Just a Girl...and an MD

Just Don't Lie to Me

2012-01-31T18:58:00.000-08:00

Florence + the Machine has an awesome CD out. I love it. One song on there has a line, "I'm not calling you a liar, just don't lie to me." I find this very apropos to a patient I'm dealing with.

He has an infection in his knee. As I've mentioned here before, working in infectious diseases, I have to ask people a lot of personal questions. Where do you live, what do you eat, what drugs do you do, who do you sleep with, etc. I try to be very open and use nonjudgmental language. During my physical exam, I look at his hands and arms, trying to find other signs of infection. He has track marks on the backs of his hands and in the crooks of his elbows. These are scars from injection drug use. I already asked him about drug use, and he denied any. We don't make eye contact during my discovery, but he must have noticed that I saw them. He mumbled something about donating a lot of blood products in the past.

I sat down at the end of the exam to tell him my plan - antibiotics and such. I said again, "You know, in this job, I have to ask a lot of personal questions, and I'm sorry for that. However it's not to judge anyone or notify any one else. It's simply to help me do my job the best that I can." He said that he understands and that I shouldn't worry about it, ask whatever I want. Again I asked about drug use and told him why this is important. Again he denies it. I tell him that I'd like to test him for HIV and Hepatitis B and C, and he said ok. He doesn't seem concerned. He's been very pleasant through this whole interview, even if I don't very well believe much that he's told me.

I'll wait to get his labs back and make a plan for his treatment. He'll probably need a few weeks of IV antibiotics at home. I'm more than a little concerned that he'll go home with the nice IV we put in place and shoot whatever he'd like into it. I explained to him the dangers of this, and he shook it off and said he'd never do that. I smiled and said ok, as Florence's words rolled through my mind.

"I'm not calling you a liar..."

One Sock

2012-01-08T19:47:00.000-08:00

I was asked to consult on a patient this weekend. She is 80+ with severe dementia. She opened her eyes when I said her name, but I'm not sure that it wasn't a coincidence. She doesn't follow commands or even track me with her eyes. Anyway, she had gangrene of her foot. Her family wanted it to be amputated, because they felt it caused her pain. Unbelievably, this is not a post about medical ethics or how we treat the elderly or the quantity vs quality of life. Her other leg had a bone infection, and the doctor wanted an opinion on how to treat it. The surgeon was going to amputate her gangrenous leg above the knee. The family knew that there was a very high likelihood that she wouldn't survive the surgery; they felt that the pain she was having from the leg made that risk one worth taking.

I saw her post-operatively as well. She made it through. I was quite surprised. I went in to see her today, and she wasn't on the board. Turns out she died. Just sort of suddenly, peacefully and completely out of the blue.

I saw a list of her belongings: one neck scarf, one blanket, one winter hat, one sock. One sock. That struck me for some reason. Kind of sad, kind of heartwarming. For some reason, I felt very relieved that her sock made it home.

Silence

2011-12-27T21:32:00.000-08:00

I'm sitting up late, in my parents' front room, surrounded by the glow of Christmas lights. They have a remarkable amount of lights, for the size of the room. It can't be more than 15x15 feet. They have 4 little snow villages on the various end tables and shelves. They have lights around 2 different windows, along with the plastic - but tasteful- Christmas tree. My folks are in bed. My little brother is out visiting friends. The other 2 siblings are at their respective homes. It's very quiet.

It's a nice quiet. It's the kind of quiet that I don't get often. I am usually wearing a pager, and even on my days off it seems to chirp any way. My cell phone often distracts me with various chimes and rings. Sometimes the TV is on in the background. Sometimes my fiance is playing is guitar. The train whistles by at least once every night. When I am at my parents' house, it's usually for an event or holiday, so everyone is coming in and out at various times. My niece and nephew are usually here, laughing and begging us to toss them around. Even growing up, with 4 kids in this house, it was not a quiet house.

Tonight, it is. Tonight, I'm waiting for the lights to flip off, when their timer hits midnight. Sometimes it's nice to get recentered, amidst the bustling rush that is Life. To take a minute or 16, and just sit with your thoughts and your heart. Not thinking about the past or wishing about the future. Just sitting in the present. It feels good. I think I'd like to do this more often.

Merry Christmas to All...

2011-12-22T18:26:00.000-08:00

This year I am taking a week off, between Christmas and New Years, to spend time with my family. I'm looking forward to spending time with my family, eating some good food, and visiting Chicago to go ice skating. I love hanging out with my family, we have so much fun. I anticipate a lot of laughing til my sides hurt and keeping milk from coming out of my nose. Even as we get older, my siblings are some of my favorite people to hang out with.

I hope everyone out there can find at least one person to enjoy spending some time with this Christmas season. Merry Christmas everyone!

You've Got All Year

2011-11-07T17:48:00.000-08:00

One of my New Year's resolution this year was to be able to do a pull-up. All by myself, unassisted, like the big boys. Anyone that knows me knows that I am ultra-organized. In school, if I had a project due in 2 weeks, I had it done in 2 days. I hate procrastinating, I hate having things hang over my head, I want to be able to check it off my list - quickly.

So, when I made this resolution, I was hopeful that I could have it done by March. I rarely pick resolutions that are ongoing, like "be nicer to people." I pick things that I can count and finish. I started the year in pretty good shape, so I thought with some specific training, this would be achievable fairly quickly. I got a few sessions with a personal trainer at the gym, to help me learn how to workout my upper body a little differently.

Every week or so, I'd mosey on up to the pull-up machine and see if I could do it. It's a machine that you can add supporting weight on, so that you aren't lifting your whole body weight up. I couldn't do it alone, I'd need 40lb of help, then 25lb of help, and finally 10lb of help. I couldn't budge from there. I was using the overhand grip, because it uses more of your back muscles, and I figured those were stronger than my puny biceps.

Well, this past weekend, I walked up to the pull-up bar we have at home. I tried the underhand grip this time, and I exhaled. And then I did a pull-up. All by myself, unassisted, like the big girls.

It took me over 10 months to achieve this resolution, and I realized that that's the point of a resolution. You have 12 months to reach that goal. So if anyone else out there is thinking it's too late to check that resolution off your list...Sister, you've got 2 more months to go.

Give me the Med

2011-10-19T20:50:00.000-07:00

I have a hepatitis C patient with cirrhosis who recently started treatment. He's doing great, his viral counts went from 3 million to less than 43. It's working! Then I got his blood counts back, and his red blood cells were low. In following the guidelines, I reduced the doses of his medication. His next counts were still low. I tried to prescribe a red blood cell boosting shot, but the insurance company said no. My nurse has been more than 4 hours total this week talking to his insurance company to get it approved. They said no again today. I will have to fill out more paperwork to petition them again, and I will try to get someone on the phone to explain that if they don't choose to cover the medication, he will need to be hospitalized weekly for blood transfusions and all the risks that numerous transfusions entail.

Hopefully I can convince someone. I refuse to stop his hepatitis medication; he is undetectable and if he remains that way his risk for liver cancer and transplant drops substantially. I'll fill out any amount of paperwork it takes to get this approved, it's just sad that I have to try and explain this to people who know nothing about medicine let alone the nuances of hepatitis C treatment.

My sister

2011-10-11T20:01:00.000-07:00

Today is my sister's birthday. I only have one sister. I have a lot of respect and admiration for her. She has 2 wonderful and beautiful children. She is the strongest person I know. Literally. She can bench like 300 pounds. She works as a strength coach and helps people achieve their own fitness goals. She is passionate about exercise and health, and if I could only clone her and put her in every clinic I think we could have a fitness revolution in this country.

Happy birthday, little sister. I hope it's a great year.

A Trip Home

2011-09-27T19:08:00.001-07:00

I spent last weekend in Chicago with a friend from LA. We went on a river boat tour, architectural and historical, and it was awesome. I learned a lot about Chicago that I had never heard before. It was cool to have the city revealed to me in a new way. We also went to see The Bean, aka Cloud Gate, by Anish Kapoor - my favorite thing to go see in Chicago. We had a late lunch at The Purple Pig, which was great. The corn relish was fantastic, and the beets were phenomenal. We had an even later cocktail at The Aviary. They had some of the coolest, most innovative drinks I've ever seen. They had one called "in the rocks" which was an ice ball (about the size of a cue ball) that you broke open to find the ingredients for an Old Fashioned mixed up inside. Pretty neat.
Next we went to...Next. For dinner. It was fantastic. They had the Thai menu, which was awesome. It's only around for another few days, and then they are putting one together with the inspiration of "Childhood." There's a pretty good article that will make you want to come out and see what they put together. I know that if my friend comes back to the Windy City, we'll definitely be trying for a table!

Maybe I Don't Know

2011-08-20T13:14:00.000-07:00

I have a 30-something-year old patient with 3 children. She got pregnant young, never went to college, and I'm not sure that she actually has a job. Her children have various ailments, some of which are real and some I think she might make a big deal out of because that's all she knows how to do. Anyway, life has not been easy for her.

She came into my office the other day, and she said, "I'm so stressed, I'm having panic attacks, and you keep telling me that 'it's going to get better' well it's not better and if you don't give me something to help me we are going to have to fight!" Her speech is usually fairly pressured, and it's difficult on a good day to get a word in edgewise. I could tell this visit was going to be beyond the 15 minute limit that follow-up patients are given.

She was smiling, but tearful, as she burst out that first sentence. I heard again about her daughter with the seizure disorder who has to go 2 hours away for her specialist. I heard about the dog that is dying and the one that died last year. I heard about the children's daddy and about her mom who doesn't help out. She told me how she tells her 16-year-old daughter to go to college so she doesn't have to rely on Medicaid like my patient does. She told me that despite me telling her at the last 3 visits that "things will get better," they just haven't and she feels like she is at her wit's end.

Then she looked at me, and she said, "You don't know what it's like. You went to college, you have a good job, you don't have to worry about money like I do." She sniffled. "I can't handle it any more." I felt her honesty and her humility.

I wanted to tell her that she really needs a therapist to help her deal with stress and time management. I wanted to tell her that no pill can make her life less stressful or put food on the table. I wanted to tell her that there is no quick fix for having 3 children, no job and no support. I wanted to tell her that looking to a drug to save you is never the answer. But, I know that she can't afford a therapist, and Medicaid doesn't pay for them. She can't force her mom to watch the kids. She can't find a job that will let her off once a week to bring her daughter to the specialist.

I felt that perhaps an anti-depressant/anti-anxiety/mood stabilizer might help keep things a little more even. I did tell her that I think she is handling things very well, and that she shouldn't be so hard on herself when she needs a break. She is actually a very good mom. Once again, I told her to be strong, and we'll meet again in 4-6 weeks.

She doesn't know that I grew up with very little money. She doesn't know that I stay up at night sometimes, second-guessing my medical decisions. She doesn't know that I go in to work even on my days off, because I am a control freak. She just sees me now as her doctor, someone with privilege and no worries. I'm not saying our lives are similar, because they aren't. She has struggles that I cannot begin to imagine. I just didn't know how to tell her that her life isn't going to change because I give her a pill to take every morning. Some people just need a break, and I have nothing that will help with that.

The Other Foot...or Shoe...Whatever

2011-07-24T15:49:00.000-07:00

I took my boyfriend to have sinus surgery last week. I appointed myself his designated nurse/caregiver for all post-operative needs. I thought to myself, "I'm a doctor, I care for patients all day. I can do this."

There is a difference, though, when you're caring for your patients. Yes, I care about them. Yes, I often go home and worry about them, call the nurse later to check in on them, and check my home computer to make sure their labs are OK. But, it's very different when it's someone you really care about.

It was awful to see him in pain. It was heart wrenching when there was nothing I could do but pat his hand and wish that the clock moved faster so I could get him another pain pill. It was horrible to wonder if all that blood he was spitting out was normal.

I think I'm a very empathetic person, and this experience has taught me to be a little more patient with family members who are struggling with how to do dressing changes, how to give insulin shots and how to help care for someone who is in pain and hurting after a procedure. If I had all of those feelings of doubt, how much more will someone with no medical background wonder about all that bloody spit.

Reminder

2011-06-16T09:40:00.000-07:00

I have a patient with metastatic cancer. She's in her 40s. She just got married, after knowing her diagnosis and poor prognosis. Her husband always accompanies her to her visits. He is very attentive and pushes to make sure she's comfortable.

Her chemo is only sort of working. Her numbers are going in the wrong direction but the tumor itself seems to have shrunk. She's got liver metastases that are not getting smaller; rather they are getting very painful. I think the liver cells are starting to die.

The husband is really hard to understand, he has a very thick southern accent. She usually has to translate for me. My patient has no hair, is in constant pain, and has no source of income. She is usually in thrift-shop clothes, but dressed like she's going to church. No jeans and T-shirts, always in the nicest clothes she has. Her husband wears a trucker hat (probably because he's actually a trucker), jeans with dirt stains, and socks that used to be white. But they are proud, and they are always smiling.

And they are clearly in love, he spends more time doting of her than she cares to admit, and he makes sure all of her concerns are heard at each visit. She actually apologized to me this past visit, because it was an unscheduled acute appointment. To watch them together is to see two people who are living in the "now." They are not worried about how much time she has. They want her to continue to laugh. They want her to be pain-free enough to go to Memphis for a honeymoon. I have learned a lot from my patients, and I have learned a lot about the importance of Today from this one. It's good to plan, but it's not good to lose sight of what's going on today.

Spring Cleaning

2011-03-12T14:15:00.000-08:00

I hate to clean. I love when things are clean. I just wish they'd magically get that way.

I broke down today and did a top-to-bottom cleaning. I plan on going through my closet this weekend as well, to donate some old clothes that I don't want any more. I love the anti-clutter effect of spring cleaning. Even though I hate the process.

One big benefit to spring cleaning is that I will have to replace all those clothes I get I rid of.

...Shopping trip!

105

2011-02-19T18:46:00.000-08:00

I just admitted a wonderful, coherent woman with a low heart rate. This lovely little lady is 105 years old. One Hundred and Five!! She is totally with it. She was telling me stories about when she was in her thirties. That was in the 1940s. Amazing. I've never met anyone that old before. As a resident I met some Holocaust survivors, some of them might be getting up that high.

This woman told me about when she fell and broke her leg 3 years ago (when she was 102). She fell in the evening and couldn't move due to the pain. Oh, I forgot to mention - she lives alone and still cooks for herself. So, she grabs some nearby pillows and lays down for the night. The school bus driver goes by the next morning and notices that her shades are open, which was unusual for the patient. So, the bus driver calls the patient's daughter, who lives 9 houses down, and tells her to go check on her mom.

Do you remember a time when bus drivers know everyone on the block, when families all lived in the same town, when people looked after each other? Living in this small town reminds me of what I've seen on The Andy Griffith Show. It's quite amazing.

P.S. I ate the antibiotic-free, hormone-free chicken and it was quite good! My belly hurt a little bit later on, but I don't know if it was from the chicken. No one else got belly pain, so maybe my system was a little shocked by the real chicken. Overall, I give it an A+.

Antibiotic Free Meat

2011-01-27T15:50:00.001-08:00

Anyone that knows me knows that I don't eat meat. Most people don't know the reason I don't eat meat. I don't agree with people adding hormones and antibiotics to my food. I know why they do it - so they can pack millions of chickens in a tiny warehouse, grow them big without letting them run around and keep them infectious-free despite getting pooped on by every chicken stacked above them. However, there are dangerous side effects to this, and as an infectious disease doctor I feel that antibiotic resistance is a huge issue that I tackle on a daily basis. I refuse to feed that fire by supporting companies that promote the reckless use of antibiotics all so they can make more profit.

Now listen to this: I am about to eat my first REAL CHICKEN NUGGET in years.

I found a company, Applegate, who sells antibiotic- and hormone-free products. I was looking through the aisles at my grocery store, and I saw this box next to the veggie "chikin" nuggets. I bought them today, and I am looking forward to trying it out.

I encourage you to read a little about the use of antibiotics in food. Applegate has a great page on their site about antibiotics in food. Check it out.

In the meantime, I'm gonna eat my real, antibiotic-free and hormone-free nuggest. I'll let you know if they are any good!

New Resolutions

2011-01-06T14:56:00.000-08:00

Every year I come up with some resolutions. I think it's important to share them and be specific about how to achieve them. I have a few this year, so I thought I would put them down here.

1. Do more art projects. I am settling in to a new town and a new job, and I think it's time to put some hours aside each week to doing some projects. I'd like to finish 4 by the end of the year.

2. Do a pull-up. I know this sounds silly, but I've never been able to do a pull-up. I always attributed it to being a girl, but my sister can pump them out like nothing. It's time to face the facts: I am too weak. Along with this goal is a second one, which is to fully rehab my hip. I did the typical runner's mistake of just running and not working out. Thus, my hips and gluts are not strong enough to support my running any more.

3. Call my mom more. This is a no-brainer for most people, but I can go weeks without calling my mom. It's not that I don't like talking to her. I don't talk to most people as much as I would like. However, before I commit to calling other people more, I think mom should be at the top of my list.

So, we'll see how I do with these 3. I tried to pick very specific things that I could continue to work on all year. I'll try to update periodically. And you know I'll be running right back here as soon as I'm able to do that pull-up!

"You can only do so much."

2010-11-12T15:44:00.000-08:00

I am extremely fortunate to work with a nurse who has over 20 years of experience. She knows how to run an efficient clinic, she gives great insight into our patients, and I really feel like we're a good team. She's funny, she's helpful, and she's very honest.

I see Hepatitis C patients, and many of them have substance abuse problems - active or in the past. In order to treat their Hepatitis C, patients need to be sober from all substances for at least 6 months. Most people have gotten over their addictions, which is why they are coming to see me - they are on their way to cleaning up their lives.

Yesterday, I saw a patient with Hepatitis C who is an alcoholic. He is still drinking, despite knowing about his liver disease. His wife is also a drug addict. He can't drive because of a suspended license, so he relies on her to take him to his appointments. You can imagine that she is not the most reliable driver; she is often gone for days at a time on binges. He had to cancel 2 previous appointments with me because she wasn't home. He told me that there is a divot at the foot of his bed where he spends nights sitting up, waiting for her. Very sad.

