This is what 80 hours looks like. And I'm running with a relatively light load! To learn this week: time management.

Thoughts from my first call:
have been a doctor for real for 6 hours and nobody has died yet, including me. Probably b/c my team is awesome.
12:16 PM
They really are. The attending is efficient, open to resident suggestions for treatments, and teaches. My upper has yet to get even mildly upset at us interns for the stupid things we do, and helps keep us on task. My fellow intern is a superstar, and fun to hang out with. The student is completely on top of his patients, and really puts in the effort.

Hour 12 and people are still alive. For the record: testing the code blue system on the interns first day is MEAN.
5:40 PM
TWICE.

Cross coverage is like doing a word-search, except you get interrupted to do a Sudoku puzzle, while simultaneously trying to do a crossword.
10:41 PM
The individual tasks aren't difficult or complicated (Potassium is 3.3? Give 20 mEq PO) but do require some amount of attention to detail, so when you are constantly interrupted, things get hairy.

Law in the hospital: the Very Second your head hits the pillow on overnight call, the pager goes off. I mean, immediately. Like murphy.
12:57 AM

Walked in at 6:45 AM on Monday, walked out at 12:45 PM today. Up 4 patients, down some sleep and very happy to have my 1st call over.
4:22 PM Jun 23rd
Current post-call strategy: fall face first on couch and don't move for ~2 hours, then get up and be a person again.

So far, call has been ok. I am slowly learning the art of cross-cover. So far, there seem to be a few rules to go by.
1. No controlled substances without going to see the patient.
1.5. If you get more than one call on a patient (that doesn't deal with poo), go see them.
2. The phrase, "Do (X), check (Y) and call me with the results, please" is magical. Because I can't guarantee I'm going to check on Y in 45 minutes on my own.
3. Take good notes at sign-out, and keep them next to the phone. The hospital is wireless enabled and computer based, but at 3 AM I want paper. Paper is simple and gives immediate information.
4. Sleeping for even half an hour is better than not sleeping at all.
5. The 10 minutes you in the AM spend brushing hair & teeth, putting on deodorant, etc will keep you going until 1PM.
6. DRIVE SAFELY.

And finally: The coffee maker in the resident lounge has a vendetta against me. It broke (at my hand) on my first day, and now mixed up a nice cup of warm steamed milk when I pushed the cappucino button.

Warm milk at 6 AM after call is the opposite of helpful.

Upcoming topics:
Our very awesome med student and the things I try to teach him.
My first patient death. Yes, in the first week. It's not the typical story, though.

Hope all the Dads out there have a great father's day.


HIPPA disclaimer: all golf and cookie levels were fabricated. Any resemblance of the patient in the video to my own father is completely on purpose - but it's ok, he's my Dad. :)

And so it starts, as it always does.

Orientation. Find the room, nibble on the continental breakfast, size up your fellow classmates-now-coworkers, introduce yourself with your name/school/interesting quirk, and then sit and try to absorb half the information they throw at you.

I definitely absorbed one piece of information: my schedule.

My first month? Wards.

My first overnight call? My first day.

Yes, like on Scrubs.

I'm actually feeling pretty good about it. I met the other resident and my senior, and both appear to be friendly, upbeat and very level-headed. So I might as well jump in with both feet - besides, if you get through the scariest part of being a resident on your first day, then things can only get better from there.

The only other surprise today is that my program has been forced to start a hybrid night float schedule - another service decided that they simply weren't taking call anymore and instead of making us Q4 overnight, we're Q8 overnight with a call until 7 PM in between. I still dislike the night float model, but I firmly believe that Memorial is going to Make This Work. Their handoff system is beautiful, and it sounds like everyone is supporting it, right down to the ER holding all admissions from 6:15-7 (both AM and PM) so the teams have protected time to sign out.

Concept taken from the Edward R. Murrow and continuing NPR series, "This I believe" - a series in which everyday people talk about one thing that they believe in.


I believe in daring. Not daring as in double-doody-dog dare, where one is forced into action by another but in taking actions that make people who don't quite understand take notice and say "How dare you!"

