It's like falling in love

From a email today from one of my college mentors, a physician and writer with heaps of wisdom and a sense of humor to match:
"Nothing is more fun [than clinical medicine] than falling in love."

Indeed, Dr. L, indeed.

Immersion

“As my life grows richer within the hospital, it becomes less so outside of it.”  ~fellow third-year classmate.

In those words, my classmate alluded to ever-elusive work-life balance and challenge of maintaining relationships with friends and loved ones while devoting full days and nights to clinical work.  It is not so much the frank amount of time spent in the hospital (although the 80+ hour weeks on inpatient months certainly contributes),  it is the emotional energy required to be in a position of constantly caring.  Indeed, there are days where I am so drained by my patient interactions that I simply haven’t any more emotional energy left to expend.  Sometimes, at the end of the day, I simply cannot give any more of myself to others.   Our relationships suffer because of it.   

Another classmate, in tears, described learning that her friend had died suddenly of cancer during her surgery clerkship.  Our school’s policy mandates no absences except for immediate family emergencies.   Forced to miss the funeral, she clearly was filled with guilt and sorrow.   All of us entered medicine understanding full well that we would have to make sacrifices.   Yet it does not make it any easier. 

Then there is the emotional disconnect.   As I grow increasingly at home in the hospital, I become more isolated from those outside of it.  I’ve noticed it with my friends and even more so with my parents.  My parents are interested; they want to understand.  In our weekly conversations they will ask, “How are you doing? What stories do you have?”   Where do I even begin?   My parents are not physicians, and luckily, have little experience with the medical system.  Even the most superficial conversations require layers upon layers of explanation (think: a resident is a doctor who has an MD but is still training.).  I don’t blame them – how could they, or for that matter, others who have not experienced the immersion that is medical school, begin to understand what it is like?  Many times, we will just end up talking past each other, and that is okay.  I am still their daughter, and it is their concern and willingness to ask and listen that matters the most.

Would I trade this for something else?  No way.  I am truly happier this year than my first two years combined.   Sure, I have good days and awful days, but I am stimulated and challenged every day by what I learn.  I am excited to talk to my patients, to understand their experiences, and learn about their diseases.   I feel the camaraderie of working within a team and a strong sense of solidarity with my fellow classmates.   I see myself growing and changing in ways that I could never have predicted.  Eight months into my third year, I have become tougher and more real, yet I remain an idealist.

Tough

Today was tough - the kind of tough that makes you want to call your mom, dad, sister right after work and tell them that you love them.

We told a lady today that she had stage 4 lung cancer and that there's no cure.  She has a teenage daughter who recently started sleeping with her parents because she wants to make sure that their hearts are still beating at night. The minute we reached the stage 4 part, she developed that deer in the headlights look.  Pure shellshock.   I watched as her husband's eyes glazed over, as he reached over to squeeze his wife's hands, as his wife struggled to maintain composure.  "4 weeks ago, I was lifting weights," she cried.   And now this.  Sometimes, medicine sucks.

Resources

I had a patient who was admitted for diarrhea - 3 weeks, every day 3-4 times/day. He came to the hospital because his daughter was worried that he looked gray and weak.  Turns out, he was really dehydrated.  So much so that his kidneys became temporally injured (acute on chronic kidney disease) and he was found to be hyperkalemic.  We took care of the hyperkalemia, but what about his diarrhea?  Ironically, his diarrhea disappeared while in hospital, just resolved entirely!  We did the whole workup - fecal cultures, leukocytes, fat, ova and parasites, stool osmolality, celiac disease workup.  It all came back negative.  This patient stayed in the hospital for 4 days.  4 days!  His hyperkalemia we corrected on the first day.  His diarrhea was resolved the minute he landed in the hospital.   In the U.S., we have such luxury.  If we'd been in another country, this guy would have been sent home after day 1, as he wasn't acute ill after his hyperkalemia was corrected.  There's nothing that would have been different had he gotten this diarrhea workup as an outpatient.

