Initiation

Today is June 30th, which means it is the end of the residency year (Hallelujah! Three down for me, one to go!). New interns started on July 25th, but "upper years" switch on July 1st. July 1st is the source of much dread... some people (patients) worry they will get appendicitis in July (where new surgery interns are salivating over OR time). Some others worry that they will have their baby in July, when an OB intern might have his/her first "whole" delivery (I delivered a lot of babies' heads in med school but, until I did a fourth-year rotation at a rural hospital, usually got bumped out of the way by a OB resident).

This is a tricky time of year. There is a very steep learning curve. I was on (acting) OB chief call for 24 hours this past Saturday with a new OB intern, and it was perhaps one of the most challenging calls as a "senior" that I have had to do. It doesn't seem like that long ago, but I was brought back to teaching a newbie how to do basic triage and admission orders, an AFI/Ultrasound in triage, a speculum exam and cervical check, writing thorough notes, finding vitals, labs, and notes in EMR, and covering the gyn onc service. She did fantastically, but I felt kind of like an intern. While it has been a long time since I was "initiated," I was reminded very much of how overwhelming it can be.

It was in a way refreshing to realize how far I've come, and how fast we have become at getting these tasks done compared to that first, heavy-learning year. It is great to see the large knowledge jump between intern and chief. However, I'm still a bit nervous about playing the role as chief. How do I be patient, but make sure that things get things done in a timely fashion? How do I give people their freedom, yet make sure things don't fall through the cracks? How do I give feedback without coming off as critical? As I've written about before, I am terrified of being a "mean" chief; however, I also don't want to be the one that the nurses, other residents, and attendings don't respect by being too "nice." It's a very hard balance. I am worried I don't have the confidence. At one point, late in the night, I literally tried to Vocera (call on the walkie-talkie) "OB Chief" and realized that I was OB Chief! It will be a tough year, not only for interns, but us chiefs. We'll see how the next call, July 2nd, goes (no more "acting"-- this will be real chief call!)...

In any case, there is time for intern and initiation fun. There is no hazing that goes on in residency. We (especially the out-going interns) welcomed the new interns with open arms (it was a great relief, as an intern, to see the "new interns," or replacements/reinforcements, arrive, as it meant that much less time for us!).

Last week, we had some great intern-chief FP bonding through Peak Adventures, a local company who specializes is team-bonding activities. We did lots of low-ropes activities, which were both quite challenging and really fun. It was neat to see the new interns' personalities come out in leadership and team situations.

Enjoy these pictures...

The whole group of us

Puzzling balancing act...

... headed towards the solution....

... Voila!

Team "Jelly," balancing on a platform

... and having a great time

Three chiefs (me with Ashby, Kristin)

... and four chiefs (+ Kelvin)

Goodbye, outpatient surgery; hello orthopedics.

365 days of residency to go (I should get a ticker for this blog!).

Deep breath. July 1st, here we come!

In the Patient's Shoes

We have spent so much time training to be, and now being doctors. It has sometimes been hard to remember what it is like to be on the "patient" side of things.

I was reminded today when I went to the dentist.

I actually remember the first time I tried to set a dentist appointment while in residency, which was at the end of intern year. If you can imagine that, some months, we work on average, 13-14 hour days from 6a - 7 or 7:30 p.m. and don't know about days off until "the month OF," scheduling appointments is rather tricky. I had this very grand plan to go to the dentist on a Thursday morning after working a week of OB nights, because on nights you actually have the daytime hours to run errands. I planned the appointment months in advance, because it is really hard to get an appointment on short notice. I remember getting a reminder phone call the day before (waking me up from sleep), reminding me of my appointment time.

But, as you can imagine, dental appointments aren't very high on my priority list (I actually despise going to the dentist... sorry, Rach!). Especially after a hard, sleepless night on OB at the end of a week or two of nights. It wasn't until later in the afternoon, when I got a phone call inquiring about why I wasn't able to keep my appointment, that, in total shock, I realized that I had totally DNKA'd! (DNKA, in our world, stands for "did not keep appointment."). I had biked home from work in a sleep-deprived state and totally missed the appointment time that morning. I was so, so frustrated at myself, as I generally consider myself to be a pretty responsible individual. I am a doctor, for heaven's sake. In our clinic, I find myself often frustrated at patients who schedule appointments in my schedule and then DNKA (no-show), preventing other deserving patients for using that spot for medical care. But, obviously, I can be a lousy, flaky patient and was guilty of DNKA-ing myself. Oops. And then I had to reschedule the appointment-- at the next available which worked for me, which was about 3 months later. Luckily, I remembered that time.

