DIA

Sitting at DIA - denver int'l airport on my way home... hooray! I'm watching these too little boys running on the moving floor escalators. Mom's letting them play - they're not in anyone's way and the escalators are rarely being used. So one of them is running the opposite direction the escalator is moving, two people board at the the other end, hands full, and pushing luggage. Mom calls out - watch out for those people - just then kiddo turns around to look back at mom - still running forward and WHAM! right into the two people. He falls backwards and lays there for a minute, then sits up, completely disoriented now that he is moving escalator now going in the opposite direction he was running. Cheap entertainment at the airport. Guess I should tidy up my mess and get ready to board. God it's great to be on my way home. ANd the ice is finally melting on the runways here... even better I didn't like the sliding feeling we had when we turned into our gate.

Where did 9 go?...7 "ate" him

Rotation 7 is finito! I am going to miss peds. I think I found my nitch. I didn't drop any of them. I didn't kill any of them. And I may have made a difference in one or two of them. Joy!
Although I am sad to see 7 go, and wish it could eat eight not nine - but that's not how the stupid joke goes - I am ready to move on. only 3 to go - 2 rotations and a microphone (aka graduate project). I'm ready to pack, typhon, homework and culminate my presentation for PPS week (which I am sure everyone is just super excited for..like myself).
I'm coming home honey...I'm coming home.

Ethics and Morals

I find very few times when the phrase "I highly encourage you to revisit your moral or ethical values" is appropriate. And just for the record - yesterday during a phone call was not one of them. Nor do ethics need to be religious-based, yet another inappropriate component to the same phone call. And finally... there is nothing more annoying then someone who acts like they care but there voice and tone is completely different (had it not been a phone call maybe I would have had a different feeling) and please don't act like you have a clue if you are coming into the middle of a situation - like the middle of a movie, or a conversation or perhaps a clinical year.
And PS - if you are going to paraphrase my words, be accurate and true to what I am saying don't add in your own words to completely misconstrue the original meaning - and I don't like your condescending demeanor so can it.

7 week save

I helped save a 7 week little girl today - well yesterday but the fruits of my labor paid off today.

7 week female into the office for a rash on the right cheek. Mom reports a "fever" of 99 under the armpit and added a degree to call it 100. I explained I was glad she came in although we don't usually get to worked up about these "fevers" unless they are 99.4axillary or 100.4 rectal. But glad you brought her in to be on the safe side. I thought her rash was bad irritateed ezcema that they'd been using the horrible baby magic on and some wicked seborrhea. She looked nontoxic - smiling cooing, eating ok, sleeping ok. My preceptor thought the rash and ear looked impetigo and yeasty so we attempted a culture of the front part of her ear. So with this feverthing - do you work her up because she is less than 2mo? or treat her rash once the culture grows out. It was my call... so I said draw a CBC, CRP and since we're sticking her a blood culture thinking if we're going to the trouble might as well go all the way. Her culture came back on her ear - yeast so a little lotrimin cream to the cheek. This morning though her blood culture had already grown streptococcus which means she has bacteremia - bacteria in the blood. SO she needs to be admitted and have an LP. So she comes into the office for a cath and LP. Long story short her LP CSF had >10WBCs (bad new bears...+meningitis) and Group B strep and another strep unknown still pending so this is one sick sick kid. Theoretically for as sick as this kid is and had the cultures not been done, just the CBC and CRP which were essentially normal - yes normal.... she most likely would have spiked a temp tonight and seized and then died or been brain dead from the extent of the meningitis and brain edema. That is really scary to think about. if I would have been on my own in clinic...would I have ordered the lab with the questionable temps? She was afebrile in the office without motrin on board and didn't appear sick. her rash is gone today and she still looks nontoxic. She's the kind of kid who would've crumped...just like that crumped. Needless to say it scared me enough that I will be a little lab-happy and jumpy for awhile. I know it's an expense and pain to the patient but if I ever doubt myself and lose a kid - I would be devastated. But for today I am relieved 9although mom wanted kiddo to be admitted to Children's which is a half hour away - which was before we knew what her LP showed and after 2hrs she still hadn't shown up with the id even though we were adamant that she had to go straight there...so I pray she made it). So like I said - for now, I say today - well yesterday...I helped save a 7week little girl - now the rest is up to something bigger than me.

