Agape

Thank you for endless slices of German chocolate cake, and for proving that you really are never to old to jump on a trampoline.
Thank you for making Christmas magical, and for patiently letting my tiny hands remove and replace every single piece of silver tinsel my 6 year-old self could reach on your Christmas tree.
Thank you for proving that a smile really is the best accessory.
Thank you for teaching me how to climb trees, and for helping me hide the evidence of scraped knees and scuffed shoes.
Thank you for teaching me that love is selfless and can be given long after a person stops being able to receive it.

For these lessons, and so many more, I will always will be so thankful. Oh, how I will miss coming home to your hugs and our conversations spent holding hands and each other. Losing you will forever leave a hole in our family, one that we will do our best to fill with sweet memories and your legacy of love.

Out of the Woods

"Code Team, to the CT Scanner. Code Team, to the CT Scanner."

As the voice of the hospital operator echoed the familiar call to action, myself and one of the radiology residents jumped up from our chairs and dashed out of the resident reading room and across the hall to the CT scanner.

When a code is called in a hospital, organized chaos quickly follows. Within seconds, swarms of white coats pour through stair well doors. Nurses with crash carts run through halls. The urgency is palpable.

When myself and the radiology resident got to the patient, the code team was already there (I swear they can apparate) assessing the situation. An ICU patient sent for imaging had semi-consciously pulled out his ET tube and NG tube. He was now in the process of desatting as all of the oxygen molecules dissociated from their hemoglobin chaperones, with no new recruits coming from the lungs.

Last block I did an elective in radiology. Which means I was out of the medical trenches for the past few weeks, safely tucked away in dimly lit reading rooms aglow with the light of high definition monitors. While I am not considering a career in radiology, I did learn a lot and it was interesting to explore a field of medicine I have never really learned much about before. But whenever I toyed with the idea of not going into clinical medicine, something (like a code being called) reminded me which side of healthcare I want to play for.

Pulmonology and anesthesia soon showed up and the patient was reintubated. I sat back and watched intently as the emergent situation was quickly resolved. As we walked back into the reading room after the patient was stable, the radiology resident mumbled, "Man, I sure don't miss that." I smiled, realizing just how much I did.

Shiny and Bright

It's been one of those weeks where my to-do list seems endless and it's left me wishing there were more hours in the day night (for sweet, sweet sleep).  At this point in my life, it seems that there are medical students who know exactly what they want to be when they grow up. And then there are those of us running around in short white coats who still don't have a clue. I, for now, am solidly in the latter category.

In between studying and making pro and con lists for every medical specialty known to man, I remembered this quote a classmate and I used to always say to each other (usually at 2am in moments of exhausted exasperation, hunched over biochem notes):

One day, when I'm all grown up and all the unknowns that currently keep me up at night are known, I'm sure a part of me will miss the mystery of not yet knowing what will be. So for now, I'll make another cup of cocoa, start a new list, and try to be grateful for a future full of shiny and bright possibility. 

More than you know

During rounds I made a mental note to go back in and check on the patient. Something about the way our attending examined him without even saying hello rubbed me the wrong way. When I walked back in I introduced myself, went over and said hi to our patient, and then turned and began speaking with his grandmother, the primary caregiver.

I then began to listen to his heart, lungs and abdomen. I looked over at his grandmother while I palpated his belly, careful not to disturb the feeding tube protruding from his abdominal wall. She was smiling at me and at her grandson, with a look of relief across her face. I finished up my exam and shook her hand. While I was walking out she began explaining to me that she was concerned that his G-tube had a hole in it, but that it wasn't scheduled to be replaced for 5 more days. I told her I would speak with my resident and see what we could do.

The remainder of Mike's hospital course was uneventful. After some arm twisting/begging, I got interventional radiology to replace his G-tube and he went home on a course of antibiotics to kick the nasty respiratory infection that landed him in the hospital in the first place. As we were discharging him, his grandmother thanked me for taking such good care of her grandson and we joked about how he was quite the ladies man, since all the nurses loved him.

Truthfully, I get why my (very intelligent and seasoned) attending didn't bother to say hello to Mike every morning. The kid has cerebral palsy. He looks different, acts different and can't speak. And most physicians really just don't know exactly how to interact with severely disabled patients. But that's the thing, patients are people. And even severely disabled and nonverbal people have personalities and needs, they just can't communicate them in the same way most of us are able to. But I've learned, and am continuing to learn, that so much about medicine is more than what you know - anyone can look up facts and treatment plans on UptoDate and clinical judgement comes with time. At it's core, medicine is about showing people, and their families, that you care. It's about taking extra time to speak with a concerned parent about their sick child - even when the attending and resident have already explained the situation three times. It's making funny faces back when your stethoscope is cold and your patient makes a silly face. It's about calling other departments and stressing the fact that something for your patient needs to be done and no, it cannot wait.  And sometimes it's simply smiling at a patient even when you know they can't smile back.