Another patient we saw was in her late 80s, who we discovered had a Cr over 7 (baseline in the 1s).  Acute kidney injury and we're starting dialysis on Monday.  Our attending mentioned that in any other country, i.e. Australia, that these individuals would not have the option of dialysis.  In Australia, apparently, individuals over age 65 are not eligible for dialysis.  Is our aggressive approach to care appropriate?  I can't help but think - this is what makes our health care so expensive!  Yet if I were these patients, I'd want the Mercedes Benz workup too!

Pooped

12 straight days in the hospital.  Or 11 if you don't count orientation on the first day.  I'm on medicine.  I love it, but I'm pooped!  Tomorrow I have a day off and then I'm on call the next day.  q4 is really brutal! 

Chocolate Chip Pumpkin Bread

This one wins approval from my hallmates!  I'm posting the original recipe + the "healthified" modifications in parentheses.  The only changes I'd made in my next batch would be to up the spices, perhaps to 1.5 tablespoons of cinnamon and 1/4 tsp. of nutmeg.

 

Chocolate Chip Pumpkin Bread

1.5 cups all purpose flour (replaced all flour with white whole wheat flour)

1.25 cups whole wheat flour

1 tsp. baking powder

3/4 tsp. baking soda

1/2 tsp. salt

1 tbsp. cinnamon (would increase this to 1.5 tbsp)

1/8 tsp. nutmeg (would increase this to 1/4 tsp)

1/8 tsp. ground cloves (didn't have this)

1 cup canned pumpkin (oops - I used a whole can and it turned out fine!)

2 large eggs

1/2 cup veggie oil (1/3 cup oil and a few tablespoons of applesauce)

3/4 cup sugar (1/3 cup sugar)

handful of chocolate chips

Preheat oven to 375 F.  Grease 1 8.5" loaf pan. Sift together flour, baking powder, soda, salt, spices.  In another bowel, combine pumpkin, sugar, eggs, oil.  Add dry ingredients to pumpkin mixture and gently stir together until combined.  Fold in as chocolate chips.  Pour and scrape mixture into prepared pan and smooth top.  Bake ~40 minutes (check at 30 minutes).  Allow to cool before slicing.

The mixture is pretty thick. Next time, I may experiment with adding half a cup of yogurt to make this bread more moist (although I overbaked it at 45 minutes), but I think it's delicious as is.  Without the whole wheat flour, I doubt you'd need the yogurt.

Honey (Nut) Granola

Another super easy recipe.  Much healthier and I think just as tasty as store bought granola.  Be warned that my adjustments again "healthify" the recipe, so if you like sweeter granola, add more honey and/or brown sugar.  Also, this granola is not terribly clumpy.  To create a clumpy granola, you need to add more honey.

Honey Nut Granola

4 cups rolled oats
1 cup sliced almonds*
1 cup chopped pecans*
1 cup raw sunflower seeds*
1/3 cup canola oil --> I subbed 2 tablespoons olive oil + 1/3 cup applesauce
1 teaspoon vanilla
1 tablespoon cinnamon
1/2 cup honey" --> I used about 1/3 cup and found the granola to be plenty sweet.
*I had none of these ingredients but the nuts really take the granola up a notch.
"If you don't have honey, mix 1/2 cup brown sugar together with some hot water and add to granola.

Preheat oven to 280 F (don't go over 300 F!).  In a large bowel, combine oats, nuts, sunflower seeds.  In a separate bowel, mix oil, honey, applesauce (if using), vanilla, cinnamon.  Add to dry ingredients and mix well.  Spread onto a parchment or non-stick foil lined baking sheet.  Bake 10 minutes, stir, bake another 10 minutes.  Repeat until granola reaches your desired crunchiness.  Remove granola from baking sheet and cool.