I was telling my nurse about the patient and about how I wished there was something we could do for him - get him to AA meetings, help his wife get sober, etc. She shook her head and looked at me. "I know you're new at this and all, but you know there are some people you just can't help. You can only do so much." She's right, I just have a hard time holding patients responsible for their actions; I tend to treat them as children who don't know any better. However, patients make bad decisions all the time - and they make bad decisions knowing that they are bad decisions! Whether it's substance abuse or not following their diabetic diet or not taking their blood pressure medications, my patients are adults and I might serve them better if I held them to higher standards. I'm certainly not helping them by dismissing their weight gain, their drinking, their noncompliance as reasonable choices. I'll need to learn how to be a little firmer on some of these things.

Perspective

2010-10-31T13:37:00.000-07:00

I had a patient last week who came on a gurney. This is odd, since I work in a clinic and people are usually ambulatory. But, after my nurse told the ambulance drivers to wait in the waiting room, I went in to see the patient.

He was mid-60s with a history of high blood pressure. I had read in his chart that he had both legs amputated due to some sort of chronic wounds. I skimmed over an operating room report that mentioned a hip disarticulation - where the leg was removed completely from the hip socket. That's a pretty disfiguring operation, but one I've seen before. What I didn't read, but noticed immediately when I walked into the room, was that both hips had been disarticulated. The man was lying on his stomach, propped up on his elbows. He had long hair and a beard, like the pictures of Jesus always show. He was just a torso and pelvis. I blinked and went to the computer, smiled and introduced myself.

We had a wonderful visit, he is quite funny and talked a lot about his various art projects. He has a piece in a museum - as a part of the permanent exhibit! Quite exceptional.

He said he would probably be depressed if he just sat and looked out the same window all day. Instead, he taught himself wood whittling, knitting, and other arts and crafts. He has friends that peddle them at various festivals and fairs around town. He gets asked to show his work in art exhibits around the country. I was amazed - he's very talented, and it's always inspiring to talk to someone about their work. But, more than that, he didn't let his limited mobility make him hopeless. He recognizes what he can't do. He said he wished he were able to get around more freely. But, he also said that he wasn't going to let that stop him from doing what he likes to do.

He showed me how life is all about perspective. You might not always be able to dictate your situation or circumstances, but how you respond to them is always within your control.

On My Own

2010-10-10T15:09:00.000-07:00

I've finished two weeks of my first real job. So much has happened, yet so much is the same. My life is a cliche.

I took my Infectious Diseases boards, which nearly killed me. I am not sure if I passed. It was extremely difficult, and I left there feeling like I missed more than I got right. That's a normal feeling, I know, but it's still unsettling. It's not the end of the world if I don't pass. It would be embarrassing and a pain to have to study again, but I could take it again next year. Needless to say, it would be much better if I didn't have to. I should know in the next 2 months.

The job has been good. I've realized that out-patient infectious diseases is much more difficult than in-patient ID. In the hospital, people are super sick, and you do your best to help them get through their infection. But, in the clinic, these people are, for the most part, pretty well. They might have a non-healing wound or a weird rash, but they can walk and talk. They want a diagnosis. They aren't just going to be happy to survive, like the patients who are in the hospital. Those patients don't need a name for their infection, they just want to live; for the most part, they do. So, out-patient ID has been unexpectedly challenging.

Most of my patients, so far, are general medicine patients. They have diabetes and arthritis. They need pap smears and colonoscopies. Those patients are not as interesting to me medically, but they are quite interesting people. I enjoy talking to them and hearing about their lives. I do wish I had more HIV patients. I have one set to come in next week, and I'm supposed to meet with the ladies at the health department about referring any new HIV patients to me. I have gotten a fair number of Hepatitis C patients, which has been good. I hope to get everything set up to do liver biopsies in the next few months. So, all in all, the last 2 weeks have gone pretty smoothly.

I have had some interesting patients. I hope to get diagnoses and then post about them soon. It's always more interesting when I can figure out what's going on.

And it Begins

2010-09-19T09:35:00.000-07:00

Tomorrow I finally go back to work.

I've been unemployed now since July 1. I use that word loosely, because I took a job with a start date of September 20, so while I wasn't getting a paycheck I did know that there was a job waiting for me.

Well, September 20 is nearly here. I'm a little nervous to learn a new system, meet the new nurses and staff, and start seeing my own patient panel. There will be a steep learning curve, I know, but I hope the other parts of the transition are easy. Like, remembering people's names and knowing where the bathroom is. The little things that can make or break a day.

Next week is all orientation, which is a nice way to ease into things. Then, on September 27, I start seeing my own patients. Weird. I am sure I'll miss the nice shelter of fellowship - having people to run ideas by and talk difficult cases through. But, it'll also be nice to make the decision I want to make, rather than the decision the attending thinks is best. There will be good and bad about it, I'm sure. Hopefully things aren't so busy that I can't reflect on some of those instances here.

So, tomorrow I take my floaties off and jump in the deep end all by myself. I hope the lessons I've had for the last 6 years pay off.

In the Trenches

2010-08-18T14:37:00.000-07:00

I don't do a very good job of reading over my past blogs. Good thing I post infrequently, because then all of my stories seem new! So, forgive me if I've told this one before.

I know that I've mentioned my amazing friends. I am blessed to have a whole host of wonderful friends, all over the country. Today's focus is on my residency friends. Each year in residency is marked by "R" and the year. Intern year is R1. Second year, R2, etc. You normally stop counting after you graduate, so for me at the R3 level. An alternate way to mark time is PGY (post graduate year). PGY is better if you're doing a fellowship, because you're not an "R" anymore, you're a Fellow (so an "F"??), so PGY is more accurate. Anyway, I bring this up because my class is crazy tight and are still counting by "R"s. We're R7s this year.

I don't know it always amazes me, but our class continues to be close. We're technically 4 years out of graduation now. Last weekend, one of our classmates got married in Hawaii. There are 12 of us (of a class of about 25) who hang out on a pretty regular basis. Of those 12, 10 of us were in Hawaii to celebrate (one of the 2 who didn't come just had a baby, the other is getting married himself in less than a month).

I was telling a non-medical friend about how going through residency creates a bond that is hard to describe. "It's kind of like going to war with these people by your side..." My friend's reply: "Is that because y'all killed a lot of people?" I admit I laughed at the morbid joke. But, I think the simile really is true. You are at your worst - and you see the worst - with these people. You laugh and cry together, you share a bunk bed together, you eat together, you support each other on a daily basis. And there are definitely those days when you look across the patient's bed at your fellow resident and think, "Truly, I couldn't have made it through the night without you."

Hola!

2010-08-05T18:28:00.000-07:00

I'll try to not turn this into a travel blog.

I am in Argentina visiting a friend who has chosen to live here for her 3 months of unemployment. She's waiting for her credentials to clear at her new hospital in Florida. Being a true adventurer, she and her boyfriend decided to live in Argentina for in the interim. Because, heck, why not. I love her spirit.

I first met W in Kenya. She was a pediatric resident, and I was a medicine resident. We landed in Kenya the same day, on different flights, and met up to travel from Nairobi to Eldoret to work at the Moi Teaching and Referral Hospital. It was through Indiana University's consortium that exchanges US residents with Kenyan residents. It was a fantastic experience, and it lead met to create the first Handle With Care charity event, that raised over $30,000 for the IU-Kenya Partnership.

So, W and I met and immediately realized we were separated at birth. Have you ever met someone you just clicked with? Just immediately felt like you could spend hours with them and not get sick of them? That was us. And thank GOD, since we were in freakin' Kenya and didn't know a single soul. At least it felt like our souls were old friends.

We were inseparable for that month, besides working in different wards (she in peds, me on the women's ward). In fact, everyone there assumed we were with the same residency program, since we just got along like gang busters.

Since leaving Kenya in 2006, I visited her in Providence, she visited me in California, and I visited her in Michigan. And now, here we are in Argentina together. We made a pact to travel to every continent together (except Antarctica, no desire to freeze to death). I think that's a good goal to have - every few years, head out to a new place, learn a new culture, and have a lot of fun together.

I'm grateful for so many wonderful people in my life, and W is one of those people that I can't imagine not having around. I picture us as old grandmas, walking in Instanbul together, and it makes me really happy.

Just a Job

2010-07-28T17:51:00.000-07:00

I met up with a good friend of mine from medical school. He was in town with his wife and one-year-old son. So, after we all ate lunch (ok, the little guy did more running than eating), the wife and son went to hang out at the mall while my friend and I caught up.

V is a general surgeon in the Army. He's going to Afghanistan for 6 months, then Alaska for 6 months, then off to Texas for his surgical-oncology fellowship. His wife will stay with her folks nearby while he's doing surgeries in a tent that is only accessible by helicopter.

We spent a lot of time talking about life in medicine. How much sacrifice it takes, how much how give up, what you expect out of it, etc. It was nice to hear someone else also feel like, "Hey I'm 30-something and my life is just now starting...awesome."

We also talked about how other people look at doctors. When people ask me what I do, I cringe. I love my job - LOVE it. But, the scene always plays out the same way. THEM: So what do you do? ME: I'm a doctor. THEM: (silence)

V said, "You know, at the end of the day, it's just a job." And he's right. It's just a job. It's a way for me to make money so I can live, like anyone else with a job. I think it's hard in medicine to not let it take over your life, so that's probably different than most professions. But, V's point was just that - don't let it consume you, it's just a job. It's something I am struggling to put into practice. This profession will suck you dry, it will take and take and take. People will ask and beg and pull more of your time. I probably need to be a little more removed and treat it more like a job, before I get so burned out I have to walk away.

D#11

2010-07-11T15:24:00.000-07:00

Today is day #11 of unemployment. I finished fellowship on June 30, and my freedom began. I've gone in to work a few times to do some liver biopsies. I've been studying 2-4 hours a day - my boards are in October. I've been sleeping in a bit, playing around, shopping. It's been fun.

I did some moonlighting last weekend. It was nice to be back in the hospital, rounding on the patients.

On patient was 19-20 years old, I forget exactly. He was diagnosed in his mid-teens with a genetic liver disease and got a liver transplant. Now, he's in the hospital after having gotten a round of chemo for a newly discovered leukemia. His immune system is literally at zero. Geez, I think, how much bad can one person get? I walk into his room, and he's not there. I walk back out, and this big guy attached to an IV pole is walking around with a surgical mask on. He asks if I'm looking for him, and I say that I am. He goes into his room, and he sits on his bed, taking his protective mask off now that he's in the confines of his own room with his own germs and no one else's.

He says he's doing fine. He was out doing laps for exercise. I listened to his heart and lungs, which all sounded fine. He hadn't had a fever in a few days, so I figured he was on the mend as far as his infection was concerned. His recent bone marrow biopsy looked clean, so one more was going to be done in 2 weeks. If that was clean, he was good to go - in remission, and able to get on with his life...albeit with frequent doctors visits.

We chatted for a bit, and he walked out with me, putting his mask back on. He said he was on lap 17 of 30, so he wanted to get back out there to finish. I said good bye, and told him I'd see him the following day. He thanked me and began back on his trek around the nursing stations.

I just smiled in disbelief. This was a kid who should be out playing basketball with his friends, sitting on the beach with his girlfriend, or just fooling around on his computer in his own room. He should be angry and frustrated about his situation. He has a liver from someone who died. He's getting toxic medications to wipe out his own bone marrow. He's at risk for infections every time he leaves his room or someone comes in. His life span, in all probability, isn't going to be what his best friend's is.

But, he was smiling and gracious, positive and determined. I don't know why I thought he'd be depressed. It's the only life he has, why would he spend it being miserable? You just keep going, right? Whether you miss your flight, crash your car or get diagnosed with cancer. We all come up against obstacles, and how we deal with them defines who we are. Sit down and pout or get up and keep going.

As I go through this transition period of the security of fellowship to the unknown world of being on my own, I hope I can have the tenacity that this young man has - the strength to keep getting up no matter how many times I get knocked down.

Pagerless

2010-06-30T23:22:00.000-07:00

Today was my last day of fellowship. I'm pagerless for the first time in 8 years.

This has been a long, long journey. I'm not sure I've ever told the "how I knew I wanted to be a doctor" story. Unlike some of my friends, it wasn't something I ever thought about doing. I didn't know any doctors. No one's dad or mom was in medicine. It wasn't something people did where I grew up. I'll save that story for another day.

Today wasn't a bad day. Busy, but not terrible. I turned in trusty pager 3446, thankful to never hear the screech of that thing again. I updated my sign-out, the list of patients we are actively following, for the next fellow coming on. I took a few last phone calls, talked to some residents about the plans for their patients.

Soon it was 5p. I unceremoniously got up, put my white coat on, grabbed my purse, and left. I saw another of the fellows, and said I'd see her tomorrow for the "We're Unemployed!" Party I'm hosting.

I walked out of the VA. It won't be the last time. I have a few more days of liver biopsies to do. But, it was my last day leaving as a fellow. I felt like there should've been music, fireworks, something. Instead, I just felt a great sense of accomplishment and freedom. True, those feelings were mixed with the nausea of wondering how I'm going to fool people into believing I know what I'm talking about.

Every one's journey to being a doctor is different. Mine was pretty straight forward. College for 4 years, then med school for 4 years. Residency was 3 years, plus an extra year for the Chief Resident year. Now, 2 years of fellowship have ended. That's 10 solid years of medical training. Ten freaking years. On the one hand it's a ton of time. On the other hand, there are a whole host of diseases I've never seen. Heck, there are a ton that I've barely read about, let alone seen with my own eyes. So, although I'm as prepared as I'll ever be, there's always that feeling of wanting to train just a little bit longer.

Eventually, we need to step out of the nest and see if we can fly. Let's hope the next years are as great an experience as the last 14.

Robbed

2010-06-21T20:43:00.000-07:00

The past few weeks, I've had a difficult patient. His personality isn't difficult; he's a complete sweetheart. His case is difficult. He has lung cancer that is nonoperable. So, he's dying, but not any time soon. About a month ago, he came down with a case of Clostridium difficile diarrhea. It's a terrible infectious diarrhea that is most often caused by giving someone antibiotics.

(Allow me to step on my soapbox...)
Do. Not. Ask. Your. Doctor. For. Antibiotics. Ever. There, I've said it. We can't cure everything that ails you with amoxicillin. Not every sniffle needs Augmentin. Not every time your kid pulls at his ear is it infected. Your body's natural immunity does a darn good job most of the time. If you doctor says it's a virus, go home, drink your 7-Up, take a hot bath, and go to bed. Atibiotics always carry a risk with them, and people forget that. They aren't Tic-Tacs. They are drugs with side effects, some of them dangerous.
(Stepping off my soapbox...)

So, Mr. W got a bad case of C.diff. He got treated for 2-3 weeks, which is standard. His diarrhea slowed down, so they stopped it. However, a week later, the diarrhea returned with a vengeance. We started him on our most potent antibiotic for C.diff. Three days later, no improvement. His tests for the bacteria were negative, but no one believed them. His case was classic for relapsing C.diff.

I doubled his antibiotic dosage. No improvement.

His white blood cell count climbed every day. 16,000. 25,000. 33,000. 45,000. [normal is 6,000-10,000). He was getting weaker and weaker. He lost his appetite. I kept assuring him that it would work. That we would figure it out. That before long he'd be back in the nursing home where he could talk to his friends and watch movies.

The team called me on Saturday morning and said his chest X-ray looked like it had a small pneumonia. I wasn't too impressed by it, and I asked them not to treat it. He had no fever, no respiratory symptoms. More antibiotics would make the C.diff worse. They agreed. Twelve hours later, he had some shortness of breath, so they started some antibiotics. It was a reasonable thing to do.

Sunday, his chest X-ray LLS. That's my shorthand for "looked like sh^t." I think I learned it from my surgical chief resident. More important, Mr. W himself LLS. He was on a face mask delivering high flow oxygen, and he was breathing fast. But, he said he was comfortable. He told me how he was doing. I told him, as I had every day for the past 13 days, "Don't worry, we'll figure this out."

Today, I walked into his room, and he looked like death. He was always cachectic - so skinny you could see his ribs, and his temples were sucken in. But, there's a look that death has. Once you see it, you know it. Mr. W was there.

My eyes welled up. The respiratory therapist (RT) was in the room, giving him a breathing treatment that was clearly futile. I asked how Mr. W was doing, and he told me the obvious. I leaned over Mr. W, and listened to his chest, even though I knew there was nothing I could do. A few tears fell on Mr. W's sheet. The RT said, "Did you know him?" I told him I had taken care of him for the past 2 weeks. He asked me if I was ok. I thanked him for his concern, and I told him I'd be fine.

I just felt like I didn't do a darn thing for Mr. W. I told him it was going to be ok. I told him we'd figure it out. I told him he'd be better soon. None of those things happened. I don't know what killed him. I don't know if he had relapsed C.diff. I don't know why he got septic.

I just know I felt robbed.

I felt like Mr. W was pulled out from under my grasp. I thought I had a hold on him, and I didn't. I thought I could pull him out, but I couldn't. I was robbed. What hurts more is that I feel that Mr. W was robbed, too. Of a few more months. A few more movies. A few more laughs with his old buddies. Yeah. He was robbed.

I'm Crazy??

2010-06-19T16:14:00.000-07:00

I was doing a liver biopsy on a patient yesterday. He's about 58 or so, very nice guy. His arms were covered in tattoos, from shoulder to wrist. His abdomen and chest were also covered. I told him I was going to be getting my first tattoo, and I asked him what he thought. He said, "I think you're crazy!"

I laughed and said, "I'm crazy? After you've got all these??..." He countered with the most logical answer: "Well, I got mine in prison."

And....End scene.

I did not see how that answered my question at all. Regardless, I pushed him on it, and he said he spent about 10 years in jail in Indiana. I told him I went to college near his jail. I figured this made us something akin to blood brothers. He didn't seem so moved.

He said that in jail, they would sharpen down the E string on a guitar to a sharp point. Then they'd rig that up to a tape cassette player and turn it on. The mechanism that would spin the heads somehow fashioned an amateur tattoo gun. I said, "Wait, you got most of these in jail - even the colored ones?" He said yep. He said, "I don't know how they do it now a-days, I haven't been in for awhile, but that's how we did it."

