tag:blogger.com,1999:blog-72750901084879216862024-03-12T21:50:46.491-07:00Anesthetic MedicL.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.comBlogger194125tag:blogger.com,1999:blog-7275090108487921686.post-24307672744578188572013-02-09T12:26:00.001-08:002013-02-09T12:30:08.355-08:00What I Should RememberSo I'm a resident. Residency is tough. It's called residency because in the Old Days, training physicians, much like old school apprentices, mostly lived in the hospital. "Resident Physicians." While arguments can be made that in that time residents learned more than we ever could, over time patients started demanding their physicians to be alert and awake. People started to worry about whether it was safe for doctors to work a bzillion hours a week and still be alert enough to perform surgery in the wee hours of the morning. There's a lot of debate about this these days, and there are valid points on each side, but ultimately we have moved to a system where residents can work no more than 80 hours a week, averaged over a 4 week time span. For some people, this will seem like it's not too bad, and for others like their own personal hell.<br />
<br />
Regardless of how you feel about the hours, it's a stressful time. It's a time of learning to do surgery (for those of us like me that are in a surgical subspecialty) on living, breathing people. And do it under pressure. This can amplify what the hours feel like, and make for a particular breed of exhaustion. <br />
<br />
But that being said, I like my job. When I pull a baby (emergently) out of an abdomen during a cesarean section, I feel like Superman. It's an incredible privilege to be given that responsibility. Likewise, when I help someone get through labor without medication, when they start to think they can't, I am allowed to be there for someone at a time of incredible vulnerability. It's a huge honor. I have been there for women when they find out they have cancer. I have been there when the cancer is completely resected and they are, for all intents and purposes, cured. I have been there when they find out they cannot be cured. All of it is part of my job and I'm grateful to have the opportunity.<br />
<br />
And job aside, I get to come home and be a mom, and a wife. I have a family who, ever so gracefully, tolerates and makes possible the hours and stress that make this possible for me. A lot of people ask all the time, "how do you do this residency thing and be a mom?" I say - how could I not?! In medicine it's so easy to say, "I'll start doing xxx when med school is over. Or maybe when residency is over, or maybe when fellowship is over..." But I get to come home, every day, and get back to the "real life" that I decided not to wait for. It gives me something to look forward to every day, and reminds me why I ever decided to do this at all.<br />
<br />
Residency is certainly hard. In my frustrated moments I want to blame absolutely everything that goes wrong on residency. But some days, I need to remember all those things that made this, and continue to make it, what I want to do. Am I (sometimes) overworked? Yes. Per hour, am I (somewhat) underpaid? Sure. But am I (100%) glad I did this. When I'm being honest, I am. And sometimes I just need to remember that.L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com2tag:blogger.com,1999:blog-7275090108487921686.post-45787220245075176052013-01-27T17:44:00.001-08:002013-01-27T17:44:05.060-08:00OverheardWe had our yearly in service exam on Saturday. As I was leaving the test I was walking behind an elderly couple. This is what I heard:<br />
Nice Lady: Is it really 2:30 already? How did it get to be so late?!<br />
Adorable man: I don't know, there was this beautiful woman I was with who kept stopping in all the shops....<br />
<br />
Made my day.L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com0tag:blogger.com,1999:blog-7275090108487921686.post-47730740962741244632012-12-16T19:53:00.001-08:002012-12-16T19:53:43.848-08:00A long, long timeWell, it's been almost 2 years! No big deal. <br />
<br />
A lot has happened since I've been here last. We moved to Minnesota, I started residency, I considered leaving residency (for emergency medicine), and I decided to stay in my OB Gyn residency. Overall, it's been a big 2 years.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-ZGwHXCNz3QM/UM6TPyC2KKI/AAAAAAAAAZY/XEFMemg6YQs/s1600/image.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="http://4.bp.blogspot.com/-ZGwHXCNz3QM/UM6TPyC2KKI/AAAAAAAAAZY/XEFMemg6YQs/s320/image.jpg" width="320" /></a></div>
For now, though, let's just jump to the present. Kendall has us wrapped around her little fingers. She's walking and talking and constantly cracking us up. She's gorgeous and perfect, and she reminds me everyday of why I ever wanted to be a mother. I know this is what every parent feels, but it still shocks me every day.<br />
<br />
I love what I do. I love obstetrics. I only want to do obstetrics, and will probably try to do maternal fetal medicine to that end. We love Minnesota (shocking, yes?) and we love the life we're building here. <br />
<br />
Overall, it's been a really great 2 years. Bumps, yes. Long hours, yes. Constant inadequacy, of course. All I can say is I've learned so much, and have met such amazing people to help me become a better physician.<br />
<br />
I'll try to update more frequently than biennially, and will hopefully update you on when we'll be making visits back to Colorado or other parts of the country. Just letting you all know we're still alive!<br />
<br />
<br />L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com0tag:blogger.com,1999:blog-7275090108487921686.post-83079190358991172972011-05-19T21:27:00.000-07:002011-05-19T22:31:55.015-07:00WowSo, it's been a long time since I've blogged in any way, shape, or form. Today is a huge day. I finished medical school today! Graduation is actually next Friday, but all requirements are finished as of this afternoon at about 2:15. I am now certified to save someone by shocking them. It's a big responsibility, and a huge burden at the same time. I'm excited to take on that mantle, but so scared to screw it up. I know that as I transition to an intern, resident, and ultimately an attending, that I will probably lose my perspective on what it is that truly drew me to my field, and medicine in general. To this end, I think tonight is the apropos time to write about what, at this moment in time, draws me to my profession.<br /><br />As an OB/Gyn, I will be a surgeon. I love the OR. I love the dance that is scrubbing and gowning up. I love the routine of a specific cycle of washing one's hands, the feeling that you'll never be so clean in your life. The feeling of being gowned by such seasoned staff who know how to touch anything and keep it sterile. The twirling of your body as the gown is tied in place, like a ballerina in pirouette. The learned ability to maintain sterility while being allowed the privelege of reaching inside someone. The trust required to allow you to heal someone from the inside out. The ability to find the best path to follow surgically, and knowledge that after closing, and withdrawal of anesthesia, the patient will feel better than before. <br /><br />I also love being an OB. To bring life into the world. To face so many complications and stare back at them, ready to take them on. To protect the most vulnerable form of life in our world, while protecting those that would bring them into it. To care for mothers who are scared, unsure, excited, nervous, etc, about bringing a new child into the world is a privelege and excitement beyond mention. To help those who are not ready; and to comfort those who are in the throws of loss is a task that very few take, and fewer attain proficiency in.<br /><br />I will learn courge, in the face of fear and possibly of certain death. I will learn true empathy in measures unknown to me as a medical student. I will learn to bring someone back from the brink of death and manage their new, complicated life. I will learn to be a friend and advisor who does not, can not, flinch from difficult decisions. <br /><br />I will also learn to seek help. Help from friends and family when things go poorly. Help from mentors and superiors when I don't know what to do. Help from the depths of myself when I am not sure where my conscience wants me to go. No man is an island, and neither is this woman. <br /><br />I will also learn to go home. To go home and greet my family as if no baby has died today; as if no mother had complications. I will learn to love every moment of my happy life for what it is; a gift that as easily as not could be blinked out of existance.