Sunday, November 27, 2005
Many are arguing that this is our first “real” vacation in about a year: since last December break. We did get 1.5 months off of class before M3 started, but that really was to study for Step 1 and any vacation time we took was at the loss of Step 1 study time. Thus, nothing much has been going on since Thursday. I did take a 36h call my first day on inpatient peds and we were slammed with patients. It does not work like inpatient medicine where your team stops taking call at
Last Wednesday afternoon we had our first real snow fall with accumulation. I had to bike home from the parking lot that’s about 1 mile away. I expected the ride back to be really treacherous with it being difficult to keep the bike on the side walk. It was not so bad! It was significantly more difficult to peddle home, however. It’s all uphill and I actually had to stop a few times to catch my breath. Good exercise none the less! Over the course of latter part of the week we got about 5 inches of the white stuff, but it started melting last night and continues today with rain.
I finally have enough sleep stored up in my hump that I got up pretty early this morning, especially considering we watched all of SNL last night. It’s actually good because I’ll have to get up around 4:30a tomorrow to be at work on time.
Saturday, November 19, 2005
Even I knew something was up.
Those of you who know me best know that I am not a big football fan. I really don't like watching on TV and I only sorta' tolerate going to games. Why did I go? Well, it's not every day that you get to stand in front of the press box for a UM/OSU game for free on a beautiful fall day. I'm not that stupid! I must say that even I could tell that our game was off. UM's throwing game was almost nonexistent and our running game was for shit. We only did as well as we did because of some key turn-overs, which is the only reason we were winning at any point in the game. We were really sucking eggs, otherwise. Below are some pictures I took during the game. One of them is from our first touchdown pass (when we did pass the ball it DID work!) but you cannot really tell where the ball is.
As we were getting ready, we were trying to figure out how to get there. Traffic, of course, is a huge problem. We were thinking about taking the bus part way and then riding in the back of a friend's truck on the way home, but since Jeremy told me he had a friend that lived really close to the Big House, and it was the guy that gave us the tickets, I thought we should bicycle there and back!
I should have guessed that his friend did not live nearly as close as Jeremy led me to believe. He said it was like a 10 min walk to the Big House. NO! It's more like a 30 min walk to the Big House. What was worse, on our way there he wanted to cut through the golf course not thinking that I would have to talk since I was on my road bike. (Yes, I mentioned several times that I can only ride of pavement.) We spent about 1.5 hours biking there. Anyway, we made it there but miss the kick-off by about 10 minutes. We picked a different route back and it took us about 40 min to get home. And it was a much easier ride. We certainly got in our exercise for the weekend!
There are a few pictures below to give you an idea of what it was like to be at the game. It was reported to be the fourth most attended game in UM's history: 111,591 fans in attendance! Unlike the Dame game I saw from the student section two years ago with my brother-in-law, we had regular seats for this game and got to sit during time-outs and such. A little nicer on the feet, but they still hurt!
Here you can see the largest block of OSU fans. The rest is a sea of blue and maize with dots of red.
The above is the shot as the first touchdown catch is being made.
Notice the swatch of OSU fans.
Those of you who know me best know that I am not a big football fan. I really don't like watching on TV and I only sorta' tolerate going to games. Why did I go? Well, it's not every day that you get to stand in front of the press box for a UM/OSU game for free on a beautiful fall day. I'm not that stupid! I must say that even I could tell that our game was off. UM's throwing game was almost nonexistent and our running game was for shit. We only did as well as we did because of some key turn-overs, which is the only reason we were winning at any point in the game. We were really sucking eggs, otherwise. Below are some pictures I took during the game. One of them is from our first touchdown pass (when we did pass the ball it DID work!) but you cannot really tell where the ball is.
As we were getting ready, we were trying to figure out how to get there. Traffic, of course, is a huge problem. We were thinking about taking the bus part way and then riding in the back of a friend's truck on the way home, but since Jeremy told me he had a friend that lived really close to the Big House, and it was the guy that gave us the tickets, I thought we should bicycle there and back!
I should have guessed that his friend did not live nearly as close as Jeremy led me to believe. He said it was like a 10 min walk to the Big House. NO! It's more like a 30 min walk to the Big House. What was worse, on our way there he wanted to cut through the golf course not thinking that I would have to talk since I was on my road bike. (Yes, I mentioned several times that I can only ride of pavement.) We spent about 1.5 hours biking there. Anyway, we made it there but miss the kick-off by about 10 minutes. We picked a different route back and it took us about 40 min to get home. And it was a much easier ride. We certainly got in our exercise for the weekend!
There are a few pictures below to give you an idea of what it was like to be at the game. It was reported to be the fourth most attended game in UM's history: 111,591 fans in attendance! Unlike the Dame game I saw from the student section two years ago with my brother-in-law, we had regular seats for this game and got to sit during time-outs and such. A little nicer on the feet, but they still hurt!
Here you can see the largest block of OSU fans. The rest is a sea of blue and maize with dots of red.
The above is the shot as the first touchdown catch is being made.
Notice the swatch of OSU fans.
Friday, November 18, 2005
OMG! (Oh My God!)
