Tales From the Pedi Student Library

• A fellow student, who attended college with me, stated that she must be the only person in the world who disliked yoga. It turned out that we were in the same yoga kinesiology class in college. She said "oh yeah, you were up at the front. You were really good." I replied that I used to be a gymnast, so I have always been flexible, and I added "Even now that I weigh three times as much as a normal gymnast now, I'm still pretty flexible." She looks at me and says "well, yeah, I mean, most gymnasts are about 70 pounds." I nearly died laughing as she tried to apologize for accusing me of weighing 210 pounds (I'm overweight and curvy, but not morbidly obese, okay?) We decided that if I weighed that much, at least I carry it well. I said it must be my extraordinary slimming undergarments.
• Funny, yet sad. Another fellow student shared her morning in specialty clinic with us: "So after this family [mom, dad, and kiddo] had waited an hour to see the doctor, he made me present the patient to him IN THE ROOM. Including a differential diagnosis. This kid had cervical lymphadenopathy [swollen lymph nodes in the neck], so his differential included really scary things like HIV, TB, lymphoma, and leukemia, and I had to keep talking about them, watching the mom's eyes getting bigger and bigger. At the end of all that, the doctor turns to the family and says 'I think it's probably nothing, just a virus', but by then the mom was totally freaked and asked for tons of tests for the conditions we'd just mentioned. To make matters worse, he then told the parents 'Well, if you were a white family, I'd probably overlook the TB thing [the kid had zero risk factors for TB], but TB tends to be a little more prevalent in African American families. After all, TB chases poverty.' Both parents shared shocked looks while I tried to melt into the floor. This family had been referred to this doctor by their pediatrician, whom they see regularly. They're well-dressed, the kid is well taken care of, and this doctor has no idea what their social situation may be." Another student replied "Perhaps he should be wearing a white pointy hat with eyeholes on top of his white coat." A third student, black herself, began to flick imaginary TB on us all.
• Yesterday in a lecture on "Health and the Human Spirit", we were cautioned against complimenting a Hispanic baby without actually touching the baby. The doctor in question said she's had parents who were CONVINCED the student gave the baby the Evil Eye, when all the student had done was the say "Oh, what a cute baby!" Note to self: do not put the Evil Eye on any innocent babies. I think I will start complimenting people I don't like more often, however.
  

Oy vey. Just another day of saving the world.

New Layout

Hope you like it! It's all cheerful and green, like Kermit the Frog. Except here it's easy to be green.

The Carpet Makes All The Difference

So I'm on my third day of inpatient pediatrics, and the differences between this and my first rotation, surgery, are enormous. First and foremost being the CARPET. Yes, friends, the pedi floors at this hospital have carpet. And giant papier-mache trees. And the individual "wards" or nursing divisions on the floor are called "pods", and each pod has a corresponding shape, for example the 13th floor beige pod. The first time I came up here, I thought I'd left the hospital. The adult floors where I worked during trauma are actually in a different building, but it might as well be another world.

The reason the carpet matters is as follows. I had my first call night Monday night. On trauma, by about 11 pm, my legs would start to ache. Deep in my back, hips, and knees, the bones and joints would hurt so badly that I'd be doing yoga maneuvers in the corner to try to stretch my muscles or standing on one leg to rest the other. Up here, however, there is carpet to shield the joints. Ah, bliss. It was my first call night since my first call night where I didn't premedicate with ibuprofen so that I could remain standing. In addition to the carpet, peds residents don't seem to mind if you sit down to do your work. Talking to a parent? Have a seat! Writing a note? Typing a newborn into the computer? Go for it! One resident actually apologized to me because the room we were in didn't have enough chairs for all of us. Wow!

The differences go way beyond carpet. On the first day, the residents learned our names, asked what we want to do when we grow up, and even learned our nicknames. When the intern's father offered to bring dinner for the whole team, I was included! Not that surgery was totally hardcore rigid all the time, but there was definitely a stricter hierarchy in place that said "residents and students are not of the same species." Separate but equal, baby. At one point on surgery, due to some unknown infraction by a fellow student, the head of the department decreed that medical students were under no circumstances to be allowed to eat the free drug rep food should it be present. Don't feed the medical students! Bad!

There's also a prerequisite amount of oohing and aahing over the babies that is required of all peds residents. If you don't coo at the newborns or all walk in and say "you are so cute!" or bring stickers, you are not part of the club. Fortunately, I adore babies and most of our patients are pretty darn cute, so I can check that one off.

