Free Sushi!

A general rule for residents is that they always go where the free food is. The attendance of a noon conference with lunch provided always beats one that says, "bring your own lunch."

So it isn't surprising to see that last night's dinner event at a local Japanese restaurant drew a full house of residents (as well as some attending doctors) from different hospitals. It's free sushi we are talking about here! The talk, which is on hormone replacement therapy (HRT), is sort of interesting. Of course, the fact that the event is sponsored by the makers of Premarin makes some of the recommendations somewhat unconvincing (the take-home message I got seems to be, "when in doubt, give patient the lowest dose" rather than considering not starting the therapy). It is also to my slight surprise that according to the WHI studies HRT actually reduces the risk of cardiovascular events in younger postmenopausal women.

Academic aside, the dinner is fun. The sushis were actually just "alright" at best (and my spoiled palate from the recent Tokyo trip did not help at all!) but the atmosphere is joyful and laid-back.

And did I say it's free? ;-p

Know Your Personality Type

I had a rather interesting seminar this morning on the Myers Briggs Type Indicator - it is apparently the most widely used standardized personality test in the world. It is based on Carl Jung's work on Personality types. There are 16 different types; to find out which type you are, you have to take a questionnaire of ninety-some questions.

I turned out to be a split between ISTJ and INTJ, and upon further analysis I am leaning more toward ISTJ. ISTJ stands for Introvert, Sensing, Thinking, Judgement - people with this type are "conscientious, reliable people who can always be counted on by friends and co-workers." They are "organized and love to set schedules" and "greatly treasure family affairs". They are traditionally-minded and are unwilling to change. They "earn success by concentration and thoroughness". In the medical/health field, careers in general surgery or primary care are a good fits.

So it looks like I picked the right field then :-)

MBTI Questionnaire: http://www.real-properties.com/MBTI/MBTI.asp
MBTI Questionnaire (中文): http://www.ksa.nkfust.edu.tw/guidance/main9b.htm

A Sad Evening in the Hospital

As I was walking out of the hospital after an afternoon of clearing out dictations yesterday, I saw an unusual scene in the lobby - there were a bunch of men in US Forest Service uniforms lining up on one side of the lobby, and not far from them there were about 20 people -some of them were weeping, others were keeping with their heads down. I did not stop to talk to anyone of them as it didn't seem appropriate, but I knew something bad must have happened - our hospital has been taking care of the firefighters who were severely injured while taming the Esperanza wildfire nearby. Later I found out that a firefighter who's been battling his life for 6 days died that late afternoon. That brings the total death toll to five. Even though I don't know the person, I could feel a great sense of sorrow for the lost...

Top 10 reasons to hate Halloween

Ok, I'll say it - I don't like Halloween. None of people in my family likes Halloween. Paul Bourgeois from Fort Worth Star Telegram wrote a beautiful Top Ten List to illustrate his dislike of the festival (see below). I believed I was also somewhat traumatized by the childhood experience of my first Halloween. In NYC, where I spent my first Halloween, rotten eggs and other biohazards were the standard "tricks" amongst kids and I once witnessed a poor child being thrown at on the street with those nasty eggs. I mean, what's the flipping point?

The whole idea of "trick-or-treat" is based on the notion of greed and blackmailing - that's pretty unhealthy for kids too, isn't it? And who likes being constantly bothered by scary-looking kids ring your doorbell soliciting free candies?

Top 10 reasons to hate Halloween
1) Trick or Treat? More like extortion!
2) Most shades of orange clash with my eyes
3) Isn't the world scary enough?
4) It's encouraging in our children liberal notions of "something for nothing."
5) Dressing up? Costumes? Makeup? Is it a holiday or a drag show?
6) Costumed dogs
7) Neighborhood dogs barking. (Is it because hoards of strange children are running amok or because these dogs don't have costumes?)
8) Large women dressed as immense pumpkins
9) Don't we already have enough hyperactive fat kids?
10) Jokes like: "What did the skeleton say to the bartender?
... I'll have a beer and a mop!"