This recipe is so versatile.  Potential variations include:
- Adding toasted pumpkin seeds and pumpkin spice for a fall granola
- Dried cranberries, apples, etc. after baking (don't bake these - you'll get a mess)
- Cashews and ground ginger.  Then, add dried crystallized ginger bits after baking.
- Chocolate chips and coconut flakes

Easy vegetable soup

I was in the mood for something filling, healthy and most importantly, had vegetables in it.  I can't even begin to go on about how poor my diet is in the hospital.  Fortunately, my mother taught me something about cooking and I threw together this easy vegetable soup.  Emphasis on the word easy - this soup is so forgiving that even folks like me can successfully make it.  The thing is, I'm not exactly bad at cooking.  It's just that I hate measuring things (1 tsp of cinnamon = okay, I think I'll just do a couple shakes); my pantry does not contain items such as spelt flour, agave nectar, nor Israeli organic sea salt (okay, I made the last one up); and I "healthify" everything such the end product never ends up tasting like what you'd purchase from Panera or Au Bon Pain (think 500 calorie butter-rich blueberry muffins that taste as such).  That's why this soup is perfect - no measurements, no special ingredients, healthy to begin with...and delicious!

Easy Vegetable Soup

Ingredients
- carrots
- potatoes
- cabbage
- squash
- spinach
- other vegetables (see below for suggestions)
- chicken stock, or if you're cheap like me, chicken bouillon

Feel free to mix and match vegetables, but I will say that I think the potatoes are key (sorry carb haters).  They help thicken the soup.  Tomatoes add a nice tang and I think fresh peas would also be delicious.  I love cabbage but they impart a strong flavor.  Essentially, you want to add veggies that take longest to cook (potatoes, carrots) first and wait until later to add the faster cookies ones (tomatoes, squash, spinach).

Dice carrots and potatoes.  Add to enough boiling water so that's there's ~1-2 inches covering them.  After ~2-3 minutes, add chopped cabbage.  When cabbage is almost soft (this takes about 5-7 minutes at med heat), add sliced squash.  When all ingredients are soft, add a few tablespoons of chicken bouillon to taste.  Then add chopped spinach until wilted and mix well.  serve with some bread.  But not the bread that I make.

Bread: 1 Human: 0

I got it in my head a few weeks ago that I had to make fresh bread. All that carby deliciousness - well, I just had to be a part of it.  No matter that I had never made real bread, with yeast, before. I was on a mission.

I hiked over to the grocery store and bought two packets of active yeast and woke up very early in the morning in anticipation.  My hopes were high.  Presenting the result:

 Yeah, that worked wonderfully.  I knew I was in trouble when the bread barely rose at all.

Fortunately, this turned out better:  Recipe to come in another post.

Half way finished???

I officially reached the half way mark of third year.  I can't believe it; third year is flying by way too quickly and at this rate, I'll still be clueless by the end of the year.  I took the neuro shelf and am pretty exhausted.  There were lots of questions about peds neuro and what the heck do I know about that, given that I'd never seen a kid the entire time while on neuro?  I hope that I passed the shelf!

This weekend, I definitely need to think, recharge, and prepare mentally for medicine.  I really want to get the most out of this medicine rotation and do well in it.

Cool (or perhaps not so cool but certainly memorable) things in neurology:
1.  Watching everyone's response to an acute stroke.  It's no joke and has been the closest thing to ER (meaning the TV show, with all the doctors/nurses running alongside a patient's gurney, mowing down everything and everyone in the way) that I've witnessed so.  The urgency of the situation is palpable.  Time is of the essence since there's a 3 hour window from symptom onset to give IV TPA and 6 hours to give IA (intra-arterial) TPA.  Sometimes we get transfers from outside hospitals and can only shake our heads: they scanned the patient, saw an ischemic bleed, yet didn't give TPA - are you kidding?  Now the patient is out of the time window!

2. TB meningitis.  So very rare in the U.S yet we had a patient in the Neuro ICU with what we are almost entirely sure had this.  The patient had the classic pattern of cerebral damage.  Unfortunately, she declined rapidly and passed away.

3. Serotonin syndrome.  Also no joke!  The patient's temp rose to 105, hypertension, tremor, and some serious clonus.  He was taking linezolid and demerol, the combination of which we think triggered the serotonin syndrome.  Did you know that linezolid, in addition to being an antibiotic, is an MAO inhibitor?