I think it'll be an okay month. I'm pretty sure I don't want to pursue peds as a career, however. That decision was cemented after holding a 1 day old infant still while the intern, then the resident both failed to obtain a lumbar puncture. I know it's necessary, but GEEZ. That baby screamed at the top of his tiny lungs, just screamed with pain and the injustice of it all, and the best I could do was try to free a hand and shove my (gloved) finger into his mouth for him to suck on. At least you can explain things to an adult (usually, and whether they understand you or care is another matter entirely), but there's no reasoning with a newborn baby. Good thing they are so dadgum CUTE. Even the one we had to grease up with Vaseline because her skin was so dry it cracked open and scabbed.

Irony

is getting your grade from 1st month of peds (finished 5 days ago) and your grade from 2nd month of surgery (finished 6 weeks ago) on the same day. Actually, I haven't officially received my trauma grade yet; I just have the composite grade for the entire course of surgery. Perhaps it is also ironic that the two grades are identical, yet I worked probably 1/3 as much for the peds grade.

Return to Innocence

or at least to childhood. One of our well child hand-outs that we give to parents says that 2-4 year old children like to be told "you're doing a good job" or "you're such a good helper." (It also says that children these ages like to do chores, so what do they know?)

Today, I was told to go home. "You did a good job today. You were a big help." Another lady thanked me "for all my good help." I basked in the glow, knowing that I hadn't been totally useless today. After all, I'd all but been petted on the head and tossed a puppy treat.

After only 13 years of basic education, 4 years of undergraduate work, >2 years of professional school, $50,000 for college and $90,000 (so far) for medical school, I've graduated to being a "good helper." Pretty soon, I'll be wearing my hair in pigtails and carrying crayons in my pocket.

ARRRGGGHH

According to the New York Times, a Canadian man arrested in 2002 for alleged terrorist links, deported to Syria, tortured, and released 10 months later has finally been cleared by a Canadian panel. I'm directing you to the Times because CNN.com strangely has no mention of this story. Curiouser and curiouser. Even the Houston Chronicle ran the story, albeit under the title "Judge: Man was tortured after US got faulty info", which implies that everything we did after getting this info was above board.

Wow. We deported a Canadian citizen to Syria for torture. Torture. An innocent Canadian citizen, no less.

A Whole New Era

I realized the other day that up until now, I have held a very privileged title: Student. The Student is a special person who is nurtured in a loving relationship with the Teacher, another special individual. The Teacher gently admonishes the Student, guiding the Student toward lofty goals of learning and achievement, mollycoddling and spoonfeeding the whole time. This type of learning starts in pre-K and for me, didn't end until the end of the second year of medical school.

In the third year of medical school, though my title still says "Medical Student", my rank has changed. I am no longer a person to be taken by the hand and guided to knowledge. Nay, I am now a peon of the lowest sort. Nurses groan when they see me coming: "Oh Jesus no, it's a medical student. Lord save us!" Interns ditch us at the slightest excuse: "I can get my work done soooo much faster if I don't have to answer all those damn questions and correct all the mistakes those idiots make." And attendings? Ah, the attendings. See, an attending is not just a "Teacher". No, an attending is a Doctor. Their job is to heal the sick and cure the dying, not to deal with the lowly 3rd Year Medical Student, who is like a fungus growing between the attending's toes.

I had an attending pimp me through a case in the OR mercilessly--I said "I don't know" to the very first question, and he just kept going. One of the questions I actually answered correctly, and he said "No! It's BRCA-2, not BRCA-1!" If I were still the hallowed Student, I could go look up the answer (which I did anyway) and email the Teacher, saying "Sir, I found this information in regards to our discussion earlier." As I am a 3rd Year Medical Student, I would do the former under pain of death (or a Failing grade). Instead, I swallow hard and say "Thank you for that information, sir."

At our clinic, we have a nurse practitioner who covers 2 shifts a week. To be a nurse practitioner, you have to have at least an RN (minimum 2 years), possibly a bachelors (4 years), and a Masters in Nursing (2-3 years). In addition, this particular NP has a PhD (I know this because the initials are on her coat). Let it not be said that I have no respect for the position of Nurse Practitioner--these people work a long time to achieve that title.

However, this particular NP at our clinic is a real work of art. Since she has a PhD, she introduces herself as "Doctor [X], the Nurse Practitioner". I'm not even sure what that means, and I'm in a health profession; patients routinely look bewildered at this introduction and mostly call her "Doctor" (which seems to be her goal). When a patient calls me "Doctor", I correct them; she does not.

