but shockingly, I feel much more prepared than I thought I would at this point and I'm truly not overly concerned. Kind of ready to get it over with.

The big exciting news of this weekend post is that I've finally found a church I feel "home" at in Jackson... why it took me so long to go, I'll never have any idea. But God was definitely drawing me there yesterday and it was an incredible experience. Very different than any church I've ever been a part of (It's. So. BIG!!), but exactly what I need at this point in my life. We also started up bible study on Wednesday, so I've spent the week getting back to the basics and the things that matter - my relationship with Jesus and His community. It's a lot easier to go through the trials and tribulations of daily living when you're in concert with Him. Even though I've struggled a bit with my humanism this week, it's been revealed to me in multiple ways and through multiple people that He is good, and He has put some amazing people in my life to help me walk this journey :)

So once again, it's kind of a boring "med school" update. I'm ready to get back in the clinical setting, the classroom is for the birds. Which is why I'm sitting at home studying today instead of in the classroom... I'm tired of being a bird. It seems we study better not sitting in class and the stress level is much lower, so I'm slowly becoming one of "those" people. I'll never be a complete non-class-goer, but not being there every class is awesome.

Now, back to breast pathology. Don't forget to do your monthly self breast checks!

doctorspeak

Sometime in the last two months, something changed. Not only are we beginning to think like doctors, we're also beginning to talk like doctors - and not in the awkward "using big words because we just learned them" way of last year. Nope. Instead, doctorspeak has become almost as comfortable, if not more so, than the common English that I've been speaking for 25 years. For example:
CC: 25yo WF presents for occasional "heart racing".
HPI: Sxs appear seasonally, with peaks in September and December/January
Physical: Normal findings... (lots and lots of three letter abbreviations)
Dx: Football FEVER!!!!!!!

Why yes, my friends, it is officially football season! As if this week needed help getting any more fun and less school productive? :)

Other things that happened this week outside the realm of study central:
-First PIG meeting on Thursday. I think it went pretty well :), and i've tweaked the sticky parts so that next month's is even smoother
-Easely Amused Thursday night was AMAZINGLY fun. Our painting "Sweet Georgia Brown" looked pretty tough, and I have no artistic ability.. so I was a little bit nervous about that. But it was super fun, turned out really well, and is definitely an experience I'll repeat.
-Mommy's birthday yesterday... we had a good time hanging out/catching up. Family is something that too often gets neglected during this process (especially last year) and I'm grateful that I've found a better balance so far this year.

Hope everyone has a WONDERFUL long weekend!

"The key to surviving ... is denial. We deny that we're tired, we deny that we're scared, we deny how badly we want to succeed..

"The key to surviving ... is denial. We deny that we're tired, we deny that we're scared, we deny how badly we want to succeed.. And most importantly, we deny that we're in denial."

Pretty good quote for the week. It seems as though life in general has been a big basket of denial for me lately. Denial that second year is in full swing, denial that the weeks are starting to fly by, denying the inevitables that are coming both in the next month and in the next 9 months. But sometimes, you just can't deny any longer.

In a moment of weakness Wednesday night, I purchased nine months of access to USMLERx, my first question bank for the *gulp* fourletterword. School buys the great bank (WORLD) for us, and we can start it whenever, but i've heard such good things about it that I want to save it for closer to actual test time. The fourletterword is also spoken continuously at school. The M3's came to give us advice, Doctors In Training came to sell their products... and it's just week two. Which leaves me wondering just exactly how psycho our "super gunner class" will be come spring semester. I can't deny (although I'd like to) that there's a bit of fear associated with the fourletterword, but it's going to be just fine. I'm going to pace myself and learn the material as I can this year, study FA along with my review books for class tests, do question blocks that match the material we're learning in class, and try my best to keep God first and NOT freak myself out. Because like my sister told me Wednesday night, He already knows exactly what I need and exactly what I'm going to make. There's a peace in that. It's still a big fourletterword in my life, and will be a major player in the next nine months. But I've got some amazing friends to keep me grounds, and M walking the coals alongside me.

