The Wind Beneath Your Wings

I promised pictures, right? Let's proceed...

Background Info:
1. Though my last 'vacation' was a week off at the end of June, I spent that week moving. And it was hot.
2. My last "real" vacation was early April, nearly 8 months ago.
3. Through the vagaries of vacation scheduling, and a little fancy footwork, four of us (three residents and an resident-turned-attending) all had vacation at the same time.
4. Given the above, it was obvious what our course of action should be: CRUISE! Topped off with Disney World!!

This is how excited I was:

(Imagine flashing neon lights and loud music with a rockin' beat and a marching band and elephants and baton twirlers and Mexican jumping beans and Tickle Me Elmo and a man playing a harmonica in the background. Oh, and fireworks, don't forget the fireworks.)

We left on a Sunday...

Time's up. More later.

Kablam!

Did you know that my last blog post was on August 1st? Well? Did you? It's true. Just look down a few inches to the heading of the post that is next on the list, AKA the Last Post I Wrote.

That was a long time ago.

For real.

What have I been doing, you ask?

Being a second year resident, I reply.

But wherefore would that totally remove you from the "blogosphere?" you inquire?

Nice job using the correct meaning of "wherefore," but I would that you desist utilizing the term 'blogosphere,' I retort.

Um, seriously, are we really going to have this conversation now? you whine.

No. No, we're not, I say soothingly.


In other news: year two of residency is busy. Busier than year one.

BUT! I just returned from a most fab vacation, and have some pictures to post, so be on the look out!

Success: Not Just for Winners Anymore

I pride myself on living a relatively drama-free life (despite my occasional tirades indicating otherwise), and I try to take things day-by-day and to remember to breathe and to not sweat the small stuff, and all those other things that inspirational posters tell us to do while lulling us into a sense of peace with scenes of wooded streams with dappled lights and adorable kittens tousling with balls of yarn. Yes, I try to live the adorable-kitten-calm-stream-dappled-light sort of life. Without actually hanging up those posters. Because I think those posters are tacky.

But. Into every dappled-light life, a little panic and chaos must fall. In my case, it comes in the form of the Pediatric ICU. Since the beginning of residency - nay since interview season prior to residency, I have been dreading the PICU. Granted, I have had some ICU exposure - the CT surgery ICU as a fourth year (during which my most lofty goal was to be invisible) and the NICU, which, though it ended well, started off as the worst day of my residency ever. Hands down.

So this little spark of terror that has been living in my chest over the last two years started flaring up last week - disturbing what otherwise would have been an idyllic weekend of good food, good company, wine tasting and overall general laziness. Because, horror of horrors, terror of terrors - the PICU was coming. (that piercing scream you hear just now is a several-days-old echo of my cry)

Yes, dear friends, I started the PICU on Sunday. Night. Sunday night. For some ungodly reason, the scheduling gremlins that live inside our cheif residents brains decided that I should start on nights in the PICU. From 5 pm to 6 am I am 'in charge' of keeping these critically ill children alive. I use quotes around the in charge, because I really have no clue what I am doing.

Thankfully (this is fall to your knees, raise your hands to the heavens thankful) there is an attending PICU doctor on with me every night - which can be hit or miss. So far, I've had one night on with the Attending Who Thinks Everyone Else Is An Idiot, but who was willing to sort of let me do what I wanted to do (which was mostly nothing), two nights with the Attending Who Thinks Everyone Else Is An Idiot, and makes me think really hard about things that I just can't remember most of the time, and end up saying ridiculously stupid things that I know are wrong, but I can't stop the words from coming out of my mouth anyway as she paralyzes me with her gaze, and tonight I'm on with the Attending Who Always Looks Like She Is Crying, who basically dictates the orders for me to transcribe. When I can hear her.

So far, it has been going okay. There have even been a few moments where I felt a glimmer of excitement and appreciation for the acuity of the patients and our ability to fix things that go wrong. And I've made some medically sound decisions all on my own (not tonight - tonight my brain is on vacation, see: dictating attendings orders). It has definitely been better than the NICU debacle of last year, and I've come to realize in some ways how much I have grown as a resident. It has also helped me realize that I'm freaking stupid a lot of the time - or, rather, that my 'medical fund of knowledge' appears to be on Welfare.

My life as a whole pretty much sucks on this schedule. I work, go home, sleep and come back to work. At work, I sit and obsessively track lab values while I try to fatten up my medical knowledge by reading numerous articles. I realized today that I haven't seen anyone outside of the hospital since Sunday, apart from a fleeting hi-bye with my roommate on Monday evening. I have developed this massive heartburn tonight that is making me quite literally writhe around in pain (which is hard to do subtlely and look professional and competent) But I think, despite the suckage of my personal life, I will be able to manage the PICU one day at a time, while breathing and not sweating the small stuff, etc. In short, I will maintain the dappled-light life. Still without the posters.

And, though I don't intend to offend, if you have those cute kitten/wooded stream/hot air balloon inspirational posters hanging up in your home? Take them down. Please. Unless you actually live in a small business or a motivational speaker's office. In which case, you really should think about getting your own place. I mean, c'mon!

Harry Potter Dorks

Fear not, there be no spoilers here. Only a couple of pretty big dorks - but fun ones, so that makes it okay. You disagree? Well, all I say to that is: watch your back. The world is brimming over with Harry Potter fans, and you don't want us on your bad side, or we'll go all magic on your behinds.

So, for those of you who have, perhaps, been living in a cave (or perhaps a resident on the PICU or NICU service), let me fill you in: The final Harry Potter book was just released on Saturday.

To celebrate the monumental occasion, my friend Susan (of adventures of yore) came up from Alabama so that we could attend a Harry Potter release party. There were several in the area - we weren't picky, we just wanted to experience the insanity. Because it is the LAST BOOK. With all the ANSWERS! And we were EXCITED! And Susan and I just do stuff like this. It's what makes us so dorky - I mean cool. It's what makes us so cool.

We got to Borders around 9:30, or so, and entered through Platfom 9 3/4 (hee!)

Both of us were little worse for the wear - Susan was not only jet-lagged, but post call as well; and I was sleep-deprived from staying up late the past few nights re-reading all the previous Harry Potters. It is truly amazing the dedication I can show for studying when it is not at all related to what I should be doing.

There were hundreds of people there, and many in costume. I made the decision to go sans costume, for the very real chance that I could have run into some patients, and didn't want to undermine my integrity as their physician. Just kidding. I just didn't have time/energy to pull together a clever costume.

Susan and I picked out our favorite Harry:

I think we almost made him cry when we asked if we could take our picture with him (we got permission from his mom), but he was a great sport in the end. Besides, who wouldn't trust us? We're doctors!

There were several different activities through the night - face painting, palm reading, the great Snape Debate (friend vs. foe) and a costume contest. Susan and I mostly observed, though I totally would have gone for the lightning bolt face-painting if I wouldn't have had to trample over scores of little kids to get it. I do have some limitations to my dorkiness - I mean... well, yeah, I mean dorkiness)


They finally rolled in boxes and boxes of books about 20 minutes before midnight.

Susan and I were quite atwitter with excitement (though still dang tired, as it was freaking LATE!)

Here I am debating which is scarier: Match Day or Harry Potter release day.