Personal dermatology

So last Friday I once again came down with a horrible cold which I actually think is just an ongoing sinus infection (for the last 3weeks) with the headaches and sinus pressure - but what do I know - I'm not a doctor and try really hard to not try and diagnose myself. Regardless I am miserable again.. c'est la vie in the life of peds. But today I have a wicked rash - an erythematous, punctate rash with white circular halos around each lesion - translation - i have red bumpies that itch like crazy with white circles around each one, on my upper legs, on my shins and now on my one side and my arm. I have no clue what it could be - a viral rash? Some crazy thing I picked up on Friday? - I had 2 tiny little spots on my leg yesterday but attributed it to dry skin and put a little eucerin on my legs... and today lots more bumpies... AHHHH! Sickness = no homework para me. Tonight I am desperately trying to do homework but no luck. I like to watch a movie I know really well to just have on for noise but don't have to actually watch because I know it so well...there are no good movies on like this tonight so...I am watching Pirates of the Carribean....en espanol. No es lo mismo pero me ayuda con espanol, pero no puedo completar mi tarea. The commercials are even different like Angel soft toilet paper - at the end it says: an ideal balance of softness and strength in a cute little sing song - but in espanol translated: the toilet paper with ideal balance. Just not the same. Ok well I guess If I am going to watch Pirates I may as well actually try to understand what the hell is going on - I don't know the dialogue quite as well as I thought I did. Although killing pirates is the same in any language so all is good.
Adios hasta manana

Great Clips

I did my first snip and clip today - it was awesome!! Actually it was very very nerve racking-and in the end it was awesome. Whomever dreamt up that little contraption was a genius (and nuts!!) - I just want to know who volunteered their little boy to try it out. And I will never look at safety pins the same again. What a truly intricate and delicate process and yet barbaric all the same - very strange. I'm not sure if I was more nervous putting the block in and praying I hit the right spot- studies have shown that blocks are incorrectly placed a good percentage of the time and are therefore ineffective. My preceptor made one joke with me today when I was too nervous to do the whole block myself without seeing it done first- I'll do one half, you do the other he said - then we'll see who did theirs right. The kiddo didn't sleep through it but didn't fuss during the "painful" parts - only when he lost his sugar water binky -so my block worked. I wish I could invent some little tool to help ensure all the remnants after initial detachment are actually gone before detaching the contraption itself - I think I was more nervous about the scalpel slipping and stabbing the little guy or my finger as I "cleaned the edges" of any leftover debris. Here's a website if you're dying to read more about it and see the procedure. I had never really thought about what we;ll do when we have kids and if we have a boy but I've had 2 little boys ages 3 and 7 who were not circ'd at birth and have had massive infections because of it and had the procedure done at those respective ages - bummer. http://www.intact.ca/vidintro.htm. All in all after all was said, done, snipped clipped and bagged as a souvenir I thought, that's a good looking circ - I think he will appreciate that later in life.

In other non-circ news - Creighton isn't dancing this year - they were robbed of their dancing shoes hopefully they don't blow it in the NIT - although they came darn close tonight against Bowling Green. sheesh.

The Potty Dance

So I am watching Discovery health channel tonight as I am diligently typhonning and on comes a commercial for the potty dance I have never been so frightened in my life by a commercial so I just had to check out the website www.thepottydance.com and was even more frightened by the sketchy people in the background of this pseudo-rap video about doing the potty dance... see what you think for yourself (the old guy with the short running shorts and the creepy guy with the gloves - makes me think that these older people in the video who by the way are mostly men are not potty trained themselves). I will never think of hoolahooping the same again.

9 and 12

It's like football, sort of, 9 days of actual clinic, 12 days until I am home (or where i put my hands when I drive). Hell yes!

1. I am really loving peds. I had a patient tell me something really great today, it totally made my clinic day. I admitted someone today and some parents are looking to me for parenting advice instead of my preceptor who A. is the doc, B. has kids of his own C. has beein doing this for almost 20years... scary - I guess everone assumes I have kids or assumes I have a clue when I talk to them - not sure which is more popular (and I had to inform one teenage mom today that no I did not go straight from HS to graduating med school - but thanks for the I look young compliment)

2. Shawn and i just discovered video IM chats on yahoo - I knwo there's skype - but we're still old shcool I guess. When he figures out his microphone then maybe we can move up in the world. Why didn't we think of this like 6months ago - best thing ever! (except that I get so giddy being able to see hom and the doggies that iIneed to unwind before bedtime and listening to my favorite tunes doesn't help.)

3. tomorrow's Tues - my favorite day!

4. my hippo still smells like Shawn - ahhhh, smelly hippo.

5. tomorrow is St. patty's day - I have the perfect outfit picked out - well no not really just one of the two green sweaters i own and a pair of green socks with monkey faces and rainbows on them. (should this be combined with #3?)

6 - if needed...Our tuition isn't going up for the last 3months of school - what a novel idea!!! I sent a personal thank you to Pacific's president.

Have you seen her?