Mouth to Mouth

Our COPD screening event at the local town mall was well underway. If you think people try to avoid that annoying guy at the random phone kiosk (seriously, has anyone ever bought a phone there? Ever?), then you should see 'em try to dodge a bunch of over enthusiastic medical students and residents in white coats. ;)

I had finished explaining to an older gentleman how the spirometer works and he had just taken a very deep breath and attempted to expel all of his air into the mouthpiece. He was red in the face, wheezing hard, and basically about to fall out of his chair at any moment.

Me: Sir, it's ok! Let's take a few deep breaths before you use the machine again. I don't want you to pass out! *Half jokingly*

Man: Are you kidding?! That's what I'm banking on! If I pass out, you have to give me mouth to mouth!!!

Me: Oh, yeah? That's a clever little plan. 

Man: You can't trust me, I'm a dirty old man, hah!

I continued with the screening test, to the soundtrack of the male residents' laughter. By the end of it, both my new friend and myself were red in the face - him from chronic lung disease, me from embarrassment.

Forget about kids, in my experience it's the OLD people who say the "darndest" things.

Happy Sunday, folks. :)

Metrics of Affection

Glancing over the patient list this morning, my eyes lingered on the bolded phrase "NbBoy X, Known Trisomy 21." My stomach sank as the possible complications of that diagnosis began running through my head.

A few minutes later, after we had discussed each patient with the residents, we began our morning rounds in the nursery to perform our newborn exams.

Walking into that patient's room I didn't really know what to expected. Disappointment? Sadness? Fear of caring for a child with disabilities? Whatever angst I was feeling quickly dissipated as we all piled into the room to a grandpa's happy and proud laugh. A dad grinning from ear to ear. And a mom gently holding her new baby, smiling that tired but completely content smile, as only new mom's can.

We spoke with the parents, wheeled over baby boy X in his crib and began examining him. Once we were done we wrapped him up snug and passed him back to mom, who was clearly already completely in love with her new baby.

Later that morning, when we were discussing patient plans, one of the interns asked if the parents were aware of the situation. My resident said yes, and that they had been informed a couple months ago. The two of them began tossing around the idea that maybe the parents were in denial or didn't fully understand the diagnosis.

And, while I am definitely new here, I don't think denial was it at all. Because watching the mom look into the eyes of her new son, I only saw one thing, and it was love.

Move over, Clement Clarke Moore

A call light flashing for a room with a 10cm dilated patient is pretty much the best thing that could ever happen on the labor and delivery floor. The nurses jump up, the midwife sets down her coffee, and the super-excited (but totally professional) medical student all rush down the hall, eagerly anticipating the birth of a fresh new little babe. Be still, my uterus.

I just finished up my Ob/Gyn rotation. Part of my rotation included two weeks on the Labor and Delivery floor which meant one thing: BABIES!!!  I've seen too many vaginal births to count, and was even allowed to "catch" a few babies myself. Because this rotation will forever hold a special place in my heart, I wanted to write something to commemorate my time with all the excited new mommas and (nervous as all get out) new daddies to-be. In lieu of another list (which we all know I love), I give you a poem...

“'Twas right after the call light flashed”

'Twas right after the call light flashed, when all through the floor

Not a person was sitting, waiting around was no more.

The nurse jumped up, right out of her chair

And the midwife, mid bite, set down her pear.

The medical student looked up, from her very dull text

And could only hope, she knew what was happening next.

The three of them rushed to the room down the hall,

When they walked in the daddy-to-be looked ready to bawl.

A look of determination swept across the mom’s face.

“Lets do this!” She said, “This baby won’t wait!”

Sterile gowns were tied, white gloves put on,

One last check was performed, that cervix was gone!

The midwife looked at momma, “You know what to do.”

“When the next contraction comes, you push right on through.”

A contraction spike began climbing, on the monitor screen

The poor woman turned red, and started to scream.

She gritted her teeth and moved that baby on down

Straight through the birth canal, until baby started to crown.

“Medical student c’mon! Put your hands right on mine.”

So I bent next to the midwife, and her hands I mimed.

“You can do it!” rang out, the nurse's loud cheer,

"Just one more push, she’s practically here!"

And sure enough, a head started poking through.

The miracle of life – with lots of other goo.

With all the strength she could muster, that momma pushed

When a head popped through, albeit kind of smooshed.

Then one shoulder came, and then one more

And finally a beautiful baby, met by no one before.

Up on momma’s tummy, new baby went

Momma smiled through teary eyes, her energy all spent.

The daddy carefully stayed at the head of the bed,

And bent down and kissed his new daughter’s head.

“You’ve done it,” we cheered. “You are such a champ!”

And I almost forgot, my scrub pants had gotten kind of damp.

The new momma glowed, and she thanked us all

“Baby girl 13:15!” was shouted down the hall.

And as another shift ended, on the L&D floor

That was awesome I thought, I’m ready for more!

I changed out of my gooey scrubs, and replayed it all

I smiled and thought, maybe I'll be an Ob/Gyn, after all.

~The End~