I guess if you've got 10 years to kill, painfully marking your body is one way to pass the time. I was mostly impressed at the resourcefulness of these convicts. I was also mostly convinced that was how he got Hep C. Regardless, he has some beautiful pictures that I'm sure represent the many people and many situations he's lived through.

Proud Asian Mom

2010-06-14T21:45:00.001-07:00

This past weekend was the West Hollywood Gay Pride Parade. It was fantastic. There were lots of fancy costumes, lots of floats about safe sex and HIV awareness, and a lot of half-naked men. Not bad for a Sunday afternoon if you ask me.

It was the 40th anniversary of the gay pride parade. There's a great history of the parade at this link if you go the side link that says "history." Quite amazing.

There was one parade participant who nearly brought me to tears. The elderly lady above was walking with 2 young men. Her sign says, "Proud Asian Mom of a Gay Kid." This woman registered as a parade participant. She may have had to pay an entrance fee. She had to make her sign. She went through all that trouble to show support for her son.

How amazing. My mom doesn't have to march in a parade to show her support for me. I'd like to think she would if it came down to that. As it stands, my vote for Mother of the Year goes to this proud Asian mom. And I'm sure there's a proud Asian kid out there who thinks the same thing.

Stuck

2010-05-28T22:54:00.000-07:00

Literally.

I was doing a liver biopsy today on a man with Hepatitis C. He needs it before he can get his kidney transplant. Fortunately, he's HIV negative and already immune to Hepatitis B.

I was numbing him up with 20cc of xylcaine. I finished and went to recap my needle. I don't always recap. I often leave it laying out, attached to the syringe. But, I'm always afraid that I (or someone else) will get stuck reaching in to the tray for a gauze pad or something. So, I found the cap and pushed the needle in, without using my hand to hold the cap - just like we're taught. But, the cap kept sliding around, so I used my knuckle to brace the cap. Well, I pushed the needle too hard, and it popped through the cap and poked my knuckle. Hard.

I immediately knew what happened, and I could see the blood pool under my glove. Dang it. I tried to biopsy the patient, but somehow missed. In my defense, he had tough anatomy. Oh, and I just stuck myself with a needle. Right. So, Dr. P stepped in and did it; he got a great sample, so it was all good. I degloved, washed my hands with soap and water and put a bandaid on. I finished up with that patient and started on the next one. I had a presentation to give at noon, so I had to bail on the next biopsy and head up to the conference room.

I didn't tell Dr. P right away. I was embarrassed - I should've known better. I could have just left the stupid needle uncapped. Plus, I didn't want him to lose faith in my ability to do more biopsies. I'm still committed to this patient population, and I want to learn this skill.

So, as our afternoon clinic winds down, I finally tell him that I stuck myself and ask if I can leave clinic to get to employee health to get my labs done. He was shocked, and said of course. While I'm in employee health, my cell phone rings: Dr. P. He says he was shocked to hear of the needle stick, and he wants me to know that he's there for me and with me during this whole thing. It was awesome of him to call and say that. He said to make sure the physician assistant (PA) in employee health orders an HIV RNA PCR now, at 2 weeks, at 4 weeks and at 8 weeks. He said he can get the PA a dozen articles saying that is the best way to handle acute Hepatitis C. I thank Dr. P and hang up.

The PA said he can't order it, because it's not in the protocol. He says he will order a Hep C Antibody. I ask him if he really thinks I've started making Antibodies in the last 3 hours. I'm not mad at him, but I'm trying to show that the Antibody is a waste of a test. So, I call Dr. P who has left clinic. He says he'll go and meet me back in clinic so he can order the proper tests himself.

Normally, if you're going to get infected, the PCR is positive by week 3. In acute Hep C, if you have a positive PCR and it doesn't decrease on it's own by 8 weeks, you need to start treatment to cure it. He admitted that I'm a low risk in the sense of the way I was stuck, but it's fairly high risk given the patient is known to be Hep C positive with a high viral load.

So, I've become Dr. P's personal patient. He's quite the world expert in hepatology, so I'm very fortunate that he's overseeing my care. He has taken quite a liking to me, and he has really pulled me under his wing to learn about Hep C and all liver diseases, really. It's nice to know he's in my corner, even though I'm pretty confident that I'll come through this with just a bruised knuckle.

To Whom It May Concern

2010-05-09T16:40:00.000-07:00

I did some moonlighting this weekend, which was much needed since I just signed up for my ID Boards - $2060. For a stupid test I don't even want to take. {serenity now...}

I had an interesting juxtaposition of patients this weekend, two in particular.

Patient 1 was a new admission. He's in his mid-20s, a student of some kind. I couldn't ask him because he came in unresponsive with a Glascow Coma Score of 6 (1+4+1). Why did he have no purposeful movements? He had been partying the night before with crystal meth and GHB. Oh, and his tox screen later revealed cocaine. GHB is often used as a date rape drug because it renders its users unconscious. However, before this end result, it can give a euphoric rush. So, his friend brought him in barely breathing, heart rate down to 50, body temperature a cool 94 degrees Fahrenheit. It's hard not to get angry at your patients in situations like this - a young kid, his whole life ahead of him, just spinning the Roulette wheel with his life.

Patient 2 is just over 60. Her lymphoma came back and isn't curable. She's actively dying. Her sister flew in from the Midwest and asked how long I thought she had. I guessed about 3-5 days. She asked if I could write a letter so she could go get herself instated as the patient's durable power of attorney. I know this is what the patient wanted, so I said sure. I wrote a simple letter, something like this...

To Whom It May Concern;

This woman is my patient, and she is unable to make her own decisions due to losing a long battle with a fatal disease. According to her wishes, her sister is to act on her behalf.

It made me want to write a letter to Patient 1.

To You, For Whom I'm Concerned;

Don't blow this life. Don't make the mistake of thinking you are invincible and immovable. You, like the rest of us, are made of frail skin and bones, and your heart is but a muscle that can only be stretched so far. Take this opportunity to get your life in order. You've been spared Death, just barely, this time. But, Death is fickle, and he may not be so forgiving next time.

"You'd be amazed."

2010-05-04T22:58:00.001-07:00

This is a completely non-medical post, so if you normally read this for the medicine, you can skip this one. Just to make it worth your while, here are two snippets: 1) we may have a man with measles up at the Zoo and b) we have a super resistant bacteria in a patient with no good options to treat him. So grab your Purell and come back in a few days, I should have a medical post by then.

I have been having a few days of feeling unappreciated. Underappreciated? Whatever. You know those days where you think, "Why doesn't anyone say thank you? Am I completely invisible?" I started thinking that I could disappear for a few days and relatively few people would notice and probably even fewer would really care or worry. I just starting feeling insignificant.

Now, to be honest, I haven't gone to church much lately. Ok, at all. In like weeks. OK!, OK! months. Geez, cut me some slack, I work most every Sunday. I remembered that song from Veggie Tales - "God is bigger than the boogie man..." And I realized that God cares, God appreciates me, God smiles when I do something nice for someone.

I read this blog that reminded me that not only is God an encouraging supportive force in my life, but God is also a strong protector. Check out this blog if you have time; grab a box of tissues before you go. This woman has the strength of an ox, and she reminded me that with God we can do anything. I love love love how she finished a recent blog, so I'm going to leave you with her thoughts:

"If this past year has taught me anything, it is that I can lean hard on my God. He can handle it all. Every priest and pastor who has counseled me along the way has said just that. The error comes in thinking that He cannot, in thinking that we have to shoulder the fear, anger, frustration, and hate ourselves. We don’t. It is not our job. God can even handle the F-bomb. You’d be amazed."

Amen, sister. God can handle the F-bomb.

Why, Grandma...

2010-04-29T20:04:00.000-07:00

I thought of Red Riding Hood today, because I saw an older lady up in the clinic up at The Zoo. She was in her 60s. She was referred because of a confusing test result. Remember, in the fairy tale, how Red Riding Hood saw the Wolf who was pretending to be her Grandma. And she said, "Why, Grandma...what big eyes you have!" And the Wolf slyly replied, "The better to see you with, my dear..." And on and on.

Anyway, this lady was like a Grandma. In fact, she could've been a Grandma (I didn't ask her; I know she has 2 kids). I had to tell her that we had gotten her confirmatory test results.

Why, Grandma, yes it is an HIV virus you have.

Wow. What a life-changing day at the doctor's office. She knew that the original test was positive but the confirmatory test was negative. So, the other doctor sent a blood test to see if the lab could see any actual virus in her blood. They saw over 200,000 copies.

At first, she seemed ok with it. Then, I asked her how much she knew about HIV, and whether I should start from the beginning. She lost it. The translator turned to me, looking as helpless as I felt. I put my hand on her leg and said I would do a basic overview today, and I asked her to write down questions over the next 3-4 weeks and ask them at the next visit. She was really strong and pulled herself together. So we went through everything, and I think she'll do great. She's smart, she's organized, and I think she'll take control of her disease rather than the HIV taking control of her.

Hopefully, I'll be the one to see her in a month. It's an immediate bond you build with someone, when you share that diagnosis with them and do the initial education. I'd like to be the one to start her on her meds and encourage her progress. I have a good feeling about her, I think she'll do quite well.

Stage 4

2010-04-16T20:56:00.000-07:00

Friday afternoons is Hepatitis Clinic at the VA. I love Hepatitis Clinic. I love the attendings there - both the ID attendings and the liver attendings. I love the patients - let's face it, if you have Hep C, you've probably lived an interesting life. I love the virus - so sneaky, so hard to treat. I may be the only fellow who loves that clinic, but I love it.

Today, I had a patient. He's got Hep C (obviously), but he also has been having nightly fevers, sweats and has had a 20lb weight loss over this time. The ID fellow who saw him 2 weeks ago ordered a bunch of lab tests to try and figure this out. TB was negative, endemic fungal infections were negative. His white blood cells were high, signalling some sort of inflammation/infection. Two random tests came back minimally elevated: Murine Typhus and Q fever.

Now, Murine Typhus holds a special place in my heart. As a resident, I once put a man through a million dollar work up (literally, I saw the financials) before I talked to the ID fellow who recommended I check for Murine Typhus. It was positive. Ever since I've never had a problem humbling myself to ask for help. I also decided that ID doctors were the coolest, smartest people around.

Q fever is a tricky diagnosis. If you don't think of it, you'll never diagnose it. My patient lives in the sticks, so he could've picked it up from whatever farm or wild animals go roaming through his backyard.

I elected to treat him - both diseases are treated the same way - and have him follow up in 3 weeks to see how he's doing. Of course, the treatment of his Hep C is on hold until we get this other diagnosis made.

His liver disease is pretty far gone. His liver feels like my kitchen table, rather than a water balloon. He has tendon contractures in his hands, which is a sign of late liver disease. I would suspect that if I biopsied him, he'd be Stage 4 - cirrhosis. This means we need to treat him now and hope he responds. He's got about a 30% predicted success rate based on his age/virus type/etc, which is admittedly not great. But, I don't think I have time to wait 1-2 years for the newer drugs to come out, because I don't know that his liver will hold up that long. It's going to be hard enough to cure him if he has frank cirrhosis, and the more cirrhotic he gets the worse it'll be.

I didn't tell him all this yet. Better to find out what is causing his acute symptoms, then deal with the chronic liver disease. I'm hoping he'll do well with the Hep C meds, but I'm not terribly optimistic. It will be hard for me to sell him on the treatment when I have such low expectations. Then again, I don't have anything else to offer him at this time.

The Hope Trap

2010-03-24T16:45:00.000-07:00

So, I did some moonlighting the other day. Shocking, I know. This was for an Infectious Diseases group, and they usually have some pretty interesting cases.

This, however, turned out to be a day of super sad cases.

The one that sticks out in my head most is a 22-year-old girl with the rarest of rare cancers diagnosed about 8 months ago. She has metastatic disease to her abdomen and lungs, causing fluid build-up in each of these cavities. We have to put a needle in her abdomen and one in each lung space every so often to drain the fluid. It keeps reaccumulating because of the tumors.

We have an expert at our hospital, so she came in for a second opinion. There is one case report of another woman who had the same cancer (different point of origin, less metastatic disease) who was alive 7 years after getting this certain chemo regimen. So the oncologist said, "What have we got to lose?"

Obviously, her parents are hoping for a miracle. The patient had gotten one round of chemo, 5 days before I saw her. I was seeing her for a possible pneumonia, which was not really a pneumonia but actually just cancer in her lungs that looked like pneumonia. But, rather than risk being wrong, we were treating her for the slim possibility of an overlying infection. It wasn't helping.

Her next round of chemo is in 6 weeks. I don't think she'll live that long. I also don't think that her cancer is going to magically melt away after one round of chemo...it's just so extensive.

Should we have even given her the chemo? Are we just feeding a false hope? It's hard not to be optimistic (even stupidly optimistic) when you look a 22-year-old girl and her parents in the eyes. You really want to believe that this might work, even when you know the odds are overwhelmingly against it.

I call it the Hope Trap.

We desperately want to give good news. We want to believe that our patient will be the exception to the rule. And I think that's ok, to an extent. However, we also, simultaneously, need to be preparing the patient and her family for the likely result of death. We need to assist in that transition - just in case. We need to make death an acceptable ending and not a failure. If - no when - she dies, it's not because she didn't fight hard enough or because the doctors did give enough medications or because the parents didn't pray enough. It's just because the cancer was too deep and her body got too weak. No one failed.

Death is the natural result of living, and I think we forget that.

Timing is Everything

2010-03-18T18:13:00.000-07:00

So, I just got home from the Zoo. Clinic was disastrous as usual. But, since it wasn't any more disastrous than usual, it seemed ok. I had to act as the attending on a few patients because we were short attendings. The clinic is definitely much better from that view, let me tell you. No paperwork, no phone calls, no making the sure the lab got the sample. Just give advice, sign your name, and next patient please. Not bad at all.

I saw my own patient this afternoon who is still an enigma. She's from the Middle East and presented with a monstrous liver cyst that we found on ultrasound and confirmed on CT. It's probably a parasitic infection that is often seen in that part of the world. However, we don't know how active it is, if that's really what it is, etc. She came in a month after we diagnosed her and announced that she's pregnant. Now, we're trying to figure out a) how do we diagnose what this thing is, b) do we need to biopsy it and how can we convince the surgeons to do that, c) do we empirically treat her with a drug that will likely harm the baby, d) do we take the chance of this thing rupturing as her uterus gets bigger - which would send her into anaphylactic shock and a chance of death for her and the baby. Oh, and did that CT scan she got 2 months ago...did that happen before or after she got pregnant? The timing is pretty close. That's a hefty dose of radiation, and I'm not sure a fetus would survive and if it did survive what kind of long term damage it would cause. I mean, the fetus would've been a few cells big at that time, so I can't imagine it would survive that blast of radiation. However, I got her to see the OBs tomorrow, so we'll let them track back for the timing of everything and see what their recommendations are.

So, now we're in this dilemma - diagnosis with a biopsy might harm the baby (not that I could convince any surgeon to get in the same room with her, let alone put a needle in her), treating without a diagnosis will probably harm the baby, taking a wait-and-see approach may lead to anaphylaxis...do you recommend termination of the pregnancy? We don't even know what this is, for all we know it's a benign cyst with no risk to the patient at all, save the abdominal pain that will occur as the uterus grows.

I don't envy this woman and her husband, they have a big decision to make without a lot of information. Hopefully, in the next month or so we can fill in the holes so they can decide what's best for them.

Unlimited Energy

2010-03-08T14:10:00.000-08:00

I'm back home, visiting my parents, sister and her husband, and my niece and nephew. My niece is nearly 3 and my nephew just turned 1. They are adorable. I love them to pieces.

They wear me out.

My sister has a long body pillow, like 4-5 feet long, and we found it yesterday. My niece loves it. We discovered a game today, which she calls "Hannah's Game." Hannah's Game is going to be the death of me.

We put the pillow on the arm of the couch. She then sits on the pillow, balancing, while I sit on the floor. We pretend she is getting off balance, and I pull her and the pillow off into my lap. That's fun, but that's not the end of it.

Next, I hold the pillow with her laying in it. One hand on her lower back, one hand under her legs. Then we count to three and I launch her and the pillow up on to the couch. She weighs about 30lbs, I'd guess. So, it's like military pressing 30lb. Over and over and over again. She shrieks with delight, and says, "I haffa do it again!" After about 20 rounds of Hannah's Game, I need a break! Fortunately, I can usually distract her with a less intense game while I recover.

I'm sure the afternoon will have many more rounds of Hannah's Game for us to enjoy. I'm hoping I can come up with an easier game for tomorrow, or I'm going to be one sore puppy.

Interesting Observation

2010-03-01T12:31:00.000-08:00

I take a class on clinical controversies, which examines clinical trials and looks at what went wrong, what could be done better, etc. Last week we had a hematology-oncology attending come talk about 2 cancer studies. He made a comment in passing that really hit me.

We were talking about lung cancer, which is his specialty. It's the #1 cancer killer of both women and men. He said that most people, even doctors, are shocked when they hear that. He said breast, prostate, even colon cancer get a lot more publicity and research money despite causing so many fewer deaths per year.

He then said, "I think the numbers shock peope because whenever you read an obituary and someone dies of lung cancer it just says 'So-and-so died of cancer.' But, if they die of breast cancer, for example, it says, 'breast cancer.' Read the obituaries some time - if it doesn't specify the cancer, it's probably lung cancer. And if it does say lung cancer, they will go out of their way to say that the person was a non-smoker."

I never thought of that, but it really rings true. I think there's a stigma attached to lung cancer - like you did it to yourself (hence the quickness to point out if someone was a non-smoker). I also think people don't want to organize marathons or raise money around lung cancer because it's so preventable. There's a lot of blame attached to lung cancer, inherently. I never thought about it, but I know that when I hear of a smoker with lung cancer, I think, "Well, what did they expect." This doesn't mean that I give them worse care or that I treat them badly. It just means I have a little less sympathy for them. Same with alcoholic patients with cirrhosis. Maybe it's because we see these patients in such volume that you get jaded to the individual patient. You see them as another smoker with another lung cancer. It's just sad.