I have managed to get in to see my PCP (primary care provider), an attending in our own FP clinic, twice in residency for routine health maintenance and much needed allergy medications, but this has also been with much reluctance and lots of schedule planning. Apparently we are supposed to get time off to be able to attend medical appointments in residency, but never have I found this in the slightest bit convenient. And I refuse to every "jeopardize" someone to cover my other clinical responsibilities for something like this.

In any case, back to my being a patient. After reminding myself daily for the past 2 weeks that I had a dental appointment today that I couldn't miss, I found myself madly rushing over there after noon conference, hoping I would not be "that patient" who was then late. Luckily, I wasn't. I was rushed right in and they commented, "Wow. It's been a while since you were here." (You bet it has -- probably a year and a half!). Then they X-rayed, poked, prodded, polished, did the usual annoying dentist stuff, and then gave me a clean dental bill of health which I always find slightly miraculous with the large amounts of coffee I drink and the not-so-large amounts of flossing I do.

And then came the "time to discuss follow-up."

The dentist said, "So, can we expect to see you next time in sooner than a year and a half?"

Me: "Um.. well, I will try. I'm not sure what my schedule is like/where I'll be next year."

Dentist: "What? Are you moving?"

Me: "Well... not exactly. I just have a hard schedule to work around. It's hard because I often don't know very far in advance when I have time off to be able to come and then, when I call, you are often booked out for many weeks."

Dentist: "Well, we'll send you a reminder postcard a month before, and would really like you to come back in about 6 months or so."

Me: "Okay...I will do my best to come back in January."

It was good to re-live this today. I am certainly guilty of being a bit self-centered and expecting patients to show up at times that conveniently meet our schedules and our scheduled clinic days, when they may certainly may have other, more important commitments. Surely their perception of the importance of blood pressure monitoring and control (compared to their kids' or family members' life events) may not be on the same importance scale as ours, when we are the ones in the office and they are the ones rearranging their lives to come in to the doctor to see us.

I will try to remember this, and how it feels to be a patient being "told" to do something regularly. Maybe this year I will floss regularly. Maybe I will be a better, more compliant dental patient and not let another year and a half elapse before I see a dentist again.

Maybe.

More TVs than I need

I am not a big TV-watcher. Yes, over the years I've gotten into shows including "Friends," and more recently "The Office" and "Glee." I like watching a good basketball game (except when Lakers win) and most sporting events; however, I don't get cable at home, and I don't really miss it. I find that I don't have all that much time, I enjoy reading too much, and now there's something called "Hulu" online.

Kelvin, however, enjoys shows and is disappointed at not being able to watch them (real time) at my apartment. Apparently I don't get any kind of reception to even get basic channels on my small 16-inch TV, the one and only TV I had, which works perfectly well for watching DVDs and things. We recently re-initiated Netflix and thus have been watching a good number of movies.

Original TV (#1)

Kelvin tried using his antenna and converter box from his house over at mine, without luck.

So when Phi moved last weekend and was trying to get rid of stuff, I accepted a large (?27 inch) TV in K's hopes that it might get better reception in my place and be able to pick up basic channels.

TV #2

It didn't. So then I had two non-functioning TVs.

We have visited Target, where we have picked up a new antenna and converter to try to pick up signal here.

No luck. With either of the TVs above.

So the next step, this past weekend, was to scope out Best Buy to get a new flat screen HDTV with hopes that all of the above problems would be miraculously solved.

TV #3

They weren't.

So there you have it. While I've been really trying to get RID of stuff (I miraculously successfully sold a foot massager on Craigslist and am working on getting rid of a stairstepper), I now have three pretty good-sized TVs in my living room.

(Two of the three)

Two are able to be returned, which I feel will be happening in the near future.

I still don't feel that I am rich enough to justify spending money on cable each month.

I guess we're just not "meant" to watch TV at my apartment! Bring on the books (and book recommendations) :)

Goodbye, chiefs, hello interns!

This last week and weekend included more graduation (and welcome) events for the outgoing chiefs and incoming interns, respectively. Thanks to everyone who was actually good about photo taking, as I can "claim" to have snapped about 5% of these photos :)

Last Wednesday, Wai Kiu graciously hosted a welcome dinner for the new FP interns at his house, which was held outside on the patio which is just perfect for entertaining. We sat under the shade having great Mexican food, playing icebreakers, and getting to know one another. We attempted to take a picture in "timer" mode which was marginally successful.