<br /><br />I am not a particularly faithful person. But I know that in this life we are guided. I know, that despite the choices presented, I was not randomly assigned this path in life. I believe it is my purpose to do this good; to help those whom I am trained to help, and to ask little in return. <br /><br />I remember when I was in college and dating someone who was clearly not my match (as J obviously is!). I told him that merely graduating and making money was not enough, that I wanted to make a contribution. He asked, "a contribution to what..." <br /><br />I want to do something greater than myself; to help so many that I might not otherwise ever know. I want my contribution to be to those who need me. A person who needs an empathetic ear; a teenager so afraid of her parents she feels she has nowhere else to go; a family that desperately wants to expand and share their love. <br /><br />My life can only get better in this practice of medicine. It's been such a long road, with so much more to come, but I know that in the end what I do will make a difference to so many people; starting with me.L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com1tag:blogger.com,1999:blog-7275090108487921686.post-81558910155704107742011-04-02T13:42:00.001-07:002011-04-02T13:46:38.690-07:00And we're....moving!That was a bit of a shock to us! We didn't really even consider the possibility. But, in the realm of, when one door closes, another opens...we're headed to the Mayo Clinic. This is definitely a good thing! I will no doubt get exceptional training there and in the end, I will be able to do anything I want. The only down side is having to move. We've really grown to love Colorado, and I never relish the thought of moving. Blech. We're trying to get all of our things out of the house now, and we plan to rent it out for the time being since the market is so-so at best. <br /><br />It's been a whirlwind for sure, but now we have a few months to gather our wits about us before the really hard stuff begins. There are days when my panic of moving definitely gives way to the panic of actually being responsible for patients. Scary stuff. The first time I tell the scrub tech "knife to me" is going to make my mouth dry and my heart pound, but I'm starting to feel like it's time to move toward that. And in some ways, even look forward to it!L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com2tag:blogger.com,1999:blog-7275090108487921686.post-53248237110952233422011-03-16T19:06:00.001-07:002011-03-16T19:11:34.184-07:00WowWell, tomorrow is the big day! I felt like I would be freaking out a lot more than I am. I guess it can be chalked up to feeling like I've already wasted too much good anxiety on this! I'm hoping for the best, but preparing for the worst, which has substantially improved since Monday. On Monday I found out that I would be matching into OB/Gyn. This means that I will, come hell or high water, be beginning an OB/Gyn residency come late June. Now just to find out where!<br /><br />I can't help but feel like Match Day is in a lot of ways a bigger deal than Graduation. After match day all the pieces come together. I know that my class is all bracing themselves right now. Tomorrow is a huge day, and I know that it's totally possible it might be an awful one. I'm cautiously optimistic, secure in the knowledge that in 4 years I WILL be able to practice Ob on my own. <br /><br />I'm sure I'll be posting on facebook at about 11:01. Stay tuned!L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com3tag:blogger.com,1999:blog-7275090108487921686.post-77487885085975825192011-03-06T21:49:00.000-08:002011-03-06T21:53:32.727-08:00Awake againWell, once again the house is completely quiet and here I am awake. I'm watching the world's trashiest tv (You're Cut Off on VH1), and staring at the computer wondering why on earth I can't sleep. Of course, I know why, but thinking about that will only make the insomnia worse!<br /><br />I really do wish I didn't have class in the morning, if so, I would be able to just take a benadryl and get some zzz's. However, I do not want to have the "hangover effect" in the morning, so I'll just make due with whatever sleep I'm able to grab on my own.<br /><br />The peanut is doing great these days. Getting to look more and more like a "kid" and not a "baby" every day. She is the ultimate distraction and makes every day a little brighter!<br /><br />Here's hoping you all are getting the zz's you need, and that you have sweet dreams when you do!L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com1tag:blogger.com,1999:blog-7275090108487921686.post-82730878137722162802011-03-02T21:41:00.000-08:002011-03-02T22:33:47.860-08:00The strangest way to get a job...So it's clearly been a really long time since posting here. If you haven't gotten an invite to my family blog and want one, send me your email address and I'll hook ya up. But, back to medicine in this forum...<br /><br />So, residency. It's the looming black cloud that follows four intense years of medical school. It's also a job. A paying job. For that, I couldn't be more excited. It's a lot of hours. Only recently have the "rules" (aka guidelines) changed to mandate the maximum 80 hour work week. This is as an average of 4 weeks. It's acceptable and expected that on occasion you'll go over that 80, but basically you shouldn't make a habit of it. I have chosen to pursue a residency in Ob/Gyn, which is typically one of the more hours-intensive residencies, up there with general surgery. Call for OB tends to be physically demanding. You don't frequently get to sit in front of the computer and write notes and answer pages, you have to be on your feet, often in the OR, often doing procedures. All this being said, there is absolutely no field I could envision myself doing except this, and there is no such thing as an easy residency, so taking these four years (in the case of OB) and making the absolute most out of them is just what needs to be done. I would never choose a field based on perceived difficulty of residency, it isn't worth it in the long run.<br /><br />Now, how does one get this dream job, you might ask? Well, this is the strange thing. After working your butt off for 3 and a half years of medical school, you begin to apply to residency programs. Generally speaking, you apply to one field. However, some folks do apply to several fields if they can't decide, or one field is very competitive and they want to cover their bases. The application is done online and is submitted to however many programs you'd like to apply to. <br /><br />The programs then start to respond and ask you to come out for interviews. Now, this is not like getting a job out of, say, law school. There is no schmoozing, there is no wining and dining (generally). There is you paying out of pocket for the interview times that are available by the time you rsvp for an interview spot. There is you paying for a hotel and a rental car and making arrangements for your travels. For most average fields, folks do about 10 interviews give or take. This number can change greatly if you are 1)applying in an incredibly competitive field like dermatology or 2)applying as a "couple" where both members of the couple are applying into a field in medicine and need to live in the same area. Both of these things make it more difficult to match, so you need to apply to more programs.<br /><br />So, you go to interviews. Meanwhile, you still have to make sure you are completing any course work you need to finish. At the interviews you generally have a dinner the evening before the interview day where you meet some of the residents, the other applicants who will also be interviewing, and sometimes faculty. This dinner is always about balance. Balance between asking too many questions and not enough. Balance between looking "fun" and having a drink with the residents and looking stupid and having too many. Balance between getting there too early and being the only applicant and getting there late and looking like a slacker, and by the same token leaving to early and looking to eager to get out and leaving late and being that awkward hanger-on that just can't get the hint. The next day is an interview day which usually includes a tour of the facility and 3-5 interviews with faculty and residents. Then you'll usually book it to the airport to get out of there.