Dictations

Dictating discharge summaries is a drag. It's worse if you don't know anything about the patients in the first place. With patients whom I discharged on the first few days of a new rotation, I know so little about them that dictating their discharge summaries is like summarizing a novel without actually having read it. And then there are situations in some services when I don't actually follow the patients every day and I just happen to be the person discharging the patients. Obstetrics is an excellent example because I worked in different place every day and don't actually know any of the patients thoroughly.

In Internal Medicine, interns are so busy during the day that dictating summaries when discharging them is impossible - so it didn't surprise me to see my long list of delinquent dictations in my mailbox the other day. This afternoon I spent 3 hours dictating 6 summaries - what a torture....

Chock Full'o Journals

I was surprised when I was checking my mailbox at the clinic this afternoon. It's filled with journals - 12 to be exact. Where do I get all these subscriptions from? Perhaps some of them are just trial subscriptions. Some of them are subscriptions given from my residency program. Some of them are from my AMA membership.

They are all very useful and informative though; whether I'll have time to digest them all is another story! (They sure make an impressive photograph though as you can see on the left.)

Tokyo, Here I Come!

As I am writing this, I am 35,000 feet above the ground, sitting on my comfortable seat en route to Tokyo. Just a few hours ago, I was still in the hospital, tired post-call, signing off my patients to the on-service interns who were taking over. It is difficult to believe the 4-week medicine rotation has gone by so quickly - and I survived it! We were luckily blessed with 2 light calls in a roll - last night we only admitted 5 new patients and with all the off-service notes to write I was still able to sleep for 2 hours. The students and us 2 interns even watched a DVD (Stoned Age..!!!)together in the lounge! I am glad that all of us in the team were able to bond together well and make this rotation so much more enjoyable.

I think because I was constantly under stress with this medicine rotation, I still don't feel like I am in vacation now. I am sure this will change after meeting my family in Narita! Enjoy my 10 days of fun!

Yum...

A sudden crave for these... can't wait for my vacation in 2 weeks!

It's All about Discharges

Inpatient Medicine, at least at the resident level, is all about discharging patients. The problem with medicine patients in the hospital is that there are just darn too many of them, and most of them have multiple problems that we'll never be able to cure completely. What we do then, while they are sick enough to be in the hospital, is to patch them up nicely, as quickly as possible, so that they get a bit better for us to send them out of the way. Many of the patients' problems don't have to be fixed "in-house". In fact, sometimes they can't be fixed in the hospital (like controlling a diabetic patient's blood sugar). My favorite phrase to patients this month has been, "this can be followed up as an outpatient." To this effect, isn't inpatient medicine just an extension of emergency medicine?

More patients means more work for the residents, so it is only logical that we set "getting rid of our patients" as our primary goal. We pride ourselves when we brought our patient list down to 1 page (or even half a page); I get a "good job" compliment from my senior when I successfully discharged a patient (especially one who has been here for a long time).

We did bring our patient list down to less than 1 page - our lowest census since I started the rotation. Just in time for our anticipated busy call night tomorrow.

Why See a Doctor When I Can Treat Myself?

This afternoon I saw a patient in my clinic who has been taking her aunt's Lasix pills for a week to treat her "hypertension, headache and fluid retention in [her] legs". That's exactly what her chief complaints are on her chart - she pretty much self-diagnose her problems and treated herself. Her hypertension and other symptoms did get better - the only reason why she's in the clinic today is to get more of the medication because her aunt stopped giving her the pills (good for her). She doesn't even know what dose she has been taking.

Lasix is not the first line of drug to treat her hypertension and she could run into some serious problem if she starts developing hypokalemia at home.

This reminds me of the pregnant patient I saw last month who has been self-medicating with insulin for 3 years....

Moving out Rocks from a Rock Garden

Every medicine team has a few rocks. Rocks are patients who have been staying in the hospital for an extended period of time - their conditions don't change, and for any reason they are difficult to be moved out of our inpatient list; they essentially just sit there and not doing much. One of our rocks, an AIDS patient with extensive neurological complication, is obviously too sick and complicated to be managed at home but at the same time has really no reason to stay because we are not doing anything to his sickness. So I am happy to hear today that the family is thinking about transferring him to a nursing facility.

