The Other Side

It was time for me to go to the doctor. I've been a healthy person in the past and really, except for a couple of issues, including some weird employment bloodwork and "cycle" stuff, I don't have any problems. I try, at all costs, to avoid going to the doctor. I think the last time I saw anyone for health care was before going to Nigeria, when I had to make sure my travel vaccines were up to date and to get my malaria meds, and I'm not sure before that. I was due for a pap, though, and was also interested in getting the Gardasil (cervical cancer) vaccine, for which I was eligible, so I had set up an appointment for today after I was done with my night shift.

Where do family practice residents go for their care? I went to the ACC (ambulatory care) building where I work in clinic, just because it was the most convenient. This was slightly weird-- the medical assistants and nurses at "Station 3," where I see my patients, were the ones rooming me and taking my vitals :) The doctor who was assigned as my "PCP" is actually one who I routinely precept patients with, but I didn't really care, even though I don't know her all that well, only having lived here a month. It was interesting to be on the other side of things. I tend to kind of be not the model patient-- for some reason, I couldn't remember the dose of Allegra I take for allergies (not sure if being post-call had anything to do with it... :)) and really had to think to come up with my LMP, something they routinely ask female patients. I had to fill out a "new patient" questionairre and had to wait quite a while for the shot, which required insurance authorization, and which HURTS, by the way (I get other doses at 2 and 6 months from today). I also sat at the lab (for what seemed like forever) to wait for my blood to get drawn, where I kept snoozing in the waiting room. It was unfortunate, but really the only time we have to set up appts. is post-call (after working nights), as we residents don't get any quality "day time" off. I was totally zonked by the time I got home, but it was one of those things I had to get "out of the way"-- all in all, things went fairly smoothly.

After being on the "provider" side of medicine, it really is extremely strange to be on the other side, esp. as my training goes farther. I'm sure there will be occasions in the future where I will have to be a good little patient, but I'm going to avoid those for as long as I can :)

Cherishing the weekend

I don't think I have ever in my whole life looked forward to a weekend as much I did this one. It is still unfathomable to me that normal working people get every weekend off, whereas it is a humongous GIFT for us to get two days off in a row. I actually had more than 48 hours off, which I felt was amazing (and extremely needed).

Friday night, some interns (Amy, Phi, Adeel, and I) joined some second and third years (Arash, Shomir, Alvin, and Antonina) downtown for pool. Saturday, I made it out for lunch to the New Canton restaurant for Dim Sum, where Alvin ordered for us all. We had shrimp balls, pork pastries, mystery pastries, unknown-named green vegetable, rice noodles with pork, wontons, spring rolls, and more.... there wasn't one thing I didn't like (surprise :)).

I was able to do some "catching up" in the afternoon, cleaning (my apartment was horrendous), doing laundry, calling people back (sorry, guys for being delinquent before!), and taking care of bills/sorting out my checking account (there's this annoying recurring $75 transfer from checking to savings which waives a monthly service fee; before, I also had a combined balance requirement, which, because we get paid at the end of the month, I dropped below and started incurring fees that I just noticed. Aargh. "Are you a student?" the Wells Fargo representative asked me. "Ha! I wish. I'm a resident. I'm just poor." We get paid at the end of the month, instead of bi-weekly, which I think would be preferable). I opened massive amounts of mail (including a very sweet musical encouragement card from Laura--- thanks, babe!) that I had just set aside.

Saturday night, I met Shomir, Arash, Din-Hai, and Trish at the Moon River Inn for karaoke. Now, let's just preface this with the fact that, over the past several years, I've gotten a lot less inhibited/self-conscious with most things in general and had, going there, every intention of joining in the karaoke fun. However, seeing all those people I didn't know just made me freeze up! I know it should be easier doing things like this in front of people you don't know, but it just isn't. It took me about four years before I'd even open my mouth in front of people like John/Wendi (happened quite a bit in Africa...recall Lion King renditions...). In any case, Shomir and Trish both got up there and did great! I may just have to wait until a smaller setting, till I get some self-esteem back, or until I just don't care what people think. It was fun listening to all the music, though!