The line to actually buy the books after the countdown was long, long, long. We were in the second hundred group, and got our books around one am (I think, I can't remember, I was just excited to have it).





We rushed home, giddy with anticipation and settled in for a long night of reading.
I crashed around four, but Susan - post-call, jet-lagged Susan was up until 6 am reading. Thus is the power of Harry Potter, people!

The rest of the weekend was filled with reading, eating, more reading, pedicures while reading, seeing the movie Hairspray (fantastic, go see it immediately), and a tad more reading. But now we know the fate of the characters in Harry Potter. And if you don't yet, well, I'm not going to tell you, so either get out there and read it, or just, you know, go outside your front door, because there is bound to be somebody out there right now talking about it. We may be dorks, nerds, geeks or just plain immature, but there sure are a lot of us:

Jump!

As our intern year approached its end, we were asked to submit schedule requests for our second year - what electives we wanted to take, any weekends that we wanted to request off, or any other 'special' requests.

I had one request: to do an ICU rotation before I did a general wards rotation. Why? Well, frankly, the prospect of being the 'senior' resident on the wards over night without having taken care of really sick kids kinda sorta freaked me. In a hugely major way.

When our schedules (finally) came out, I was delighted to see that I started with Nephrology - a subspecialty that I chose to take as one of my electives (the kidney is perhaps the most complicated and elegant thing EVER created, and therefore way above my head), followed by my first ICU month. Success! My one request granted. Happy was I.

Then, the schedule for the month came out and, horror of horrors: I was scheduled to be on call my first Friday night. Ever. On call, overnight, after less than a week of being a 'senior' resident with a brand new intern. Not to mention the fact that as a cross-covering senior, I wouldn't know the patients at all. Or how to take care of anybody if they got, you know, really sick.

Terrifying prospect.

And then tonight came. Oh boy. I literally spent the first hour or so telling myself repeatedly, 'You're the senior, Brenna. The senior. SE-NIOR. That means you're in charge.'

Now, I was fine being the intern overnight. In fact, I dare way that I was great being the intern overnight. The senior said 'jump,' and gosh darn it, I'd jump. I wouldn't ask how high (I leave that question to the med students), but I would get up off my butt and jump - over hurdles, around obstacles, or even just straight up into the air for no good reason.

But tonight, I find myself in the position of telling other people to jump. I don't know how I'm doing. I really don't have any clue. No one has died (knock on wood). I have my PALS card on hand just in case any one should try to, you know, die. (somehow carrying a laminated quad-fold card with lots of small writing and confusing diagrams with arrows pointing in every direction makes me feel more capable of handling a patient who is trying to, you know, die)

My week as a 'senior' resident on Nephrology was great. So far, my night as a 'senior' resident does not appear to be an epic tragedy. Or even a comedy of errors. So I guess that's good. Right?

I really wish there was someone to tell me to jump, though. Because right now, I'm just going to go to sleep. And I'm sure there are many hurdles that will remain un-jumped tonight.

The Importance of Sturdy Footwear: A Lesson Learned

When I moved last year, I was great. I packed those boxes to within the merest cubic centimeter, protected fragiles with just the right amount of tissue paper and bubble wrap, and loaded it all in my truck so exquisitely that I fit in all my worldly goods, with literally no room for a sneeze. But of course, when you're moving across the country, you kind of have to be organized and efficient.

When you're moving across town? Not so much. Especially when you have a whole week in which to do it!

I've been moving in shifts. Saturday, I moved most of my clothes. Monday, I moved my yarn. (As Susan pointed out: surely moving yarn could not have qualified for a whole day's worth of moving. And she was correct. I also moved my DVDs that day... along with a lot of yarn) Yesterday, I decided, was the day to tackle my books.

So, I was a good little worker-bee, and loaded up (most of) my books into banker's boxes - perfect size that I can load up and still comfortably carry (are you not so thrilled with excitement to learn that?!). I am mighty fine at loading up them boxes, if I do say so myself. After I got bored of packing, I put on my most comfortable-ist pair of shoes on hand and started lugging my boxes down to my truck.



Ta-da! The shoes.

Even as I put them on, I knew better. I am the granddaughter of a foot doctor. Flip-flops = evil. My father, who taught me to pack so well in the first place, pounded into my head over and over as I grew up that one should wear STURDY shoes when one is going to do such things as lug boxes of books down, then up, stairs.

It was the second box that my folly did me in. My foot slipped, the flip-flop went one way, my foot the other, and I went d-o-w-n. Hard. Knock-the-breath-out-of-you hard. When-I'm-75-with-bad-arthritis-I'll-look-back-on-that-day-that-I-wore-flip-flops-while-I-moved-books-and-curse-that-day hard. Thankfully, my skill at falling (due to extensive, if unintentional, practice) saved me from hitting my head, or falling onto my hands (hello, scaphoid fracture!)


I did get this nice little souvenir from the trip, though. (hee-hee! catch the pun?!)

They say "Pride goeth before the fall," but for me it is "Sturdy shoes cometh after the fall."

Today, I am going to move Miscellaneous and Sundry, including Shoes. And I will be wearing tennis shoes whilst I do it.

And Then There Were Two...

...years left, that is. Because (drumrollllll): Intern year is over! And, oh. my. goodness. did it speed by! Like flying on the Lear jet from New York to Paris. Not that I've been to Paris. Or, you know, on a Lear jet. But I bet the trip goes by really fast, and while you're still just barely getting over that 'oh-my-gosh-I'm-on-a-Lear-jet' feeling you find yourself being bienvenue'd to Paris. Much like intern year flies by. Which I do know from experience. Because (have I mentioned?) I just finished intern year!

We're putting aside, for the moment, the absolute terror that is the Beginning of Second Year and the Responsibility and Presumed Growth and Expansion of Knowledge Base that implies.

Now it is time for Intern Year Rehash. Because I know that everyone is incredibly fascinated wiht my little life. (for my fellow interns-at-large - I got the info from e-value)

* Total Days of Intern Year: 364
* Vacation Days: 29.58 (I don't know how that works, I'm just reporting stats!)
* Total Hours worked: 2,725.25
* Average Hours per Day (over 334 days): 8.15
* Average Hours per Week (over ~48 weeks): 57.04

* Number of Patients I Saw: Lots
* Number of Parents Who Yelled at Me: 2 or 3. But one mom yelled at me about several of her children, so maybe she should count more...
* Number of _My_ Patients Who Died: Zero - I'm more lucky than skillful
* Number of Patients Who I'd Helped Care For Who Died: Four (sorry to be morbid!)
* Number of Absolutely Freaking Miraculous, Saved From the Brink of Death Cures of My Patients: One (I was not directly involved, just watching from the sidelines)
* Number of Days I Overslept: Probably 10 or so
* Number of Days I Said At Least One Incredibly Stupid Things: 364
* Number of Days I Regretted Choosing This Life: Surprisingly, none.
* Number of Days I Reminded Myself That This is Only For Three Years: 334

Alright, I could keep going with more nonsense, but I'm even beginning to bore myself! I have this next week off, and the masochist inside of me decided that it is time for me to move again. Sigh. So I have to go pack. Which will likely not fly by like those hours on the Lear jet.