I probably wouldn't have noticed the above quirk, but this same NP seems to delight in raking 3rd Year Medical Students over the coals. She barged into a patient's room while I was in there, grabbed a prescription from me and said (loudly) "You wrote the prescription wrong!" She fixed the error with a flourish and handed it back to the patient's dad, saying "I'm sure glad I saw that it was wrong!" In the hallway, she lectured me on the error I had made, using the word "wrong" at least 6 more times, just in case I didn't hear it the first time. I'm wrong a lot. I know this. I don't mind being told that I'm wrong. I just prefer being told in a nice manner, preferably very quietly behind a closed door so that NO ONE could possibly overhear. Seriously, there was no reason to loudly inform the patient's father, more than once, that I, me personally, no one but me, had written that prescription wrong. (Also, the error in question was very small, and the prescription would most likely have been filled, correctly, no questions asked as written.) In one afternoon, this NP managed to loudly correct each of us three lowly 3rd Year Medical Students. At one point, I literally waved a chart in her face for five minutes while she and the other ladies swapped stories about their weddings. HEL-lo, it's Friday afternoon at 3:30, you ladies can socialize later, but if you don't see my patient soon it will be after 5 when ALL of us get to leave (things move slowly at this clinic).

My grade from my last surgical rotation is still pending. By "pending", I mean that apparently the faculty who graded me have not turned in my evaluation yet. Nor have they turned in the evals for the students who rotated through the first month. If these were "Teachers", the people in charge of turning in grades would fuss at them--"I know you're busy, but your job includes turning in those evals." Instead, these are "Doctors", "Surgeons" even. No one would dare suggest that these noble persons were not doing their jobs or were not doing enough work.

Someday, I'll be one of them. I'll be a Doctor. Then you will all bow to me as to a God.




The Fine Print: Naturally, this was satire. Fiction. Lies, all of it, lies. Except the parts that weren't. I've had lovely attendings and very few assholes. I just wanted to attempt to be funny. Laugh! Laugh, damn you!

Fuckers. If you won't laugh then all 2 of you who read this blog should go the fuck away.

I'm sad

And when I'm sad, I want to withdraw. If my hubby didn't live here, I'd probably not even see him, unless he came over to see me. I was picturing my life if he'd stayed in DC, and I can't imagine that I'd be dating anyone, because when I get down I see everything in my life as down. I don't like writing when I'm down, because I like to be happy and funny in my writing, and I just can't do it right now.

My dad tried to call a little while ago, and I didn't hear the phone ring, but I didn't want to answer it. I feel so fatigued that everything takes effort, including picking up the phone. Answering the phone means sounding chipper and pretending that I feel fine and I don't have that kind of energy at the moment.

One of the things that I can always find joy in, no matter how I feel, is food. I'm not a thin depressed person; when I'm down I eat (more than normal, which is saying a lot). This morning, we kept our Sunday morning tradition of eating out for breakfast, and today I had huevos con nopalitos--eggs with cactus. It was incredibly tasty--I was surprised.

Sometimes I think I ought to turn this blog into a food review, since I talk about food so much (and eat so much of it), but that wouldn't work: I'm a "rut" eater. I have 1 or 2 dishes at each of my favorite restaurants that I can always count on, and I usually stick with those. So if you didn't want to hear about the cheese ravioli at Olive Garden, the chicken fajitas at Taco Cabana, the vegetable enchiladas at Mama Ninfa's, or the nugget 6-pack at Chick-fil-A, then my reviews would be useless.

I think I eat the same things over and over again for several reasons. 1, I know they're always good. 2, what if I ordered something that sucked? And here's the last, 3, life is too short not to eat what's good. I am really bad about delaying my gratification when it comes to food. Maybe it's because my career and school lives have totally been delayed gratification, so I need to indulge myself in something NOW. Maybe I just have ZERO willpower (well, definitely). For whatever reason, I cannot deny myself food if it's present. It's why I don't buy Double Stuf Oreos anymore--I can't stop myself from eating the whole damn package (and then groaning for hours with the stomachache).

Damn, now I want some Oreos.

TOOL!!!!!!!!!!

So my hubby and I are going to go see Tool tonight!!!! I am so excited. This will be my second time to see them, and my 5th time to see Maynard perform live. Woo! I'm officially a groupie.

I use rock concerts as a way to recharge. I haven't had anything to report about my current clinic because all I see are abused and neglected children. On Sunday, at my godson's christening, I cried during the service, just thinking that there really are parents out there who love their children, who feed them and bathe them and don't abuse them in any way, parents who treat their children like precious gifts. I kind of feel toxic, like I've ingested something bad.

Some people go to church; some people go to gardens or temples; I go to rock concerts. I scream and jump and flail my arms and head bang and sing at the top of my lungs and lose my voice and let the music control my body--and I feel a little better about the world. This Tool concert is going to be like a visit to a spa or a Swedish massage; I'll be tired and sore afterwards, but a little tingly and thoroughly relaxed. And smelling a wee bit more like cigarette and marijuana smoke (I swear it's not mine!) than I would at a nice spa, but that's beside the point.

