A couple of updates from me . . .

Andrew Alexander Gomez is due Dec 2.  Yes, it's a boy.  He's started to kick, and I'm definately showing, so it's becoming a lot more real.  The nausea is improved, but not completely gone.  I've started to get swollen ankles if I don't wear compression stockings.  Also find I need to go to the bathroom a lot more lately . . .

I intend to do the nursery in green, with turtles (which is harder than I thought it would be, given I'm avoiding frogs at the same time).  Anyone seen the paint commercial, where the parents are painting the room "Spring Meadow," and it's supposed to be calming, and the wild kids sit right down and start reading when they run into the room?  That's the green that I'm going for.  Melissa is just about moved out of her room, which will be the nursery, and Victor is moved in all over the place at the moment.  Honestly, I'm having stress dreams about organizing and baby-proofing the place.

Also, I was named Intern of the Year, out of our class of sixteen.  Comes with a plaque and everything.  Now I'm shooting for Chief Resident . . .

Tomorrow I'm headed to Kansas City for the National Family Medicine Conference, which is attended by all the residency programs and tons of medical students.  I'm going as the FAFP rep for the program and as a member of the recruitment committee.  Recruitment at a booth, sure, why not.  Socializing is not my strong point, so I'll have to work on that.  Also working on an 80's themed outfit for the one of the social events.  Really?  The 80's?  Fortunately Melissa happens to own a pair of leg warmers and some jelly bracelets.  I went out and bought a bottle of hair spray, and I intend to use the whole thing.  I tried putting my hair into a side ponytail without any, and it was really pathetic looking. 

Victor has officially moved to Orlando, and is jobless for the time-being.  He took off for a week in Chicago almost as soon as he got here, so we haven't actually had to deal with each other on a daily basis yet.  Honestly, I can't wait.  He's planning on working for Habitat for Humanity to build some contacts and some local experience, and maybe get into real estate investing (urgh).  He's also planning on staying home with the baby (his idea, I swear!).  Given he hates getting dirty and finds body fluids repulsive, I'm very interested in seeing how this works out. 

Jane is walking all over, and is starting to climb.  She claps and dances some to music.  She also can do this adorable thing where she puts her fists to her chubby cheeks in a "aren't I cute?" gesture.  She isn't really talking yet, but we are counting "whoa" as her first word.  She uses it in context!  She can also sing "row, row, row," but she sings that for almost any song these days.  So, still utterly adorable.  Don't know how Andrew will manage to outdo her, but I firmly expect that he will.  I know he'll win in the hair department.  Jane isn't bald anymore, but she still doesn't have much to speak of.

I just finished a month of night float, which was actually a lot of fun, at least for the first three weeks.  I liked the independence I had, and the lack of rounding definately helped.  I liked my week on OB more than I thought I would.  The C-sections weren't as bad as I thought it would be, I got three continuity deliveries during that time which was nice, and actually had a bit of fun problem solving and working with the attendings, who were more available than I thought they would be.  Medicine was nice because I got to seriously focus on the assessment and plan portion (no dictations!  yay for being a senior!) and be very thorough, which was a nice stretch.  I also liked making decisions without always having to check with someone.  Most of the time I wouldn't chief with the attendings, since I didn't want to wake them up for stupid things.  I had three patients start to crash on me, two going septic, and have to be transferred to the ICU.  That was a bit more nerve wracking, but a good experience.  A bit scary when the decision comes down to you, but rewarding when I figure out that I made the right decisions.

Okay, I think that's about it.  My sleep schedule still hasn't recovered, so I'm trying to adjust things so I'm not awake at 3am and dying to go to bed at 4pm.  Have a nice weekend!

(no subject)

I have no idea how long it's been since I last posted here.  I do pop in to catch up on friend's posts every now and then. 

So, what's been going on with me . . .

I'm pregnant!  14 weeks and 4 days, to be exact.  5.5 weeks before I can learn if it's a boy or girl.  I've been nauseated pretty much since I learned I was pregnant, which has been . . . interesting.  I also have nasty heartburn and have developed gastritis, which is painful.  The fatigue is better, which is nice.  I'm still kind of early, but I don't fit my normal pants any more, so I had to go buy maternity clothes already.  I'm going to have to go up in scrub pant sizes soon, I think.  Basically, don't think I'm glowing yet.  There is another intern who's 5 weeks behind me, and we comiserate about the side effects of pregnancy.  At least I wanted to get pregnant this year--she was caught by surprise and I don't think it's quite sunk in yet.