Biblical Prophecy or Resident Contract?

I was sitting at a nursing station checking my patients' vital signs and lab results this morning, when I looked up and saw some artwork adorning a child's door.

It was a lovely picture with a big sun, and children by a river, and birds in the sky, and flowers and a big tree. And over everything, in big, black letters, the words: "And no resident will say, 'I am sick.'" (Isaiah 33:24)

Seriously? They've got the patients giving us a hard time too now?

Homework, Chipmunks and Coleslaw

Lately I have really enjoyed tying random concepts together as the title of my blog post. Yes, I am stating the obvious - something else I like to do.

I have finally reached the Last Week of Intern Year. Ideally, I would have started this week in top form: knowledgable about a vast array of topics; quoting scholarly articles in my discussion of patient management; balancing demands of patients, parents, nurses, dietitians, discharge planners, subspecialists without a drop of sweat. In reality? Not so much.

Two things impeded my glory today: #1: I am ridiculously tired, and am barely able to complete my normal daily tasks (i.e. walking, talking, eating), much less balance all the people who want me to do things AND #2 My attending is VERY PASSIONATE ABOUT TEACHING. He asks a lot of questions. And gets very excited when I answer right. And when I get a question wrong (which I frequently do), he gets even MORE excited that I have the chance to LOOK SOMETHING UP!!! LEARNING OPPORTUNITY!!! This stresses me out. See #1.

And, now? At the end of a long, stressful day during which I had to do all sorts of challenging things like WALK and TALK IN SENTENCES and DRIVE (and manage a septic patient in respiratory distress on the floor)? I have to look up those things that I didn't know. Because tomorrow, he is going to ask again. And I think if I don't know the answer twice in two days, he will get so excited that his head will EXPLODE.

It is my last week, though. The new interns - aka our replacements - started their orientation last Friday. They're all bright-eyed and bushy tailed. Like chipmunks. But better dressed. I'd say that I can't believe that this year is over, but that sounds very cliche. So I'll just think it really hard. (Because I can't believe it!)

I'm trying to think of a smoothe way to transition from new interns to coleslaw. Hmm. Okay, follow me here: One of the new interns maybe, kind of, sort of looks like a cabbage patch kid. Speaking of cabbage... (hee-hee!)

I have recently developed a great love for coleslaw. I always thought I hated coleslaw. But now I love it.

My goodness, but that was a boring story. If life were like DVR, you could rewind back to the part about me not saying that I couldn't believe that intern year was as-good-as over, then fast forward through the part about cabbage patch kids and my new-found love of coleslaw. But life isn't like DVR, and you just spent several seconds of your life reading, first the boring story of how I like coleslaw, followed by the even more boring exposition about how you should have fast-forwarded through it if you could have. Stop the insanity!!!

I have to go do my homework now. I'm trying to figure out if there is any information I could glean about hemoglobinopathies or glycolysis (seriously, people - I have to review glycolysis) in Harry Potter. Because I really just want to read Harry Potter.

So You Think You Can...

A lot of semi-interesting stuff has been 'going down' (to use the street slang that I am so known for) lately. But nothing compelled me to actually sit down and write another blog post until my beloved show, So You Think You Can Dance, managed to amuse me so greatly tonight.

Plus the fact that we have our "Rising R2" retreat tomorrow, and I don't have to go in until nine. Nine! NINE! I would like to tattoo the number nine to my forehead and take a picture of my face while I am skydiving out of a clown-populated jumbo jet through rings of fire into a pool of sharks to demonstrate just how happy I am about going in at nine. Except that particular demonstration of X-treme emotion would probably be taken more as fear/apprhension than the actual joy it means. So, instead, I should take a picture of me with the number nine tattooed to my forehead while I am asleep, deeply, at 5 am and 6 am. And 7 am. And, why the heck not - 8 am!

Oh, how greatly I digress.

I was watching SYTYCD tonight and for just a second, on the screen flashed by what was possibly the oddest grouping of facial expressions I had ever seen in TV: (brought to you by the magic of DVR)


Until I saw this shot:


Hee-hee! These are some of the contestants from last year, in case you don't follow the program. They're actually reacting to the judges, not the dancers.

Maybe later I'll write more.

But maybe I'll be sleeping.

NINE!!!

Spontaneous Compliments

I don't know what the deal is, but over the last three days, I have had three totally random people just spontaneously compliment me.

On Monday, one of the patients on the floor (not mine) came up and said, "I like your eyes" then made me some art.

Yesterday, the lovely lady selling me my coffee handed me my change and, quite out of the blue (all I'd said to her was 'medium coffee, please') said, "You're pretty."

Then today, I was literally just walking past someone carrying bags of IV fluid in the hall who said, "I like your hair."

What's up people? Apparently, I must be giving off enough 'I'm miserable and my head hurts and I'd so much rather be at home sleeping off this virus that is trying to take over my sinuses and bronchi' vibes that total strangers feel the need to brighten my day with compliments.

And, to be quite honest, it worked! (At least temporarily.)

Have I mentioned, dear reader, how fantastic you are? And beautiful!

The Plague is Coming! Or Maybe Not...

Apparently, one hundred years ago today a small epidemic of the Bubonic Plague broke out in San Francisco. Less historically notable, but more personally relevant, one year ago today: I broke out in Sacramento. (Yes, I am comparing myself to the Bubonic Plague.)

And on my Year-In-Sacramento Anniversary, I am also celebrating the beginning of my Last Rotation As An Intern. I looked but Hallmark does not, in fact, carry a "Congratulations On Your One Year Living In Sacramento Anniversary And About To Be Starting Your Last Rotation As An Intern" cards. I'm totally going to send them a sappy poem so they can make one.

I've found that I always sink into this slight depression at the beginning of a new rotation. I think it is really just the way my anxiety plays out. That, and the fact that, despite all my other Gemini-like traits (inability to make a decision, a tendency to shy away from philosophical/meaning-of-life discussions, optimistic, etc.) I hate change.

Okay, I take that back (hello, inability to make a decision). Part of me obviously loves change and the challenge it presents, or I would not find myself living in the fifth state of the last ten years. I'm sure there is some psycho-analytically based reason for that, but we'll just call it a gypsy heart (and there's the shying away from meaning-of-life issues!)

The part of me that has to start a new rotation is alway gloomy on these transition days, though. (Did I mention that Gemini is the "twins" - multiple personalities?) I hate not being in control, which is what I think this gloominess boils down to. On the new rotation, I have to start over with new people, places, schedules, attitudes, everything. No control. Grumble.

My Last Rotation is Hem/Onc, which is generally accepted as the 'hardest' rotation of intern year. Seeing as it is the Last Rotation of Intern Year (have I mentioned that?), I'm not dreading the work so much as the change. I am actually looking forward to this month as a whole - the new interns arrive (!), it's my birthday, there is graduation stuff for the seniors, I am moving - all sorts of big and cool stuff is going down. But I still find myself (metaphorically) beating my head against the wall.

Still. It could be worse. I could have the plague!

I Make This Look Easy

Guess what! Guess what! It is my last time on the wards at night as an intern! And, after four overnight ward calls, and three weeks of night float, I totally have this stuff all down. I am Intern Extraordinaire (imagine that in bright green, sparkly letters, with a marching band playing in the background, and the Shriner's on their crazy trikes throwing out bags of candy and occasionally Frisbees)

Being an intern on night float, has now become easy!