Daring to be and do outside of the norm is a genetic for me. Our family motto "Audentes Fortuna Juvat" assures all descendants of the Clan McKinnon that fortune will assist them when in need if they simply dare to take action. This action began with a rural Scot defending himself against a wild boar by shoving an already feasted upon bone vertically into the swine's mouth, and continued through my maternal lineage. My grandmother, who has never failed to speak her mind in her 80 years upon this Earth even when society told her it did not befit her gender. My mother, who dared to go back to school after practicing as a nurse for nearly 30 years so she could climb the hospital ladder, and now gives marching orders doctors who used to throw charts at her.

Having been steeped in audacity, I now dare to speak up about our broken healthcare system. I dare to maintain a visible and critical presence in the medical blogosphere and refuse to pretend I don't see patients suffering because they don't have the money or power to advocate for their interests that pharmaceutical and insurance companies use so freely.

I dare to practice primary care medicine, even though I know the hours are longer, the paychecks are smaller and the battle will always be uphill.

So I say to everyone who is struggling against something bigger, stronger or more entrenched to be daring; be slightly reckless, make the kind of noise people don't want to hear, and don't give in to complacency. You may find that fortune smiles upon you as well.

I made it through. I am a Doctor.

It still doesn't feel "real", and I'm sure it won't until I have my first terror-filled day on the wards, but knowing that our current address in Savannah is helping to make things more concrete.

I could say so many things about the journey, about the ups (honoring my first (and only!) exam, the first time an attending told me I'd make a good doctor, going to my Savannah interview and *knowing* I wanted to work for them) or the downs (failing an exam, my first patient dying, going to my 5th interview in a week and falling asleep) but I can say that every second was worth it.

It's worth the money, time, and tears to spend the rest of my life doing a job that I've dreamed of for about 20 years now. The bad times taught me the things I need to know about being a doctor - the importance of being patient, thorough and kind. The good times got me through the bad times.

Of course, I'm not done. Not by a long shot. I look around and see so many examples to live up to - my training truly begins now.

I started this whole blog with "I'm just a bit nervous", and I've come back around to that. Excited, of course - but still dealing with the knowledge that it's my signature on the line now.

I hope to once again return to prolific blogging. This journal has been such a joy - not only to record my thoughts along the way, but also the people I have met through it. The end of 4th year was a bit of time off - taking care of some important real-life issues - getting married to my wonderful and supportive husband, honeymooning, graduating and then immediately packing up & moving 945 miles.

(And yes, the above was crazy. Also fantastic.)

I'll leave you with a photo from the wedding, care of our awesome photobooth. The lovely people in the background are my parents, who have also shown themselves to be wonderful and supportive on occasion. :)

Getting married/moving 944 miles away (Mom, stop crying)/Graduating from med school/Starting residency?

Plays merry hell with any kind of regular blogging schedule.

As a mea culpa once again, here's the talk I did at Penguicon - How to Kill a Character 2.0, No bullets or pointy bits.


Topics I would have loved to cover and forgot:
Infections (flesh-eating bacteria and the plague)
Compartment syndrome (I don't think I covered it last year, and it's always good for an EWW.)
Seizures (not all seizures thrash around on the ground, and status epilepticus is v. scary)

As you can see, I pick topics on a basis of how common they are, how interesting they are...but mostly if I can get my audience to say "Oh my."

Once again, it was standing room only. :) Penguicon next year is April 30th through May 2nd, in Troy Michigan - you should come!

If I had tried to manage a cardiology consult/ICU month this last month instead of Radiology.

Life lesson: If there is ever a month to take a rotation that focuses on "self motivated learning", make it April of your 4th year. Weddings, bridal showers, trip to Georgia to find an apartment, trying to sign a lease from Michigan, residency paperwork, finding furniture and a dishwasher for the new apartment, my own wedding...this whole month has been a series of "Let me get through X, then I'll work on Y!"

Y right now being the finishing touches on a presentation for Penguicon 2009 "How to kill a character 2.0: No bullets or pointy bits." Y'all should come.

There's also something reasonably exciting that just went down today, but let me get through Frostbite and Full-body radiation first. :)

Instead, a fun exercise: describe your chosen field of medicine in 6 words or less.

Mine (internal medicine): "Take insulin or lose your foot" or "Yes, 220 over 140 is high."
legeix How's this: "I'm going to cut you open." or "Just turn your head and cough." or "This wont hurt me a bit." I like this game! (Oh, surgeons...)

spartanmd "Recieved in formalin is a tan . . ." or " The decident appears to be a . . ." (Pathology has a definite form to their notes...)

