Saturday, June 27, 2009

Sign Up for More?

I just found out I was accepted into a K30 program. That's an NIH-sponsored program where you learn how to conduct research -- ethics, statistics, logistics of research. I'd do classes during my next year of fellowship, and then I'd do another year of "fellowship" which would be most research. I'd have a class or 2 to take.

Now I have to decide if I want to do the program. It would give me more options. I'm always up for a challenge. I enjoy research. It would provide me a good framework to get an academic position.

It's another year of poor pay. It's another year of instability and "temporary-ness." It's another year of putting off the real world. It's another year of waiting for life to start.

I have 6 or 8 weeks to decide. No pressure. :)

Tuesday, June 23, 2009


Tomorrow the new interns start. Joy.

Now, don't get me wrong, I remember what it was like to start day #1 of intern year. I was on wards. Blue Team. With WW and MC as my co-interns - we had a blast. You form a bond with that first team that no one can take away.

I was very well prepared for my intern year. Georgetown gave us a LOT of responsibility as 4th year med students. We took overnight call, we cross-covered on other 4th years' patients...we were basically interns (we just needed our residents to co-sign our orders). So, my transition to intern year was pretty smooth.

Not so for everyone. Some are overwhelmed by it all. And it is, surely, overwhelming. For the first time, you're being asked to make decisions. You start to think, "Should I give this person Tylenol? Will I throw them into fulminant hepatic failure??" It's a little scary. But, you need to work through it and learn what you know and what you don't know. It's actually more important to know what you don't know, so you don't hurt anyone.

Starting fellowship was a bit like that. People are asking your "expert" opinion, not realizing that you don't know squat about your own specialty yet. But, again, you push through - read a lot, see patients and learn from them. It's a steep learning curve.

Now that I'm nearly done with fellowship (1-2 years left, depending on whether I do that research year or not), starting a new year isn't much different. More of the same. Only tomorrow, it'll be dozens of new, young faces, scared out of their wits. I'm anticipating the next week will be rough with unnecessary consults. See, the new interns start tomorrow, but the R2s and R3s are the same - they've got it down at this point. But July 1 marks a new year for residents -- the old interns are now R2s and the old R2s are now R3s. Transitioning to R2 year is tough, as you're responsible often for running the whole team. So, that's going to me a whole lot of unnecessary consults, with R2s just wanting to make sure they've got it right. [nb: these are the same people who just 2 weeks earlier (as interns) would roll their eyes when their resident wanted an ID consult to treat a simple pneumonia; things are different when you're in charge!]

So, we'll see how the next 2 weeks play out. Should be interesting, to say the least. Hopefully I can impart some knowledge on these newbies and teach them a little about ID and a lot about being a caring, compassionate doctor.

Sunday, June 14, 2009

A Beautiful Sight

This is just a quick snapshot of something I saw last weekend while moonlighting. I wish I could've gotten an actual snapshot, but here's my description.

There was an elderly woman in a hospital gown, walking down the hallway. She had her slippers on, and her shoulders were slightly hunched over. From her left arm sleeve, IV tubing came out and stretched behind her to the IV pole.

The IV pole was attended to by her husband, an elderly gentleman with the same slight hunch. He had his right hand on the pole, pushing it at the exact right pace to keep up with his wife. His left hand cradled the IV tubing, so it wouldn't pull at her arm.

Seeing them together caused me to smile. I'm sure they don't have the perfect marriage, and who knows how long they've been together. Perhaps they're celebrating 50 years. Perhaps they've just recently found each other. In either case, the dedication he showed her was genuine and touching. I hope to be so lucky as to have my partner with me during my time of need.

Wednesday, June 10, 2009

Door #1

Today was a fairly light day, by Zoo standards. We took a trip to the pathology department to try and get some information on a skin biopsy that was done on one of our patients yesterday. "We" is the attending, my resident and myself. I have only a faint idea of where things are in the hospital, so I spend most of the time following closely on the heels of the Attending. He's kind of like a hurricane, in that he's all over the place and often disorganized. However, he's brilliant with more knowledge than I could ever hope to attain. And he's super nice. I like him.

So, he's leading us down to the path department, and Resident and I are following closely behind him, like ducklings in tow. We stop at the first open door on the right - a pathologist is in there, but on the phone. We proceed to the next door, which leads to an empty office. The doctor we passed called out to us, so we go back. He tells us it's the pathologist 2 doors down who has the slides. We rush down two doors and find that pathologist. She tells us her resident is reading the slides, across the hall. In a bustle, we whip around (seemingly as one organism) and Resident and I quickly follow the Attending directly across the hall and open the door. He stops short after opening the door about 24 inches. "It's the restroom..." he says sheepishly, and I notice the "Mens" sign on the door. I stifled my laughter for a good 20 minutes after that. Even now, I laugh out loud as I think about our ridiculous journey.

Sunday, June 7, 2009

Rock Star

So, I've gotten my first taste at what it must be like to be a rock star. Here's a typical day at the Zoo:

- Get paged about 3/hour
- People calling your name out as you walk down the hall
- People waving forms in your face, asking for your autograph
- Being unable to take a pee break or a lunch break because you're so in demand

I'm going to start wearing big sunglasses and a floppy hat to see if it helps quell the masses. Something tells me they'll find me anyway.

I had a sad case of a kid (he's in his mid-20s) who we just diagnosed with HIV/AIDS and an infection in his colon. Given the degree of immunosuppression and kidney disease, I suspect he has had HIV for about 7-10 years. I think he was in a lot of denial about it all. He didn't understand how sick he really was. This weekend, he left the hospital against medical advice ("AMA"). I've been really concerned about him, because I don't think he'll come back to the clinic for follow-up. We need to start antiretrovirals on him. His CD4 count is in the toilet, and it's only a matter of time before he winds up with a very serious infection. He has a higher chance of being dead in a year than not. However, if he'd just come to clinic, we could get his CD4 count up, his viral load down, and he'd have a half-way decent chance of reaching 40. As it stands, I don't think he'll see 29.

Monday, June 1, 2009

The Zoo

So, I will refer to the hospital I'm now rotating through as the Zoo for two reasons. 1) It's a county hospital and is extremely busy and hectic. 2) The name actually rhymes with it's real name. In no way am I trying to disrespect the patients or employees of the hospital. Heck, I'm one.

So, today was my first day at the Zoo. Wow. My pager went off fairly non-stop all day. It's going to be a busy month. It's also going to be a great month, because I'm going to see some crazy, crazy stuff. Already I have a lady with pachy meningitis (I had never heard of it before today), a guy with miliary TB (where tuberculosis is extensive throughout the lung), a young man with newly diagnosed HIV and CMV colitis (a viral infection of the colon causing severe diarrhea and dehydration), and a new mother who likely has herpes hepatitis. And, I just admitted a transgendered male-to-female with a bizarre rash and facial droop.

I'm slowly learning my way around the hospital and the different things I'm expected to know and do. I have a feeling it's going to be 30 days on a steep learning curve. I'll post some updates as I get to know my patients more and hear their stories. I think I'm going to learn a lot - about medicine and about life.