Saturday, November 6, 2010
I'm really glad I had the opportunity to experience neurology and I learned a lot, but I don't think I'd want to do it forever. I definitely learned how to do a better neurological exam though, which will be really useful. A neurological exam includes assessing mental status, strength, reflexes, sensation, coordination, and gait, which is useful in any area of medicine. Neuro isn't just about the brain, it involves the spinal cord, nerves, and muscles, so there are a lot of problems people have that would require a good neuro exam. I had a patient during my family medicine rotation who complained of numbness in her leg, and I really didn't know what to ask about or what to look for in my exam, but now I have a much better idea of what to do in that situation.
I started Pediatrics 2 weeks ago (yay!) and I'm loving it! I did my first week in a private practice setting which was a good learning experience. It was a big group of pediatricians, so I saw a lot of different styles and it was a great way to start this rotation. One of the MD's I followed was Dr. Sue Hubbard and she has a great website with all things pediatric. Last week, I spent time in the newborn nursery at Parkland and it was so much fun. We saw so many babies and I loved it! I'm excited for the rest of the rotation!
Monday, October 11, 2010
Many patients I saw this month had financial difficulties that prevented them from receiving the textbook treatments for their disease. It was often necessary to look at the Walmart $4 prescription list to choose medications that would be feasible for a patient to purchase. The five minutes it took to figure out which medications would fit a patient’s financial needs made treatment possible. Sometimes though, patients had multiple comorbidities, so even the $4 medications would add up and a patient was left deciding which medication was the “least important.” Before I jumped to labeling a patient as noncompliant, it was necessary to figure out WHY they hadn’t been taking their medication. After hearing that paying for prescriptions took a huge percentage of a patient’s monthly income, I suddenly became much more understanding and less judgmental of their “noncompliance.” Furthermore, some patients had difficulty finding transportation to their appointments or figuring out how to get childcare. It is easy to tell a patient to come back to do fasting labs or to follow up in two weeks without recognizing how big of a request that may be. Socioeconomic status also affects a patient’s ability to follow certain diets, especially when they have to provide for the needs of children. It is imperative to be aware of these issues and to be ready to counsel patients on less expensive ways of achieving their goals.
Education level also affects the way a patient responds to their disease or treatment plan. It is easy to take for granted that a patient would understand what kind of diet they should follow as a diabetic, when a patient may think they only need to avoid candy or coke. Also, certain conditions carry stigmas in different cultures, so the way information is presented to a patient with those beliefs is so important. I’ve learned that cultural competence, socioeconomic awareness, and being educated on social issues are going to always be a big part of my career. I need to work hard to learn as much as I can about the community I practice in and the resources available around me."
"On my first day of Trauma call, within the first few hours of the morning, we received a page for a Level 1 trauma. The patient had fallen 20 feet on the job and landed on the concrete below. The paramedics were already performing CPR as the patient rolled in, and the nurses and doctors resumed CPR as they moved him to a trauma bed. The room was packed, it seemed like there were 20 people there and they were rushing around, yet it was surprisingly quiet so everyone could hear instructions. I watched as they performed the ACLS protocol and waited anxiously for some sign of life from the patient. After the protocol had been followed through, one of the doctors in the room said, “What time is it?” My heart sank. She called the time of death at 11:17 am and you could see the energy in the room drop and people started taking off their masks and gowns and walking away. The whole thing must not have lasted more than 10 minutes, but it is an experience that I will not soon forget.
It was strange to me how everyone just sort of dispersed afterward. They didn’t seem to be overly affected by the event. They resumed conversations, talked logistics, even smiled. It was sort of shocking to see people just move on. I couldn’t help but wonder how they could just walk off and leave the man lying there. One of the nurses said that we needed to still do a full evaluation of the patient to document the injuries, so I went with the resident over to the patient. It was so strange to see his face and know that he woke up that morning thinking he was heading to work just like any other day. He probably had a cup of coffee, said goodbye to his wife, and may have told her he’d be home by 5. Then I thought about his family. They were about to find out information that would completely change their lives. There was no warning for them, the patient suffered an accident in an instant that claimed his life. And yet, the rest of the team was back in the hallway talking about discharging the guy in the next room. How could it be that easy for them?