This morning, I went running with Kate and Lefty, which was also a good time :) Our Fleet Feet 1/2 marathon training starts this week, which I will have to miss Wednesday because I'm still on nights, but I'm going to try to make the weekend run on Sunday. I also was able to go back to Arcade for Sunday service. I've kind of been a heathen in recent weeks due to the Yosemite trip and schedule, being on call the Sunday before that. I'm really not sure how consistently I'll be able to go, but I like the music a lot and introduced myself to the Pastor today (who'd come across my blog because I'd previously linked the church). I know that I still need to be more outgoing and talk to people while I'm there instead of popping in and out. Don't know why I'm getting all shy again-- I thought I was over that whole social anxiety thing! :)

I also slept a lot this weekend, which was very nice. I didn't realize how behind I was. Although I feel that I sleep better during the day than most people do, I was still obviously very sleep-deprived from a week on nights. I slept all Friday afternoon, all Friday night (for like 9 hours, after the little social time I forced myself to have), a couple of hours on Saturday afternoon, all Saturday night, and a few hours this afternoon. I was still haunted by work, though-- I was having dreams of being on Labor and Delivery, but where there were wild animals that you had to fend off. I didn't want to get any more dog/leopard/tiger bites, but was trying to do my job, checking women's cervixes! Very weird.

But no more is it a dream (or a nightmare...) I have to head back to work in about an hour. The upper-level teams switched this week, so I'll be with a different 2nd year and chief, but I hope they're as awesome as were Kyla and Steph. What will be getting me through this week is the thought that Nicole and Bay are going to be in San Fran next weekend for a wedding... I'm going to try to drive there Sat. to meet up with them depending on whether they can "squeeze me in" to their social schedule :). Wish me luck (/pray for me :)) as I start another week of nights...

Light at the end of the tunnel (+ more Yosemite pics)

Okay, I'm in a much better mood now. I think, in writing my last post, I scared a lot of people with how stressed I was. I was very stressed. I'm less stressed right now. The rest of the week went more smoothly. I started feeling less bad about asking the upper levels for help... I just want to do things right and be good to patients. My trusty medical student Diana returned to help me deal with Triage. I have gotten to the point where I am able to go see someone, confirm they have SROMed (ruptured membranes), check her cervix, check the baby/placenta's position and guess size, and admit them/add them to the labor "board" in under 10 minutes, which I did twice last night. After board signout on Thursday, we sat down and had a morale-boosting potluck (I brought a bean salad, Steph some barley dish with feta and salmon, Diana Tiramisu, and Kyla ice cream... mmm. [Ice cream will make anyone feel better!] ) We actually had time to eat. We also had time, this morning, to go on "baby rounds" (informal visiting rounds in the NICU) to see the preemie babies we've recently delivered-- good times. Post-call clinic today also was fine. I can dictate d/c summaries in 2 minutes instead of 20. I'm finding that I'm more efficient now, after being forced to be on the OB floor. Maybe it will be okay after all.

I am off until Sunday night, which is a huge blessing. Tonight, some FP residents (the upper years, having more time, are great about sending out "social" text pages) got together at the Blue Cue downtown for some drinks and pool-playing, which was fun, except I was kind of a zombie at the end and I'm terrible at pool. I'm so tired right now, but I'm not sure whether to try to stay on a "nights" schedule or try to stay awake all day Saturday to try to take advantage of my day off! Hmm. We might go get dim-sum and I might go to a luau party tomorrow- we'll see how much energy I have.

Other cool things:

• The Rays started a blog (link is also to right)! I'm very excited about this and hope it's not just a tease. More people's lives to stalk. Yay! :)
• Erin's wedding pictures are out HERE. They are really beautiful!
• I checked with the Peds chiefs, and it looks like I am post a 12-hour o/n ER shift on Thanskgiving morning and actually have Thursday, Friday, and Sat. off. I wonder what I should do with this time. It might be too rushed to go somewhere, but I would love to celebrate Thanksgiving with people impt. to me!
• More Yosemite pictures from Saturday/Sun. are below... pictures and reliving adventures with friends always makes me happy! Enjoy!