Another one of our rocks have been with our team since July - she has no medical problem except that she initially came in due to dehydration. It is then determined that she has dementia and is not able to take care of herself, so she is just staying in the hospital while her social worker works out her placement. Today we found out from the social worker that they have found a place for the patient and she can be transferred there within the next 2 days.

That's TWO rocks that we are going to move out from the garden - there's a definitely a sense of euphoria amongst our team members today.

24+6

I survived the first two 24+6 calls. "24+6" denotes the hours of the call - 24 hours of call time plus a maximum of 6 hours post-call time for education and transfer of patient care to the next call team.

As an intern in a busy service like Medicine, it means in most cases you don't get any sleep at all. Last night we had 16 admissions overnight amongst 2 interns and 1 student - and with me and the other intern in the team being new to this whole system (this is our first general medicine ward month) it didn't really help. We had some really interesting cases though, not just the usual "CP r/o ACS" kinda thing. We had a patient with lupus who came in with neutropenic fever and cutaneous lesions all over her body; a guy who was brought in after being found lying unconsciously in the hospital lobby; a guy with sickle cell disease who is stupid enough to stand in the back of a truck and fell off when the truck accelerated; a schizophrenic social admit... the list goes on...

Partly because we are not efficient enough, and partly because there are just darn too many things to follow up, I stayed until around 3:30pm the next day, which means I have worked for at least 28 hours straight without a second of sleep. I started dozing off while writing for patient's note, and felt like a zombie walking around the hospital. The good thing that my fellow intern and I noticed though is how fast we have already improved our efficiency a lot in one short week (with a seal of approval from our R2). Hopefully this will continue to improve.

Medicine

Today's my first day in the Medicine service. The Medicine department is huge here - there are at least 15 residents rotating in the medicine wards service at any given time with a daily total patient load that is way over the century mark.

It has been at least 2 years since my last medicine rotation in med school! It's a rude awakening of the reason I was drawn away from pursuing internal medicine - it's a service where discharging patients seems to be the main goal, rather than caring for them. At times, I feel that we are just patching patients' problems and send them out of the door as soon as they do a bit better. Let's see if my perception changes in the next 4 weeks.

Last Day of OB Rotation

Strange feelings today - I feel like I am going to miss my OB rotation. This is weird because for the past 2 months I have been bitching about the hours and the quality of the rotation, but when I signed out the patients to my colleague after this super busy morning, I had this weird sense of emptiness. Suddenly I am no longer following these patients....

And of course I'll miss delivering babies. But I am sure I'll be doing more deliveries in the very near future.

Jail Mom

We rarely discharge patients during our float nights, but a few nights ago I was told by a nurse to do one. The patient had an uncomplicated NSVD with normal postpartum course in the hospital; the only thing different about her is that she is a jail patient and has just come back from a court appointment. For the past 2 nights, I have been seeing this patient, with cuffs on her feet tied to the bed rail. She always smiled at me when I walked into her room, and grateful of the time that she was having with her newborn. I carefully selected my words when talking to her to avoid saying something inappropriate, but sometimes words just slipped out of my mouth:

"Try to walk as much as possible tomorrow." (What walk? With these chains?)

"Ms. K, it looks like you are doing well so we'll send you hom- (wait a second..) we'll discharge you from the hospital tomorrow."

"What kind of contraception are you planning to use?" (oops~ she probably has no need for that now.)

The patient was in the detention room when I examined her for discharge. She was crying the whole time and asked me repeatedly if she could see her baby one more time. I sympathized her, but I don't know her story enough to judge.

"Why did what you have done if you knew your consequences today?"
(早知今日, 何必當初)

*NSVD - Normal Spontaneous Vaginal Delivery

My (Future) Home - An Update

8/16/2006:




9/10/2006:

Under a Full Moon

What could be a better way to finish my last shift of OB night float than an action-packed night? The post-partum floor was a full-house with 40-some patients, and I did 3 out of the god knows how many normal deliveries. The residents were swamped with laboring patients all night long. It kept on going and going until I realized I had 2 hours to see 18 patients and complete all their progress notes by 6. Even though studies have proved it otherwise, it makes one wonder if there is really a connection between a full-moon and pregnant women going into labour?

