Thursday, December 27, 2007

Happy, Happy, Joy, Joy

Don't tell my mom, but I love Christmas time. I used to give her a hardtime for playing Christmas music everyday from Thanksgiving to New Years' Day. I still find that a big excessive. However, I love Christmas time. The joy, the faith, the forgiveness, the family love...It's amazing.

I had the opportunity to spend Christmas with my whole family -- Brother #1 and wife, Sister and husband and baby!, and Brother #2. Plus, my mom and dad and my own husband. And Toby, the dog. That's a lot of love.

And we all get along at this point in our lives. I won't pretend that it's always been that way, but it's good now. We laughed a LOT, played games, visited, hung out...just enjoyed each others' company.

I don't think I'll be home for Christmas for the next few years, so I'm especially thankful that this one will live on in my mind as one of the best Christmases ever.

Monday, November 5, 2007


Ah, little bundles of joy. I do love babies. My sister has the cutest baby. Her blog is listed on the right. Adorable.

People always ask me if I want babies. I waffle between "no" and "I don't know." The first sounds so definite. I mean, who knows if I'll ever want babies. The second sounds so noncommittal. But, it about encapsulates my feelings on the issue.

My single friends don't bug me at all about it. Only the married ones. Not sure why. Most of my single friends do want babies some day. Maybe they don't want to jinx themselves. Maybe they just know me better.

I think my feelings on babies are this: I'd be an awful mom. I'd probably screw them up. I'd be gone too much, or not enough. I'd give them too much freedom, or not enough. I'd push them too hard, or not enough. I'd do it all right, and they'd come out bad...or I'd do it all wrong and they'd come out bad. I always say that I don't want that kind of responsibility, but then someone points out that I'm a doctor. And I think that's the point -- I can walk away from my job. If I make a mistake, if I push too much, if I wait too long...eventually I go home and have a break. I can stop being Dr. and resume being me. My fear is that you can't stop being Mom, because there's no "me" to resume being.

Plus, I'm terribly selfish. Really. I don't want to share my husband with babies. I like having all his attention. I like being the center of his universe. I don't want to spin into a corner when the babies tip our world out of balance.

Maybe someday I'll feel like it's time to open my life to someone tiny and pink and new. Until then, I make an awesome babysitter.

Tuesday, October 30, 2007

Good News!

This post will be short. And sweet.

I passed my Boards.


Saturday, October 20, 2007


Breaking bad news is never easy.

I'm a non confrontational person, so it's something I especially hate.

I remember breaking up with boyfriends in letters, rejecting potential dance partners by checking "No" in the "Will You Go to the Dance With Me? Check Yes [] No[]" notes in 7th grade.

I have had to tell a few people they had cancer in the last 3 years. That sucked. I've had to tell people they had diabetes, HIV, Chlamydia, Hepatitis C, and just about every other awful disease out there. But, when I break that bad news, it's not about me. It's about the patient and being there for him or her.

Yesterday, I had to confront a resident about whom I had heard a rumor. I had heard from a 3rd-hand source that this resident had violate a residency rule (not putting any patient at harm, but violated a policy rule that we have). So, I had to confront this person and find out the truth. It's hard -- calling someone out and asking them to be honest with you. At the end of it all, we got it straightened out, and things seem to be back on the Straight and Narrow.

I think this resident appreciated my honesty and courage to come to him for the answer. I also wasn't accusatory, but rather asked for verification of the rumor. He appreciated that, too (even though the rumor did turn out to be true). So, I'm learning how to handle people, how to manage people, and how to keep their trust and confidence even in tricky situations.

This year has been a year for character building for me. Yesterday, I worked on Courage. We'll see what next week brings.

Sunday, October 14, 2007

Music to My Ears

This might be the most personal post I ever make. It's definitely the most personal one I've made so far.

I was walking from autopsy rounds a few days ago (yes, in the morgue), and I had a very strange sense of peace wash over me -- and my main thought was how loved I felt. From my friends and family. And from my husband.

My husband is an interesting man. Without going into "How do I love thee..." let me give one example: he sings to me. He is an awful singer (as am I, which is why I can say that). But, what he sings are his own made-up songs. About me, about us, about what we're doing that day. Little jingles that encapsulate whatever he's feeling at the time. I realized a few days ago how much I love that about him.