<br /><br />After each interview you try to make notes about the place, the people, the program, etc. Some people go to such lengths as to make complicated spreadsheets with numerical values assigned to each category and a tally of total points. I just wrote about the general feel of a place, could I see myself working with these folks in close quarters for long hours for 4 years?<br /><br />After all your interviews are done the end game comes into sight. Ultimately how this whole deal is decided is remarkably similar to Greek rush in college. Applicants make a rank order list, where they rank each program they interviewed at (or if you're really nuts you list programs you didn't interview at...they will not rank you). The programs will also make a list of the applicants they interviewed in the order that they would like to accept them. This is all due in late February. For us, Feb 23 at 9pm EST sharp! From this date until "Match day" some sort of black box computer program sorts through all this, matches up who wants to be where, and presto-chango, you will become a resident! Signing up for the match is a legally binding congtract, so you better not list somewhere that you really don't want to go. You need to be willing to move wherever you list on that rank order list. <br /><br />Sometime between your interviews and the due date for the rank list, it is generally accepted that students should send "love notes" to the programs they are most interested in and thank you's to all their interviewers. Some programs will send love notes back and there is a strange kind of courtship that goes on, all the while walking a thin line that the National Residency Match Program deems within the rules. You are never allowed to outright ask a program where you will fall on their list, just as they are not allowed to solicit this information from you. Both parties are allowed to voluntarily offer this information, but even that can be deceiving. For example, a program might tell an applicant "you have been ranked to match at this program." Well, that sounds great! Maybe they should be first on my list so I can for sure match there. Not so fast! Think how different it would sound if they wrote to a different student "we have ranked you in our top five, and you will match here if you rank us number 1." Apparently two different students from last year's class got these two messages. Knowing these are both possible, it makes it awfully hard to interpret what they tell you. And to make it worse, so many of the programs will give you absolutely no guidance at all, in part to not influence your decision, and partly to abide by the rules of the match. <br /><br />Applicants are informed of whether or not they matched (but not where) on March 14th. If you did not match, you will then join the "scramble." That is, you will be left to scramble into one of the positions that did not get filled. This may or may not be in your field of choice! Match day is when you actually find out where you matched if you were able to match without scrambling.<br /><br />Match day this year is March 17th. I'm hoping it's lucky since it's St. Paddy's day. The process on that day is neuroses inducing as well! It's not mandatory to go to match day, but it's a big deal and most of the class does attend. Family is invited as well. We are having it at Invesco Field this year at an indoor conference room. A nice lunch is going to be served, etc. The weird part is the ceremony. The program starts at 10am (and the bar opens as well) with some speeches by professors we've chosen and a toast from the dean. Then, and this is the crazy part, at 1pm EDT EXACTLY, you are allowed to open the envelope that contains the location of your residency assignment. Again, you don't have to open it there, you can bring it home or whatever, but most people choose to open their envelope with their class. This makes the atmosphere at the luncheon totally bizarre. There are people screaming with joy, there are people crying with joy, there are people screaming in agony and crying in desparation. It is the strangest, and most electrifying, environment I've ever seen (I had the honor of going to last year's match and helping to plan this year's). Last year they had all the envelopes on a table and everyone ran up like a herd stampeding. This year we will have them in a goodie bag at the tables (covered in very noisy cellophane so no one thinks about opening it early...). We are doing this 1)so no one gets trampled and 2)because programs often text message their new incoming interns at the 1pm EDT marker, and a lot of folks thought it was kind of anticlimactic to find out in a text while you were waiting to get your envelope.<br /><br />With only 2 weeks to go until the big day, I am starting to feel the effects of the stress. Let me just say that a few weeks ago, I would not have been awake after 11 when the baby is still waking up repeatedly throughout the night. When I do sleep, I have nightmares about ending up somewhere I truly didn't want to be. I worry about having to move my husband and my daughter, I worry I won't be happy. It's a huge weight on my mind. To make matters worse, we have a mandatory two week class through next Thursday that puts us all captive in a room, our anxiety feeding off each other. It's just insane. We've had beautiful weather lately, and hopefully it holds out, maybe I can burn off some steam since we just inherited a running stroller from some family friends.<br /><br />No matter what happens, on March 17th, green beer will be had. Probably in fairly large quantity. The in-laws are taking la nina so we can have a night out and if you're in town and want to join, shoot me a line so I can tell you where we'll be. I'll either be celebrating or crying into said green beer, but you are welcome either way!L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com3tag:blogger.com,1999:blog-7275090108487921686.post-3895057450040027512010-08-23T13:35:00.000-07:002010-08-23T13:58:15.373-07:00Isn't She Lovely!Well, two days after my last post I was in the hospital being induced! We went in on the evening of J's birthday to get things going. I didn't have enough amniotic fluid anymore and my blood pressure was starting to creep up so we scheduled the induction at 38 weeks. The next morning contractions were really intense but the little one's heart rate was not tolerating the stress. She was having what's called late decelerations. In most cases this is due to "uteroplacental insufficiency". It's a dangerous situation if it is allowed to continue, and if the baby doesn't come out it can cause a serious loss of oxygen. So 18 hours after we checked into the hospital we made the decision to get her out via c-section. The little one was born on July 29th at 2:45pm. <br /><br /><a href="http://2.bp.blogspot.com/_sxzSTUZZdZw/THLdOwTmYNI/AAAAAAAAAOM/36eH6hxbvws/s1600/IMG_2772.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://2.bp.blogspot.com/_sxzSTUZZdZw/THLdOwTmYNI/AAAAAAAAAOM/36eH6hxbvws/s320/IMG_2772.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5508708539782553810" /></a><br /><br />Here's the very tired momma after the c-section when I finally got to hold my baby. Somehow the epidural traveled up to my arm and face so for a while I was numb really high and couldn't hold her.<br /><br /><a href="http://4.bp.blogspot.com/_sxzSTUZZdZw/THLd7rMh47I/AAAAAAAAAOU/QLhsEOKyGv8/s1600/IMG_2838.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://4.bp.blogspot.com/_sxzSTUZZdZw/THLd7rMh47I/AAAAAAAAAOU/QLhsEOKyGv8/s320/IMG_2838.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5508709311504835506" /></a><br /><br />Day before we went home from the hospital in mom's favorite piggy pjs. <br /><br /><a href="http://3.bp.blogspot.com/_sxzSTUZZdZw/THLeUjKwh9I/AAAAAAAAAOc/p1pQOdzTWjM/s1600/IMG_2853.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://3.bp.blogspot.com/_sxzSTUZZdZw/THLeUjKwh9I/AAAAAAAAAOc/p1pQOdzTWjM/s320/IMG_2853.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5508709738846652370" /></a><br /><br />On the way home!<br /><br /><a href="http://4.bp.blogspot.com/_sxzSTUZZdZw/THLfbKJTeeI/AAAAAAAAAOk/OOG-ZsAZeOQ/s1600/IMG_2975.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://4.bp.blogspot.com/_sxzSTUZZdZw/THLfbKJTeeI/AAAAAAAAAOk/OOG-ZsAZeOQ/s320/IMG_2975.