Had a great lunch with a NICU friend today. Nice to be able to gush about the babies and be not only loved in spite of it or for it, but to be completely and utterly understood. YAY NICU team. I hope she's my nurse someday :)

The first PIG meeting is next week, and I'm pretty excited. I'm hoping we have a good turnout - but we always do :). There are some exciting things in the works for the club this year... so all the future pediatricians, please come out and hear what we've got up our sleeves!

I'm beyond grateful for a weekend. I'm at the tired enough to be almost sick point, and hoping some extra rest takes care of that. It's going to be a busy week. I think I've got something going on Wednesday night that I can't remember right now... Thurs is Pig and Thurs night the Three Muskateers are going to a painting class (stay tuned for info on how the non-creative babydoc did during said experience).

In wrap up, the class week was fairly boring. I'm still going to class, along with 20-30 other people. It's not that I get more out of being there, it's just I'm afraid i'd sleep too late if I stayed home and therefore wouldn't be as productive. We'll see how long this lasts... I'm giving it my best shot. Oh, and immunology needs to die. It sucks. It's boring, and there's just nothing anybody can do to change that.... except perhaps Clinical Immunology Made Rediculously Simple, which is sitting out on the porch in its box from UPS. That's how excited I've been about studying tonight. I think I'll just let it stay there a while.

Back to the Saints game and overall veg-out-til-I-feel-better.

Meredith: "I can't think of a single reason why I should be a doctor, but I can think of a thousand reasons why I should quit..."

Meredith: [voiceover] "I can't think of a single reason why I should be a doctor, but I can think of a thousand reasons why I should quit. They make it hard on purpose. There are lives in our hands. There comes a moment when it's more than just a game, and you either take that step forward or turn around and walk away. I could quit but here's the thing, I love the playing field."

That quote definitely sums up our lives in general and the first week of M2 year. I've been pleasantly surprised at the overall progression of the week - not that I love every class, but that, in general, the material is much more clinically oriented. That makes it much more relevant and easier for me to bring myself to study. On a case by case basis:

ICM - I can see how some people say this class is too easy and gets blown off, but I really, really like it. However, I really, really, really like clinical medicine. Not the books. The first two years have always just been a "learn all I can to be the best physician I can"... not a "I want an A in every class because I love studying and study 20 hours a day and deserve it". Worst part about this one? It's always (so far) at 8:00AM, but so is grown-up life, so I'll get over it.

Genetics - Continuation of last year. I like genetics - it's very NICU related. I've seen most of the things we talk about in class in clinic or in the unit, and it's super cool to get to put them together.

Path - So far, so good. This one's heavily clinically relevant as well. The material isn't fun, and next week should be a REAL treat (I've heard scary things abt immunopath), but it's still a good class. Lab & small group today were easy easy... and very informative.

Micro - So far, this is the one I loathe the most. I loved micro in undergrad, but so far, we haven't talked about one real pathogen. It's all immunology - BLAH. Bring on the bugs already!!! There was also one real interesting rabbit-chasing prof so far, and that's always fun.

Pharm - Ick. It's biochem on steroids so far. We haven't learned any drugs yet - except Ibuprofen... Yup.

In other news, I went to the NICU yesterday to get some baby love. I also went to M & M - which was really interesting, considering I had been in the unit when the case came in. M & M was a combo of genetics and path so very useful.
Tomorrow is the NICU reunion and my quarter-life crisis. However, with these friends and family beside me, I'm excited to start the BEST quarter of it next ;)

"We enter the world alone and we leave it alone. And everything that happens in between, we owe it to our self to find a little company" - Meredith

I thought that Grey's quote was appropriate for the last couple of days.... as I've been "reconnecting" with my medical school life (minus the school part).

Yesterday, M and I went shopping and followed it up with a Grey's Anatomy marathon. It's funny to watch what LITERALLY seems like ourselves played out in Meredith & Christina. Gave lots of laughs and lots of girl time - both of which were desperately needed.

Today, I met with my buddies... both my M3 buddy and my M1 buddy. It's kind of weird (and nice!) to be sandwiched in now, but parts of me are thinking "when did I get enough authority to give anybody advice?" Hopefully I'll be able to be half of the M2 buddy that mine has been - I really couldn't have asked for a better mentor along the way. Seemed like everytime I was falling apart, she just happened to be in the right place at the right time. And catching up today, I've realized that we will be lifelong friends.... which leads me to the real reason for this post.