Hazelrah@twitter Mine is: What did the diarrhea look like? (my sister-in-law-to-be, the Vet student.... we are REALLY good at playing the gross out game during family dinners)

turnberryknkn "Today, your child's blast count: zero." Jeff cheats with colons. But he's got peds heme-onc fellowship results waiting to come out, so we'll cut him some slack. :)

exxorcyst "Say peace out to your gallbladder." (Again, with the surgeons. If they weren't such great guys, I'd worry.)

"Thoughts of hurting yourself or others?" and "So tell me about your mother...." a pair of Wayne alum psychiatrists, my first med school mentor and the other newly minted.

Allergic to all meds except Dilaudid??? or He wants a sandwich? D/C home... (One of my favourite new ER docs. She also believes in the Sandwich Sign)

"Yes you must brush AND floss" My cousin, the Dentist. Ask her why you need actual tooth left to have a crown put on.

"You put WHAT in WHICH orifice?" My brother-in-law-to-be, in nursing school and just assigned to his clinicals. Godspeed man, Godspeed.

Rat A differs from Rat B. Karen's that kind of Dr. that sounds more like "Fudd" than "Mudd".

"So...is it like physical therapy?" The battle cry of PM&R. Lucky guy gets to practice out in Colorado, too.

fuzzyfoxtess I'm the jack of all trades. She's not kidding, folks. Looking to do underserved/rural family med, even.

"Seriously, you all have Aspberger's Syndrome." Or does computer programming not count as a medical profession? (The source works for an unnamed large computing conglomerate that has an operating system named after a paned glass housing feature. I have no doubt that some of their colleagues have "difficulty engaging socially with their peers")

PS. Still love NPH.

The last one of medical school! We'll see if I can manage one as an intern. :)



If it's in my ER case logbook, it's gonna happen. For this month, that pink cardstock spent more time nestled up against my backside than my favourite warm fuzzy blanket.

( And so it goes... )

It's been brought to my attention that my blog has been horribly neglected for the last month. While there are good reasons (post-match celebration, 2 weddings, a bridal shower, a week of nights at the ER, an EMT ride-along, a written final exam, wedding cakes, wedding dresses, a trip to Georgia for a week of apartment searching, signing on an apartment, moving logistics, finding a suitable dishwasher for said apartment, prepping for my sequel to my talk "How to Kill a character"....and somewhere in there - sleep.), watch this space as I do have posts lined up and ready to go.

A preview of coming attractions:
My final Day In The Life (one a year for four years - how life has changed from the first!)
The worst head CT I've ever seen, and what we did for the patient
Riding along at 60mph on Detroit surface streets - bouncy AND educational.
The 4th year dilemma - take a breather or a last-chance opportunity before you're a real Doctor?
A retrospective for the "must take" electives.
The books I'm keeping, those already tossed, and those I'm buying for next year.

Starting this July 1st, I will be an internal medicine resident at Memorial Health in Savannah, Georgia

From Match Day

Getting a big hug from my Mom after letters were opened.

( Some additional pictures from match day! )

It was my first choice, and Nick and I are very much looking forward to moving down after the wedding. Even though I'm going to melt in my first down-south summer!

And to you dear readers, thank you - thank you so much for your support over these four years. Livejournal has given me some of my biggest cheerleaders, mentors who helped guide me through the occasionally bewildering process of med school & friends who held me to promises I made to work hard and not give up... it means so much to me to know that I had a few hundred of you pulling for me to get where I am today. Thank you again, to every single one of you, and yes - I will still try to blog during residency! (We'll see how that goes!)

The promised ER tweets. They're in backwards chronological order this time, so scroll up from the bottom!

This is also a reminder to watch http://twitter.com/inked_caduceus tomorrow for up-to-the-minute coverage of match day, 2009!

Tried to keep a poker face as my attending pulled out tobacco chew. Effect ruined by eyeballs falling out of head & rolling across floor. 10:42 PM Mar 13th from web
...I still have no words for this. Spit cup and everything - if anyone should know better!

Said in a voice more calm than I could have managed last year: "Doctor, could you come in here? My patient's heart rate is 170."1:58 PM Mar 12th from web
Relatively healthy young person, went into a supraventricular tacycardia due to a re-entry rythymn. They had no clue, and I wouldn't have either if I wasn't watching her monitor and then listening to her heart right after. The ensuing cardiac workup ruled it due to low magnesium. Happily, 6 of adenosine fixed them right back up - textbook stable narrow complex tachy.

