Baby boy!

Baby G is now 5 weeks old! I'm typing this one handed as he completes his absolute favorite past-time: eating. The child has gained a pound a week for the last five weeks. I'd worry if he was formula fed, but amazingly he has gained it all from breastmilk. Every 2-3 hours. 3.5 if I'm really, really lucky at night. Since he's over10 pounds now, I'm hoping this will slow down soon...but no luck yet.

I fell in love so much faster the second time. I wonder if this is typical. He looks more like me - red hair, blue eyes (though they are starting to turn brown like daddy's). He's also a lot calmer than Little Girl; but maybe this is just my perception as a more relaxed second-time mom?

Lately I've been feeling much more Mom than MD. Don't know if it's being mom of two or being on maternity leave. I'm not sure I'd go back if not for the large chunk of studen loans I need to pay off eventually. Then again, I've been reading the AFP Journal and The Vaccine Book (very interesting) in my "free" time (while Baby G is eating). I really do think that anyone who has a child should get credit in residency. There's nothing like learning by doing - you've been that Mom with a squalling child at 4 am when you'd give your left arm for just a half-hour of sleep, you know all about breastfeeding (positions, engorement, how tempting it is to quit sometimes, Fenugreek and reglan etc.), and you have the developmental milestones imprinted on your brain. Don't think they'll go for it though.

Eating is done. Must go change diaper.

The pregnant resident

I am sooo grouchy. Just like all my ob patients at the end I hate being pregnant and want to get this child OUT of me. I look like a battleship (bullous belly on skinny little legs), walk like a turtle, and am trying desperatly hard not to snarl like a badger. I had to take time off. The last three times I worked - including one 30 hour shift - I went into contractions every 2-3 minutes. Damn things hurt. Cervix changed only a little, not enough. Had one hit yesterday in clinic while I was trying to inject a shoulder...I am not safe for patient care anymore. So here I am at home. Where I was longing to be just last week. And I'm sooo bored and sooo grouchy. I'm taking care of Beautiful Little Girl at home and am so proud that I haven't been grouchy to her at all yet. I've had 5 tea parties in the last 2 days and am not sure how much more I can take though. My pelvis hurts every step I take. *whine whine whine* I'm tearful, hubby has to work late the next few nights. If I could put pitocin in my veins right now I could...but there's no medical reason. blah!!

Read the articles on pregnancy during residency. Studies show that we enjoy our pregnancy a lot less. Go into preterm contractions but not preterm labor. Yup. Why didn't I become a nurse? Or a pastry chef?

The Inhumane Code

Working the ER this month. Yesterday I got a heartbreaker.

87 yo F dementia, CAD, CHF, CRF, etc. 1 week AMS per her nursing home. Before I even walked into the room, one of my favorite hospice nurses pulled me aside and told me that the woman had been considering hospice last week, the day before she became altered. Had almost signed on. Has no family. Here's her guardian's number - talk to him.

Turns out lady is SICK - CXR white out, STEMI, LFTs of ungodly number, etc. Medical opinion is: it is not appropriate to code her but we need the okay from guardian. Guardian says he thinks that sounds appropriate but need to talk to his supervision (you are the $$*(*#@$ guardian on the legal document, make a #*$* decision). TAlk to supervisior. By her notes, two years ago, 87 year old wanted to be full code, so we want full code. $*(#@$* If she wanted a piece of paper to make her decision for her, she could have signed it, but no, she asked a human being with a concious who is capable to judgement to make that decision. That's you. Step up to the plate.

Codes are ugly. They are not the heroics on all those television shows. They are ugly, ugly, ugly. Ribs are broken, flail chests, crunch, crunch. Sheets, gowns, covers are all over the bed - breasts, pannuses, legs are all spread open. There is no dignity. Why can't people just die because they are supposed to die? Legally, when I'm on the code team or that doctor I have no choice - I have to hurt these people in their last hours when I know I'm doing nothing, NOTHING for them. YEs, I'm happy to try when they are 32 or otherwise healthy but so many times we beat dead bodies.

And it makes us inhuman. I feel bad not only for the body we are hurting but for every health care person in that room. You always have to store part of yourself on a shelf when walking into death but when its beyond futile, it kills the Human in you a little bit.

