anna in med school

After three weeks of caring for some seriously sick kiddos, this past week of mostly well visits has been a welcome reprieve.  While I think I’m more of an inpatient kind of girl, a month of clinic every now and then, or an afternoon or two a week of outpatient is a sweet deal.

First of all, the schedule is simply lovely: arrive at the office at 8:30; take 30 minutes for lunch; leave by 5:30 at the latest…and that’s a busy day.  (This is definitely not to say that all outpatient pediatric experiences are like this…to the contrary, most attendings in private practice are feverishly swamped.  But, as a student, things are a lot cushier.)  As I enter my 35th week of pregnancy, I’m overwhelmingly appreciative of the extra time allotted for sleep and study–oh God, I’m horribly behind on studying.

Two: at a tertiary care center, it’s easy to forget that rare diseases are rare, that not every child has a catastrophic  illness or injury.  Not all children who have asthma have to be admitted to the pediatric intensive care unit for days in order to make sure they oxygenate their blood.  Not all children who have a fever have bacterial meningitis.  For me personally (and somewhat selfishly), it’s nice to be reminded that there are so many healthy, happy children out there.

Finally, outpatient peds is a fairly unique environment for providing true preventative care.  Parents love their children and, for the most part, they’re pretty amenable to changing behaviors, considering suggestions, and making some hard parenting decisions if it means their kids will be better off.  Sure, we’ve all seen parents who refuse to get their kids vaccinated, who could care less what and how much food their kids consume but, although they’re a loud minority, they still are very much the minority.  The challenge is much more a battle of resources.  It’s hard to argue with the fact that cheap foods are often not the healthy ones.  And it sucks when you and mom are in agreement that her child needs to get outside more for stimulation and exercise, but the neighborhood is far too dangerous to allow for it.  So, in the mean time, we have things like WIC to provide healthy supplemental foods, and Brighter Futures to provide (among other things) a book to take home for every child who comes in for a well child visit.  It’s something.

Oh, and this is funny: I think I’m starting to develop age preferences.  Right now, I’m totally digging 4-month-olds and teenagers.  4-month-olds will smile responsively and make all sort of fun vowel sounds.  Teenagers will, sometimes, talk shockingly openly about their sex lives and their completely untempered, borderline lofty life/career goals.  Love it.

I just finished my three weeks of inpatient pediatrics on the Heme/General Peds service at the Children’s Hospital of Philadelphia, affectionately called “CHOP.”  There’s just something about a children’s hospital…it does something to people.  John once remarked that even the assholes he knew peripherally during residency would morph into not only tolerable , but kind and accommodating people while on their peds rotation at Boston Children’s.  One of my senior residents, when describing her love of CHOP, commented that the attitude was even written into the HR agreements–all staff understand that it’s their duty, which they feel compelled to uphold, to be as generous to their patients and fellow workers as possible.  She sees it in the night janitorial staff, for example, who will often go out of their way if they notice something in a patient’s room that’s at all possibly disconcerting.

As a student, I’ve been blown away by the residents.  I can’t imagine how busy and stressed they must be.  Yet they are the only residents with whom I’ve worked who I have literally never heard complain or be negative, and they somehow still always find the time to go over presentations with me or provide me with teaching points.  They’re not saccharine, they’re just nice.  It’s part of the pediatrics culture, and it’s heavily engrained in the CHOP institution.  I would love to see how the HR contracts actually read, wondering if they’re anything to the effect of: “Thou shalt not be a pain in the ass, even if you’re on your 30th hour of call, have had children vomit and defecate over you, have had parents scream at you for keeping them waiting two minutes while you were saving someone’s life down the hall…all the while the pesky med student is perpetually asking ‘What can I do?  What can I do’  like an annoying chihuahua yapping at your heels.”

This is premature: I think I might want to be a pediatrician.

Love how Sissy Spacek surprised President O…love how he’s still just a little starstruck.  I miss Charlottesville.

It’s Wednesday, so it’s appropriate to finally post a little something about the best site director on the planet.  Of course, it will not do her justice.

Did you know the term “doctor” meant “teacher”?  I might have posted something about that before.  The emphasis and dedication some doctors place on education, even at an academic institution, is mind-blowing.  It takes a special kind of love of medicine, love of learning, love of sharing…not to mention the organization and efficiency to set aside time strictly for the students…and patience, so much patience.  We, medical students, are insufferable.

Yet among the mass of brilliant physicians not only willing but eager to teach and work to improve our education, Wanda takes the cake.  She is an Ob/Gyn who serves as the site director to the hospital where I did my clerkship.  Rumor has it that she is so beloved that she is perpetually booked up to the brim, a patient of hers has to either move cross country (though plenty still commute) or die in order for her to take another patient (but this is a rumor).