Me: I can't let you eat because then we can't give you sedation to reduce your hip. (pt eats). Me: I vote to reduce w/out the meds! 6:38 PM Mar 11th from twitterrific
I was so, so angry at this guy. Stupid doesn't even begin to cover it. Ended up getting a 23 hour admit so we could wait the 6-8 hours and put him down for conscious sedation.

If one is ever so foolish to say "It's 8 & I haven't had a finger in an orifice yet" they WILL have to do a rectal on a 400lb patient at 9 9:36 PM Mar 10th from web
It was... an ordeal. And I brought it all on myself.

Sickle pain crisis is ugly. Treat with IV fluids, Oxygen and the question "How much IV dilaudid (10x morphine) do you usually get?" 6:57 PM Mar 10th from web
The patient in question ended up with about 4mg of dilaudid every 2-3 hours. For reference, half that dose could kill the rest of us.

Nasal packing. Our fancy kind are basically flat tampons: use lights at home for nosebleeds. Bonus: we soak ours in lidocaine + epi. 4:41 PM Mar 10th from web
Seriously, if you're at home - use tampons. The lidocaine and epi really do help - and if you think it's going to be really bad, you can shove some cotton balls (on clamps, of course) up there first to numb them a bit first. Because nasal packing is not comfortable.

Is wary about her first ER shift scheduled a) under a full moon and 2) at night. I already had a little old lady swearing at me yesterday. 1:02 PM Mar 10th from web
Real charmer. Decided they didn't like their roomate at the adult foster home, so spouted off "I'm going to kill them" in hopes of getting a private room on our inpatient floor.

Me: Do you drink, sir? Pt: Not really. EMT (making drinky-drinky gesture) Me: How much did you drink today? Pt: About a pint. Of vodka. 6:17 PM Mar 9th from web
I really like our EMTs - and am continually amazed by the amount of EtOH in a person's system. The legal limit is .08 - to join the ethanol 500, you need a .5, but to win it you have to walk in with that number.

Must. Stay. Vertical. This will require caffeine. Thank god for hospital coffee - it'll strip paint, but the stuff works. 7:41 AM Mar 7th from web
It requires two sugars and a creamer, though.

What are the odds of two angioedema cases (one ACE, one ARB) coming in within 5 minutes of each other? New definition of "difficult airway". 9:00 AM Mar 6th from web
Man, swelling around the airway is Scary. The worse case of the two was a bad anatomical setup to begin with (short, fat neck). The guy came in sounding like Andre the Giant, the muffled speech which is what the medical community calls "hot potato voice". Even the anaesthesia guy who came down breathed a huge sigh of relief when get got the tube down (with assistance of fiber-optic)

New game: most unlikely symptoms to generate a "they're faking" diagnosis. ie, fixed&dilated pupil or st segment elevation. 1:54 PM Mar 5th from twitterrific
Most likely symptom to be faked? Abdominal pain. Far and away the diagnosis most likely to get sent home.

Advanced resus model who has blinking eyes that react to light - cool & very useful (is that wide or narrow tachycardia?) but also creepy. 11:00 AM Mar 5th from web
It also has palpable pulses, a blood pressure, heart & breath sounds and generates its own rythymns. We've been running codes on it for the last two weeks, and I'm thankful to have the refresher before I go out and try to be a Real Doctor.

Waitress, when scrub-wearing me grumbled about night shift. "You're too young to be a nurse, what do you do?"8:01 PM Mar 4th from web
I just laugh about it at this point...

Dr, I did vigorous irrigation of the head wound like you asked, and it's bleeding-vigorously. "oh, him? I'm sending him for CT now instead." 12:42 PM Mar 4th from twitterrific
ER doctors are not known for their attention span.

Meticulous repair of a deep laceration means that my pig's foot will be unscarred and functional, should it ever be reattached to said pig. 10:44 AM Mar 4th from twitterrific
Oh, where would we be without cheap & legal intact body parts with almost quite nearly analagous skin to a humans?

The department is q-word. Eerily q-word. (if you actually say the word, the nurses will hurt you)
6:44 AM Mar 4th from twitterrific
It stayed Q-word too - I like the 6A-2P shift, if not for the 6A part.