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5508710951900379618" /></a><br /><br />She's now three weeks old! Being a mom changed everything, from the very first minute. It scares me all the time, but I've never smiled so much. I have four more months home with her and I plan to enjoy them as much as possible. It's hard work, keeping a baby alive, more than I ever could have expected. The days fly by so fast I can't even believe it. I'm sure the challenges will just keep coming, but I'm already starting to know her better. One of these days I'll possibly even feel comfortable taking her out of the house on my own! I'm getting there, slowly.<br /><br />I will be starting to keep a password protected blog to post all the updates about the baby. If you would like to be added, just send me your email address, either as a comment or on facebook or to my email address. I just wanted to let everyone know that mom and baby are doing great. And dad couldn't be more proud (or more helpful, he's the best!)L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com7tag:blogger.com,1999:blog-7275090108487921686.post-88966718284933112802010-07-26T15:00:00.000-07:002010-07-26T15:11:31.507-07:00What I'll miss...About being pregnant? This is a question I read online all the time, and I always laugh. Miss about being pregnant....hahahahahahaha! But there are a couple of things I might miss. I'll miss her moving and grooving in there, when she's not bruising my ribs. And I'll miss blaming all my food desires on her ("the baby wanted the ice cream. I had to have it")<br /><br />But seriously. Am I done yet?L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com3tag:blogger.com,1999:blog-7275090108487921686.post-67191155810164701212010-07-21T08:50:00.000-07:002010-07-21T09:10:46.301-07:00I see the finish line....Inching so much closer! As of now the kiddo is full term. She can come at any time and be ok. I prefer sooner, so we'll see. She's already over 6 and a half pounds. Which is plenty if you ask me. So hopefully soon. We got her room ready and I even took some pictures!<br /><br /><a href="http://1.bp.blogspot.com/_sxzSTUZZdZw/TEcY9ZTm9pI/AAAAAAAAANc/pxnRFnjmCbk/s1600/IMG_2735.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://1.bp.blogspot.com/_sxzSTUZZdZw/TEcY9ZTm9pI/AAAAAAAAANc/pxnRFnjmCbk/s320/IMG_2735.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5496389313273198226" /></a><br /><br />That's pretty much my favorite seat in the house. Gotta love the glider. The dresser was a partially finished mess we got for $5 but was made of good wood so J refinished it to match the crib. I think it looks great! What you can't see is how completely packed with clothes it is! She has more clothing than I do!<br /><br /><a href="http://4.bp.blogspot.com/_sxzSTUZZdZw/TEcZeLWy7aI/AAAAAAAAANk/LoCD0qZe7DA/s1600/IMG_2736.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://4.bp.blogspot.com/_sxzSTUZZdZw/TEcZeLWy7aI/AAAAAAAAANk/LoCD0qZe7DA/s320/IMG_2736.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5496389876464151970" /></a><br /><br />Here's her cute crib and bedding. I suppose once she's in it, and leaking all over it, it won't look as cute, but I like it lots right now!<br /><br /><a href="http://4.bp.blogspot.com/_sxzSTUZZdZw/TEcZ07rnI_I/AAAAAAAAANs/DJTm-ArU0uk/s1600/IMG_2738.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://4.bp.blogspot.com/_sxzSTUZZdZw/TEcZ07rnI_I/AAAAAAAAANs/DJTm-ArU0uk/s320/IMG_2738.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5496390267393483762" /></a><br /><br />We also got the bathroom fixed up. Not that she'll be using it anytime soon, but we seem to like the monkey theme so we're going with it.<br /><br /><a href="http://4.bp.blogspot.com/_sxzSTUZZdZw/TEcaOGqGUoI/AAAAAAAAAN0/YiECDo232mg/s1600/IMG_2740.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://4.bp.blogspot.com/_sxzSTUZZdZw/TEcaOGqGUoI/AAAAAAAAAN0/YiECDo232mg/s320/IMG_2740.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5496390699836658306" /></a><br /><br />Yes, I know she won't have teeth to brush for some time, but come on, how can you not get the see-no-evil-hear-no-evil-speak-no-evil monkey toothbrush holder?<br /><br /><a href="http://1.bp.blogspot.com/_sxzSTUZZdZw/TEcajA1fJRI/AAAAAAAAAN8/_hcAbm08Wrk/s1600/IMG_2739.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://1.bp.blogspot.com/_sxzSTUZZdZw/TEcajA1fJRI/AAAAAAAAAN8/_hcAbm08Wrk/s320/IMG_2739.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5496391059051062546" /></a><br /><br />And, last but not least, J's very favorite outfit for her. Even though it probably won't fit her until long after the regular season!<br /><br />Speaking of finish lines, J crossed his first half marathon finish line at the end of June! He ran the Slacker half marathon in Georgetown. He even kept his time under 2 hours! Not too bad for not training!<br /><br /><a href="http://3.bp.blogspot.com/_sxzSTUZZdZw/TEcbJSm48QI/AAAAAAAAAOE/x9XREM5m2Fk/s1600/IMG_2728.JPG"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="http://3.bp.blogspot.com/_sxzSTUZZdZw/TEcbJSm48QI/AAAAAAAAAOE/x9XREM5m2Fk/s320/IMG_2728.JPG" border="0" alt=""id="BLOGGER_PHOTO_ID_5496391716656705794" /></a><br /><br />Well, I think that's enough for today. I have today and tomorrow off from the clinic, so I'm just trying to keep myself busy until either the baby comes or it's Friday. I hope everyone is having a great week!L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com2tag:blogger.com,1999:blog-7275090108487921686.post-12757677996023764742010-07-09T13:10:00.000-07:002010-07-09T13:20:46.712-07:00I'm still here!And still pregnant. And still studying. But the good news is the end is in sight on all counts. I'm taking my boards on Sunday, and after that I will post pictures of the baby's room and our little herb plants we're growing this year. J has had the whole week off, which has been awesome, and we've cleared a lot of clutter so that it actually looks like a 3rd person might fit into this house in the near future. My practice scores are creeping closer to where I won't be calling J in tears when I get the scores back. I'm spending this month doing some elective work with my OB, so I'm sure I will be constantly thinking about the day that I go in to the office and don't come home without a baby in tow. But, that will come after boards on Sunday.L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com0tag:blogger.com,1999:blog-7275090108487921686.post-52147293200902526892010-06-28T07:46:00.000-07:002010-06-28T08:07:36.568-07:00Boards, boards, boredI have officially moved my test back to July 11th, and it's truly as late as I feel I can take it without going into labor during one of the blocks. Though it might make for a great story, probably won't make for a great score... I took a practice test on the weekend and I'm still not quite where I want to be for this test. The problem is, I have other rather pressing things on my mind that make studying more than a little difficult. Why would I want to stare at practice questions when I could be refinishing the baby dresser, buying those last minute things that I haven't gotten around to yet, putting shelves into the closet, packing the hospital bag, reading the mounds of books I've accumulated on labor and infant care, making frozen dinners that can be easily reheated after we have her, etc.<br /><br />I would be less freaked out if I felt like this kid was going to term. But somehow I just know that is not the case. I've been having some seriously painful contractions, disturbingly often recently, and not only does it make it hard to concentrate (or sleep or anything productive..) but it makes me worry about getting this test done before we have a kiddo. Yikes.<br /><br />Not to mention that she's definitely "dropped" and now I truly understand the uncomfortable pregnant woman. Blah. I'm just a little stress ball right now, and hopefully I'll get it together this week so I can relax a little. Anyone have any tips?