Saturday was the OB department graduation downtown. It was, as usually, very fun! It is always nice to see people dressed up (OB residents virtually live in scrubs!) and with their families.

Goodbye, chiefs! (Elizabeth, Kyla, Aisha, Jen, Ashley, Erica, Shanee)

My chief class (Priyal, Julia, Charmian, Lucy, Gaea)-- I think I was in the bathroom or something when this was taken, and Alex wasn't able to make it!

Here I was included :)

Congrats, you're almost done! (Current OB interns, with 7/7 turnout- Natalie, Andrea, Mike, Stephanie, Jessica, Anna, Alison!)

New OB interns!

OB two pyramid!

Joe loves being the sole male in their class :)

(with Sarah, Cara, Ingrid, Siobhan, Pia)

FP OB picture (me, Jessica, Kyla, Joe, Suzanne, Blanca)

me with Kyla and Stephanie

On the dance floor!

Dr. B hosted a pool party over the weekend to welcome the FP interns. There was great food, and fun karaoke which I'm finding really makes a California party!

Mason, Brian, Rachel

Kelvin w/ Mason

Kim, Vin's legs, Mason, and us

Mason (7 months), thinking about standing

Mad karaoke (Caesar, Kristen, Jose)

The social gatherings continue- Monday night was the FP department welcome dinner (Italian) at Espanol restaurant and there is a breakfast this morning. I think we have an FP ropes event Wednesday afternoon, OB chief dinner on Wednesday, and then Friday, the new interns start! Whew!

Alaska News

The good news:

• I am going to Alaska for a two-week family medicine elective in August- I was able to arrange a short rotation with a clinic in Wasilla (home of Sarah Palin), an hour from Anchorage. While it's not too far into "the bush," I am very excited about this opportunity to get some outside training!
• My Alaska resident license should be on the way in the mail, after countless hours and considerable cost spent completing very cumbersome paperwork which gave me many gray hairs.

The bad news:

• Bears attack people in Alaska. They attack bikers!

Per CNN today:

"Alaska man survives bear attack"
(CNN) -- A bicyclist riding to work in Anchorage, Alaska, was attacked by a brown bear Tuesday, police said.
Sean Berkey, 45, of Anchorage, was riding his bicycle to his office at the medical center where he works as a pediatric pharmacist. He was crossing a wooden bridge when a young female brown bear with a cub began to charge him, police reported.
Berkey tried to place his bicycle between himself and the bear, but the bear was able to attack him, police said. He suffered an ear laceraton, puncture wounds to his right calf, and several scratches."

Yikes!

The good news:

• He survived

What this means:

• I need to become a faster biker... or get a rental car for my time there!

:)

Another graduation, more goodbyes

FP Graduates, 2010

Saturday was graduation #1 of this year to sit through-- the Family Medicine department graduation. I knew it was coming; these past few weeks, I watched in mild jealousy as my classmates coasted through their last days of clinic while I am still struggling to keep up my patient numbers, and watched wistfully as they started completing their "graduation checklist" while I know I have another year of "jail." I have known since starting residency that I was in a four-year program and that I would "outlive," in a way, my original third-year classmates; however, watching them all finish was still difficult.

I have written/commented before that I think that residency is kind of a hard time for making truly close friendships, due to limited time and conflicting schedules; however, I think the rigors and pain of so much of what we go through automatically builds in a type of bonding which words can't really describe.

I will miss my classmates so much. The people that graduated Saturday included the FP psych troopers (5 year program!) Alvin and Joby, who were third-years when I started residency, Kyla, who was the first person I met coming to Sacramento, who greatly influenced my choice of this FP/OB program and who served as a "big sister" all along, and all of the people (minus Michelle and Betza, in the FP/Psych dual track) who started with me as interns. They are done with residency in three, and I have one more year to go (M/B have two).

While we still have half of block 13 to complete (new interns start around 6/25) and because many people are still around and in clinic until the end of the month, graduation wasn't a true goodbye for all. However, there are some (i.e. Phi) who intelligently scheduled vacation for the end of the year, literally took off right after the ceremony, and I'm not sure will be coming back from the East Coast for a long time.

I'm excited that Amy and Jeremy will be staying on here as sports medicine and faculty-development fellows, respectively, and that most people will be relatively close (within a couple of hours, if not right in town) in their new jobs, but it definitely won't be the same. I have other friends from medical school across the country who are also graduating this month-- some of whom are relocating to places as far away as Turkey (JB), doing fellowships (Tia), or chief years (Erin, Les). It seems that this is another one of those junctures in life where lives take new directions.