I stayed 2 hours past my shift with the lady. Of course she didn't make it. Cried the whole dang drive home and then put on a smile for Fairy Princess. Some people wonder how I can make it through residency with a child, I can't imagine not being able to heal without hugs from a Fairy Princess.

Who gets to sleep?

I had a bad call night on Saturday night. Though I am now an esteemed "upper level" and don't get all the floor calls, I get all the outside pages from patients who want an antibiotic over the phone (no), a refill on their narcotics (absolutely not), or want to know how much Tyleonl to give their three year old with a fever (happy to help). I also get to carry the code pager (insert drums of doom here.)

Before noon, my intern and I ran a code on a 32 year old schizophrenic with diabetes - a terrible combination if there ever was any. He took too much Seroquel and and was in DKA. We pulled out most everything in our arsenal but he died. The primary doctor came along just in time to tell the family...we were saved that horrible task. As we wrote our code note though we heard his mother sobbing. There is nothing, that tears me up more than hearing Mommies cry over their dead child - be they 32 weeks or 32 years.

And things never went uphill from there. We got less than two hours sleep. I'm not sure exactly how much as my rule is that if I get less than two hours, I'm not allowed to calculate exactly how much. It doesn't really matter because you are exhausted anyways and the numbers only depress you. Both the intern and I are pregnant - she in her first trimester, me in my second - so the night was a little harder than usual on both of us.

When I got home, I immediatly went to play with my daughter, now two, for a bit. Daddy went upstairs for a moment while we played princess-dress-up and made pretend muffins. After a half hour, I was getting pretty tired so I went up to find Daddy so that he could take over. He was lying in bed and said, "I'm going to take a nap; I didn't sleep much last night." And the bum feel asleep. Four hours later, I got my nap.

This is not the first time this has happened. Is this because I'm a sucker Mommy? Is this because I'm a woman MD? I was going to get all up in arms but then I talked to my male colleage who is a Daddy of an almost two year old and apparently the same thing happens to him. He gets home exhausted after call to have the child placed into his arms and Wife disappears for awhile. It tough work being a single parent for over 24 hours and, yes, we do desperatly want to spend time with our child...but sometimes we just get tired. I knew if I pressed the issue if I ever was so tired that I wasn't a safe mommy, Hubby would take over...but it would be nice to be tucked into bed by Hubby and Beautiful Daughter soon after getting home with both their blessings.

Then again, I am an awfully lucky mommy to have healthy child.

MD sees a car wreck. Now what?

I've discussed the hypothetical situation of seeing a car wreck and if I'd stop with my white coat on and see if anyone needed help. He's been a little nervous about the situation for litigation reasons. He thinks I should stop and help and just not mention being a doctor.

I've passed car wrecks since we've talked about this. At first I didn't stop because I was a medical student and heck, I'd read lots of books but didn't trust my clinical exam or ability to think clearly in a possibly scary situation. Since I got the MD letters behind my name I haven't passed one that hasn't had lots of sirens at it; I figure those are under control. There were no sirens today.

I was driving along the highway and saw the slow down up ahead. I was a little miffed and hoped it wouldn't take long to pass because I wanted to get home to see my baby (the last few days I've only gotten to spend 45 minutes at most with her - makes me want to quit - but that's another post). Then I passed the three scrunched up cars with no sirens in sight and decided that baby could wait.

I pulled over and my heart started beating very fast. What if there was lots of blood? Though I'm a doctor, I have to avoid the traumas in the ER because I faint. What if someone doesn't slow down enough as they are going by and I get hit? What if hubby is right and I get sued? I grabbed my pen light and stethescope and put on a good game face and walked calmly over to the first car.

The other two cars were empty and the drivers millling about but in the first car a young girl was sobbing with bruises already forming on her face and arm. The air bag had deployed and she had diffuse bruising rather than a face in the steering wheel; G-d bless airbags. I talked to her for a bit and she was A and O x3 (alert and orientated to person, place, time). No neck pain, but her face and arm hurt. After a quick physical she seemed not to have broken anything and seemed to just be crying mostly from the emotional trauma but I'm sure her face didn't feel good. At this point, the sirens arrived and a police officer came over and asked my assesment. I told him she'd probably be fine but a trip to the ER was in order. She probably needed a head CT and to be watched for awhile. I talked and reassured her a little bit and then left.

