Life with the 'Tars

Wow, I haven't posted in a week! It was a whopper of a week, too. I suspect we were being punished for actually relaxing over break.

Monday wasn't too bad. I spent most of the day doing PreCal homework and trying to track down a new graphing calculator because my screen was crapping out and I needed it by my Thursday exam. Luckily, I found one on EBay for a decent price being sold by someone in our metro area who agreed to meet me in person, rather than shipping it. Yay! That night was scouts for the family and hospital shift for me, as usual.

Tuesday was a full school day for me and the evening was spent on PreCal homework. I think there was an emergent load of laundry done, too.

There was an increase in stress load on Wednesday, as my PreCal exam was steadily approaching and I hadn't really had enough time to study for it. I had been doing my online homework, but that doesn't really help me study, because the online format is so freaking frustrating. I work book problems to study, so I can actually learn something from it. I studied a little in the morning, then took KayTar to the ophthalmologist. Her left eye is getting worse, but he said it isn't enough to change her prescription...he said we'll do it next time. She sure missed a lot of letters, though! After I took her back to school, I went back to studying. Then about an hour later, it was pick up time, so it was back to the kids' school. We got home, started homework, had snacks/tube feeds and it was time to go to the district science fair for BubTar. He was one of the last to be interviewed, so I was there until about 6:15, then came home to wait for KayTar who had gone home with my mom during the fair. The boys went out to dinner and brought me back takeout. Once the kid's were in bed, I went back to studying...I was up until 12:45 working PreCal problems and listening to 90s punk rock. After I finished, I rewarded myself with an episode of Top Chef, so I didn't get to sleep until 1:30ish.

Thursday morning was the PreCal exam. It was fine, but not a 110 like last time. There was one problem I missed completely, it was a calculator problem and I was absent the day we learned how to do it. The rest went fairly well, I think. We were only allowed to use a scientific calculator on over half the test and I'm not used to that one, so I hope I didn't make any entry errors that will affect my answers. We'll see. After that, I started studying for my Storytelling exam (which was later that afternoon and I hadn't had time to look at yet) and skipped Govt so I could finish studying and start working on my slides for the first half of my semester long project in Cancer Bio. It worked out perfectly and I had exactly enough time to do both and get to my exam on time. It was easy, but wouldn't have been if I didn't review the material. That evening, we had science fair awards. BubTar got a gold medal! Everyone medaled, but silvers were for participation, gold was the next tier, and then a handful of kids got trophies. This was BubTar's first year participating, so now we have a better idea of how it all works. We went by DQ for post-fair treats.

Friday, I had Cancer Bio. I got my midterm back...it was an A! I'm especially proud of this one, because on the first day of class the teacher said, "If you haven't taken Genetics and Biochem, you should think about dropping this class." and I haven't had either and I'm doing well. I also finished my exam first, which I was nervous about, but when the professor gave me my test back, she said, "I'm so impressed! You finished in 45 minutes and made an A! That is the best use of time I've ever seen." Then she said, "Weren't you the one who emailed me earlier in the semester because your daughter had pneumonia?" I nodded, and she said, "You are doing all of this with kids? I'm even more impressed by how you are balancing everything!" It was very encouraging! I took time off from studying the night before the exam to go to the rodeo with the family, and I'm glad I was still able to do well on it, especially well enough to get such compliments from my professor! After class was out, I went to the pediatrician's office and spent the rest of the day shadowing. I listened to sinus arrhythmia and visualized an infected ear...and saw many cute kiddos. I know I see more interesting cases in the hospital, but I really enjoy the primary clinic more. We spend more time with the patients and I like being able to follow the same kids...I've already seen a handful of patients on more than one occasion. I can see myself being happy in the environment for a long time. I picked up Subway on the way home, spent the evening cuddling with KayTar and watching BubTar play video games, helping Josh with his homework, and watching Law and Order UK in bed. It was lovely.

Saturday, the boys went out of town and KayTar and I had a girls day. We saw Gnomeo and Juliet at the "fancy" theater, went to the big bookstore, and had ice cream at Ben and Jerry's. I brought KayTar's feeding backpack into the theater and the ticket taker asked to search it, to make sure there was no video equipment in it for bootlegging, ha! I said, "Sure, it is just my daughter's feeding bag." as I was unzipping it and he got ALL flustered and apologetic. It is no big deal to us, but I guess it is odd and personal to some people. Last night, we went out to eat with my best friend/sister-in-law and she came over to hang out after and we watched Grey's Anatomy reruns...from back when it didn't suck so much. It was a nice relaxing evening.