<br /><br />PS. The application for residency opens this week. Not that it's stressful or anything....L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com4tag:blogger.com,1999:blog-7275090108487921686.post-73510881751217570252010-06-18T10:19:00.000-07:002010-06-18T11:14:40.705-07:0033 weeksI don't talk about my pregnancy too terribly often on public forums. It's just kind of a private thing, and frankly, not my favorite experience ever. But I thought I would update folks about the little peanut. She's doing great! Had an appointment this morning and she's wiggling around as usual. As of right now she's about 4.2 pounds (seems shockingly big to me!). My doc thinks she'll probably get to about 7-7.5 pounds by the time we have her. He also thinks we won't make it all the way to the due date, but of course doesn't have a crystal ball and can't really predict when she'll make the grand entrance! I'm ready to start a pool soon, so let me know if your interested! J thinks she'll come on July 26th since that's the date I was assigned to for my meeting with the dean to go over my dean's letter for residency. I think my doc thought there was some dramatic irony in that, would be about par for the course in the past 7 months! I'm just hoping for the end of July so I have all of August to spend at home with her. But, she'll come when she wants to. One can dream though!<br /><br />As for me, I'm getting to the point where I can't really sleep. I fall asleep no problem but I'm uncomfortable and wake up often. She's super low now and it makes my hips pull apart which is not super comfy. I feel bad for J since I wake him up as well. But I have lots of time to rest today. So it's good. I'm really more rested than I have been in the past year, and a lot less stressed out. Overall, things are good. Now I just need someone to walk one of the pups so I can just handle one of them. It's so beautiful outside and I want to enjoy it. I feel really lucky that as of now, I really feel happy in the heat. Everyone has been telling me how miserable summer will be, but I've always been the type of person who is more comfortable in the heat than in the cold, so I'm just happy I can wear nice loose clothes and enjoy the Colorado sunshine. So far so good!L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com2tag:blogger.com,1999:blog-7275090108487921686.post-21225725811208807822010-06-09T06:30:00.000-07:002010-06-09T06:44:12.782-07:00HappyThings that make me happy this June:<br /><br />-I actually took a bubble bath in the middle of the day yesterday, just because I could!<br />-It poured down rain yesterday with the sun shining. Summer is wonderful!<br />-Studying for this set of boards is infinitely better than the last time around, and I feel good about learning a lot in the past year<br />-My dogs are great company! They love me even when I waddle.<br />-I am already finding time to meet up with old friends. So great! One of these days I will get my big belly to Golden and revisit my favorite places. Then it will really be a perfect June!<br />-The house is starting to look like a 3rd person is at least on the way. Scary, but exciting!<br />-I baked cookies on Monday, and they didn't turn out like big puffy pillows for a change!<br />-I have made and eaten my weight in pasta salad in the past week. I do not feel bad about this. It is delicious.<br />-It's farmers market season, and the big guy is great company. He's such a ham when we go to all the stalls, everyone has to pet him. He's great, and never pulls me around. I don't think I could so much stop him anymore so at least he's good on the leash!<br /><br />June makes me happy. It's gonna be a great month!L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com0tag:blogger.com,1999:blog-7275090108487921686.post-26020788462996605672010-06-07T05:18:00.000-07:002010-06-07T05:39:51.333-07:00Heart failure....and summer!I think I promised a while back to have some less depressing stories from my 3rd year of medical school. I've been saving this one. Now, don't judge. Although I find this absolutely hilarious on some level, it's still sad that there are people who really let things get this bad.<br /><br /><a href="http://3.bp.blogspot.com/_sxzSTUZZdZw/TAzm8-iBIlI/AAAAAAAAANU/LVfXBZeDhGw/s1600/Cartman-CheesyPoofs.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 247px;" src="http://3.bp.blogspot.com/_sxzSTUZZdZw/TAzm8-iBIlI/AAAAAAAAANU/LVfXBZeDhGw/s320/Cartman-CheesyPoofs.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5480008781855269458" /></a><br /><br />Last week of my medicine rotation we get a consult on a patient who is in kidney failure (yes, I know the title is heart failure). She has no history of previous kidney failure. She has pitting edema in both her legs. Pitting edema is just what it sounds like, you push your fingers into her legs and the imprint of your fingers stays there like a pit. Hers was particularly bad. I was sent in to get her history. You know it's bad when...<br /><br />"Well, I last went to the doctor about 3 months ago and I was so surprised because I had lost about 20 pounds, and all I had been eating was cheesy puffs. So I figured, if I could lose 20 pounds eating cheesy puffs, it must be because of the cheesy puffs. So that's all I've eaten for the past 3 months."<br /><br />Me: "When you say that's all you've eaten, do you mean that's mostly what you've eaten?"<br /><br />"Nope. I am on the cheesy puffs diet. Sometimes I have water, because they make me thirsty."<br /><br />Far as we can tell, she was on such a low protein, high salt diet that several things happened. The decrease in protein in her circulation allowed her blood vessels to get really leaky and her blood volume got squished out into her interstitium (area in tissues that is not in blood vessels). This made her functionally dehydrated, even though she was full of fluid weight that was making her all puffy (the pitting edema). Her heart was trying hard to keep up with the decreased fluid by pumping faster than it was used to. Over time, this put her into heart failure causing fluid to back up further and contribute even more to her edema. This also made less blood available to the kidneys, which are very sensitive to changes in blood flow. The kidneys were also seeing all this extra salt that made them think the body was very dehydrated, holding on to as much fluid as possible and making her more fluid overloaded, which also ended up in her interstitium. Also over time, this led to renal failure, which was then picked up on routine labs and ended her up in the hospital.<br /><br />Lesson: though cheetos are delicious and a fun bright orange snack, they are in no way enough to maintain a human being for any sustained length of time. Sorry Cartman.<br /><br />The good thing, for this woman it's a reversible condition treated readily by protein replacement and fluids. And likely lots and lots of nutrition counseling. <br /><br />More good news: she'll likely lose even more weight after all the fluid is diuresed from her legs.<br /><br />The best news: this was actually the day before I was done at this particular hospital, so I didn't have to be responsible for the care of this misguided patient.<br /><br />Ah memories.<br /><br />I'm happy to say that my subinternship ended well and that I had a wonderful time. I learned so much and I feel like there's no doubt in my mind that this is what I want to do and that I found "my calling." I find that folks in medicine are always on about where their passion lies and what they are called to do. Considering all the training that goes into medicine, it doesn't completely surprise me that people want to end up doing something that really speaks to them and will make all that work worth it. I'm glad that I've decided to bite the bullet and do that. When I started med school I was pretty focused on "lifestyle" specialties which could afford me a lot of free time and good pay. But, ultimately what I do for a living will have to make me happy while I do it, since so much of my time will be spent working, regardless of the field I enter.<br /><br />And for now, I'm even happier to say that summer is here and I'm home to enjoy it! Today starts the first time off I've had in some time and I am looking forward to it. So are my feet. They get tired standing for 14 hours at a time. I am taking my Step 2 board exams this month, so it's not a complete vacation, but I think it will probably seem like it! And the way fresh air feels in the morning in the summer is something I'm excited to experience again! I love summer!!!! Shoot me an email or text or let me know when you all have some free time! I'm looking forward to catching up again!L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com0tag:blogger.com,1999:blog-7275090108487921686.post-53721770731331224972010-05-28T19:14:00.000-07:002010-05-30T18:17:49.756-07:00Time FliesI'm still crazy about my subinternship. It really does make the time fly when you're having a great time. I love what I'm doing at work every day. I might not alwaays love getting up at 4:30, don't always love the beautiful way my ankles swell when I am on my feet for 14 hours, and don't live for the bad outcomes that seem inevitable on this service, but I know now more than ever that I want to do this. And that counts for a lot!