The infamous Britney Spears is about to release a new song. I think the lyrics are perfectly fitting to the rest of her album and new image. I'm not praising her ability to write songs because I know she didn't write her newest release - If You Seek Amy.... but damn-I think that's clever - and a catchy tune (and would have loved to hear it air on the radio before anyone caught on to the mixed message and watch mothers and fathers nearly run the car of the road in attempts to cover their young children's ears - ok so not into the crashing car thing - more of the shock and awe (like the opposite of the last 8 yrs of president which was more awe and shock)) Love her or hate her - she's back and for a whole new audience.


- and yes I used a double parenthesis in my run on sentence -

Asleep on the job

So apparently I am just a freakin' germ magnet. Whatever I had last week or the week before or even before that either came back with a vengeance or I picked up a new buggy from one of the poisoned-nose dwarfs. Thanks kiddos for breathing, hacking, coughing, sneezing, spitting, vomiting, peeing and snorting on me. I appreciate it - really I do because I know that you are helping build my apparently weak immune system. So thank you kiddos, thank you.

In other news, I hear the crazy train (new clinical coordinator and the program director in tow) is in full swing after some hiatus. Can't wait to see if they stop by my station maybe those little critters can share the love with them too. All is fair in love and peds right?

Had 2mo old triplets today, some well child checks, and so sick-o kids. Nothing too interesting like duodenal atresia from the other day or bronchial dysplasia or 22q11 duplication and deletion. No ear pits, fatty filum terminale or oligohydrosis and a SGA baby. (oh wait, that was this morning.) Otherwise nothing too exciting - doc had parent-teacher conferences from 12-2 - so although he encouraged me to follow another provider, the NP didn't want me - she wanted me to go home and get well (since this is the 2nd week in a row I have a husky voice and "look like hell" according to her) I tried catching up on some assigned reading but started falling asleep in my book in the break room so the nurses/m.a. told me to go lay down fro 30 min in one of the rooms and they would wake me up before the triplets and before the doc was back. I napped, it was good - enough to get me through the afternoon. The logical thing in retrospect would have been to just go home but that's just not my style.

Small World

had a kiddo the other day (yesterday) cute chunk he was. Mom had a Spanish accent, but had more of a South American perhaps Spain look to her. Talking about the options of the Hep A vaccine and doc asks so do you have plans to travel with baby? Do you have family that live elsewhere? "No plans to travel while he is so young, but I do still have family in Ecuador." My ears perked up like Wrigley's when you say food. After further investigation she was born and raised in Guayaquil- check and mate!! She's even been to the clinic where I'll be going. She gave some places to go and a few places not to go - my preceptor at the end of the day slipped me her phone number (which I thought was pretty weird) just in case I want to call and get some more ideas. Funny how small the world is.

Loss

Jays lost today in a terrible game - and I'm going to lose an hour of sleep tonight - what a bummer.

I should be typhonning or writing a paper or writing a presentation but once again I am floundering and watching a movie: Love in the time of Cholera. I flounder, it's what I do best. Only 3 weeks left in the rotation, that means 21 days, I like the way 3 weeks sounds better.

My in laws and Shawn lost a close family friend this week. It seemed very sudden. The Christmas letter made no implications of illness or failing health. She and her husband and their children were Shawn's neighbors in his birthtown and they attended our wedding. At the funeral on Friday they learned she had been ill for about 3years, she had uncontrolled DM had been on dialysis for the last couple years, the husband taking care of everything for her and so it was not so sudden for their family. She sadly passed away in her garage on the way to the car.

Life is so short which is why I feel like I have such a huge loss in my life when I am without my Shawn. So for another 3 weeks I will gain what I can but with a large loss in my heart. Amen for family.

Whatever you do, don't drop it

Morning flew by, I'm getting a little more independent although the preceptor never believes my findings, then decides that my plan will do just fine. It's 1pm, still have morning pts to see and we get a call there's a C-section planned for 2. Doc usually only goes to primary sections or secondary ones that are not during clinic hours but this case was a little unique. Mom was 25weeks pregnant last year or so when her car was T-boned crushing her pelvis and the twins she was carrying. The twins did not survive the trauma in utero and mom nearly died of blood loss. Today is the same due date as her twins and the birthday of her new beautiful little baby. So we decided we should be there for the c-section. (we also learned she was pre-eclamptic had a raging headache with vision changes and contracting every 1-2min - so despite the fact it was during clinic hours, it needed to be done now not later). "ever seen a C-section?" Why yes, I said, I actually got to first assist one last summer, very cool. "Wanna catch?" ummm ok. So waiting for mom to get draped and prepped, I was introduced to several people including the neonatal RN, the OB, and some other lady in charge of the L&D staff. All of whom gave me the same advice: whatever you do, don't drop the baby. (duh I thought, wasn't planning to).