I neglected to even post pictures lately, so here are a handful of my favorites from the past few weeks... 









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On Monday night, during my volunteer shift, I ran into KayTar's GI doctor. She greeted me and struck up a conversation about volunteering/school/so forth. I'm still not entirely convinced that she didn't have me confused with someone else, as we only see her 1-2 times a year. Regardless of whether she actually recognized me or not, I half-jokingly asked her how I could get on shadowing her and she said "What are you doing this week? I'm not on service again until this summer." She gave me her email address, so after making sure I had a sitter, we set it up for Friday!

I arrived at the hospital at 6:45 and spent about 30 minutes trying to get in touch with the fellow to find out where to meet the team, so I finally just email the attending again to find out where to go. After that, it was smooth sailing. I had a very interesting day! I pre-rounded on a couple of new admits with the fellow, then went to grand rounds with the interns. The speaker was KayTar's ex-neurologist and while I didn't care for him in that capacity, he was pretty entertaining! The subject was orthostatic intolerance (Can You Withstand Standing.). There was food and coffee. :) After grand rounds, we started morning rounds. I saw a lot of new-to-me cases:

-A few short-gut kids
-Rhett syndrome
-intestinal lymphangiectasis
-Langerhans cell histiocytosis
-newly diagnosed CF in a preschooler
-ulcerative colitis
-Megacystis-microcolon-intestinal hypoperistalsis syndrome

It was a lot more variety than I expected to see on GI service, honestly. A couple of hours into rounds, the OR called to say they were ready for one of our patients to be scoped, so I had to go change into scrubs and head to the OR. GI procedures are non-sterile, so I didn't have to scrub or anything...just don scrubs and a hat. I got to handle the endoscope and fidget with the controls before the procedure. The interns were the ones who asked if we could play with it, so I guess it was new to them, too. They seemed pretty excited about it. I got to watch the procedure up close and the attending explained what we were looking at while the fellow did the actual scoping/biopsying. It was cool, even though the GI tract was completely normal as far as we could tell. After that, we went back rounding, it kind of took forever! We didn't finish "morning" rounds until after 4pm. Around 2:30, the fellow and I split off and he sent me for lunch. I appreciated it and ate as quickly as I could and met up with him again...I don't think I even missed a patient! Shortly after, we were pulled into a family conference with a translator for the CF kiddo, that was interesting! It was a complex situation and I hope it all works out in the end. Not everyone is equipped to deal with chronic medical conditions.

They let me go around 4:30 or so, I could have stayed longer...but they said it was fine for me to go and I got the feeling they wanted to move a bit quicker for the rest of the afternoon and I didn't want to interfere. I had a wonderful day, it was very interesting and the fellow said I had seen more than most med students get to! I'd love to do it again sometime. I still prefer the primary pediatrics clinic, though. I love the patient contact and there wasn't much of that in the hospital...at least on this service. We spent a lot of time charting...I don't know if that is typical or has more to do with the new EMR system...but for every 2 minutes spent in a patient room, there was probably 10 minutes spent in the hall making notes. I like the pace in the primary clinic better, even though I know the charting still has to get done sometime! I'm glad I got the opportunity to see so many new things and get a glimpse into how things run at the hospital. It was nice being on the OTHER side of those early morning rounds for a change!


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I shadowed the pediatrician on Wednesday. It was a little more exciting than usual because the water was not working. No sinks. No working toilets. Nothing in the entire building! The hospital next door also did not have water, but they could run off the reserve tanks. Nobody talks about urine as often as they do when emptying your bladder is no longer an option! The nurses joked about cathing each other and a few little patients needed urine specimen cups because they simply could not wait. It was the first time I ever left campus for lunch while shadowing because venture out into the world in search of working restrooms. I had to ration my beverage at lunch so that I wouldn't have a full bladder later in the day, which worked like a charm. Nice to know I can hold it when I have to, I've heard enough horror stories about med school and residency to know it is a skill I need to have.