I think people probably do this with HIV as well. It's super easy to rally around kids with HIV - they are innocent in their disease. But people with multiple sexual partners, people who use IV drugs...those people are gambling and losing. I don't know why I have so much more sympathy with HIV patients. Maybe because people diagnosed with HIV in the beginning were "innocent" - no one knew how it was being passed around, no one knew who was going to get it. And these people were shunned, attacked, and left for dead. Literally. When I see a person recently diagnosed with HIV, like any other preventable condition, it makes me sad. I can't understand why they don't protect themselves.

I guess it's time for my pitch: Stop smoking, no excessive alcohol, no intravenous drugs, practice safe sex, wear seat belts and use sunscreen. Life ain't half bad if you can surround yourself with lovely people and act lovely in return. Might as well make it last.

Last Night??!!?

2010-02-25T19:16:00.000-08:00

I saw a patient today in clinic at the Zoo. He was diagnosed with HIV in December. Actually, he meets criteria for AIDS, because his immune system is so shot. He also had a terrible brain infection with Toxoplasma gondii. He came in, at that time, very confused and unable to care for himself. His wife brought him in. She, fortunately, says she tested negative...at least so far.

I see him today, 2 months after being discharged from the hospital. He left with 3 medications to treat his meningitis. He told me that he stopped taking his medications a week or so ago, because he felt that they were causing burning when he urinated. I think my jaw hit the floor. He has an active parasitic infection in his brain, and he stopped his medications on his own because of some pain when he pees. He claims the burning has stopped now that he's off the medications. I'm not challenging that he got the symptoms - people get weird side effects from medications. I'm questioning his judgement and understanding of his illness in stopping his medications without consulting a doctor.

I looked at my translator and asked about 3 different ways if he was really not taking his medications. His wife agreed that he had stopped taking his meds. She didn't seem to think this was unusual at all. Their 3 year old boy was playing with the paper on the examination table, and all I could think was, "This kid isn't going to know his father." The man has a limited lifespan even in the best case scenario, and not taking his medications does not exactly put him in the "best case" category.

I presented him to Dr. D, the attending, who is very hands-on when it comes to couples with HIV. She wanted to come talk to them herself.

She asked if the wife had been tested - she claimed yes, and it was negative. The wife then claimed that the nurse hadn't set her up for a repeat test. Repeat testing is standard procedure - in discordant couples the negative partner should be tested every 6 months. So, we began to question if she really got tested in the first place. Dr. D asked them when was the last time they had sex. The wife looks at the husband, who says "Ayer." I think he's speaking English, and I ask, "A year?" The translator looks at me and says, "Last night" (literally, "Yesterday"). Dr. D looks at them and say, "Last night?!!?!" She then went on a rampage about how he has a sky high viral load, is amazingly infectious, and does she want her child to be an orphan. She said, "I don't want you having any relations until he is on HIV medications." They agreed, but I am not convinced they are going to follow this advice.

We explained backwards and forwards how HIV works, how serious his brain infection was, etc. They kept saying they understood, but they didn't look scared enough to have understood. Even the translator was worried for the wife.

They are supposed to come back next week, hopefully after him returning to taking his meds, hopefully with her getting an HIV test again, and hopefully with them in the right mind to take care of themselves. We don't need another child watching his parents die of AIDS.

Nonsense

2010-02-20T19:53:00.000-08:00

I am moonlighting this weekend. It's for an Infectious Diseases group, so I like it. I get to see some interesting cases, learn from those great MDs how they are managing the cases, and I get to make some extra cash. The only downside is I have no day off for weeks and weeks. Oh, well, there are pluses and minuses to everything.

I had a patient today who was really interesting. I think I've said this before, but a patient's wife once told me, "You never want to be an 'interesting case' - it doesn't usually bode well for the patient!" She's right. "Interesting" to doctors usually means rare, bizarre, and usually portends a bad outcome.

This super cute, elderly patient had a bone infection in his ankle and foot, because he's bed bound after a massive stroke. He got a pressure ulcer on his ankle with an infection that eventually settled in to the bone. That, in and of itself, is not interesting at all. That's run-of-the-mill infectious diseases. Dime a dozen stuff. His stroke, however, produced a fascinating symptom. I'm pretty sure "fascinating" can be added to "interesting" in the list of things you never want to be called by a doctor.

The patient is aphasic. Wikipedia has a great chart that describes a bunch of different language disorders often resulting from stroke or brain injury. This patient has Wernicke's aphasia. He probably doesn't understand me much, but I can't tell because I can't understand him at all. He has no trouble enunciating. His words are just a bunch of garbage for the most part. Some are real words. Some are made up. Most just don't go together at all.

I asked him how he was doing. He said, "Well, the angels all go in a row, and then baddle and baddle, and then it's done." He then looked at me and asked, "How diddy come splot and biggin to know?" I had no answer, so I just said, "I'm not sure..." It was terrible, because I didn't know if he comprehended that he made no sense and that I had no idea what he said. He seemed happy enough, "pleasantly demented" as we usually say. But, in this case, he's not demented, he just has a problem with the language center of his brain.

I'm assuming he didn't realize that he was not making any sense, or he would've gotten frustrated with my lack of a response. So, I guess that's a silver lining in his case. I told him his antibiotics were working, and that he'd be out of the hospital soon.

He said, "There you go."

Guru in the Clinic

2010-02-10T14:20:00.000-08:00

Last week, I returned to Clinic at the Zoo. [If you've forgotten, I've termed the county hospital the "Zoo" - a) because it rhymes with the real name and b) because it really is a free for all up there.] It was, as usual, extremely busy. I never feel like I can give great care in that environment. There are way too many patients smashed into a 4-hour morning. Even when the 4-hour morning turns into a 5-hour morning (as it does 99% of the time), it's still not enough time. I don't get to look through labs as closely, I don't get to ask enough questions and I don't get to really know the patients.

Last week, I had an older man who had moved here from India about 10ish years ago. He was quite funny and nice. He had a nonhealing foot ulcer, but it was gradually getting better. He was refusing amputation, which would've cured the infection and probably (eventually) given him greater mobility. But, he was rather attached the foot, so I didn't push it.

He started giving me little words of advice, like a talking fortune cookie. I spent quite a bit of time with him (relatively speaking), partly because I liked his sound-bites of wisdom and partly because he seemed like he enjoyed an audience. He said, "If you're driving a train, you cannot stop and remove all of the little pebbles on the track. You will never get where you're going. Those pebbles are like life's problems - you just have to keep going and push them out of the way." He said a few other snappy things which were very inspirational. I wish I could remember them all. I told him that his family and friends are very lucky to have him around.

He looked a little sad, and he said, "You know how a lamp gives off light - lots of light! - everywhere except underneath the lamp. That is like me with my family. They do not see my light, they only see me as a old man." I wished I could've spent more time with him. I told him I'd see him in 6 weeks, and I thanked him for being a light to our clinic.

Just Takes One

2010-02-03T21:26:00.000-08:00

I had a patient today with diabetes and a nonhealing foot ulcer. He has already has a below the knee amputation on the left. He's probably going to need another one on the right, due to the ulcer.

My attending starting to talk to him on the importance of good diabetic control to avoid even further complications. The patient cut him off and said, "Doc, I mean no disrespect, but I don't want to hear it." He said that no one ever listens to him, people just sit and lecture him about his illness, and he doesn't want any more of it. The attending is a very, very caring man and really tried to talk to the patient on a more personal level. The patient just shut down.

Once the attending left, the patient told the med student and me his reason for being so angry. It seems he had a bad experience once with a nurse. She told him that he needed X units of insulin. He said that X units had cause him to have an episode of hypoglycemia - he got shaky and passed out. Hypoglycemic episodes can be scary as well as life threatening.

He told her what had happened the last time he took X units. He asked, "So, how many units do you think I should take now?" She looked at him and said, "X." No difference, no acknowledgement of his past symptoms, no regard for his fear of another bad event.

All it took was one bad encounter, and this patient has closed himself off from having an honest conversation about his diabetes. It's sad, but it happens all the time. I think we healthcare providers forget that just one encounter with us can make a lifelong impression -- for bad and for good. We need to listen to our patients, let them know that we really hear what they are saying, and approach things as a team. The only way to be effective providers in patients with chronic diseases is if we're both on the same side.

"I don't think you have cancer..."

2010-02-01T12:46:00.000-08:00

So, this past month has been pretty light. I had vacation for 2 weeks, then I had clinic only 1 day a week for the rest of January. Those last 2 weeks were supposed to be for research. I took "research" to mean sleeping in, working on an art project, and reading the occasional medical article. I'm pretty sure that's what it means. [Some people may be dismayed by this idea that their doctor is off somewhere wasting time rather than reading every new article that comes out. I prefer to think of it as making myself well-rounded.]

I covered this last weekend at the hospital. Thirteen patients to see each day, so not bad. One I saw on Sunday is a middle aged man with an intestinal disorder that requires he takes steroids. This makes him a little immunocompromised and at risk for weird infections. He came in with abdominal pain, which isn't unusual for him given his condition. What was unusual is that the abdominal CT scan picked up a weird finding in his lower lungs. A scan dedicated to the lungs confirmed a weird nodular pattern with a focal problem in one of the upper lobes. Now he's got to get a procedure done to figure out what the heck is going on in his lungs. Could be an infection (hence the reason I saw him) or cancer or some other inflammatory process.

He looked sad, so I asked if he was doing ok. After chatting for awhile, he said, "Do you think it's cancer?" To be honest, I have no idea. I suppose I could've said that: 'Well, sir, I'm not sure that's why we need the biopsy.' But, he knows that. So, instead I said (with as much confidence as I could muster), "Well, maybe I'm biased since I do infections for a career, but this pattern is more suspicious for an infectious process, I think." I'd like to say he breathed a sigh of relief, and I renewed his hope in the world. What really happened is he looked at me skeptically and didn't say a word. So, I said, "We should know for sure by the middle of the week, when we have all the results back. Either way, we're going to do our best to get you through this." Again, he didn't look all that convinced; I said good bye and put my note in the chart.

Sometimes you just can't make someone feel better. Sometimes they are too scared, too nervous, too cynical to think they might catch a break. He's been sick his whole life with an incurable intestinal disease. Why should things start looking up now? I encouraged him to have a positive outlook, and we'd see how things went.

Maybe some people are just hardwired to be "glass-half-empty" and nothing you can do is going to convince them that it's also half-full.

Quick Trip

2010-01-24T18:49:00.001-08:00

I was asked to attend a meeting in DC yesterday. I was flown from LA to DC on Friday night, then back to LA Saturday night. I was in DC for 18 hours. DC, other than Chicago, is the one place that when I get there, I truly feel like I'm home.

This meeting was put together by a pharmaceutical company. They brought in 12-14 hospitals - mostly academic medical centers. Each center was represented by a senior faculty person and a junior faculty or fellow. The focus was HIV. The goal was to anticipate what the future of HIV is going to be - who are the patients, what are their problems, what will doctors need to best treat them. We discussed what resources we, as physicians, are missing in dealing with HIV patients. We discussed our "wish list" of what we want. We discussed patient programs we'd like to see, social workers we'd like to have, and electronic medical records we'd like implemented. I met a lot of great people who are also passionate about fighting this disease.

I don't know that I am much of an expert, although I have a lot of opinions for sure. :) I was flattered to be asked to join this group. I hope my input, and the meeting in general, will help this company come up with ways to help physicians treat people with HIV. I came across a quotation by Seneca (a Roman philosopher in 1st century AD) in a magazine on the plane ride home: "Luck is what happens when preparation meets opportunity." I think this quotation is great because it reminds me that people who take advantage of situations and are able to turn them into success stories are people who worked and prepared so that when that one opportunity comes, they can make it a "lucky" one.

So, don't feel guilty that you got the promotion and someone else didn't. Alternatively, don't make yourself the victim in a situation that doesn't go your way. We all have to be working hard and preparing ourselves daily for that chance that happens to come - you never know when your "luck" will change.

Back at It...Soon

2010-01-16T15:51:00.000-08:00

My vacation ends in a few days. This last week has been nice - a few errands to run each day, a little bit of work to catch up on, but all in all not much to do.

It's nice to wake up without the alarm going off. It's nice to go for a run and not rush through my post-run stretch. It's nice to make lunch at home and sit in my kitchen and eat it.

I thought I would get bored. Maybe there were a few stretches were I got restless. But, there are so many books to read, so many trails to run. I would always want to work in some capacity. But, it would be nice to take a week off every now and then. It would be nice to have my evenings not full of articles to prepare. I know that day is going to come soon...it was nice to get a glimpse of it now.

Still Cold

2010-01-09T13:05:00.000-08:00

The race is over. It's been over for 8 hours. I'm still cold.

We got up at 3a to catch the shuttle to the race at 3:30a. I layered on running tights, dry-fit long sleeve shirt, dry-fit short sleeve shirt, cotton long sleeve and a hooded sweatshirt. Not to mention gloves and ear warmers. The sweatshirt was my Brother's - thank goodness I wore it. It was 34 degrees. I saw a few snow flurries.

We stood out in the windy cold for two hours. Wow, I was chilled to the bone.

Then we got to our corral and waited some more. Soon the freezing rain started. Eventually the fireworks went off to let us know we could start! We ran 4 miles into the sleet. My plan was to shed the sweatshirt after a mile or so, but I kept it for the first 5 miles. I saw my Sister-in-Law's parents who were there to cheer us on. I gave them the cotton long sleeve and the hooded sweatshirt. The next mile or 2 was awesome. Through Main Street, into the Magic Kingdom Castle. We saw Cinderella and Prince Charming and the whole Royal Family outside the castle! It was still dark out, so the lights were all on. We also saw a lot of the Disney characters around the park. Peter Pan, Wendy, Captain Hook and Smee. The Bears. Captain Jack and the pirates. So many more. It was awesome! Those 2 miles were the best by far.

Then I immediately wished I had my sweatshirt back. The last 6 miles had the wind at our backs, which was better. My hip started to hurt with about 3 miles left. The rest of the run was fine - rain began so we got wet. At the end, we got Mylar wraps which usually toast you like a baked potatoe - unfortunately, you need the sun in order to really make them effective. In the end, they just worked to keep the rain off.

We got on the shuttle bus to go back to the hotel. For some reason, the bus was frigid. I don't know why the bus driver didn't have the heat on. We got back to the hotel and ran (literally) back to our room. I didn't think I had another 10 feet in me, let alone a few blocks. I couldn't get the water in that shower hot enough. My toes are still cold.

We got cool Donald Duck metals, and we finished the race in just over 2 hours. Not bad for below-freezing temperatures. If I do this again next year, I hope it's a tad bit warmer.

I thought Florida was the Sunshine State

2010-01-08T08:30:00.000-08:00

So, it's race time. Tomorrow is the Disney Half-Marathon that my Brother and Sister-in-law and I are running. When my Brother asked me about doing it, I thought, "How fun! Running around Disney World in the Florida sunshine with my family...what could be better?" I've never been to Disney World, but it seems to be like Disney Land - warm, Mickey Mouse, sunny, happiness on a stick.

Not today. Not tomorrow.

Weather.com tells me the high tomorrow is 38 degrees ("feels like 29") with rain likely the whole morning. Not exactly what I signed up for. Good thing I packed running tights and long-sleeve shirts. I have no rain slicker, so we'll just see how it goes. It has the potential to be the most miserable 13.1 miles I've ever experienced. At least my Brother and SIL will be there to whine with.

Stay tuned for the post-race recap!

Family Time in The Region

2010-01-04T20:55:00.000-08:00

I got to spend a few days with all my siblings. This is not an easy thing to do, because we're spread all over the place. While I live in LA, my brothers live in Orlando and my sister is Northwest Indiana - affectionately known as The Region. People from The Region are (affectionately?) known as Region Rats. Do with that piece of information what you will.

It was great to see them all. I won't pretend that we grew up sing Kumbaya together every night, but for the most part we got along. We've grown closer as we've gotten older, and I think we appreciate each other more now. We definitely cherish our time together. And we love spending time with the kiddies - my sister has a little girl and boy. As you can see in the picture, some one made sure Uncle Dude was cozy with more than enough stuffed animals during his nap.

This time off has reminded me to stop and smell the roses - metaphorically, of course, since it's 3 degrees here right now. I hope to remember this lesson when I get back to the bustle of LA. In the mean time, though, the Disney Half-Marathon is in a few days...there I'm just hoping to make it across the finish line.

Best Christmas Ever

2009-12-27T16:13:00.000-08:00

So, imagine that it's Christmas Eve. You're with your wife and 2 grown daughters. They don't live very far, and they've come over for brunch.

Your pager goes off.

Except that you're not a doctor. Or a fire fighter. You're a patient with end-stage liver disease and that pager means a new liver. You call the transplant coordinator, and she tells you that there's a local match. It's time to drive down to the Hospital and prepare for surgery. Good thing you hadn't eaten that brunch yet.

So, after approximately 10 hours of surgery, you got a new liver. It's nearly midnight and your family is in your ICU room. It'll be a few days before you're extubated, so you're going to miss Christmas.

Somehow, I don't think Mr. H will mind. He and his new liver and doing well. He's not out of the woods yet, but the first critical days are going by smoothly. Even though his memories of Christmas 2009 will be foggy at best, something tells me it'll go down as the best Christmas ever.

"It's been a good experience"

2009-12-24T17:39:00.000-08:00

I did some moonlighting today, so I saw some patients who aren't normally mine.

One is a 54-ish year old guy with newly diagnosed lymphoma. He's been in the hospital for a few weeks - he says he was a terrible mess when he came in, but he looks good now. He pointed out that I hadn't seen him back then but if I had it's night-and-day compared to now.

Right now, he's 20lb heavier from water weight - though he points out that he was up 40lbs a week or so ago, so it's improving. Right now, he's yellow. Right now, his liver and spleen are riddled with metastatic lesions, though some of the MDs comment that it's looking better. Right now, his white blood cell count is in the toilet, making him at high risk for infections. He quickly points out that he's not having fevers anymore, so that's an improvement.

Right now, his 27-year-old daughter is at home, having just flown in from DC where she works. She doesn't know how sick her dad is. He has gotten a few rounds of chemo and was deathly afraid of losing his hair. He's not vain, he just wants to ease his daughter into this diagnosis. His nightmare was having her walk through the door to see a yellow, swollen, bald man claiming to be her dad. He called Patient Relations a few days ago and asked them how he can get a hair cut. He wanted it to be short (but not shaved), in case he did start losing his hair. He figured it wouldn't look as bad if it was patchy and shorter.