A friend of mine has a blog, dedicated to hear search for her perfect man (See: I was fortunate to meet my husband in college, and I have seen in my many single friends how hard post-college life makes it to meet someone. Especially when you're in residency and have no time to just hang out randomly waiting to meet Mr. Right. Hang in there, Christian Girl, God's got one out there for you. In the mean time, keep blogging, as your escapades light up my day!

Monday, September 24, 2007


I wanted to make a post today, but I didn't know what to say. Something lighter after the last few.

So, I've settled on the only joke I can remember:

What do you call a dog with no hind legs and steel balls?


Good night!!

Tuesday, September 4, 2007

Where has the Easter Bunny gone?

So, I was talking with my husband yesterday. We hit on a topic about which I'd like to see how others feel. When we tell kids, "You can be anything you want!" are we just lying through our teeth?? And if we are, why do we do it? Is it like Santa Claus and the Tooth Fairy -- where we think, "They'll figure it out eventually...I don't want to be the one to rain on their parade."

For example, can you really be president of this fine nation without having a bazillion dollars in the bank? Can anyone be a brain surgeon? or a ballerina? or a singer? [If you said yes, you've never heard me sing.]

So, why do we do this? Why when kids say, "I want to be the president!" or "I want to be a professional basketball player!" do we not tell them the truth? What's wrong with telling the 5'3" high school junior that it just ain't gonna happen?

I know this seems strange after my overjoyed post about having dreams. Don't get me wrong: I do think we should have dreams. My about-face came after reading my brother's blog (; realism can put a damper on dreams. But ultimately, I think pragmatism is how you actualize your dreams. So, where does this put us in my discussion with the hubby?

I think that when you have a blank slate (read: child), it's good to encourage all avenues until they find one they love, one that becomes their dream. I think people gravitate toward what they are good at; after all, it's no fun failing all the time. So, you develop dreams that fit with your talents, making them seem attainable. So, I think, kids learn on their own (and with good parenting) what they are capable of.

I guess I've discovered that the bottom line is learning how to dream with one foot in reality.

Thursday, August 30, 2007


I was ruminating today on the topic of dreams. Not dreams as in nighttime, REM state, etc. I never remember those. I was thinking about goals, aspirations, where-you-see-yourself-in-twenty-years kind of dreams. As eloquently stated in Pretty Woman: "Welcome to Hollywood...what's your dream?!"

I've been lucky in that I was raised with a "sky's the limit" mentality. Whatever I wanted to do, I could -- just put in the hard work, and it'll pay off.

I had an experience recently, where I wanted to tackle something that I have never done before and have no knowledge about: putting on a fundraiser. I have a big dream for this -- it's going to benefit the group I worked with in Kenya, that works with HIV patients. A cause to which I've dedicated my life.

So, I starting asking people with experience, people who have done this for a living. They all said, "Great cause, great idea, you can't do it if you've never done it before. You'll waste your time. You won't get the support you need." I kindly thanked them for their time and their opinions, and I kept moving on. Several residents have also dedicated themselves to this project, so we all just kept moving.

I just got word today that a big institution is going to sponsor our event -- lend their name and their credibility to a bunch of people who have no idea what they're doing, but are doing it all for the good of the less fortunate.

We've got a lot of work ahead of us, but naysayers beware -- we're moving forward!

So, I ask you, all the way from Hollywood: what's YOUR dream?

Friday, August 17, 2007

The Wait Begins...

3 days ago I took my Boards. It's a situation similar to the Bar for lawyers. You have to pass it to be certified. It covers all of medicine. Yes, ALL of medicine. It's a bit daunting.

Studying began nearly a year ago, when I starting reading the MedStudy book series. Everyone seems to use them, and I was very happy with the organization of it all. So, throughout last year, I'd read different sections. Then a few months ago, I starting rereading, at a quicker pace, trying to pull out what I felt was essential. Basically the whole book is highlighted.

Then, I started doing practice test questions. Lots of them. I felt as prepared as I could have been, given all the rest of life that had to go on during this time. Life doesn't stop for the boards.

The test itself was l-o-n-g. 240 questions. 4 sections of 60 questions each. 2 hours per section. Sucked. Being stuck in front of a computer for 8 hours. No watches, no phones, no personal belongings. They didn't even let me bring my chapstick in there! I'm so bitter.