In good news, Victor will be moving down from Jacksonville soon.  He's going to be quitting his job, since there isn't any branch for him to transfer to down here.  Although the evil boss, who's fired everyone on the original team except Victor, and has managed to get fired quite a few people who don't even work for him, loves Victor so much that he tried to get him transfered to keep him in the company.  (I think either it means Victor is spectacular at him job, or he has incriminating photographs of this guy.)  He's looking into getting in real estate, working for Habitat for Humanity, and eventually being a stay at home dad.  I tell people that and the kind of laugh and ask how long I think that's going to last.  I respond by pointing out that he's the one who thinks it's important for one of us to be the ones staying home with the kid (as opposed to getting a nanny), and there is no way I can stay home (I go nuts on a two week vacation), so it's his idea.  Anyway, it'll be nice to have him in town.

As for work . . . I'm in my last month of internship!  Definately looking forward to less call.  I'm on my emergency rotation, which is pretty light comparetively.  I have a bunch of OB call, but I'm feeling a lot more relaxed about that since my second month of experience.  Plus, my first two calls are basically baby-sitting the East resident.  For some reason, the DO program doesn't let their residents, who had an OB rotation in medical school, have a medical degree, and are as qualified as any of us are to be real doctors, take call on their own for the first two weeks of the OB rotation.  They're supposed to "shadow" us.  I wouldn't have a medical student shadow me for two weeks, much less a doctor who's less than a month from becoming a senior.  Fortunately, the one on this month is really good about holding the pager.  I mostly just have to sign off on his work and check his wet preps.  It lets me practice for being a senior myself, which is good because I'm starting out on night float next month, and two of those weeks will be on OB.

I had a good intern year, I think.  I got a lot more confident in pediatrics, and I'm getting more confident in OB.  I have a pretty cool OB patient right now who I met last week.  She's 22 or so, and didn't find out she was pregnant until about 4 months when she went for her physical to join the Navy.  Oops.  She went to the abortion clinic three times but couldn't go through with it, and is giving her baby up for adoption.  I think that's pretty courageous, and I like her.  She asked for a run down of the labor process with only a couple minutes left in the visit, so I think I overwhelmed her, but she was happy to hear she could get an epidural when she gets there.

I loved my medicine rotations.  The attendings are all great.  I'm also doing two research projects.  One is a survey about the impact of medical missions on residents, and the other is the incidence of MRSA colonization during residency.  We'll see if either turns out to be actually interesting.

My niece is going to turn one this month.  She's have a "Super Sweet First Birthday" party in two weeks.  She's having a grand entrance, a fancy cake, a surprise performer (her dad is doing a puppet show), and at the end she's getting a car from her parents (Fisher Price, of course).  Should be very cute.  She is getting more confident in her walking, although she still only takes a few steps at a time.  We're not sure if "whoa" is a word, but she has that one down and uses it in context, so we're leaning toward yes.  And she is adorable!

I do need to figure out how to incorporate theatre into my life next year.  The Shakespeare Company and two community theatres are within walking distance of the hospital, so there's got to be a way to make it work.

I think that's about it for now.  That's all the excitement here.


(no subject)

I'm on peds right now.  Night float, to be specific.  Currently, I am bored out of my mind.  I love coming to work.  I love the challenge, I love discussing (arguing) with attendings, I love working with patients.  But this week, I have spent every night up in the call room, trying to find something to watch on the computer (I've watched all of "How I Met Your Mother," "Pushing Daisies," "True Blood," and the most recent season of "Dexter") and I'm BORED!!!!!  Plus, I go home in the morning, sleep the whole day, and get up in time to wave bye to my roommate before I go back to work.  Ugh.  Only one more night of this.

Not to say we haven't had some interesting patients.  My first day in clinic last week we had a 14 month old girl come in with a week of easy bruising.  Just putting on diapers bruised her.  She had a bruise in the top of her mouth from her spoon.  She'd falled the day before and given herself a black eye.  (Note to parents out there--these are all bad signs--don't wait to bring your kiddies in.)  We knew from looking at her that her platelet count was low.  The only question was--were her platelets the only cells that were low?  Or were they low because her white blood cells had infiltrated her bone marrow, making no room for platelet production or red blood cell production (ie, leukemia)?  Her parents knew enough to know leukemia was in the differential.  I can in early the next morning to find out what her labs showed.  The average person has platelets between 150 and 300.  We don't worry about bleeding until the level drops below 50.  I recently had a guy leave AMA with platelets of 26 (and I worked hard to get him to stay).  Spontaneous bleeding doesn't happen until aroud 15. 

This little girl's platelets were 4.

It was the kind of lab that pops up and your first instinct is to run to the room to make sure the kid is still alive. 

