A Day to Relax

I'm off today.

Completely off - no moonlighting, no pager.

I was off last weekend, but my brothers and sister-in-law came to visit. And while it was fun, it wasn't relaxing. We went out every night, usually leaving as soon as I got home from work. Like I said, we had a blast! But, it's been nice to just sleep in. (The photo is from the Venice Canals, off of Venice Beach. Quite amazing.)

Yesterday, I finished putting together a big presentation that I'm doing in September. It's about creating successful HIV programs in Africa. It was very interesting to learn about, and I'm excited to refine the talk over the next month. This presentation is why I missed the bachelorette party a few weekends ago. It's finally done!

Sure, I have a little reading to do today. Some chapters to get caught up on. But, over all, I feel like a normal person today.

It's kind of nice.

A Sad End

So, one of the great things about ID is that you can cure people. Not always, not with HIV or Hepatitis C, but for most, run-of-the-mill infections, you can cure people.

Not so last week.

We had a fantastic lady with a raging pancreatitis. The worst I had ever seen. We see a lot of pancreatitis, and most people do fine. In fact, we get kind of cavalier about it. "Oh, it's just pancreatitis." Not this time.

Our poor lady got super sick, then seemed to rebound. Then, a turn for the worse. But, she popped back! - not quite as good as the peak before, but she looked ok. Then, she tumbled again, farther down than before. A little blip back up, but then down down down.

We kept searching for abscesses, more infections, etc. We had her on excellent coverage for the bacteria we knew about; the rest was up to her body to make a come back.

It wasn't meant to be.

Her family decided that she'd had fought enough, and they elected to make her comfort care only. So, the ICU team made her comfortable, and she died not long after she was extubated.

We were really pulling for her, so our team took it pretty hard. She was such a nice, nice lady, too. I'll miss seeing her everyday.

Square One

So, fellowship is grand. I enjoy specializing and learning about just infectious diseases. I even (usually) enjoy getting a call for a new consult, because it's a new case and something to learn from.

With this new position comes a big piece of humble pie. I don't know anything. Well, I know some things, but I get a lot of calls that require me to call the person back after spending time looking up the answer...and then frustratingly having to call the attending just to make sure I've got it right.

It's a rough transition -- from attending to "intern" again. It's not the workload, which I don't mind and am very used to. It's the impotence I feel when someone asks me a question about MY specialty, and I have absolutely no idea how to answer it.

Last night the ER called me about a patient who had just returned from an African vacation with a few weeks of fever, nausea and vomiting. They wanted to make sure that if the malaria smear was negative, was it ok to discharge her from the ER with follow-up. Well, I'll be darned if I know! So, after checking the CDC website and finding nothing terribly useful about fevers post-Africa, I had to call my attending. Did I mention it was midnight? Yeah, embarrassing. She was terrific, and we talked things through (no, there's nothing else to work-up acutely in the ER). But, I still felt bad calling her.

So, I'm hoping with time I'll pick up a thing or two and be able to handle some of these questions on my own.