Insulin is OTC

It was a surprise to me to learn today that one does not need a prescription to buy insulin (as well as insulin syringes) in a pharmacy, except for newer formulations like Lantus. One of the antepartum patients on the floor today has been self-medicating herself with regular insulin for a few years without seeing a doctor, and if it wasn't because she decided to come to the hospital to check if her pregnancy is "ok" (she has no insurance and said she doesn't qualify for Medi-Cal), no one would have told her that this is a problem.

Insulin can be some pretty lethal stuff and I think the fact that you can get it over-the-counter is scary. You could overdose yourself or someone with insulin and kill the person. Sure you could overdose someone with a bottle of Tylenol or by just taking someone's insulin vials, but the fact that there is no regulation regarding the sale of insulin is awry. Regular insulin acts in minutes, whereas the prescription-only Lantus insulin is long-acting and relatively less lethal when overdosed. In comparison, most sleeping pills are available by prescriptions only. On the other side of the scale, inadequate control of diabetes due to lack to a doctor's guidence can be dangerous to the patient (and in the above case, her unborn child) as well.

This page shows that most states do not need a prescription for insulin and syringes.

Preeclamptic Patient on My Watch

Last night ICU refused to admit one of my OB patients - the patient has just delivered her baby via emergency section due to extremely elevated BP. Her BP went down to normal after the operation but the attending felt that the patient still has high risk of having eclampsia. ICU said her BP readings do not warrant a bed there. Then the attending said the postpartum nurses will freak out if the patient has an eclampsia attack because they wouldn't know how to react. The patient ended up staying in the postpartum floor and that's when I started to worry - do I know what to do if the patient throws me a seizure attack? That's when I went back to my call room and started reading up.

Sure enough, nothing happened to the patient overnight. Well, at least I forced myself to study :)

Progress Notes

I did 23 progress notes last night. Do I even know most of these patients? Did they know who they were talking to when I woke them up at four o'clock in the morning?

Speculum Exam

Speculum examination is without a doubt one of the most embarrassing and stressful procedures for patients. The same can be said to the inexperienced health provider (Ahem~) who performs the procedure; moreover, when it's not done right, it can only make a patient even more stressful. I have the "pleasure" the other day to supervise a medical student to do one - my mind was thinking "run!" when I got the assignment - I have barely done enough to do it on my own, let alone teaching a student. As nervous as I am (as well as the student), I walked into the room and handed the speculum to the student. Then I handed over a glass of water as said, "here, use water as lubricant." The nurse who's standing next to us immediately stopped us and told us that there we use jelly instead of water. That's when I realized that it was the patient's darn drinking water container that I was holding!

I laughed it off and continued on. The rest of the procedure went well actually, and I was surprised that I was actually able to show the student a few techniques from the little that I know. One of the most important things I've learnt that I was trying to tell the student is the need to communicate with the patient well during the ordeal - tell the patient exactly what you are doing before each step helps the patient to relax, and at the same time the provider will feel more comfortable.

See one, do one, teach one. So the adage goes.

"Hot" Work in the ICU

OB Attending to MICU Resident: Boy, your hard work in the ICU is keeping you hot huh?
MICU Resident: What do you mean?
OB Attending: Your hair's all wet...
OB Resident: I think that's his hair gel!
MICU Resident: ... [embarrassed]

Grey's Anatomy

I have to admit that I enjoyed watching Grey's Anatomy after the first 2 episodes. I have been avoiding the show since the beginning, knowing that it's an overly-dramatized show that is not realistic and all (who does 48-hr calls anymore? And where are the Meredith and Izzie in my class?). I found the interactions between characters interesting, and I can actually relate when they sit in the dimmed corridor complaining about intern lives. My life is nowhere as stressful as them of course. I know the show becomes even more dramatic in later episodes so... but I'm sure Katherine Heigl's presence will keep me watching. I am sure...

Another medical drama I like a lot is none other than House, M.D. It's a much more realistic show and I can actually learn something from it. And Hugh Laurie from the Blackadder fame as Dr. House? He is great.

