Still Alive :-)

In case anyone was wondering… I am still alive and kicking.

I have been back in St. Louis now for about a week and a half and I have been nonstop busy the whole time.  I started my sub-I (sub-internship: a way to test the waters and let me see what things will be like when I am a doctor next year, and I get evaluated to make sure I am up to par) and it is going fantastically well.  Though it started out kind of crappy with a disorienting first day (new people to meet, given a patient load right away without good instructions, I was also on call…) but it just got better from there and I am all settled in now and loving it.  I am on call again right now, I’m on call Q4 (which means every fourth night) but sometimes it feels like I haven’t had a break for a long time.  I really like the independent feeling of working as a sub-I, and it will be even better next year when I don’t have to get anyone to co-sign my orders. 🙂

I have been seeing kids with asthma, diarrhea, pneumonia, cellulitis, acid reflux, diabetes, cat scratch disease (we think), osteomyelitis… lots of different things.  All very interesting, all things I am trying to read more about so I can better understand the management end of things.  Last year I spent so much time learning about the conditions, what causes them, how to diagnose them… but I didn’t learn a whole lot about how to treat thing so that’s what this year is for.

Outside the hospital things are good too.  I saw "Serenity" and totally loved it – though I was disappointed by the small turnout at the theatre.  Too bad that people are missing out on a great movie (and that they missed out on a great tv show when it was on).  I don’t have any brilliant solutions or suggestions.  I just wanted to say I loved it, it was full of Joss Whedon, which was fantastic.  You could totally tell that this was his movie from the characters to the plot to the witty dialogue and subtle treasures included in every scene.  Joss is brilliant and I want more of him.  I am not so sure about this new Wonderwoman thing he’s got going on – I fear he will be a collaborator and not the driving force so his stuff may get lost in the crowd. But I will see it – I will support Joss – and hopefully he will continue creating great entertainment.

I also saw "The Corpse Bride" – because it was at the Moolah and I like going to that theatre. 🙂  If anyone visits out here, you will definitely see a movie there – no matter what’s showing, you just have to go.  It’s worth the experience.

Hmm, guess it’s back to work.  I have to call some primary care doctors and let them know their patients are in the hospital, and go dictate a few "clinical summaries" for kids I discharged over the past few days… and maybe go watch an upper endoscopy if there’s time.  Hopefully I can find some time this weekend to get some more pictures up on here.  I’ve taken a lot over the past week since I’ve been back, but they’re all on my computer at home so no love right now.

I know, I know

I know I haven’t written for a while… actually it’s only been a week since my last post, but I feel like so much has happened and everything’s going so fast.  I got sick this week, which slowed things up a bit, but now it’s my last day here in Seattle and I can’t believe that at this time tomorrow I’ll be getting on a plane back to St. Louis.  It feels so far away, like a different life or something. 🙂

Not much else to say right now… I just like to check-in every once in a while.

Oh, and I have missed almost ALL of the premieres of my TV shows this week since I forgot it was that time already.  I really hope A.J. has them waiting on the DVR for me in St. Louis.  Especially "The Office" – although I have a sinking feeling that it’s one of the shows I didn’t include on my list of "Premieres to set the DVR to record" that I gave to A.J.  Oh well – I will muddle through.  🙂

Old Friends

Picture(10).jpg

I know, I know – it’s kind of blurry and not the greatest picture but it will do (and remember – camera phone in outstretched hand… this is not bad under those conditions!)  This is me and Arielle – my best friend from high school.  I had dinner at her house tonight and then we sat around and chatted till the wee hours… clarification, what we now consider the wee hours, so, like, 10pm or so.  🙂  I had such a great time, and like I said before the conversations just flow, which is nice.