It's hard to believe that it's been a year already... a full year in the bank. I remember meeting C (my M3 buddy) when I was the brand-new M1 and she was an M2... and I remember other older med students giving me advice. My mom mentioned something similar as she's been in the healthcare field for 25+ years . One piece of advice in particular stuck out from everyone... "you'll make friends here that you'll never forget. When you stand over a cadaver for the first time, when you see the inside of a body... when you take care of your first patient, when you LOSE your first patient... people who aren't here can't understand that. The people who ARE here will give you strength."

And boy, is that true! You draw on each other, cry with each other, laugh with each other... and in the end, you grow - as friends, as individuals, and as doctors-in-training. It's a privilege to walk beside these people I humbly am blessed to call my friends here, and cannot wait to call on them as colleagues. As we begin a new year, with new friends and new places to be (and undoubtedly many new challenges), I find myself much less afraid of what it brings - because I know we're all in this together.

So best of luck to the M4's as they finish up ERAS, M3's as they get the hang of rotations, us as we prepare to finish our classroom lives and STEP, and the M1's as they join us on this journey. It's going to be an AMAZING year. I can't wait to get started :)

(By the way, first PIG meeting Sept 2: BE THERE!!!)

M2 excitement/terror

The last week of summer has arrived, and with it, anxiety and excitement at beginning M2 year. I'm determined to make this one better than the last - I think the schedule will have a lot to do with making that happen. And there'll be lots of PIG fun as well. But looming over everything is that great big nasty four letter word that will take over my holidays and summer - STEP.

I had full intentions of studying/reviewing a LOT this summer. Thankfully, my summer job was way too fun and I just didn't have time. I may kick myself in May, but for now I think that was a good thing. I'm not burned out already - I've got a little bit of initiative (not much) going into next week.

Thank God for amazing friends and people who understand this brain war when no one else does. It's a masochistic kind of excitement... no one in their right mind would want another year of this. Good news - none of us are in our right minds.

Happy new school year, everyone!

And just when I thought it couldn't get better...

I had the best day today... an emotional high from early this morning well through getting home this evening. Starting at the beginning... (because generally that's a good place to start)

When I got to the unit and pre-rounded on the babies I'm following, everybody looked good. I made the decision that I thought one was ready to come off CPAP, and cleared it with my attending. Yay for tube-free babies!
Then I went to look up labs, xrays, etc to prepare for rounds and was talking to one of the residents when I found out that not only were none of them on call today, the three that were there this morning had clinic in the afternoon. This means there was a lonely little delivery pager going to be sitting all by itself.... or not :)

Clipped the pager on about 8:30... finished prerounds and plans and started rounds. We were about halfway through when the pager went off for the first time. Off to the delivery room. Big baby, fairly healthy, just a little extra work of breathing. After watching him for a while, the NNP decided to send him on to the transition nursery. The rest of rounds went by without issue and we got done really early.

My amazing mentor/attending then called to take me to lunch for my last day :) We had a great lunch and then went over my presentation for tomorrow, giving it the final touches. I told her I wanted to hang out in the unit for a while and see if anything interesting would happen because the delivery board was full and several of them were preemies.

Went to check on the twins and ok'd mom holding... for the first time. This was what I thought would be the most inspiring and rewarding moment of my day. Then.....

Got settled at my desk about two to review test results and... beeep.. 911. That means RUN, not walk, not elevator... scale the stairs two to three at a time. When I get in the room, it's just me and the delivery nurse... and in runs the resident OB with a tiny bundle. On the warmer is delivered the smallest person I've ever seen. For what seemed like an eternity, I got the initial heart rate and had the fleeting thought of fear as an NNP hadn't responded yet. Thankfully, she was there almost as soon as the thought went through my head. I gladly stepped back from the head of the bed on that one and had her take over for the intubation, assuming a first-assistant role. Fast forward through all the medical details and you'll be pleasantly surprised to know that AMAZING child, God's perfect creation, looks more alive than anyone ever thought possible. A fighter, we say. And even though the odds are stacked against him, this part deep inside of me is almost sure he'll make it.