Starting out! (From left): TJ, Erin, Mike, and Brian. That's Half Dome in the background. Doesn't it look high?? THAT'S BECAUSE IT IS!!!!!!!!!!!!! Reunited! :)
This greeted us in the parking lot where we left our car....the reason that you are warned to not leave ANY food in your vehicles. We wondered, "Do cars have bear-insurance?"
Isn't he cute??
The Trail begins. That's Vernal Falls behind us. This pic's for you, JB. I think it's a Steller's Jay. Confirmation??
"Napoleon" Mike, rock climbing :)Erin scrambles up there Mike, Brian, ErinThe remains of apples the others ate. I was aghast at how much fruit was left on these cores (I believe the middle one is TJ's). We had to carry all of our trash out of there on us... even more reason to eat more of the fruit!!
Looking upwards at Half Dome from Little Yosemite Valley
Pretty Doe
"Don't get so close to the edge, Brian!" exclaimed Erin. Cute little slithery friend
The ascent that greeted us at the end of the uphillCan we say we are rock-climbers now?? Erin thinking about not going up there.
Brian leads the way. Remember, we also had to descend this rock face.


Two thumbs up (the pose I stole from Kelsey). Getting ready for the final push

THE CABLES
The Summit (2 of the three brave ones pictured here)!!! Pretty valley on the other side
This was there already when I hit the top! On the way down ... Isn't all the granite amazing?!
It was starting to get a bit dark when we were near the bottom of our descentHeadlamp stare-down

It was a great trip! Sunday, we drove some along the Tioga Trail and saw pretty Tenaya Lake (in which Mike went skinny-dipping!) before returning out of the park to Manteca and going our separate ways. I think we all want to go back to Yosemite in the different seasons (we still want to do Yosemite Falls), so if you come visit, I could be easily talked into going back :)

Yay for trips, days off, social contact, and having time to enjoy life. Happy weekend, everyone!

Not Good

My friend Eva sent me this link about a concert no-no.

While it made me smile, this got me thinking about other things that are not good.

• My current life. OB nights is really killing me.
• It is not good to be anxious every time it's about to start your shift and really worry about going in and whether you're going to survive. Getting through nights is really all about survival. As soon as it nears 5 a.m. and I start to see the residents from their actual teams trickle in, I start to feel way more calm... I really feel depressed and hopeless. Maybe it's because I'm tired, but this is not normal nor good.
• It's not good to not urinate-- I realized that, on the past two nights on, I only went to the bathroom once in each 14-hour shift. Mainly, it's because you're too darn busy to even drink to have the urge. I know I'm dehydrated. Much like for post-op patients (which I get called on, especially last night), oliguria is bad.
• It is not good to cry on call. I burst into tears at one point on Monday night because I was too overwhelmed with everything. I was trying to take care of people in triage (my main job), but then people were delivering left and right (I am supposed to do as many as I can-- I think there were like 8 dels night-- and really like that, esp. being in there to help push, except that you just don't have the time and usually get there just in time for the baby to come out, knowing not much about the pt), I had to do delivery notes and postpartum paperwork, there were post-op checks to do and labs to follow up on from gyn onc patients/day surgeries, and then I was fielding calls from the gyn-onc patients' nurses since the gyn-onc team doesn't take overnight call. Postpartum patients had issues with tachycardia, cellulitis, and more... I have to, after midnight, create "the list" to decide who gets rounded on by whom when the day team comes on, and this is supposed to be up and posted by 5 a.m., except that people started delivering and my chief had to help me out, which I felt awful about... Kyla has also been bailing me out left and right, despite also having things she has to take care of, like ER visits and managing the laboring patients. I just don't know how to juggle it all. No service I have ever rotated on as a med student was this crazy. Nothing I have ever done has been more challenging for me, honestly. I'm not as cool and collected as the other residents (I think I am "high strung" in general :)) and really wonder if I ever will be. I'm not sure I was made for this.
• It's not good to work this much. I've been going in at 6 p.m. and leaving around 8 a.m., for five days straight, and then have an added Friday a.m. FP clinic to look forward to. Doesn't that violate something?! I know that 80-hour-work-week thing is averaged over a month's time, but I think this is what the schedule for the whole month will be like (and I have a 24 hour Saturday call mixed in there to, which will add hours). I'm on track to do 80 in five days' time.
• Working so much is also terrible because it makes me waste food! I'm just not even home enough to eat it, and so far this week, I've had to throw out: moldy tortillas, old yogurt, cottage cheese that didn't get finished, withering corn on the cob, and even hummus. This is really a travesty in my book and sign that something serious is wrong.
• I find that the "10 hours off" between shifts is not enough for any semblance of a personal life-- mainly I just sleep. I do have to clean my inbox and call back patients, do discharge summaries, etc. It is not good to not talk to anyone in your 10 hours off... I usually just go home, sleep, putter, and then go back to work. I'm totally lacking in social contact. In the short-term, that is okay, but that is just not going to be sustainable for me! I can't fathom doing errands or grocery shopping or really much of anything, although I forced myself to go for a run today (which ended up being more like a walk because I was too tired and hot). I can't even imagine what it must be like to have to support or spend time with a family. I'm just hanging on by a thread on my own.