<br /><br />So what have I been up to? I've gotten to do a lot! A couple of weeks ago I got to do an amniocentesis, the procedure where a needle is inserted into a pregnant woman's uterus and amniotic fluid is removed for evaluation. An amnio! Me! I was excited. I've been in surgery, and happily have retained my knot tying skills. I've seen lots of forceps deliveries, and now have a new greatest fear for my own delivery. <br /><br />And now I feel like I'm on cruise control. I had the whole weekend off, which after the 24 hour call last weekend was greatly appreciated! And since tomorrow is technically a holiday, there are no scheduled procedures or anything of that sort. My resident is having me come in at 7am instead of the usual 5 and told me that if there's nothing interesting for me to see I can go home. This is my last week on this service, and though I'll miss it, particularly the patients I've been taking care of for the last month, I'm also happy to have some rest. <br /><br />We get to see the kiddo this Friday and we're looking forward to it. If my growing gut is any indication, she's definitely a lot bigger. J has the week off to get the house ready for her, and I'm pumped to be able to set things up in her room instead of continuing to make many, many piles. One of these days I'll post an ultrasound picture of the little bug.<br /><br />But it'll be sweeter to have a picture once she's here!L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com1tag:blogger.com,1999:blog-7275090108487921686.post-80766262620028055702010-05-15T07:11:00.001-07:002010-05-15T07:40:00.392-07:00Fourth Year Rocks!I have to start out by saying sorry, sorry, sorry to everyone who has been trying to get ahold of me, or expecting a call or email that just isn't getting to them. I am exhaused. Currently I'm taking my sub-internship, which is a fourth year medical school elective that focuses on students learning to act as an intern and be more autonomous with their patients in their chosen field. It also kind of acts as an audition at the residency program where you are doing the rotation. I am doing mine in Maternal Fetal Medicine (high risk obstetrics) at a major referral center. I have never been this busy at work in my life. And I love it!<br /><br />The hours are crazy. I get in at about 5am and leave after 7 most days. This isn't the most I've ever worked since I don't have every fourth day (or q4 in medspeak) call on this rotation, but being over 6 months preggo and on my feet for every one of those hours gets exhausting to say the least. I originally specifically chose this rotation because weekends are free. I need this time to recover right now. And it's a luxury I won't have as an intern. I was worried when I registered that I would have nothing but bad outcomes for my patients and that I would feel sad and overwhelmed for the whole month. This has, thankfully, not been the case.<br /><br />My patients are almost exclusively women who are pregnant but not yet at term (defined as 37 weeks pregnant), so their babies are premies. They usually have either an obstetric or medical condition that causes them to have a difficult pregnancy or to have the expectation of a difficult labor (or no labor at all). This week I scrubbed on a c-section for a 28 week baby(due dates are at 40 weeks of pregnancy). I have never seen a kiddo that tiny. At this center we have an amazing NICU (neonatal intensive care unit) and this little one has been very well taken care of and is doing quite well. I know they won't all go well over the next weeks, but I love that I can really get to know these women and give them some sort of comfort when they are so uncomfortable most of the time. <br /><br />And I'm learning SOOO much! It's been a year since I got to spend any time on labor and delivery. It is a place I really like to be. I think the medical issues are challenging and there's surgical issues too. It's definitely the field for me, and even though I'm tired and my feet hurt, I am happy. <br /><br />I also really love this residency program. I love the residents, and yes, they are exhausted. But I've never really seen residents who aren't tired. Residency is hard. Every one of them. But I think these residents are so well trained. They really know what they're doing and they come out exceptionally well trained. My favorite part is the awesome OB training they get. I think other programs get great surgical experience, maybe better than here, but OB is such a big part of practice and the OBs from here really know what they're doing. I would feel confident after finishing a residency here that I would not panic regardless of what walks through the door. It makes me excited!<br /><br />I'm not gonna lie, though. Sitting here in my chair with my feet up on a Saturday morning feels pretty great, and after June 4th, when I can do this all the time, I will be a happy camper!!!<br /><br />Patient story of the week:<br /><br />A woman was being induced (unsuccessfully) for labor. Her cervix was not dilating much and we were inserting what's called a Foley bulb. It's when you take a Foley catheter (the kind that goes in your bladder), thread it into the cervix, and blow up the baloon. This acts like the baby's head and makes the cervix start to dilate. We were explaining the procedure to the patient and her mother. Her mother had this horrified look on her face and said "they're gonna pop you like a champagne bottle!"L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com0tag:blogger.com,1999:blog-7275090108487921686.post-14304990810021223142010-05-06T19:53:00.000-07:002010-05-06T20:29:57.900-07:00Third Year MemoriesNow that 3rd year is over, I'm starting to prepare my personal statement for residency and filling out questionnaires for the dean's office to make sure my dean's letter is the best it could be. It makes me remember a lot of the memorable patients and situations that I've been presented with in the past year. All of these things have shaped who I've become and what kind of doctor I will be. I feel humbled to have been a part of their lives. <br /><br />The most vivid memory I have of my entire clinical experience to this point was from my OB rotation on labor and delivery. I did my rotation at the University Hospital, which does a lot of high risk OB care. I think I wrote about my experience with the fetal hydrops baby at the time, and it's an experience I've thought about often throughout the year. As the year went on I felt I needed to write the experience down. It was just published in the arts in medicine journal for my school. I'm copying it here. It's a sad story, but it was a life changing experience for me. I promise to write happier stories in the days to come!<br /><br /><strong>Can We Name Her</strong><br /><br />The induction of labor had carried on for 48 hours when I sat at board rounds. My intern was nowhere in sight, and someone let me know that the lengthy labor was at an end and Mrs. T was ready to push. I remember running down the hall, feeling strongly this was where I was supposed to be. My first vaginal delivery. <br /><br />But it wasn’t to be a normal delivery. Mrs. T had come in two days ago to triage at 32 weeks. Her ultrasound showed a baby with severe hydrops, edema so bad that waiting much longer to deliver would only make the delivery more difficult. The baby had little chance of survival regardless of how long the pregnancy was allowed to continue. The parents, who spoke only Vietnamese, spoke with the fellow for hours before the understanding started to show. Their child would not live; mom’s health was at risk if delivery was postponed. They would induce. And so for two days they would walk the halls, without pain relief, to deliver their first child, a daughter.