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.

Human vs. Doctor and Being Up in the Middle of the Night

I was just called urgently to the bedside of a patient. So I went. Urgently. And then? When I got there? The nurse that had called me? Wouldn't tell me anything. I don't know what she was expecting that I would do with... no information. So, I think I kind of got a bit short with her. I basically demanded to know what was going on. Because... I kinda sorta needed a medical-ish opinion or at least description of what I was looking for. To, you know, actually evaluate the patient. And I ended up having to get all the info from the mom. Even though the patient is in a constantly monitored environment with a nurse not ten feet away who should be looking at things. Like the monitor. And the patient. Anyway, I was annoyed.

I think I scared the nurse.

And... the part of me that's human (and I am pronouncing this in my head in the North-easternly way, you know - 'yoo-man.' Just in case you were wondering) felt really bad about it.

But the part of me that is a resident doctor up in the middle of the night dealing with all sorts of bizarre goings-on? Feels like she should just deal.

Hmm. I had assumed that by doing pediatrics, I would avoid some of the cynicism and arrogance that seem to get added on to our collective personalities as the MD degrees go on our walls.

Perhaps not.

Or perhaps I can attribute it all to the un-naturalness of being up and functional at 3 in the morning.

Banner Day... er... Night

It has been a remarkable night so far. Just... weird things going on. But also things that I am actually managing to Handle. Big "H" handle. Almost like a "real" doctor handling.

Patients with all sorts of weird exam findings that I am able to actually explain - physiologically, even.

A lumbar puncture - with mom and grandma in the room - that I got on the first stick in an unsedated child. (and though not quite a champagne tap, it only had one cell).

A swearing patient that I managed to calm down (at least temporarily).

A seizing patient, that I dealt with on my own, while my resident was dealing with another crisis.

Actually... listed out, these things don't seem all that major. But... I feel particularly competent tonight. (apart from the fact that I just had to look up the spelling of 'competent' because I was doubting my intracranial lexicon)

I ALSO bought a plane ticket to Spain tonight!!! I'm going to Spain!! This notice also serves as an open invitation for any of my friends to join me for part, or all, of my trip. Assuming you don't annoy me too much. :)

To top everything off - I won an iPod Shuffle! For real! It was delivered to my apartment today. Well... they tried to deliver it. I was sleeping. I should get it tomorrow, though. I can take it to Spain!

And the Beat Goes On

Today is my last day on the wards as an intern (never minding the four weeks on nights, the four weeks on hem/onc and the four weeks of sub-specialty rotations) EVER. And, in fact, these are my last few minutes here. I'm about to go drop off my LAST intern note.

This is really exciting!

And, yet... I find myself dawdling. Look! I'm here, writing a blog post, when I should be leaving. I'm kind of... sad. Which seems just bizarre. Crazy bizarre. This past month has actually been... fun. Weird, right?

I think it's mostly that I just don't want to go onto another rotation when I already know these patients so well. And my life is so well entrenched in the pattern of getting up at the crack of dawn, spending most of my waking hours here, and going home and crashing in front of the TV. I just... don't know what to do when I'm not here any more. Plus, I don't want someone else messing with my patients.

This is bad.

I need a vacation.

...It Was the Worst of Times

I'm generally a pretty mellow, laid-back person. And before members of my family or old friends scratch their heads and wonder if they've unwittingly stumbled across a blog written by someone who is obviously not Brenna, I should qualify that statement: Compared to a lot of other residents/medical people, I am generally pretty mellow and laid back at work.

Three admissions in the ED? A chance to multi-task! Another RSV bronchiolitis patient? At least that will be a fast one! Present a patient I barely know at morning report? Why not! Call twenty billion consults on one patient? A chance to learn more! Work 19 of 20 days? At least I got that one off! Three pages in ten minutes about the same asinine issue? Obviously I didn't explain myself well in the first place!

But there comes a time every month or so - one might call it cyclical if one were so inclined, where I'm less... patient. And much more annoyed. With everything.

At the beginning of residency the fates were so kind as to allow that 'period' to occur at the start of a rotation. Because at the beginning of a rotation, I'm nervous, scared and unlikely to 'rock the boat,' as it were. These feelings outweigh my general annoyance with the world, so I maintain my cool. But, thanks to the vagaries of time and hormones, it happens that my annoyance grows at the end of a rotation. When I'm more confident with what is going on. And sooo-o-o much less willing to put up with... well, much of anything.

I was on call on Friday night. We had seven admissions between 5pm and midnight. Five of them arrived within half an hour of each other. At least one of them I deemed totally unnecessary. The pediatric floor is completely full, so the keep admitting patients all over the hospital. Plus I had to cover for all the patients that were already on the floor. And there are some new nurses that page a lot. In the middle of the night. With questions that could be handled at a time other than 3 am. And, to top it all off, there was a radiothon going on to raise money for the hospital. Which is totally cool and a wonderful cause, but they were all over the peds floor and just basically getting in my way.

And I was so sick of the RSV bronchiolitis and acute gastroenteritis and complicated MR/CP kids with 20,000 issues that I could spit.

On a normal day (or night), I would have been fine with all of the above. But this particular call night, I was not in the mood to deal.

I feel particularly bad for the upper level resident that was forced to work with the contentious me that night...

Ah, well. There's not much I can do about it now. I've got my last week on the wards coming up. Although, then I start two weeks of night float. Which is like the wards without the daylight. So... that's exciting. And then I do two weeks of Pulmonary. Which is like the wards without the interesting cases.

There appears to be no real point to this blog. Hmm. That's too bad. I guess you'll just have to deal.

Me? I'm off to get a pedicure - I'm working on the theory that I can handle things better with pretty toenails.