But, it's done. I will have to wait 8 weeks or something like that for my results. I'm hoping for a fat "P" -- no need to ace this thing, just pass.

Monday, August 6, 2007

Another test?!?!!?

That's right, another test. Just one week from tomorrow, I will sit for my boards. And I mean SIT -- for 8 hours, in front of a computer screen, answering any and every question about...medicine. All of it. Oh, the joy. I want to poke my eye out with my pencil.

When will the madness end?!?? When will They realize that I can look up any answer that I don't know on my palm pilot in 15 seconds. I don't need to memorize charts or medication side effects. I CAN LOOK THEM UP when I need them. Gone are the days of 3000 page Physician Desk Reference books on medications. Gone.

Regardless, They have got me by the throat and they are squeezing a board exam out of me. Let's all have a moment of silence and say a quick prayer that I'll come out victorious. If not, well, I was the top seller of Girl Scout cookies when I was 11. [Well, not really, but I was close.]

Sunday, July 8, 2007

To the Surgeon who slept next to me...

Dear Dr. Surgical Resident,

I understand how sleep deprived you are. I've been there myself. I also know how important it is to be up and ready to go in the morning -- to squeeze every last minute of sleep from that call-night, getting up with barely enough time to brush our teeth before rounds.

However, please please please do not set the callroom alarm clock as your method of waking up. Because, you see, when you get paged before the alarm clock's set time, and you leave, not remembering to turn it off, those of us within a 5 room radius of yours get woken up exactly when you had wanted to. And, FYI, the alarm clocks in the callrooms aren't like the fancy ones you have at home. No, they keep beeping and beeping and beeping, without the 2 minute automatic shutoff. So, from 6:18 until 7:45, when I had originally planned to get up, I sat in bed listening to your alarm, wondering where you had gone.

Next time, please use your pager's alarm feature. That way, if you forget to turn it off when you leave, at least it will leave with you.

Thank you,
Just a Girl...and an MD.

Tuesday, July 3, 2007

In helping all of these new interns get acclimated to life in the hospital, I starting reminiscing with my classmates our experiences as interns. The time when the power went out, and we had to go to the bathroom with flashlights (the hospital has a generator, but only to keep the ventilated patients alive, not to light our bathroom). The time when J got a call at 3am because the night nurse "was just wondering" why we were collecting a 24 hour urine sample on the patient. The time when we had 7 of our patients die in 7 days on the Hematology-Oncology service. The time I broke down sobbing after a night in the MICU...

I'll never forget that patient. She was in her upper 50s and had been diagnosed with metastatic breast cancer a few months back. She was admitted to the medical ICU (MICU) straight from the ER for respiratory distress. We tried to do everything we could to not intubate her. She had metastatic disease to the lungs and brain. Her prognosis was poor. In my opinion, this was it. After a discussion with her, she elected to be intubated (I don't blame her; struggling to breathe is not fun and if you offer someone a way to not feel like they are suffocating, 9 times out of 9, they'll take it).

She had a younger sister, who visited every night after work. And I mean late, like 11p - 2a. Both of the women sang in the church choir, and you could tell they had a special bond. I would update her on her sister's condition, answer some questions, and undoubtedly end up listening to some stories about the patient. We are q3 in the MICU, so I spent a few nights up listening to the sister sing, laugh about their childhood memories, etc. I surely would have loved to go to bed, but I felt like this woman needed someone to hear her.

It became obvious that the patient wasn't going to make it. She got a pneumonia and her blood pressure was dropping. We had to augment it with medications or it would go so low she would lose perfusion to her brain and other vital organs. I began having conversation with the sister about Code Status - would the patient want us to do chest compressions, etc if her heart were to stop beating. I explained that with the infection and the overall state of her sister's health, she would NOT survive the code. It would be futile. Plus, with metastatic cancer, what exactly would we be bringing her back to? After days and days of discussion, I was finally making headway. Why, I asked, put her through the pain of broken ribs and electric shocks...shouldn't we just let her go home to God?

Her sister was torn, but did start to see the logic in what I was saying. She told me that their pastor was coming the next day, and we could all discuss it then. I was on call that night, and we stayed up again, and the sister even got some of the maintenance men to join her in a few church songs!

