hating (a little) on hospitals

that's my backyard

I definitely needed to do some yoga back here after work today

I feel sooo lucky to be living here.

so after my first week of inpatient (meaning, actually in a hospital), I'm not sure it's the place for me. I know that it's only been a week and I've spent most of it running around exhausted, not sure where I'm supposed to be or what I'm supposed to be doing. But is that maybe what a hospital is about? All the big things that infuriate me about our medical system including lack of emphasis on preventative care, running unnecessary and sometimes harmful tests, lack of coordination of care, and dark, dingy places where people are supposed to feel better - all are at their worst in a hospital.

For example, I have one patient who is a 15 year old who just had a bone marrow transplant for his leukemia this past spring and now has low grade fevers that have lasted for a few days. Because he is immunosuppressed (meaning, we've taken down his own body's defenses in the hopes that we can sneak by the new bone marrow and his body will accept it, but it also means we open his defenses to anything else that wants to come in) - we have to make sure he doesn't have any other type of infection - so we are literally culturing every orifice and secretion from his entire body. Plus, even though I'm the person who presents him to the pediatric team - there's the heme/onc team who also has a plan for him and understands his disease the best, the nephrology team who has a plan for him because his kidneys shut down a bit during his chemo, the nutritionist who has a plan for him to maintain his weight, the infectious disease specialist who has made sure we're treating or at least considering every possible type of infection - all of whom come to see him once a day and give him pieces of information.

I see him in the mornings before rounds (around, 5:30am-ish), and then later in the afternoon after rounds and my required lectures, usually around 2:30/3pm. Between those two times, he sees around 10 other people who are changing things about his care, not to mention nurses, chaplains, pharmacy techs, the man who comes to empty his garbage -

the kid is exhausted yet we never give him more than an hour to actually REST. I know we have to check him and that he's in the hospital so we can check him, and that it's good for him to be in the hospital because there's so much knowledge in one place. BUT it still seems to me like a poorly coordinated, unhealthy situation. We think he's infected and we know he's at risk of another infection yet we have 10-15 people walking in and out of his room every day.

maybe I just needed a little rant time. I'm honestly really liking pediatrics - I love thinking about development and the differential at different stages of development. For example, a newborn with vomiting versus a 5year old with vomiting, versus a 10 year old with vomiting, versus a 16 yo with vomiting are all likely to be different things based on the ages. With adults, you have the same differential each time. Plus, kids are fun. one of my other patients is in an electric wheelchair due to a spinal disease and he decided today he wanted to give the staff rides around the hallway, charging us $1 each to sit in a rolling chair behind him and be pulled down the hallway. dangerous? mildly. awesome? definitely.

stay tuned, next week I'm on nights.

******

"there's a darkness upon us that's covered in light

and the fine print, it tells me what's wrong and what's right

and it flies by day and it flies by night

and I'm frightened by those who don't see it"

-Avett Brothers

Elastic Doctor Women

an anesthesiologist recently wrote an op-ed about women in medicine where she discusses how the personal decisions made (mostly by women, she says) about having children should be taken into account when we're deciding who to admit to medical school and residency programs.

And I quote:

"I have great respect for stay-at-home parents, and I think it’s fine if journalists or chefs or lawyers choose to work part time or quit their jobs altogether. But it’s different for doctors. Someone needs to take care of the patients."

"Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine. It’s fair to ask them — women especially — to consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency. They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve."

I'm not quite sure what to say first.

Luckily, other people responded faster and I got to read some eloquent Letters to the Editor.

One, from a neurosurgeon who said that this had long needed to be said, that maybe you could be a part time pediatrician and be okay, but any part time surgeon would be inferior because her skills would be worse.

Another, from a family med doctor who said that she thought it was interesting that an anesthesiologist - who walks away at the end of the day without any patients, whose patients are asleep for 90% of the time she sees them - would be able to comment on what constitutes "full-time". Spending 30-35 hrs/wk face-to-face with patients grappling with all sorts of diagnostic dilemmas certainly is different than 40hrs/week of unconscious patients who never call you at 2am.

One of my favorites was from a doctor who wondered why the author wanted to ask prospective med students about working part time and not if they wanted to subspecialize, or if they wanted to do academic medicine or work for a pharmaceutical company... or all the other ways doctors practice that is not filling our major needs for doctors.

***

At this point in my career, those decisions about family and lifestyle seem to be closer and more real than ever before and I do feel a strong pull towards the honor and responsibility of practicing medicine, of being someone's doctor. So I'm doing a lot of adjusting of my vision of being a mom, of being a wife, of being a neighbor, a sister, a cousin, an aunt, a dog owner...

but don't we want our doctors to be all those things too?

we don't want to create these doctors who live in the vacuum of a hospital, where they don't interact with anyone without asking them how they'd rate their pain on a scale of 1 to 10, do we? we want doctors to understand the importance of parents, of siblings, of partners, of children. how can we expect doctors to understand how we value these people without expecting them to value them also?