Trying hybrid sleep schedule for ER month, phasing out nightime sleeping for longer daytime naps as I go day->night shifts. Naptime=now! 3:11 PM Mar 3rd from web
It worked just fine for the 2-10 shift, but switching to the 10P-6A shift still left me fuzzy for about a day.

Very happy that my combative demented pt decided to like me, given the trauma shears within easy reach. 12:15 PM Mar 3rd from twitterrific
So far all my really crazy patients have been female. This one tried to stab their son before coming to the ER.

@inked_caduceus Unless there are kids in the car. :( Also, wear your damn seatbelt.
8:54 AM Mar 3rd from twitterrific in reply to inked_caduceus
PLEASE PLEASE WEAR YOUR SEATBELT. So many deaths could have been avoided this month already. Unfortunately, this was an especially tragic case as it was a family of 4 who were t-boned by two stupid kids in a stolen car.

On medical codes, not trauma. Down one urethral swab before the sun rose. Drive however you want, just wear condoms. 8:07 AM Mar 3rd from twitterrific
Asking a woman in the ER if "there is any chance you could be pregnant" is the IT equivalent of asking "Is the computer plugged in?"

FUCK IT IS EARLY. Everyone in the St. Clair shores area: drive safe, don't take drugs (except insulin-take that) and no shooting people.
So far no shootings, a few out-of-control diabetics (ewww feet) and several accidents.

So it's half way through match week, and I find myself with a relative lack of ER shifts. And while Felicia Day's (the redhead from Dr. Horrible) blog and independent project The Guild was all I could brain while I switched to night-shift circadian rythymns, I'm finally mostly on track.

And so, the match. The short version I give to aquaintances is that "I interviewed at a bunch of programs and made a list of which ones I liked the best. But at the same time, they rank all their applicants, everything gets put into an enormous computer & spit out on March 19th"

Here's the slightly more detailed version.

Much like the application process for any school or professional position, you comb through everything you've done for the past 5-20 years and compile it into a CV, personal statement, etc. Then you have a few people write you very complimentary letters and send it all off in hopes that programs will invite you out for an interview, usually with dinner the night before.

Of course, everything you do and say during both of these is scrutinized to determine if you'll be a good fit. (But you shouldn't be so harsh on the programs, because the applicants are doing the exact same thing.)

The end result is a list on both sides. They start with either the program or applicant that would be the number one ideal, and ends with the option that will be acceptable.

So once the computer chugs through all the data, two separate notices are sent: the first to applicants, letting them know if they matched or didn't match. There's a 24 hour lag, and the programs find out if they filled all their available slots. (I have NO IDEA why there's a 24 hour difference, especially given that all the information is available at the time).

Once the programs and applicants are both notified, the scramble starts. At that point, all the organization previously seen in this agenda goes out the window. The contact information for the unfilled programs is released and applicants basically stampede to get to any open spot left in the area & specialty they want. Generally, it works out - it's ugly, but people get a spot they can work with, and programs fill up. The scramble is allotted two days (Tuesday afternoon and wednesday) and once all is said and done, everyone else gets their notification for where they're going.

And just think... if I want to do a fellowship, I get to do this all over again!

And so did quite a bit of the Twitter population. :) (All taken from a search of "matched" on twitter.com)

MATCHED!!!!! :-D
well i matched. at least not everything went wrong. now i have to wait till thurs to find out WHERE i matched.
MATCHED! find out where on thursday :)
Emily matched! The medschool system is screwed tho, so have to wait till Thurs to find out where we're going to live, come June .
I matched! I'm going to be a surgeon!
I matched! Now Thurs needs to hurry up and get here so I know where!
Well I matched, stage one down
So incredibly relieved to have couples matched successfully!
So happy right now! I have officially matched!! Now I just have to wait 3 more days to find out where.
Matched in dermatology...somewhere
I matched. Huzzah!
Word has come out and it official, I have matched! So at least now I know that I am employed next yet and will be studying emergency med!
I matched (somewhere)!
matched as well. congrats
MATCHED!
Congratulations to my gf Genny who found out she matched today. Hopefully it UofL!!
I MATCHED...now i just have to wait 3 days to find out where
Match status in! I matched! The prize: wait another 3 days to find out where.
Yay! I get an envelope on Thursday. I matched!
I matched :-) ill find out where on thursday
I matched! 3 more days to know where I'll spend the next 4 years!
Hakunamatata! Kat got an email explicitly stating that she matched. No more anxiety! Except for the WHERE question.
I matched! Just 72 hours until I find out where!
Well, it's official - I matched! Now I just need to wait until Thursday's ceremony to find out where.
Oh, thank God. Matched. And wal-mart was definitely not on my rank-order list, so there goes that recurring dream. Thursday, get here!
I MATCHED! ! !
I matched!!!! :-)
So I matched somewhere... (thanks NRMP for drawing this out as much as possible).
Holy Fuck.... I matched!!!!
i have matched
I MATCHED.


