Olympic Smiles

Yes, even though they are over, I am still re-living The Games.

You have GOT to read this absolutely HILARIOUS article, "Raising the Stakes" by Joel Stein published in Time.

Visit Laura's blog for a funny illustration about Phelps.

Visit Vanessa's blog for a Phelpsian comparison.


Just do it :)

Current events...

Currently on:

Outpatient pediatrics!!! It is so awesome. It is amazing to work 8-5 (or even 4:30 occasionally!, 5 days a week) instead of 5-8 (6 days a week). This is actually a new rotation, as last year as interns, my fellow classmates did a whole month of inpatient pediatric wards. Now the interns (yes, I'm still doing "intern" rotations-- this my last, though!) do 2 weeks on inpatient (which I start in a week) and 2 weeks of this outpatient stuff. Did I mention that it rocks?? I've spent a couple mornings at Kaiser- in the autism clinic at Rancho Cordova and the general peds clinic in Davis, a day with the lactation consultants and an additional 1/2 day at WIC, learning everything one ever wanted to know about breastfeeding, and then at a few half days of FP clinic. I even had a morning designated for reading, which is great (I'm still a big nerd and love to devour my American Academy of Family Physician, Journal of Family Practice, and Green Journal of OBGYN journals when they come in...). I have had time to album-ize all the photos I've taken this year (!), get some errands done, eat lunch outside in the California sunshine, and go to the gym, which has been totally rejuvenating. Why can't life always be like this?

I've also had time to do some reading! On Wendi's recommendation, I'm currently reading and thoroughly enjoying John Grogan's Marley and Me. It is utterly amazing that people could have the energy to put up with such a rambunctious character (makes Scrubs look like an angel!). If you're a dog lover, this is extremely humorous and a very entertaining read.

Currently planning:

A trip to Central America!!! Last week, Shomir and I bought tickets to fly to Belize for our vacation in October. I've been browsing the Lonely Planet guides to set up an itinerary, but in addition to exploring Belize and relaxing on the beach in Ambergris Caye, we want to try to hit the Mayan Ruins of Tikal in eastern Guatemala (another country to the list!). Darina is giving us some recommendations of places to stay and highlights (I'm already set on cave tubing and visiting some wildlife refuges). We are then flying from Belize to Boston (visiting Shomir's sister and nieces, and hoping to meet up with Tia/Rob and Nicole/Bay) before flying back to Sac. I can't wait! This trip will be the light at the end of the tunnel of a every-weekend-call-filled September and October for both of us.

Doesn't this look marvelous?? :)

Other recent events:

Although it was my first weekend off in months, I was called on Friday night (I guess it would be early Saturday a.m.) around 2 a.m. because one of my FP continuity patients was in triage for SROM (breaking her water). I had built a great relationship with her in the past year, her coming to see me as she was trying to get pregnant, and then for all of her prenatal visits, and so I loyally went in to admit her and settle her in. She ended up progressing very slowly (she was also on magnesium for preeclampsia)-- I had to put in a foley bulb to help her dilate, an IUPC to assess the adequacy of her contractions, and she was on pitocin for about 12 hours. All day, the OB chief was anxious to have me just "call it" and do a c-section because of her slow progress, but I just couldn't give up that she would do this "naturally" (vaginally) even though, exhausted, I, too, just wanted the baby to come out so we could all get some rest. After lots of praying ("please, please, please, be more than 7 cm this check"), when I went to check her around 5:30 p.m., she was completely dilated and ready to push. Once the attending got there from where she lives in Davis to supervise, she pushed like a champ and, at 1854, 20 hours after SROM, she had in her arms her beautiful baby boy. Despite my frustration at the slowness of the labor and being cooped up in the hospital for half of a rare and precious "golden weekend," hearing that baby cry and seeing her become a mom made it all worth it!!!! I walked across the street to Shomir's just in time to eat some dinner and promptly fall asleep in front of the TV with Olympics on, which has been my pattern this whole week.