My neighbor just called to invite me to go with him to the UM/OSU Game! And, we'll be in REAL seats, not the student section, which means I'll be able to sit when I want. For those of you that don't know, this is the biggest grudge match all year! This is the BIG Game! Even bigger than UM/State! Even bigger than UM/Dame!! (Well, maybe not in my brother-in-law's eyes.) If we win tomorrow, and State beats Penn, and something happens at some other game tomorrow, we'll be back in the #1 position. At least that is what my wife is telling me. Can you tell that I'm not a big sports fan? But I know this game will be huge. And, if I get bored, there's always beer around.
ML just told me that we'll have 10-20 MPH winds and 42F at game time. Nice!
My neighbor just called to invite me to go with him to the UM/OSU Game! And, we'll be in REAL seats, not the student section, which means I'll be able to sit when I want. For those of you that don't know, this is the biggest grudge match all year! This is the BIG Game! Even bigger than UM/State! Even bigger than UM/Dame!! (Well, maybe not in my brother-in-law's eyes.) If we win tomorrow, and State beats Penn, and something happens at some other game tomorrow, we'll be back in the #1 position. At least that is what my wife is telling me. Can you tell that I'm not a big sports fan? But I know this game will be huge. And, if I get bored, there's always beer around.
ML just told me that we'll have 10-20 MPH winds and 42F at game time. Nice!
Bread, Pastries and Pleasant Conversation...
the path to a medical assistant's heart.
My dear father has pointed out that I have not posted in some time. I must admit, I have had something of a writer's block. Things have, of course, happened, but I have not been inspired to write. I suppose, since I'm writing now, that my dad's kick in the literary-rear has got me started. I think my frustration has been multi-fold. For the last few weeks I was very dissolutioned with pediatrics. You see, I have had SEVERAL people (some that know me and others that do not) tell me that I should become a pediatrician. So many that even my wife has made comment about it. I always ask why, when people tell me that but they usually cannot articulate an answer. They just shrug their shoulders, but they are certain that I'd make a great pediatrician.
All of that built up the expectation of an instant love affair with the field which really did not happen. Certainly, not a realistic expectation on my part, but an expectation none the less. When it did not happen I was a bit crestfallen, as one might imagine. This week, however, things took a turn for the better. As I try to put my finger on what was different, all I can say is that I had a month of experience under my belt and I was able to spend the majority of the week in the same out patient clinic. Granted, during my OB/GYN rotation I was not bothered by shuttling around to different clinics, but I think that may have been a factor here.
This week it all seemed to come together! Part of it may have also been a slew of compliments that I received from my attendings both of whom made several comments on my prowess with girls aged 3 to 6. That's right! I, apparently, have special talents with girls in that age group. This, of course, made my loving spouse raise her eyebrow. But, in fact, it was a tremendous compliment. We had several girls that were very afraid to be in the clinic and I was able to engage and comfort them. Yesterday, we there was a patient (6 year old girl) who was so freighted that they medical assistants (MA's) could not even get her weight nor height! She was crying up a storm and clinging to her grandmother when we (me and the attending) when it. We were supposed to see the 6 yo girl and her 3 yo sister. (The 3 yo was a doll!) We all sat in the room, I sat down on the step stool to the table. Tried to talk to the frightened girl a little and went to get her one of the many books that we hand out. I believe I picked "Dogs have bad breath!" for her. During this time, the attending was talking with the mom about the history on the 3 yo. The 6 yo started investigating her book a little and I decided to start examining the 3 yo while the attending was still taking her history: thinking that this would show her what we were going to do during the visit.
Now you might say, "What on Earth made this little 6 year old girl so frightened?" And I would say, it was her lousy dad! He told her that we were going to prick her finger because she was anemic and it is going to hurt. A) She was not anemic! We're still not sure where he got that idea from and, no, he is not in the medical field. B) Why would you tell that to your daughter? What good would come of it? There are probably more problems many of which may have precipitated the parent's divorce, but, we are pediatricians, not psychiatrists.
While I was examining the 3 yo, I asked her if she wanted to listen to her heart, which she did and said it sounded cool! After we were done, the older sister had finished her moping and started looking at me and her sister. I sat back down on the step and asked her if she wanted to hear her own heart. She said no. I asked if it would be okay if I listened to her heart. She said yes. So I listened while she was sitting next to grandma. She perked up a little until the attending started talking about her. Softly I said, "would it be okay if grandma' and I went to measure how tall you are?" That was okay too. After that, it was easy to get her on the scale, check her vision and perform the rest of the well-child exam back in the room. Their mom wanted the two of them to get flu shots (we're almost out by the way) and she did, but the 6 yo did not want one. Oddly, she wanted her 3 yo sister to get one! We have her little sister a shot and she did pretty well. I told the 6 yo that if she got a shot she could have 3 stickers (stickers are their form of currency, you know) and I'd be right there to help her out. She was not budging! So the visit ended and my attending said, "go ahead and give her a sticker."
I said, "No way! The deal is 3 stickers if she gets her shot."
"Yeah, I know, but I'm a push over."
"Well, I'm not! She knows the deal. Her little sister gets stickers because she got the shot."
