Aug 31, 2006

Boffo!

I'm going to bring back the word "Boffo." (Was it ever really a word?) You know, as in "You passed the test? Boffo!" Or, "I was on call again last night, and it was totally boffo." Only one of those statements is true.

Don't worry, I didn't fail a test - that statement was just hypothetical.

But I was on call last night, and well, it was kinda boffo. Not I've-found-my-purpose-in-life-and-only-want-to-see-tiny-sick-babies-for-the-rest-of-my-life boffo. More like I-actually-had-half-or-even-three-quarters-of-a-clue-of-what-was-going-on boffo.

I have this tendency... If someone has a strong personality trait, I find myself doing the polar opposite. I'm around a talkative person, and I get quiet - I'm around a quiet person and I can't quit gabbing. My own little way of balancing out the universe, I guess.

Last week, the fellow on call with me was laid back, chill - cooooool, even. We're talking Fonzi cool. Unflappable. Which I didn't need to react oppositely to (is oppositely a word?) as I was already in semi-panic mode all day.

But last night was another story altogether. The fellow on was... well. Flappable. She wore a long yellow gown over her scrubs and just kind of flew around everywhere talking to herself. It was quite amazing. Very smart person, but very... hectic. And any time she'd talk to me, I think she started whatever she was going to say in her head (despite the consistent talking to herself out loud), thus only delivering 2/3 of the message to me. Her: "...so give 2 cc IV push now." Me: "Okay, but. Um. Of what? On who?"

Anyway, combining her strong personality trait, which we'll call "Flustered-ness" and my tendency to go anti-other-person's-trait, I was remarkably calm, cool and collected last night. Anti-flustered, if you will. Which is, overall, a much better way to manage a call night.

Boffo, man.

Aug 27, 2006

Never Fear, Grasshopper.

My second NICU call was worlds better. It helps to actually know the patients that you're supposed to be taking care of. And to know where the rooms are. And how to use the Vocera. And when you load up with jelly beans instead of dinner and you and the nurses order some of the best sushi ever made.

That didn't stop me from breaking out into hives (quite literally) when the Attending this morning said that he wanted to "talk to me" before I left.

Side note: I seem to have developed some sort of chronic neck hives as a response to stress. Or perhaps some strange rheumatologic disease that will henceforth be known as Brenna Bumps. They've been a-flaring up lately, let me tell you, though. Itch, itch, itch.

What did the attending say to me?? Well, today was his last day, so he wanted to give me feedback on my performance this past week. And... he said I'm doing great! HUGE sighs of relief that promptly deflated the hives and made all the babies all acidotic-like by increasing their CO2. Maybe not that big. But big.

One week down, three to go. Total hours this week? 82.5. Not counting the couple of hours of paperwork I've done at home. Oops.

Aug 24, 2006

Super Star


I think she likes having the run of the place while I'm gone on call.

What's The Worst That Could Happen?

In our lives, we are privileged to have a certain number of Memorable Days - days which will stand out in our memories for the rest of our lives. (Or until we get all old and senile) And if you're lucky enough to be a resident working on call, you have the unique opportunity of having one of those Memorable Days co-incide with a Call Day, meaning it will last for a full thirty hours. Unfortunately, some of these Memorable Days stand out for the sheer horrible-ness-osity of them.

I had my first NICU call on Tuesday.

Here is some background on the NICU set-up: The team consists of three residents - one first year (me!), a second year and a third year. There is also a NICU fellow and the attending. For some reasons the rooms aren't numbered - they're labeled with names. Animal names, to be exact. So we have the Bunny, Bear, Deer, Elephant, Lion, Koala, Giraffe and Zebra rooms. The area is actually quite huge, so we wear walkie-talkie thingies (called Vocera).

Not surprisingly, I don't know all that much about taking care of babies in general - not to mention premature babies that weigh 860 grams (for comparison's sake - a loaf of bread weighs 680 grams). So I was happy to know that all those people would be there to teach me, and guide me and basically save my butt.

Except... On Monday, my 'orientation' consisted of "Here's the Vocera. Rounds start at nine." That was pretty much it. I knew a little about the four patients I was picking up from the last intern. I knew that there were a bunch of calculations I was supposed to do - not what or how, though. I winged my way through on Monday, but amid a crisis (not related to my patients) and other hullaballoo, I really didn't get any more instruction. And then I had to leave for clinic.

So, Tuesday morning felt as new to me as Monday did. And the third year had the day off, so we had to cross-cover her patients. Meaning, I had to round on eleven babies - still not really knowing the babies or the calculations or even what room was what.

The second year resident was post call, so we rounded on her patients first so she could get out by noon. Which left me to round with the attending and fellow by myself.

