Pediatrics!

I think I found my calling.  I really enjoyed Peds!  I think a few good ways to know if you enjoy something include...
1.  You don't mind waking up in the morning to go to work
2.  The day goes by pretty quickly
3.  You don't mind staying later than usual a few times
4.  Staying up all night to do your job doesn't bother you (as much)
5.  The people already doing the job seem to really enjoy their work

Pediatrics was a 2 month rotation, 1 month outpatient and 1 month inpatient.  The outpatient month was split into 1 week of a private practice clinic, 1 week of newborn nursery, and 2 weeks of specialty clinics at Children's.  For my inpatient month, I spent 2 weeks on the Hematology/Oncology floor and 2 weeks on a General Pediatrics floor.  So, I got quite an array of pediatric experiences and I really enjoyed every bit of it.  I liked both sides, the outpatient was more well-child check ups and growth/development stuff, and the inpatient had a lot of pretty sick kids.

Usually, when people don't like pediatrics, they give two reasons.  #1 being the fact that it is difficult to see sick kids because they can't always tell you what is wrong and it is sad, #2 being it is difficult to deal with parents either being super scared and emotional or at the other extreme, being absent.  I actually loved the interactions I had with parents and the relationships developed with them, because they are usually really wanting help and guidance and if they are the absent type, you have a chance to be an advocate for child.  As for watching kids be sick, I felt a strong motivation to try to help them get better, and the good news with kids is that they are pretty resilient and do get better.  It is extremely difficult to watch a child suffer, and heartbreaking when they die, but I trust in God's sovereignty and rest in the knowledge that matters of life and death are in his mighty hands.  As my medical training goes on, I've learned more and more that end-of-life issues are an area where a doctor has an opportunity to help provide comfort, dignity, and loving kindness more than almost any other time.  We had a lecture about pediatric palliative care, and the doctor said something along the lines of all books are different lengths, but every book has an ending, and we can be a big part of making it a good ending.  As semi-cheesy as that sounds, I thought it was a good way of looking at it.  Most of the time though, our goal was to help kids get better and go on to live a long life. 

So, if nothing else changes, I'm starting to look into Pediatric residency programs.  Mark and I have talked a lot about where we'd like to end up, and the cities with the best job opportunities for Mark's field of work are New York, Chicago, LA, and Seattle.  The good news is they are all big cities with lots of different Pediatrics programs, so we'll see where we end up!

Neurology

This semester has really flown by!  I finished my Neurology rotation 2 weeks ago and actually really enjoyed it.  Learning neuro during the first 2 years of medical school was never my favorite, so I wasn't sure what to expect, but it was pretty interesting.  The brain is such a fascinating thing, and the signs and symptoms you see when certain parts of the brain aren't working are so specific to that part of the brain's function.  Some disorders produce involuntary movements, while others cause paralysis.  Some change a person's ability to speak, while others affect language perception.  Some have impacts on a person's memory, cognition, or personality.  Certain strokes can cause a person to completely ignore one side of their body (usually the left), and they won't even recognize their own arm if you show it to them.  So from an academic perspective, it was really interesting to talk about a patient's symptoms and where they localized in the nervous system, but there was not always very much you could do for a patient.  We did a lot of diagnosing and symptom management, but there wasn't always plans for a cure.

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!

Family Medicine!

Next up was Family Medicine! I was excited to start this rotation, but I didn't know just how much I would like it. It was all outpatient clinics (meaning not in the hospital) and I would see a patient, listen to what was going on and do a physical exam, and then present my findings and plan to a faculty physician or resident. I realized that I love education and disease prevention, which is a big part of Family Medicine. I learned about Community Medicine which is sort of a branch of Family that is involved in community health, advocacy, social programs, and improving patient care among many other things. I got to see patients of all ages, from newborn babies to 98 year old ladies and that was really fun. I liked not having any patient population excluded. I got pretty excited about it so Family has definitely made the list of fields I may pursue! There are a variety of settings you can work in, and the training is really broad which excites me. I met doctors who chose their own hours and had a great family life which is really important to me. The more I learn about it, the more I get excited about it, so we will see if that's where I end up! Here is my essay from Family Medicine...

"In the first few months of my clinical training, I have spent most of my time learning about how to recognize signs and symptoms of diseases and how to treat them. I have also learned a lot during my Family Medicine rotation about disease prevention, patient education, and health maintenance. I get excited about figuring out a diagnosis, deciding what steps to take next, and counseling patients. It is exactly what I’ve been waiting for, the chance to practice medicine. However, over the past few weeks of Family Medicine, I’ve recognized that not everything is quite so black and white. Often there are financial, social, spiritual, and educational barriers to healthcare that require flexibility and sensitivity on the part of the physician. It is just as important to find out about those issues as any other part of the encounter. If a healthcare professional does not take the time to ask about different aspects of a patient’s background, then the rest of their plan of care may not matter because a patient may not follow it. Or, they may cause unnecessary emotional strife by being insensitive to a patient’s beliefs or level of understanding.

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."

Surgery Part 2

So much for keeping up with writing things down this year. I had all the best intentions, but free time has come at a premium these days.

Surgery ended about 6 weeks ago now, and I'll be the first to admit that I was very happy to see it go. I learned some valuable things, but I am definitely not going to be a surgeon. On Trauma, we saw patients on the wards from about 5-6ish, and then went to the Trauma Hall in Parkland and waited for patients to come rolling in. We carried a pager with us and it would go off whenever someone was on their way and give us a few key pieces of info to be prepared for. To this day, the sound of that pager gives me chills. I also do not love the whole trauma scene, it is pretty horrific to me but I'm thankful for the people who want to take care of those patients. On my first day of trauma, the first patient that came in ended up dying and it was pretty hard to watch. We have to write short essays at the end of every rotation, and I reflected on that experience...

"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!

Food is Good

Alli is almost done with her surgery rounds, but I've grown to see that cooking is something that I can ACTUALLY do. Here's some more of my creations.

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.

The Grouchy Chef

Now that Alli is out being a doctor most days, I (Mark) have decided to give cooking a try. Alli calls me the Grouchy Chef because when she asks me questions while I am cooking I get really flustered and can't do two things at once. But I don't look THAT grouchy, do I?
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!

MS3

I started my 3rd year of medical school a month ago, and it has been quite a busy month. I brought it on myself though- I purposefully put my surgery rotation first because I knew it would be the most time-intensive and exhausting rotation, plus I am pretty certain that I do not want to be a surgeon. So, the idea was to more or less get it out of the way. I know I won't regret doing it first once it is over and the rest of the year feels a little less stressful in comparison to surgery, but in the meantime, I have been thrown in full-force to the fast-paced and demanding world of doctoring.

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.