Okay, that's enough whining from me right now in one post. It's time to shower and go back to work.

"Wiiiiiiiiiiiiiii at Phiiiiiiiiiiiiiii's:

Something I don't think I'll be doing a lot of in the near future is hanging out with my classmates. Working nights is really tough. While rounding on postpartum pts this a.m. (it is way easier to do this when you are fresh), I was getting really annoyed at myself because I knew I was in a fog and wasn't thinking very clearly (I seriously was like, "THINK FASTER, brain!!!!"). I was so mentally and physically exhausted. The night wasn't too busy, but we did start to have a steady stream of patients in triage who had to be ruled out for labor. I had a delivery and lac repair right around 4:30 a.m., when I should have been starting to divide up the list on rounding on pp patients, which kind of stressed me out, but it all turned out okay.

Good things about working nights (or at least positives from last night):

• Diana, the student who was on last night, was extremely helpful with paperwork and getting the supplies together for all of our duties!
• I am on (at least this week) (as my upper level) with Kyla, who is really patient and kind! The chief, Stephanie, is also great.
• There are plenty of bike parking spots at the rack when I'm commuting for these hours.
• It's kind of nice to go in to work and come out when it's light out (on days, you may come in at 5 a.m. when it's still dark)
• You have an excuse not to return phone calls and e-mails (or to blog), although I enjoy all of these things. :)
• Shift-work is less demoralizing than q4 call; however, with discharges to do, this can eat into your required "10 hours off between shifts," which will be tricky to not violate.
• Nights are harder than days, just because there are less residents in house and so you cross-cover more, so my second two-weeks should be better than these first two.
• It is less lonely-feeling to be at home alone during the day than it is at nights.
• I am done by Friday afternoon and get the weekend off (well, till Sunday night when I start again for another week).

In any case, I wanted to share some pics from Friday night , where we had a little FP get- together to celebrate completing rotation block one...

Adeel:"Here, baby Fahtima, try some of Phi's mom's yummy Vietnamese yogurt!" :) This is Adeel, Fizzah, and Fahtima

Expert Wii bowling technique (Do you like that follow-through?! :) This is Phi; Betza and her husband Tom look on)

Betza in action

Boxing: "It's like this," explained Adeel. Except that he's facing way away from the screen and it appears that only I am paying attention. Noelle is holding the little remotes and looking a bit clueless.Adeel and Phi going at itNewlyweds taking out their aggression (but smiling all the while)-- Jeremy and Noelle

Phuc, smiling finally beacuse she's"FINISHED WITH OB! PHEW!"

I have napped for several hours since I got home this morning but am up for a bit. I feel like I should do something and take advantage of the day and things, but the eyes are getting so sleepy again... zzzzzzzzzzzzzzz. I can't believe I have to repeat this wacko cycle in just a few hours...

Half-Dome... in short

We hiked Half-Dome! :) It was Erin, TJ, their friend Mike, Erin's brother Brian, and me.

We walked around 17 miles. It took almost 11 hours, although I think if we had been less leisurely, we could have done it in under 10. There were millions and millions of steps to climb. In fact, a climber we passed, who was going up as we came down, said, "Man! This is just like an evil stairmaster," which struck me as very amusing for some reason.