Today, Shomir and I went to church with Darina and her friend Adam from LA and had a yummy lunch at Crepeville (pictures courtesy of Darina, on whom I can always count to whip out her camera before I even remember to document the events for the blogs-- thanks!!)

I'm looking fwd to the Olympic Closing Ceremony tonight (I missed the what I hear was spectacular opening ceremony!). While I will definitely lament not having the sports on anymore and at being able to watch the heroic comebacks and unbelievable performances these games, I am actually relieved. As I've written before, obsessive Olympics-watching is really not very compatible with residency hours! If I felt like (on this outpatient rotation) I had a lot of free time before, I'm going to almost be BORED now, without that 4+ hours of ritualistic primetime Olympics-viewing every night :)

Hope everyone has a great week! I know I will! Yay for outpatient medicine!!!!!

Busy month for births!

Whew.

While I have really enjoyed this month on Newborn and now feel much more comfortable dealing with the little ones, it has been pretty hectic. Tuesday was a busy day on the OB side when I think they had something like 10 C-sections over a 24 hour period... which meant that all of those moms and babies had to be dealt with and rounded on daily for (generally) a good three days... Of course, there were also normal vaginal deliveries on top of that so that our newborn census by Friday was something like 23 babies... We tried to discharge about 12 of them, but some had issues with feeding/jaundice/fever/OB complications and, sadly, despite running around like crazy people all day, trying to coordinate discharges and arrange follow ups, we had new admits all day and our census was about the same! I was doing some diabetes log updating this afternoon and saw the list of 24 currently. Although Bob, who has been my co-intern this month, tends to have the "black cloud," I only wonder how many people I will have to see when I walk in tomorrow a.m. But at least it is the last day! I rememer that August was such a busy month last year too, when I was an intern trying to figure out how to juggle all the tasks on Labor and Delivery! I have to wonder what everyone is doing in November to make August such a busy month for birthdays ;) !!!





So, with respect to birthdays:
Happy Birthday, Nicole! (today is her big day and it was great to talk to her although she is separated from her hubby who is on call in Boston).

Also Happy Birthday to Kate, who's *real* bday is today, although a bunch of us residents celebrated with her and Lefty at a bbq last night (sorry, no pics).

Happy Belated birthday to Lesley (the 13th).

Phi's "Baskin Robbins" birthday was last Saturday the 9th, when we got together for Thai takeout, cake, and Olympics-watching at Shomir's place (note that the Christmas tree from the Christmas-in-July party is still up!)

This expression cracks me up :)

Noelle, Jeremy, and Shomir look on while Michelle deals with the dessert.

Happy Birthday to Molly (Monday the 18th) who seems to be liking Surgery in Salt Lake City despite being yelled at by mean surgeons from time-to-time.

Happy 17th birthday to Natasha later this month although I can't remember what date.

Other news:

• It was so great to see Hans and Rachel last weekend! They stopped by here on their way back to the Sac airport from their stellar honeymoon in Tahoe, and Shomir and I were very lucky to get treated to breakfast. Unfortunately, the picture I'm trying to hijack from Rachel's blog isn't uploading correctly, so you'll have to visit her blog for a pic (and beautiful shots from Tahoe).
• I am totally obsessed with the Olympics. I have stayed up until 12 or 1 most nights this week to watch the finals (why do they have to taunt us w/ the swimming so late?!) and then, every morning going in, wonder "What was I thinking?!" And this is all on Shomir's giant TV. I cannot believe Michael Phelps.
• My sister Vanessa started a blog! She moved to Denmark this past week for 6 months to work at OSCE, an international policy organization, and will surely provide amusing updates from Copenhagen.
• After I finish newborn tomorrow, I go to OUTPATIENT peds! I'm so excited! I also will only have 2 more "real" weeks of intern rotations to complete (peds wards later in Sept) before officially being a second year :)

Recommendations .... (?)