All of the above posted in the space of 35 minutes. Admittedly the Jon Stewart vs. Jim Cramer got more coverage, but not nearly so enthusiastic.

PS. I have another post coming up of my Day-shift ER tweets. It's indicative of the ER lifestyle that I can only manage to blog 140 characters at a time. Most of them are incredulous.

Congrats to everyone who matched, and thank you very much to all those who helped me through my very silly anxiety over the whole thing.

And no, it didn't affect my choice in specialty.

11 days until I get the you matched/you didn't match notification.

In recognition of this occasion, I refuse to eat scrambled eggs from now until the 16th.

Had a long & serious talk re: putting a 13 yo kid on a statin (for high cholesterol) today. Bonus: Kid knew more about nutrition than mom. 9:26 PM Feb 24th
This was the last theme of pediatrics: Kids are not little adults, so what do we do when they get adult diseases? Diabetes (Type II) and High Cholesterol were sadly all-too-common.

FYI "chest pain" and "extreme fatigue" are NOT best classified in the "10 minute visit" slot. Especially when they are at 4:40 & 4:50 PM. 8:12 PM Feb 23rd
Thankfully, I had a doc who was able to walk that fine line between "Stuff that really needs to be dealt with today" and "Stuff than can wait for a 2 week follow-up visit."

My clinic took Nick and I out for dinner. And I got a bag of pharmaceutical rep goodies. YAY trauma shears - but WTF is "enablex"? 8:08 PM Feb 23rd
The office ladies really were lovely. It was strange to be in an office and see reps only bearing samples, though. Pharm swag is a thing of the past, and we'll all be better off for it. Even if I lost my nice paid-for pen in the space of 2 hours today.

Over-the-counter meds exist because they work & don't require a doc. So please TRY SOME before you come to clinic and whine about a cough. 11:15 PM Feb 20th
Tylenol, Motrin, Sudafed, Robitussin, Mucinex, and NyQuil/DayQuil. It's not rocket science, but if you want to get fancy, try some hot tea and extra sleep.

Smart-alec almost two year olds cure the baby rabies. She wanted me to go home so mom (Melissa) could read to her. "Bye bye!" (repeatedly). 8:17 PM Feb 17th
Two year olds are the example of that "too much personality" end of the spectrum I mentioned earlier. They're also able to make noises I have only before heard from howler monkeys at the zoo.

Dr: How's that earwax buildup we treated last time? Patient: Sorry, what'd you say? 12:52 PM Feb 12th
Ba-dum-TSSHHHH. But seriously, folks. Cerumen impaction happens. We have little plastic scoopers and a HUGE syringe for irrigation.

And other med students think House is real. See term "questionable admission". 2:46 PM Feb 10th
This and the previous entry were provoked by me being cranky during lecture. Not entirely unwarranted, the kid's response to "Is my mother dying, please tell me what's going on!" in a roleplay scenario was "Are you her durable power of attourney?"

Learning that some of my fellow students should not be allowed to talk with patients. You can lead him to medicine, but he's still an ass. 2:38 PM Feb 10th

My patient today requested the bubbblegum flavoured Ear Drops today. The kind that go in your ear. Pink makes everything better. 10:15 PM Feb 9th
I actually got pretty good at ear exams (even on screaming targets) by the end of the month. "It's just a special flashlight!"

Full migraine turn-around in less than 4 hours. Sumatriptans are a godsend. 3:54 PM Feb 8th
Doctor, heal thyself.

