Embarrassing Residency and Med School Moments

Today I'm going to share a couple personal embarrassing residency and medical school moments, because we'd all like to think we don't make mistakes - but I know I do. Here are some times I wanted to sink through the floor. Details have of course been changed in order to protect patient privacy.

1. As a 3rd year medical student I was presenting a patient on the inpatient rotation who had recently had an Echocardiogram (ultrasound of the heart). The report included that the patient had "levocardia." Without thinking about it, in reporting the results I said, "The Echo was normal except that the patient has levocardia."

Levocardia means the heart is on the left. That's where it's supposed to be.

2. I was performing a lumbar puncture as an intern. This was not my first time - I was probably capable of performing the procedure by myself but it was early in the year and wasn't nearly as experienced as I would eventually become. My attending, who did not know me well and had not supervised me in this procedure before, chose to talk through each and every step of the procedure as I did it even though the parents had chosen to stay in the room. It definitely led to an an atmosphere that maybe I didn't know what I was doing. So what did I do? I proceeded to accidentally stab myself with a needle in the process of drawing up the lidocaine (fortunately a clean needle). I was bleeding a little, had to ask for a new bottle of lidocaine, new needle, new gloves etc. The parents pulled the attending out of the room and I'm sure basically said, "I don't want that shaky first-timer doing a lumbar puncture on my kid." It was an awesome moment. I still did the lumbar puncture, and it went fine, but goodness I'm on their side with that one. Did not exactly inspire confidence.

3. Often when a kid is hospitalized, multiple family members are involved in the care and sometimes one will relieve another at the bedside so they can take care of some things. This is great, and we love to see kids with lots of family support. Sometimes though, the switch happens ninja-smooth. More than once I've left a room just briefly and not paid close attention upon returning. The aunt often looks a lot like the Mom and I've definitely tried to pick up a conversation I was having earlier and taken way too long to realize I'm talking to someone else.

4. On my pediatric rotation in the 3rd year of medical school, I was a constant basket case. I mean, I did well on the rotation, but my stress levels were off the charts. I would overreact to not knowing answers to questions, and I cried frequently. It was only my second rotation and I just put a lot of pressure on myself because it was what I wanted to do.

My attending sent me into the room to examine a kid with an "interesting physical exam." She had clearly done this plenty of times before because the family was super chill about it. He had some interesting skin findings but otherwise seemed normal. I didn't know what he had, but after spending a while asking questions I couldn't justify staying in the room any longer and stepped out with a mounting sense of irrational panic. My attending asked me what I thought and I just stammered. I could have at least come up with a guess, but at that point I had a hard time making guesses I wasn't sure about and also with saying I didn't know (this did improve). Inexplicably, I felt myself starting to cry. That would be embarrassing enough, but then my nose started to bleed - a lot. Like staining the carpet of the clinic. In a way I was relieved because that was a distraction from the fact that I was crying. We got that all under control and I was informed the little boy had neurofibromatosis. That diagnosis now always sticks in my mind and I have no idea if the blood came out of the carpet.

5. Put Your Clothes On
Also on my 3rd year pediatric rotation, sign out was at 0600 and I was always on time, sometimes running into the residents on my way into the hospital. I once ran into a couple of the seniors on my way in, said hello, and proceeded to walk a little in front of them to the sign out room - which was a long way from the entrance (multiple hallways, multiple floors). When we finally arrived, one of them informed me that my skirt wasn't zipped. And it wasn't. I had done the hook at the top so I hadn't noticed a feeling that it was loose, but my entire lower back and the top of my buttocks were exposed the entire time I had been walking through the hospital. My shirt was long that day, but I honestly have no idea what they saw. At least she told me before I'd gone through more of my day like that.

I'm sure there are more, but these are the ones that still make me cringe when I think about them. I'll write another post if I think of another collection.

I hope you all get some joy from my moments of shame.

Thanks for reading, see you soon.

What's in a Resident Doctor's Work Bag

Hey all.

Back in March 2014 I wrote this post chronicling of all the stuff in my work bag.