Then I started to realize that they were doing what needed to be done to be a good health care team. If everyone were completely crushed for the rest of the day, then other patients and their own personal lives would suffer. Death is a reality on the Trauma Hall, and the doctors and nurses need to be able to pick up and move on from it. Over the course of the next week, I watched other patients come in and became aware of many others in the SICU who had sustained major injuries and may never recover. I think for me, I need to find a line between processing what is happening around me when it comes to disease, injury, and death, and not dwelling or thinking too deeply into it to where I can’t move forward. I want to always respect life, to not take it lightly or to treat death flippantly, but I see now that all patients are not going to have good outcomes and I am going to have to learn how to deal with that in a healthy way. I don’t think I need to stop feeling sad when people are hurting or when they die, but I recognize that in order to be a good doctor, I’m going to have to do my best to treat the things I am able to and accept the things I can’t change. It will be through a combination of prayer, processing things with others, and talking about it at home that I will continue to learn how to cope."
After Trauma was Emergency General Surgery which was probably the roughest part of Surgery for me. We had to be there at 4am most days and were pretty busy all the time. We drove the camera for the laparoscopic procedures which is not a super easy task in my opinion. Maybe its because I never played video games, but it was tough to navigate those cameras when the surgeons were moving their instruments all over the place. I also learned about working with people who are very difficult to work with which was not fun at the time, but I know it was an important lesson. All in all, I think I took a lot away from the surgery rotation, but I couldn't have been happier when it was over!
Sunday, August 15, 2010
Here I am on the way to making another Greek Salad, this time as a side.
It was a side to lamb. I figured I should give it a try since it was the recipe of the same chef that I had ordered it from in New York.
Then I made these Melon Slushes from a cantaloupe we bought at the farmer's market. There is also pink lemonade concentrate and ginger ale in it. They were really refreshing.
For my first pasta dish, I made Spaghetti with Red Bell Peppers and Kalamata Olives. It tasted like The Olive Garden. There was a lot of Parmesan cheese in it.
For a side, I tried to make a Chilled Avocado and Mint Soup, since it has been so hot out, but it was probably my first two thumbs down dish. It was too minty or something. The flavor was just something that you became weary of. Although, it did look cool, so it took very good pictures.
I went to Whole Foods and got a Salmon, big enough for two meals, so that I could experiment. The first night I cut the skin off the part I wanted to cook, which was really hard, and I never want to do again. Then I marinated it in an Asian flavored mixture that had Soy Sauce, mustard, Bourbon, and maybe a few other things. It turned out suprisingly good. Alli previously thought she didn't like Salmon, but now she does. :)
Alli made cookies! She got the recipe from Molly in our home group and they are good! Even better with ice cream.
For the second part of the salmon, I left the skin on and cooked it in a skillet, one side on the stove, and one side in the oven. Then topped it with a tomato vinaigrette. We also made Hush Puppies! They were kind of scary because you fry them, but the dough was really sticky, so it was hard to figure out how to put it in the oil with it in a ball. We took the picture with our two most successful tries.
And we had breakfast for dinner the other day. Ricotta Pancakes with Orange Syrup. They were fun to make and really good. Probably the least healthy thing I've made too. But we made the Orange Syrup by boiling orange juice with orange zest, water, and sugar. I learned words like blanch and julienne.
Wednesday, August 4, 2010
I bought a "Food and Wine" magazine, mostly because I liked the layout and photographs, but have really tried to make some interesting things. My first go was an Omelet with Herbs. It was ok, I think I put too many herbs in it, but it wasn't bad.
We had some ribs in the freezer, so I went all out, because ribs are one of my favorites. We went to the farmer's market and picked up some veggies and fruits for the next couple weeks. This recipe was for Blueberry-Glazed Ribs, so I made this Blueberry Syrup and after putting the ribs in the oven for an hour and a half, you brush this mixture of blueberry and other stuff onto the ribs and broil it until it browns. These were some of the best ribs I've ever had to be honest.
We have a lot of leftover Blueberry Syrup, so I put it in lots of different things like vanilla ice cream.