<br /><br />When I reached their room my intern calmly asked if I really wanted to be there. I agreed that I did. I had been taking care of this family since they came in, and I wouldn’t feel right if I left them now. I gowned and gloved, and for some time only myself and the intern were there. Slowly, as rounds were finished and the baby was imminent, the room filled to capacity. Every OB resident, attending, student, pediatric fellow, attending, resident, student found their way into the room. Fetal hydrops is not common; quite a learning experience. <br /><br />The delivery was nothing like what I had expected. When she was born there was no crying; not from the baby. She was hurried to the pediatricians. I saw her only briefly, but for weeks to come I saw her again and I again whenever I closed my eyes. My first baby. The saddest thing I’d ever seen. <br /><br />I couldn’t keep the tears out of my eyes as the pediatricians intubated and compressed; trying desperately to keep fluid out of her lungs. They tried to make a miracle. <br /><br />Twenty minutes later, though, it was clear that there wouldn’t be a miracle today. She hadn’t made it. She was swaddled and wrapped as any other infant headed for the nursery. She was brought to mom and dad, who waited to hold her just once. <br /><br />Quietly, everyone wept. The pediatricians quietly left the room, holding each other for support. I stayed with my intern as the placenta delivered and the lacerations were repaired. We stayed as the family cried together, trying to stay quiet and small, to give them their moment together, as alone as they could have it.<br /><br />Out of their quiet moment, as the instruments were being put away and the drapes taken down, came a question. The English was broken, but the question was clear – “Can we name her?” <br /><br />“Of course,” my intern said, “I think that you should.”<br /><br />I felt like a voyeur watching this tender moment. My mask still covered my face and it was as if I was watching from behind a two way mirror. Such a small comfort, but one the family needed so desperately. I couldn’t imagine a time when a physician could have made more of a difference than she did for that family. In such a terrible moment, so much compassion. <br /><br />In the week to come, so many happy deliveries came through that floor. And every happy delivery confirmed just how great this career could be. But I’ll never forget that day when I learned what it was to be truly needed. From surviving the lowest low I could imagine, I found new meaning in my future work, and I’ll be forever grateful for the lesson.<br /><br />I never found out her name. But, somehow, knowing she has one makes me feel better. I know this moment changed me forever. At that moment I knew what I would do with my life.L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com3tag:blogger.com,1999:blog-7275090108487921686.post-66591921116891663852010-04-23T20:32:00.000-07:002010-04-23T21:18:48.765-07:00RantSo, I avoid politics on this blog. I find it's a topic that is unpleasant whenever discussed unless you are certain that the other person shares your exact view. And hence, I'm not going to rant to anyone about health care reform or anything else along those lines.<br /><br />However.<br /><br />Some things are too ridiculous to watch them roll past without comment. In my post third year reading (for fun!) I came across the story of Sue Lowden, the woman running for Senate from Nevada. Ms. Lowden has an interesting idea of how to move forward health care reform in this country. The barter system.<br /><br />She states, in nearly so many words, that doctors should, in fact, be paid by barter, specifically citing the fact that in the past docs have accepted chickens and paint jobs for their houses as reimbursement. <br /><br />I wish I were kidding.<br /><br />My questions are these, Ms. Lowden: <br /><br />1)Should I pay my tuition this semester with eggs? I am actually fairly skilled at making paper airplanes, I could potentially pay for tuition with those instead...<br /><br />2)When I have my future practice and I need to order new equipment or lab supplies, do you think I'll be able to, in turn, pay for things with the barter system as well? Or will I actually have to make money by taking on a second job at the grocery store (likely the only thing I could be qualified to do outside of medicine) so that I can cover the costs of my patients' care?<br /><br />3)Will the electric company, landlord, heat, internet, etc also work on the barter system, or shall I rely on my husband to pay for that for the rest of my life?<br /><br />4)Do you really think that doctor reimbursement is what drives the cost of healthcare up? Do you think so many docs are jumping ship to take on jobs in the corporate sector because they are just rolling in dough? Do you think that bartering, to some extent, does not already go on for the good of the patient?<br /><br />Ms. Lowden believes that doctors are an altruistic bunch and I agree. However, they are human and they are citizens of this country too. They are people with families of their own and they undergo a difficult training which leaves them sidled with debt. How can we possibly in all seriousness afford to take care of ourselves and our families. Why should the (way over 40) hours we work a week be worth nothing because what we do helps people? I fully intend to provide pro bono care as a regular part of my career and I truly believe that everyone deserves health care. I don't aspire to be a rich woman from practicing medicine. I also don't pretend to know the answer to how to fix health care. I just know that this ain't it.L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com2tag:blogger.com,1999:blog-7275090108487921686.post-42520308539035771382010-04-23T06:08:00.000-07:002010-04-23T06:17:08.540-07:00And just like that...It's over. I take an exam this morning and this year that I have been counting down since before it began comes to an end. <br /><br />I learned more than I could have imagined, truly. When you study for boards you think you have learned a lot, but it pales in comparison. I've seen wonderful stories and terrible stories, met wonderful people and horrible people. It's a lot when I think about it and I plan to write about some of the stories when this test is over.<br /><br />For now though, it should be a fun day! A short exam, then a short presentation. I'm meeting a friend from high school for some coffee and we get to go to the doc to see the baby. Should be a great day!L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com2tag:blogger.com,1999:blog-7275090108487921686.post-42113057828775304282010-03-23T11:17:00.001-07:002010-03-24T10:17:26.217-07:00Snow Day!!!!Hurrah! Snow day! We got a bunch of snow in one of those CO freak spring storms and classes were cancelled this am. Me and the dogs are enjoying some quality R&R, which is extra nice since I haven't been able to sleep properly for about the last week. In fact, I've been so miserably tired I've started writing a blog post about 3 times entitled "Not glowing" referring to the difficulties of being preggo.<br /><br />But, everytime I've started it, I've deleted it. Even though there are days (many) when I totally want to fast forward to August, I don't want anyone to believe for a minute that I'm not thrilled about this baby. Baby yes. Being pregnant...less so. It makes it even less tolerable when you're so excited to meet this little person who's coming to change your life forever! She's kicking the crap out of me even as I write this. Letting me know she's on the way and to get ready!<br /><br />Days like today make me think about it even more since, seriously have you seen what's on TV during the day? Wow. And really, who studies on a snow day?! I can't wait till I have a little 1 1/2 year old to run around in the snow with on a day like today! <br /><br />The big bright side right now...half done!!! Wahoo! On Friday we go for our anatomy scan, which means a lot less when you've had as many ultrasounds as we have! Since the big 16 week ultrasound where we learned she is in fact a she, my doc's checked two more times and there's no doubt in my mind, it's definitely a girl! Also on Friday I'm doing my oral glucose tolerance test. Basically I drink a high sugar syrupy drink and one hour later they check my blood sugar to make sure I am able to use it appropriately. Women become more insulin resistant during pregnancy so that a larger amount of glucose stays in the blood to be taken up by the baby. This becomes a problem when blood sugar gets too high and can lead to birth defects if it is uncontrolled early in pregnancy (we're past that point) and very large babies in women with poor control. Then after birth, the baby does not get as much sugar as it is used to, but it's pancreas is still kicking out a ton of insulin, so these big huge babies get hypoglycemic after birth and can have seizures from that. I have a strong family history of diabetes and so we are doing this test a little early. I'm hopeful that it will be ok, but this has been my biggest anxiety about pregnancy for years. Those women who have gestational diabetes are 66% more likely to develop type II diabetes later in life, so it's a big deal. Hopefully it will go alright; should find out by Monday or Tuesday next week. I'll feel better when that's done with!