Of course this was all out of ear-shot of the 6 yo, but off she went without stickers. I went to the other attendings office to help her out with some computer stuff and about 10 minutes latter one of the MA's came back to the office and said, "some one wants to see you before she goes." I walked down the hall to see a tear rolling down her check and three stickers in her hand. I knelt down and said, "you know I'm very proud of you. That was very brave." I asked if her leg still hurt, knowing the answer would be yes. I whispered, "if you skip down the hall way like you did during the exam, it will hurt a lot less. That's why your sister's leg doesn't hurt anymore." (Yes, skipping is a measured goal you ask a 6 yo to do, and she really liked showing off how well she did it.) I offered her some Tylonol, but she did not want not. I told her again how proud I was of her and as I left I whispered to her mom, "I really hope she does not end up getting the flu this year!" Yes, you can still get the flu even if you get the shot. It just doesn't last as long and you are much less likely to have complications.
Now, on the flip side are my skills with 15 year old African-American males. Well, one at least. We had this young man come to the clinic to get a physical for high school basket ball. Which was a good think because the kid was 6'2" and not done growing yet! Yes, I know that because I performed a full physical exam. I went into the room started with an introduction and take a history. We talked about school, extracurricular activities, and home and that when pretty well. He got really shy when I asked about romantic relationships, "Awe man! I knew you were going to ask about that stuff." We took a moment and talked about confidentiality and why it was important for doctors to know about this kind of stuff. Now, this whole time he is wearing a T-shirt and gym short with a robe over top opening to the front. I told him that he needs to take off his clothes and have the robe open to the back, and I walked out. Waited a few minutes and went back in to find him with the robe on correctly but still had the shorts and T-shirt. He said that he had already taken off his warm-ups.
"Come-on," I said, "you have to take off your shirt and shorts because I have to do a full physical."
"I've got running shorts under my shorts, can I..."
"No. You can leave on your underwear, but everything else has to come off. This is a real physical exam!"
I left again for a few moments and knocked again.
"Man! Every time I have one of these things it gets more and more complicated."
"Well, I'm a student and if I miss something I'll get in big trouble."
I started the exam head to toe. I stopped after palpating his abdomen. (He was really ticklish so I put his hand on top of mine and had him push with me, which worked well.) Stopping before the genital exam, I said, I'll save the worst for last so stand up and let me check for scoliosis. I thought that was a good idea so he knew what would be next. I had been telling him what I was doing throughout the exam anyway.
"What's that?" he said in response to the spine check.
"I'm checking to see if your spine is curved?"
"Is it curved?"
"I don't know yet, I haven't checked! Stand up and I'll check it."
For those of you that know me, I'm about 5'10" and so asking a 6+' kid to bend at the hips while I hold on to the robe to keep him from falling forward was quite a challenge.
I was ready to do a testicular exam but his legs were locked tight. I said, "you gotta' put your knees out to the side a little or this isn't going to work."
Once that was complete he said, "can I put my clothes back on?"
"No, the attending has to come back and perform a physical, too."
"What? I have to go through that again?"
"Yup. Remember we talked about that? But don't worry, she'll be much faster than me." Which she was. She actually was actually dictating another patient when I first finished so I popped back into the room and said,
"You know, if you ever have any questions about anything including romantic relationships or other stuff that you're not comfortable talking to your parents about, you can talk to your doctor. That's one of the things that we're here for. If you can, you should certainly talk to your parents, but were here as a back up."
I left again and the attending filled out his form for basketball and I took it back to the exam room. He thanked me, shook my hand and gave me a hug. There was also some finger snap thing that I had him explain to me. (Not knowing how to properly shake hands is sure sign of getting old.)
By the end of this week may attendings were regaling me with praise for being able to connect with the children and put them, and their families at ease. I said, well part of that is I have time to do it. To which she relied, "all students have the time, very few have the ability."
It's shit like that that keeps me going. The other attending had very similar things to say and, I sort of expect that she and I will remain friends. Actually, one of the nice things was we were all within two years of age and there was not this big-ass hierarchy. Although, the MA's all made comments how one of the attendings (the tougher of the two, the one that paid me the compliment above) treated me much better than all of the other students even before she knew how old I was. Granted she saw me working with the other attending for several sessions before the two of us worked together which may have helped considerable. But she never really sat me down and lectured me on what I should know, as she had done to other students.
Today I worked with a third attending that had been on vacation before. Everyone, even the other attendings, warned me that she has really had a short fuse since she became pregnant, so I should not be surprised or offended if she pawns me off on the other attending. But, it seemed to work out okay and worked together all morning.
The MA's had brought in pastries for my last day. Monday, I had brought in a loaf of cinnamon-raisin bread because they were going to be stuck with me all day and I wanted a little insurance. Also I know they tend to be grumpy on Monday's because we are always over-booked. When I left (at 12:30 which was 30 min late) we all hugged goodbye and they told me I could stay if I wanted. The told me to come back to visit and they wished all students were more like me. Apparently, students usually sit off in the corner. (But they probably get more studying done.)
At my afternoon lectures, the student who is taking my place for the next month (I switch to in-patient pediatrics this week and he is switching to out-patient) asked me how I liked it. I told him, "on your way in to work Monday, stop by Panere' and pick up a loaf of cinnamon-raisin bread. Tell them I told you to do it, and you'll be an instant hit. Also, talk to the MA's. Don't sit in the corner." So, hopefully, he'll do it and continue the positive experience.