So it’s surreal and surprising that she dedicates Wednesday mornings (the full mornings) to the 6-7 students at her hospital.  We start with waffles in the cafeteria, then we move up to a reading room just off the original surgical amphitheater in the oldest hospital in the country to discuss cases, alternate topic presentations, and receive regular coaching and encouragement from Wanda, literally the sweetest physician you’ll ever meet.

Can you believe I studied here?

If you meet her, you will instantly love her.  Not only is she wickedly brilliant and as fierce an advocate for her patients as they come, who receives the utmost respect from patients, colleagues, and students, she is also adorable.  Have I ever described a physician as “adorable” before?  When she speaks of the Labor & Delivery floor or the NICU, even though L&D is not really her area of focus, she’ll say things like, “There’s nothing better than an infant.”  In reference to my pregnancy: “Oh, to be pregnant!  It’s like having a little friend with you all the time!”  Adorable, right?

I want to be her one day.  Until then, would she consider adopting me?

Shortly after we found out we were pregnant, John sent me this sweet card detailing his excitement over what would happen over the next several months and of prospect of raising a kid together:

I’m not sure my belly’s quite so exaggerated yet but, with my recently acquired outie belly button, I’m well on my way.

At our recent prenatal, the midwife performed Leopold’s maneuvers (an abdominal exam to determine the position and size of the fetus), then looked at my weight tracking.  “Well, your weight is exactly where it should be.  How big were each of you when you were born?”  I was 8 pounds, 3 ounces.  John was well over nine pounds.  “I think you have a very long baby in there.  Don’t worry, you’re tall and you have big feet, you can handle it.”  Some (additional?) good news is that the baby’s vertex (head down, ideal for delivery); hopefully she’ll stay that way so that I might be able to deliver vaginally this giant of a child I’m growing.

So, it began two weeks ago today.  I took my Ob/Gyn shelf exam.  Then John picked me up for a prenatal check-up, at which it was revealed that I do not, in fact, have gestational diabetes three weeks after I enjoyed my glucola cocktail–hence my excuse to carb-load guilt-free that entire glorious weekend.  Then I got to watch one of our closest friends receive his white coat, a kind of official induction into medical school, and celebrate with him and his family before passing out on our couch, feet propped high on our wall.  That was Friday.

On Saturday morning, we drove to Virginia.  First, we met Ellie, daughter of Nick and Amy:

Next up was my first opportunity to meet Jonathan, son of Lauren and Glen, nearly six months old!  (John has known him for months, and I’ve been green with envy.)  And this was also my chance to pick Lauren’s brain about the whole unmedicated childbirth thing…oh, and motherhood.  You would think after finishing Ob I would feel slightly less clueless than before.  I do not; not one bit.  Which is why I am SO thankful for good friends who did this thing first and are open and generous enough to share their experiences.

Then we scooted off to a baby shower hosted by the yayas and the Westcotts.  I don’t think I’m really a shower type of girl.  I identify with Miranda from Sex and the City, who specifically requested fried chicken and absolutely no baby games.  My girlfriends are the best.  They gave me a gathering of some of the women most special to me, with lots of soulful foods (I did not see a single crustless sandwich), optional baby games, gifts with which to help make our daughter at home in her new world, and a few choice “baby Jesus” jokes.

(I’m not sure why we turned out blue and luminescent.)

Finally, we got to be witnesses to Erica and Dan’s engagement!  Okay, I might actually be crying as I re-watch their engagement video–tears of course interrupted by a lot of laugher due to all all the side commentary by Dan, Zach, and John, my husband’s uninhibited, uncontrollable laughter, and Erica’s reactions and responses at every stop on the path to proposal.

Seriously, you want to watch this documentation: 

The following morning, we ate three brunches, drove back to Philly, took a cat nap (John told me I was worthless to him that tired), then stayed up until 3am cleaning out our guest/child’s room, which we’ve been using as storage space for all the things we didn’t want to unpack/deal with for the last year and change.

Five hours later I started orientation for Pediatrics.  John spent the day constructing a crib, taking multiple trips to salvation army, and making our a apartment less of a death trap for an infant.  Could not have possibly imagined it better.

There’s a bizarre-o disease called idiopathic thrombocytopenic purpura (ITP)–a.k.a. an abnormally low platelet count (thrombocytopenia) of unknown origin (idiopathic) that causes, among other things, red-purple splotches on skin (purpura).  For some reason, when it occurs in young children, it often resolves itself readily, and interventions are seldom required.  Still, it’s somewhat terrifying to send a kid home with a soft helmet and instructions to try not to run into anything, who has a platelet count of 2 (I’m not exaggerating), when the normal count should be 150,000-450,000.