Should I have left? When is the right time to leave? I wasn't doing anything more but was the Aura Of The White Coat reassuring her? I was still tachycardic and didn't want to get too involved in things (isn't that what all people use as an excuse?). She was going to be fine. I don't know. I kind of feel like I should have stayed at least until EMS got there. I don't know.

Can we help?

One of my favorite patients on our peds rotation is a 6 yo hispanic girl with PPA (a metabolic disorder) . She's in the hosptial more than out due to almost constant line infections with nasty bugs. We've tried to arrange it so that she could be at home while getting her Vancomycin but Mom doesn't think she could handle that; Mom has other kids at home and The Little One really does take a lot of daily tweaking.

So The Little One stays with us most days. We threw a big birthday party for her last month, the secretaries have learned spanish in order to talk to her and try to teach her words, and the nurses throw little dance parties with her behind the desk in the evenings to keep her entertained. She's of course developmentally close to a six month old but is happy and seems to be having a fairly good quality of life.

Mom just asked me today if I could help her with immigration. Turns out she and Dad are both illegal. Dad left four months ago to go back to Mexico to help with their famlies - their parents are both quite sick. He was supposed to come back three months ago...but hasn't shown up. We don't know the full story - Mom isn't disclosing everything but I suspect he's either been caught or just can't get back across after multiple tries. Now Mom wants to cross back to help him and her parents. She wanted to know if there was anything we could do to help her get back across.

The fairly simple answer is 'no' and I told her that. We discussed the risks - she planned to go at the start of one of The Little One's hospitalizations (usually 14-21 days) and get down and back in a week. Bu what if she couldn't make it back? What if she couldn't ever make it back? What if she got hurt or died? Who would take care of The Little One? And who would take care of her other kids?

I cannot imagine being in that situation. I would be desperate to find and help my husband and my parents but I could never leave my children behind. How awful to be put in that position. I hope she doesn't go but I suspect she might. Who will take care of The Little One?

Medicine is so much more than making sure the Vanc trough is in the right range.

Changing my Colors

I bought a stethoscope today.

I had lost my last one a few weeks ago and have been borrowing one in the hopes that old stethoscope would magically reappear. Magic rarely happens in the hospital in the dead of winter.

Stethoscopes come in very few colors. Black, navy, and maroon are the only colors I see around the hospital and the maroon is a rarity in the sea of black and navy. In medical school, I almost bought a black one but thought it too conservative. So in my wild and crazy ways, I bought a navy blue one; the maroon was just too reckless. For I was going to be a female doctor and I felt a need to fit in with the throngs of black and navy as well as I could.

When I started medical school, I didn’t want to be known as a girl. I’d rather be a solid medical student and in my mind, solid medical students weren’t girly. During medical school, I dated and married quietly. Skirts made an occasional rare appearance in my wardrobe but besides the numerous scrub sets I mostly wore pants with a conservative button up shirt. I didn't gigle, I most certainly didn't lean over in short little tops, and I couldn't be bothered with make up. My little navy stethoscope blended in well with the other serious students.

Then a few things started to change. I got pregnant my third year of medical school. I threw up a few times on rounds, didn’t fit my scrubs very well anymore, and had to change my rotations so as to be within ten minutes of the hospital at all times (placenta previa). After the baby, I’d disappear from the wards now and again to breast pump…something black and navy stethoscope don’t usually do.

This year, my intern year, I thought I could work at becoming a better navy stethoscope. However, the color and I are just not working out. Beautiful Baby Girl gets sick now and then and Hubby and I split the days we take off with her and I’ve missed four days already. The only other intern with a child, a black stethoscope with a stay at home wife, has never stayed home with his sick baby. Skirts and dresses are actually faster to put on in the morning when you only have ten minutes to get out the door because you played with Beautiful Baby Girl for too long. My inpatient exam scores were better than 93% of all residents, not just interns, all residents, but yet I occasionally come to work with a little handprint of oatmeal on my pants. And now I’ll have a new stethoscope, not black, not navy, and not even maroon.

I’m sure I’ll be called ‘nurse’ more often now. I’m sure I’ll get a few funny looks but somehow it felt right.

I bought a stethoscope today. A pink stethoscope.