Except that I am totally and completely lying, and most of the time still feel like I am "playing" doctor and other times feel that I am completely over my head and I don't really know much of anything, and am mostly just flying by the seat of my pants...

And the next time I'm on a night? I'm the senior resident. Which means that I'll be in charge. Which means that I should know stuff.

Which explains why I have broken out into Brenna bumps tonight. My last night as an intern.

Watch Out For Black Cats

I believe there are jobs out there that are pretty... routine. You get up, go in at a particular time, deal with the things that you expect to deal with, meet with people, have breaks, make a few phone calls, order office supplies, and then go home at a particular time. And you kind of have a general idea of what to expect your day or week or month to be like. If you're going to be busy, you know it and can duly prepare.

The same can't really be said about inpatient medicine. Or outpatient, for that matter, but it is really true about inpatient. At the beginning of a day (or night as the case may be - I'm back on night float again) I have NO idea what the day (or night) is going to be like. Because I have no control over when or how kids get sick. Some days we get flooded with kids, other days, it is like someone has pumped a cure-all into the water and it is very quiet. No control.

Which can be hard when you're a control freak.

Not that I am.

(I am.)

(But so are most residents.)


As a result of this lack of control, there is a kind of pseudo-control that exists in resident culture. In laymen's terms, it might be known as "Superstition." I think it becomes our way of feeling that we have some control over what might become of us during our next night. I myself am guilty of believing that I have an 'unlucky' pair of socks. Twice I wore them, and had busy nights. Those socks are now at the back of my sock drawer.

One really universal concept is the "Black Cloud" or "White Cloud." It is the idea that a resident has a certain aura around them that either invites work, or keeps it at bay. So ingrained is this concept in medical culture, that they actually did a research study on it a while back. And it was published! Granted it was in the "Letters" section, and not the actual research article part, but still. It is a big part of our lives.

While I've always been on the fence about colored clouds (mine's kind of a mottled lightish gray), one superstition that I NEVER took stock in was the idea that if you say the name of a patient who is frequently admitted, you're basically inviting that person to come to the hospital.

So last week, when I accidentally called one of the current patients by a name of one of our 'frequent fliers'* and everyone around me got all up in arms, I was like, oh yeah? I don't believe that! Watch! And proceeded to name two more 'frequent fliers.' Just to prove my point.

The next day, the patient who's name I'd accidentally said was admitted. Within the week the other two were.

I think I may be changing my tune here!

And I'm totally going to throw out those socks.



* Frequent Flier is a patient who is frequently admitted, and generally has some bad systemic illnesses or problems - cerebral palsy, bad seizure disorder, etc. I actually hate the term, but as of yet, don't have anything better to call them. And it is faster than saying 'he is a patient that is frequently admitted.'

Board Question For You:

You are working in the ED one afternoon, when the ambulance brings in a woman who was found unconscious on the sidewalk near a park. Witnesses in the park say they saw her run past, then she stopped and slumped to the ground. When EMS arrived, she had regained consciousness, but was feeling shaky and dizzy. Initial vital signs showed temperature of 39 C, heart rate of 195, respirations of 24, blood pressure of 110/55. She received 500 mL of normal saline en route to the hospital and her heart rate is now 100. On questioning, she tells you that she is a resident who had taken her licensing boards earlier that day after many days of studying. After the test, she went for a run to wind down. Admits to feeling weak and lightheaded befroe she passed out, and had noted tingling in her fingers and had stopped sweating. Denies any headache, vision problems. Physical exam notable for tachycardia and sluggish capillary refill. She hadn't been sleeping well lately, and had been drinking 8-9 caffeinated drinks a day, and no water. Denies smoking or other medications or illegal drugs. Drinks 1-2 glasses of wine a week. What is the appropriate initial step?
A. Electrocardiogram
B. Chest x-ray
C. Stress echocardiogram
D. Fluid resuscitation
E. Tell her what an idiot she is

While the real-life answer may be some combo of A-D in this case, the right answer is E. Because, of course it is me we're talking about! I didn't actually pass out. But I certainly felt light-headed and numb/tingly. Yeah. Water is a good thing, Brenna. That's my new mantra. Especially when it is 89 degrees outside. Oh yeah, apparently it was 89 degrees out. (I had no idea)

My test is over! The first day was pretty rocky - starting with me showing up a whole hour early (Who starts taking tests at nine?? That just makes no sense!) Step 3 has SO MANY WORDS for each question. They just go and go and go and go, and by the time you get to the question, you have to go back to the beginning to see what the heck the presenting symptom was. 336 of those questions day one. Mind-numbing. And at the end of the day, you don't even get that 'thank God I'm done and I don't even care if I failed' release, because you have to come back for more!

Today was not nearly so bad. Either the questions were easier, or I was smarter, because I didn't feel as idiotic today. There were only 144 questions today, plus the - dare I say it? - fun (!) part of the test. The "interactive" part. And interacting is always more fun than... not... interacting. They'd give you (me) a bit of background information on a patient, then you had to choose which tests to order, and which medicines to start, and whether to admit them to the hospital, or send them home. It was kind of scary, but also kind of fun. Chest pain? Get an EKG! Chest x-ray! Echo! Labwork! Look, she had a heart attack! Admit her to the ICU! And why not get some angioplasty! And counsel her about exercise! Now send her home (okay maybe not just yet).

I did a lot of "counsel patient/family" and "reassure patient." Because I like to talk, and I thought that my virtual patients should get the same treatment as my regular patients. Thankfully, three of my nine patients were pediatric patients. I was all over that business! (at least I hope)

I'm not guaranteeing that I passed. In fact, I really don't feel terribly confident. Sigh... I really, really don't want to take this test over.

Speaking of doing things over - remember how I won that iPod shuffle a while back? They accidentally sent me another one! How funny is that?? I never win anything, but when I do, I guess I get it twice! Sadly, they've requested I return it. Ah, well. I just hope that didn't count as my next 'lucky' thing. Lucky things only happen to me every 20 years or so!

I'm going to go drink more water now. Because water is a good thing.

Test Three of Three, Part the First

Guess what time it is, friends? No, not 9:45 pm. I mean... it is, but that's not what I'm Announcing. And it probably isn't what time you're reading this either, so why would you guess such a silly time? No, no, no. It is time for A Test. And not just a test. A Test. A Test. Remember how I've taken the Boards in the past? Did you wonder to yourselves, 'I wonder, self, if she is done with those pesky Boards now?' Probably not. But had you wondered such thoughts, the answer would have been thus: No.

First came Step One. Then the personal saga that was Step Two. Followed by - no not Step 3 - let us not forget the 'test' Step 2, Clinical Skills (sounds like a bad Hollywood blockbuster).

And now, now we get the joy of Step 3. Which, thrill upon thrills, is a two day test. Conventional wisdom says... actually, more like resident folklore says "Study two months for Step 1, two weeks for Step 2, and take a number 2 pencil for Step 3." I was going to do that, then realized that Step 3 is computerized... So I went ahead and did a number two pencil's worth of studying. Let's hope there are lots of Skillz locked away in my brain that will come to the forefront tomorrow and Friday. Yeah, the second day of my test is Friday, thus prolonging the agony. Sigh...