HSV meningitis

Classic characteristics:
1. Temporal lobe involvement
2. PLEDs (periodic lateralized epileptiform discharges) on EEG
3. CSF : normal to slightly low glucose, mononuclear pleocytosis with lymphocyte predominance, elevated protein, can have elevated RBC

Parkinson's Disease and Atypical Antipsychotics

We saw a pt today who looked like he had classic Parkinson's Disease - masked facies, cogwheel rigidity, trouble swallowing, stooped posture, trouble initiating movements, and a resting, pill-rolling tremor.  Turns out, he had Parkinsonism, likely from the risperidone he had been taking for many years for his bipolar disease.  So what do you do about pts with bipolar/psychosis/schizophrenia (too much dopamine) who have Parkinson's features (too little dopamine)? 

Olanzapine (Zyprexa), risperidone (Risperdal), and aripriprazole (Geodon), all atypical antipsychotics, worsen motor function.  Clozapine (Clozaril) is an acceptable alternative due fewer extrapyramidal side effects, but since it requires vigilant monitoring for agranulocytosis, the drug of choice is quietapine (Seroquel).

Publishing in EMR

Resident #1: Did you see that NEJM editorial that Annie (senior resident) published?

Resident #2: Yeah, she's a publishing machine.  Did you see the article she wrote for JAMA last year?

Resident #1: I heard about it...she did it on bedrest.

Resident #3 (overhearing): Ha, the only articles I've authored are in [name of electronic medical record system.]

Stuffed!

Good food makes everything better!  I'm currently enjoying mushroom ravioli with squash and sage sauce, spinach salad with blue cheese, cranberries, Granny Smith apples, and candied walnuts, and cannoli.  The delivery person forgot the cannoli and came back within 10 minutes with twice the cannoli I had ordered.  Great for my palate, not so much for my arteries!

Sigh...

Totally can't bring myself to study...what happened to motivation? :(

Mr. G

Mr. G arrived on the Neuro ICU early Thursday morning.  A man who had barely crossed the threshold into middle age, he suffered from relapsed refractory leukemia.  The cancer had left him with few functioning blood cells, causing him to develop an intracranial hemorrhage.  The resident loaded him up with bag after bag of FFP and platelets, to no avail - his INR, at 1.7, would not budge.  Finally, she pulled the "big gun" and ordered Profile 9, a specialized blood product used as a last resort in coagulopathies.  The resident jokingly pointed out that with one click of a mouse, she had spent her entire year's salary on this patient.  (Profile 9 is apparently extraordinarily expensive.)  But the cancer had put its foot down, and his INR went up to 1.8.  The bleeding, however, was only one of his many problems.  Overnight, he had spiked fevers as high as 105 and no amount of antipyretics, chilling blankets, and even cold saline would touch his fever.

Mr. G's room was located directly across from the Neuro ICU resident "nook," where we sat to type notes,  examine images, and check lab results.  Even from 20 feet away, I could see that he was miserable.  Shivering and delirious, he managed to nod when we asked if he was nauseous.  His wife visited daily, and I learned that he had a young school-age daughter.  Over the next few days, I watched him slip further away and become less and less responsive.  Eventually, he was transferred to the oncology floor, where he died the next day.  In my short two weeks in the Neuro ICU, I would see 3 others on the floor pass away, but none that were as excruciating to witness as Mr. G.  I hope his family finds peace.

Neuro and the Stanford 25

It's been over a month since I've written and I feel that so much has happened since then. I see so many things in the hospital, and as I've written about in my last post, sometimes it is just easier not to think about them. Of course, the unconscious thinking doesn't, or rather, can't stop.