Today I decided to sit down, have a chatty little bag clean out, and talk you through all the stuff (old and new) that I'm still hauling around.

Also featuring Luna.

Thanks for watching, see you soon.

The Price of Residency

I started this post because in mid-December I was on cross-cover nights on the wards over the weekend.

I was invited to 3 Christmas parties on the same night, and I could not go to any of them because I was working on a Saturday night, because that's the job.

I feel like I should put a disclaimer at the beginning of this post; I should be clear that I'm grateful for my job and having had the opportunity to become a doctor - I think I keep it pretty positive over here. A lot of people have this dream and don't have the privilege of seeing it through, so I don't want this post to seem ungrateful. I'm also absolutely certain that it used to be much worse for residents, as we're now restricted to an average 80 hour workweek.

That said, I think it's important to give both sides of this life.

So the following are just some real life times when I had to remind myself that I wanted to do this.

My first year my parents came to visit in early December because I couldn't travel for the holidays. I didn't see any of my family at Christmas.

On Christmas morning last year I got home at 7:30 AM from my shift, said hello to my husband, and fell asleep until it was time to get up and go back to work.

My sister graduates from college this spring and I'm working straight through - I'm trying to figure it out but it's just about impossible for me to go.

Two of my best friends from college each had weddings this summer that I couldn't go to, because I was working right through the weekend. There are already more I will miss this spring.

There are no sick days in residency. When I have a cold I always go to work. You just wear a mask over the cough. If I did get sick enough that I actually couldn't work, I'd usually have to work an extra weekend or something to cover for the person that fills in for me.

On any given inpatient rotation I spend half the time on days and half the time on nights. I'm never rested, but I am often confused.

There is an expectation, a professional expectation, beyond just showing up for work, that we will do research, apply for grants, participate in quality improvement. It's a different type, but essentially there's still homework even in the practice of medicine. It is also vitally important that we do, in fact, learn the medicine we're there the practice, and reading outside of work is an expected and important reality of the job. The hours don't end when we go home.

I grieve the loss of my hobbies. Our typical schedule is 1 day off per week. We do have electives sometimes, but for most of the rotations with 11-13 hour days, not including our sign out and commute, it is hard to keep up with things I used to love. That one day off usually includes laundry and buying some vegetables.

Some weeks I get to spend most evenings with my husband. Some weeks I see him for 20 minutes a day.

Before residency, I used to exercise. Most days usually. Now I mostly do not. Some residents do, and I admire them. I think I was happier when I did.

Sometimes I find myself choosing between sleeping and eating at the end of the day. Last night, for example, I fell asleep at 630 and woke up starving at 3 AM.

This hasn't happened to me, because I have a cheerful work face, but there is also an expectation of a positive attitude. It's not that there's no support, or we can't have bad days, but if we're really hating a rotation, it may show up in the evaluation if we don't keep that to ourselves.

Several of my colleagues are always well put-together. I, on the other hand, typically go for a "well, my clothes don't have stains on them" aesthetic. Today I painted my nails for the first time in a month. My last haircut was over a year ago. I do brush my teeth, so at least there's that.

I have $245,000 dollars in debt. The majority of it to the government, some of it to family. That's just medical school; I was blessed enough not to have undergraduate debt thanks to my parents. I make enough to live on, but it will take me 20+ years to pay back the cost of this education. And interest accrues all the time.

We see a lot of senseless loss and sadness. Horrible accidents, child abuse, neglect, chronic diseases that leave kids spending months or years in the hospital, cancer, premature babies, parents that care a lot but are dying of terminal illnesses and also parents that can't overcome their own addictions in order to care for their kids. While I think this is one of the most rewarding specialties in the big picture, it's true that it's hard.

I have a lot of nightmares, especially when I've been taking care of really sick kids.

So what's the point of airing all of this?

This is what I always say to people who ask me about getting into medicine now: It's worth it if it's the only thing you could imagine doing. On the other hand, if there's another career that would make you equally happy you should do that instead, because this is life with a cost.

Thanks for reading, see you soon.

WIAW: The Final Week of NICU

Thanks as always to Jenn for hosting.