I'm still not sure how I will be all these things at once, and it certainly hasn't been easy to be a med student and all these things, but I'm going to keep trying.

(in case you don't know, that's Elastigirl, a pixxar character from the Incredibles,

designed to be able to to everything at once - the perfect mom)

a good day off/how viral pharyngitis can be a good thing

I had a pretty awesome but definitely less-than-restful weekend - my fault of course, for how much I packed in, but I truly wouldn't have wanted to miss any of it.

After a 50 hour week plus driving 2-4 hours/day (another 20-30 hours), I woke up early on Saturday and drove an hour to attend a Pediatric Conference (so great) then had lunch with a friend from college I hadn't seen in forever (amazing), drove 2 more hours to go rock climbing with some friends (who also happen to be pro rock climbers) then grabbed some delicious pizza before driving another 2 hours back to Burlington for a total of 12 beautiful hours filled with a little bit of sleep, delicious brunch, and board games in the sun with friends - finally, I headed back Sunday evening to stay with my grandparents for my final week of outpatient peds. They greeted me with a delicious dinner and scintillating conversation, but I was exhausted.

so exhausted, in fact, that I woke up at 3 am with chills, unable to swallow because my throat hurt so much. Being the budding doctor I am, I checked my throat for soft palate petichiae, exudate on my tonsils, any swollen cervical lymph nodes and noted that I did not have a cough: ack. strept throat?

they say everyone gets sick on their pediatric rotation, so when I drove the hour into the clinic, my attending looked at me and said, "I guess it is about that time - you're two weeks into pediatrics, so it was just a matter of time before you got sick. let's check out your throat". My throat looked pretty awful, according to him, so we did a rapid strept test: negative. So we diagnosed me with viral pharyngitis (translation: sore throat not caused by bacteria like streptococcus), I took naproxen and continued as normal. But by 2, I was seriously fading, and my attending could tell because he stopped quizzing me as we went and by 4:30, he told me to go home and take the next day as a "reading day" at home (he's off anyways so I don't feel too awful that I probably exacerbated this sickness by my busy weekend).

which leads me to the point of this post: how to take a good day off (whether it's because you're sick or just in need of a mental health day or both)

step 1: sleep in - but not too much that you just want to sleep forever! I actually slept until the late hour of 7:30am this morning and it was GLORIOUS! I never thought 7:30 would sound so late...

step 2: get outside, especially if it's sunny. fresh air and circulation do wonders for feeling better. I took a long walk with a run in the middle. It felt so luxurious to not be rushed through a workout.

step 3: eat well. listen to what your body craves and eat that and only that. I think when you're sick, your body gets even better at telling you what it needs. my body really liked this smoothie combination: (cantelope, peaches, spring mix salad, blueberries, arugula, banana) made in the awesome magic bullet that I'm borrowing from my friend while she's away. I want one!

step 4: be by water or better - be IN it. nothing takes away the aches of being sick like being weightless and smooth. I decided to swim just a few laps in the heat of the day after my walk/run.

step 5: only talk to people who are good for your health (you know what I mean) - luckily I have these two around:

"there is no duty we underrate so much as the duty of being happy"

-robert louis stevenson

people first

"the difference between

the right word

and the almost right word

is the difference between lightning

and the lightning bug"

-Mark Twain

before I headed south (though not as far this time), I had a section of my pediatrics clerkship focused on Family Centered Care. This included a lecture on children with disabilities and how providing good health care for kids means understanding the impact on (and of) the whole family. We also were each assigned to meet with a family of a child with a serious medical problem in their home.

In the lecture, we talked about People First Language, which is appealing to me because my mom has talked about it for my whole life, and also because it stresses the power of words.

What IS people first language, you ask?

it's saying "people with disabilities" instead of "the disabled"

or saying "she has autism" instead of "she's autistic"

or "he uses a wheelchair" instead of "he's wheelchair-bound"

or "she has a learning disability" versus "she's learning disabled"

the former all remind you that you're talking to/about a human being, not a broken toy.

My visit with the family to which I was assigned was amazing. They live right down the street from where I am staying these next few months and welcomed me right into their home. As the mother, let's call her Hannah, introduced herself, two children (age 3 and 1) tore through the living room screaming at the top of their lungs. It took me a little while to figure out which child had the disease, they were both so happy, so eager to have my attention, so active.

fast forward 2.5 hours later - Hannah and I are sitting on her living room couch. She's crying but smiling, her husband is putting her kids to bed, I'm apologizing for staying so long, and she says, no, thank you. this was like the therapy I never had.

I'm going to check in with them in a few weeks after their daughter has surgery. It makes me wish I was hanging around more - all the relationships I could form in this community, if only I could stay in one place long enough to actually form bonds with other people.