I hope this breaks up some the boredom. I do apologize but I just wasn't inspired. I still have pictures to post but I have actually been snooping around to find a better way to do it.
In other news! We has our first snow-fall this last Wednesday. Just a light dusting, but snow just the same. It actually did not stop until today, but we did not have any accumulation. ML and I celebrated our 3rd anniversary together. I, coincidentally, had the day off (Nov. 9th for those of you who forgot, which was many people) and she took off, too. We had a nice day farting around and just spending domestic time together.
Oh! In more other news!! Last Saturday I built a new platform bed frame! It almost screwed it up and then I did screw it up, but it's working now. When I measured the width of the bed I dropped 16 inches so one of the planks that was suppose to make the base ended up being the platform. As such the base was a little smaller than I had originally intended which means the platform overhang is a foot instead of 6 inches. Which is okay on ML's side, but on my side the wood would flex by 1/2 inch when I sat on the edge. I've got it propped up and I will probably rebuild the base over the December break. (It will be really easy to fix.) But the funny part is ML doesn't like it. The bed no longer cradles her to sleep since the box springs are now evenly supported instead of only being supported at the edges. I, of course, like the firmer bed. She waiting to see if she learns to like it, otherwise we'll have to think about a sleep-number bed! Well, maybe once I start working again.
Oh, wait! Even more news...I received a partial scholarship for this next year. It's about 1/4 of my tuition, but it's better than nothing! The funniest part was I received the letter in the mail from the dean of the medical school. Always a scary form of communication. I said I had been awarded a Sink scholarship and that sometimes the donors like to meet the recipients and to try to make time. But, it said nothing else! Not the amount, reason or duration! It took four e-mail (two to the same person) to find out. I thought that was a little ridiculous, but I'm not complaining. At least not to anyone else but you!
I think that's all of the major developments. I doubt it was worth the wait, but thanks for waiting and reading this far.
the path to a medical assistant's heart.
My dear father has pointed out that I have not posted in some time. I must admit, I have had something of a writer's block. Things have, of course, happened, but I have not been inspired to write. I suppose, since I'm writing now, that my dad's kick in the literary-rear has got me started. I think my frustration has been multi-fold. For the last few weeks I was very dissolutioned with pediatrics. You see, I have had SEVERAL people (some that know me and others that do not) tell me that I should become a pediatrician. So many that even my wife has made comment about it. I always ask why, when people tell me that but they usually cannot articulate an answer. They just shrug their shoulders, but they are certain that I'd make a great pediatrician.
All of that built up the expectation of an instant love affair with the field which really did not happen. Certainly, not a realistic expectation on my part, but an expectation none the less. When it did not happen I was a bit crestfallen, as one might imagine. This week, however, things took a turn for the better. As I try to put my finger on what was different, all I can say is that I had a month of experience under my belt and I was able to spend the majority of the week in the same out patient clinic. Granted, during my OB/GYN rotation I was not bothered by shuttling around to different clinics, but I think that may have been a factor here.
This week it all seemed to come together! Part of it may have also been a slew of compliments that I received from my attendings both of whom made several comments on my prowess with girls aged 3 to 6. That's right! I, apparently, have special talents with girls in that age group. This, of course, made my loving spouse raise her eyebrow. But, in fact, it was a tremendous compliment. We had several girls that were very afraid to be in the clinic and I was able to engage and comfort them. Yesterday, we there was a patient (6 year old girl) who was so freighted that they medical assistants (MA's) could not even get her weight nor height! She was crying up a storm and clinging to her grandmother when we (me and the attending) when it. We were supposed to see the 6 yo girl and her 3 yo sister. (The 3 yo was a doll!) We all sat in the room, I sat down on the step stool to the table. Tried to talk to the frightened girl a little and went to get her one of the many books that we hand out. I believe I picked "Dogs have bad breath!" for her. During this time, the attending was talking with the mom about the history on the 3 yo. The 6 yo started investigating her book a little and I decided to start examining the 3 yo while the attending was still taking her history: thinking that this would show her what we were going to do during the visit.
Now you might say, "What on Earth made this little 6 year old girl so frightened?" And I would say, it was her lousy dad! He told her that we were going to prick her finger because she was anemic and it is going to hurt. A) She was not anemic! We're still not sure where he got that idea from and, no, he is not in the medical field. B) Why would you tell that to your daughter? What good would come of it? There are probably more problems many of which may have precipitated the parent's divorce, but, we are pediatricians, not psychiatrists.
While I was examining the 3 yo, I asked her if she wanted to listen to her heart, which she did and said it sounded cool! After we were done, the older sister had finished her moping and started looking at me and her sister. I sat back down on the step and asked her if she wanted to hear her own heart. She said no. I asked if it would be okay if I listened to her heart. She said yes. So I listened while she was sitting next to grandma. She perked up a little until the attending started talking about her. Softly I said, "would it be okay if grandma' and I went to measure how tall you are?" That was okay too. After that, it was easy to get her on the scale, check her vision and perform the rest of the well-child exam back in the room. Their mom wanted the two of them to get flu shots (we're almost out by the way) and she did, but the 6 yo did not want one. Oddly, she wanted her 3 yo sister to get one! We have her little sister a shot and she did pretty well. I told the 6 yo that if she got a shot she could have 3 stickers (stickers are their form of currency, you know) and I'd be right there to help her out. She was not budging! So the visit ended and my attending said, "go ahead and give her a sticker."
