Archive | January, 2013

philadelphia protocol

18 Jan

One of the biggest arguments/fights John and I got into was in mid-November when I took Ari with me to a good friend’s 30th birthday party.  Ari was just shy of 30 days old, and I took her without confirming that every single person at the party was free of disease, though I did hand out Purell as soon as I walked in the door.  In all honesty, John was right to be miffed as he was, though, in my defense, I thought exposing her to some germs was probably safer than spending another night in the care of a sleep-deprived mommy with a case of cabin fever so severe that she thought she might literally push her head through a window.

I know we medicine types must seem crazy overprotective when it comes to newborns.  It’s because we know what’s in store for them if they even hint at being sick.  Turns out these little tikes can somewhat easily develop what we call a Serious Bacterial Infection (SBI), such as meningitis, pneumonia, pyelonephitis, and gastroenteritis.  Fever may be the only sign of illness.  Evaluation of a potential SBI includes a full sepsis work-up: blood work; urinalysis via catheter; lumbar puncture; chest x-ray; possibly CT, MRI,  and ultrasound of the head in cases of meningitis.  The treatment for an SBI includes empiric antibiotics and hospital admission.  No fun.  Possibly the most un-fun situation you could imagine except, of course, not providing empiric antibiotics and admission to a kid who actually has an SBI.

If the kid is 28 days or fewer in age, he is considered to be at high risk of having an SBI.  Therefore, a full sepsis work-up, hospital admission, and antibiotics are required.  Age 29-60 days is a grey area.  There are a number of different protocols used to determine which infants in this category require the whole rigamarole .  In Philly we, not surprisingly, use the Philadelphia protocol.  A full sepsis work-up, pleasant as it is, is still required to determine which kids are at “low risk” and can therefore be sent home without antibiotics as long as there is assurance of 24-hour follow-up.

Although there is no protocol, that I know of, that guides our treatment of the febrile infant at 61-90 days of life, I understand that most pediatric emergency med docs are cautious.  If a kid less than three months old comes in with a fever, he’s likely to undergo the diagnostic work-up.

Therefore, it is with one great sigh of relief that I quietly celebrated Aurelia’s three-month birthday yesterday!  She’s still pretty squishy, but she seems just a little stronger each day I get to know her.  We got through three months with nothing worse than a little reflux and labial adhesion (yeah, that apparently is a thing…don’t be too aggressive with them wipes!); nothing some zantac and estrogen cream can’t fix!

photo-10

the plan

16 Jan

I was recently arranging a visit with a friend during her study break.  She, like many of my classmates, is studying for Step 1 of the boards, the first in a series of tests on the way to becoming a board-certified physician.  Most students at Penn choose to take this exam in February/March of their third year of med school, after the completion of the year of core clerkships the December prior.  From what I understand, they typically study about 10 hours a day, 6 days a week, for 6 weeks.  This exam tests the basic sciences, which I’m sure is interesting to some, but biochem and physiology are not the stuff that gets me up in the morning.  That said, I admit I’m starting to feel a bit envious of my classmates, both for the opportunity to study 10 hours a day (I can’t believe I’m writing this!) and for the continuation of their progression toward becoming a doctor.  I feel left behind.

I don’t believe I publicly confirmed my plan for the completion of medical school.  After many, many conversations, John and I decided that I will be taking a year out of school, though a bit unconventionally.  I will be returning for nine weeks April-June to complete my remaining clerkships: neuro (three weeks) and psych (six weeks).  John’s grandparents will be staying with us during that time to look after Ari.  In the summer, my hope is to prepare for and take Step 1, and hopefully take the Clinical Skills portion of Step 2 as well.  I’m currently looking for daycare options for that time.

In the fall, I will be a full-time graduate student of bioethics.  The MD/MBE is normally completed within the four years of medical education at Penn.  At this time, I’ve completed a little over half of the requirements.  We thought that, though it’s feasible for MD students to get this Masters and still finish in four years, and it’s feasible to have a child and still finish in four years, an MD + Masters + child seemed a bit overkill.  I will resume my MD pursuit in January 2014.

Truthfully, even if I wasn’t working on a Masters, I think I would want to take a year out.  I feel like it’s a very rare privilege to be able to take this time to be with my daughter–to witness all her small discoveries (the look of wonder and the muttering “guh! uh!” as her eyes fix on a lamp…never gets old)–that I might never have again, with any of my children, if we’re lucky enough to have more.  From what I understand, it’s so much easier to take time off in school than it will be in residency and beyond.  And, although being six years behind one’s husband in professional training does have it’s downsides, we feel so lucky that one of us is making an income, so it actually makes some short-term financial sense for me to stay home to avoid some childcare expenses while not paying tuition (in the long-term, it’s probably better for us that I get out of school as quickly as possible and start making an income but, hey, we’re living in the now!).