In any case, I'm currently on my neurology rotation, and it's been among my favorite so far. I finished two tough weeks in the Neuro ICU, spending long hours seeing very, very sick patients, most with such poor prognoses. I love neurology. I love how diagnostic it is, how doing a thorough neurologic exam correlates with the pathology. These neurologists are some of the best observers and diagnosticians that I've seen. I love how academic the field is, how we spend hours discussing patients and case reports and latest treatments based on clinical trials and pathology and pathways. At the same time, it intimidates me a bit. What I don't love is how little we have to offer these patients. Stroke - okay, let's watch it and make sure your BP doesn't dip too low. In the meantime, you're weak on your L side, encephalopathic, and probably just lost half of your ability to function.

At the beginning of third year, my top choice specialty was oncology. A field within internal medicine is still at the top of my list, and if I couldn't go into IM, I'd probably pick neuro. Neurology and oncology. Two extremely academic specialties. Two with very high morbidity and often, mortality. Tell me why I'm attracted to fields where the patients are sick, sick, sick and often die?

Other thing is that I really need to work on my physical exam. I can do the motions yet, but I certainly haven't any where near mastered the ability to elegantly palpate a spleen, access a thyroid, listen for heart murmurs. I like this site that I found from Stanford's Abraham Verghese, a physician-humanist who wrote The Tennis Partner. It's 25 "must know" physical exam techniques to master, called the Stanford 25. Yeah - go Stanford! It's here at: http://stanford25.wordpress.com

Sensory overload

I'm still in a low, funky mood tonight and therefore feel compelled to write more. Since third year started, I've experienced periods where my sleep is completely off. Not because of call schedules and long hours. In fact, I've come to love post-call days in a perverted way because the exhaustion makes for such solid, dream-less sleep. No, I think my problem is "sensory overload." Much for third year is so novel and raw. On gyn onc, it was the open laparotomies where we'd literally be digging and pulling out chunks of tumor - ovarian cancer - in 40 year olds. In peds, it was kids with anorexia, CP, kidney failure. In psych, well, psych is constantly sensory overload. Even radiology didn't spare me, as I'd spin stories from the films - patients with traumatic brain injury and the like. And it's not limited to patient experiences. Even day to day interactions with residents, attendings, and the rest of the clinical environment can be challenging.

In the hospital, it's usually go, go, go, and I end up unconsciously suppressing whatever reaction I have to a situation out of necessity. Things I don't even realize affect me at the time reveal themselves at night. Nighttime is when I do the processing, the reflection, and yes, sometimes the ruminating. It does not make for good sleep. I suppose medical training is about character building, but right now, I have yet to build a thick enough teflon coat.

Quick update

Feeling kind of blah today...many things that I feel pressured to do (i.e. navigate this university system and find a research project and mentor, write my psych report) and yet am procrastinating on. That, and a few worries creeping up like if I'll getting all that I can out of third year, if I'll ever be competent, and what I want to do when I grow up. Neuroses should be a DSM diagnosis, because I have many of them! Of course, I deal with all of this by doing PreTest.

The ah-ha moment (or perhaps self-admission) came today in psych didactics. We met an inpatient in psych today with schizoaffective disorder who was clearly psychotic and perhaps manic - impaired reality testing, bizarre delusions, expansive affect, pressured speech, the whole bit. Afterward, the psychiatrist said: this is a defining moment - either you think "this is utterly fascinating" or you think, "this is cool but not in my department." I fall dead in the latter camp. Fascinating, yes, and certainly amusing, but not something I could do long-term.

As an aside, this past weekend, I met up with some high school friends who I hadn't seen since high school! It was so fun to catch up. And go [big high school] - many of my high school classmates seem to be doing quite well these days, although it's not entirely surprising!

Psych

1 week of psych down. Finished with radiology. I'm assigned to a locked inpatient unit and am glad to be talking to patients again, although this time it's really different! One of my patients has MDD with catatonic features (so you can imagine how much talking is involved). He seemed much better today and was actually able to hold a conversation! The other has some schizoaffective features combined with anxiety and depression. Being on the ward is kind of surreal. Also, apparently our chief resident really loves squirrels and we're her baby squirrels. Psych people are nice.

Physicians talking with one another: what a novel idea!