I said, "No way! The deal is 3 stickers if she gets her shot."
"Yeah, I know, but I'm a push over."
"Well, I'm not! She knows the deal. Her little sister gets stickers because she got the shot."
Of course this was all out of ear-shot of the 6 yo, but off she went without stickers. I went to the other attendings office to help her out with some computer stuff and about 10 minutes latter one of the MA's came back to the office and said, "some one wants to see you before she goes." I walked down the hall to see a tear rolling down her check and three stickers in her hand. I knelt down and said, "you know I'm very proud of you. That was very brave." I asked if her leg still hurt, knowing the answer would be yes. I whispered, "if you skip down the hall way like you did during the exam, it will hurt a lot less. That's why your sister's leg doesn't hurt anymore." (Yes, skipping is a measured goal you ask a 6 yo to do, and she really liked showing off how well she did it.) I offered her some Tylonol, but she did not want not. I told her again how proud I was of her and as I left I whispered to her mom, "I really hope she does not end up getting the flu this year!" Yes, you can still get the flu even if you get the shot. It just doesn't last as long and you are much less likely to have complications.
Now, on the flip side are my skills with 15 year old African-American males. Well, one at least. We had this young man come to the clinic to get a physical for high school basket ball. Which was a good think because the kid was 6'2" and not done growing yet! Yes, I know that because I performed a full physical exam. I went into the room started with an introduction and take a history. We talked about school, extracurricular activities, and home and that when pretty well. He got really shy when I asked about romantic relationships, "Awe man! I knew you were going to ask about that stuff." We took a moment and talked about confidentiality and why it was important for doctors to know about this kind of stuff. Now, this whole time he is wearing a T-shirt and gym short with a robe over top opening to the front. I told him that he needs to take off his clothes and have the robe open to the back, and I walked out. Waited a few minutes and went back in to find him with the robe on correctly but still had the shorts and T-shirt. He said that he had already taken off his warm-ups.
"Come-on," I said, "you have to take off your shirt and shorts because I have to do a full physical."
"I've got running shorts under my shorts, can I..."
"No. You can leave on your underwear, but everything else has to come off. This is a real physical exam!"
I left again for a few moments and knocked again.
"Man! Every time I have one of these things it gets more and more complicated."
"Well, I'm a student and if I miss something I'll get in big trouble."
I started the exam head to toe. I stopped after palpating his abdomen. (He was really ticklish so I put his hand on top of mine and had him push with me, which worked well.) Stopping before the genital exam, I said, I'll save the worst for last so stand up and let me check for scoliosis. I thought that was a good idea so he knew what would be next. I had been telling him what I was doing throughout the exam anyway.
"What's that?" he said in response to the spine check.
"I'm checking to see if your spine is curved?"
"Is it curved?"
"I don't know yet, I haven't checked! Stand up and I'll check it."
For those of you that know me, I'm about 5'10" and so asking a 6+' kid to bend at the hips while I hold on to the robe to keep him from falling forward was quite a challenge.
I was ready to do a testicular exam but his legs were locked tight. I said, "you gotta' put your knees out to the side a little or this isn't going to work."
Once that was complete he said, "can I put my clothes back on?"
"No, the attending has to come back and perform a physical, too."
"What? I have to go through that again?"
"Yup. Remember we talked about that? But don't worry, she'll be much faster than me." Which she was. She actually was actually dictating another patient when I first finished so I popped back into the room and said,
"You know, if you ever have any questions about anything including romantic relationships or other stuff that you're not comfortable talking to your parents about, you can talk to your doctor. That's one of the things that we're here for. If you can, you should certainly talk to your parents, but were here as a back up."
I left again and the attending filled out his form for basketball and I took it back to the exam room. He thanked me, shook my hand and gave me a hug. There was also some finger snap thing that I had him explain to me. (Not knowing how to properly shake hands is sure sign of getting old.)
By the end of this week may attendings were regaling me with praise for being able to connect with the children and put them, and their families at ease. I said, well part of that is I have time to do it. To which she relied, "all students have the time, very few have the ability."
It's shit like that that keeps me going. The other attending had very similar things to say and, I sort of expect that she and I will remain friends. Actually, one of the nice things was we were all within two years of age and there was not this big-ass hierarchy. Although, the MA's all made comments how one of the attendings (the tougher of the two, the one that paid me the compliment above) treated me much better than all of the other students even before she knew how old I was. Granted she saw me working with the other attending for several sessions before the two of us worked together which may have helped considerable. But she never really sat me down and lectured me on what I should know, as she had done to other students.
Today I worked with a third attending that had been on vacation before. Everyone, even the other attendings, warned me that she has really had a short fuse since she became pregnant, so I should not be surprised or offended if she pawns me off on the other attending. But, it seemed to work out okay and worked together all morning.