Mom in clinic: She's not eating enough formula! Ma'am, your 4 month old is the size of a small 9 month old. Any more & she'd eat Tokyo. 5:54 PM Feb 6th from web
Theme #2 of Pediatrics: Too big, too small, and how much food is required to make them grow. The answer: There's a pretty wide range of normal, so stop worrying so much.

@aiela Grab some of those Shower Soother things, and then if you can get over the gross, blow your nose while in the shower. Miracle! 2:19 PM Feb 5th
More than anything, clearing sinus/nasal congestion in a timely fashion (before it turns into chest congestion, etc) is the hallmark for treating much of the winter nasty

TEXTBOOK cases of benign positional vertigo (maneuvers worked!) and Fifth's disease (it DOES look like slapped cheeks!) today. 11:29 PM Feb 4th
BPV is much, much more common than I had realized. Quite a few were provoked by sufficiently nasty head colds

Baby rabies is transmitted through chubby 6 month olds who drool and grin at you while not crying. I narrowly avoided infection today. 6:07 PM Feb 4th
4 monthers are pretty cute too - it's that golden age where they have some personality, but not too much. :)

Toddler during clinic: "I go chuck e cheese if I poo poo!" Evidently Mom has resorted to bribery during toilet training. 9:52 PM Feb 3rd
Theme #1 of pediatrics: Poop, and the frequency/consistency/placement thereof.

Lecture titles for the ambulatory rotation: bad news, pain, and suffering. It's going to be a fun month.
1:34 PM Feb 3rd
The lectures turned out pretty great - learning about pain medicine from someone who is no stranger to dispensing 200 mg of morphine a day. Palliative care is an under-appreciated specialty.

You know when you find a cat curled up in a bunch of blankets and you try to move or interact with it, but all the feline does is open one eye to look at you and send a telepathic message of "Go away, it is warm in here, and cold out there. Hence, only nuclear war will make me move from here."

That's what I do in winter.

Will try to catch up soon.

Dear Katie Renee Burgett:

Your rank order list was certified at 02/08/2009 10:02 PM for use in the Main Residency Match and is now on file with the NRMP. The listing of an applicant by a program on its certified rank order list or of a program by an applicant on the applicant's certified rank order list establishes a binding commitment to offer or to accept a position if a match results. Failure to honor that commitment may result in penalties as described in the NRMP's Violations Policy.

If you change your certified rank order list, your status will return to 'Ranking' in the R3 System. You MUST re-certify your rank order list prior to the rank order list certification deadline in order to be included in the Main Residency Match. To re-certify your list, click the 'Certify List' button on the Maintain Rank Order List page. Please note that the System does NOT save any version(s) of previously certified rank order lists. It saves only the version you see on the Maintain Rank Order List page.

You have a total of 10 rank(s).

NRMP Staff

For the savvy readers, you'll notice that I dropped one more program off the list. After some hard thinking, I decided I wasn't going to get the neccesary ICU exposure there, and left it off.

Clinic is good. Worryingly good. As in "I really enjoy going in every day. To Clinic." Good.

This pokes holes in my previous theories about being allergic to outpatient medicine.

So I've recently rejoined Twitter (same name as here) and have been using it over the last month, mostly at work, and mostly when I have something to rail against. And thus, I present Nephro:The Twittering, with bonus "what I did on the weekend!" feature.

Clinic medicine for the next month. Snarky tweets will have to wait for ER. They will return in March and be about drunk/high/stabbed pts. about 16 hours ago from web

consults for 5879: surg, psych, neuro, GI, cards, ID, nephro, PT/OT. Stupid, lazy, 'I'll scratch your back if you scratch mine' medicine. about 21 hours ago from web
By the time we were done, there was another consult added. I understand that non-academic medical centers run on consults, but soft ones were really starting to get on my nerves by the end of the month

Is less oblivious having talked to the health care worker who got stuck & required the stat HIV/Hep labs. Still grumpy about mine, though. 3:23 PM Jan 29th from web
Thankfully, everyone got the all clear

Who orders HepB/C+HIV panel in a 90 year old STAT? Meanwhile, my STAT labs have taken approx 4 hours. Club Beau now officially ghetto. 2:05 PM Jan 29th from web

Why you don't need a consult, reason #58769: Your patient is stable, improving and a candidate for discharge home. 12:11 PM Jan 28th from web
We got quite a few "They're improving, but not FAST ENOUGH" consults

