Spectacular powder!

Jeremy, Noelle, and I drove up to Tahoe to ski/snowboard last Saturday (I was able to get my jeopardy covered-- yay!, and Jeremy's mom watched baby Kacey for thd day!). While the drive up took a long time-- there was rain, slow traffic, we saw signs for mandatory tire chains and so put ours on, but then realized the road was too good for chains, and took them off, we made it (about 3.5 hours after departing-- normally takes less than 2 hours) to Northstar by a little after noon.

Since we have been having nothing but RAIN in Sac for about 2 weeks, we figured there would be excellent powder up there in Tahoe. There was (about 10 feet of it!). Tons of other people had our same thought.

The lifts were a bit crowded, although the slopes weren't too bad. Although with only a half-day, we didn't get tons of skiing in and it was a bit cold (20s), it was perhaps the best snow I have ever been on. I mainly stuck on groomed blues, but maybe could have dared a black diamond because the conditions were so great (maybe next time :)). Noelle, in her first time back on her snowboard after having baby Kacey last year, did great, and Jeremy attempted the moguls on skis, which he hasn't been on in 7 years (Phi has converted him to a snowboarder)!

It was such fun being out there, as well as hanging out in the car with Jeremy and Noelle, singing Glee songs the whole way there and back, and catching up on their lives :)

Noelle and Jeremy

Us three

We'll see if I can go skiing again this weekend before the Asia trip in February, as I'll be gone and missing out on a big ski month. At least I'm not on jeopardy anymore!

Jeopardy Jail

I am currently on Jeopardy Same Day Access clinic for 2 weeks.
It might be my least favorite rotation yet.

While it means that my "scheduled" hours are quite nice in that I am supposed to be present and see patients in FP clinic from 8-5 (M-F) and have no scheduled weekend calls, I am only opened up for "same day" clinic slots in the chance that someone a) gets ill or has an emergency and can't go to work, b) forgets about and doesn't show up to work or call, c) has an alternative educational opportunity to attend during their rotation/call, d) is busy with a continuity OB delivery, or e) there is a scheduling snafu and someone's clinic has to be covered because they somehow were scheduled to be in 2 places at once.

There may be more scenarios that I am not aware of.
Basically, I am needed nowhere, but I have to be accessible at all times.
It is kind of a bummer.

It was actually convenient this past Monday, when I felt awful after fighting a week long URI with hacking cough (which certainly was not improved by skiing last weekend... more on that below) and was sent home from clinic (never mind the 30 or so patients I probably infected while seeing patients all day, bearing a mask, last Thurs and Friday). No one had to cover for me, because I am the jeopardy resident and, as mentioned above, I am sort of an "extra body" but not really anyone of any importance.

I would say I'd rather be on OB as Antepartum resident or at Mather VA than on Jeopardy, but that might be just being dramatic. I'm not sure I believe that. However, it is just quite restrictive and rather annoying.

I am not allowed to schedule in advance any of my own patients in clinic, in the off chance that I get "jeopardized" somewhere else to cover someone else. With already-limited clinic slots and somewhat lagging (relative to my classmates) in patient "numbers" (we are required by the residency accreditation committee to see a certain number of patients before graduating or completing each year) due to all the time I spend on inpatient OB, and with an upcoming away rotation in the month of February, I definitely don't have enough clinic slots to see my own patients on my panel. And I am still not really building numbers because they often don't open me up in same day clinic until a few time slots in the day have already gone by, so I basically sit in clinic, bored, "trolling" other residents' schedules for patients I can take off their hands in order to be doing something useful, if not only just something. It is not efficient. It is bad for continuity. However I must say, my inbasket (of results, patient calls to return, refill authorizations, etc.) is pretty pristine (perhaps the cleanest it's been in residency!).

And while I technically have weekends off, I don't really, because I have to be within an hour of here, and bearing my pager 24/7, to potentially cover someone if they need it. Bummer, with a three-day weekend coming up, and it being ski season with Tahoe so close.

Last weekend was awesome (note that it was the end of my ENT/ophthalmology block and pre-jeopardy). Despite not having a voice due to a bad cough, I was not about to let plans fall through (esp ski plans with good friends!) and I joined Erin, TJ, Christian, and Mike (friends of theirs from Stanford) skiing at Sugarbowl up by North Lake Tahoe.

It was awesome! Due to an early start, we basically got a full day in, from lift open to close.
It was so great to see Erin and TJ, as well as Mike and Christian, who I'd met before, both in Palo Alto and at Erin/TJ's wedding.
Mike had never skiied before, but (a true natural) was doing blue slopes by the end of the day!
The snow was good, it was not too crowded, the slopes were varied and interesting, the weather was great (warm in the 30s just until it started to rain at the very end of the day), I think I inadvertently made it down a stretch of black diamond (which I swore I would never intentionally get on), and I didn't fall the entire day (that is my measure of true success!).
Good times. Here are some pictures:

me and Erin on the gondola up

at the top

all looking at something interesting!