The MA's had brought in pastries for my last day. Monday, I had brought in a loaf of cinnamon-raisin bread because they were going to be stuck with me all day and I wanted a little insurance. Also I know they tend to be grumpy on Monday's because we are always over-booked. When I left (at 12:30 which was 30 min late) we all hugged goodbye and they told me I could stay if I wanted. The told me to come back to visit and they wished all students were more like me. Apparently, students usually sit off in the corner. (But they probably get more studying done.)
At my afternoon lectures, the student who is taking my place for the next month (I switch to in-patient pediatrics this week and he is switching to out-patient) asked me how I liked it. I told him, "on your way in to work Monday, stop by Panere' and pick up a loaf of cinnamon-raisin bread. Tell them I told you to do it, and you'll be an instant hit. Also, talk to the MA's. Don't sit in the corner." So, hopefully, he'll do it and continue the positive experience.
I hope this breaks up some the boredom. I do apologize but I just wasn't inspired. I still have pictures to post but I have actually been snooping around to find a better way to do it.
In other news! We has our first snow-fall this last Wednesday. Just a light dusting, but snow just the same. It actually did not stop until today, but we did not have any accumulation. ML and I celebrated our 3rd anniversary together. I, coincidentally, had the day off (Nov. 9th for those of you who forgot, which was many people) and she took off, too. We had a nice day farting around and just spending domestic time together.
Oh! In more other news!! Last Saturday I built a new platform bed frame! It almost screwed it up and then I did screw it up, but it's working now. When I measured the width of the bed I dropped 16 inches so one of the planks that was suppose to make the base ended up being the platform. As such the base was a little smaller than I had originally intended which means the platform overhang is a foot instead of 6 inches. Which is okay on ML's side, but on my side the wood would flex by 1/2 inch when I sat on the edge. I've got it propped up and I will probably rebuild the base over the December break. (It will be really easy to fix.) But the funny part is ML doesn't like it. The bed no longer cradles her to sleep since the box springs are now evenly supported instead of only being supported at the edges. I, of course, like the firmer bed. She waiting to see if she learns to like it, otherwise we'll have to think about a sleep-number bed! Well, maybe once I start working again.
Oh, wait! Even more news...I received a partial scholarship for this next year. It's about 1/4 of my tuition, but it's better than nothing! The funniest part was I received the letter in the mail from the dean of the medical school. Always a scary form of communication. I said I had been awarded a Sink scholarship and that sometimes the donors like to meet the recipients and to try to make time. But, it said nothing else! Not the amount, reason or duration! It took four e-mail (two to the same person) to find out. I thought that was a little ridiculous, but I'm not complaining. At least not to anyone else but you!
I think that's all of the major developments. I doubt it was worth the wait, but thanks for waiting and reading this far.
Sunday, November 06, 2005
Some Darn impressive wind out there today! We're having sustained winds at 23 MPH with gusts currently at 37 MPH and expected to be near 50 MPH by the end of the day. ML noted someone's broken plastic lawn chair in our front yard this morning. I went outside to find out that it was not broken until it slammed into the tree in front of our house. Too bad people didn't batten down the hatches last night like we did. Alas, they're not used to tropical storm force winds, I suppose. Off to our traditional sushi brunch!
Thursday, November 03, 2005
How to make a 4 year old child your friend for life.
Ever heard of a horse-whisperer? Today I watched a lecture from a Baby-whisperer! Granted the doctor was a little granola-ish, he’s from southern California, but it was quite impressive to watch. There were a couple of babies in the audience, which I want to believe were shills, but were probably just there with their moms. One of them did start crying earl in the lecture and the guy walked up to the back row and did his thing. And, it worked! We saw several videos showing how it works and, while most of it is pretty common knowledge, he claims that the order is very important (and he did throw in a few tweaks). So, it’s the 5-S’s. If this sounds familiar, it’s from Dr. Harvey Karp. The 5 S’s are:
The keys to doing this right are: 1) The swaddle must be very taut and if it is a full term baby, the arms must be placed down. A premature baby should have the arms crossed against the chest. 2) The swaddle must be square, sufficiently large and folded correctly. 3) Babies tend to be very angle dependent when it comes to being held on the side/stomach. Most of the babies where place on their side with about a 10 degree tilt toward their stomach. 4) The shush should start VERY loudly: louder than the baby is crying and done very close to the ear that is facing up. He pointed out that the sound in the womb is louder than most vacuums thus that is what they are used to. As the baby quiets down (which is usually instantaneous at this point) you can become more quiet. You can also switch to other sources of white noise like tuning a radio to a frequency which does not have a station, running a vacuum, or playing a white noise CD. If the baby starts crying again, you have to restart the shush verbally. 5) The baby’s head has to be able to move back-and-fourth in the palm of your hand while you are jiggling like the baby is a bowl of Jello. He likens this to what the baby feels in the womb when mom walks up stairs. Once the baby is quiet, you can transition into a swing while keeping the baby in the swaddle (although you must make sure the buckle goes between the baby’s legs). With the baby fully reclined in the swing, jiggle back and forth for a few moments and then put the swing on fast. No other speed will work as well. 6) Breast feed the baby often and don’t worry if they fall asleep while feeding, they are supposed to do that. After 3 weeks of life, you can put the baby down if he/she falls asleep at the nipple, but you should briefly arouse them so they know, as they fall into a deeper sleep, that they are not on the breast anymore.