But then - THEN I will be done with tests.

Until the Pediatric Boards... Drat!

Not The Ohio One.

My next (and last) stop was Toledo. It used to be the capital of Spain - like ages and ages ago, before "Spain" really existed. It is nicely located on a big hill, and is surrounded on three sides by a river (and the fourth by a big ol' wall). The whole city has been declared a national monument, and the government has forbid any modern exteriors.


I took a (cheesy) tourist 'train' around to the other side of the river. There was a piped-in commentary that was telling some sort of history and mythology surrounding Toledo. I couldn't really hear it though, and I swear, the voice said "Welcome to the magical bubble train!" It provided some good overviews of the city, though.


Mmm... Pretty.

After the 'bubble train,' I decided to go see the El Greco Museum. El Greco was a painter who lived in Toledo in the 16th century. He was from Greece, thus was just called "the Greek." His real name was really long and Greek-sounding. I really like El Greco's work (like the painting View of Toledo which is hanging in the Met in New York... It looks SO much like the real place after you've actually seen Toledo)

The thing about Toledo is that the streets aren't very... organized. And combine crazy medieval street plans with my sense (or lack thereof) of direction... well. I walked a lot that day.

I searched FOREVER for the El Greco Museum, finding, instead the Victorio Macho museum.


I was so, so frustrated. I asked the nice man at the Museo Victorio Macho where the El Greco Museum was. And guess what? They closed it! No WONDER I couldn't find it. I don't know who Victorio Macho was. Apparently a sculptor. But his museum is nicely displaying some very lovely El Greco works, so all was well. The sculptures were pretty cool too!

After that, I decided to go to Toledo's Cathedral. I went to where the entrance was _supposed_ to be (and I got there pretty easily). But there were two guards standing there in front of a locked gate. Hmm. So, I walked around the cathedral. No entrance. Then I went to lunch. Then I walked around the cathedral again. Still no entrance. Then I went to a different church to look at a different painting. Then back around the cathedral. Finally, I found a little alley way I hadn't explored before. And behold! An entrance! It took me so long to find things in Toledo...


This was my favorite inside of a cathedral in Spain. (My favorite outside of a cathedral was the one in Sevilla). This is the main altar. The iron grate in front of it has one of the requisite interesting stories that goes along with it. The man who the church commissioned to build it sold everything he owned to have enough money to finish it. The church didn't pay him for the extra work, so the poor guy lived out his days in the poor house. That's dedication. But look! Centuries later, here I am taking a picture of it.


This is the altar itself. Covered with scenes from the life of Jesus.


Including this scene - by far my favorite. It is slightly blurry, unfortunately.


I loved this explosion of sculptures. See the red spots hanging from above? Apparently cardinals can choose where in this church they want to be buried, then they hang their hats above the grave until they rot and fall down. So two cardinals were buried right there. I counted about seven hats hanging in various places in various states of decay.

After I left the cathedral, it was approaching dark - I'd been wandering (mostly lost) most of the day!


And that was pretty much it for my Spanish excursion! I went back to Madrid, slept, then got up and went to the airport. Very unromantic, I know... Airports aren't nearly as exciting as cathedrals.

The Ocean Blue

I left Spain a week ago. Sad! Here are the rest of the pictures (that I am going to post - there are about half a million other ones). Perhaps it will make me feel like I'm back there!

When we last left Brenna, she was in Sevilla. Let's take a look inside her head, shall we? If you dare...

Brenna's Mind: Dum-de-dum. I'm in Spain! I think I need to leave Sevilla now, though. Where should I go? Barcelona? Too far away. The coast? Nah. Lindsay says Segovia is cool, but that is a lot of traveling to take in one day. I could go to Cordoba. What's in Cordoba? I could just go back to Madrid. Or go to Granada and just look at the Alhambra from the outside. But I have hostel reservations for Monday in Madrid, so I should get back there that night. What the hell. I'll go to Cordoba. Got to be something interesting there, right?

I didn't say the inside of my mind was interesting, did I? So, yeah. I went to Cordoba. Which, according to both my sister and my guidebook (they contained a lot of similar information, interestingly) has the 'second best' Islamic mosque in Europe.


This isn't it. This is some other random building I came across while I was horribly, horribly lost. It was the Alcazar de los Reyes Cristianos, and I mostly paide the 4 euros to enter because it was starting to rain, and I wanted a dry spot to try to figure out where the heck I was. Interestingly, it was donated by Ferdinand and Isabel (yes, THAT Ferdinand and Isabel) to the Inquisition in 1482. Which led to the common school-kid saying in Spain - "In fourteen hundred eighty-two, Ferdinand and Isabel donated the Alcazar de los Reyes Cristianos to the Spanish Inquisition." It rhymes in Spanish. (obviously I'm totally kidding. It doesn't rhyme).


Think Isabel ever fell down these stairs?


More arches! See how empty this particular tourist location was? I think everyone that was there was like me - lost and trying to escape the rain...


...Because not too far down the road was the Mezquita! Turns out I wasn't as horrifically lost as I had feared. The Mezquita was built on the site of an old, ruined cathedral, and initally used as a mosque. Now, in the olden days in Europe, they appeared to have something of a land crunch. As the various Super-Powers of the time rolled into town, they'd tear down some prime real estate to build their own. Generally church--> mosque --> cathedral --> mosque --> high rise, etc. Maybe it was a power thing, but the _really_ old buildings were generally demolished.


This particular mosque survived the destruction.


With LOTS of arches...


...and dramatic lighting. So how did this mosque survive where others were destroyed? Simple...


...they just built a cathedral in the middle of it. After all, why not?

Cordoba was an interesting town. But it was rainy and I was grumpy, so I went to the train station before dinner to get a train ticket back to Madrid. There are 30 trains a day from Cordoba to Madrid. I got there at 5 pm. ALL of the trains were sold out until 10:45 pm. I sat and watched 7 or 8 trains leave before I did. Granted, I could have gone back into town, but I was grumpy and it was rainy. So I just sat there!

I was going to finish posting pictures today, but my last day was in Toledo, which was the day I took the MOST pictures. So that is going to get a whole separate post.

Now I'm going to go study. Blech.

Do What I Do - Do Better.

Goodness, today has been something of a traumatic day. The absolutely horrific shootings at Virginia Tech, for one. So scary. And I started my "Child Abuse" rotation today. I don't learn how to abuse children, of course, I just work at the center that takes in most of the abuse cases in Sacramento County - physical, sexual, emotional, neglect... you name it. So that's pleasant. And then, after noon conference I was informed that one of my patients - a patient I cared for in the hospital a few weeks back, and followed as an outpatient, and bonded with the patient and the mother - is in the PICU and will likely not make it. Which totally and completely sucks. On top of all of this, I've been trying to study for the boards today, but my brain is not into it.

So. I'm having a glass of wine, watching television that is not the news, and posting more Spain pictures.

Oh, before I do that, one insight I got from a (physically abused) child's grandmother today as she talked about her relationship with her own daughter -- She was basically describing her relationship with her daughter, and how she wanted her daughter to have a better life. In the middle of a lot of ramblings, she said "Do what I do; do better." It seemed so profound at the time! Maybe it was just that it was a beacon of sense in a morass of a scared/stressed/guilty diatribe. Anyhow. To the pictures!