She was fine, in the end.  She had something called "idiopathic thrombocytopenic purpura," which happens following an infectious disease (in her case, the chicken pox) that causes the development of anti-platelet antibodies.  Her platelets were being attacked by her own body.  Two days of IVIG solved the problem and she went home with platelets of 46, with good follow up.  Pretty impressive, and a great lesson.

This morning, Sarah called me because Jane had yellow boogers when she woke up.  Jane, in case you don't know, is my niece.  She just turned 7 months two days ago.  She's adorable.  She is sitting up on her own and just learned to crawl.  She eats baby food now, and apparently her own snot as well, which I learned when I went over to make sure she was fine (which she was).  She does this nose-wrinkle thing that is so cute.

Anyway, hopefully I'll get to see Victor this weekend!

(no subject)

So, yes it is 3:30 in the morning, and no, I have not slept since I got a 30 min nap around 2pm yesterday afternoon.  But I'm way too awake to sleep right now.  That, and my pager will go off anytime I get close to falling asleep.  Besides, if I stay awake, I can start rounding in 30 minutes.

Anyway, last year I did the play "Patient A," which is about a girl who dies of AIDS.  And now I have an AIDS patient dying in the ICU right now.  It's not my first AIDS patient, but he's my first patient who is really going downhill.  I've had him on a couple of admissions, and happened to be picking up a couple of medicine calls this weekend and he came in again.  On the day after Thanksgiving I put a chest tube in him, and tonight he coded and required intubation.  I think the most frustrating part, and the saddest part, is that his mother is there every step of the way, and she isn't ready to let go.  I mean, neither of them are.  It's tough, because he's only 26 years old, and two weeks ago he was pretty normal looking, except for the big Kaposi sarcoma spots all over his face.  But then his face started swelling and wouldn't go down, and now he has huge pleural effusions and pulmonary edema and he can't breathe.

"She had yet to experience the final effects of the disease: incontinence, incoherence, the intense pain.  But these were coming they knew.  She was dying.  The only questions was: in how much pain?"

That line keeps running through my head.  That and the sad little poetry line from the play as well.  He's maxed out on two pressors.  He is awake, but even if he recovers, he's just going to keep coming back here over and over until it really is over.  Personally, I don't think he's going home this time. 

His mom insists that God isn't done with him.  Who am I to argue with God?  But there are medical facts--you can't live if your lungs are filling with fluid and if you have no blood pressure.

Which brings me to another lady, who I have never admitted before but who is a frequent flier.  She came in with difficulty breathing and had to be intubated this morning.  Somehow she is still awake although she's maxed out on three pressors and her systolics are in the 50's.  Her family insists that she would want everything done, but now she's telling the nurse she just wants pain meds even if it causes her pressure to bottom out and kill her.  Her family is telling her to fight.  I've spoken with them, and my resident has spoken with them, and we've told them it's very serious, but they seem to think she'll turn the corner.  Again, in my opinion, that's extremely unlikely.  Her kidneys have shut down.  All day, she's produced about 5 ml of urine (that's really bad, by the way).  Her bowels are probably dead.  She's acidotic to 7.0 after numerous amps of bicarb.  Seriously, it's amazing that she's awake and coherent.

Also, I do not want to be left on a vent if I'm in the same position.  Give me the meds, let my pressure bottom out, and don't try to revive me.

Although, if she's still alive on Monday, I could drag my reluctant diabetic to her bed side and show her what she has in store if she doesn't take her medications and keep her appointments with me.

Anyway, I'm going to go round on my patients who are still alive.  Hey!  Some of them will even go home today to live long and fulfilling lives!  That's exciting!  And then Monday I go back to OB, where at least some of the mothers haven't screwed over their unborn offspring, and sometimes they don't even smoke!

(no subject)

 I saw "Wicked" on Saturday with Sarah.  It was . . . amazing.  I left the theatre wondering why I was still in medical school, and shouldn't I drop out to join the theatre?  It was magical.  Every single note was perfect.  The set was fabulous, as were the costumes and the voices.  And the lighting.  Oh, the lighting.  They made it rain on stage with the lights.  It was so beautiful.  Anyway, I'm seriously drooling over it, and I really am loving the theatre right now.  I hope I'll find a way to keep it up during residency.  I'll miss it my intern year.

Also, I have FOUR DAYS left in my formal education.  21 years of my life spent in school, and it's really almost over.  Whooo!

(no subject)

So, really quickly, since House was on last night, and we were barely into the second act when I had to yell at the screen--VDRL is KNOWN to be a poor test for syphilis. Honestly, no one orders it any more because it has so many false positives. Lupus causes a false positive VDRL test. That's why all modern medicine docs order an RPR, which actually tests for syphilis. Also, did they not get a subsequent MRI with contrast to find out if the positive syphilis test actually correlated with neurosyphilis? I mean, just because the dude has syphilis doesn't mean it's in the tertiary phase, and even if its in the tertiary phase doesn't mean it's causing neurosyphilis. Way too many holes in it. And seriously, how can I trust House at all if HE didn't know about the VDRL stuff? Honestly, I learned about that as a first year medical student!

