Boards, boards, bored

I 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.

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.

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?

PS. The application for residency opens this week. Not that it's stressful or anything....

33 weeks

I 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!

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!

Happy

Things that make me happy this June:

-I actually took a bubble bath in the middle of the day yesterday, just because I could!
-It poured down rain yesterday with the sun shining. Summer is wonderful!
-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
-My dogs are great company! They love me even when I waddle.
-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!
-The house is starting to look like a 3rd person is at least on the way. Scary, but exciting!
-I baked cookies on Monday, and they didn't turn out like big puffy pillows for a change!
-I have made and eaten my weight in pasta salad in the past week. I do not feel bad about this. It is delicious.
-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!

June makes me happy. It's gonna be a great month!

Heart 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.



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...

"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."

Me: "When you say that's all you've eaten, do you mean that's mostly what you've eaten?"

"Nope. I am on the cheesy puffs diet. Sometimes I have water, because they make me thirsty."

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.

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.

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.

More good news: she'll likely lose even more weight after all the fluid is diuresed from her legs.

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.

Ah memories.

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.

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!

Time Flies

I'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!

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.

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.

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.

But it'll be sweeter to have a picture once she's here!

Fourth 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!

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.

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.

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.

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!

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!!!

Patient story of the week:

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!"

Third Year Memories

Now 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.

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!

Can We Name Her

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.

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.

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.

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.

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.

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.

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.

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?”

“Of course,” my intern said, “I think that you should.”

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.

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.

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.