Welcome back WIAW-ers. I'm Kari, I'm a pediatric resident in New Mexico, and I really appreciate you clicking on over.

4 more work days of NICU (Neonatal Intensive Care Unit). I like to think of it in terms of wake-ups. 4 more wake-ups for the NICU. For this academic year anyway. I'll be back in December. 

I don't want to give the impression that I don't love my job, being a pediatrician is totally my dream, but being a resident is sometimes hard to enjoy and though the NICU has been an unexpectedly positive experience overall, it's still not my life's work. 

Switch day is next Tuesday, and I go to the Emergency Room. The major advantage of that rotation is that the shifts are spread throughout the month so since I'm not taking vacation, I still have a couple stretches where I might have 2 days off in a row. 

I've taken to referring to Wednesday mornings as "Housewife Wednesday" while on this rotation because I get to send John off to work and then hang out with Luna and I don't have to be in clinic until 1. 

She's giving me these eyes because we're not outside.

I typically get some house or cooking things done, grocery shopping, laundry, though not always - sometimes I just have piles of admin stuff and work to catch up on. This morning I have a meeting for a community grant I'm writing, but after that I need to go get a gift for a friend's bachelorette party, so it will be a mix of both. 

Wednesdays this month are also often one out of maybe two days when I manage to fit in a blog post. Better than nothing?

So thanks for reading the long intro. Here's WIAW:

Breakfast: Quinoa Bran (idk what to call this, post about it coming later) with Strawberries and Banana. Naked Juice/water and coffee. Costco was closed for Easter this week so I liberated these from my hospital cafeteria to tide me over.

Lunch: Instant Minestrone. I thought it was a little ambitious of this instant soup to dry to do minestrone, complete with beans and pasta, and I had to try it. It was all right, but I think I'll stick with the asian flavors and noodle soups - they seem to lend a little better to the instant variety. Unpictured apple.

Snack: Trail mix.

Dinner: Zucchini Quinoa Lasagna. This is from More Peas, Thank You and it's a favorite. It's easy, healthy, and very easy to adapt for food allergies. This picture looks like it's glowing and all I can say is I'm grateful the days are longer and the blinding sun makes it into my house.

Dessert: Soy Creamy Ice Cream Sandwich. Chocolate.

So that's how it's going this week. I hope you're all having a good one. See you soon.

Golden Weekend

There's a thing in residency - the elusive Golden Weekend.

For many of our rotations we work 6 days a week, sometimes longer stretches, but it's definitely not common to have both weekend days off.

Thus, it's called a Golden Weekend. Depending on your program, working both weekend days might be a Black Weekend, and a regular 1 day on, 1 day off might be Gray or Brown, but we pretty much just use the Golden terminology.

Anyway, for the first time in several weeks at least - maybe 3 months? (not including vacation) I actually had a golden weekend built into my schedule.

When I'm working a schedule that gives me regular weekends, I think I don't appreciate them as much as when they are few and far between, but this weekend I really tried to make the most of it.

There were board games, breakfast out, hiking, biking, Church, long dog walks, some TV, a ton of cooking and Game of Thrones on Sunday with an ever-expanding group of friends, which makes it so much more fun.

I almost feel as though I've had a vacation.

So, sad though it was to return to work, I think I spent the time well and that made it feel easier to go back.

Breakfast at the Grove: Oatmeal with Strawberries

John got the pancakes. Apparently they were awesome.

PBJ flatbread on our hike.

And Luna feeling like we are so lame, why are we not still walking?

It's just about time to start another day, happy (belated) Easter and I hope that you had a good weekend too.

What's in My Work Bag

Happy Sunday!

Despite being on a rotation that has limited set appointments, I am feeling the sting of a new work week and it's not even here yet, there's so much to get done.

So, to build some clarity in my mind I cleaned out my work bag and I thought I'd share the contents. This is the full build up of everything that ended up in there, with probably 6 weeks since the last thorough cleanout.

Here's the overview, let's take a closer look. 

This is my bag. It's from Target. It's held up really well for a bag that was only about $30. 

Plenty of pockets on each side and enough room to carry lunch, thermos, scrubs etc. on days when I need to.