Yesterday, our weekly small group topic "Transitions in Health Care," referring to the process of transitioning pediatric patients with special needs/chronic illnesses from pediatricians to adult providers. The take home was that such transitions are hard and need to facilitated long before the child reaches "adult age" or age 18.

A couple examples of cases used in class: 20 yo Hispanic female with h/o Type 1 diabetes presenting to ED with out of control blood glucose after losing her health insurance at age 18 (why the heck does she have to be Hispanic??). 22 yo college student with h/o ALL treated at age 5 presenting to student health center for routine physical. Her pediatrician back home has been looking out for her before this. What issues need to be considered? How can we facilitate management of conditions that began in childhood in an adult setting?

One of my astute classmates asked at the end: "Why don't pediatricians and the new adult provider pick up the phone and have a 15 minute conversation about the patient?" Duh. Seems like a no-brainer. After all, in inpatient medicine, we have sign-out at the end of every shift, right? Yet, of course, the answer lies in financial incentives: because insurance companies don't reimburse for this, then these conversations just don't happen. Grr... another piece in this frustrating reality of how reimbursement strategies often limit effective healthcare delivery!

Shin splints

Ran outside for the first time in a long while. Asphalt. Ouch.

Ants in my pants

I haven't wanted class to end so badly since high school. Something about sitting in a dark room, at 4:30 pm on Friday, at hour 8 of radiology lecture. Depressing. But I truly have nothing to complain about - I'm done by 5 pm every day on this rotation! If only we didn't have to sit in the dark...

Please, please, please wear a helmet

I was shadowing in the ED radiology reading room the other day when we received a stat request for a CT read. 20ish female bicyclist* with severe head trauma after crashing into a car on a neighborhood road, flipping over it, and striking her head. Glasgow Coma Score at the scene was 6. She had not been wearing a helmet.

As soon as we began reading her CT scans, we knew the prognosis was extremely poor. Multiple skull fractures, subdural, subarachnoid, and intraparenchymal hemorrhages, dissection of a carotid that explained the pulsating blood coming from her ear. It was truly heartbreaking. In the words of the ED radiologist, "I have to detach myself from this. Otherwise I could never read these images."

I never saw the patient, as she was rushed off to the OR soon after arrival. A few days later, I learned that she had died that day on the operating table.

People, please, please wear a helmet. I don't care if you think you're skilled enough to not need one, or think it doesn't look cool - it's going to be way less cool if you scramble your brains. At my college, most people rode bikes to get to class, and I was always stunned that the vast majority of students never wore helmets. Biking accidents are common and while most are minor, sometimes, the terrible occurs. Remember to learn to ride safely and please wear a helmet and protect yourself.

*details of case have been changed to protect privacy

I love my iPhone!

Currently tickled by: my iPhone, clearly. Today in the main corridor of the hospital, I ran into a Mandarin interpreter whom I had worked with on a couple occasions. He looked to be dashing off to his next interpreting job but kindly flagged me down and showed me how to use the International Languages feature on my iPhone. Silly me...I should have known that iPhone is enabled for multiple languages. The coolest thing is that you can write Chinese characters on the iPhone and the characters are recognized by the phone. And there's pinyin too, for fake Chinese School graduates like me! More about working with an interpreter in another post...

Update: Rebecca Bross finished 1st on Day 1 of senior nationals! I'm not a huge fan of her style, but she deserved it. I'm am so taking advantage of radiholiday, I mean radiology.

That pesky little thing called lactose

I have spent the day benefiting from the fact that I am 1) stubborn 2) live to eat and 3) cannot learn my lesson...all due to a lovely glass of ice cold milk.

In college, I practically lived off milk. I relished drinking a large glass of it at every meal, without fail, partly because I loved the taste and partly because I am paranoid about osteoporosis. Early into second year of med school, I started experiencing random episodes of "GI distress" (I'll leave you all to interpret that as you wish, okay?) At first, I thought they were due to mild food poisoning or perhaps stress. After all, I was busy and sometimes, I may have pushed my luck with those leftovers one day too far.