Whaddya know - Patient Relations called up Al the barber. I didn't know we had a barber. Apparently, Al comes in and cuts hair for those patients who can't leave the hospital. Al's daughter was (is?) a nurse at the hospital and got started doing this awhile back. Al is 82. My patient said that Al did a great job with the tools in his little black satchel, jumping over IV tubing, ducking antibiotic bags, etc. He is really glad his hair hasn't started falling out yet (it might never), and he was extremely happy to have had Al come by.

Mr. T looked at me and said, "You know, it's been a good experience, being in here." I just looked at him - jaundiced, edematous, belly full of over sized organs. His prognosis is up in the air, mostly because his type of lymphoma is so rare there's not a lot of data on it. Mr. T looked at his wife, who smiled, and then looked back at me, "I know that must be weird to hear me say, but it's true. You, the nurses, Al...it's been a good experience."

I wished him a merry Christmas with his daughter and complemented his hair cut. Then I left before I started to cry in front of him.

Merry Christmas! You have cancer.

2009-12-22T22:12:00.001-08:00

So, Christmas time is great, except when you're sick. And except when you're taking care of the sick people. This past week has been full of not-fun things.

- I diagnosed someone with metastatic cancer
- I watched a family opt to turn off life support
- I told a daughter that grandma won't be able to leave the hospital in time to go on the family cruise
- I can't figure out why my lady with her second organ transplant is back in the ICU
- I handed a man his vomit bucket as he told me hasn't been able to eat in 17 days
- I got the autopsy results from a 33 year old patient, and I'm still not sure why he died

It's been full of little miracles, too, if I think about it.

- Mr. M took his first steps in the 6 weeks since his liver transplant
- Mr. L is going to make it home on Thursday, in time for Christmas with his wife
- Mr. H got his liver transplant a week ago and is sailing along
- Ms. O is home, even though she doesn't have a diagnosis yet
- Mr. K isn't having 18 bowel movements a day since the treatment finally started to work

I guess that's the way life is. Ebbs and flows. Ups and downs. Without one, how would you know the other? Without a low, how could you recognize (let alone appreciate) a high? So, I'll be thankful today for both the trials and the joys. I can learn from the trials, making the joys that much more exhilarating.

Memories

2009-12-15T19:49:00.000-08:00

I was recently asked to talk about one of my favorite holiday memories. I have so many funny family stories. How to pick just one...

Perhaps one of the most memorable occurred about 15 years ago, when my youngest brother was about 10. Being the youngest, he was, of course, the most excited for Christmas. He also wanted to get up at the crack of dawn to open his gifts.

The other siblings and I were in our mid-teens. We loved Christmas, but we also loved sleep. You remember those teenage years when you couldn't sleep enough? That was all three of us. We all had our own room at this point. My other brother was in the basement. My sister and I were down the hall from each other upstairs. The little guy was across the hall from us.

Around 5am, the little guy comes in to my room. He shakes my shoulder until I wake up. He can barely keep his excited voice in a whisper as he tells me it's Christmas. With a sense of urgency, he tells me that it's time to get up and open our presents. "Is Brother up yet?" I ask, my eyes drifting close. He admits that no, Brother is not up yet. "Well, go get Brother, and when he's up, let me know. I'll come right down." The little guy goes skipping down the hall and down, down to the basement.

About 10 minutes later, he comes walking back in. I hear the patter of his feet and open my eyes. "So...?" He drops his arms down, leans on my bed and sighs with the weight of a hundred years. "Brother asked if you and Sister were awake, and when you were both downstairs he'd come up for presents." I just smiled. "Ok, so go get Sister, tell her to go downstairs. Then tell Brother to meet us. Then, come get me." I must have sounded convincing because he left for another round of trying to convince each of us to be the first to get up.

Sister caved first, probably because she was second youngest...plus she is easily worn down by whining. Brother and I held out for a long time, sending the little guy up and down 2 flights of stairs several times. By the time we both agreed to get up (it's probably only 6am at this point), the little guy had separated all of the presents into nice piles for each of us, arranged pillows and chairs near the stacks, and was grinning madly near his stash. Brother and I laughed as we realized we had sent him back and forth no less than 4 times. It was at this point that we learned that the little guy had been up since 4a and had watched an old VHS copy of Scrooged before coming to get us. Watching Scrooged became a yearly tradition for him, and I'm actually not sure if he's outgrown it yet...15 years later...

Can I get a liver?

2009-12-08T18:12:00.000-08:00

I was recently consulted on a patient who developed acute liver failure of unknown etiology. He was fine until 3 weeks ago when he felt tired and achy. Then someone at the store told him his eyes looked yellow. Two weeks later he was transferred to our hospital because we do liver transplants. Infectious Diseases physicians are consulted to make sure the patient has no infectious contraindications to a transplant as well as to make sure they are on proper antibiotic prophylaxis pre-operatively.

This patient crashed fast. He was intubated, on continuous dialysis, on 2 medications to support his blood pressure, and his heart rate kept plummeting. We had done a bone marrow biopsy on him a few days earlier because his blood cell counts were a little off. As we waited for that result, and many other lab tests, to come back, we were supporting him in every way we could.

Yesterday morning, I was in his room in the ICU when the transplant surgery fellow came in. I've gotten to know him well, since we share a lot of the same patients. The nurse was also in the room. A few minutes later, the patient's wife and a priest came in. The 3 of us healthcare providers took a step back and let the priest pray over the patient. The surgeon's eyes never left the heart monitor, but his lips moved with the Lord's Prayer. The nurse watched the dialysis machine while she made the sign of the cross. I stood, hands folded, and alternated watching the priest and the ventilator.

Then, the priest and the wife left, and we all went back to examining the patient and talking about what we needed to do next. It was a very surreal moment, and it wasn't one that happens often. But, it was nice.

We later found out that the patient had an aggressive type of lymphoma, which rendered him "not a transplant candidate." He died shortly after.

3 Years Later

2009-12-06T17:32:00.000-08:00

I got this amazing email the other day. Before I go into it, I'll need to go back three years. My memory is a little foggy because of a) early onset dementia and b) the sheer number of patients I see in a given day/week/month. I don't always remember details about each of them. Except for Raphael*. Beautiful Raphael. But that's another story for another day.

(*not his real name, of course)

I was doing a rotation at one of the free clinics on the west side of town. I must have had a patient that I saw more than once in that month and that I connected with more than just the normal amount. I remember her name but not why I saw her. I remember she had a brother with leukemia (he was about 22 years old) who was in the hospital. She mentioned to me that his favorite show was House, MD and that he watched it faithfully even while in the hospital. I happened to know people on that show, and I mentioned that to the patient. She couldn't wait to tell her brother. I spoke with my friends and got a signed cast photo, which I then mailed to my patient's brother. I never heard from her again, but I didn't think anything of it. I moved on to another rotation and that's life.

Until this past week, when I got an email from her:
"It has been almost three years since we have communicated. I'm not sure you remember me, but I remember you for the beautiful things you did for me and my brother. I once asked you if you can get me the signatures of your friends who are actors from the show "House". I never got a chance to thank you, but thank you. Unfortunately my brother passed away in October of 2007. We got the news that he was getting close about a year before which was when you mailed us the pictures. My brother loved them! But it has been tough. I hope you can remember me, and not think that I completely forgot about what a thoughtful thing you did.
-M. P."

Wow, did that cause me to pause. It made my day, of course, but it also made me think about all the little things we do every day that someone else doesn't look at as being so "little." The cards we send, the candy bar we give, the CD we make. Those little extra gestures that really make a big impact on someone else. So, this week, I am going to be uber aware of the extra mile I can go for others because just maybe it'll be something that sticks with them forever.

Three Ladies

2009-11-28T19:11:00.000-08:00

I happen to have 3 female patients on my service right now who rock my world.

D is in her mid-thirties and has Down's Syndrome. Her intestine popped a hole in itself and she got a mad infection in her abdomen requiring surgery. She's doing quite well now, though it was touch-and-go for awhile there. She has slowly begun to trust me. Her mom is amazing; she's about mid-60s and is rarely away from D. The mom showed me some drawings D did recently (she is an avid artist). I told her I'd bring her in something of mine, so I sketched a little dog that looks like Muffy, her favorite stuffed animal who never leaves her side. D loved it and said she'll color it. She gave me a big smile and a high five.

Ms. O is close to 60 and has brain cancer. She has fought for 2 years and it recently recurred. Ms. O's younger sister is a saint. She has made the tough decision to not prolong Ms. O's suffering. Ms. O was having fevers to 105 with no identifiable source, so I attributed them to her brain cancer or recent seizures. A few days ago, I told Ms. O's sister that she is amazing for listening to her sister's wishes and making this hard decision. I told her that she shouldn't second guess herself, and that she needs to stay strong in this because that's what the patient wanted. She was tearful, but she thanked me. I hadn't seen the sister over the past few days (it was Thanksgiving), but I saw her today. She thanked me again for my kind words, and said she's at peace with everything now. Ms. O is even having periods of lucency where she tells her sister "thank you" and "I love you." The sister gave me a Starbucks gift card today and said, "Thank you again. Please, use this and think of us when you take a few minutes to yourself." I plan to take my own sister out for coffee with the card. I think Ms. O and her sister would like that.

K is also in her mid-30s, like D. K is a mystery because she seems to have a recurring illness. It's either reexposure to something leading to recurrent infection or a latent infection that comes up from time to time...or it's not infectious at all. It's a strange story, and one that I hope to figure out in the next few days. K and I hit it off, she's a great girl. She has a tattoo, and we got to talking about tattoos. She got hers with a few girlfriends - they all got the same one. She loves it and says she always will, "Because it meant so much to me when I got it." I told her that I was thinking of getting one, but I can't decide on something I'll want forever. She told me to just get one, because it will always be special to me. Today she was reading that book Push, which is what the movie Precious is based on. She said, "Just when you think you have it bad, you can just look at the person next to you." She has a great outlook on life, especially for someone who has been dealing with this recurrent mystery disease for 3 years. Then she said, "You know what? This world is filled with crazy."

She's right. This world is filled with Crazy. Once again, it takes a special patient to remind me to realize how blessed I am to not only survive amidst the Crazy but to flourish here. I love my job.

Soundtrack

2009-11-06T14:26:00.000-08:00

I have a difficult patient.

Ok, I have many difficult patients. Attendings like to give me the difficult patients. I'm not sure why, but I have a few theories. 1) I'm nice but firm. 2) I'm a girl. 3) I don't complain about it. I'm not sure which of those theories factors most into the equation, but the end result is that I have a lot of difficult patients.

The positive side to my patient panel is that I occasionally make a break-through with a patient. Almost always, my patients at least start to prefer seeing me as opposed to the other fellows (we don't always get to see our own patients, due to scheduling conflicts). So, even if they hate me, they hate me less than they hate the others! Ah, the simple victories.

I have a patient - Mr. S. Mr. S is HIV+ and in an electric wheelchair. I'm not sure why he's in a wheelchair, because he can walk. I haven't dug deep enough in his chart to figure out why he has chronic leg pain. Maybe from HIV neuropathy. Maybe from HIV-associated bone destruction of his hips. I'm not sure.

Mr. S is difficult because he has a lot of psychiatric issues as well as his chronic pain. He gets a lot of narcotics to deal with the pain. He also takes a lot of anti-depressants and other psych meds. As a results, he can be drowsy and not a great historian. He's also a little whiney and demands a lot of attention.

Mr. S has outfitted his wheelchair with solar panels. I had never asked him about the panels, because he was never my patient. Until now. About 3 months ago, he got moved to my patient panel (see the above 3 reasons as to why). So, half way through our appointment, I asked him, "Are those solar panels?"

Long story short, he went into how they work, what they do, etc. Smart guy. They don't power his wheelchair. Oh, no. They power his sound system. Yes. Yes, I said sound system. Mr. S always rolls with music. He has a receiver and speakers that are rigged to an MP3 player. You can always hear when he's arrived to clinic. This week, he entered to Green Day and waited with Jimi Hendrix. He always turns the music off when he comes into the see the MD, though.

Next, I asked him what kind of music he likes. He said all kinds, and he explained that his current MP3 player got run over by his wheelchair, but still seemed to work. Mr. S actually got run over by a car a few days prior, but he still seemed to work, too. Fractured ankle, but doing ok.

He pushed play, and Tupac filled the room, singing about California Love. My favorite. So, I did the rest of his physical exam with Tupac jammin'. At that point I came to a conclusion:

All patients should come with a soundtrack.

Fellow Fellows

2009-11-02T19:01:00.000-08:00

I just got back from Philadelphia and an IDSA conference. Nerdy ID docs from around the world come and listen to hours and hours of lectures about their favorite diseases. It was awesome. Really. I had a great time.

I really enjoyed Philadelphia, much to my surprise. I'm not sure why I was surprised. I didn't know much about Philly before I got there. I thought it was going to be dirty and run down. Not so. It was super cute! Lots to do and see. I could see myself living there. It's close to DC... And we all know how much I love DC.

The other pleasant surprise was how well my fellow fellows and I got along. I shared a room with 2 of them - A and T. I find them both hysterical people, very witty, fun to be around, etc. I was hoping we'd still be friends at the end of the trip -- 5 days of living with people you only really know at work could spell disaster. This time, it went great. I haven't laughed that much in I don't know how long. I love those guys.

Some of our adventures:
- 'A' trying 3 times, unsuccessfully, to give away his Ahi tuna leftovers to any homeless person we could find.
- Visiting the wawa store next to the hotel as often as possible for snacks and Diet Coke.
- Watching our 2 flat screens on the same channel in our hotel suite. The TVs were 10 feet apart. Max.
- Coming back, every day, to a room that was at least 54 degrees and still pumping out AC. We're not sure why Nicole, our cleaning lady, was trying to freeze us out.
- Taking a wrong turn on our run past the Rocky steps, making our 4 mile run a 7 mile run.
- Eating our weight in candy over those 5 days.
- Taking pictures of each other falling asleep during the lectures.
- Listening to our pharmacist try to sell 'T' on going out with her friend who "has a great personality" and "isn't hideous looking." He wasn't biting.
- Trying to come up with a clever title for 'T's talk on Neurosyphilis. I offered "Neurosyphilis: the other spirochete." He wasn't biting on that either.

So many more awesome memories. I'm very thankful that I work with 2 wonderful people. I look forward to our next adventure together!

Weekend Off

2009-10-17T21:33:00.000-07:00

This is my first weekend off -- and in town -- since April 25. Holy cow. To be honest, the only reason I didn't sign up for a moonlighting shift was because I had 50/50 planned on going home to Chicago to see my parents and sister. I opted to stay back because I've got a presentation, a grant and a research proposal due in a week and a half.

Wow, April 25. That's so sad. Half of those weekends I was working for my fellowship, but the other half was moonlighting. I don't think people fully understand medical education. You work like a dog in med school to get good grades, learn the material and get to the residency you want. Then, residency is (at first) a lot of overnight call working 24-30 hours at a stretch. When you get to be in your final year of residency, you have less call and more consults/clinics - that means more 8a-6p type hours. So, you start moonlighting. Working extra clinic shifts at night, covering for attendings to make extra cash. At first, it's not a big deal, because you're so USED to working all the time. Now that you have free time, it's easy to give it up for some extra money, because you're not used to having the free time.

Then it's a vicious cycle: you get used to having the extra money, so you can't stop moonlighting, but you're so tired you want to stop, but if you stop you can't pay the new car payment or go visit your folks, etc. You establish a new income for yourself that you can't let go.

Well, I'm taking the weekend off. I'm nearly done with all of my work, and I'm going to have a day filled with no medical stuff tomorrow. I'm going for a long run in the morning. I'm going to enjoy a cup of coffee with my husband. I'm going to church for the first time in a loooong time. I'm going to look for a new satchel for work. I might even go to a cafe and read a book for fun. Crazy!!

I'm getting more and more of the mindset that life is for living. Not for working. If I never see the pyramids in Egypt because I didn't want to work X number of extra shifts, then so be it. I'll enjoy my friends and family right where I am. Life is too short to be living for tomorrow. Time to live for today.

One Phone Call

2009-10-11T17:22:00.000-07:00

On Friday, I had Hepatitis Clinic. I love that clinic. I'm the only fellow that loves that clinic. I'm not sure why it is so hated by the GI and ID fellows alike. I only know that I find the patients interesting, the disease fascinating and the attendings knowledgeable and fun. Most of them.

I had one patient whose wife kept calling his cell phone during our appointment. He kept answering and telling her he'd call her back when we were done. From what I gathered a) she was supposed to come to the appointment with him but couldn't because of some other family situation; b) she was going to be coming to pick him up when he was done; c) she was afraid he was going to die.

Now that last statement is humorous because people don't die of Hepatitis C when they've had it for 20+ years. Death from Hepatitis C comes on slowly as the liver starts to fail. I'm not sure why she thought he was going to die, but she was very concerned about him. On her last call, I took the phone and told her that I would have more information for her after our visit, so could she please wait and we'd call her back.

After we were done and the attending had concurred with my plan, I asked the patient if I could call his wife back. I spoke with her for about 6 minutes. She had a lot of questions, mostly not understanding the chronic nature of Hep C. I took my time and explained things to her, and she was very grateful.

As I walked the patient out to the front desk where he could check out, he said, "You know, thank you for calling my wife. A lot of doctors don't like talking to the family, so it means a lot that you called her. I appreciate that." I remembered back to when my mom had my grandma's surgeon call me regarding her operation and how everything went. How much it meant to me and to my family that he took the time. I said he was quite welcome, and that I was looking forward to meeting her at this next appointment.

It's the little things - one phone call - that can mean so much to our patients.

New Patient and Correction

2009-10-03T19:54:00.000-07:00

During my moonlighting today, one of my patients was a Cambodian refugee. I'm not sure when he came to the US and under what circumstances. He tried to commit suicide some time back, but it didn't work. He's terribly nice, and he currently has an infection that he'll recover from. I've seen him once before, actually, several months ago. I don't remember why.