AMA

I was on day call today and got my first experience of a patient who wanted to leave the hospital against medical advice - or AMA as we call it. I can't blame the patient but there are times when I just don't really understand what a patient wants. The patient, who has just delivered a baby through c-section 3 days ago, has an uterine rupture and high blood pressure reading that warrants a full 96-hour stay. She has a complicated social history - positive drug screen, no prenatal care, and G10P4504 prior to this delivery which means she had 5 prior miscarriages. Her newborn did not live beyond the first 24-hour and I was told by the nurse that when the baby was sent to the NICU she didn't spend any time there. After the baby passed away, she would cry in her room in the Postpartum area and constantly complained about pain from her c-section incision. As her bed is in an area surrounded by newborns, we offered to switch her to another room on a different floor but she refused. Then she would complain about how we don't understand how emotionally painful is it for her to hear babies crying all day long. All the nurses there wanted me to send her home so they became ecstatic knowing that she wanted to leave AMA. I had to explain to her all the risks of leaving the hospital early and have her signed a form saying that she understands.

"What about her meds?" I asked the charge nurse.
"You don't give them any meds home if they are leaving the hospital this way."
"What? Really? But her BP is still high despite the BP meds!"
"Don't worry - you are free of any liability after she signed the AMA form - she'll come back if she's sick enough. And definitely no pain meds."

But that's not the point!! I ended up writing a prescription for her BP meds (which I later found out that I did the right thing) and told her to come back in a week for staple removal. I hope she got the part about coming back. She was then taken away by a guy who's at least 10 years younger than her.

"What do you mean he's not her son?" I asked the nurse.
"That's her partner, kiddo."
"Oookie."

Talk about complicated social history.

"Thank you doctor; you're a very good man."

What's more rewarding than being told by a patient that you are a good doctor?

I was in my clinic the other afternoon and saw this new patient. He doesn't speak English, but his sister was helping with the interpretation. He's a typical case of someone who needs multiple visits to the clinic to get things straight - a male in his 40s with sub-optimal health care due to insurance issues, with history of insulin-dependent diabetes, high cholesterol, hypertension, as well as a chronic lower back pain that is the main reason for his visit today. I took the time to learn more about the pain and explained to him the management plan. I told him that it will probably take some time to fine-tune his meds, since besides the back pain we'll need to address his other problems too after checking his lab work. A quick neuro exam revealed that his diabetes is not too well-controlled either as he's showing signs of peripherial neuropathy.

As they walked out of the patient room, his sister said to me, "thank you doctor; you're a very good man and we'll see you again next month." As I always say, that extra mile you take to learn and talk to your patients' problems shows that you care about them and often times this is the most important thing they need. Of course, as an intern I have the luxury of seeing only 3 patients in the afternoon instead of the typically 12-16 for a typical family physician; when you have only 15 minutes for a patient it's not easy to try to address his problems all at once.

"Here's the motivation," I told the medical student standing next to me who smiled at me after hearing the lady's remark.

A Quiet Night in the Call Room

It's 2:20 am. I have just finished seeing all my patients (16 of them tonight, which isn't too bad) and my progress notes are half done. It's a surprisingly quiet night - I only got called twice for some minor things. But shhh~ touch wood... just keep this to myself because someone up above may listen!

I have a sudden crave for hot scrambled eggs for some reason. I think I still have some eggs at home; i know what I'll be having this morning before I go to bed.

Just Come Over And Talk

I got called by a nurse last night. (what's new)

"Doc, can you come over to talk to this patient?"
"Which patient is it?" I asked.
"Just come to the station and talk to them." (What?)
"What do you mean?"
"I tried to explain to them but... (muffled)... could you come over now?"

So I walked to the station and to the patient's room - the patient was sitting in her bed, and her mother, with a somewhat frustrated look, was sitting on a chair nearby. As the nurse saw me walking into the room, she said to them, "here's the doctor, he'll talk to you," and swiftly left the scene. "Oh that's great." I thought to myself.