The next day, I was eagerly awaiting the pastor. Finally, I thought, someone who will convince the sister to let God's will be done. I met the pastor, and updatee him on the patient's condition. I talked to him about Code Status, the patient's prognosis and how she would not survive the code regardless. He looked at the 2 of us, looked at the patient, and said after a thoughtful pause, "We must do everything possible." My heart sank, and with it any hope of saving this woman from the pain and futility of the code. I don't even remember if I said anything, I was so in shock. I think I just nodded and walked away. Stunned.

Just a few hours later, the patient's blood pressure took another dive. Unresponsive to medications and fluids. I was just about to walk out the door to go home, after my 30 hours on call. I saw what was happening, and I told the nurse to call the code.

I put my backpack down and went into the room. I ran the code with the Attending. After 15 minutes of chest compressions, broken ribs, IV placement and rounds of medications, I called it. Time of death: 1:35p. I went out to tell the sister, who began to sob. I simply looked at the pastor with disbelief, and I couldn't help but think: this is your fault -- she could have been with her sister as she drifted off, but now she has to hear the news second hand and wait in the hall while everyone files past her, going back to what they were doing before they were summoned to the MICU by the code pager.

I got home and went to bed immediately. My husband came home and woke me up. In my delirium of near-wakefulness, I told him the story and began sobbing. I cried because a young patient lost her life. I cried because a loving sister lost her best friend. And I cried because a pastor -- who is supposed to understand that there is far more to this life than the present -- wouldn't step up to the plate and make a decision to let her go. I hated him. I hated that pastor for what he did and how he mislead that sister. I understand now that people who don't deal with death have a hard time embracing it, though I do hope that he learned as much from that patient as I did.

Friday, June 22, 2007

Life's Not Fair

I just met our new crop of interns. Technically, we aren't supposed to call them interns anymore. We're supposed to call them PGY-1s (as in Post Graduate Year 1; I'm a PGY-4). Whatever. Tomato / tomato. Ok, that doesn't really come through in print...

They seem nervous, but ready to be moving on to the next chapter in their lives.

I got a few emails from them, as I sent out the schedule. Things like, "I have wards block 1, can you make sure I don't have call for the following 4 dates?" or "I have a wedding in Canada to go to, so can I have 2 days off in a row in the ICU?" Both of these emails have caused me to shake my head in wonder. What's happening to the doctors of the future?

First of all, when on the wards, you're q4. That means every 4th night you're on call. That means asking for multiple days to NOT be on call is not going to work. The ICU is worse, because you're q3. That's a darn rough schedule. There's no way to get 2 days off in a row, because you're on, post, off...on-post-off...etc etc. Don't ask me for 2 days in a row off, when it's not mathematically possible.

When I was a 3rd year med student, we didn't have the rules we do now -- can't work more than 80 hours in a week, can't be on call more frequently than q3, can't work more than 30 hours in a row... My first rotation was surgery. I did vascular surgery for 3 weeks. I got 1 day off. Total. I got in to the hospital at 4am daily. I didn't leave until 7 or 8pm when I wasn't on call. When I was on call (q3), I'd get in a 4a, stay over and work, then leave at 6 or 7 the next night. It sucked. When I was on OB, we were q2 for the few days before Thanksgiving. My roommate R. and I did 4 days of q2. I got done the Wed before Thanksgiving and went to bed at 8p. I didn't wake up until 4p on Thanksgiving. I almost missed the big lunch at my friend's in Baltimore.

Do I think we should go back to that? No. I was miserable, my classmates were miserable, and I'm sure patient care suffered. However, it did teach me that residency is work. It's more than a job, it's your LIFE. For 3 years. In my email to the new interns, I wrote: "Here's your schedule for block 1. I have done my best to accommodate requests. Unfortunately, you will miss a lot of things this year. You will miss birthdays and anniversaries and holidays and religious holidays and graduations. You will work on your birthday and your child's birthday and most major holidays. Residency requires a lot of sacrifice."

I heard through the grapevine that one of the R2s was upset because of her schedule. She said it wasn't fair that she has 2 more weeks of call than a lot of her friends. I said to her, "You know what? Life's not fair." To my shock, that answer didn't satisfy her. Perhaps if she did a few q2s or worked 18 days without a day off, perhaps then she'd see things differently.