I think I mentioned that the attending on service is the Head of Pediatrics? Did I mention that he's from the East Coast? And, quite stereotypically, is very smart, very picky, and very not afraid to reprimand dumb interns during their presentations. And, unfortunately, he very much didn't know that it was only my second day.

It just went on and on. Me presenting, him yelling at me, me presenting while trying to not burst into tears. And, then? In the middle of all of it? My period started. Early. So I wasn't prepared. So. Add to the yelling, and fighting back tears, the worry that I was going to bleed through my scrubs and be on display to all the nurses and parents of these tiny babies. (Thankfully, I didn't bleed through - until Wednesday morning, that is.)

Rounds didn't end until 12:55, and we had a discharge planning meeting at 1:00. So, I did get lunch! And then I got to go over the disposition of all 30+ babies on the service with the social workers. Did I mention that it was my second day? I DON'T KNOW WHEN THE BABIES ARE LEAVING. Thankfully, the (very nice) fellow helped me with that.

After the meeting, I started working on a new admission. The fellow was supposed to help me, but... he disappeared. He left with a ground transport team to go pick up a sick baby at a different hospital.

Wait.

He left.

My back-up.

The person who knew the patients.

And how to manage NICU babies.

Left me alone.

The attending was still there. But... He scares me!

They did call in another fellow to help out. But she was ABSOLUTELY USELESS. She read articles. And she didn't put on her walkie-talkie. So everyone called me with the issues. Baby isn't peeing. Baby has a distended stomach. Baby's temperature is down. Baby's glucose is 35. Baby's CO2 is up to 75...

These are things that a week from now, I will know how to handle. But not on my first real day.

It was so awful.

I wasn't so successful at holding back the tears for a few hours there. I didn't know it was possible to be on the verge of tears for hours on end - and still run around writing orders and filling out paperwork. But it is.

The night fellow came in around five - so I was really only alone for three hours, but man it felt like longer.

The night fellow was a great person - very smart and on top of things and relaxed. But I am used to working with other residents - working as a team, checking in a lot with the other person. It's not quite the same with a fellow.

I did get to put in an umbilical vein catheter, which was cool. (And so easy!) But most of the night, I felt totally lost and stressed.

I finally crashed around 2 am. I couldn't stay awake any longer. I actually ended up getting over two hours of sleep. By Wednesday morning, I felt much better. Except for the diarrhea. But I won't go there.

I was doing okay getting vitals and numbers on Wednesay, feeling much more in control (it was, after all, my third day!). But then, six am came and went, and the third year resident didn't (the second year had the day off). About 6:15, I started to get worried. Around 6:20, I started panicking. What would I do if the only other resident didn't come? I paged her. No answer. I was about to call the chief resident, when the third year finally arrived. I almost burst into tears again, but this time out of relief.

Writing it all out here, it doesn't sound as bad as it all felt! I think it was all made worse by the fact that I barely got to sit down. Through the whole 30 hours, all I got to drink was one bottle of water, a Diet Pepsi and a cup of coffee. That's about ten times as much liquid as I give my baby that weighs less than two pounds. I don't weigh ten times that baby.

The whole day I felt lost and confused and just plain stupid. And there was no one there for me to complain to!

You know - it probably could have been worse. The patients were relatively stable, no one died, I did get sleep - and I even got out at noon on my post-call day. Plus, I'm off today! I just hope that I never again have a work day as bad as that! I get to do it all again on Saturday, so wish me luck.

Aug 21, 2006

"That Was Fun!"

Eventually, I'll get around to writing about this past week (which included, for one, my ten year high school reunion!)

But first -

I started the NICU today. I won't even begin to talk about how utterly clueless I am. They're so small, you wouldn't think they'd be all that scary. But they are. Terrifying. Especially when the Peds Department Chair is the attending, and both chiefs and the program director decide to join you on rounds on your first morning when you don't know the patients or how to calculate all the crazy calculations or how to even touch an 800 gram baby without feeling like you're going to break them into ten million pieces.

But. Anyway. I had clinic this afternoon. Two of my patients were siblings, just in for their regular check-ups. I did my normal schpiel with them, and as I walked out, the older sibling said to the mother, "That was fun!"

Fun! The kid had fun! At the doctor's office! And I was the doctor!

It's nice to know that I'm not completely hopeless.

In other news. I'm on call tomorrow night. In the NICU. Alone. Me. The doctor. Taking care of thirty babies who are very, very sick. And being the doc to go to deliveries where they expect the baby to do poorly. Ha. Haha. HAHAHAHA.

Okay, so... There is a fellow on, which is SO SO SO nice to know. But not all the fellows are terribly helpful. I hope they're nice to me.