We talked all about work (hers and mine) and especially about how we’re both in the midst of getting started in our careers – not just continuing on as students anymore.  We shared about how we both have found ourselves shaping what we let others see of us in our role as students – how we conform to what we think our supervisors (professors, attendings, teachers) would like us to be like so that we are well accepted.  Never going so far as to lose ourselves, of course, more just the little things – the order of activities, the phrasing of statements, how much of our "social" selves are divulged to those around us – things like that.  I am still painfully conscious of the fact that I am a student and that I am working hard to leave a good impression on those around me so that when the time comes for residency programs to decide who they want, I will be near the top of the list for Children’s…plus I’m trying to learn and make sure my patients are faring well.  I have learned that socializing is so very important since just being intelligent isn’t enough – and in fact is a negative if all you have is intelligence and no personality – so I have to make sure I take the time to shoot the proverbial… breeze… with the residents and attendings so they will see me as a person, and hopefully remember me.  It’s funny to talk about socializing as a chore like that, but getting conversations started often feels that way.  They usually end up flowing with ease, but I have been learning to take that initial step of introducing myself and asking questions in order to meet the people around me.

Hmm.. so yes, we chatted about those kind of things, but also about other things… like Battlestar Galactica!!!  I never would have guessed that Arielle would watch that show – but when she said she had been taping it, I just about burst to find out if she was up to date on the episodes… something like "Did you see last week’s?!?  With the reporter chick!?!  At the end?!? " and then us together "She’s a cylon!!!!"  It was a great moment.   And if that was a spoiler for you I am so so sorry… I only know of a few people (mainly my relatives) who read this blog and I don’t think any of you watch BSG… and Brasten, I know you already knew that tidbit – so I should be all fine there. 🙂

Anyway – I have a busy, busy week ahead – my last bit of Seattle time before heading back east-ish.  It is totally packed with engagements of the work and social variety – hopefully I’ll find time to pack before I have to leave on Saturday morning!!

Smells

Did you know that the average smell weighs 760 nanograms?  If you think about it, that’s kind of gross.  Some smells you just don’t want to think of as being material and having weight.

While I know that, mechanically, smell is produced by little teensy weensy particles that attach to very specific receptors and trigger recognition… I’d rather just think of them as airy and without real substance.

Go Mariners!

I went to the Mariners v. Angels game tonight with Heather, Justin and Carrie.  We sat out in the left field bleachers and had a great time.  And the M’s won, right at the bottom of the 9th, so that was cool too.

Picture(18).jpg
Me out front before the game

 Picture(20).jpg
This was a sign posted all the way up by the refreshment stands behind the 100 level seats… I found it entertaining.

 Picture(19).jpg
My cool camera phone panoramic feature!

Week At A Glance

This was going to be a prospective Week-At-A-Glance, but then I kept putting off the writing part and just made little notes of what I did.  So I went back and filled out the details and now it’s a long retrospective look at what I did last week.

Monday – A.J.’s last day here over this long Labor Day weekend.  We got up and took a walk around the part of the Interurban trail that runs by the office.  It is lined with blackberry bushes on both sides, so we often bring containers when we walk and pick the berries.  There are 2 or 3 different kinds of blackberry bushes along the trail so there are always some that are perfectly ripe.  A.J. has been bringing bags of frozen berries back to St. Louis with him and we’re going to have little blackberry pies when I get back.  He made some for Jill2 for a Star Trek night and she said it was the best blackberry pie she had ever had.  Today we also had lunch over at the Lynnwood Claim Jumper with Sandi and the visiting South Dakota relatives.  This was a first time experience for the out-of-towners, so we got one of the big desserts (an "I Declare") to wow them with.  I’ve found that ordering a black decaf coffee and then just using the whipped cream off the dessert works wonderfully.  No messing with cream and sugar, just a mouthful of whipped cream and a slug of coffee – heaven in my mouth. 🙂  After lunch we had just a little bit of time before we had to head to the airport, so A.J. and I got out our Beamo and tossed it around in the driveway.  This frisbee-like thing has got to be the most fun park toy I have ever played with.  I like to play ring toss with it, where A.J. is the thrower, and I am the thing that the ring has to land over – I can catch it by putting my up-stretched through the hole in the middle, then the beamo just falls down around my waist to my feet.  It is so much fun – sometime I’ll get a video or picture or something so you can all see what I’m talking about.  Well – then it was time to drop A.J. at the airport – which was a funny goodbye since he would be back on Thursday night (a little mix-up when buying the tickets led to visits 2 weekends ina row instead of more spaced out – but it still worked out well so no worries).  After that I got some laundry and visiting done over at mom and dad’s and then I headed out for an evening of socializing and reminiscing with Arielle – my best friend from high school.  I hadn’t seen her for a long time – we usually end up talking on the phone once or twice a year and seeing each other maybe once a year – but I love how we can just pick right up like no time has passed.  We went down to Alki and ate at the Bamboo Grill followed by coffee at Starbucks.  I love how we can talk about everything from school/work to relationships to current events and life in general and there’s no awkward pauses. no worries of "should I be saying this?" or wondering how she’s taking the things I’m saying.