As I sat with his chart, I didn't really think about his infectious issues. Instead, I kept wondering what he saw in Cambodia. What horrors did he experience? What was is like right before he came to the US? Did he come here first and then seek asylum, or did he try to get it prior to leaving his homeland? Was that his family that just walked out of his room? Did they come with him? Was he scared when he arrived here? Did he fear deportation? What kind of adjustment period did he go through? What lead him to eventually try to kill himself? Is he glad he failed?

So many questions for this soft spoken man. None of them relevant to his current infection, so none of them were asked. I mostly hoped and prayed that he was glad to be alive, and that whatever atrocious acts he saw and experienced were outweighed by the love he gets from his family and friends.

Correction: in my state of overwhelming gratitude (and in the confusion of too many initials) I left out an amazing friend. JS: Where to start! From an random roommate a true lifesaver. Thank you for your support.

Blessed

2009-10-02T07:53:00.000-07:00

I'm feeling very emotional today. Not like I need a box of Kleenex or anything. Just overwhelmed by the wonderful people in my life.

I'd like to take a minute to thank some wonderful people (who may or may not read this blog, but that's beside the point):

AL: You are my glue. Seriously. Doesn't matter how far apart we are. Glue.

MW: Thank you for your wonderful blog which I have just stumbled upon. I still regret that we didn't spend more time together in DC.

JL: You're my rock in LA. Thank you for being there. Oh, I love the lungs, too. Remember that.

LR: My other LA rock. Thank you for trusting me and for being so trustworthy. We'll hike again soon.

RM: Our time at G'town went so fast. Thank you for being a great listener.

JB-C: Leaving stupid voicemails to each other will never get old. No matter how long it's been, when we talk it seems like we never left.

My sibs: You all rock. Thank you for making me a better (and funnier) person. Thank you for loving me through everything, even when I didn't deserve it. Thank you for keeping me humble. Thank you for giving me so much more than I could ever give back.

Remember to tell the people you love how much they mean to you. It'll make their day (and probably their week).

Happy New Year!

2009-09-28T19:15:00.000-07:00

It's the Jewish new year. I'm not Jewish, but one of my best buddies is. Inspired by another (non-Jewish) friend, I'm going to use this time to Atone, just like the Jews. Atone, fast, then feast. I'm going to skip the last two. Unless you count a cinnamon chip scone from Panera as a feast, then I've got 2/3.

Things I'm sorry for:

1. Not calling home enough. I live so far away and I love my family so much, you'd think I'd be better at this. Sure, the time change makes it hard to call them. My 'rents and my sister go to bed fairly early. The bro's probably don't, but I don't know. I feel like I'm barging in to their lives when it might not be convenient. But Doc, you say, if it's a bad time, they'll let it ring and call you back. You, my reader, are correct. This leads me to #2.

2. Not giving other people a chance to say no. I never want to bother anyone, never want to burden them and never want to be intrusive. Thus, I never ask people to help me. This is bad, I've realized, for two reasons. A) I often need help and make myself crazy trying to do it all myself and B) People often like to help! I know I like to be helpful. I like to do things for other people, so it would stand that other people would like to do things for me. So, I'm going to try and be less self-sufficient and ask people for help when I need it.

3. Pride. I'm not a terribly prideful person, but my pride definitely gets in the way sometimes (see #2). I'll try to be more humble and if I do something stupid, I'll just own up to it. I need to laugh at myself more anyway.

4. Smell the roses. Metaphorically speaking, of course. I need to take some breaks, not work myself to death. I need to reconnect with things I love to do: drawing, making cards, camping, reading for fun. I do have a life outside of work, I just need to find it again.

A friend of my Jewish Buddy died unexpectedly and suddenly at the age of 31. I new her fairly well. It was a big shock, obviously. So, it's given us both a new sense of what's important in life.

*Do what makes you happy.
*Do what brings you joy.
*Hug the people you love.
*Don't worry who thinks you're crazy.
*Be the best person you can be.

I hope I can work on my shortcomings, and I hope I can live this next year to its fullest. Happy New Year everyone!

The Other Shoe. Or Foot. Whatever...

2009-09-27T19:47:00.000-07:00

So, I awoke a few mornings ago at 2am. Why? Because someone had shoved a hot poker into my upper abdomen. Or so I thought. I have rarely been in so much constant pain. After 2 hours of unrelenting fire, I elected to go to the Emergency Department. Yes. I did.

[aside: I have a few cousins with aortic tears recently, and the pain I felt was not incompatable with that syndrome. I have a bicuspid aorta and may be at higher risk for aortic tears, so I didn't want to bleed out in my living room. Without that history, I doubt I would've gone in for a belly ache.]

It was interesting being a patient. I wondered why, at 4am with only 5 other people in the waiting room, did it take an hour to register me? I wondered why, with only a handful of people in the ED, did it take me an hour to be seen by a physician? Were the nurses raiding the candy drawer like they did every night about this time?

In the end, it was very educational. I had my first CT scan. I drank liquid lidocaine (which worked wonders). I got a not-helpful diagnosis of "epigastric pain" (no kidding, Sherlock). I then diagnosed myself with a stomach ulcer brought on by too many ibuprofens for the tendonitis I just got over. Seems I should follow my own advice of taking those little pills with food.

So, I'm slowly recovering, thanks to my bottle of Mylanta and omeprazole.

Physician, heal thyself. Or at least, don't kill thyself on over-the-counter pain medications.

But, another lesson learned. I'll try to be better at explaining to my patients what is going on and apologizing for the wait. Because while we may be running around behind the scenes, they are just one person waiting in a room, scared, wondering if they are going to be ok.

How do you explain...

2009-09-08T21:44:00.000-07:00

My patient today is HIV+, has Hepatitis C and is on hemodialysis for his nonfunctioning kidneys.

He would like to be evaluated for a kidney transplant, which you can totally do in HIV+ patients. However, it's his Hep C that may stand in his way. It's really hard to treat Hep C after someone gets a transplant, so we try to do it beforehand. But, it's really hard to treat Hep C in patients on hemodialysis because the toxicities of the medications are so much worse.

You can do it, but the success rate isn't great. There's a new drug that should be out in about a year, but that pushes his (potential) transplant off for a year. And there's an old drug that is being looked at for a new use - Hep C treatment. It's not being tried in HIV patients yet, and he feels slighted. The patient said, "Why do they always leave us out?"

He's right. People with HIV have been marginalized in society and in medicine. However, when researchers are trying out new medications, they want to try them on the people who have the best chance of responding. The ideal patient. Patients with HIV are not ideal patients and so they are excluded from most trials.

How do you explain that to someone who feels neglected and uncared for? Who has lived through the days of Martin Luther King, Jr. Who has watched people die of HIV. Who now lives alone in a nursing home. Who probably feels the whole world is against him. I can't blame him.

I was able to convince the attending to look at the patient's case and see if we can't at least try something. We'll see what happens. Hopefully we can at least try, and if it doesn't work, well, at least we tried. And he is validated that we cared enough to try.

No...Thank YOU

2009-09-02T17:44:00.001-07:00

I was in clinic today at the VA. It was a good clinic day, despite the air reeking of smoke from the California fires burning not too far away.

My fellow fellow Dr. L and I whipped through the patient list like it was butter. We were ahead of schedule (cue choir singing Handel's Messiah). We were going to leave before noon. I was going to get to my 1p meeting across town on time. Sweet.

My last pt was Mr. P. Mr. P is a new patient with a nasty foot infection. He's been suffering with it for 3 years. It hurts, it's itchy, it inhibits his mobility. He's miserable. He begins the visit by saying, "If I would've known that I would be suffering from this for this long...I would've preferred to have died in Vietnam." Oh, brother, I'm thinking. The hyperbole is a bit much.

Granted, when I looked at his foot, it did look painful. And itchy. And I could see that you might not be playing basketball with a foot like this. Mr. P, now 70 years old, bragged that he used to be very active: "I would play beach side, blacktop basketball all the way until I was 48!"

So, the attending and I concocted a plan for him - some medications, some lab tests, and an attempt to try and get a solid diagnosis for his man. Mr. P said, "I've lived a long life. If you can't help me that's ok. Just please tell me that you can't help me. Don't tell me you can help and then don't. I've lived a good life." After assuring him that we weren't about to put him in a box yet, I told him that he needed to give us more than one visit to get this nailed down. He agreed.

At the end of the visit (time check: 11:40a), he was going to put his zinc oxide cream on his foot and wrap it back up. I asked him what "support services" meant. He has mentioned that he was in Vietnam in the early 1960s, and he went over for support services and recon. He explained that he went to help the scouts gather information and to make sure they had the supplies and equipment they needed to do their job.

He told me a story. He said that he was with a group of men who were trying to move from Point A to Point B. "Like getting from here to Manhattan Beach. On foot." (Note: that's about 30 miles) I expressed shock at this, and he said, "It don't take smarts. If you can read a map, you can do it." I chuckled, because I'm pretty sure that despite my medical degree I could not navigate the jungles of Vietnam for 30 miles - with or without the threat of gunfire.

He said his group advanced to a clearing in the early morning. He felt that it was too light out to try and cross; he wanted to wait until it got dark out. However, the decision was made to go. The first 4 guys crossed without difficulty. The next group went to pass and the shots rang out. Mr. P was not shy in stating that he "was going to do whatever was necessary" to stay alive and protect the other soldiers, but he didn't know who he was shooting. He just knew that it was in a general direction.

He starteds to cut up the gauze to create a pad for his foot. He assured me that at home his dressing change goes much quicker. I assured him that there's no rush (time check 11:50a). He resumes his story.

Things quieted down and it was his turn to cross. Last. He almost made it through the clearing when the firing began again. He was hit, but he made it out. The other soldiers didn't want to leave him. "I told them that they had a job to do! They had to get to the guys that were waiting for us. They had already called in that I was injured, someone was coming. I told them to go on, I'd be fine." He said that they left, and he laid in that grass for 5 days. "They came back for me -- the helicopter, not the other guys...I never saw those other guys..." He teared up and it was clear that not only did he never see his friends again, he wasn't sure what their fates were either.

We went back to getting his wound dressed. I asked him to finish teaching me "proper" wound care. He thanked me. "For letting me bare my soul a little bit back there." He said that I was very nice for listening to him. And then he said something that pierced my heart. He said, "When God comes to get me, I'm refusing to go unless I can bring you with. Now, He can get you on your own time, but I won't let him take me to Heaven unless he'll let you in, too." I was so touched, I was speechless. I mumbled something lame, thanking him for sharing with me and hoping that his foot responded to our treatment. (time check: 12:05p, but I didn't care)

I think he came in frustrated because people weren't listening to him. Not every doctor can give 20 minutes of non-medical time to his/her patient. But, every doctor should be listening to what their patients are saying and acknowledging the pains and itches that they have. I think Mr. P was grateful that I listened, that I saw him as a person and not just a busted-up foot. What Mr. P probably doesn't realize is that I learned a lot from him today. He reminded me of how awesome it is to be a doctor -- how great a privilege it is when someone trusts you to care for them, how humbling it is when they invite you into their personal lives, and how marvelous it is to have someone look you in the eye and thank you for reaching out to them.

Breathe

2009-08-23T18:08:00.000-07:00

I have one patient who is intubated. He's got a tube down his trachea and the machine is breathing for him. We've given him a lot of sedation so it's not uncomfortable. He's sleeping relatively peacefully.

He's been that way for about 3 weeks.

He's 23 and has H1N1, aka swine flu. He's morbidly obese with asthma, two big strikes against him in this H1N1 epidemic.

I'm trying to remain hopeful that he'll survive, but every day it's harder and harder to imagine him recovering. He'll get a tracheostomy this week - a hole in his neck for the tube to go in, rather than passing through his lips and down his throat. His white blood cell count (a marker of infection / inflammation) is still high. He spends most of the day with a fever of 101-102. He's starting to get bed sores, because it's so difficult to turn him adequately due to his size. I'm not sure if he's infected somewhere else, becaues he is too heavy for the CT Scan (weight limit 350lb).

I'm really hoping that by the time I leave the Zoo on 31 August, our big guy will be off the ventilator and on his way to recovery. I can't say I'm all that optomistic, but we will do our best to support him through this.

Facelift

2009-08-17T21:46:00.000-07:00

A big thanks to my sister for giving my page a facelift! I'm not so good at these technical things, so I'm glad that she stepped in took control.

The Zoo is going along as always. We've had some interesting cases. It's been busy, but things have quieted down a bit this past week. I've got a new attending who is awesome. She's the kind of doctor I want to be. She's amazingly smart and articulate. She's also an extreme advocate for her patients. She will do anything for them. She stands up for them, she pushes for the best care possible, and she doesn't care what their background / imigration status / etc. Each patient is a person, and she works hard for him or her.

I'm looking forward to working with Dr. D and learning from her in every way.

Amazing Case

2009-08-10T20:11:00.000-07:00

A friend of mine told me a story about a patient he discharged from the hospital about a month ago.

She's a mid-50s-year-old lady, who had an underlying lung disease, something called idiopathic pulmonary fibrosis. That translates roughly to "scarring of the lungs and we don't know why." She developed a heart condition, possibly as a result of the scarred lungs. She also had renal failure - an unrelated, but equally unfortunate, condition. She had been on peritoneal dialysis for awhile - her heart condition meant that she couldn't tolerated traditional hemodialysis three times a week, because the fluid shifts associated with that caused her blood pressure to drop. In hemodialysis, they remove your blood, clean it, and give it back. Not all at once or anything, but a large enough portion is removed that you need to be able to handle the fluid change. So, she did peritoneal dialysis - she would get fluid pumped into the abdomen every night so that it could clean her blood, and then it was removed at every morning.

Well, she recently underwent a heart-lung-kidney transplant. All three (or four, if you count both lungs)! She got all three organs from a 50-ish year old donor, and they are working great. My friend saw her the last 3 weeks in clinic, and she's doing great! Apparently, she's super nice, and she is so grateful for her renewed energy. She can walk around the grocery store now, she can go with her son to Home Depot to get supplies for a home improvement project...she's a new person. Well, with 4 new organs, she really is like a new person!

It's amazing what medicine can do nowadays. Blows my mind.

Back to the Zoo

2009-08-03T20:56:00.001-07:00

So, we didn't win the Lotto. Shocker. So, I'm back to work at the Zoo.

Today was a nice 12-hour day. We are battling a swine flu epidemic. We've had quite a few people admitted with H1N1 (the official name for "swine flu") symptoms. Some have turned up positive. Some are negative, but we still think they have it. And some have turned out to have something else. It's been very educational, learning how to deal with an epidemic. There are interesting questions: Who gets prophylaxis? Who gets screened? Who do you still treat even though the screening test is positive? How accurate are the tests? Who should get the vaccine (when it comes out)?

It's not every day an ID fellow gets to be a part of something like this. So, while it is going to make for a very busy month, I'm trying to stay positive and focus on what a great opportunity it is. And while I'll likely watch my summer tan fade without any hope of seeing the sun for awhile, I know I'll end up in a better position when it's all said and done.

Lotto

2009-07-28T21:48:00.001-07:00

So, one of the other fellows and I have taken up to playing the Lottery each week. We put in $1-2 and pick which Lottery we want to play. I'm waiting for that late night phone call to come in, telling me we're winners.

What would I do if I won? Well, of course it depends on how much. But, if we're talking a prize of at least $100k...

Well, I'd like to pay off my med school loans. Those are totaling about $200k last I checked. I'd pay off a big chunk of that, for sure.

I'd stop moonlighting if I had any left over. I am tired of working so much extra. That's probably the first change I'd make.

I'd like a new car - nothing fancy, just a Jeep Wrangler. Not even the Special Edition.

I'd probably hit the outlet mall for a new wardrobe. I'd say >50% of my clothes are hand-me-downs from my well-dressed aunt. I'm super thankful, because they are awesome and new to me! But, it'd be nice to actually choose some different outfits.

I'd give a bunch away. I've got some great charities I'd like to support more. I like Project Angel Food. Doctors without Borders. International Justice Mission. To name a few.

I'd like to open my own clinic. This would only be if I hit it big. Like $10 million big. I'd model it after the CORE Center in Chicago. Create a truly comprehensive place for people with HIV and Hepatitis to come for treatment, social services, dental work, massage therapy, etc. People would pay on a sliding scale. It would be awesome.

So, keep your fingers crossed. The next drawing is tomorrow night. I hope to be writing a new post on Thursday, detailing my trip out to pick up my oversized check. :)

Dairy Queen and Popcorn

2009-07-15T17:19:00.000-07:00

There are a few things that were staples growing up. Baseball. Summer days at the local (man-made) lake. Sleepovers at the Neighbors. Nighttime snacks.

Nighttime snacks were either ice cream or popcorn. Dad makes the best popcorn - on the stove with oil and everything. We always eat it with cheese. I don't know why, we just do. Bite of cheese, few kernels of popcorn...yum.

Or we'd have ice cream. Sometimes plain vanilla or Neapolitan. Sometimes we'd crush up Oreos or candy canes. Sometimes we'd get the ice cream with fudge swirls or put our own Hershey syrup on top.

I was home this past weekend with all the sibs, and it was awesome. We had a blast together. It's nice to see them and hang out as adults. I really appreciate their unique personalities. I see how my life has been -- and continues to be -- enriched by each of them. I am truly blessed to have such wonderful siblings. We played hours and hours of beanbags. We played games at the kitchen table. We laughed with my niece and nephew. We visited Grandma together. We made fun of each other, exercised together, and made dinner together.

And, of course, we ate ice cream and popcorn.

Movin' Up

2009-07-03T16:13:00.001-07:00

So, I'm officially a second year fellow now. As of July 1. Nothing much changes, really. I have more clinic months this year, less in-patient consult months. But, overall, it's more of the same. I know a whole lot more than I did a year ago, which is nice. At least I can give advice without asking the attending every freaking time. Well, usually. There's still a very long way to go.

The new fellows start up on Tuesday - they work with us on the consult service for half a day and then all day Wednesday. We show them how things run, answer questions, etc. Then they are on their own on Thursday! Oh, and if you didn't know already, never get sick in July. Ever.

On a personal note, I'm going home next weekend, which I'm super excited about. I'll get to see all of my siblings (which is a rare event, since we live in the far corners of the country -- literally). I'll also get to see my "new" nephew Noah. He's almost 6 months old, but I'll meet him for the first time in a week. It's going to be a blast!