<br /><br />I hope everyone enjoys their day, even if you're all not lucky enough to have a snow day!!L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com0tag:blogger.com,1999:blog-7275090108487921686.post-33142706826823342102010-03-12T05:50:00.000-08:002010-03-12T05:59:47.761-08:00Light Reading<a href="http://3.bp.blogspot.com/_sxzSTUZZdZw/S5pIzd2JxJI/AAAAAAAAANM/uqfdbl0EADc/s1600-h/farmer%27s+market.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 214px;" src="http://3.bp.blogspot.com/_sxzSTUZZdZw/S5pIzd2JxJI/AAAAAAAAANM/uqfdbl0EADc/s320/farmer%27s+market.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5447746748280325266" /></a><br /><br /><br />I don't think any one will really appreciate how pumped I am to have stumbled over a copy of The San Francisco Ferry Plaza Farmers' Market Cookbook! I love that farmers' market so much that it inevitably leaves me disappointed when I visit any market around here even in the bounty of summer. Maybe J, but maybe not, could understand how much I think about thsi place. I get cravings to go there. Many cravings. And not just because I'm pregnant. At least once a week I think about being there on a Saturday morning, seeing all the delicious produce and looking at the beautiful city, bay, bridges. I probably tell J about these once a month or less, so really I control myself better than I get any credit for. Anyway, I'm pumped to read the recipes and look at the great pix. It's like an early birthday present! (I love my birthday, and my birthday is tomorrow...woohooo!)<br /><br />On a sadder note, I actually heard someone running for office on the platform that as a state legislator she "defunded Planned Parenthood." Whaaaaaa? Regardless of your feelings on abortion, I think we can all agree that birth control, affordable birth control, is one of the most important services health care can provide. In this country 50% of pregnancies are unplanned. The emotional, physical, and financial toll this takes is enormous, not just for the individuals involved but for society at large. I feel very passionate about pregnancy prevention, it is a major part of my desire to be an OB/Gyn. I'm not asking everyone to feel like I do, but seriously, I was taken aback by that commercial. <br /><br />One more reason to read my awesome cookbook and turn off the boob tube!L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com3tag:blogger.com,1999:blog-7275090108487921686.post-65425387056275445472010-03-09T16:02:00.000-08:002010-03-09T16:32:50.817-08:00Hard<a href="http://3.bp.blogspot.com/_sxzSTUZZdZw/S5bnWLPmlvI/AAAAAAAAANE/J0u0r2tWuqg/s1600-h/hospice.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 216px; height: 320px;" src="http://3.bp.blogspot.com/_sxzSTUZZdZw/S5bnWLPmlvI/AAAAAAAAANE/J0u0r2tWuqg/s320/hospice.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5446795167512565490" /></a><br /><br /><br />Today I spent the day in a hospice setting. It was a difficult day. I really only saw one patient throughout the course of my day, she is dying from cervical cancer (don't get me started on getting paps in a timely fashion, that's for another post). Advanced cancer is painful, and this woman is in pain. Her family does not want her to receive pain meds because they've "seen other hospice patients and they are all out of it." They want her to only receive pain medications when she asks for them, or in med lingo, prn.<br /><br />Here's the difficulty with end of life pain meds. Pain is difficult to control, particularly in patients who have a lot of it for a long time. And once the patient is feeling the pain and asking for meds, it is harder to keep it at bay than it is if we "stay ahead of the pain". By staying ahead of the pain this does not mean snowing people so they are completely incoherent. It means giving a monitored dose of long acting pain medication in a scheduled fashion so that people are less likely to need the short acting, heavy hitting "breakthrough" meds. In addition to the benefit of less pain, the patients are often less agitated and better able to handle their surroundings and are less likely to become delirious secondary to pain and anxiety. <br /><br />It's also important for patients and families to understand that addiction to pain medications in this setting is almost never an issue. Addiction implies an illness defined by the patient actively seeking out a drug. Pain medications for chronic pain almost never fit this category. Dependence on the pain meds often does happen. The patient will grow to require higher doses, but often this stems from advancing disease processes rather than the patient getting used to a certain dose of meds. The patients may withdraw if they are removed from the pain meds, and this is also not a sign of addiction. In fact, withdrawal can occur even from antidepressants, a class of drugs which is not addictive in nature.<br /><br />It's important to me that patients become informed about what palliative care and hospice really mean. It is not simply a place to die. In fact, hospice is not a place at all, but a philosophy of care. Hospice often happens at home. Currently the average patient is in hospice care for a median of 15 days. 15 days until they pass away. This is most often because both physicians and patients are not informed about when a patient may receive hospice and what kinds of services they may be eligible for when they do. If you feel a loved one may need Hospice care, or would like to find out more about what Hospice entails, please visit www.hospicenet.org. <br /><br />The people who work with Hospice are about as caring and giving as it gets. I truly believe if more people understood hospice and what they do, more people would take advantage of this amazing benefit at the end of life. Check them out.<br /><br />And as one last note from my soapbox - talk with your loved ones about your wishes long before you reach an end of life situation. It can make all the difference in the world.L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com3tag:blogger.com,1999:blog-7275090108487921686.post-62273001362031902232010-03-04T05:30:00.000-08:002010-03-04T05:45:28.723-08:00I learned sumthin...Everyone all year has told me how much they learned on the internal medicine rotation (re: rotation I just finished with). I didn't really believe them as I went through the rotation and pretty much just struggled to hang on for the ride. But now as I go through my family medicine rotation, I know that it's true. I know what meds to give people with specific conditions. I know when a symptom is very serious and can't be ignored, and when "it's just a virus." And I'm finally starting to understand treatment of diabetes. Starting. Diabetics who can alter their insulin levels to their carb intake are still much more proficient than I am. I'm starting to feel like a doctor. Or at least like I could someday be a doctor. Which trust me, at the beginning of third year, was not the case. And more importantly, I like it and know it was the right decision. Every now and again when the hours are long I haven't been able to shake the feeling that maybe I should have just finished the PhD and moved on. It would be done by now, there would be no residency to follow. But there would be no catching babies. No teasing out a history of potential endometrial cancer that may have gone overlooked. No pulling off ascites fluid to make someone's quality of life better in their end stage liver disease. It would be a different life. In some ways better (more time with the coming kiddo) and in some ways so much worse. I know residency will seem impossibly hard at times, but in the long run, I don't want to do anything else. <br /><br />It does make it easier to feel this way when you get off work at 3 every day.....L.G.http://www.blogger.com/profile/09127709480412323183noreply@blogger.com0