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.

Rant

So, 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.

However.

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.

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.

I wish I were kidding.

My questions are these, Ms. Lowden:

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...

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?

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?

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?

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.

And 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.

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.

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!

Snow 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.

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!

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!

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!

I hope everyone enjoys their day, even if you're all not lucky enough to have a snow day!!

Light Reading

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!)

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.

One more reason to read my awesome cookbook and turn off the boob tube!