Tuesday – After the long holiday weekend, I went back to work at the NICU today.  I met up with Heather and we bussed back to West Seattle together.  After some dinner down at Puerto Vallerta (in the West Seattle junction) with Heather and Justin, the three of us went to The Garage (on Broadway by Seattle U) for some bowling and pool.  I slept over in West Seattle and got to experience the bus ride to the U by myself the next morning…

Wednesday – Yes, so the bus ride… funny how it costs half as much to get to the UW from West Seattle ($1.50 compared to $3.00) but it takes twice as long as when I leave from Lynnwood.  I was on call today and we had a lot of 31-week babies threatening to deliver, but in the end only 2 (a set of twins) actually showed up.  I get to follow them now for as long as they are here… well, catually for as long as I’m here, because they’ll likely be here longer than the two weeks I have left here.  Surprisingly enough, after those two little guys showed up around midnight, I got to go to bed and didn’t get woken all night. 🙂  Oh, and A.J. e-mail my Step 2 CS score sheet to me today, and surprise – I passed!  And the score sheet was really lame without any explanations or anything – but the main gist is that I passed so I suppose nothing else really matters anymore.

Thursday – So after being on call, I got out of the hospital early and bussed home to Lynnwood where I showered and ate lunch and watched a little sci-fi before falling asleep.  I slept for three or four hours and then still had time to watch some more sci-fi and an episode of House (great GREAT show – very funny!!) and work on the Camp Casey newspaper before leaving to go pick up A.J. at the airport.  We had a late dinner (and A.J. spent an hour on the phonewith T-Mobile debating a charge on the monthly bill) and then went to bed.

Friday – Last day at work this week!  It was a short day, I was done by noon or so and then had lunch with Heather.  A.J. came to pick us up from the U and we dropped Heather off at a bus stop downtown so she could get home to West Seattle.  Then A.J. and I went down to Pike Place Market and had the chowder sampler for lunch.  It’s from a little chowder shop in Post Alley – but I forget the name.  It’s really yummy – I especially like the seafood bisque!  We also got some fresh peaches and a maple doughnut!  We walked around downtown a little bit, and then headed up to Queen Anne.  We sat in Starbucks and reminisced about our years at SPU – and both agreed that we would take much more advangtage of the area (Queen Anne) if we were at SPU now.  Funny how hindsight works, huh?  But I think we took good advantage of other areas during those years – I just miss being in Seattle and being able to hang out in places like that.  As we sat in Starbucks, I had the great idea of visiting the SPU campus to go see if our University Scholars Honors Projects were really in the library like we were told they would be.  I wasn’t sure what I expected to find there, but I was really excited to see that I could search the database by my name and my project would show up.  It was catalogued and numbered and everything.  It was very cool. 🙂  I felt very special.  After that ego boost and reminder of how I used to understand very technical science-y things, we wandered around the rest of campus.  We explored the new science building, and then the old Slick (Miller Science Learning Center = SLC = Slick) which is now called Otto Miller hall – which I don’t appreciate at all.  I like the old name better, it had more character.  Anyway – that building is all remodeled too, and we ran into a couple of A.J.’s old professors who showed us around and chatted.
     Wow, this is a long day – I’ll start a new paragraph. 🙂  So after the SPU fun, A.J. and I headed back up to Lynnwood for some racquetball with Brasten and Chris.  It was a great night and we all played well – I had so much fun.  I am going to miss playing racquetball when I go back to St. Louis.  A.J. plays on Wednesdays there with his law school friend(s), but I will only sometimes be available for that.  After the exercise, we all went to the Claim Jumper for appetizers and dessert – and we celebrated Rainbow Bear’s 6th birthday.  You should go to his website and check out the picutres.