Jeremy asked if people wanted to go skiing this or next weekend.

I want. I want a lot. But I can't. I'm not a gambler and I can't head up there if the off chance I could be called back.

Please let me know if you want to be jeopardy jailbird for any of the above weekends :) I will pay you well :)

A new year...

Happy New Year 2010!!!!

It's hard to believe 2009 is now behind us. It was a very good year, filled with great friends, travel, adventures, and lots of fantastic memories! I stole the idea of "recapping" in pictures from Wendi, so here's a brief synopsis of what I was doing in 2009 (besides working hard as a third-year resident, that is :))

January 2009 -
Lots of skiing at Tahoe (actually, how we brought in the New Year 2009)



Monterey- Trip to the Aquarium and whale-watching


February
Skiing in Salt Lake City and visiting Molly!




Cruise from Florida to Jamaica!


Parasailing in Key West

March
Visiting the Kitsteiners at Eglin

Running the Shamrock Half Marathon with Chrissie

Hosting Cathleen's visit to Sac-town (and finally getting to visit the Jelly Belly Factory in Fairfield!)

April
Celebrating many friends' pregnancies:
Triple baby shower for Noelle (and baby Kacey), Betza (and baby Rafael), and Anika (and baby Madeline).


Congrats to other great friends who are now parents after babies in 2009-- Wendi/John
(Elijah), Laura/Tony (Abbie), Hans/Rachel (Kaia), Katie/Ryan (Luke), Natasha/Nikola (Cristiano), Sarah/Matt (Eleanor), Susanna/Mike (Gemma), Wai Kiu/Hanh (baby Mason who I had the privilege to deliver!)

Can't wait to see the 2010 round!

May
Attending Ajit/Jeny's wedding in New York ...



... where I got to also catch up with the Kitsteiners and Joneses


June
Hiking with Erin: Mt. Diablo


Graduations, where we said goodbye to Aline :(

FP/OB force


OB graduation


OB roast


Camping with my new class (now R2s) at Folsom Lake

July

Hiking in Mammoth Lakes over the 4th of July

Playing frisbee: a new tradition!

Roadtripping to Mendocino/Ft Bragg


River Rafting!

Courtland Pear Festival

August

Visiting with Jeremy in San Francisco

Jumping out of a plane with Kelvin

September

Swimming in San Diego with Molly for Labor Day Weekend

Celebrating Amy and Jesse's engagement

(and subsequently, celebrating engagements of also Kate/Darrel, Kyla/Ben, and Phi/Cassie!)

Visiting Lassen Volcanic Park

October

Peru: Lares Trek hiking (Mindy)

Machu Picchu, for the second time


Salar de Uyuni, Bolivia




November

Seeing "Wicked" in San Francisco

Turning 28

December

Getting to fly home to Virginia to see my wonderful family for Christmas

I love my little sis!...

... and dogs :)

... and godparents....

New Year's Eve was spent at a house party with Amy and some friends of hers. It was a really fun time, and I'm super excited that I made it until midnight without falling asleep :)

While I hope there are more great times ahead to be had in 2010, I welcome the New Year with a bit of wistfulness. While I have another year and a half of residency training left, some great friends I've met in California with whom I started residency are going to be finishing their third year and graduating in June. I am quite sad when I see them all looking at jobs/fellowships (some far away) and at what they will be doing in their next stage of life. While they are moving onwards, I feel that in some ways, I am being left behind. While I have definitely bonded with the class (R2s) that started last year and with whom I will graduate, I am hoping that some of my "original" classmates stick around to keep me company so that I don't miss them too much.

I am reminding myself:

"Just because something good ends doesn't mean something better won't begin." - N. Bowers

"Learn from yesterday, live for today, hope for tomorrow." - A. Einstein

Best wishes to all for a happy and healthy 2010!

Holiday Cheer

"For unto us a child is born, unto us a son is given: and the government shall be upon his shoulder: and his name shall be called Wonderful, Counsellor, The mighty God, The everlasting Father, The Prince of Peace." - Isaiah 9:6

Merry Christmas!

This December season has been filled with much holiday joy; here is a quick post on Christmas Day to recap the month's events.

Although I admit I have not been a great picture-taker, I have a few highlights:

Family Medicine Holiday Party,
with "babies galore"
(Susanna/Gemma, Betza/Rafa, and Sarah/Eleanor... missing are Noelle/Kacey and Anika/Madeline)



Merry Christmas, Kunkels! (Betza, Rafael, and Tom)



Wine-tasting around Livermore, where the Satows graciously hosted us pre- and post-tasting :)

Kelvin and me



We had an eggnog (mmm) and tree-decorating party at Char's but, alas, I took no pictures.