Sign Up for More?

2009-06-27T14:04:00.000-07:00

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. :)

Newbies

2009-06-23T22:04:00.000-07:00

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.

A Beautiful Sight

2009-06-14T21:42:00.000-07:00

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.

Door #1

2009-06-10T21:24:00.000-07:00

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.

Rock Star

2009-06-07T21:14:00.000-07:00

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.

The Zoo

2009-06-01T20:31:00.000-07:00

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.

Homesick and a Patient's Course

2009-05-23T17:51:00.001-07:00

Sometimes, as I start to write a new blog post, I wonder if I'm not just saying the same few things over and over. I hope not. However, I try not to go back to reread my posts, as I'm sure I'd be aghast at what I've written and vow to never blog again. As it stands, I will keep writing and naively think that what I'm saying is having an impact on people. :)

I was recently back in the Midwest for a wedding. It was a college friend, and it was a lot of fun. It really made me miss the Midwest. Now, it's not perfect back home, but I miss the simplicity of life there. I also miss seeing my siblings. I'm jealous of people who can drive 20 minutes and hang out with their brother or sister. Not that moving back home would allow me to see them more (since they are equally spread out), but I'd at least be in the same time zone. Well, close to the same time zone.

Fortunately, I'll see everyone in July which will be awesome. I can't wait.

To add a medical side to this post, I saw a patient recently who is HIV+. She is close to 50 and really rebelled against taking any medications for a long time. She weighs about 75lb. Her daughter brings her to clinic every week so we can check on her. We often get frustrated at patients who so blatantly refuse life-saving treatment. I wonder what her daughter goes through. Is she frustrated with her mom's condition, is she tired of spending her entire Thursday at our county clinic? Is she the driving force behind her mom now staying adherent to the regimen? Next time, I think I'll ask her how she's doing. I'm sure her role as care taker is stressful, and we doctors don't do enough to recognize that.

Moms

2009-05-10T18:28:00.000-07:00

Today is Mothers' Day. I need to say thanks to my mom for doing an awesome job raising 4 very independent, very ambitious kids.

As I get older and I realize how much my mom really did...it has hit me that I can't adequately say thanks. Not that she'd want that, but I know that there's no way to repay all of the sacrifice, the tears and the headaches. Sure, I caused some joy and laughter. I just hope the good memories outweigh the bad!

So, Happy Mothers' Day - to my mom and all the moms out there.

When You Can't Move On

2009-05-02T11:27:00.000-07:00

I had a patient on Friday in my Hepatitis C clinic who was coming in to be evaluated for treatment. Not everyone with Hep C needs treatment, and it's not an easy treatment to tolerate.

To get right to the point, he had problems with depression before so I asked him how he was feeling. He said that this week marked the 10 year anniversary of his mother's death. He's the 2nd oldest of many many children. His mom had some sort of head bleed and was on life support. His dad was having a rough time of it and was quite elderly himself.

The other children (all grown adults) kept saying that the decision to withdrawal life support was the dad's. This was clearly wearing on the dad, and my patient couldn't understand why the oldest didn't step up and make the decision -- one way or another -- to help the dad out. So, my patient took the burden and stood up for withdrawing care.

He tearfully said that decision has weighed heavily on him ever since. He'll hear of someone "waking up" from a year-long coma and wonder if he did the right thing. I tried to reassure him that a 22 year old waking up from a few months after a car accident and an 80-something waking up after a ruptured aneurysm are very different things. I tried to explain that the young people aren't usually vent-dependent -- they have their brainstem intact, whereas his mother didn't. I don't think I helped him too much.

I hope he can find some peace soon, it's been 10 years that he's been torturing himself with this. I referred him to Psychiatry, where hopefully he can get in with a therapist and make some progress. His Hep C is definitely taking a backseat to his mental health. I hope the next time I see him he'll have been able to move on.

Saying Sorry

2009-04-28T20:47:00.000-07:00

So, I blew it.

It wasn't the first time, and it certainly won't be the last.

I was in clinic last week, and I greeted my patient who had been waiting about an hour. I could tell he was upset. I would certainly be upset if I waited an hour. Sadly, I can only move as quickly as there are attendings available to hear the case. No attending = I wait to present the case = I get backed up = my patients wait. It's the nature of the beast that is a training program.

Turns out he was a bit peeved at the wait. However, he was mostly upset that I had forgotten to order his labs to be drawn 2 weeks prior to the visit. With HIV patients, you bring them in every 3-6 months to look at their CD4 counts and viral loads. No labs? Nothing to talk about and nothing to do. A waste of a visit.

I could've gotten defensive: why didn't he call in and tell me when he went to the lab 2 weeks ago, so I could've ordered them on the spot? Why didn't he just call that day and change his appointment so we could get his labs done? There were a few ways we could've salvaged things if he had been proactive.

However, the blame was mine: I forgot to order them. I took a deep breath and just said sorry. I told him that he was right, that I had forgotten, that I had wasted his time, and that I was sorry. Contrary to the Movie-of-the-Week, this did not end in hugs and rainbows. He was pissed and left unhappy. But, I heard him and acknowledged the hardship I had caused. He looked a little relieved, which is nice, but ultimately he was going to be upset with me. And that's ok.

Not everything turns out peachy, and I am not a perfect doctor (or person for that matter!). I can only show my patients the respect they deserve by confessing my mistakes and apologizing for them. Hopefully, when he comes back in 3 months, we can have a better doctor-patient relationship because of it. But, if he never wants to see me again, at least I was honest with him. That's the best I could do.

Back to Work

2009-04-15T18:37:00.000-07:00

So, I've had a light clinic month for the last 2 weeks. No complaints from me! I needed a break after a hellish 2 weeks on the consult service at the VA. I can't talk about, I'll get too angry.

So, in clinic today, I had a patient with PTSD -- Post Traumatic Stress Disorder. He came in to the ID clinic for fungus on his toe nails. What he really wanted to talk about was the horrors of Vietnam. I wish I had more time to dedicate to that for him. As it stood, I did the best I could with my limited amount of time.

He kept coming back to one main theme. He said he was born a Mormon. He studied and went on his mission trip. He then went into the Marines (enlisted or drafted, I'm not sure) and went to Vietnam. He went TWICE. Two tours in the violence and horror that was the Vietnam jungle. He looked at me and said, "I killed 6 people in my first 2 days there. 'Thou shall not kill.' How do you deal with that??" Of course, I had no answer.

He proceeded to tell me that when he came home after his first tour [aside: why do they call it tour, like it's a fun romp around the world?], he was talking with his family. "They were all 'Peace' and 'Love' and 'Jane Fonda.' They didn't want to hear about it. They wouldn't let me talk about it." He was so conflicted about his religious upbringing and the acts he witnessed and committed. He was crying out for help, for someone in his family or community to listen to him and let him purge his nightmares. He got nothing.

No matter how you feel about the Vietnam War, our involvement in it, etc, you can't punish those men that were sent to fight. They were doing a job and often just trying to save their own skins in the ordeal. America really treated those vets poorly when they returned. Thankfully, my patient has a group for therapy that he enjoys. Sadly, he says he lost his first two wives because of Vietnam -- they couldn't take his emotional lability, his voluntary admissions to the psych ward, or his leaving for hours / days at a time. He gets these flashback and then wakes up under some tree, not knowing where he was or how he got there.

I can't say he'd be different if someone would've let him unload back in 1970-something when he returned the first time. I can't say that his PTSD wouldn't be as bad if someone would've given him a shoulder 30+ years ago. I can say that he turned his back on his religion and his God for many years because of that moment. Fortunately, he has found his way back, and he said that getting back to church was one of the best things for him. It's just sad that he was pushed out in the first place.

Where do we go from here?

2009-04-06T20:09:00.000-07:00

Ever hear that song by David Essex - "Rock On"? You can see a YouTube video here. There's a line where he says, "Where do we go from here..."

That's how I'm feeling these days.

I'm near the point in my fellowship where I have to decide what I want to do when I'm done. This doesn't sound hard -- I've been training to be an Infectious Diseases specialist...so, duh, go and be an ID doc! It's not that easy.

There's outpatient HIV work. There's hospital consulting. There's any combination of those two. There's joining a group, starting your own group or (for those who love risk) starting your own solo practice. There's research - many, many different types. There's staying LA (which is a pretty saturated market) or looking out in the 'burbs.

Here's the kicker: I don't know what I want.

I know what I don't want. I don't want to be bored. I don't want to work 28 days a month. I don't want the pressure of starting my own group. I enjoy research and teaching. I am fascinated by HIV and Hep C. I love international HIV work.

Ideally, I want a job where I can do frequent over-seas trips to either do research or direct patient care, possibly some teaching of residents or med students there. I want to do HIV work with some HCV work here. Teach and supervise residents/fellows here. So, I think I need to stay in academics. In order to try and get a job in that competitive world, I think I'm going to need to do a 3rd year of fellowship. This pains me mostly because of the salary. I'll have to moonlight still to make enough to pay off the house and such. But, it's just one more year in the grand scheme of life.

So, I've got some meetings coming up to see where that 3rd year will be and how it will be structured. So many questions still.

Clinic #4: Mityana

2009-03-31T22:02:00.000-07:00

This was going to be our final clinic, and we knew it. It was a little bitter sweet loading up the luggage of medications for these final two days. Ok, it was mostly sweet, since I know I was darn tired of lifting and pulling 7 bags through the back windows of the bus and lugging them over uneven dirt sidewalks.

The night before our first day, we brainstormed on how to make this one run most efficiently. We had definitely run into some speed bumps along the way. So, we formulated a plan to try and get through all of the orphans and school kids as well as the adults in the community. So, with a plan in hand, we started the clinic early.

Things ran really well. Partly because we finally knew what we were doing. Partly because Joshua and Paul, who run the orphanage, were very capable leaders [in the photo below, Joshua is on the far right, with Paul in the yellow shirt]. We arranged a line of children and the NPs saw them. We arranged a line of adults who saw the nurses for vital signs. Then they arranged in a line outside the door and waited for the PA or me to be free. By this time, we all had our own translator. I worked with Nicholas, a very bright and caring young man who one day will be a world-class economist. However, I was lucky enough to have him as my translator and friend. By the end of our week together, he could diagnose arthritis, give medication precautions for Benadryl and educate people on conservative treatment of low back pain. He was a lifesaver.

We were seeing a young mother who was holding a baby who was about 5-6 months old. All of the sudden, the baby's arms started shaking. Nicholas jumped up and translated for me: "She says this has never happened before - what's wrong with the baby?" I looked at the baby. His pupils were fixed and pinpoint. He was unresponsive to painful stimuli. He was shaking. He had a pulse. I grabbed my sister-in-law, the NP: this baby was having a seizure. {He only seized for a few minutes. Needless to say, we recommended that the mother take the baby to the hospital to get evaluated for a seizure disorder.

We saw about 250 people in 2 days. We were running out of medications at the end of the second day. Mostly over-the-counter things like Tylenol and Omeprazole. But, we did what we could, and the people were very thankful.

It was sad to pack up at the end of the day on Thursday. We said goodbye to the people in the town. We said goodbye to the kids. We eventually had to say goodbye to the translators...our new friends [here's a picture of some of them with some of us]. But, we have great memories and thanks to Facebook we are still keeping in touch, all these miles away. I have no doubt that some of us will go back to Africa, perhaps even Uganda. Some of us will work on helping the poor and under-served right here at home. All of us have been touched by the warm hearts of the people of Uganda, and that will leave a mark on us forever.

Clinic #3: Canaan

2009-03-30T20:37:00.000-07:00

For the next two days, the group split up. The 4 providers (me the MD, a PA and 2 pediatric NPs), along with another NP who was running the pharmacy, would go to the orphanage in Canaan. There, we would see the 100 orphan kids along with the 200 kids who come in for school there. Now, that's a lot of kids, but we had a plan. The PA and I would screen the kids with a quick eye-ear-mouth-heart-lung-skin check. Anyone with any issues would go to see the NPs (since they do peds for a living) and get meds from the pharmacy. We'd give worm meds to the appropriate kids (ie, kids with big bellies).

This started out great. We had Paul, our Ugandan friend and translator, helping give out worm meds after we checked the kids. The meds taste awful, so he'd tell them in Luganda, "Be strong!" and make a chomping noise. Then, he'd give them a yummy vitamin to follow it up with. We laughed every time we heard him say, "Be strong!"

Then, at about 10:30a, I noticed that more and more adults were congregating in the big main room. The main woman at the orphanage came over and asked me when we were going to see the adults. I nearly bit her head off. We had 300 kids to see, when exactly did she think we were going to see the adults?? And we had never planned to see any adults, so what would make her think this was part of our day? I asked how many there were, and she said about 27. I said I would start seeing them after lunch. I figured I could see them all in the 3-4 hours after lunch, and let one NP and the PA do the congo line of kids. We weren't sending too many back for treatment.

At 11a, I see a ton of adults now, hanging around. I marched over the lady and saw that her sheet of paper, previously 2/3 full on one side is now full of names, front and back. I'm livid. I just told her that we weren't supposed to see any, and now she's adding on names?!?

"What's going on? How many people do you have?" Before she can answer, I continue. "No more. I will see as many as I can see, but I cannot see everyone. No more." "No more?" she asks. "NO. MORE." I state firmly.

I grab Paul to help me translate; he gives his "Be strong" strategy to Seggy, our main point-person in Uganda.

To make a very long and painful story short(er), I saw 55 adults in 5 hours. We got a 20 minute lunch consisting of Coke and Poptarts. We saw 160 kids. We saw one baby with meningitis that the parents didn't want to take to the hospital. We were exhausted, emotionally and physically.

When we finally got home, dirty and tired, we found out that the other group had a fairly relaxing day in Waka Waka - eating lemongrass fish cooked by Carl the South African, playing with kids at the orphanage, and talking with the orphanage staff about their needs. Granted, they did arrive at the Waka Waka clinic to an angry mob of 100 people who thought they would get medical care (miscommunication). They triaged those people and had about 20 for us to see the next day, as we switched sites. The providers went to Waka Waka and the rest when to Canaan the next day. We didn't get lemongrass tilapia, but we did get to see some monkeys running around Carl's yard. [this is a picture on the way to Waka Waka...Lake Victoria is in the background]

Next up: Mityana.

Clinic #2: Seeta

2009-03-23T20:52:00.001-07:00

Our second clinic was in a place called Seeta. Pronouced See-et-uh. There we met Betty, who runs a school for the surrounding children. It's not an orphanage, but many of these children come from vulnerable families and wouldn't have the chance to go to school if not for Betty. Most of the children have classes with her and the teachers in the morning and afternoon. Some of the older kids return to her HOUSE in the evenings for additional classes. (Here's a pic of some kids outside the school.)

There is one building for the school, divided into 4 sections. Each section holds two classes. The classes are divided by a chalkboard -- one teacher writes on one side, the other writes on the other side. The kids face each other, but can't see one another because of the chalkboard. The whole room is about 8x16 feet. Pretty small once you put a chalkboard and 2-3 benches on each side.

We went to the "clinic" after meeting Betty and the students at the school. One of the community leaders lent his house for us to hold the clinic in. We had 2 rooms -- one for seeing patients and one for the pharmacy. Each of us 4 providers took a corner of the room. We put 2 chairs in each corner and a coffee table dividing the room in half.

At this clinic, we learned that each provider needed her own translator. Waiting for one to free up was not working. We became more efficient in seeing patients this way. We also set up our pharmacy with several chairs so people could wait for their medications. We learned that it's essential to have a dedicated translator in the pharmacy.

We saw about 180 patients over those two days. There was some chaos, but overall it wasn't bad for our first real clinic. We had a very dehydrated baby that we mixed up some oral rehydration solution for. We also had a baby with suspected pyloric stenosis versus severe reflux. He would vomit after almost every feeding. He had gained only 1lb in the 2 months since birth. He should've gained over 10. His mother was also have severe pelvic pain after having a C-section.

We arranged for them to go to the hospital. We actually took them ourselves on one of our final days in Uganda. Mom ended up having a severe bladder infection (thankfully nothing worse!), and the baby was going to be checked by a radiologist a few days later to look for pyloric stenosis. I'll have to check to see if we have an update on the little guy.

Seeta was a good way to start things off. We learned how to pack and unpack all of the meds into our 7 suitcases. We learned how to maneuver all of the suitcases on and off the bus. We'd have to do this every morning and every night, so that we could keep the meds safely with us.

The next clinic was supposed to be more low key. Half the group would go to Waka Waka and the providers would go to Canaan. Then we'd switch. Let's just say it didn't turn to be as "low key" as we anticipated.

Uganda - Clinic #1

2009-03-21T14:58:00.000-07:00

Our first clinic in Uganda was in a Kampala Slum. Kampala is the capital of Uganda (see map). There are about 30 million people in Uganda; about 1.5 million live in Kampala. I'm not sure exactly where we were in relation to the rest of the city, but we turned off the main (paved) road down into a dirt road. All around the mini-bus we saw little stands set up. People were selling tomatoes, potatoes, bananas, shoes, etc. Children were running around and people walked, shopping for goods.

We travelled a bit down the main dirt road (which was only wide enough for the mini-bus), when all of the sudden the driver stopped. Apparently we had arrived. The building was made of concrete and, like most things in Uganda, adopted the red hue of the dirt. We piled out and went in. Inside the main room (which stood about 50x30ft), approximately 25 people sat on plastic patio chairs. There were 2 tables in front and some chairs up there. We had carried in the 7 suitcases that contained our "pharmacy" -- medications purchased both in the States and in Uganda that morning.

We were ushered to sit in front of everyone, behind the tables. We introduced ourselves, and Seggy (our Ugandan partner) told everyone in their native Luganda language that we were from the US and here to provide medical care.

We went back to the "treatment rooms." We discovered that this building was probably a type of hostel or dorm. The rooms were small -- about 10x6ft -- with barely enough room for a twin bed. Myself and the PA (who also saw adults) took one room. The two pediatric NPs took the other room. Across the hall from our rooms was a slightly bigger room -- about 15x15ft, with a queen bed. We unloaded the drugs on to the bed and left a 3rd NP and a lawyer to figure out the pharmacy.