As it turned out, the mother was concerned that we are sending her pregnant daughter home that night when the patient was still having some diarrhea and nausea from her urinary tract infection. I asked the patient repeatedly if she has any pain and if she feels comfortable going home and she said she's fine. I explained to the mother that her daughter's condition is stable and that she has not been having a temperature for 2 days. The nausea is residual and rather than monitoring it here, it'd be better for her to rest at home and come back to the hospital if any of her symptoms worsens again. The diarrhea is the side effect of the antibiotics and it is common.

"Do you want to go home?" I asked the patient. "YES!" I ended by saying that I'll double-check her labs and vital signs to make sure we are happy to discharge her home as well.

The amazing thing is that they are both very satisfied after I talked to them. I am sure the nurse has said the same to them as well, but they apparently trust a new doctor more than an experienced nurse? That can very well be the reason, but I also think that when talking to a patient it's very important to take the time to listen to him/her and respond accordingly. Often times, just showing that you care is therapeutic.

I happily walked back to my tiny call room afterwards, took a short nap, and enjoyed the rest of the peaceful night with 20 progress notes to write.

What Can I Say to a Weeping Medical Student

While I was at the nurse station the other day, a medical student came up to me, with her joyful and smiling face as usual. I started talking to her, and very soon into the conversation she expressed to me that she's feeling stressed as a 3rd year student and asked for my advice because I always look so relaxed despite all the stress as an intern. Apparently she's feeling the competition with the students rotating with her.

Her eyes started turning red. I told her the most important thing is to not take anything seriously, and that sometimes these seemingly competitive students are not directly against a specific person. Now her eyes started tearing. I walked to the other side of the station and was going to guide her away from the patient floor and find out what exactly happened, but suddenly a nurse came up to me with a patient chart and so the student broke away and left. I hope she's doing ok as I hadn't seen her again that day.

What I wanted to say to her is that I do have stress but I usually don't show it on my face. I think I can handle stress well in general because I tend to take things very lightly. Those who know me know that I don't get angry easily. When something doesn't go the way as planned, I usually let it go instead of getting all upset about it. Now how can I tell her not to worry about being competitive in the hospital, when the 2 clinical years seem to be all about competitiveness and showing your best? I don't know. When I was a student in the hospital, I never tried to act competitive because I know I will never be "the top of the crop." Some may say I am an underachiever but again, why should I be all tensed to be the best?

"Whatever rocks your boat," I'd say. Do anything that makes you happy - life is too short to be stressed out everyday.

Banana Bread

I LOVE the banana bonanza bread I got from Trader Joe's today.

A Much Needed Day Off

Tomorrow is my day off of the week... a much needed one indeed. For the past week I have been doing 6am-6pm'ish hours and I am feeling a bit exhausted, especially on "floor" days when I'll be running all over the place doing patient discharges. I have been a late sleeper for years and now I definitely feel the need to adjust my bed hours to accommodate the work schedule. Each afternoon is just a drag and I can't drink coffee because hospital coffee sucks! Starting this weekend I'll be on night float again for a week... yeah I am REALLY looking forward to it (sarcastically, of course).

I am definitely sleeping in tomorrow... and run some errands in the afternoon.

INSANE Heat

Today is hot. Very hot. I saw the temperature display as I passed by Loma Linda and thought I HAVE to take a couple of pictures of it.

A Stupid Delivery Mistake

I was assisting with a vaginal delivery this morning. Everything went well for the most part for the mom and the baby, although a little incident happened and it's all my fault. After we clamped the cord, I was told to collect a bit of the cord blood from the mom for analysis. For some unknown reason I lost control of the hemostat as I was releasing it and I stupidly lifted the cord upward - and voila, blood start squirting all over me and my colleague. We clamped the cord back quickly, but the damage is done. I got a bit of the blood on my lip too but luckily I didn't have any in my mouth.

Well, a good lesson learned.

Goodbye Peds... Hello OB

Today's the last day of my first rotation! I really don't want to move on. I love taking care of children and I don't think I can say the same for their moms - my next 2 months will be in obstetrics and I know I won't be enjoying it as much as peds. OB is just such a different atmosphere - mothers screaming in pain, all sorts of little problems during pregnancy, pelvic exams, negligent meth positive moms (this area is often cited as the meth lab capital of California, if not of the US)...