Aug 15, 2006

The Great Equalizer

I got to go back to the DMV today. As you may remember, I went a while ago to get my driver's license. I was on top of that because my Oregon license expired on my birthday in June. The registration part, I've been putting off - mostly because, well... I've been working. Officially, though, you have ten days - ten - to register your vehicle in California when you move here. Most states give you thirty days.

Regardless, I've exceeded that time period. And, me being me, I was honest about it. Darn you scruples!!

Anyway. Let me tell you about the registration process in the lovely state of California. Aren't you just filled with excitement?!

First, you need a car. Haha! Duh.

Then, you need to take the car to get emissions tested. Your options are: a test only site, a test and repair site, or a something-something certified site. You might think that a certified site seems appropriate. Wrong. Then, a test and repair site obviously seems like the right choice. Also wrong. You need a "Test Only" smog testing site. Duh. It costs $50 for the test, and another $10 for the certificate saying you got the test. (Why not just charge $60?? Like anyone is going to get tested just for the heck of it.)

Then, the DMV needs to verify your VIN. This part, thankfully, is free. Plus you get to watch someone fail a motorcycle driver's test and give props to a 16-year-old who just passed her behind-the-wheel test.

Then comes the Great Equalizer: the DMV waiting area. What a fantastic cross-section of Culture. Everyone has to go to the DMV at some point. Unless you're so rich that you never even bother getting a license, I guess, counting on a chauffeur to take you everywhere. I wonder, too, if Tom Cruise or Paris Hilton, etc. have to _wait_ at the DMV. Maybe there's a special "Stars Only DMV."

But I digress. Thoughts do tend to wander far and non in the DMV waiting area, though.

So, when your number is finally called, you go to the window with: the registration form, VIN verification, Smog certificate, old registration, vehicle title, driver's license and proof of registration.

I had it all! I was SO set. I even remembered my checkbook, since the California DMV only takes cash or check. (Actually, they do take debit cards now, but that is a fairly new development)

But, guess what? IT WASN'T ENOUGH. Apparently, Mother California considers pick-up trucks - ALL pick-up trucks - to be 'commercial' vehicles. Never mind that they may be driven by a girly pediatrics resident. Nope. Commercial. Meaning: I need to go to a TRUCK STOP to have my Commercial vehicle WEIGHED.

They did let me pay the $212 to register, though (including the $23 late registration penalty.)

Now I get to go get my truck weighed - who knows how much that costs. Then I get to GO BACK, wait some more, to pay for license plates and tags. Another $50-70.

Goodness.

I'm going to need to start using my truck commercially to pay for all of this!

The best part of all of this? I'm leaving town tomorrow (for my ten year high school reunion!!!!!), so I'll have to take care of the truck stop issue when I get back. While I'm in the NICU. Which is the rotation notorious for consistently exceeding the 80 hour work week regulations.

Sigh. What can you do?

Did you read this whole post? Crazy person. It's about the DMV. Let me get your opinion, then... Personalized plates or no? I can get the "Kids" plate with either a heart, star, handprint or plus sign. What would it say, though?

Aug 10, 2006

Gimme a Shot!

Once upon a time, I caught a little bug, which I dubbed the "Reality Television Virus" - RTVV. The main symptoms are watching - and enjoying - reality TV. Associated symptoms include getting 'attached' to the contestants, talking about the shows with other people, recording the shows and possibly re-watching them, and actually wanting to either audition for a show or to attend a post-show performance tour. Differential diagnosis includes General Television Addiction, Thinking You're Better Than Those TV Freaks and Frank Insanity. Treatment at this point is mostly supportive.

Shows that have supported my Illness (this is probably not an all-inclusive list):
Survivor
Big Brother
American Idol
Amazing Race
So You Think You Can Dance
How To Get the Guy
America's Next Top Model
Project Runway
Made
My Super Sweet 16

And now, there is a new addition to my list. Possibly the most egregious sign of RTVV's hold on me yet. Are you ready for it?? It is called Who Want's To Be A Superhero? And it, my friends, is awe-some. Inspiring of awe. It is on the Sci-Fi channel. The concept is that Stan Lee, of comic book fame (I hadn't heard of him either, but he's apparently super-famous) - has gathered together 12 superhero wannabes - including Monkey Woman, Fat Mama, Cell Phone Girl, Feedback, Major Victory, The Iron Enforcer and more! - and puts them through challenges to see who possesses the most super-hero qualities. It is so fantastically staged that I can't even begin to express the wonderful-ness of it. One of the characters is actually a spy; one gets recruited to be a super-villain - and that's just the beginning. It's reality TV at its best - some people obviously placed by the producers to fill a certain role, others in it just for the fame that being on TV will bring them with no actual passion for comic books, and a couple gung-ho-Stan-Lee-loving-actually-thing-they're-superhero people. It's the kind of group that makes you feel good about yourself as a person. And after all, isn't that the point of Reality TV - to make you, as the viewer, feel superior?