The 4 providers looked at each other and got to work. We had enough Purell for a small country, and we used a ton that day. After a few patients, the PA felt comfortable enough to look for another room. Having 4 adults in that tiny space was too much. Thankfully, she found another room down the hall.

We had some translators bouncing between rooms to help with the people who didn't speak English. School is taught in English, so anyone who spent any significant amount of time in a classroom spoke fairly good English. However, most of the people who we saw didn't have much of an education.

The saddest case I saw was Ronald. He is 26, and his English was amazing. He had served in the Ugandan Army and was stationed in Iraq. He sustained an injury to his left eye in 2003 and was sent back to Uganda. He was discharged from the military, but his vision continued to decline. He came to me with a letter from a Ugandan ophthalmologist. She described his eye and the growing pressure that was occurring. She had performed a few drainage procedures, but the fluid kept returning; he needed a definitive procedure if he had any hope of saving his vision. As it stood, he could see light and dark and basic shapes on my exam. He couldn't count fingers in that eye.

The letter went on to explain that there were no doctors in Uganda who could perform the procedure. They hadn't been trained to do it. She asked for help so that this young man could get a place that might be able to help him. My guess is that the closest facility would be in Nairobi.

I introduced him to Julie Clark, the leader for doma. We had travelled to Uganda with doma so Julie could try and figure out how doma could best partner with orphanages and community groups to provide medical care to orphans and vulnerable families. Julie took down his name and contact information, and her hope is that we can raise money to get him to Nairobi for further care. He was very thankful, and he came back to my room twice to express his gratitude. He was hopefully that we might be able to provide some way for him to save his sight.

We saw just over 200 people in 5 hours. We had to turn about 30 people away because it was getting dark, and we needed to be on the road before it got too late. There was such a need for basic primary care -- blood pressure monitoring, nutrition counselling for new mothers, STD testing and treatment -- we probably could've spent all week there and barely made a dent in the population that lives in the slum.

However, we had 3 more locations to visit before our trip was done. Next up: Seeta.

HWC Recap

2009-03-16T21:08:00.000-07:00

So, we had a successful event on March 1.

Caitlin rocked the house with an amazing performance. Jesse Spencer on violin and James Denton on guitar provided excellent support. It was magical. I hope to have a video up soon.

Kevin Pereira and Alison Haislip were awesome co-hosts. They put together a video of their experience, which you can find here. I hope you like it! The best part: you can make a donation from the page to support the great work at the Los Angeles Christian Health Centers.

Kevin Parry, of wireimage, did an amazing job photographing the event. You can check it out at the wireimage site here.

So far, we've raised almost $28,000 for the clinic! This is amazing, especially given the current economy. It reminds me once again how generous people are. We had so many people donate auction items, donate their time to help organize the event, and then donate their money via ticket sales and auction bidding.

A big thank you to everyone who came out to support us! Remember: whether you donate to our charity at the link above, to another charity, or whether you give of your time to help those in need, we can all make a big difference if we just take the first step to care.

Tomorrow...is only a day away...

2009-02-28T20:49:00.001-08:00

The big day is here!!

My brothers are in town, my sister-in-law is in town. My parents come in tonight. My sister and her husband can't come, but they are doing their part as well: visit her blog here to find out how you can win awesome scrapbooking supplies while raising money for the Clinic!

Caitlin is going to be singing. Check out her video here. She is awesome! The song in the video shows her playful side. She is also a very socially conscious singer, whose music really touches your heart. I'll be linking a video of the Clinic done to one of her songs after the event. Stay tuned.

Jesse Spencer from House, MD is going to be playing the violin with her; James Denton from Desperate Housewives is going to be playing guitar. And Jeremiah James is going to be chiming in on bass. It's going to be a rockin' night!

Our co-hosts, Alison Haislip and Kevin Pereira from G4 TV's Attack of the Show have got a great evening planned.

We've got all the auction items accounted for. We've got all the decorations ready. We've got our outfits picked out and waiting. This is going to be a great event!

I hope to update after the event, so be sure to check back in a day or so to find out how it went! Thanks to everyone for their support - financial, emotional, and otherwise!

Sickness

2009-02-25T19:45:00.000-08:00

So, the timing is pretty poor, but I've come down with some illness. In my best estimation, I'd say either bronchitis or pneumonia. I hesitate with a simple bronchitis because I have such a productive cough. I even coughed up a mucus plus last night. It was nasty.

Fortunately, I started antibiotics today, and I'm hoping to be in top shape on Sunday. Again, luckily for me, I'm on a lighter rotation, and my attending was fine with me taking a day off. I can remember the last day I took off. It was the Saturday after Thanksgiving, 2005. I had to get someone to cover my clinic because I had a temperature to 102.

I don't like calling in sick. Don't get me wrong, I often fantasize about staying home from work, watching television all day, or going to the beach. However, I feel a strong commitment to my patients that I be there for them. And, I do love my job (most days!), so it's not torture going in. Today, however, I felt I'd just spread my germs around, and we don't need any transplant patients coming down with whatever nastiness I have.

So, I'm taking it easy today. I should have a light day tomorrow and Friday. The Brothers come in tomorrow, so that's exciting. I hope I don't get any of them sick!

One Week Away

2009-02-21T15:47:00.001-08:00

So, the charity is just one week away!

March 1.

Wow. Most of the family is coming, so that's awesome. My sister is home with the kiddies, but the rest of the fam is coming out.

We're benefitting a clinic on Skid Row that has just started diagnosing and testing people for HIV. It's an expensive endeavor, but it's a needed one given the high risk nature of the patients there.

Check out the website for more information:
www.handlewithcarenow.org

Crushing

2009-02-13T09:18:00.000-08:00

A few weeks ago, I was in clinic and I met a man with AIDS. This is not unusual, since a meet a lot of people in clinic with AIDS.

The difference was this man was dying. Right before my eyes.

He was in his mid-30s, very pleasant, very grounded. He had been through a lot in his life. He was diagnosed several years earlier, and he had actually started treatment. Then, as he explained to me, he got very angry. "Angry at God," were his words. He stopped seeing his doctors. He stopped taking his medications. He just stopped trying to live. He went back to using drugs. He was transiently homeless.

Then, about a year ago, something inside him woke up. I'm not sure what, and he wasn't really able to explain it all that well. He worked through his anger, and he was ready to really live.

He was admitted to one of our hospitals with pancreatitis and fulmanent liver failure. Our best guess is that it was an extremely rare reaction to one of his HIV medications. He nearly died. For the doctors out there: his Ranson score was through the roof.

He made it through and was discharge, but when I saw him in clinic he was pale and wasted. He started crying as he told me about what he'd been through in his life. He had a glimmer of life in his crystal blue eyes, but it was faint. He had a firm resolve to make it through, but his physical body seemed to say otherwise.

I admitted him for anemia and failure to thrive, a diagnosis usually given to neonates. His housing situation was still tenuous, and he really needed close to 24-hour nursing care. He was barely strong enough to get to the bathroom, let alone stand in a shower and wash. However, with no income and no insurance, finding a place to accept him was going to be a nightmare for the social worker.

The hardest thing was the complete faith he put in us to make him well. His chances of survival are so small. If he does make it, it's purely because of his will to live and his faith in God. Medicine can only do so much for him now. The best thing was the sense of peace he had about his situation. The paradox of his physical condition and his spiritual one still strike me now, all these weeks later.

Finished!

2009-02-07T09:29:00.000-08:00

So, I ran the Surf City Half-Marathon in Manhattan Beach on February 1. It was quite an experience! I finished in just under 2 hours, and I ran about a 9 minute mile, which is better than I anticipated.

It was quite fun running with all those people around you.

I don't think I'll ever have the desire to run a full marathon, but a 10k or even another half would be fun. For now, though, I'll stick to a few miles around my house for fun. :) I need a break!

5 (or 6) Things

2009-01-27T22:28:00.001-08:00

I am feeling very grateful today, so I thought I'd write down the 5 things I'm most thankful for today (not in general, just today).

1. I'm thankful that clinic ended early tonight.
2. I'm thankful that we'll soon have an online link to buy tickets to the charity event.
3. I'm thankful for Campbell's soup-on-the-go.
4. I'm thankful for cell phones.
5. I'm thankful that I am married to my best friend.

Ok, I have a 6th one:
6. I'm thankful for Christian Girl, who always makes me laugh, always acts with grace and always comes through in a pinch.

A View of Life

2009-01-19T20:35:00.000-08:00

I'm an optimist. Really. Optimists not only see the glass as half full, they see the optimist in everyone. Even the pessimists. That's where we optimists get into trouble -- the pessimists don't want to see that the glass is half full. They'd rather pour the contents over your head and walk away while you're dripping wet, staring at a now fully-empty glass. My blog today is for the pessimists out there:

Are things really so dire? Are the stakes really so high?

Are we so arrogant to think that we are above disappointment and failure and frustration?

Are we so misguided as to think that life is all sunshine and rainbows?

I grew up with more "no"s than "yes"s, with more disappointments than gifts, and with more struggle than easy roads. I subsequently chose a career where I would see death win, tragedy happen and people break down. However, what I have learned through all of this is that we (meaning humankind) DO persevere, we DO fight even when we're losing, and we DO occasionally come out victorious.

I've also learned that you sometimes have to redefine what "victory" means. Sometimes it means your cancer is cured. Sometimes it means you die with dignity. Sometimes it means you finally get that baby. Sometimes it means you grew closer to your dad as you watch your mother die.

Life, I feel, is all about perspective. And we can choose from what angle we want to view things. That starting point is our decision to make, and it will make all the difference in how we look back on where we've come.

A December to Remember

2009-01-02T18:06:00.000-08:00

Well, I finished by "31 Friends in 31 Days" experiment. I successfully sent 31 emails to 31+ people throughout December to tell them what they mean to me.

I'll be honest -- I missed a day here and there, so some people got it the day after their assigned day...but they didn't need to know that I was slow on delivering. Besides that little hang up, it went smashingly well.

I learned a lot in this experiment.

1. We don't tell people we love them nearly enough. (I hope to do a better job of this in the future.)
2. People enjoy knowing that they mean something to you.
3. It doesn't take much time to tell people how wonderful they are.
4. When I really looked at my friends and what their best qualities are, I found a lot of similar through lines. Generosity. Loyalty. Sacrifice. It seems that I am drawn to people with these qualities...they certainly make for awesome friends.

So, don't be afraid to tell people what they've done for you, what they mean to you, etc. We shouldn't have to wait for some tragedy to tell people how amazing they are. I think it's awesome to think that perhaps my everyday actions can touch people in ways that mean something. So, when people do that for me, I am going to tell them.

Spread the Love.

A Narrow Escape

2008-12-12T20:03:00.001-08:00

I survived a day at jury duty.

I get picked for service about every 18-24 months. I don't know why, but I do. I even got picked to serve on a jury for a Grand Theft Auto case. Very interesting. Everyone should do it. It really teaches you a lot about the justice system.

But, this time, I just didn't have the time to dedicate to serving. So, I walked into the jury assembly room just hoping for a break.

I got called to be on a panel for selection around 10:30a. "Great," I thought, "if I am lucky enough to get dismissed, it's so early, they'll put me in for another panel!" We walked up 2 flights to the 4th floor, and we went outside the courtroom door. We waited about 5 or 6 minutes, and a lady pokes her head out.

"Are you guys here for District 36?" We all moan a collective, "Yes." She looks confused and goes back in the room.

About 3 minutes later a fat man comes out and asks the same question. "Yes," we sigh again. "Well," he says smiling, "we don't need jurors until tomorrow, so you're free!" We must have looked too happy, because he quickly clarified: "You are free to go back to the jury assembly room." We all start to trudge back down the hall. One guy yells, "Hey, let's not walk so fast!" We all chuckled and moved like sheep toward the escalator.

At noon, they called me for another panel. Only this time, we were all to report to Traffic Court...19 blocks away. Again, the collective sigh, as we packed up our belongings and started to walk out to the parking lot. While reading the map in the car, I am pretty sure I ran a red light. I just envisioned myself getting a ticket on my way to serve at Traffic Court. The coincidence of it all.

Traffic Court was the Ritz Carlton of the court houses. I've been in 3 so far for jury service in LA -- criminal (where I served), civil (where I reported this time) and now traffic. At the Traffic Court, there are vending machines in the jury assembly room! The chairs are nicer! There are magazines ALL OVER for you to read! It was heaven for people stuck in potential-juror hell.

Here, again, I saw the walls of differences between people collapse. I saw an Indian guy on a lap top and an Asian girl start talking about nursing school -- he was finished and she wanted to go. I saw a Hispanic guy and a middle aged lady laughing about some private joke they had managed to develop during the last 4 hours of being in that room.

It got me thinking about how, at jury dury, everyone is on the same team. Everyone is hoping for a dismissal. Everyone is hoping to get out of it. Strangers with nothing else in common start talking to each other, laughing about their kids, etc. It was one of the few places I've even been that the playing field is level. We're all just there to serve.

It was a great snapshot of America. Or at least, the America we all want to believe in.

Cancer Sucks

2008-12-07T18:25:00.000-08:00

I was moonlighting last weekend (or the weekend before, I have lost track), and one of the patients I was called to see was a young man (less than 30 years old) with metastatic germ cell carcinoma. He was dying.

He had a wife, who came in when the nurse called her to tell her that the patient was having trouble breathing. Everyone knew he was in his last days, and even though there was nothing new that day to make anyone think that today would be "that day," you never knew.

So, I evaluated him and ended up transferring him to the ICU per the primary physician's orders. It was, in my opinion, an inappropriate transfer but that's another story for another blog.

The patient has a 3 month old daughter. She will never know her dad. She'll see pictures of the two of them, later on when she's older. She'll wonder what he was like, and what it would be like to grow up with a dad.

It seems sad and unfair that this little girl won't get the chance to be a "daddy's girl." And it is. But, it's actually a miracle that the patient got to see her at all. Six months ago, he was told he had 2-3 months to live. He outlived the predictions and in the meantime saw his daughter born and got to spend 3 months building his memories and trying to build some memories for her.

I never checked back in on him. Mostly because I thought he'd be gone within 2-3 days and seeing that he had expired would just depress me. It made me, yet again, appreciate my friends and family, and it reinforced by resolution to write an email a day to express my gratitude and appreciation. You never know when you won't get that chance again.

The Day Before

2008-11-30T14:16:00.000-08:00

So, tomorrow is December 1.

I like December for quite a few reasons. One is Christmas, and that's a big one. The lights, the trees, the bows, the festivities... I like December because it's cold. I've always liked the cold weather, which is odd because I'm always cold. But, I like that EVERYONE is cold in December, not just me. That wasn't meant to be as mean as it sounded. I meant that it's finally ok for me to say, "I'm cold," and people don't look at me like I'm a freak of nature.

I like hot chocolate. A lot. And that's also more fun to drink when it's cold. Don't forget the marshmallows.

I like getting together with friends and family. I like socializing with everyone, drinking, eating, laughing. It's so much fun, and everyone wants to hang out in December. There aren't a lot of other distractions, like vacations, trips to the beach, etc. Most people aren't doing a whole lot in December.

I've decided to try something this year. Since I can't go home, and since most of my friends are in fellowship and stuck working a lot, I want to make a list. One person for each day in December. And I will email that person on that day and tell them how much they mean to me. I think it'll help me keep up the spirit of Christmas -- the giving and the sacrifice Jesus made, as well as the love Mary and Joseph committed to him.

So, we'll see if I can come up with 31 friends and family to dedicate to each day in December. Feel free to do the same -- even just an email or two to a few people who have been especially helpful, amazingly loyal or just made you smile when things were gloomy. I know for sure they'll appreciate it. You can't give a better gift than to lift someone up like that.

I'll let you know how my experiment works out. I have a feeling I'm going to get a lot of out of this exercise as well.

T-day

2008-11-26T21:43:00.000-08:00

Tomorrow is Thursday and Thanksgiving. And another day of work at the VA.

I met two vets today -- they are roommates right now. I was consulted on both of them. One (Mr. H) for bacteria in his blood and one (Mr. R) for a possible wound infection. When I saw the 2nd one, at the end of the day, it was dinner time. Both had gotten their dinner trays.

I finished talking to Mr. R and on my way out, said hi to Mr. H, who I had seen earlier in the day. He asked when he was going to get his food. He had a tray on his table, so I lifted the top and asked, "Isn't it in here?" He said no, that it wasn't right.

Mr. R said, "Oh, he needs a new tray, he can't eat the pork."

I was struck by this -- Mr. R and Mr. H had obviously talked about why Mr. H wasn't eating his dinner. Mr. H has dementia, and he's very pleasant, but he may have forgotten to tell the nurse that the pork was not something he should be eating. I found it very sweet that Mr. R was looking out for Mr. H, making sure he got a dinner he could eat.

What else could you ask for on Thanksgiving -- or any day -- but someone to watch out for you and make sure you got a meal you could eat?

Home, Sweet Home

2008-11-16T20:35:00.000-08:00

We had our Housewarming Party yesterday. We weren't sure we were going to make it at first.

We were up until 5a Saturday morning doing final unpacking, touching up paint in a few rooms, and cleaning. I ended the night by repainting the stairs (they are wooden floating steps, and they were badly nicked). We found the paint left by the previous owner, so I started at the bottom and went up, effectively painting us into our bedroom. :)

We woke up at 9:30 on Saturday and had to do some baking, final cleaning and decorating. The party was supposed to start at 3p. At 2:20p, Kevin hopped into the shower and then left for BevMo to pick up some drinks. I was hanging our pictures on the "Picture Wall" until 3p. I took a quick shower and prayed that people would be late. Since it's LA, the first guest arrived at 4:15p. Perfect.

In total, we probably had 50 people come through, and at critical mass we were near 40 at one time. Thankfully, we have a lot of room now, so it wasn't too crowded. I think people had a great time.

For me, it was the first time the place really felt like ours. We had our pictures up, it was our colors on the walls, and our furniture in the rooms. And, most importantly, it was our friends laughing, sharing, and goofing off. It was so special to be surrounded by everyone out here that we love. I wish my siblings and a few close out-of-town friends could've been here. But, that just means another reason to throw a party when they finally are able to come visit.