*le sigh*

what love means (from kids)

I have just been loving pediatrics and working with kids, partially because you just never know how they're going to react. In keeping with the theme of my life right now, my mom sent me a link to this website about how 4 year old's answer the question "what does love mean?" so profound. (I've copied and pasted below straight from the article):

A group of professional people posed this question to a group of 4 to 8 year-olds, “What does love mean?”

The answers they got were broader and deeper than anyone could have imagined. See what you think:

“When my grandmother got arthritis, she couldn’t bend over and paint her toenails anymore. So my grandfather does it for her all the time, even when his hands got arthritis too. That’s love.” Rebecca- age 8

“When someone loves you, the way they say your name is different. You just know that your name is safe in their mouth.” Billy – age 4

“Love is when a girl puts on perfume and a boy puts on shaving cologne and they go out and smell each other.” Karl – age 5

“Love is when you go out to eat and give somebody most of your French fries without making them give you any of theirs.” Chrissy – age 6

“Love is what makes you smile when you’re tired.” Terri – age 4

“Love is when my mommy makes coffee for my daddy and she takes a sip before giving it to him, to make sure the taste is OK.” Danny – age 7

“Love is when you kiss all the time. Then when you get tired of kissing, you still want to be together and you talk more. My Mommy and Daddy are like that. They look gross when they kiss” Emily – age 8

“Love is what’s in the room with you at Christmas if you stop opening presents and listen.” Bobby – age 7 (Wow!)

“If you want to learn to love better, you should start with a friend who you hate,” Nikka – age 6 (we need a few million more Nikka’s on this planet)

“Love is when you tell a guy you like his shirt, then he wears it everyday.” Noelle – age 7

“Love is like a little old woman and a little old man who are still friends even after they know each other so well.” Tommy – age 6

“During my piano recital, I was on a stage and I was scared. I looked at all the people watching me and saw my daddy waving and smiling. He was the only one doing that. I wasn’t scared anymore.” Cindy – age 8

“My mommy loves me more than anybody You don’t see anyone else kissing me to sleep at night.” Clare – age 6

“Love is when Mommy gives Daddy the best piece of chicken.” Elaine-age 5

“Love is when Mommy sees Daddy smelly and sweaty and still says he is handsomer than Robert Redford.” Chris – age 7

“Love is when your puppy licks your face even after you left him alone all day.” Mary Ann – age 4

“I know my older sister loves me because she gives me all her old clothes and has to go out and buy new ones.” Lauren – age 6

Karen – age 7:

“When you love somebody, your eyelashes go up and down and little stars come out of you.” (what an image)

“Love is when Mommy sees Daddy on the toilet and she doesn’t think it’s gross.” Mark – age 6

“You really shouldn’t say ‘I love you’ unless you mean it. But if you mean it, you should say it a lot. People forget.” Jessica – age 8

And the final one — Author and lecturer Leo Buscaglia once talked about a contest he was asked to judge. The purpose of the contest was to find the most caring child. The winner was a four year old child whose next door neighbour was an elderly gentleman who had recently lost his wife. Upon seeing the man cry, the little boy went into the old gentleman’s yard, climbed onto his lap, and just sat there. When his Mother asked what he had said to the neighbor, the little boy said, “Nothing, I just helped him cry”

photo source

new to the world

after spending yesterday in the pediatric cardiology clinic, seeing babies and children who had lots of different heart problems, today I spent the morning in the newborn nursery, doing exams on all the new babies that had been born in the past 24-48 hours and didn't have any serious problem that would take them to the NICU (neonatal intensive care unit).

it was pretty spectacular, not only because there is some part of us human adults that is clearly evolutionarily programmed to respond to a totally helpless newborn baby - otherwise they'd never make it. I bet this response can be even bigger if it's your own child. having done quite a few now, I think the best parts of the newborn exam are:

1) testing the sucking reflex - babies respond by sucking if you stick your little finger in their mouth, this also makes them quiet down and relax a little, so it's one of the first parts of the exam

2) testing the moro or "startle" reflex - which is when you have the baby on it's back, and you lift its upper body up by its arms just a few inches then drop it back onto the mattress, and the baby waves its arms and legs excitedly.

3) telling the mom (and dad or grandma or big sister) that the baby looks great!

may the clay dance to balance you

because he's one of my favorite poets and I feel so blessed to be back in town:

Beannacht (Blessing)

On the day when

the weight deadens

on your shoulders

and you stumble,

may the clay dance

to balance you.

And when your eyes

freeze behind

the grey window

and the ghost of loss

gets in to you

may a flock of colours,

indigo, red, green,

and azure blue

come to awaken in you

a meadow of delight

when the canvas frays

in the currach of thought

and a stain of ocean

blackens beneath you,

may there come across the waters

a path of yellow moonlight

to bring you safely home.

may the nourishment of the earth be yours,

may the clarity of light be yours,

may the fluency of the ocean be yours,

may the protection of the ancestors be yours.

and so may a slow

wind work these words

of love around you,

an invisible cloak

to mind your life.

~John O'Donohue

Echoes of Memory