Bad News

1) Iran is becoming a nuclear power. It's not quite there yet, but the country is definitely trying, and is very defensive about letting anyone come in and look around. The UN specifically told them not to do this, and threatened them with sanctions. Where are the sanctions now? European nations, including Russia, are afraid to administer sanctions at this time. Why? Because of America. They're afraid we're going to go invade Iran and start yet another Middle Eastern war of attrition. (New York Times, 09/02/06)

Way to go, America. Our invasion of Iraq, under largely false or trumped-up charges, has almost guaranteed that Iran, the scarier country with a larger inferiority complex, is going to make a bid for nuclear power. Good job on keeping down that Axis of Evil, there, Georgie.

2) A study in France found that women without any prenatal complications had 3.6 times the risk of dying after caesarean section compared to vaginal delivery. The deaths came from anesthesia, infection, and blood clots. (Obstet Gynecol. 2006 Sep;108(3):541-548)

Now, even at 3.6 times the risk, this is still a very small risk--the study included 65 deaths out of over 10,000 births. However, we need to study this very closely. In 2004, 29% of births were C-section, compared to 20% in 1996. More and more of these are elective C-sections by first-time moms who want scheduled births or have elective scheduled inductions, which increases the risk of having a C-section (the key word here being elective). This is frightening. These are young, healthy women choosing dangerous procedures for essentially "convenience" reasons.

Mind, the rate of C-section has risen not only because of elective procedures but for several other reasons: 1) obese women have more prenatal complications which necessitate C-sections. As our obesity rates climb, so will the attendant C-sections. 2) Doctors are afraid of lawyers who sue at the drop of a hat and recommend C-sections more frequently. 3) Multiple births following fertility procedures often require C-sections. 4) Women who have had 1 C-section often require later births to be C-sections as well.

I just wonder how "convenient" some of these women would find a C-section if they knew they had an increased (yet still small) risk of not going home to raise that baby.

(Note: I have friends who have had C-sections for medical reasons. I'm not referring to you. Nor am I trying to lay all the blame on the women who want elective procedures--there are still real live doctors performing these procedures, knowing the risks, after all. I think our culture has encouraged this mindset, and we all need to evaluate these risks fairly and change our minds together.)

3) Texas Family Code 261 ties clinic funding to mandatory physician reporting of child abuse, including "sexual indecency with a child". According to this law, "an acceptable affirmative defense for abuse as defined in the Penal Code §21.11 (sexual indecency with a child) may be that the actor was not more than three years older than the victim; and of the opposite sex [emphasis mine]; and the actor did not use duress, force or a threat against the victim at the time of the offense."

Okay, so a 15 year old boy who sleeps with a 15 year old girl (assuming this was consensual and not coerced) has an affirmative defense against abuse; yet a 15 year old girl who sleeps with a 15 year old girl has NO affirmative defense, and this action is considered abuse under Texas law, and must be reported as such to Family Protective Services or the police.

This is clearly discriminatory. If a 15-year-old heterosexual couple can "consent" (it's not really consent since they're minors under 17) then a 15-year-old homosexual couple should be allowed the same protection under the law. If you're going to report one, you should report the other; or you should not be required to report either.

4) Under this same law, physicians are required to report to the authorities if a minor (under 17) requests a pregnancy test or tests positive for an STD. So, we're not required to tell the kid's parents about this treatment, but we have to tell the authorities?? What are the authorities going to do, arrest the kid for trying to obtain health care?

These laws were originally passed as a "rider" on funding legislation for the state health department. Since then, if you are a minor seeking treatment at Planned Parenthood, they hand you a form when you walk in delineating what may or may not be reportable; you have to sign to receive treatment. So either 1) kids are lying or witholding information when they receive treatment or 2) they're leaving and not receiving treatment.

As with the homosexual law, I believe that when these kids are afraid you'll call the police to tell them they're having sex, these kids will then NOT TELL YOU what they're really up to. I don't think this is discouraging teenaged sexual behavior; I think this is discouraging teenagers from receiving health care related to that behavior. If a 15-year-old male who is homosexual and sexually active cannot tell you, his physician, that he thinks he might have HIV because his male partner does, then he won't receive treatment or testing. If a 16-year-old girl thinks she's pregnant and can't come to the doctor for a test, the doctor can't assess what risks she's taking or try to counsel her regarding safe sex, abstinence, or anything that would decrease her risk.


It's just a bad news day today.