As he's settling into his bed and I'm beginning to catch my breath, beeep... 911. Adrenaline rush, straight back to the second floor. This one we at least beat to the room. A little bigger, a little stronger. But still tiny. Heart rate, intubate. And in the meantime, realize the child's head is bleeding... profusely. Stitches in the resuscitation room? Has that ever been done? The prayers go up. Pressure is applied, the intubation is complete, we watch and wait. The bleeding slows and the baby improves. It's off to the transport incubator, and down to meet the new friend across the hall, who was born less than an hour before, 7 weeks more premature.

As I signed out tonight, returned the delivery pager to the front desk, and said a few goodbyes, I found myself less sad than I thought I'd be. Maybe because I was exhausted, but maybe because God allowed me to have an amazing last day, showing me how much work He's done in me this summer and the endless blessings He has in store. This time last year, I said I wanted to be a neonatologist and save babies. Now I've tried my hand at it. Is it stressful? Of course. Trauma-heavy? Definitely. Hardcore? Some say so. Devastating? Some days. Rewarding? Everyday.

I may not be spending 8-10 hours a day in the NICU in the coming months or years, but I'll be there as much as possible... and my heart will never leave. I carry a tiny footprint to remind me of what's on the other side.

This IS the rest of my life. Welcome to it. :)

Today is gone. Today was fun. Tomorrow is another one. Every day, from here to there. funny things are everywhere.

I thought i'd finish up the "one fish two fish" reference from the previous post...

It was an amazing week in the NICU. Carrying my own patient load is just wonderful - i've learned so much about fluid and electrolyte management, lab values, sepsis workups... and those two little angels in general. The thought of returning to the classroom soon is just UGH.

Took my "last" call on Thursday night. It was a crazy day... I rounded on the kids, gave my presentation to the residents during their morning lecture, then we had regular grand rounds... by then things were starting to get crazy. I went to a delivery during that and by the time I got back we had a kid falling apart on one side of the nursery with surgery at the bedside doing a repair... then we had a significant problem on the OTHER side (and since my attending was on call and that one had left we were covering all 95+ beds). I got to see a pretty neat procedure over there. It's funny, because there's a set of twins on that side that are similar to the ones I'm following - just a couple weeks earlier and sicker. I've learned a lot about twinning lately. :)

It never really settled down through the night - I slept for a couple of hours. By the time it got quiet, I couldn't settle my head down and sleep, so I helped with late night feedings. There just isn't anything sweeter than rocking a baby while you coax them to eat. Especially looking at that baby realizing that three months ago, it was highly unlikely he would survive, much less make it to this point. "I was unconditionally and irrevocably in love"

One more week. It ends too soon, but I must return to the classroom. Time to get it over with.

One fish, two fish, red fish, blue fish

During my last post, I wrote of the excitement of following my own baby for the first time. Due to the complexity of the medical conditions, she survived only a day after admission. I finished my differential dx thoughts at least, and anxiously await chromosome studies to see if I had any of the right ideas.

In the meantime, we had a set of "grower-feeder" twin girls come in and I was assigned both of them! (Hence the one fish, two fish title ;)) It's a lot more conducive to learning because they are acting like typical preemies, so I'm able to figure out the nutrition, respiratory management, etc. I'm learning the art of teeny-tiny physical exams and what to look for each time I see the patients and learning what makes "grower-feeders" tick in general. It's great. In case you guys missed it, I LOVE my job :):)

In other news, my research project is finished, my powerpoint is getting polished, and Dr. K and I have started the next project. I'm grateful for the opportunities I've been given and look forward to staying involved in the newborn medicine department in the coming years :)

159 (class/tests days in M2 year)

159 days of class and tests in the upcoming year.
This translates to 257 total days, including weekends and holidays (most of all which will be spent studying).

These numbers are discouraging and encouraging. With two weeks left in the NICU, I'm already fighting a heavy heart going back to the classroom. However, I know it's necessary evil - something that must be done in order to reach the ultimate goal. I know I'll be able to visit and stay involved in pediatrics as much as my study schedule allows this year - I just hope that is at least occasional. I'm going to do my best to stay on top of the work, not get behind, and have an amazing year. /End future-freak-out-moment.