Except for a few people on a few shows - specifically this season of So You Think You Can Dance. I cannot express how in love I am with all of the finalists. They are just Good People as far as I can tell. Takes away from the Superiority Complex aspect of the show, but definitely adds in spades to the Tugging On The Heartstrings aspect.

Hmm. Methinks I should do a whole breakdown of the Reality TV Virus and It's Appeal.

Despite my love of the shows, I realize that the RTVV is Not Healthy. I'm on vacation from work right now, and I think I should use some of this time to develop an anti-RTVV vaccine. I just read an article about a new anti-Rotavirus vaccine (rotavirus causes nasty diarrhea in kids). I think it can give me some clues as to where to get started with the anti-RTVV. Specifically this sentence:

"The parent bovine rotavirus strain Wistar Calf 3 (WC3) was isolated from a calf with diarrhea in Chester County, Pennsylvania, in 1981 and was passaged 12 times in African green monkey kidney cells (79)."

Hmm. Okay, maybe not. Hopefully RTVV is a self-limited illness that will eventually run its course. In the meantime, I'll just continue to watch.

Aug 6, 2006

Clarification:

When I write orders for patients on the floor, a lot of times... well... I mess up - get a dose wrong or forget to specify that the patient with a G-tube should get their G-tube feeds in the G-tube. When I do that, I have to come back and write a 'clarification' order.

Today, I'm clarifying my blog! Though I don't think I've given any orders here. Until now: Send Me All Your Money!!!

Okay, back to topic. So. I just got a comment about my previous tirade about the new Chrysler ads. Turns out that Dr. Z is totally real! He is the bona fide CEO of Daimler Chrysler. I feel a bit bad about slamming an accent that is, in fact, a real one. Oops!

Knowing that, I guess I now _get_ the ads, in the fact that Dr. Z is making fun of himself. I still think the ads are a bit too 'inside joke' for me, though. Or that Dr. Z comes off as too much of a caricature to be believed as the CEO.

And the commercials still bug me.

Thanks for the info, though, "Interested Observer!" Gotta be someone out there keeping me honest.

Otherwise patients may start getting their G-tube feeds in their IV or something.

Aug 4, 2006

What Do These People Have In Common?

Annette Bening
Mira Nair
Kim Basinger
Kate Hudson
Jon Bon Jovi
Michelle Rodriguez
Hugh Jackman
Jessica Alba
Danii Minogue
Joan Collins

Any guesses?

Nope. No, again. You're totally wrong.

So what is it? According to MyHeritage's face recognition software these celebrities share certain facial characteristics with yours truly! Meaning... they look like me! What an honor for them. Especially Hugh Jackman.

Who do you look like???

(hint - someone I know looks like Meryl Streep and Naomi Watts... and Elton John.)

Aug 1, 2006

Pay Day!!!

They pay me for this!! Seriously!

We finally got our first paychecks today. Which means that I can finally pay for the things I've been buying.

And now that I actually know how much I actually get to take home from my salary, I can actually set up a budget. And I discovered that I can actually afford to go to a movie - or even buy a whole can of soup! - withouth experiencing paroxysms of guilt or breaking out in hives. (Shopping hasn't been too pretty these past few weeks)

Ooh, except that I didn't figure in gasoline yet. Scratch that whole can of soup thing.

Today, at work (for which I get paid), I went to the audiology clinic - that's where they test hearing in kids. They've got these scary automaton bears that bang drums and blow whistles. Kind of like hairy, incredibly scary Small World characters. That's supposed to be the 'reward' when kids look in the right direction when they hear a sound.

Hmmm.

And to once more completely change the topic:

Back in about... junior high I decided that I was so far from being cool that I'd just embrace my dorkiness and go with it. For a few years, I was so far from cool that I purposely went anti-cool -- I wouldn't carry the Espirit bag that everyone else had in sixth grade, I didn't like the guy that everyone liked in seventh grade, and well... I never really had a 'fashion sense.' It was an attitude that served me well.

As a matter of fact, it is an attitude that I still heartily embrace. Minus the purposeful anti-cool part. If I happen to stumble into a 'cool' outfit, I'll continue to wear it now.

But it was this attitude of embracing my inner dork taht led me to spending the weekend attending "Lambtown" (a small-town California celebration of... lambs) and going to see a live stage version of "Seven Brides for Seven Brothers."

What I love is that, where ever I go, I manage to find other people who are totally in tune with their own inner dorks.

And now? I'm a paid dork.