Three people made it to the very tippy top via the near-vertical cables and two chickened out at the end. I'll let you guess who actually summited and who just came close :)

I was definitely not the slowest and kept up the whole way. In fact, on the way down, Brian and TJ were whining ("our knees hurt!") that Erin and I were taking it too fast and claimed that we were doing so because "women are so dainty that going down is easier for them." Yeah, like Erin and I are really dainty.

Neither was I the klutziest one. 0 (yes, zero) falls in 17 miles is a pretty non-klutzy record, I'd have to say. BVB (and yes, that is the Van Brussel sibling-- remember that Erin is no longer "VB"), on the other hand, basically slid down the mountain and there was much swearing to be heard.

Everything in my body hurts right now. I have some bruises on my shoulders (not sure how those got there...) and chafing marks from my backpack straps. I can barely walk because my quads, calves, and hip abductors are sore as heck. The down was really rough on the knees.

I also really, really, really want to go to sleep right now.

But my overnight call starts in about an hour and a half and it's just not worth lying down.

It is surprising what you can push your body to do, as evidenced by that massive hike. I think much of it is mental. So here I go.

I promise more photos soon... when I'm more rested! But, regardless how tiring it was, the trip was TOTALLY worth it!

Half Dome from Tioga Road

Lasts

• Today was my last day of my first month of intern year! I'm actually kind of sad because Gyn was a very nice and easy first rotation.
• This might be the last time I'm alive and breathing.... or at least walking normally. I head to Yosemite tomorrow for what appears to currently be a plan to hike Half-Dome (I will still try to do some persuading otherwise in the car ride on the way in tomorrow). That 17-or-whatever-mile hike would be the closest I will have come to a marathon, which I hear can be very tough on the body for a while. I really hope I don't go over a waterfall. There will be no gum-chewing for me.
• This is last day/weekend I will likely, for a while, have any semblance of a social life. I start OB nights on Sunday and will probably just be coming home after a shift, going to sleep, not talking to anyone, and then going right back into work come 6:00 p.m. Now, the advantage of the day/night-float system is that weekends are covered by the general OB call pool (the reason why, even though I wasn't on L&D this month, I was on call a couple of weekend days), so I think I may have next weekend off. But I can't say I think I'm going to be doing much "hanging out" with anyone with my schedule. From nights it goes to 14-hour days, and then onto Internal Medicine at the VA, which is also apparently kind of butt-kicking.
• Which is why I have to make up for it now. Yesterday, Kate and I checked out a "Third Thursday" jazz concert at the Crocker Art Museum downton. It was very relaxing-- we just sat out on the lawn and listened to the mellow band. (I actually want to invest in a couple of low lawn-chairs or cushiony-thingies, as I anticipate I might be doing a lot of lawn-sitting while I'm living out here). In about an hour or so, I'm meeting Alex and Lucy (2 of my OB co-interns) downtown for Tapas (and likely sangria :)). Later, I hope to make it over to Phi's mansion for an FP get-together, also celebrating the end of rotation block 1 (for some; I know people who have to work through the weekend- yuck!). But since I have to get up before the crack of dawn to be on the road by 5, it may not be a very late night.
• It was my last half-day at the REI clinic, which also makes me sad. I looked forward to these half-days more than I think any other parts of the rotation and continued to learn TONS from Dr. W. Some stuff we saw/I learned today included (*WARNING*, there are lots of medical things and uses of the word, "sperm", so skip the rest of this post if you get bored easily or don't like bodily fluids!):
• Spinal cord injury is bad for male fertility. While paraplegic female patients often have no trouble getting pregnant, male SCI patients, in addition to having "sexual dysfunction" in general, for some (neurally-mediated) reason, have "lousy sperm." I learned that, for these male patients, urologists can go in with a rectal probe to near the spinal cord and pass a current that allows the collection of a semen sample that can then be used for insemination. I had never even heard about this.
• REI places used to restrict treatment to "married" couples; now, this is considered discrimination. If a lesbian couple wants to get pregnant with donor sperm, these centers do it. If I (or any other single person) wanted to try to get pregnant with donor sperm, they would do it.