As for this week, it's been wonderful. I went to the OR three days this week with three different kids from the NICU. Ended up being with three different specialty surgeons (peds general, ENT, and neuro) and getting lots of OR/anatomy experience. It's not as bad as I thought it might be. In fact, surgery is almost fun. It's definitely not something I can see myself doing for the rest of my life, but at least I'm not freaked out about/dreading 3rd year rotation anymore.

I also learned NEODATA today, our charting system. Dr. K is preparing me for 4th year externship - for that I am really, really excited. Granted it's totally early... but as quickly as last year passed I know it'll be here before I know it.

With experience comes freedom, and responsibility... which is a little intimidating but leads to more experience and the circle continues. Today I was assigned a patient to follow with a NNP. "My" baby isn't a full term grower-feeder or even a micro preemie. It's a really, really complicated case. I'm slightly intimidated by the complexities of it all... but the NNP's are wonderful and she'll be making the decisions - I'm just allowed to verbalize my thoughts first and see if I can come up with the right ideas. So here I am on a Friday night, formulating a differential and planning to go up to the hospital both days this weekend to do a physical. Some call it crazy, some call it love.... but I'm soaking up EVERY possible moment.

a post in numbers (following my good friend M's last one)

7:37 - time I headed to the operating room this morning
2 - big brown eyes asking "what's going on?" - that baby is a heartbreaker in the making!
86 - minutes from "timeout" to final sutures
80 - fingers and toes counted on discharge exams
20 - carseats, diaper bags, and other misc "patient belonging bags"
4 - happy, healthy infants released home today from our side of the unit
89- current census (AFTER the discharges)

What an AMAZING day in the NICU :)
It was my first time to go to the operating room with one of our kiddos, and it was fun (for me, probably not so much for the baby). Our pediatric surgeons are awesome and the baby did great and is recovering quickly. We'll be adding another to the "homegoing" list very soon!

"Call the pharmacy and put in the order"

"Call the pharmacy and put in the order". Said like it was just another day, another doctor. Someone who'd been there forever. But it wasn't just another doctor. It was ME... Not only am I not a doctor (merely a quarter of one), but it was my first order, handed down from an attending, during a crisis situation.

So what do all good doctors-in-training do? Follow the order. Ask for help when you need it. And realize the impact of what you've learned when you finally have time to breathe, days later.

"Dopamine, such-and-such loading dose with such-and-such mcg/kg/hr?" I yelled across the unit to the attending at the baby's bedside. He nodded and smiled.

And even though someone else checked it and signed off on it, I put in my first order. Of course if I wouldn't have been standing there, anyone else could have done it... and probably more confidently. I was honored to have had the chance, for one moment, to participate in trauma care.

It was one single moment in everyone else in the room's life... and a moment that will never be forgotten in mine. It was perhaps the first moment that medicine leapt off the textbook page and into the incubator. I wasn't doing something because it was exactly what we'd done for every kid all day, but because it was what SHE needed at that particular moment.

I'll never quit asking questions, and I'll probably never quit questioning myself - at least a little. But with every day and every learning experience, my confidence is growing. My faith is stronger than it's ever been - God is closer than I've ever felt him. As long as I stay this close, I can hear His directions, those of the ultimate Attending. And He will never lead me astray.

Happy birthday, sweetheart...

Happy Birthday... it's something we say every day in the NICU. The lullaby plays over the Women's Hospital loudspeaker, another baby has been born. It's another Happy Birthday.

Sometimes those birthdays aren't quite so happy. If a birthday comes too soon, the human part of each of us may be wondering exactly what the baby is doing here. The part that believes in God's ultimate plan never wonders that. Sometimes I find myself a little too human, a little too heartbroken. I suppose I'll struggle with that for the rest of my life. However, it's a struggle that fits - a struggle that feels right. You take the good with the bad, you hope you can make a difference, and you pray. A lot.