• That residency give me more time off so that I can blog in more elaborate posts than just a few sentences.
• The movie Mamma Mia if you: 1. are a girl, 2. like ABBA (Dad, you would hate this movie!) 3. enjoy watching people break into random song and dance and 4. are up for a cheesy flick (Amy, Kate, and I saw this on Friday)
• Pampering oneself once in a while... Tired of having aching feet every day I have worked in residency, today I bought myself a foot massager from Target. I am using it as I type and love it!
• That you check out Shomir's bilitool if you ever want to know what to do with a jaundiced neonate. It is soooo helpful to decide how to manage the daily transcutaneous bilirubins we get on the babies in the nursery.
• That you come to visit me in Sacramento. Hans and Rachel may swing by here next Saturday on their way back from their honeymoon in Tahoe (they fly in and out of Sac), but I won't see them for more than a couple of hours for breakfast, most likely.

and, from you:

• Book recs? I start an outpatient (yay!!!!) rotation in 2 weeks and am looking forward to (I hope) have time to do some pleasure reading. I will try to get some library books and need some recommendations.
• Travel recs. Shomir and I think we're going to try to go to Guatemala/Belize as well as Boston to visit his sister and family during our first vacation block (Oct 18- Nov. 1) and I need some recommendations of specific places to go to plan the itinerary.

2 posts in 2 days....

... a record!
Mainly, this is an excuse to (for mom) post my R2 schedule, which is supposed to be way better than intern year but I'm having my doubts!!!

7/1- 7/20 was OB
7/21- 8/17- Newborn Nursery
8/18- 8/31- Outpt peds (Hooray! Outpatient!!!)
9/1- 9/14- Peds wards
9/15- 10/18- OB** (see interesting call schedule below)
10/19- 11/1- VACATION (will be MUCH NEEDED)
11/2- 11/16- UCD Night Float
11/17- 12/14- Peds urgent care
12/15- 1/4- Peds and FP clinic (+ Christmas eve 24h call)
1/5- 2/8- OB
2/9 - 2/22 Sports Medicine
2/23- 3/8- Vacation!!!!
3/9 - 3/15- FP clinic
3/16- 5/3- OB
5/4- 5/31- Mather VA
6/1- 6/30- ER

** for 5 weeks on L and D, my call schedule is as follows:
9/15-9/19- Days + Sat 9/20 (24h)
9/22- 9/16 - Days, + Friday night 9/26
Nights starting Sun 9/28 - 10/3 + 10/4 Friday a.m. post-call clinic.
(Off the weekend of Sat 10/4-5 until 10/5 night when I return to nights).
Nights Sun 10/5- 10/9 + Friday a.m. 10/10 post-call clinic.
Off Sat 10/11 but Sunday day call on 10/12.
Days 10/13 (hey! isn't that supposed to be a holiday?!) - 10/17, + Friday night call 10/17
(then vacation [much needed! Hey, working 80 hours will feel like vacation after that!!!])

(Not) floating/rafting down the American River

Darina has a nice little post about the adventure on Saturday that she took on with the boys that says things better than I can (and which saves me time in blogging because I obviously blog so frequently that it is a huge time sink ;) !). They floated about 7 miles down the American River on the contraptions you will see pictured below!

Needless to say, (according to Shomir), I may have missed out on the fun by ducking out (after learning the estimated time afloat and having to be back by 6 p.m. to be on newborn pager call/take care of Kate's dog Lefty), but Darina was pretty roughed up and I'm not sure she's going back.

Some pictures (half of which I stole from her!)...

The poster child on the box (doesn't he look real? And a lightweight, too, don't you think?!) :) Recall that these rafts were supposed to hold no more than 120 lbs.

Blowing them up.... took a lot of windpower, let me tell you!

All blown up and ready to go

Trying them out (on the asphalt) from left, Alex, (me and Shom in back), Darina, and Dinh Hai
En route to the water's edge... Dinh Hai and Darina posing before the ordealAlex looks a bit skeptical that the raft will hold his weight (Shomir, however, plunges ahead)...

Maybe this will work after all...
Shomir looks very gleeful...Alice points out that, "they're off!"Alice and instead took a walk along the American River bike trail and also went down to the River where we saw this cute doggie swimming for his ball :)

Note that there are no "after" pictures of this ordeal... see Darina's blog for details... However, most of us are back at work and alive.