Here is my rendition of the swaddle fold:
1. Place a (some-what) large and square swaddle blanket on the floor positioned in a diamond and fold down the top corner. I suspect you could go to a fabric store and pick up some (very) light fleece: seems like having a little stretch is a good thing. Then place the baby with the neck just above the fold you made.
2. Place the baby’s right arm down by its side and hold it there as you bring the left corner down and across the body of the baby (without capturing the baby’s left arm) and tuck the corner under the baby. This should be very snug.
3. Bring the bottom corner up. This should also be snug and it does not matter if the legs are straight or bent a little. The baby’s hips should be straight or flexed (curled in) just a little bit.
4. Bring the baby’s right arm down by its side and grab a little bit of fabric in the middle of the remaining side down and across the chest part-way. This should lie across the shoulder and part of the left arm.
5. The remaining part of the swaddle should be brought up and across the body very snug. The fabric should reach all the way around the back of the baby and tuck back in on itself. He calls this “the belt.” I had some difficultly drawing that last part, but I think you get the point. Also, you can tell that the swaddle requires a decent amount of material to do it correctly.
All of this is supposed to work really well up to about 4 months old for babies that you would say as having colic. Certainly there are some babies that cry because they are genuinely ill, but this is pretty rare.
Can you tell I’m in my pediatrics rotation? I started on outpatient but the last week I have working my newborn week. The outpatient practice is much like outpatient was in medicine. My main clinic is back out at Briarwood with a few various clinics at the university, including a hematology-oncology clinic and a cardiology clinic (which I have not been to yet). When I was out at Briarwood, I overheard the nurses talking about giving a flu shot. I perked up and volunteered since I have really enjoyed giving flu shots in the past. What I failed to put together was that I enjoy giving flu shots to old people. I went into the room of this 9 year old girl and got ready to give her a shot in her left arm. I quickly realized that the needle was too long. I went back out to the nurses and said,
“This needle won’t work, it’s too long.”
“Oh, it should be more than strong enough to go into her skin.”
“I understand it will go through her skin, the problem is it will go there her arm and out the other side!” She thought I had said the needle was too weak as opposed to too long.
“Oh! Just give the shot in her thigh.”
I asked her to show me. You position the child with her legs dangling off of the edge of the examination table, hold them in position with your legs, and deliver the injection. I gave a few shots that day mostly to children around that age.
The next time I had that clinic I walked in and the nurse said, “Good, you’re here! He’s another flu shot you can give.” And she sent me to room 5 where I found a 4 year old boy with his mom and 3 month old brother. I put the tray down behind me on the desk (out of sight of the 4 year old boy) and he knew what was going to happen. He started screaming louder than I have ever heard a child scream. I crawled behind his mother and begged her to take me out of there. “I don’t want to be here! I don’t like this place! Please get me out of here! Please don’t make me do this! Do let him hurt me!” I had not said a single word at this point. I waited what seemed an eternity for him to calm down, but after several minutes he just kept getting worse and worse.
I poked my head out the door to see all of the nurses covering their faces in laughter, to which I announce, “You all set me up!” One of the older nurses sheepishly said, “Do you need any help?” To which I replied, “I’m in WAY over my head here!”
Somehow she got hold of him, held him up while his mother pulled down his pants, and she injected him while he was hovering in air. I’m still not exactly sure how she did it because I was holding the little brother, but I was amazed none the less. After that I announced that I officially don’t like giving shots to till kids anymore. But, they still get a kick out of having me do it. I think I’m the first student ever to give shots. And you can tell from the title how much most children enjoy receiving shots.
This week has been spent in the New Born service which is pretty much just what you’d think. It’s been pretty calm so far. We also do one day in the Neonatal ICU (NICU) which I did on Tuesday. What was really neat was there were three babies that I had delivered there (two were twins) and there was a set of triplets which I had helped with before their delivery. It was great to see the two families again and see how they were doing! Yesterday I saw a woman that I had seen in an OB clinic a couple of weeks earlier. That was nice, too. Today, I walked into a patient’s room to do a new born exam and she said, “Elliott!” before I could introduce myself! I had also seen her in OB clinic but I did not recognize her name/face like I had with the first one. Really, that is something they should try to arrange more often because it’s just too neat!
Oh! I need to do a Halloween posting too. I better do that this weekend.