Here is my darling sister, Lindsay, in Sevilla! This is the Plaza de Espana, which looks ancient and regal, but was actually built for a World's Fair in the 1920s. There were lots of gypsies trying to force us to take rosemary here. Made me wish I'd brought rosemary from home that I could have whipped out of my purse in retaliation. Or maybe some basil. Garlic?


One of Sevilla's major attractions is this beautiful cathedral. It is the third largest church in Europe, and the largest Gothic church anywhere. You'll find, if you haven't already, that almost all tourist sites in Europe have some sort of qualification attached to them - like "largest (or smallest, or the only one still used, etc.) xxxx in xxxx" Or there will be an interesting story that goes along with it. Or both. Like this cathedral! The interesting (to me) story: there used to be a mosque here, which the Reconquista Christians tore down, and claimed that "we'll build a cathedral so huge that anyone who sees it will take us for madmen." It took 120 years to build, and currently displays a certificate from the Guiness Book of World Records certifying that it is the 'cathedral with the largest area.'


Close up!


View from the bell tower.


On Easter Sunday, Lindsay and I celebrated as you can only do in Spain - we toured the bullfighting ring! In Sevilla, Easter Sunday is the first day of the bullfighting season, so things were bustling. We didn't get to see any bulls, but we did see the chapel where the matadors pray before the fight. We walked by later in the evening, and the place looked like it was packed - and everyone was all dressed up in their Easter-Going-to-the-Bullfight best.


The Alcazar in Sevilla - a palace built in the 10th century in the Moorish style. It is the oldest royal palace still in use in Europe today (see what I mean?!?).


Proof that I was actually there (and one of... three pictures of me among the several hundred I took!)


There were lots of arches. I love arches.


I love this shot of Lindsay - an arch, sunshine, wisteria, and random children running in the background. Fabulous!


It was a gorgeous day. Really the only day while I was there with this much sunshine.

Alrighty. Enough pictures for today. I'll probably post the last two days of my vacation tomorrow, so check back!

Life Lessons and Photographs (installation one)

I am of the school of "You Learn Something Every Day." Today I had ear-marked in my schedule to be my Start Studying for the Boards Because I Only Have Ten Days Until I Take It Day. So I went out to Barnes and Noble, my old studying friend, to get my study on. And what did I learn today? I learned that when the weather report calls for "Wind" - not sun, not rain, but Wind - you shouldn't wear a skirt. Yeah. I totally flashed the Barnes and Noble parking lot. Ah well.

In other news, here are some Spain pictures!


First picture (of many) of the trip! This is Gran Via in Madrid. Apparently is a big and very bustling street. This was the only time I was there (until my last night, which was when I figured out what it was!)... I kept getting lost in Madrid, but not here apparently.


This was one thing I stumbled upon in my (lost) ramblings. I actually knew where I was at this point - Plaza Mayor. It is a big plaza (duh). They used to have bog city-wide things here like bullfights and public court hearings (like during the Spanish Inquisition. For real! No one expects it...) This was some street mime/opera production going on. It was really neat! They kept pulling people from the audience to do things - thank GOD they didn't pick me!


These are the crazy purple people that I stood for hours and hours waiting to see. Aren't they crazy?!?


And the culmination of the hours-long procession (note that it is dark now) was the for-lack-of-a-better-term Jesus Float. I think I heard someone call it a 'chandelier.' Tons of real candles, and real gold, surrounding the lifesize Jesus with real human hair blowing in the breeze. It weighed over half a ton, and took about 72 men to carry it.


My second day in Madrid was less sunny. In fact, it was incredibly rainy. I toured the Royal Palace (I have pictures, but they're mostly of chandeliers. I was chandelier-obsessed that morning), and then wandered around (mostly lost) some more. Then, it started raining. Shortly after I took this picture (a bear pawing at a madreno berry tree - a symbol of Madrid), I bought an ice cream cone - a madreno berry flavored ice cream cone in fact (I think), and stood under a small awning to survery the passers-by. Then it started raining harder. And harder. Then it was pouring. Then, it started hailing. My awning was... less than adequate, so I ran through the hail to the Metro station to go to...


The train station! Isn't it beautiful? There was actually a wedding party there, taking photos with this as the background.


This is the memorial built after the bombing at this train station on March 11, 2004.

I took the train Friday to Sevilla where I met my lovely sister, Lindsay. I'm tired of posting pictures now (and aren't you tired of looking at them? Really?), so I'll do more later!

Last Day...

I´m about to go to bed for my last night in Spain. It feels like I have been here for a very long time. In a good way, I mean! Though I am exhausted. I´m like the Energizer bunny on vacations, which is why it is ideal that I still have a couple of days to recover once I get home.

I haven´t been seeking out the internet because it just interrupts my trip too much! Plus, I´m a little put off on all the college-age kids obsessively updating their myspace or facebook everywhere I go. But, well, here I am updating my blog, right? Sooooo.... I´ll be the kettle today.

Anyway. Even now, at the end of my trip - or perhaps even more now at the end of my trip, I feel that this place - Madrid, Toledo, Sevilla, Spain, whatever - is all fake. Like I´m in Disney Land, and all of these people will just go home to their ´real´ lives at the end of the day. Real lives that don´t involve amazing buildings, food, statues, paintings, etc. around every corner. It is hard to wrap my brain around the fact that this will all be going on once I leave. It has been great! I don´t know that I could have an every-day life like this, but I think I will definitely ´plan´ on coming back - after I hit all the other countries I have to see, of course.

I have done tons, and have taken more pictures than you can even imagine. Pick a number of how many you think is reasonable to have taken in 6 days. Then double it. I still probably took more than that. I´m of the ´more is better´ school, and hope that among the chaff, there will be a few really good pictures. I´ll cross my fingers, anyway. And I will post some of the more meaningful ones. Assuming I can get my dial-up internet at home to cooperate.

So, back to the people. I just went out to make my Good-bye Madrid Tour, hitting the major sights that are see-able in the dark. There are people out everywhere. Everywhere, everywhere. And it is everyone out. Old couples, families, babies, school-age kids, locals, tourists. Dogs. The only people who appear to be sleeping are the homeless people. And it is approaching midnight. On a Tuesday!

I had a fried squid ring sandwich for dinner tonight. (total non-sequiter, I just couldn´t forget to share that)

One of the points of the "Paseo" (which I do believe is technically earlier in the day) is just to walk around and be seen. Show off your "Sunday best" as it were. Or Tuesday best. And let me tell you, all those uncomfortable shoes that American women wear? Have nothing on the Spanish ladies. Goodness. The heels! On cobblestone! That, my friends, is dedication. I, myself, am wearing Teva flip-flops. And I have never ever ever in my life had so so SO many disparaging looks at my feet as I have had today. All day. Everywhere I´ve been. I don´t know why they are looking at my feet in the first place, but when they do? I get this pursed-lip, head-turn-away reaction. I can count at least 7 of these instances today - and those were just the ones I noticed. I´m trying to tell myself they were just fascinated that I was wearing sandals when the majority of the population is still bundled up for winter. But I really don´t think that´s the case. They just think I have poor taste in shoes. How sad! The foundations of my existence have been shattered! I totally need to go shoe shopping.