Saturday – After a little sleeping in, A.J. and I got up and headed out for the Puyallup Fair.  Fun, fun, fun times. 🙂  I went down the Giant Slide 5 times in a row and it was awesome! We had yummy fair food (sliced caramel apple, spud’s fish and chips, strawberry milkshake, scone) and browsed through all the vendor displays.  A.J. took lots of pictures of the info-mercial people, and I think he’s going to put together a little photo album of them.  I love going to the Puyallup Fair and just wandering around.  Did you know that people enter their collections of things to be showcased?  I could enter my vast array of koalas for people to ooh and ahh over.  I might just do that one day.  People had Lion King and Dolphin and Spice Girls collections… so why not koalas? 

Well – this entry has gotten very long.  Hopefully it was a not too uninteresting read for all of you, and hopefully it has captured my memories well enough for it to mean something to me when I read it again later on.

The things I see

I see the strangest and most interesting things at work.  I also see the happiest and saddest things.

Tuesday morning I was at the birth of a very tiny little baby.  He was only 25 weeks gestation (full term would be 40 weeks) and his story is heartwrenching.  His 18-year-old mom had at one point made the decision that she was not going to carry this baby anymore and went in to have an abortion.  However, something changed her mind once the procedure was set in motion, and she ended up not going through with it.  However, her membranes had already been ruptured and she had lost a lot of the amniotic fluid.  This was not a great thing for the little one inside, and sure enough mom and baby both ended up getting an infection because the protection of the membranes was no longer intact.  This necessitated induction of delivery since it was going to be much less healthy for the baby inside than out here, where we can give him medicines and help him get better.  So mom had the baby at 25 weeks.  Now she’s going home (to far to commute to visit) and is planning to come back and rent an apartment closer to here so she can visit her baby.  Her baby who will be hospitalized for months because of his age.  Her baby who will endure the hardships of prematurity and all that it brings – infections, lung disease, feeding difficulties, risk of blindness, bleeding in the brain…  and very likely a less than ideal outcome as far as disabilities go.  I wonder what this girl had planned for her life and how things will work out for her now – so different than what she expected I’m sure.

On Wednesday we anticipated the arrival of a new baby with a sacrococcygeal teratoma.  Whoa, big word!  It’s basically a really big growth near the tailbone.  It makes it nearly impossible to have a vaginal delivery (it would be like trying to get 2 heads out – and just 1 is work enough, ask any mother!).  Usually they are benign growths, but 10% can be mailgnant so it’s important to have the surgeons go in and remove all of it.  So I was there in the operating room when this little guy was born, and I watched as he was stabilized and then put into a sterile plastic bag to protect the growth from rupture/infection until he could be transferred to the operating room.  Don’t worry, the plastic only covered from his feet up to his chest, his head was open and free to breathe. 🙂  It was pretty amazing to be able to see this kind of birth defect in person – one of those "I hope it never happens to anyone again, but if it has to, then I would appreciate the opportunity to see and learn from it" kind of things.  It’s considered the most common tumor of newborns with an incidence of 1 in every ~40,000 births (which still doesn’t make it that common).  My attending said that maybe there are one or two born here every year, so it’s not often that one gets a chance to see it.  I’ve seen lots of textbook pictures of these tumors, but this was my first "in person" experience and it will definitely stay with me.  The tumor was at least 1/3 of the baby’s weight!  Anyway, here’s a drawing of what one looks like:

This morning there was another baby born with an abnormality – he had some blockage of the urinary tract and his bladder was really distended.  While he was still in utero, a surgeon put a little tube in so the bladder could drain (into the amniotic fluid – where it would go anyway, people, so don’t be grossed out by that!).  It looks like he might have "prune belly syndrome" where the abdominal muscles don’t form well and the urinary tract may have malformations.  He was a twin, and his brother is totally fine.  Actually, he was totally fine too.  Breathing well, heart beating fine, good muscle tone – all the good stuff.

And finally, this afternoon a little boy was born (all these boys, oh my) by C-section because his mom was getting sick from being pregnant.  She had HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), which is something moms can get for unknown reasons and it can be fatal – the treatment is delivery of the baby as soon as possible.  Luckily, this guy was almost 35 weeks, so he was barely premature.  He came out a little dazed and confused since his mom had gotten general anesthesia and it affected him as well.  But soon he was kicking and breathing well.  And his dad was just so happy and excited.  He teared up and held the little guy’s fingers and was positively giddy.  It makes me smile just thinking about it. 🙂

There are lots more happy stories too – but of course not all of those stick around in my head as much as some of the "interesting cases" do.  Kind of like on the evening news – we hear lots about the crazy and bad things that happen, but not too much that warms the heart.  I’m trying to make sure I remember the good experiences with as much clarity as the not-so-good.  It helps to remember that more than 90% of babies don’t need any help from us doctors when they are born.  That’s a big number.  And it’s just fine with me. 🙂

Commuting By Bus

So this morning I took the bus as a commuter for the first time ever – and it went pretty well.  I found that the Community Transit 855 runs from the Lynnwood Park and Ride right down to the University of Washington Medical Center.  It takes half and hour and costs $3 (though I’ve heard it’s only $2.25 if you’re a student, which I am, so maybe I’ll try that out tomorrow).  This is espcially nice for when I’m on call so I don’t have to find a place to park my car overnight (virtually impossible down at the U).

So all in all I liked doing the bus thing.  I can read a bit during the drive, I don’t have to deal with traffic, and it’s fairly convenient.

Just for fun, here are some pictures from this morning:

Soccer in the rain

I just got home from playing soccer with my old Seattle team, Red Alert.  We played out at Nathan Hale HS on their "synthetic turf" field, which is a very interesting surface, kind of grass-like, but definitely fake, with lots of little rubber chunks.  Heather came to play with us also, and brought a whole bunch of turf shoes for me to choose from, since I don’t have my own pair anymore.  It was like I was at a shoe store, with boxes everywhere… 🙂

Anyway – the game was so SO much fun!  I haven’t played soccer in so long, but I was still able to pretty much keep up and I think I played pretty well too.  And Heather did great (as always!).  I love playing with her out on the field.  It just feels right.  It started raining in the last few minutes of the game and it turned into a total downpour for about 5 minutes.  Everyone got totally soaked through to the skin, then it died down a little right as the game ended. I’ve been home for almost an hour now and my clothes (now hanging up to dry) and hair are still soaking wet!

I’m so glad I’ve stayed in touch with this team – and so glad I started playing with them in the first place.  That was all the way back in freshman year at SPU when I was working in the Admissions Department with Kathy… I wore some "soccer clothes" to work one day and she asked if I played, and if I was interested in playing with her team.  And so it goes.

Hopefully I’ll be able to make it to the three games that will happen while I’m in Seattle – and hopefully there really will be three games – and no byes or forfeits or weird schedule changes.  I sure miss playing while I’m in St. Louis, maybe I’ll try to find a team out there again now that my schedule might allow for it better.