Eyes opened

(Nerdy medicine post again).

Well-- I can't say that I have too much to report on apart from the day-to-day excitement of residency. I was on terminal Saturday 24 hour call to end my 3-weeks of R2 OB to start second year. It was not a bad call day overall, which included involvement in some interesting cases. I was surprised and had my eyes opened...

Some patients are really crazy.
Saturday afternoon, we did a c-section on a patient with bipolar/schizoaffective disorder with extreme paranoia that prompted a "are you poking and hurting the baby?" with every cervical exam (you can only imagine how she handled the placement of the IUPC [intrauterine pressure catheter] or how long it took to consent her for the c/s for failure to progress [I was wondering if she even had the competence to be consented]). The attending and I jumped sky-high in the OR when, when we used the suction machine to get some clots out of the uterus, she grabbed the [sterile] drape down, glared at us, and shouted, "are you hurting the second baby??" [she was convinced she was having twins and thought that the suction sounded like a second infant crying]. Interesting.

Signs of pregnancy?
Later in the day Saturday was the delivery of a teen girl who had presented to labor and delivery one prior, which was one day after discovering her pregnancy by taking a pregnancy test (positive, obviously) but who had been "leaking fluid" for about 2 weeks. Now, as you can imagine, this was amniotic fluid, she was PPROMed (preterm premature rupture of membranes), found to be about 34 weeks on bedside ultrasound, and was augmented so as to not be at risk for infection. She is on our OB Wall of infamy as the patient with the most recent shortest discovery-of pregnancy-to-delivery interval (although, believe me, other women have rolled into our doors not knowing they were pregnant and were even farther along!! We see ridiculous stuff at our hospital!!!).

Preterm labor happens
A few hours short of the call day/night's end, I went to see a patient in triage who was put up on the board as "rule out preterm labor." Now, you must understand how much we see in triage. Truly, anyone pregnant with any hint of abdominal, pelvic, or back pain/pressure gets put up there as a "rule out (and honestly, 98% of them are truly ruled out) preterm labor" which gets very old. Every patient like this automatically buys herself a workup that includes a sterile speculum exam, doing a wet mount, sending FFN (fetal fibronectin, a sensitive test that, when done between 24-34 weeks and negative, can effectively rule out the likelihood of delivery in the next week), sending cervical/ vaginal cultures, sending a urinalysis, doing a cervical check (or, often, serial checks), and ultrasound. It is labor-intensive indeed.

So when I went to see this new patient at around 30 weeks' gestation complaining of vaginal "pressure," I was expecting to see and feel a closed cervix and counsel her that she was likely feeling the baby's head drop. Until the speculum went in and all I saw was a bulging bag. A cervical exam and ultrasound later showed that she was completely dilated.... and breech, prompting an immediate c-section (due to risk of cord prolapse) and, as she was preterm, had to be consented for a classical c-section (vertical uterine scar, which leaves one unsafe for a later trial of labor). Fortunately, we were able to do it low-transverse and baby did well. However, this really opens one's eyes! I won't take the "rule out preterm labor" patients lightly for quite a while now! Amusingly, while closing the uterus (baby long out), we got a call from the laboratory to inform us that the FFN was positive.... you think??! :)

WOW
Check out these photos of Ovulation seen in the OR captured by a British OB/GYN, forwarded to me by my FP/OB advisor. Cool, huh?

The other side of things
Today, I switched from OB to Peds and newborn nursery. It is actually quite cool because not only do I know the L and D nurses well, know my way around the L and D floor(s), the OB and delivery paperwork, and how to find mom's info. to fill into the babies' charts, I got to round on some babies that I delivered in the past few days (great for continuity!). It's interesting being on the other side of things! The paperwork is quite tedious, as are newborn exams, but it is, UNlike L and D, very low stress. I got out at 5 p.m. today (I don't think that's happened in about a YEAR!!!!!!), and don't have to be in until 6 a.m. tomorrow. It feels like vacation :)

Well, while my eyes are still open, I am going to try to get some reading done!