We’ve had a number of otherwise healthy kids with ITP during my brief time on the pediatric hematology service.  I was examining/playing with one of them today and, as I was placing him back into his crib, the edge of my stethoscope got caught on his shift sleeve, and he banged the back of his head on the railing.  He cried for about a second before he realized that he wasn’t hurt–this was the type of bump that most infants/toddlers experience probably multiple times a week/day without any problem.  But this kid can’t quite clot correctly with a negligible platelet count.  So, though I tried to remain calm and cool (yeah right) on the outside, I was thinking to myself, Oh God, this kid is going to develop of huge hematoma on the back of his head…forget that!  He’s going to BLEED INTO HIS BRAIN!  Oh my god oh my god oh my god!!!

I carefully examined between his hair and around his neckline for any signs of bruising, told the mother I would check in with them soon and asked her to let us know if she noticed any bruising, and asked his nurse to do the same.  I felt somewhat reassured that the mother, who was as loving and doting as they come, was unconcerned, and her son truly did seem completely fine.

A half hour later, his nurse soberly approached me, “Can you come take a look at K’s head?  The bruise seems to be expanding quite quickly.”  I must have turned white as a ghost as I rushed to his room.  His mom, holding her giggling bruise-free son, met me at the door, unable to contain her laugher, at which point the nurse cracked as well, “I’m so sorry…it was just so easy!”

So I haven’t killed any children in my first two weeks of Peds.

I cannot study while I eat–I don’t know, it’s just how I’m wired.  So, when not able to enjoy a meal across the table from or on the grass with people I at least sort of like, I normally retreat to comforting books (Harry Potter) or the internet.

Just now, over my chicken caesar salad, I caught wind of “Dear Hypothetically Gay Son.”  I am hooked.  And this is why I’m posting the day before my shelf exam (please wish me luck!).  In my mind, this letter is the best; it conveys an abundant supply of support while still admitting to surprise and ignorance.  I’d really like to be this type of parent.

Also, I have renewed confidence that my current dancing ineptitude will be enough to get me through at least the first couple years of our daughter’s life.

There’s a fabulous gynecologic oncologist who we each get to work with for a week on Ob/Gyn.  He gives us nicknames, things like “Junior” or “Goose.”  Guess mine?

So…he was teasing me last week for being “like 43 weeks pregnant” as I struggled to squeeze between the table and the robot in the OR.  With no clever retort in mind (early days lead to a slow sense of humor), I think I said something along the lines of, “Hey, I’m only 29 weeks and change here!”  “29 WEEKS?!!  What have you been packing, FATSO?”  (I can’t be offended because I figure that he would never call me that if it was true…right?  RIGHT?)

He also loves to do things like introduce me to a patient and quickly explain without prompting, “And, no, she’s not really pregnant, so don’t make a thing about it, <through side mouth> she’s really sensitive about it…”  The horrified looks in response!  I guess when you cure people’s cancer, you can get away with being just a little “endearingly” inappropriate.

Lessons from oncology (not to get all preachy):

1. If you can, please get your gardasil.  Even if you’re not going to have sex for decades…like many vaccines, it actually is more effective if you get your doses younger.
2. Seriously, pap smears, a pain in the ass, granted…but the combination of pap smear screening and HPV testing reduces a woman’s risk of dying of cervical cancer by 90%.  What other cancer screen does that?
3. If you’re over 35 and experience abnormal vaginal bleeding (whether a drop or a bucket), please see a doctor.  Endometrial cancer is one of the few malignancies that actually flies its own red flag before it’s not too late to do something about it.

Blogging is a funny thing.  It’s a little like a journal left open on a picnic table…something that should be private and intimate but that I carelessly made available to anyone.  I’m terrible at journaling.  I’ve never kept one for longer than six weeks, tops.  It’s the public nature of the blog keeps me honest.  Even though I’ve been light on posting for stretches of time, I’m still here, after what will be two years in just a week.  That’s pretty successful for me.

Yet it still surprises me that people actually read this blog, and I’m always tickled pick when I get a new subscriber or receive a comment–for the record, I love your comments, thank you!  If I don’t respond in a timely fashion, I apologize.  And then there are statistics, which I try to ignore at all costs because I do not want blogging to be about that.  But at the end of the year, when analytics informs me that there is a solid population in Singapore, for example, that checks in here daily…come on…Singapore, that’s pretty rad!

So you can imagine how floored I was to have made this list, included among other med student/doctor bloggers that I admire for their clever writing, natural honesty, and fresh take on life and the profession.  My goal (maybe post-delivery) is to check out all of blogs listed on Plans side column (not to mention her recommended books).  Especially during “maternity leave,” I think I’m really going to love tapping into newly discovered med school experiences.