I'm scrubbed and draped myself waiting for the handoff (after a mock walk-through with the doc to make sure I knew how to walk over to the warmer and not trip, fall and drop the baby.) Then I heard a beautiful cry, my tears welled in my eyes and then the OB plopped the chunky newborn in my arms and I ran him in for a touchdown in the warmer with no fumbles!! I dried him, assessed him and then got to wrap him off and congratulate the new dad (who was slowly regaining colors in his cheeks and now up from sitting on the floor) and I handed the new addition over to his arms. It was beautiful. I wonder if I surprised anyone that I managed to hold on to the 8+pound kiddo - do they have a lot of students drop newborns? Births never get old, never. (and I think I will always get teary-eyed)

Now I am procrastinating doing 2 presentations I have to give tomorrow for the EMS refresher. uggg...

Oh, ok I guess I'll go

It's 6:00 tonight, more patients to go, finishing up around 6:45 ish and my preceptor says, hey I've got this kiddo with neurofibromatosis in the ER who had a seizure and is spiking a fever. He's needs an LP, but you've had a long day and I can understand if you want to leave and not learn anything else today but if you're up to putting in a few more hours.... I probably was going to go home. We had 2 patients left. It was a long day. Several admissions, angry parents - I would be too if I waited 2 hours in the waiting room. I'm tired, hungry - no lunch, again/as usual, low grade temp of 100-101 and major body aches (sorry liver, I'm trying to function with Tylenol), I've had 6 tsp of Trimenic for my hacky cough. So sure, I'll run down to the ER and watch an LP. It felt really good to get home a little after 8pm, talk to Shawn who always reminds me I'm so close to being done and crash. I won't be doing any of the reading I was assigned tonight. We had 6+ influenza's today alone, a couple admissions, some other crazy ass things like: a 7yr old girl who had over 35 cafe au lait spots miraculously appear OVERNIGHT. It looked like a little girl got into some bad tanning cream and had left over splotches all over her (hand, arms, legs, face, legs, feet - sparing the back - for now.) oddly enough she also has Thalassemia trait. A 10yr boy who's gained 17pounds in the last year, but only grown an inch or so in the last year or two, he has also started going gray. There were some other bizarre things too, but will save those for now... I think it's bedtime already.

A lovely weekend

Shawn left today, back to PDX - without me of course. He came in on Friday afternoon - I somehow managed to get off early for it! The rest of the weekend just flew by from there:
Friday evening - quick Lenten dinner at Long John Silvers (umm don't need to eat there for the next 25 years or a lifetime), went to nephew's b-ball practice - good to see them running and dribbling together not one or the other or rolling on the floor in the middle of a fast break. Then off for desert with the niece and nephew and sis/bro-in law. Did I mention it snowed 4inches? Late night cuddling.
Saturday - sleep in, get ready for a Creighton B-ball game. Clutch game for co-champs of reg season. Miss my dancing days - weird to think that Shawn and his rents saw me dance, just didn't know who I was. That evening - dinner at Quaker Steak and Lube - I know strange name. You can get things like Chicken fenders, a 4-wheeler sampler or some good old soft pretzels with cheese. Late night card playing (1opt pitch) - Shawn won us the 5th game by shooting the moon with an Ace, 2 and 6. What luck - what a game, what a husband!!
Sunday - another late morning - homemade breakfast with the whole fam. Shawn made his famous french toast - life is good. Went bowling - took 3rd over all, thought I had Shawn beat for the first time EVER. My first game was the best - I had 4 strikes and 2 spares. It went downhill from there. Shawn's parent's broke out their (as his mom called them) old balls and rubbers (shoes). Shawn's mom did better with a few beers and a rosin bag and everyone else warmed up by game 3. I can't believe Shawn use to bowl - and his family bowled in a league - welcome to the 70s'/80s - literally before my time. Sunday night - family pizza night -a tradition and then cuddling on the couch and movie on demand the Changeling - very good.
Monday morning - one of the hardest goodbyes in the parking lot of the hospital I'm working at. I am sure everyone working in the radiology department and outpatient registration watched our soap opera drama good bye. We just don't do good byes.
15minutes to compose myself and I was back seeing patients. Now I'm no expert but when I he asked me what I wanted to do with a patient and suggested at 10 til 5pm that we admit a little girl with a resp rate of 70+, deep cough and raspy lungs, RSV and hx of pneumonia it would have been nice to maybe ponder the idea instead of waiting until 6:10p to do it. But again I'm no expert. Tomorrow's my favorite day - Tuesday.