I can only hope that these new residents remember my words of warning. Perhaps I should put a sign up in my office...

Friday, June 8, 2007


Today was Day 2 of my tenure as Chief Resident. Lots of drama in the past 2 days. Suffice it to say, this may be a very busy year.

I published the schedules for all 125 interns and residents today. I'm waiting for the flood of complaints, arguments, weeping and gnashing of teeth. I was extremely nervous as I went to put the schedule online. I kept thinking, "Should I check it again? Should I make sure I've everything?" I don't know how many more times I could have checked it. I'm just crossing my fingers that any mistakes that are there aren't going to be major.

Wednesday, June 6, 2007

Working 6 to 8...

Not as catchy as the old Dolly Parton ditty. Oh, well. It's actually 6p to 8a, so it's terribly depressing. It's horrible going home in the morning, only to know you've got to come back -- the same day! It's like time never moves. I hate it. Just one more night, then I'm done!

And by "done," I mean done with my responsibilities as a resident. Yep, tomorrow starts my tenure as Chief Resident. I'll be glad to shed one job and just focus on the other.

Starting this position is extremely overwhelming. I've been getting 3-4 emails a day for the last week, where the old chief is telling all her contacts that they should be contacting me. I don't even know who these people are or why I need them! I suppose I'll figure that out, slowly and painfully.

Let the games begin...

Monday, May 28, 2007

One Big Happy

I watched Grey's Anatomy for the first time a few weeks ago. Dramatically intense, medically underwhelming, but I enjoyed it.

The one thing the show's writers do get correct is the camaraderie between the residents. My class really is like a big family. You are there to support each other, you stay late to help someone out, you do shifts to get someone out of a jam. Sure, you get annoyed with each other (you do spend 3o hours at a time with some of these fools). Sure, you grumble when someone asks you to cover his clinic. But, in the end, I've gone through highs and lows, exhilarating diagnoses and gruesome deaths with these people. We're tied together by the experiences we've lived through -- experiences most people can never dream of.

Saturday, May 5, 2007

To Err is Human...

I recently had drinks with a friend of mine from residency. She was having a rough time in the ICU (intensive care unit). The ICU can be a brutal rotation for several reasons: 1) we're on call every 3rd night, 2) the patients are sick as dogs, and 3) it's a very high stress situation requiring us to be good in a pressure cooker.

My friend, J, was just about at the end of her rope. She had just experienced 2 brutal calls, the first where she admitted 6 patients, the second where she only admitted 3 patients but they were really complicated. Her problems began at the first of the two bad calls.

She admitted a patient with HIV and some kind of pneumonia. HIV patients with pneumonia are scary, because they can look ok one minute and crash the next. They can have everything from a run-of-the-mill bacterial pneumonia to all sorts of crazy stuff like fungal or parasitic pneumonias. It's not an easy situation to deal with, and they often end up requiring intubation.

This patient was no exception, and before long he was breathing an even 12 breaths per minute on the ventilator. She starts to write orders and the admission H&P (history and physical). Then the patient's family comes in.

My friend, J, doesn't know how much the patient's family knows -- do they know he is HIV positive? Many patients don't tell their families, for a variety of reasons. Some aren't open about their life style choices, some don't want to scare their families, some haven't dealt with it themselves yet, and some don't think their families have a right to know. For every person that doesn't disclose their status, there are that many different reasons for not doing so. We, as physicians, take people's medical information very seriously and do not (for ethic and legal reasons) disclose medical information without the patient's consent.

This patient, however, is intubated and sedated. No consent happening there.

"So, what do you know about your brother's medical history?" J asks the patient's brother.

"I know he said his T cells were low," the brother answers. This is a relief to J, because T cells are a marker for HIV infection and only talked about with regard to having HIV.

"So, you know about his HIV?" she asks, relieved.

"He's got HIV?!??" the brother asks incredulously. J's heart sinks. Now, if by some miracle the patient wakes up, she's got to tell him that she has just disclosed his status to his family. The patient could get angry -- irate even. He might be disowned by his family. He might even contemplate suicide.

To top the night off, the attending points out on rounds the next morning that she forgot to cover for the run-of-the-mill bacterial pneumonia. The attending is visibly disappointed in her.