We had a Family Medicine Resident holiday party/applicant dinner at Rocky's mansion, which was awesome. We did a gift exchange of nice-ish gifts, but white-elephant (a.k.a steal-) style, which was absolutely hilarious. Who knew that Trivial Pursuit and a leopard-print Snuggie (in California!) would be such hot commodities?!

Kim, Char, me, and Jessica, staying warm by the fireplace (one of four in that house!)


Last weekend, we had a delicious dinner at Kyla's, which included her baked mac and cheese, some tomato soup I attempted from scratch, Joe's famous artichoke dip, salads, and delicious desserts including baklava and chocolate cookies w/ peppermint icing (the rumballs were just okay).
Then, we headed to Davis to watch Handel's Messiah which, as always, was enchanting.

Char, Kyla, and me at the Mondavi Center


And.... perhaps one of the best gifts of the season has been .... being home in Virginia.
I was lucky last year to have the Christmas holiday off, and was able to be home with my parents and doggies; we celebrated in McLean while my sister (living in Europe at the time) was gallavanting across the Ukraine. This year, all four of us were able to be in the same place! Although VA feels less and less like "home" the longer I'm away, it is always great to see family and old friends. I hadn't seen my parents since last year, and hadn't seen my sister in over a year and a half, I think, so it's been a phenomenal blessing to have had the 4 day weekend to travel here and hang out with all of them!

I had no travel delays (nor luggage delays... hooray!) flying Wednesday evening from Sacramento (through LA) to DC and luckily missed the delays that came with last week's blizzard which dumped something like 2 feet on the Washington area (Vanessa said she shoveled snow for 7 hrs!). I'm so glad to have skipped the midwest layover on my cross-country journey, and (as expected) slept the whole way here; I am convinced that the red-eye is the best way to get east from the west coast, which can often suck up a whole day of travel time.

Since being home, I have:
- slept a lot (my dad asked me yesterday, "Why are you so sleepy? You just slept the whole plane ride here!" to which I replied, "I haven't slept in 2.5 years!")
- ventured out on the icy roads to pick up my dad from the car repair place due to the Ford's car battery (or alternator) dying (I felt like I was back in MN!)
- read a lot (currently reading Cutting for Stone by Abraham Verghese, which is fantastic)
- gone to the Christmas eve service at Redeemer Lutheran, which brought back many memories from high school. I knew virtually no one there, but did run into Dylan, a guy I graduated with (my 10 year high school reunion was last month and, although I couldn't attend, it would have been fun to see everyone. How old I feel!)
- slept some more
- opened Christmas presents with the family which included some awesome and practical gifts including a water filter and travel adaptor, which I very much needed!
- talked, via Skype (awesome, by the way!) to Marco, Vanessa's Italian boyfriend, who is in Torino right now
- played with the doggies
- drunk lots of tea and eaten mom's rumballs, which are far superior to mine

Vanessa and me with the doggies (me with Duncan; she with Freya) and tree



I think a viewing of It's a Wonderful Life, which may be one of my favorite movies of all time, is in store this afternoon.

We have some more meal plans with friends (the Heimers, my sister's godparents/family) and John/Inara (my godparents) later in the weekend, but today, it will just be us.

It has been a glorious break so far, and is passing all too quickly.

Merry Christmas, again! (and, per Tiny Tim, "God bless us, Every One!")

Clouds

" If all of life were sunshine

our face would long to gain

and feel once more upon it

The cooling splash of rain"

- H. J. van Dyke

Most of us residents are familiar with the "cloud" phenomenon; that is, at one time or another, you get a reputation of either being a "black cloud" or a "white cloud," depending on what "goes down" during your shifts.

A "black cloud" is someone on whose watch disaster strikes. This applies to all call, but particularly seems to be the case with respect to OB patients. Rocky had about 4 code c-sections called on FP patients in labor (including one preterm labor/breech in the vaginal vault) while she was on night float as a 2nd year. I remember hearing about a call in which Jeremy had, amongst ER admissions which he always has, a 26 week pregnant FP patient come in with PPROM (preterm premature rupture of membranes) and another woman who basically coded on him post-delivery. Call is seemingly always like that for him which makes most of us very reluctant to switch for days when he was supposed to be on :). I did my last week of nights as an intern on OB with him, and I remember it was disastrous!!


Mehrdad, one of the FP residents that graduated last year, was also very very "black." On FP calls, he'd have like 7 ER admissions, 4 patients in labor, central lines to place, and at the end of the night he'd say things like, "That was such a great night! I learned so much!" VA calls were the same way-- I don't know how many codes he had to run there while on night float. But he had such a wonderful attitude.