Next, I made a Summer-Vegetable Casserole that had potato, zucchini, tomato, yellow bell pepper, and onion in it. The dish was pretty good, but was more of a side in my opinion.
When we were at the farmer's market, we also got some red grapes so that we could make this Harvest Cake with Grapes and Sangiovese Syrup.
It was a little lemony and sweet enough for me to enjoy it.
You serve it with a grape syrup that you make by boiling grape juice.
Finally, there was a bunch of Greek recipes by a chef of a restaurant in New York called "Kefi". We went there when we were living in New York and loved it, so I really wanted to make a few of his dishes. So we made these Greek Salad Sandwiches, and they were AWESOME.
We made the dough from scratch, and then you fry it. You spread a tzatziki suace (which we also made) and then top it with the greek salad (which would have been great even by itself).
There will be more dishes soon!
Sunday, August 1, 2010
Mark will be the first to tell you that surgery is not my favorite. While I have really enjoyed starting to finally be involved in patient care and have really liked my residents (they de-stigmafied the "super-demanding, overly-intense and often angry" personality profile they sometimes get), the OR is just not my home. 90% of the time I spent in the hospital this month was in the OR with the patient under anesthesia, and I tend to enjoy my time in clinic and on the hospital floors more. I'm glad I confirmed that though, and now I have at least a little more direction as to what I want to be when I grow up. Also, I have learned so much this month that I know will make me a better doctor in the future even though I won't be going into surgery. I definitely will not forget this experience!
For the month of July, I was on Surgery C at Parkland Hospital, which is the Colorectal Surgery team. Lots of guts and butts. My hours have been really long- waking up at 4:30 AM most days and getting home about 6:30 PM, working Monday-Saturday, averaging about 70 hours/week. Mark has been SO understanding of my inability to stay awake much later than 9 o'clock most nights. ALSO- he has found a new talent/hobby that we will blog about soon, I'll just say that it has helped me out tremendously and it has been a huge surprise that he enjoys it so much!
Starting tomorrow, for the month of August I will spend 2 weeks on Trauma and 2 weeks on Emergency General Surgery. My schedule changes big time- I will be on what is called "Q3" where I am on-call every 3rd night. That means I stay in the hospital for about 24-28 hours every 3 days, but the other days I'm only there for about 4 or 5 hours. So, I'll say goodbye to Mark Monday morning at about 5 AM and not see him until he gets home from work on Tuesday night. Kind of a bummer, but it will only be for a month and only every 3 days. I am NOT an all-nighter kind of girl, so we will see how it goes!
I am learning so much about patient care now that I am finally in the hospital and starting to do what I came to medical school for. For the past two years, medical school has been predominately classroom/lecture work, but now I am full-time in the hospital. It is a HUGE learning curve. I know a lot about disease process and physiology, but I know very little about how to take care of patients in the hospital. Even the everyday things like how to dress a wound properly, how to manage IV fluids, what to pay attention to on a daily basis to track a patients progress. Most of the time I feel really dumb, but I have to remind myself that it takes time to learn all of this stuff and everyone in my class is in the same boat. I don't know how many times this month I was asked a question and had no clue what the answer was. But, I know it will come and I will just have to keep reading and asking questions. It can often be a frustrating place to be though.
I LOVE seeing patients everyday. I have really enjoyed the relationships I've made and I have learned so much from them. I've learned that you can't expect to approach different people the same way and expect the same results. It is so important for me to know my patients well so that when something changes, like Mr. J this month who just wasn't himself one morning and ended up having an infection in his abdomen, I can be aware of it. I've also become intensely well aware of how much of a blessing my health is. Some people are just sick all their lives- one thing after another just keeps breaking down. It is so difficult to watch, yet so important for me to be present for. It is going to be such a great privilege and responsibility, and one of the main reasons I chose medicine, to be there for people when they are vulnerable and hurting. I am going to learn so much this year and on about what my role is in that situation, which brings a lot of mixed emotions. On the other hand, it brings so much joy to see patients get better and go home, and it makes the hard work worthwhile, to learn what I need to do to help patients get better.
I think that's enough for now. I fly through a lot of thoughts and emotions lately and I want to remember them, so I'm going to try to keep writing more.