Ah well, to bed with me. I´m sharing the room with 9 other people. Three of them were also there last night, and came in at 3 am and were really, really loud, and turned the big light on. I need to get some sleep before that happens.

My flight tomorrow is at 1pm, thank goodness. Gives me all morning to get lost on the way there. Which, if this week has been any indication, I will. I´ve been lost a lot.

Sevilla

Being in Spain is exhausting! I think it is all the walking combined with just trying to pay attention to everything that I´m seeing.

I finally made it to Sevilla yesterday - the main point of the trip. My sister has been studying here for the last few months. I took the train down from Madrid last night. I was so proud of myself - managing the whole train station and everything all by myself. Again, I realize that this is something young kids, straight out of high school do on a regular basis. But still. I´m proud :) And exhausted.

There is SO much that I have done that it it quite absolutely impossible to go into all of it. Hmmmm. Highlights from yesterday:

- Left hostel, to train station, wanting to go to Toledo, then to Sevilla. Well, Toledo was sold out! So, I spent the day in Madrid again, after depositing my luggage at the station.
- Did a self-guided walking tour of Madrid from my (fantastic) Rick Steve´s guide book.
- During my walking tour, purchased cookies (dulces) from a cloistered nun. I pushed a random, barely marked intercom button on a wall, said "dulces," walked through a door, down a dark hallway to a lazy-Susan with partitions on it. Talked to a nun through the wall, put money on the lazy Susan, and she turned it, and there were cookies for me! It was SO cool
- Visited the Royal Palace, where I encountered a few of the "ugly Americans" you hear about
- Took the train to Sevilla
- Found my sister!
- Saw the tail end of another procession here - very similar, but with a different statue on the float
- Ate my first churros with chocolate. Mmmm. Good

Today, I´ve been exploring Sevilla with Lindsay. It is a beautiful city. I´m just too tired to do much more. And it is only 6pm. The night is literally quite early here. I may crash before this is all over!

For Instance

Good grief! I was just writing a post about how this keyboard was messing me up, then I accidentally published the post, and couldn´t edit it without pulling up some strange screen. See? Point made.


I also can´t figure out how to ue the 'at' symbol. Which makes it hard to, you know, check e mail.


Anyway! To the point! I AM IN SPAIN! And relatively unscathed at that. Though I did manage to baptize the streets of Madrid with my freshly falling tears this evening. Yes, I was wandering around in the midst of hundreds and hundreds of people trying really, really hard to not burst into sobs. All out of exhaustion and frustration - a deadly combination on my tear ducts. Most frustratingly part of that little incident was that there was literally no place I could go to collect myself away from the maddening crowd. So I just gritted my teeth (grut my teeth?) and put my head down and breathed really hard.

How did I end up at that point? Well. Take a tired me, give her two hours of sleep, a frustrating shuttle ride to the airport (wherein the shuttle driver gets lost), add three flights, with an international one that has shaky foundations (i.e. I was worried all day that I´d miss it), throw in a elbow to the side for an 8 hour flight, very little sleep and then put her in a brand new city with weirdly winding roads, and a very large language barrier. Then try to have her figure out how to call her sister. Bad bad bad.

There were some GREAT parts of the day, though. Amazingly great. Note that most of my tear-inducing stress was pre-arrival.

I got in, took my luggage (I didn´t check any! hallelujah!), breezed through customs, got a 10 ride pass for Metro, figured out where I was going, easily made a few transfers, and found the Puerta del Sol - kind of the center of Madrid (the touristy part anyway). Feeling confident, I had breakfast, walked around for a while, then went to the Big museum in town - The Prado. Tons of great art - mostly religious - I have seen more pictures of angels holding dead Jesus than I would have ever thought existed today (at least three). I spent hours and hours there. Then I was exhausted. And hungry. And I wanted to check into my hostel, which I decided to do first. Got a bit lost, but not too bad.

Had lunch around 4, at an Argentinian tapas bar (didn´t mean to do Argentinian, it just looked nice). Struck up conversation with a street artist expatriate while there (hee! I totally just threw down the word expatriate). Left without being hassled to even look at his art (thank goodness, I would have had to buy something), to find a street opera of sorts going on in the Plaza Mayor. Very fun.

Then I wandered more. And saw some amazing things. I saw they were setting something up somewhere, and people were starting to wait, so I had to know what was going on. I discovered that "it" was going to start around 7, so I came back at 7, and waited. And waited. And waited. And more and more people came. And I wanted to leave because my feet hurt and my back hurt and I was exhausted and bored, and tired of trying to translate my eavesdropping. But I was packed in by a wall of people.

Then, after 8, "it" started. Along came a long procession of people wearing purple cloaks and REALLY REALLY tall pointy purple head mask things. Like ku klux klan, but purple, and ridiculously tall. And they were carrying gigantic candles, and some of them had chains on their feet. Weird. Weird, weird, weird. Somewhere in the cockles of my brain (can the brain have cockles), I recall this being someting Catholic. Or at least related to organized religion in some way.

Well. They kept coming and coming and they were moving SOOOOOOO slowly. Like a mile an hour. Or less. And they kept stopping. And I so wanted to go then. But after about an hour (I was seriously trapped) of the purple hoods, people started applauding, and this giant candle-lit, human carried float/chandelier/Jesus statue came bobbing down the street. There were like 50+ BIG men (in purple, sans hats) carrying it. IT WAS AWESOME.

Not quite worth the three hour wait, but anyway....

After that, I hurt every where, and jut wanted to sleep, but I knew that I should call Lindsay. And I couldn´t make the phones work. My fault, I knew I needed a card, and hadn´t purchased one at the airport - thinking, naively apparently - that phone cards would be a universal item. No such luck.

Anyway. Tears, tears, people everywhere.

Finally got a quick dinner, despite my desire to simply go roll myself in bed. And now I´m at the hostel, with free internet (though a 20 minute limit which I´ve gleefully exceeded despite the people obviously waiting), sangria in hand. I like this hostel.

More adventures tomorrow, but no more tears, I promise. Because I´m going to sleep!

Nueva Entrada, and Lack of At

I´m on a Spanish computer. With a Spanish keyboard. Which is just a TAD different from what I´m used to.

Where Exactly Is Sleep?

In the past year, I have: driven across the country with the bulk of my worldly possessions in the back of my truck; started calling myself 'doctor,' sutured the chin of a four year old child screaming "No! No! No!" repeatedly (get a friend and try it), been on several semi-blind dates, gone regularly to movies by myself, put in IVs and endotracheal tubes, and sang "Edelweiss" in front of a large group of elementary school students. Okay, that last one was in the second grade, but still...

No, I'm not creating some weird, free-form resume, I just want to point out that I've done all that and none of it made me quite as nervous as the fact that I'm leaving for Spain in about... four hours. Well, leaving for the airport, anyway. Where I'll sit for several hours because the shuttle is coming at the butt-crack of dawn to get me for some ungodly reason.