I spoke with one of our pediatrics course directors a few weeks prior to Ari’s birth.  She had taken a year off after the birth of one of her children.  She said that it was a great year, but that it also helped confirm that she was a happier (perhaps better) mother if she was not stay-at-home.  I imagine my first day back in the hospital will be painful.  I’m not ready for it now, and I doubt I’ll be ready come April.  But I miss school, I miss it very much.  There are moments when I’m holding Ari, and she’s so sweetly clinging to the folds of my clothing, breathing rapidly on my neck, and I can’t help but think, “Why the hell did I go to medical school?”  Then I find myself getting jealous when my friends talk about studying for the boards, or I can’t wait to run home to read up on chronic lyme disease after I learn that a mom at my yoga babies class suffers from it, and I know that I will be a better mom if I have a career that I love outside the home.

The plan is for me to graduate from medical school in May 2015, hopefully figuring out how to strike a good balance between motherhood and medicine and other good stuff in the mean time.  Suggestions welcome.

what a champ

15 Jan

We’ve taken Ari out and about a bunch in the last week.  Our three dinner parties this weekend seem to have sufficiently worn out our little champ, as she has been found napping while she was supposed to be burping.  Submitted as evidence:

rough nightrough morning

Her hair and eyes might scream “John,” but her sleeping habits she definitely got from me…I can just see her years from now, in one of the front rows of a lecture hall, nodding off mere yards from the professor.  Or, worse yet, if she chooses to go into medicine, falling asleep in an OR like her classy momma.

 

flava favs

10 Jan

We took a flying trip to Charlottesville right before Christmas.  We spent as much time as we could (never enough) with people we love, ate our way through some of favorite restaurants, visited old stomping grounds, and even had our first date post-baby, thanks to our friend Alaina, a pediatrician–okay, seriously, our first babysitter was an attending pediatrician!  Who does that??!  We also swung by Barboursville Vineyards, where we were married almost three and a half years ago.  This visit prompted us to start testing out her tastebuds (I know, I know, no solids until 5-6 months, and no alcohol for another couple years).

Wine: puts her to sleep.

wine

Beer: less interesting than the ceiling fan.

beer

Fro-yo: mmm…have we found a decent substitute for mama’s milk?

froyo

Yaya Megan: cannot get enough!

megan 1megan 2

today’s ari-ventures

9 Jan

Oh my little bear, you make a trip to the post office fun.  My bar for excitement is so, so low.

usps 1usps 2usps 3

Today I will finish the first draft of a paper I’m writing on the laborist model in obstetrics…I got the data back in early September on the interviews I conducted in 2011-2012.  Since then, I’ve only managed to write about 2127 words.  Today I will finish, likely while breastfeeding with the brest-friend (nursing pillow, my fav) propped between me and computer.  So it is written…

 

the oldest trick in the book

3 Jan

Baby is crying.  Daddy passes baby off to mommy so he can use the bathroom.

20 minutes pass.  Then 30.  Mommy notices daddy’s cell phone and book are nowhere to be seen.

Baby miraculously falls asleep after lots of bouncing, swaying, and singing.  Daddy emerges from bathroom, at which point he generously offers to give mommy a break.  Meanwhile, he is being praised far and wide as being progressive for knowing how to change a diaper.

I love my husband and I think he is a phenomenal partner and father (even during his half-hour escapes to the bathroom at choice times–let’s be honest, we can all use them).  Folks now need to make current their concept of fatherhood.

in the spirit of this holiday…

2 Jan

When you have friends with kids older than your own, it’s hard not to constantly be looking forward, excited for the day when she too will be able to reach her arms up toward you with desire and anticipation–hell, right now I’m eager for the day she’ll have enough muscle control to stop slapping herself in the face.  But that’s a problem I’ve had in most/all walks of life: looking ahead instead of appreciating the now.  So some of the resounding advice I’ve received recently has certainly struck a chord with me: appreciate the portability of the two-and-a-half-month-old child.

I hadn’t considered the ease of going place to place with our young infant.  Every time Ari and I leave the house together feels like a traumatic event.  I dread the 15 minutes before departure spent trying to gather what we need, all the while Ari is making her discontentment known, that I’m we rarely leave the house.  But now she’s robust enough for her carrier, she’s developed (had forced upon her) some immunity, and I think our recent trip to Charlottesville has given us more practice in the ways of carting infants to and from.  I’m determined to make greater efforts to not be couch bums.  We will attempt to leave the house at least once a day, tears and frustrations (much more mine than Ari’s) be damned!

On New Year’s Eve we took care of all the errands!  Then Julie was kind enough to let us bring Ari out to her New Years bash–oh what fun it is to have real adult conversation while sipping on crazy strong cocktails and still be able to see the look in your kid’s eye when she sees fireworks for the first time!

On New Year’s Day we were hungover and decidedly less ambitious, and a stroll around Haverford and the neighboring strip malls (see below…I probably chose the least scenic location at which to snap a picture) more than met our quota:

walk 1

(Notice me looking like a tool with a headset in place.)

So confused and tuckered out post-walk, tangled in said carrier because mom hasn’t figured out how to properly remove baby:

walk 2walk 3