We got there on the weekend, so there were a lot of tourists in the park. Mark and I thought it would be a good idea to go for a harder hike because then there wouldn't be so many people. Mark looked up a trail that sounded a little tougher, but led to the tallest waterfall in the park. I love waterfalls so I was sold. Little did we know......
We started up the smaller trail and it got really tough. Every step was uphill and we were drenched in sweat. We came upon a group of people and asked how far from the top we were, they smiled and said that we hadn't even started the hardest part. There was one point where Mark asked me if I wanted to turn back. I told him in a very serious voice, "I'm NOT going back." We were determined to finish. And finish we did! We finally reached the cascades and it was beautiful. We were beyond exhausted but pretty proud of ourselves for finishing. I was, however, wishing I had brought 3 fewer books and 1 more powerade. Oh well, you live you learn.
We stayed for a while, put our feet in the water and took some pictures. Then we realized that it was getting a little later in the day and we still had a 4 mile hike back to the car, so we started down. By the time we finished, we were fully exhausted and our feet were hurting pretty bad, but we came out alive! The soreness the next day is another story...
The next day we decided to go for a scenic drive and go to the highest point in the park, Clingman's Dome. It is only a 1/2 mile hike on a paved road to the top, so it was nothing to us. We took the rest of that day and the next off to rest and watch more of the World Cup.
After a few days of resting, we were up for another hike. We were more careful this time to read about the hikes- realizing that Ramsey Cascade's is rated as "strenuous" and we gained over 2000 feet in those 4 miles up. We went for Rainbow Falls, a shorter hike to the highest single drop waterfall in the park. It didn't disappoint!
On the way down, we saw some giant catepillars. We loved all the nature around us, but were absolutely fine with not seeing a bear this time like we did on our Thanksgiving trip.
The Smokey Mountains is one of our favorite places now. We decided that it could be a neat place to take our kids one day if its possible. It was so fun to get away from the city for a while, have some fresh air, and appreciate God's green earth!
Mark and I had our first anniversary last month. It is hard to believe that a year has gone by since our wedding day. At the same time, it is starting to be hard to remember what it was like to not be married to each other. I know him so much better than I did a year ago and appreciate him so much more.
Many people say that the first year of marriage is really hard, but I can honestly say that we had a fun and happy first year of marriage. While there were some things to get used to, like figuring out how to find a happy medium between my semi-obsession with keeping things clean and in order and Mark's, well, lack of obsession, and learning how to approach finances, we came out of the 1st year feeling even more in love and excited for the future. Marriage has been the greatest catalyst for spiritual, emotional, and relational growth that I have ever experienced and has pushed us both towards maturity. I'm thankful for the ways it has made me let go of, or continue to try to let go of, areas in my life where I can be so selfish and self-centered and move toward putting another person's needs first. It also helps that I am married to a man who is so forgiving and makes it easier for me to apologize :)
Mark gave me the best 1st anniversary present I could have ever imagined! He made a book with pictures and descriptions of all the things that happened during our 1st year of marriage. I love it now and I can't wait to share it with our kids one day! You can see some of the pages on his website - marknlopez.com
The bakery we got our wedding cake from made us an anniversary cake so we didn't have to eat year-old cake. I guess it kind of ruins the fun of it, but at least the cake didn't taste like freezer. We had it for over a week though because it was packed with frosting. We had a bottle of champagne that we saved from our wedding which turned out to be a golden-yellow color and disgusting, so we had part of the experience. The champagne in the picture was a fresh one :)
We went on a wonderful anniversary trip that Mark planned and he's going to put up some pictures of it soon. It was a huge blessing for us to be able to get away and spend some time together because life has changed in a big way since I started my 3rd year of medical school. More on that to come!
Monday, June 14, 2010
Sunday, May 30, 2010
Sunday, April 18, 2010
I've never been to a toddler birthday party, and it was pretty awesome. The kids are loving everything about what they are doing, except every kid has to have one melt-down. But, as soon as its over, they are back in the game. Amazing.
The newest addition the the Lopez family, Lucy Lopez!!! She was born March 7 and is such a cutie! She looks a lot like Annie and it is neat to see Annie be a big sister! Can't wait to see them again!