I distinctly remember sitting in the basement cafeteria of a local hospital (studying for boards, yes, actually, in a hospital basement) with my study buddy and literally running to bathroom every hour. After the first few trips, my concerned friend asked what the problem was, and after some explanation and sympathy, he suggested that I might be lactose intolerant. But how could this be, I thought? I had never had a problem with lactose intolerance before. (Recall: 3 large glasses of milk a day in college). Yet the proposal was entirely reasonable. Desperate for relief and thinking that I simply could not afford to be disabled by further GI bouts, I made the decision to cut out milk entirely. A few days later, like magic, no more GI issues.

A few weeks later, we had our GI block and learned all about intestines, enzymes, hormones in great, fun detail. Importantly, I learned that most cases of lactose intolerance are acquired. In fact, most of the world is lactose intolerant, such that some scientists have suggested that the thinking about lactose intolerance should be reversed, with "lactose persistence" considered abnormal. Only certain populations of Northern Europe ancestry, where it was advantageous to be able to digest milk and dairy products, does the lactase enzyme persist beyond infancy.

How to determine for certain whether one is lactose intolerant? Most of the time, people eventually figure it out on their own. But for trickier cases, there's something called a hydrogen breath test. Basically, you're fed a certain dose of lactose and then your breath is measured for hydrogen. If you lack sufficient lactase enyzme to break down lactose, the extra lactose enters your large bowel, where it's broken down by bacteria that produce hydrogen gas and all those wonderful symptoms. There's also an easier test that my GI discussion leader proposed: just drink 16 oz of milk and wait for the fun (or not) to happen.

Granted, I'm lucky. I've determined that I suffer from only a mild case of lactose intolerance. I believe that this is why it took me so long to figure out that I am indeed lactose intolerant. After boards, I took my GI leader advice and downed that 16 oz of milk. Several hours later, sure enough, bloating and diarrhea. Fortunately, I still can eat copious amounts of yogurt without problem and sometimes up to a glass of milk or so. Not so fortunately, some days I miss plain milk too much, temptation gets the better of me, and well, I pay for it.

Currently tickled by: 2010 Visa Championships or U.S. National gymnastics championships, an annual competition where the best gymnasts across the country compete and are selected for the U.S. National teams. Most people don't know that I'm a huge gymnastics fan. I got into it in college, after watching my two dormmates, who both competed for the gymnastics team, in a few live meets. Gymnastics is such an amazing sport to watch - the stuff that these athletes can do is incredible! Check it out at www.usa-gymnastics.org.

I love how refreshingly straightforward and fun it can be to take care of adolescent patients, as evidenced by one patient in Ob clinic several weeks ago, an adolescent at 29 weeks.

Snippets from our conversation:

When I asked how she was doing, she responded: "I dunno, I'm feeling these 'thumps' at the bottom of my belly." She immediately took my hand and placed it on her abdomen, earnestly asking if I could feel them. Those would be fetal movements, my friend!

Adolescent: "Do you guys (referring to my resident and me) like being doctors?"
Senior resident: "Sometimes...it depends on who the patient is."
Adolescent: So you like me, right?
Senior resident: (slightly taken aback) "Of course!"

The conversation was more lively than I can convey in writing, but suffice it to say that this teenager made my day with her candor and spunk.

The fun begins!

OK, so I've finally bitten the bullet and started a blog. I'm only about 12 million years late joining the bandwagon. Put simply, this blog is for me, as I'm realizing that there are so many new experiences this year that I need to write, to reflect, and to document. Why public? Haven't quite figured out that yet.

I'm currently a medical student a couple months into my third year clinical rotations. Thus far, it's been a blast, although certainly stimulatory overload, yet another reason to write, write, write.

Currently tickled by: the "1500 pager," the pager carried by the Ob resident on call. I didn't get it until someone explained that the minimum beta-HcG level at which an intrauterine pregnancy can reliably be detected is 1500. Clever! OK, so who said I'm not a nerd? :)