I didn't bother to document all the trash, but there were 3 empty orbit packs, a US Airways boarding pass from my Hawaii trip, a massive pile of receipts and plenty of other this and thats.

My iPad. Her name is Mindy. Like iPad Mini.

John asked me the other day where all our spoons were. I found them. In my bag there were 4 spoons and a fork.

Academic articles. I pretty much always have something in my bag that I'm supposed to be reading.

Clipboard. I carry clinical papers on here during the work day. The patient list, notes etc.

Pager. Curse of a resident.

Sunglass case. Keeps those shadies safe. 

Here's a picture of the actual sunglasses. Warby Parker is a brand that donates a pair of corrective lenses  to someone in need for every pair of sunglasses or regular glasses sold. John and I are both on our second pair, we love them.

Wallet. I just got this one on clearance at Icing. Made me feel like I'm 15 again.

Full of cards!

I found all these lip products floating around in there. The left 2 are Revlon Colorstay Stain, which I love. The next is a Revlon Colorstay Gloss, which has a little less staying power than the stain but is also really nice. The Rose Salve is from Bath & Body Works. I use it on my lips and my cuticles. And then 3 chapsticks. If I don't keep a layer on at all times here, my lips will be cracked and bleeding after just a day - it's SO dry. 

WHAT?! I always feel like I can't find a pen. I have no explanation.

Real tools: stethoscope, with my Timex Weekender watch on it to use for pulses, respiratory rates etc.

Stamps! Mail! yay!

A pen light. For blinding children.

Tea.

My hairstyle typically takes 2-4 bobby pins a day, but I hardly ever take it out away from the house, so I can't explain why I have so many pins.

I was very disappointed by the paucity of cash, but then again I almost never pay for anything with cash, so no surprise.

2 deodorants. I always have one, not sure why I'm carrying 2 at this particular time but I assume I at some point did not realize I already had one in there. Of the two I really like the Degree.

My med kit. It's a little Snapware. There's ibuprofen, tylenol, daytime cold meds, and usually bandaids though I'm currently out.

Toothpaste and hand sanitizer. At the moment my toothbrush is missing from my bag, but usually I have both, especially for night shifts.

A gum pack with some gum still in it. We buy them in sets of 18 packs from Costco.

My Jawbone bluetooth headset. This was a gift from my parents a few years ago and I love it. It's easy to use, super light, and most importantly makes it safer if I need to answer a phone call while driving.

Badge. I ordered the panda holder from Amazon. Kids love it. I keep my badge with my card of useful phone numbers and PALS (Pedatric Advanced Life Saving) cards - references for pediatric emergencies.

A mostly empty bag of cough drops.

Water flask.

Salt packet. Hey, you never know when you'll need to salt something.

I also found a bunch of loose cards from coffee to insurance. And random passport photos from 5 years ago.

There were a couple things missing that were already out, typically I have a thermos, some container from my food that day, maybe some scrubs. 

And with that, we've cleaned out my bag. I pared down the lippies, the pens, the cards, the silverware and the articles and felt much less weighed down, both literally and figuratively. 

So I hope you have a great Sunday and if you're feeling burdened, maybe it's time to clean out that bag.

What's in your work bag?

Let's Talk About Mountains

Moving to New Mexico wasn't easy. Although I finally got to start my dream job, there's a lot that's been hard about the past 8 or so months, both professionally and because we left pretty much everyone we knew to come here. 

Knowing the year starts to feel rough, our program does an intern retreat in February. The seniors graciously cover for us and we get to go to Taos, stay in a Bed & Breakfast, do a little admin stuff but mostly ski and spend some time relaxing. 

There was some enthusiastic karaoke.

Plenty of hangout time.

Mabel Dodge Luhan, the B&B

We went skiing. The sun was really bright.

At the top. 

I totally neglected to take pictures of the meals, but there were vegan muffins every morning and bunches of great food supplied by the B&B. 

Although at times this year feels never ending, we're actually well over half done and I'm going to be a senior resident before I know it. 

And when we get to see sights like those mountains, I really appreciate living here.