Clinic itself was interesting, as always. A few new things I saw: a 5 year old who broke 100 pounds (I thought the nurse had written the temperature in the wrong spot on the chart!), molluscum contagiousum, and fingernail shedding from HFMD. I also got to use the otoscope to visualize an infected ear (KayTar was so jealous when I told her I used the otoscope). We saw a few kids with pneumonia, one poor guy with both flu A and strep, and a lot of cute 9 month old babies. It was 9 month old day, evidently. I learned that sometimes, no matter how many different ways you say it, parents/patient just don't understand that something cannot be cured with a prescription...be it eczema or a virus. These are the patients/parents who leave very unsatisfied when they don't leave with a magical cure-all prescription and feel like they've wasted their time in clinic. I also learned that sometimes you can spend 10 minutes explaining something to patients/parents in great detail as they nod in what you perceive to be understanding, and as soon as your hand touches the door knob to leave the room, they ask you the EXACT SAME question you just spent 10 minutes answering. It makes you wonder about people.

We ran behind and didn't finish up until nearly 6pm. I got home between 6:30 and 6:45pm. Josh and BubTar had been working on his science fair project. The house was messy, the kids hadn't had dinner, and they go down for reading time at 7:30pm and bed at 8. My feet were quite tired (I'm not used to standing and walking all day yet!), so I took a 5 minute break when I walked in the door (well, if holding a chatty 5 year old in your lap counts as a break), but then we had to get down to business. We cleaned up a bit, made BubTar a quick dinner, and then KayTar begged me to play a game with her, so I did. We played anarchist Cootie (Cootie without rules) and she decided to make a KayTar-Cootie and an Uncle Z-Cootie and marry them. I told her, "KayTar, you can't marry your uncle!" And she said, "This is NO RULES Cootie, we are going NUTS!" I couldn't argue with that logic, so I officiated the Cootie marriage. In the blink of an eye, it was reading time. Once the kids were in bed, I took my shower, ate a pudding cup for dinner, and fell into bed. I think I watched a little TV, too, before zonking out around 10pm...which is early for me. This was the first mid-weeknight I have shadowed and it was quite a different experience at home. On a Friday night, things are much less structured around here so it doesn't make much of an impact, but during the week it does...it felt more accurate. Makes me wonder what evenings are like for most doctors with young kids! By the time I'm an actual doctor, my kids will be considerably older...but I'm sure we will have plenty of wild evenings during training!

It seems as though I brought home a little souvenir from clinic, as my throat has been inflamed for a day or two now and sleeping last night was next to impossible between little apneic episodes and the general discomfort in my throat. It isn't painful, it just feels swollen. I feel fine otherwise, but my throat sure is irritating me. I really enjoy being in clinic, though, so a little viral pharyngitis is a small price to pay, right?

I spent the day yesterday shadowing our fabulous pediatrician. Beforehand, I worried that it might be a little awkward, following someone around all day without contributing anything, but it turned out to be a really enjoyable experience! I'm looking forward to doing it again next month.

We saw a lot of kids, of course...kids who were there for well-checks, URIs, EIs, rechecks, and one patient who came in for a rule-out of a fairly rare condition...kids who loved the doctor, hated the doctor, and were ambivalent about the doctor...and they were all adorable. I got a lot of smiles from all of those cuties. It was a busy day, though not unpleasantly so. It was a nice pace. We spent roughly 10 minutes (my guesstimation, I didn't pay attention to the actual time) with each patient which seemed the perfect amount of time, and from 9:30am until about 1:30pm there were not any lulls. Then we went to lunch, visited a baby in the NICU at the hospital, and came back to clinic and saw a few more patients before I morphed back into a parent when BubTar arrived for his 3pm appointment.

Things I learned, in no particular order:

1. I am not used to wearing heels all day. Ha! Obviously, I was on my feet all day and we did a lot of walking and took the stairs quite a bit. It didn't bother me a bit until I was OFF of my feet for a while...then, OUCH. Gotta work on that. ;)

2. Primary-care pediatrics is a lot of repetition. We saw many kiddos that were there for the same well-check, and so you basically repeat the same thing over and over. It isn't a BAD thing, just something that hadn't really occurred to me previously.

3. 4 months old infants are particularly adorable patients.

4. I need to learn more Spanish and get brave enough to utilize what I already know.

5. I can see myself being happy with this sort of career.

6. (which is not specifically related to yesterday) I can survive a week with roughly 3 hours of frequently interrupted a sleep per night, two sick kids, feeling mildly under the weather myself, while keeping up with my coursework and responsibilities, and still manage to enjoy myself.

PS: The pediatrician did a mono spot, a re-swab for strep, and a CBC for BubTar yesterday and all signs pointed run of the mill virus. He has a pretty inflamed throat and very swollen lymph nodes...but his fever broke this morning! I don't know if it will stay down, but it is a start! Also, KayTar seems to have a plain old URI, so I expect her to recover pretty quickly, too.

Cross-posted at Mothers in Medicine