I'm totally an adult now. I get that (much as I might rail against the fact). As an adult, I should be able to travel confidently, competently. Right? I don't know! Something about the trans-Atlantic flight and the new city and the new country and the language barrier... terrifying. Granted, my 'Spanglish' is passable, but only in a medical setting. I can get through a well child check perfectly well as long as the parents speak a bit of English. But I am saying things like "open your mouth" (abre la boca) or "does he have a fever? cough? having fevers?" (tiene fiebre? tos? hay vomitando?). Not necessarily conversational Spanish to get me through things like figuring out where the heck I am or where I can find a place to sleep for the night.

Speaking of sleep. I need to go to it. To sleep.

Why am I up? I am mentally and physically incapable of leaving my apartment without cleaning it thoroughly. I should have done it during the day, but I was doing important things like having my brakes checked, and having my oil changed, and getting a pedicure. Leaving the cleaning for tonight. The compulsion to clean drives me to mop my kitchen at ten o'clock at night, knowing that I have to get up for the shuttle in less than 5 hours. My apartment is never so clean as when I am not in it!

Anyhow. I'll try to write from Spain, but no promises.

My Knee Hurts

My right one.

I really have nothing else important to say about my knee hurting. I just felt like complaining, and there was no one close at hand to whom I could complain. Except that as I sat down to write this blog about how my knee hurts, and I have no one to complain to, a Fellow Intern walked into the room, thereby providing someone to whom I can complain. Which negates the whole point of the blog.

So why are you reading it??

I'm going to go complain about my knee now.

Fake It 'Til You Make It

My intern year is rapidly drawing to a close (*gulp*), as evidenced by the fact that we now have NAMES of the people who are going to take our place. Which is, on the one hand SO FREAKING AWESOME, but on the other, absolutely terrifying. (For me, and probably for them - I'm remembering back to me one year ago).

This year is passing quickly, and while I do know that I must be learning something (I have not, after all, been called aside for any uncomfortable conversations), it is very hard to empirically judge this. We're not getting tested, for one. Which, don't get me wrong, is probably the number three reason why it is Great To Not Be A Student Anymore... but it also takes away the one concrete way we knew that we were Making It. Pass the test? You learned!

Lacking the concrete tests, I seem to have adopted the mannerism of just Faking It, and Being Cheerful (the more professional version of the Smile and Nod).

And it seems to be working! I consistently get, if not stellar, at least perfectly decent and occasionaly great, evaluations. Evaluations, by the way, are really the only empiric way we have to know if we're doing okay, however subjective they may be. Empirically subjective - what a great oxymoron!

You're an oxymoron.

So. This is the advice that I would like to pass on to those coming after me: show up, work hard and have fun. That's the guts of what I've learned this year - well, that and maybe a bit about pediatrics. It may (and for me often does) feel like you're faking it. But as long as you keep smiling and don't actually fake the important things, you'll make it just fine!

But then, what do I know? Anybody got a test for this??

I'm A Pediatrician, Not a Vet Darn It!

My cat has gone crazy. This is an acute behavioral change. And... I feel quite clueless!

Every day at work, parents describe symptoms to me. To the best of their ability, anyway. And my job is to take their description of "those muscles at the bottom of the neck caving in" or "eyes looked like they were staring off into space" and refine it into "retractions" or "absence seizure."

But? My cat? I dunno. She's just gone crazy.

I'd opened the patio to let her get some air and be outside. She was fine for about half an hour, during which time I fell asleep on my couch (just finished night float!). But then she started running around all crazy-like (picture the cat in Cinderella) and furiously licking at her side and leg. And hissing. And running around some more. And growling. And occasionally panting.

I tried to wrap her up in a towel to calm her down. Got a nice scratch across the cheek for that one.

The only thing I can think of as a possibility is that she got stung by a bee. There was a bee flying around my apartment yesterday, and she was enthralled. I think one must have gotten her... Either that or she's got neurosyphilis. :)

I decided to give her some Benadryl to help calm her down. Then I realized I had nothing to tantalize a pill into her mouth. I haven't been grocery shopping in ages (see: just finished night float), and literally the only meat I have in my home is hot dogs. So, I tried hiding crushed Benadryl in a hot dog. She wanted nothing to do with it. (Note to self: get rid of food even cats won't eat). Nor did she want the crushed-Benadryl flavored cream cheese. I could have forced it, but she is kind of scaring me...!

It is strange to be in the position of having no clue what is going on. I try to be empathetic with the parents I see daily. Try to let them explain things that to them are terrifying, and to me are totally normal variants without interrupting or downplaying the situation. It does get hard sometimes, though, when you're seeing your seventy-eleventh patient with RSV bronchiolitis.

So having no freaking clue what to do here is probably good for me. Though people do often compare pediatrics to veterinary medicine (since the patients can't talk, not because they're furry)

Except that I'm really not a cat person, so... I don't care enough to actually call the vet... (I'm a bad pet owner!!)

Here she is - not swollen or in any respiratory distress (stopped panting), so she's at least not allergic to bees. If that is what happened... She's totally still paranoid, though. Crazy cat.

Happy Match Day!!!

Not to be trite, but... I can't believe that a year has passed since I matched (and celebrated)

Congratulations to those coming after me!!!

And thank GOODNESS the end of intern year is in sight.

Not that I'm all that excited to be a second year...

Taupe and Childhood Fears

My upper level (Who is very mean. Oops - I mean nice. Very nice. I swear! Really!!) wants me to be posting in my blog every day. As if I should have something interesting and worthwhile posting about. Every day.

And in an ideal world, my life would be like Paris Hilton's, without all the drama (but definitely with all the shoes) and I'd have fascinating, mind-boggling, earth-shattering things to write about. Like the pair of new shoes I'm going to buy. For instance.

But, alas. Such is not the case.

I find that my life is rather taupe of late. You know... taupe. Like... boring? But very useful and practical at the same time. With taupe you can accessorize with anything from cherry red to teal to gold-hued with a hint of peach. Or even lime green. Probably not all the aforementioned colors simultaneously, but you get the picture.

So. Lacking anything interesting to write about that has happened recently, let's re-visit my past. Shall we?

Let's see. A story from the past.

Hmm.

There's really nothing.

How about this: You know how most children are scared of monsters under their bed? (Obviously by 'most children' I am acknowledging a stereotype used and abused since the dawn of the bed, from before Little Monsters up to and through Monsters, Inc.) Well. I never fell for that 'monster' thing. But I was scared of under-the-bed happenings. Read on if you dare.

My own personal night-time terrors stemmed from a simple book that would seem pretty innocuous on the surface - a biography about Helen Keller.

You know - Helen Keller. She was that woman who is famous for being deaf, blind and dumb. Which left her solely with the senses of touch and smell, making those two senses vitally important in her life.

Apparently, in the course of her life, a fire started under her bed (at least to my recollection from the book), and her sense of smell woke her up, and she saved the day! Made a huge impact on 8-year-old Brenna.

Because, well, my sense of smell wasn't (and likely still isn't) nearly as good as that! What would happen if a fire started under my bed? I wouldn't smell it! I wouldn't wake up! The pain! The heat! Horrors! Terrors!

I spent months smelling really hard before I went to sleep, and frequently moving my legs around to confirm that there was no heat emanating from the nether-regions of my bed.

Sigh. I was an impressionable young thing.