- Swaddle
- Side or Stomach position
- Shush
- Swinging (really jiggling like a bowl of jello)
- Sucking
The keys to doing this right are: 1) The swaddle must be very taut and if it is a full term baby, the arms must be placed down. A premature baby should have the arms crossed against the chest. 2) The swaddle must be square, sufficiently large and folded correctly. 3) Babies tend to be very angle dependent when it comes to being held on the side/stomach. Most of the babies where place on their side with about a 10 degree tilt toward their stomach. 4) The shush should start VERY loudly: louder than the baby is crying and done very close to the ear that is facing up. He pointed out that the sound in the womb is louder than most vacuums thus that is what they are used to. As the baby quiets down (which is usually instantaneous at this point) you can become more quiet. You can also switch to other sources of white noise like tuning a radio to a frequency which does not have a station, running a vacuum, or playing a white noise CD. If the baby starts crying again, you have to restart the shush verbally. 5) The baby’s head has to be able to move back-and-fourth in the palm of your hand while you are jiggling like the baby is a bowl of Jello. He likens this to what the baby feels in the womb when mom walks up stairs. Once the baby is quiet, you can transition into a swing while keeping the baby in the swaddle (although you must make sure the buckle goes between the baby’s legs). With the baby fully reclined in the swing, jiggle back and forth for a few moments and then put the swing on fast. No other speed will work as well. 6) Breast feed the baby often and don’t worry if they fall asleep while feeding, they are supposed to do that. After 3 weeks of life, you can put the baby down if he/she falls asleep at the nipple, but you should briefly arouse them so they know, as they fall into a deeper sleep, that they are not on the breast anymore.
Here is my rendition of the swaddle fold:
1. Place a (some-what) large and square swaddle blanket on the floor positioned in a diamond and fold down the top corner. I suspect you could go to a fabric store and pick up some (very) light fleece: seems like having a little stretch is a good thing. Then place the baby with the neck just above the fold you made.
2. Place the baby’s right arm down by its side and hold it there as you bring the left corner down and across the body of the baby (without capturing the baby’s left arm) and tuck the corner under the baby. This should be very snug.
3. Bring the bottom corner up. This should also be snug and it does not matter if the legs are straight or bent a little. The baby’s hips should be straight or flexed (curled in) just a little bit.
4. Bring the baby’s right arm down by its side and grab a little bit of fabric in the middle of the remaining side down and across the chest part-way. This should lie across the shoulder and part of the left arm.
5. The remaining part of the swaddle should be brought up and across the body very snug. The fabric should reach all the way around the back of the baby and tuck back in on itself. He calls this “the belt.” I had some difficultly drawing that last part, but I think you get the point. Also, you can tell that the swaddle requires a decent amount of material to do it correctly.
All of this is supposed to work really well up to about 4 months old for babies that you would say as having colic. Certainly there are some babies that cry because they are genuinely ill, but this is pretty rare.
Can you tell I’m in my pediatrics rotation? I started on outpatient but the last week I have working my newborn week. The outpatient practice is much like outpatient was in medicine. My main clinic is back out at Briarwood with a few various clinics at the university, including a hematology-oncology clinic and a cardiology clinic (which I have not been to yet). When I was out at Briarwood, I overheard the nurses talking about giving a flu shot. I perked up and volunteered since I have really enjoyed giving flu shots in the past. What I failed to put together was that I enjoy giving flu shots to old people. I went into the room of this 9 year old girl and got ready to give her a shot in her left arm. I quickly realized that the needle was too long. I went back out to the nurses and said,
“This needle won’t work, it’s too long.”
“Oh, it should be more than strong enough to go into her skin.”
“I understand it will go through her skin, the problem is it will go there her arm and out the other side!” She thought I had said the needle was too weak as opposed to too long.
“Oh! Just give the shot in her thigh.”
I asked her to show me. You position the child with her legs dangling off of the edge of the examination table, hold them in position with your legs, and deliver the injection. I gave a few shots that day mostly to children around that age.
The next time I had that clinic I walked in and the nurse said, “Good, you’re here! He’s another flu shot you can give.” And she sent me to room 5 where I found a 4 year old boy with his mom and 3 month old brother. I put the tray down behind me on the desk (out of sight of the 4 year old boy) and he knew what was going to happen. He started screaming louder than I have ever heard a child scream. I crawled behind his mother and begged her to take me out of there. “I don’t want to be here! I don’t like this place! Please get me out of here! Please don’t make me do this! Do let him hurt me!” I had not said a single word at this point. I waited what seemed an eternity for him to calm down, but after several minutes he just kept getting worse and worse.
I poked my head out the door to see all of the nurses covering their faces in laughter, to which I announce, “You all set me up!” One of the older nurses sheepishly said, “Do you need any help?” To which I replied, “I’m in WAY over my head here!”
Somehow she got hold of him, held him up while his mother pulled down his pants, and she injected him while he was hovering in air. I’m still not exactly sure how she did it because I was holding the little brother, but I was amazed none the less. After that I announced that I officially don’t like giving shots to till kids anymore. But, they still get a kick out of having me do it. I think I’m the first student ever to give shots. And you can tell from the title how much most children enjoy receiving shots.
This week has been spent in the New Born service which is pretty much just what you’d think. It’s been pretty calm so far. We also do one day in the Neonatal ICU (NICU) which I did on Tuesday. What was really neat was there were three babies that I had delivered there (two were twins) and there was a set of triplets which I had helped with before their delivery. It was great to see the two families again and see how they were doing! Yesterday I saw a woman that I had seen in an OB clinic a couple of weeks earlier. That was nice, too. Today, I walked into a patient’s room to do a new born exam and she said, “Elliott!” before I could introduce myself! I had also seen her in OB clinic but I did not recognize her name/face like I had with the first one. Really, that is something they should try to arrange more often because it’s just too neat!
Oh! I need to do a Halloween posting too. I better do that this weekend.