• Bad cervical mucus, as well as uterine malpositioning, can be major factors contributing to infertility. Luckily, if discovered, these can be overcome quite easily with IUI. We saw patients with both today. I actually saw a pt in FP clinic a few days ago with a practically non-locatable cervix. I could feel it on pelvic exam (which I went ahead and did after about 2 minutes of hunting with the speculum)--it was very deep, anterior, and way, way, way tilted sideways, but could not for the life of me get a speculum to get it into view and had to call for doctor back-up so that I could do the Pap smear :). Not surprisingly, this patient was having trouble getting pregnant (if I couldn't find the cervix, how in the world could a blind little sperm find the os?! :)).
• Saw a patient who, after a couple of children with her first husband, had had a tubal ligation. Then her husband left her. She is now in a "wonderful" relationship with another man, "the man she wishes she would have met first," who doesn't have any biological children and wants to have them with her, but she has this infertility issue which is generally not reversible.
• Money is a huge issue. There are some countries who are wonderful about insurance benefits for infertility treatments (Scandinavia having some of them), and there are four U.S. states-- Mass., Illinois, Rhode Island, and Maine, which apparently mandate insurance coverage of infertility treatments; nevertheless, most insurance plans do not. If you have an individual, as opposed to a group policy, you are generally out of luck. Cycles can be extremely expensive, i.e. thousands of dollars (even not talking about IVF)-- close to $400 for IUIs, plus medications, ultrasounds (which, at UCD, cost about $400/each), medications (Clomid is relatively cheap but FSH isn't). Dr. W. told me people about getting a second mortgage on their house to pay for treatments. And then there are the people who don't have insurance and have to self-pay everything out of pocket-- one woman called in today wondering if she could just take a "rest cycle" rather than coming in for another mid-cycle ultrasound because she really didn't think she saw a positive ovulation response on her home urine test and didn't want to spend more money without any gain (she hadn't moved yet to paying for insemination). Whether or not infertility treatments should be covered by insurance is a topic of debate, and everyone has their own opinions. But it is totally heartbreaking to see people who just don't have the resources to try more than maybe one time with ART (assisted reproductive technologies). Or at all-- there are, of course, all the many, many, others who never even hit the REI clinic door because they just can't pay. I would love to be able to round up the equipment, appropriate lab stuff, etc., to work on being able to do this (inseminations at least-- it is really quite straightforward and takes like 1 minute) for low cost for people with little or no insurance.
• Getting older is bad (very bad) because it is really one of the few factors that cannot be overcome with even the end-of-the-line fertility treatments such as IVF. As we age, we have very poor quality eggs left. I learned that about 1/3 of women who get pregnant in their 40s miscarry, mostly because of poor egg quality. Dr. W almost universally will refuse IVFs to women over about age 41 because the likelihood (about 3-5%) of them going home with a baby are so low and he doesn't want women to waste their money. We saw a 43-year-old patient today who we basically told, "you are too old to even have a successful chance at IVF." She was very disappointed, but thanked us for being honest.
• So what would someone like her, who still wants children, do? Either move towards adoption or look into egg donation IVF. With a 20-something's egg, that 3-5% can go up to 50%. Now, this is very expensive (like $20,000), but actually an interesting solution. I sat there with her and starting thinking, "Man! How could we tell her that pregnancy is just 'not possible' for her. Maybe I could donate my eggs (she kinda sorta maybe looks like me... ). They're still fairly young and will certainly not be used for a while!" There's all this rigorous screening for egg donors (like there is for sperm donors) where you have to answer questions about medical history, genetic diseases, as well as "Do you smoke?" "How much do you drink?" "Are you athletic?" "What did you major in/how many degrees do you have?" :)) to find "high quality" donors. Recipients can then actually search for people of similar ethnicity/looks (there are catalogs!), and with traits they desire (much like you can do in selecting sperm donors). You don't even have release eggs on your own (normally) to be a suitable donor, b/c they pump you up with FSH and all kinds of stuff to stimulate your ovaries. But it's kind of a complicated process and means that, as a donor, you probably have to be flexible enough to be able to drop what you're doing and fly somewhere random so that they can harvest your eggs, mix them with the male sperm, etc. , in preparation for transfer into the recipient. Probably not going to happen while I'm an intern. But I really might look into this. Do you think someone would want my eggs? :) Apparently they pay egg donors well, but I'd definitely give them away for free. :) Along with maybe a kidney.
• Okay, enough blabbing. This is the last bullet point of this post.