Stalking the board of directors of the Accreditation Council of Graduate Medical Education. Just a little bit, though. 5:23 PM Jan 27th from web
To be explained at a later date

Daydreaming of residency. ie, warm weather, deep fried everything and getting paid to do what I've been doing for the last two years. 9:25 AM Jan 27th from web

Recovering from Revenge of the $9.99 Steak. 9:55 AM Jan 26th from web
Birthday dinner with Nick's Mom. Lovely evening - just don't have what I had

Uploading pictures from Con Fusion. Looking forward to Penguicon. I let my geek out in concentrated weekends of Pirates and Open Source. 11:24 AM Jan 25th from web

Fucking Dictations. We use something called a GAMMA KNIFE for BRAIN SURGERY and yet this antiquated data entry system remains. 7:44 PM Jan 22nd from web
...my eternal battle. I still have some to do today. Yuck.

Evidently there was drama at the formal resident reception. AKA Residency Prom This + facebook drama-Beaumont is officially high school. 1:33 PM Jan 22nd from web

It is NOT the consultant's job to ensure daily labs are ordered and drawn. Club Beau is tasty, but also strangely ghetto. 9:18 AM Jan 22nd from web
This was my first glimpse of medicine by consult. The criticisms grow in volume and vulgarity as time goes on.

I have a system. Start on the 8th floor south, then 4 central, then 5 west and then 6 North. Mr. 9 North, you are screwing up my system. 9:13 AM Jan 22nd from web
9 North eventually moved to 8 center, and all was right in the world

Pre rounding & staffing 6 patients over about 2.5 hours. Haven't seen my resident yet today. I'm LEARNING. 10:45 AM Jan 21st from web
We had a very, very busy service this month. Even the attending commented on it.

Watched Obama sworn in as my patient got dialysis. It's "out with the old and in with the new" for everyone around here. Bush=Urea. 2:09 PM Jan 20th from web

Skipping noon conference and watching as much of the inaguration as I can on in-room patient TVs during rounds. I hope. :) 10:10 AM Jan 20th from web

Have enough energy to either stay awake or digest delicious bleu cheese burger. Burger currently winning. 8:33 PM Jan 18th from web

From behind me in the resident dictation room "Patient complains of eptasis..epsitaxs...nosebleeds." 1:40 PM Jan 13th from web

@funkotron No, you cannot. Snakes stay at the bottom of the food chain in our house. 1:34 PM Jan 13th from web in reply to funkotron
I don't think this requires too much more explanation.

Doctor's dining lounge at Beaumont is SWANK&AWESOME-$2 for grilled cheese/tomato soup served on real plates w/silverware. Worth 150K in debt 1:31 PM Jan 13th from web
The dotor's dining lounge continued to be a bright spot in the otherwise frustrating infastructure

Learned that student coordinator/program critic has green hair 2* to self-dye mishap, not disease. Feeling vindicated. 11:11 AM Jan 13th from web
I will not say who this is... but I am looking forward to them seeing the glee on my face as I match there in March. (When it's still bitterly cold in Michigan)

Our student coordinator used my top-choice residency as a "Do what I say or you might match at $" boogieman scenario. 9:04 PM Jan 12th from web

Modeling my new wee paper chain. Only 66 days until Match Day, holy shit! 1:35 PM Jan 10th from web

Yes, I decided to use twitter. It will be used for passive aggressive med student whinging. 12:27 PM Jan 9th from web

Helpful hint when consulting for "refractory hyponatremia" - make sure pt is hyponatremic. or refractory. 12:27 PM Jan 9th from web
And thus begins my month-long question of "Why were we consulted for this?" Pt. sodium was 135.

A randomized, 10 year study of children exposed to Thimerosal revealed no significant differences on a battery of Neuro-psychiatric tests.

Of course, this will be discredited by the anti-vaccine crowd, because they "Know" their children became instantly autistic after receiving the MMR vaccine.

Meanwhile, Children continue to die of illnesses that could have been avoided by routine vaccination..

This whole subject makes me unspeakably angry - when This American Life recently covered the anti-vaccine scandal in a show aptly entitled "Ruining it for the rest of us", I became so furious, it came down to turning off my favourite NPR show or risking a road-rage incident.

Thankfully, cooler heads than mine prevail and continue to do great work to combat this dangerous misinformation spread on irresponsible "What your doctor won't tell you!" entertainment TV.