Back on the subject of birthdays... we recently had a baby celebrate their "third" birthday with us. You see, almost everyone celebrates their "first" birthday here... that's Day 1 of life. Then there's the "second" birthday. That's the day you were SUPPOSED to be born. Your due date. More often than not, that birthday is spent here as well. But the third... that one is rare. So we celebrated. Like any family celebrates their child's true first birthday. Ok, so our party attendees couldn't have cake - and couldn't actually attend the party at the bedside... but that child had more "friends" at his birthday party than any one-year-old I know! The next day, the sad reality kicked in. The banners were still up... "happy birthday"s all over the bed. But the baby had turned sick overnight, and we were all reminded exactly why it'd been a year that he'd been living in these walls. I pray your second year, and your "fourth" birthday, is happier and healthier, little one. And until you can make it on your own, we'll continue to hold your hand.. and God will always hold your heart.

first day "on service"

Yesterday was the first day of the summer that my attending physician has been on service in the NICU. I was excited about this because I knew I'd have the opportunity to be more involved - and boy was that an understatement!

We started rounding yesterday morning and I got to do a few exams... there's just nothing like putting your hands on a tiny patient <3. Yesterday afternoon, we had a new admission - and I got to help do lots of things handed down directly from the attending - for a few hours, I totally felt like a doctor. And helpful. Which is an interesting feeling that doesn't happen a lot... sometimes I feel more in the way than helpful, especially in crisis situations. There's just so much activity in the NICU and so many people involved when things go wrong. But yesterday, I was involved. Helpful. Useful.

And I can't wait for the next day. And the next.

In other news, M has started her ER rotation - and seems almost as madly in love as I am with NICU. Yay for the rest of our lives! I'm glad to have friends who want to do different things - that way the next time I make a stupid decision or trip over some flat surface, I have somebody I can call personally... before I have to show up and explain it in the local emergency room.

the little things...

a workup on a sick baby yesterday... normally, we are worried about sepsis, staph, etc.

"Mr x's workup is back. he has an ear infection"

and I smile. because underneath it all, under all the high tech medicine, these babies are still babies. and normal things make us happy.

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“Father asked us what was God's noblest work. Anna said men, but I said babies. Men are often bad, but babies never are."

“Father asked us what was God's noblest work. Anna said men, but I said babies. Men are often bad, but babies never are." - Louise May Alcott, Little Women

It's been a trying two weeks for me personally. We had quite a scare with my grandfather's health that only the good Lord brought him out of. Thanks to lots and lots of prayers and his strength and resilience, today marked the end of a tumultuous and long hospital stay. He's home and doing well! Due to those developments, I spent the better part of last week playing doctor- but not on the babies. I went home to be with my family and try, to the best of my ability, to fill my role as the family rock. It's hard to be the one everyone looks to for medical knowledge, especially just one year in. There's still so much I don't know. However, just one year gives you a lot of pull in the hospital environment. I was able to follow more - and help more - than I ever thought possible. Once again, I thank my Heavenly Father for that.

As far as the NICU goes, this week has been wonderful - a great learning experience. My attending is still off service, so I've spent each with rounding with a different attending... this week's was incredibly intense teaching-wise and I learned a ton. I was also able to make it to all of the Pediatrics meetings (Grand Rounds, Case Management) this week and those are also good....

Rounds today were crazy. What usually lasts 90 minutes or so was complicated by an intubation, cardioversion, and delivery. I got to assist a bit (as in hold stuff) on the intubation, and I'm looking forward to being certified Monday.. hopefully I'll get to do my own first intubation soon! I finished my written test for certification this week, so it's just practice on Monday and meet all the new residents.

I'm settling in nicely and my research is going well. I'm looking forward to the next month and continued involvement throughout the next couple of years, M4 rotation, and residency & fellowship. Is it June 2013 yet???



Random quote from an unnamed in the unit:
"Honey, siblings aren't allowed back here..[in the NICU]. Where's your mom or dad?"
...
"I was just bringing my baby some breast milk"

And so it goes in today's society. Insert foot in mouth, unnamed.

quotes of the day

"it'd be easier to cannulate a moose"

"why are we talking about poop?" "because we're doctors, and that's what doctors do".

and it's only lunch...

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Call night... and the end of week 1... never trust a preemie

Wednesday night I completed another first on my list for the summer. I took call with my attending physician. I actually carried a resident pager, slept in house, and responded with the residents/nurse practitioners. It was super cool - very little sleep involved, but very much worth it. I've learned in just a week that I am EXACTLY where I am supposed to be doing EXACTLY what God has called me to do. It is an amazing feeling... a blessing, and huge responsibility. I couldn't be happier. Even with the story I'm about to share.