Bryce changed so much from the last time we saw him, which was when he was only a few weeks old. He is such a little boy, and so fun to play with. Just a happy-go-lucky kind of guy.
Lydia, Bryce, and Jo. They are growing so fast and change everytime we see them!
We went to Phil's Ice House for dinner one night and took some family pictures.
J and Sally, with Annie and Lucy.
Sally's sister Molly with Annie. Molly is an AMAZING chef. Check out her site - Vanilla Orchid.
Greg and Britt with Jo, Lydia, and Bryce.
The whole gang! We love the Lopez's and Burton's!
Saturday, April 17, 2010
This was my team on day 1 at our first clinic. I really enjoyed our team, so many great new friends!
Each team had doctors with them to help/teach/encourage/make sure we didn't hurt anybody :) We had Dr. Zee (left) and Dr. Yam (right) and everyone loved them. They were both so encouraging and loving and taught me a lot about the kind of doctor I want to be.
End of day 1 outside the church. It was a great day filled with learning how to really be a doctor. It is amazing to think about how much I learned that week, thinking back on how comfortable I felt with everything by the last day compared to the first. My last patient of the day was a man I don't think I'll ever forget. When I was running through the basic questions you ask everybody pertaining to their history like "Do you smoke/drink/do drugs?" he answered no, and that he quit 7 years ago. I told him that was a great thing, and he proceeded to tell me why he had quit. He had been living in some of the greatest darkness and sin I've ever heard about firsthand from a person, and a he told about a lady who shared about the love of God and his Son, Christ, with him. He became a believer 7 years ago, and his life changed dramatically. He couldn't help but tell me all of the details of what had happened because of how much joy it brought him. By this point, we were both in tears and he said, "If God can save me, He can do anything." It was such a testament to God's grace and I was so thankful that he felt so compelled to share it with me.
Day 2 of clinics, at our next site. We set up exam rooms in random rooms in the church, I'm pretty sure this one was the nursery.
A sweet family we treated. The little boy was so animated and cute!
Day 3, at probably the nicest facility we had seen. It was great to have a little more space.
This was a really nice mother and daughter that came in together. I think it is going to be really hard to choose what I want to do as a doctor, because I loved seeing kids, adults, and the elderly. They are all different in their own ways, but so fun to talk to and learn from.
We were right next to Juarez, Mexico. You could see the fence dividing the US from Mexico. A lot of our patients were from Juarez. I found out that El Paso is the 3rd poorest city in the US, which really surprised me. I hadn't seen poverty like that in the US before. Even so, right across the fence in Juarez was even worse. The disparity that exists in our world is unbelievable.
Our makeshift exam rooms. Most doctors offices have high-tech, thousand dollar tables. We used desks. It worked fine, but I did find myself wishing we had better things to offer our patients. They didn't seem to mind at all though.
On our last day, the church we went to was in the middle of nowhere. It was what you picture when you are thinking of desert El Paso/Mexico. There were already a bunch of people waiting for us when we arrived, and we got going fast. My "exam room" that day was a table set up in the corner of the room. Not exactly private, but again, no one seemed to mind at all. I was so humbled by how kind and thankful the people we saw were.
Finished on the last day! We worked hard, but we also had a lot of fun. It was a good reminder of why I am doing what I'm doing. I won't lie, 2nd year of medical school hasn't been my favorite. I study more than ever in my life, and it wears me out. I have had plenty of moments where I've wanted to just put everything away and go become a teacher or anything else that doesn't require me continuing this marathon. But, then I get to go on a mission trip, or we visit patients in the hospital, and I feel refreshed. I only have 3 weeks left of 2nd year, and I couldn't be happier. Life is going to change pretty dramatically in July though. I will go from studying all day to being in the hospital all day, which will carry its own challenges but will be much more exciting. Mark and I are trying to prepare for the crazy schedules and such. I'm so thankful for how supportive he is. He is a big part of the reason I'm still in this game, he is always encouraging me and having patience when I'm crazy. His personality is great for the part too- not too much shakes him up so it reminds me to chill out. I love that guy.