It is so odd to not be the one leaving. I imagine that what I'm feeling is what many of the MD/PhD students at medical school felt, when we, their original "traditional track" students, left prior to them even starting their year 3/4 clinicals. While I have really bonded with my "new class," and have a wonderful group of residents (current interns-- who were also congratulated on graduating from arguably one of the hardest years of life, current second-years, and my OB classmates) who will still be here next year, it feels weird to not be graduating with my original class. I am usually the one who is taking off to a new location or stage in life, and, this time, I am not the one getting ready and excited to start a new adventure. I feel very much as though I'm being left behind.

On a happier note, we did have a fun pre-graduation karaoke party at Phi's on Friday, which served as somewhat of a sendoff. The Delta King (boat on the River in Old Sac) served as a nice venue for graduation this year. Here are some (mostly stolen-- thanks, Wai Kiu and Amy!) pictures from the events:

Jlaw- true musician

Phi- irreplacable

Me, protecting Mason's ears amidst the raucous singing

Serena and the little one (who we hope will convince her that kids can be a future option)

Graduation night:

Happy grads (Mahsheed, Amy, Phi, Kyla)

Goodbye to these three fabulous chiefs: Amy, Phi, Jeremy

my favorite Natomas boys

...and girl

with Kelvin

with Kimie, who I'm thrilled to know will be around for 2 more years!

FP/OB photo


Next graduation: OB graduation on Friday.

I think the next one after that might be mine. Should I start a countdown? :)

Doggie days and down time of summer

This past weekend was the first weekend in a long time that I just stay put. While I love to travel and explore new places, it was so nice to relax... at home... and do fun things in good-ol' Sac-town!

Thanks to Swati for organizing happy hour at Kasbah Lounge on Friday. The wings, falafel, company, and yogurt dessert at Mochii (it's been too long...!) made for a great evening!

Thanks to Jose who reminded us that, on Saturday, Sacramento hosted the 17th annual Doggy Dash to benefit the SPCA. You could register yourself and your dog in the 5K run/walk to help raise money. You (well, your dog) could also enter a host of other fun events, such as the "Running of the Pugs" (complete with heats! Alas, we missed this one!), pup contests such as "Ugliest Dog," "Best Wag" and "Look-a-like," as well as relay races. They also had a police/K-9 demonstration.

It was quite amazing to see so many dogs in such a small area (Land Park is pretty huge, but it was virtually overrun with canine creatures!). There were booths, hot-dog (ha ha) and other food stands, kiddie pools for the pooches on a warm day, and "interest-groups" including things like "Pitbull Owners and Friends," etc., where you might see a group of 10 owners with their similar-bred doggie friends :)

It was pretty cute. Although I went dog-less (sniff... perhaps I can get one sometime in the near future), I got to see tons of cute ones and get my doggie-fix for a while. I also was ecstatic that I came away from their without stepping in any of the doggie droppings that were a realistic ever-present danger at such an event.

Here are some snapshots from the morning:

Ah, doggie patience. I, as a small child (not my dolls), used to ride my dog, Khumbu :)

Cooling off

Greyhound focus group

Getting ready for the relay race!

...in action!


There was this once miniature schnauzer that really tried his hardest to keep up in this race with the border collies that seemed to dominate. The hilarious thing was that every time he finished a run, he'd bound the 4 feet or so vertically into his owner's arms. This never failed to crack me up! Ah, how I miss our old mini schnauzer (our first family dog), Toccata, who died about 10 years ago and sweet Duncan/Freya, the crazy Cairns back east with my parents.

Saturday was finished out with precepting at Clinica Tepati (free clinic in Sacramento serving a large Hispanic population), cooking steak dinner (I have been quite good lately on the cooking spree!), and falling asleep to a movie (typical).

Sunday included church, errands including shopping at Costco (my favorite!), Macy's (ugh! but free stuff with gift cards), some lazy reading, and then a show at Arco Arena; Cirque du Soleil's "Alegria."

The show was great! The acts included amazing trapeze artists, a balancing strongman, bouncy gymnasts (a bit reminiscent of "dodgeball on trampolines"), a spinning guy in a big ring, fire dancers, and more. I am always so impressed by the performers' talent!

We then had yummy sushi at Kobe (directions including "next to the Pole-dancing studio," per Wendy) and called it a night.

Sacramento surprises me so much. It has fields all around it, phenomenal weather, virtually no traffic, diversity, great restaurants and quite a lot of "culture." I really like living here! Perhaps I should stick around for more weekends from now on ;).