Hao, one of the OB chief residents last year, was perhaps the blackest cloud I have met. She had a horrible vaginal breech head entrapment which everyone still talks about today. I prolapsed my first (and only) umbilical cord on AROMing someone on a shift with her, and have never worked so hard on ER consults or labor management as when I we were on nights together (I remember saying one time to her, "Hao, I have never had a night as bad as that one" and thinking to myself that that it was unsafe for patient care. You know she was a black cloud when she replied lightly, "You think that was a bad night?!".


However, lately, I wonder whether being a black cloud (in terms of work) is really a bad thing, or whether it just makes you better trained, as "what doesn't kill you makes you stronger," right?


I tend to have a white cloud. On FP night float, I found it amazing that I was able to sleep most nights due to the ER being quiet. I had no one code on me while on VA night float. There have been some 24 hour OB calls (including Thanksgiving, as well as last Saturday and this past Friday night) when, despite having the ticking OBGYN ER consult time-bomb pager, I have not had to go down there once. I felt so bad because last Friday night before I came on for my Saturday call , Sarah had, amidst a fairly busy night on the L and D floor, in a 12 hour period, seven ER consults, including delivering a placenta down there, and a couple of D and Cs! I think her former white cloud label (along with that of Jen, the chief she was on with), got revoked after that night.


Granted, I do a lot of pre-call praying that I won't get overwhelmed. I pray that the ER residents will just use their brains and figure out how to manage a miscarriage or vaginal bleeder rather than reflexively calling the obgyn resident every time (do they call cardiology every time someone comes in in afib? I think not. We joke that they consult us every time someone with a uterus rolls in to be seen!). I prayed my way every day to the VA in Rancho Cordova, and had not one veteran code on me. I'm not sure I can always attribute my luck entirely to prayer, but I'm wondering: why am I a white cloud, and is it really good for me?


I feel that, in some ways, being "lucky" may not be optimal for residency training and actually may, really, be very unlucky in the grand scheme of things. I have had pretty good OB training, including decent c-section numbers and antepartum management; however, I am limited in my experience particularly in operative deliveries (vacuum, forceps) , higher-degree repairs, and in dealing with shoulder dystocias. I have not been involved in any c-hysts (cesarean-hysterectomies, usually done emergently to control excessive bleeding).


It is pretty standard that we FP/OB residents don't get quite the volume of the categorical OB residents in most everything, particularly because they rotate at Kaiser, but I have basically had no training in the above. Maybe no one on my calls have needed operative deliveries because I am more patient with pushing, fetal monitoring strips, or am strong at getting people push harder or more effectively. I have not had any bad shoulder dystocias. I have not had a patient have a deep 3rd or 4th degree tear (maybe I protect the perineum well?). In c-sections, I have not yet lanced the uterine arteries or had a cystotomy (bladder puncture). Although it certainly wouldn't be good for the patient, I have joked that, one of these days, I am going to poke a hole in the bladder just so I can learn to repair it.


And while I got to do some cool things last week (such as a c-section for triplets I'd been following for the better part of the month!), I also felt very unlucky. I had never delivered twins vaginally before and it is pretty rare that mom a) goes to term, b) has the twins in a position to permit vaginal delivery and c) wants to try a vaginal delivery over just scheduling a c-section. However, last week we had two twin inductions, one last Saturday while I was on and another later in the week. The first mom (a multip) got to complete dilation with her twin A and then decided that she couldn't push any more than about 1.5h and requested a c-section. I almost said to her (but was definitely thinking), "you have got to be kidding me!" The second mom being induced ended up not having a stable presentation with twin A moving from vertex to oblique/other and, while I also got to do her c-section, I was very disappointed at not being part of a twin vaginal delivery, as I have had a grand total of zero.

This past week (my only week of the block that I was not antepartum resident) was my last full week on UCD Labor and Delivery until the end of the year when I may have to be "acting chief" (I do have some OB calls here at there this next month). There were four assisted vaginal deliveries this week during the hours I was on. I was present at each of them. I got to do zero of them. Maybe it's because I am not assertive enough. Maybe it's just not meant to be. However, as far as building my skills goes and in missed opportunities, this was the the "blackest" week I have had, which punctuated a pretty unsatisfying month in general filled with lots of call, early mornings, rounding, note-writing, and painful clinics.

While it is great for patients for me to generally be such a white cloud and it really isn't fair of me to wish an obstetrical emergency on anyone, I am nervous (esp knowing I will be chief next year) because I haven't seen/managed those complications so that, when they do happen, I'm not sure I will be prepared. Someday, and rather soon, I will be out in the real world without the kind of backup we have here and the best time to learn such skills is now, in residency, when we have a lot of help and supervision. I am pretty sure those people who are the "blackest clouds" are going to be the best trained physicians, and I do envy them in many ways.


So, from now on, I am going to stop wishing I am such a white cloud. Despite loving the sun, I'm going to try to embrace the rain. I'm going to tell myself that stress and a little disaster is probably good for me. Even if it means I have to go to the ER! :)