Almost as soon as I clipped the pager on wednesday night, a baby started "crumping" (medical terminology for falling apart with no known cause). Blood gases were off, oxygen sats were bad... the kid just looked sick. Really sick. She'd been sick for a while (and touch and go a few times), but suddenly I found myself watching a full out resuscitation effort. The IV access was poor and it was determined that she wasn't receiving all her meds (causing the other problems), so the nurses and doctors tried again. And again. Finally surgery was consulted to put a line in. For what seemed like an eternity, the ventilator was off and Andrea was hand-bagged while the surgeons tried to get access. It took much longer than anyone anticipated, and she lost a lot of blood. A lot, in the nicu, is about the equivalent of what you and I would get if we sliced our finger open. Not even enough to go to the hospital for stitches. But this kid needed blood, and fast. All the appropriate tests were run and the blood was brought up. Enough blood to fill a medium size syringe. Wouldn't volume-expand a grown person at all - but it was enough to replace Andrea's entire supply. And mind you, she was a "big kid" (once again - "big" is relative... in the NICU, >3 lbs is big and 5+ is huge). With central access and medications finally being delivered, she seemed to improve slightly. Not enough to admit success, but enough to return her to the ventilator, and for us to return to the family in the waiting room (who had been called from several hours away to be at the bedside). Deep breath, babydoc. Put on the white coat. Get ready. This is the not fun part, my attending says. It's never easy to gently tell a family that their baby may die. Or has died. You don't have to come with me, she says. But I put on my coat, she puts on hers, and out we go. To do the job no one ever wants to have to do. Even at this time, it was admittedly easier than I expected. The family has experienced these "crumps" before. She'll come around, they say. And who are we to say otherwise? Preemies can never be trusted. You really just don't know.

At this moment, the delivery pager goes off and I race upstairs to find quite the opposite - a bouncing, beautiful, perfect, and HUGE healthy newborn. Couldn't be pinker. Couldn't have better APGARs. This one gets to bypass our unit directly. And transition. She's a direct admit to the newborn nursery, or mom's bedside. We smile and coo with her... encouraging the first-time parents and sharing in their intimate moment.

It's how things change in neonatology. It's the moments of birth and neardeath, often intertwined, with no fine line of delineation. The uncertainty of medical knowledge and the certainty of God's ultimate healing - no matter what our role in that may or may not be.

The night continued fairly quiet, with a little (about an hour) rest in between. Post call, I left the hospital about 9-10 and had a full day off. This morning, I returned to the hospital fresh. In Grand Rounds, I sat with a couple of my classmates who are also doing my program but are in different areas of the children's hospital. Close to time for conference to start, the residents I'm working with filed in. A sat down next to me, and I asked how his call night was. "Baby Andrea died" was all he had to say. And I knew. "She went peacefully, and very quickly, early in the night... by the time the nurse took her off the vent to listen for any signs of pulse/breath sounds/heart sounds, it was over."

But for me, she didn't go quickly. A baby born too soon, and taken too late. It's never easy, I suppose. Part of me wonders if it would've been easier if she would've been a micropreemie, a <1 lber, a brand new admission. The other part knows it wouldn't have made any difference. It was my first live patient to lose. I held her hand for that treacherous hour, while the surgeon desperately attempted to get us access so she could get the drugs (and now blood) she had to have. While my attending tirelessly hand-ventilated her, never growing angry, never showing fear or trepidation (Stay calm, always, she said. The babies know. They always know. If you're afraid, they're afraid). We worked as a team - doctors, nurses, xray, respiratory, surgery - and kept her alive night after night. But preemies can't be trusted. They decide if they are going to get better, they decide if they are going to die. Personally, I think they've got a direct line to God. Andrea decided that sitting in His lap was better than in her incubator, surrounded by all that medical technology and the twenty-first century had to offer. And once again, the preemie knows best. She is healed and perfect, resting peacefully in His arms.

And I will never be the same. I know it'll never get easier, and yet I can't imagine a life of doing anything else. I'm home in the NICU. I'm home in the quiet and "scary" parts of the hospital, where no other outside physicians like to go. I've found my calling doing God's work here. And I'll never be able to forget that it is indeed HIS work, not my own, that I am doing. Goodnight, baby Andrea. I can't wait to meet you again in Heaven!