After staying up all night, after trying so hard to do the right thing medically and ethically, she feels defeated. She goes home after working 30 hours in a row and cries herself to sleep.

We are talking over beer at our local pub, and she tells me she is wondering if she's cut out to be a doctor. Maybe this isn't right for her, maybe she's not smart enough or can't handle the stress well enough. Now, J is extremely bright, personable, just a terrific doctor into whose hands I would trust my own loved ones.

Nothing I can say will help get her through this. We both know this. It's something we all go through, over and over again, to varying degrees. I've made mistakes and wondered if maybe I -- and my future patients! -- wouldn't be better off if I did something else. Something harmless, like horticulture. Your confidence is shot, you second guess yourself, you stop enjoying medicine. But, there will hopefully be that next patient you connect with, who you diagnose and treat appropriately, who rekindles your passion for being a doctor.

I think it was FDR who said, "When you get to the end of your rope, tie a knot and hang on!" All I could do for J was help her tie a knot, cross my fingers, and hope that her next redeeming patient would come along sooner rather than later.

(PS...The patient did miraculously recover, and J told him about the conversation she had with his brother. The patient shook his head, "Oh, he knows I got HIV, I don't know why he said he didn't know." Crisis averted.)

Monday, April 30, 2007


I'm doing a rotation in Addiction Medicine right now, which is through the Psychiatry Department. It's an interesting rotation, because I get to both observe recovering addicts in group therapy as well as see new inpatient consults.

Group therapy is my favorite: I get to sit and observe these (mostly) men get real about their addictions, their depression, their broken lives...It's truly a gift for which I am most grateful. They are in varying stages of recovery -- some are just a few days sober, some are a few weeks, some have been down this road over and over again, and some are here for the first time. The veterans of addiction are the most inspiring, even though they have been struggling for so long. They are so brutally honest with the younger recovering addicts that it almost pains to watch. They have no problem telling the youngsters, "Hey it seems to me you're going to leave here and use today," or "You are too proud of your using, man, all I hear from you are war stories." There is, of course, a benefit to having someone with advanced medical knowledge talk to them about medications, how to organize their newly sober lives, and how to manage their coexisting depressive disorder. However, there is something invaluable to hearing from someone who has been in the trenches and who has felt the anxiety of having to live life sober for the first time in years.

So, to all those people who are Sponsors in AA, NA, etc, I salute you. Your work does not go unnoticed or unappreciated.

Friday, April 27, 2007


Many people don't know how little residents make. I think most people assume that you graduate medical school, you're officially an "MD" and you just sit and wait for the oodles of money to fall into your lap. Not quite.

Let's have a little math lesson:

Undergraduate Education: $20,000
Medical School Education: $180,000
Total Educational Debt: $200,000

That's before Sallie Mae, the hardhearted wench, capitalizes all my interest every 3 months. But, I digress...

Salary of a PGY-1: $39,000 (PGY = post graduate year)
Salary of a PGY-2: $41,000
Salary of a PGY-3: $43,000
Salary of a PGY-4: $45,000

You get the picture. My student loan bill per month would be $900. That's roughly 1/3 of my monthly income! You can't live like this! And - I'm sorry Dolly - residency is not a 9 to 5 job. More like 7 to 8, on a good day. On a bad day it's 6a to 12p...the NEXT day. That's 30 hours. Wait, did I sign up for this?? I guess I did.

I LOVE my job. Love it. I wouldn't trade it for anything. However, it would be nice to make a little bit more, to be able to start paying off my loan debt, to stop living like a starving college student, and to start living like a normal person. Someday, someday.

Tuesday, April 24, 2007

My First Blog

I hope I can keep up with this blog. Creating a blog seems like creating a child (I obviously have neither...until now) - so much upkeep and responsibility! At least if I ignore this, the Department of Child Protective Services won't come take me away. Although I didn't totally read the "Terms of Agreement," so I'm not 100% sure on that.

My plan is to recount my journey as I start my year as Chief Resident here in LA. That's like being made the Head Peon, so it only sounds prestigious. I will be in charge of putting together the schedules of about 100 residents, making sure they get the proper education during the year, scheduling conferences for them, serving on some administrative committees, etc etc. For this I will be paid just a few peanuts more than my previous salary. Ah, but that's another topic for another day...