The hours are longer too... oh well...

Birthday

A big thank you for all who wished me happy birthday today; for someone who's living alone in this strange new place and going through all these new changes in my life, your messages really meant a lot to me. THANK YOU!

Vacation

It's weird but I am on vacation right now, after just one week of work! All vacations are prearranged by the department and my first one happens to be in my 2nd week. I actually chose it because I wanted to have my next break in October for my much anticipated trip to Hong Kong (yay!) Having this break early also allows me to take care of my stuff back home, as well as getting some relief from my night float week. Everything works out perfectly!

Call Gears for a Peds Intern

I got a bit bored during the night and decided to take out all my gears and took a picture of it with my phone. What's not included is the tiny peds stethoscope that I usually wear instead of the general one shown here.

Night Float

Night float is one of those things that you just have to love to hate. It's a system that swamped out after the ACGME's so-called "80-hour rule" came into effect in 2003 and now has been adopted by a lot of residency programs. Instead of having the same resident staying overnight during call, there is one designated floater who works just night shifts - usually for 5-7 days (sometimes this can be 2 weeks or more depending on the program). The great benefit is that most of time you won't have to stay in the hospital for 24+ hours continuously. What sucks, of course, is when you are the floater and have to work during the darkest hours. Trying to sleep in the morning is no fun but it's such an necessity and the sleeping eye cover becomes my best friend. You'll end up feeling tired all time too with your now messed up sleep pattern. Even during down time, I can't sleep well because I am always afraid that one of those suckers will go off when I am asleep. I keep the room light on to prevent falling too deep into sleep.

That said, I enjoy walking around the hospital during my down time - imagine having the clean, brightly-lit corridors all by yourself... where you can hear your echoing footsteps and a time where you can just sit anywhere and read. It's the only time you can stand behind the windows and stare at the stars and totally infuse yourself into this moment of solitude...

...until the call phone goes off again. Back to work.

What a Night!

The very first thing in my mind as I walked out of the hospital entrance in this warm Sunday morning: "Is this what I signed up for??" I was overwhelmed. At the beginning it looked cool wearing so many gears on your scrub pants - an on-call phone, a trauma pager, and my own pager. 20 minutes later the trauma pager went off - "scheduled c-section for a twin gestation, OR#1". Alright, what do I do... luckily my R2 was next to me and she went to the OR with me (it's a twin afterall...we need two residents there). I walked into the room and help prepared the resuscitation kits, and then boom - we have a newborn covered with a sticky layer of cheese... alright what to do next...

"dry the baby first!" said the respiratory therapist.
"Here, suction the baby"...
"Give the kiddo oxygen"...
"Ok, let's let go of the O2 mask"...
"Here, remember how to put in the OG tube?"
"Yeah, just stick the whole tube down the throat... you are not going to hurt him."

At the end it was a job well done because the baby is breathing pretty well on his own. I wrote my little resuscitation note and walked out of the OR.

"Maybe I should get some water," I thought.
"Emergency c-section for a non-reassuring FHR tracing. OR#3."
"Darn it!!"

So there I go again - back to the OR. Another 20 minutes have gone by. Out of the OR.

"I could really use some water now," I said to myself. Ring~~Ring~~
"Hi, this is nurse xxx calling from the peds floor... the baby in room xxxx is NPO tonight but no IVF is ordered. Do you want to give him some fluid doctor?"

Whoa. What did you just called me? Oh yeah I am a doctor alright, even though I don't feel like one.

"Geez, what kind of fluid should I give?" I was speechless for about 10 seconds. I've decided if anything, the nurse on the other side of the phone should know more about this than this clueless doctor here.

"So what do we usually give?"
"We usually give D5 1/2NS doctor."
"Okie, let's do that then. Just a moment while I calculate the amount."

Another problem solved. This went on until around 1:30am. I tried to take a nap...

4:00am - Ring~~Ring~~. "Yes doctor, we have a few newborns for you to examine in the nursery."

5:30am - finished examining 3 babies. Time to work on the progress notes for the ones that are here.