Also, while I don't know the answer to this, they already had a neurosyphilis patient. It was an old woman who was sexually inappropriate, and House convinced her to take her penicillin by reassuring her that it WOULDN'T change her personality because the damage was already done. And now they have a whole episode about how the treatment will reverse the personality changes? Do the writers see the old episodes?

EDIT:  So, I looked it up.  It doesn't take much, really.  If the writers bothered to look at Up To Date at all, they would know the treatment is not, in fact, one pill daily for a month, but involves more than one medication or a shot for a few weeks.  Also, they would have found that neurosyphilis is usually the cause of irreversible symptoms.  Also, they would know that a lumbar puncture is necessary for the diagnosis.  Given how often they enjoy sticking patients with needles, you'd think they'd love that opportunity. 

(no subject)

So I should probably post that we had Match Day. I got my first choice, which is Florida Hospital at Orlando! Yay! Melissa and I have already found an apartment we want, and I got a bunch of paper work in the mail yesterday, so scary and exciting as this is, it seems it's actually going to happen.

Staying quite busy. Patient A is being performed next Friday, so lots of rehearsals/preparation for that. Beauty and the Beast is coming along, although I wound up having to do the set almost entirely by myself, so that's been a little bit stressful. The choreography is finally finished, thank goodness.

Sarah is getting hugely pregnant at six months. My start date for orientation is the day before she's due, so I hope she delivers early!

(no subject)

From springdove

 Here's how it's supposed to work.
-Put your iTunes on shuffle
-Post the first line from the first forty songs that play (no cheating!)
-Strike through the songs when someone guesses correctly.
-You must say the band name and song name for it to count.
-No cheating by looking it up on Google, people!

Collapse )

(no subject)

 Last Thursday, Victor's mom suffered a stroke.  Her heart didn't beat on its own for 35 minutes.  Because she did not have a DNR signed at the time, the doctors resusitated her, but she had already suffered severe anoxic injury.  Her sons arrived, and the next day a little before 11am she was taken off the respirator and the medications that were keeping her blood pressure up.  About 10 minutes later she stopped breathing.

The funeral service is this Saturday, with a viewing Friday evening.  Kike and his wife, Esther, are in town for the week.  There are a lot of details to work out (and funerals turn out to be very expensive).  But the funeral home has been very good.  All of her nurses were very kind.  This came as quite a shock to my father-in-law, so if you could keep him in your prayers, we'd appreciate it.  The rest of us are holding up okay.  

Just wanted to let you know.

(no subject)

 The update on Victor's mom:  she completed her chemo, and then developed an infection requiring her to be moved to the ICU last Sunday.  Unfortunately, she developed sepsis, which means the infection got into her blood as was affecting her systemically.  Currently, she is intubated (a machine is helping her breathe), she has had to undergo dialysis and is still connected to the machine since her kidneys aren't working in order to take off excess fluid, and she is still requiring two vasoconstrictors to keep her blood pressure up.  They keep trying to take her off, and wind up having to put her back on.  They've tried to wean her off the ventilator, but she had spells of decreased breathing and had to restart it.  She is no longer sedated, and she will grimace with pain or movement, but has not woken up.  She's supposed to be getting a CT scan today to evaluate for brain damage that would explain why she hasn't woken up.  Her liver and kidney suffered from the septic shock, but her lab values are looking better.  She has had to receive several platelet transfusions and at least 2 units of packed red blood cells.  An ultrasound of her heart shows decreased functioning, although I suspect that may correct itself when her kidneys start working again and she isn't so fluid overloaded.  What does this mean?  There has been improvement since earlier last week.  Her oxygen requirements have decreased, and she's not on continuous dialysis.  Her numbers are looking better.  Her chest xray is clear.  However, she is still requiring medication to keep her blood pressure elevated, she hasn't woken up yet, and she has not been able to come off the ventilator.  It's really kind of a draw at this point.  She isn't actively dying on us, but she's not exactly making leaps and bounds in recovery either.  She had a bone marrow biopsy last week, which will hopefully show that at least the chemo worked.  And now it's just about waiting.

So, this week I was supposed to have only three lectures a week and plenty of time to focus on the yearbook and the musical.  Instead, I wound up with jury duty and out of 130 people I was one of eight selected for a murder trial.  Ugh.  It's expected to run three, maybe four days.  Ugh.  I guess I won't have to worry about wasting my days now.