7:40am - Finally my shift is over and I am a free man. I graciously handed over my call phone and pager to the Day Call person.

It was a warm Sunday morning. The morning sun warmth has never felt so good. Time to get some sleep and prepare for tonight - Round 2.

It All Comes Down to This

15 years of preschool to high school, 4 years of college, 4 years of medical school, and all the time and money I spent in preparing for the USMLEs, applying and interviewing for residency - it all comes down to tonight - my first day as an intern. I am nervous as heck, digging through my peds notes this morning but couldn't put any data into my brain... we'll see what happens!

I am scheduled to do 5 days of Night Floats too... what a nice way to start the year, by messing up my sleep cycle for a week!

Orientation Week

Today marks the first day of the 5-day orientation for my residency program. I met a lot of new faces today, and at the same time it's refreshing to meet two familiar faces - two of my schoolmates whom we knew back in medical school. You see, graduates from my school come from all parts of the country and I didn't expect any one of them to be in the same program as me. But there it is, I have not one, but THREE other people from my school in the same program. A bit unusual, but it works to our advantage!

This week is probably going to be the most relaxing week of the whole intern year... better enjoy it while it lasts.

Keeping Junk

I keep a lot of relatively junky stuff - used train ticket stubs, tourist maps, useless toys from drug reps, name tags from meetings and interviews, etc. I keep all the letters and emails sent from my friends, as well as all the businese cards I received from all walks of lives. I know many of these things are just taking up space in my room, but often times it's difficult for me to let go. I live my life forward, but at times I am a person of reminiscence. Looking at my random collections brings back memories, and sometimes I try to reconstruct events in my mind from what I can still remember. Things do change, and some of these fond memories, unfortunately, now bring me a sense of sourness. Nevertheless, I would rather keep these memories than to lose them - who's to predict if these memories will become sweet again in the years to come?

Now should I keep these loose papers in a box or take them with me to San Berdoo?

It's Now Scientifically-Proven: Men Are Sexual

Man Meets Woman, Man Thinks Sex? (WebMD)

When a man and woman meet for the first time, men may be more likely to think about sex -- or at least more likely to admit it.

That's the core finding of a study in June's issue of Psychology of Women Quarterly. The researchers included Maurice Levesque, PhD. He worked on the study while at the University of Connecticut and now works in the psychology department of North Carolina's Elon University.

I think...

I think I am finally starting to get over it now.

A Hectic Day at Work, But I Love It!

Today is a great day at work. It's a hectic day, with 2 major study visits, a study monitoring visit (with a heck of issues with a couple of the subjects in the study), and with my back up co-worker taking a day off. What made my day was that one of the patients in my dementia study, despite having a long and emotionally draining day in the office, gave me a big hug at the end of the visit after knowing that I will be leaving the job soon. Both the patient and her husband commended my work. It is really encouraging and refreshing to receive their compliments after a busy morning running all around the clinic. I love it!

I Deserve Better

I keep saying to myself today - I deserve better. I think I really do. There's no point of trying to please someone who doesn't appreciate you. If the person doesn't appreciate what you do, then please my foolish self leave it for someone who does.

Tired

I am pooped after spending two days in Modesto learning how to deliver plastic babies who are stuck in various strange positions and managing their mother's postpartum hemorrhage emergencies. The course is fun though, don't get me wrong. And I ate like a pig as soon as I got home - my mom was amazed and thought I looked like someone who have just escaped from prison. I don't know why I was so hungry since I actually had a pretty big lunch today.

Maybe I Just Don't Get It

I'm about to lose my composure, I'm gettin close
To packin up and leavin notes, and gettin ghost
Tell me who knows, a peaceful place where I can go
To clear my head I'm feelin low, losin control

Have I done wrong? Have you done wrong? It doesn't matter because nothing has gone right.

The Origin of BabyDocJackie

I have been using the "BabyDocJackie" alias in several places on the internet. I picked "BabyDoc" originally because I planned to specialize in pediatrics and thought that it would be relevant. Of course, since then I have decided to pursue family medicine instead. I thought of changing my alias, but then I am, in fact, a "baby" doctor with little experience... Hence the original name stays.