We Remember

The dichotomy is odd, really. While our nation and the world mourn the senseless loss of so many innocent lives on this fateful day 10 years ago, I will be at work today being one of the first people the newest babies in our nation and world get to meet. They lay there, totally innocent and requiring our help in every way. They are the hope that anything is possible. They have not yet been tainted or ingrained with such deep hatred that our world can foster in some.

My prayers today are of course with all the families who were affected, but also, with these newest little ones. My hope is that each of them will be responsible for achieving something amazing and wonderful for our world and improve it in awesome ways.

Day in the Life of a Pediatric Intern

In an effort to decrease the number of "Is it like Grey's Anatomy" questions I receive (no, we don't shack up in the call room after every patient), I will share what different days as a Pediatric intern have been like for me. I can't say there is a "typical" day because every day brings unique issues, families and new diseases. Plus, every 4 weeks we switch to a different "service" so we are always moving. So I invite you to sit back, relax, and enjoy vicariously the adventure that is Residency!

A Day in the Life...on Night Float

Arrival Time: 630pm Sign out
Departure Time: Depends on how long sign-out takes, but usually by 7 or 730am

When we first arrive, we go to "Sign-out" room and receive sign-out from day team. This is where the Docs from the day shift present every patient on the Peds service to us, the night shift team. Once a patient is signed-out to us, the day Doctor is no longer responsible for the decisions we make as the night team. During the Day shift, there is a separate Doctor who covers the Newborn service, 5-Central and ER Admits (the Peds floor at CRMC downtown; can be 2 residents if we have a guest from Family Practice), and Neonatal ICU (actually 2 residents, sometimes 3 if we have a FP guest).

At night, there are only two of us - the Senior Resident and the Intern Resident - to cover all the above areas. Since we are "only" covering and not responsible for necessarily moving care forward, it isn't as bad as it seems. However, there are times when you have two babies born simultaneously, each requiring resuscitation, an ER admit and a regular newborn who needs screening and it all happens at the same time. That can be pretty hectic.

As the night Intern, I am primarily responsible for all Newborns who join our world at night and for any ER Admits and/or Consults that occur during the night. On some nights, this can consume all 12 hours. On other nights, not a single baby will be born, in which case we either read, sleep, snack, or round with the Senior resident on NICU. It must be noted that every senior resident I have worked with so far has been incredible. Patient, guiding, kind and smart. And every single nurse is always willing to help and offer advice or just a joke to help you smile and make it through the night. The NICU nurses especially are most kind and really know their stuff.

On my busiest night so far, I received 4 pages for newborns (yes, we still use pagers), one of my mommy's needed resuscitation and I handled a consult - all within the hours of 2am and 630am. It went from being a quiet night to suddenly non-stop action. And of course, two of my babies were from mom's who either a) didn't know they were pregnant until last week or b) knew they were pregnant, had good prenatal care, but had fevers going into delivery - something called "Chorioamnionitis", which requires that I treat the baby with antibiotics after delivery and observe for at least 48 hours to ensure that baby won't become septic. The clock ticks pretty doggone fast when you have to make lots of decisions quickly.

And then, after a night of carrying 2 pagers (my own and the Newborn one) and a "Vocera" (the NICU in-house walkie-talkie-ish phone), I get to hand over all but my own pager, sign-out all the patients to Day team, and go home and rest for a bit before coming back and doing it all again.

Stay Tuned for More "Day in the Life..."

Wedding Bells Are Ringing!

Since midnight last night, Eastern Standard Time, folks in New York who identify as gay and lesbian have been afforded the legal right to marriage. A union between two people who love each other. One of the first couples to marry was a lesbian couple in their upper 70s and 80s - one using a walker, one in a wheelchair, who had shared their lives together for so many years, but not been recognized as a unified couple by the law.

Congratulations to all those who have been afforded the civil right to have their love for each other formally recognized by the State!

As a Doctor, I wanted to discuss this issue from the perspective of Medicine. Although it has been less likely to occur in New York, up until today Doctors and Nurses had a legal obligation to ask the "significant other" of a gay or lesbian couple to step out of the room when discussing the health issues surrounding the patient. Regardless of how many years the couple may have been together, the patient's loved one was not considered to have the legal right to make health decisions for him/her, unless they had the foresight to make a legal document naming each other as proxy to make health decisions. In a heterosexual marriage, it is assumed and legal that the patient's spouse has full legal authority to make health decisions for the patient if they are incapacitated. Now, with couples legally marrying, the same-sex spouse of a patient will also be afforded the legal right - and human dignity - of being in the room to make health decisions for their spouse.

No human being should have to spend their last few moments on Earth alone. What a blessing that this law will ensure that doesn't happen in NYC any longer for same-sex couples.

Grade Inflation

http://economix.blogs.nytimes.com/2011/07/14/the-history-of-college-grade-inflation/?hp

Go to the link above - the NY Times has some AMAZING graphs on how grades have gone up, up, up over the last 40 years. It is staggering.

ONE possible explanation, in my opinion:
1. Private schools offer more 1-on-1 instruction and greater access to the Professors, therefore allowing students more tutoring access. They also have smaller class sizes, therefore allowing more evidence-based teaching methods to flourish and allow students to understand the material better.

That's it, that's all I've got and that only explains why private schools may have higher grades than public. Why grades have shot up overall is a study in the pressures Administrators place on Faculty to keep the numbers up...and that's a whole post for another day! For now, check out the startling evidence in the graphs.

I have come to the iPhone...

...and I LOVE it.

The phone is so friggin' easy to use. The designers obviously thought about the user experience and made something beautiful. I love my new phone and really am just wondering why it took me so long to purchase it!

Details:
iPhone 3GS (yup, I went with the older model because they are $49. And for me, 8 GB is more than enough memory space.

Otter Box phone cover. I really like the Otter Box because it doesn't add a ton of bulk to the phone, while still effectively protecting the phone quite well.

First App Downloaded: Epocrates. This is a medical program that helps me determine dosages for the various medications I prescribed.

Favorite App Downloaded: Words with Friends. It is addicting, although pretty frustrating that I have lost WAY more games than I have won!

Tip: If you can, but the phone somewhere OTHER than California (and I think NY) because these States apply tax on the original retail price! So tax on my $49 phone was more than the sale price of the phone. That stinks. In other states, the tax will be on the actual sale price.

Lifestyle: Eating Healthy

There has been a lot of buzz lately on the government's new dietary recommendations. You probably have heard of the "food pyramid" - the confusing, practically gutted of all useful information, pyramid looking thing that you probably pretty much ignored. There were some good recommendations in there for a healthy diet (and by diet, I mean the food you would regularly eat on a daily basis, not a "diet" meant to lose weight, which often never works). But now, instead of a pyramid has been retired and the United States Department of Agriculture has introduced the "My Plate" - click here for the visual.

The new recommendations are presented as a dinner plate with sections representing the major food groups. Vegetables and grains take up over half the plate and Fruits and Protein take up the remaining sections. There is also a separate, cup-shaped section meant for dairy. You can click on each section for a listing of healthy foods that you should consume.

Some highlights to keep in mind:
1. they have fruit juices listed as an option. Don't get me wrong - I love fruit juice - but they are only slightly better for you than a can of soda. Slightly. It is MUCH better to eat the fruit whole as the added fiber and nutrients not lost to the squeezing of the fruit will help you digest it better and not turn it straight into a glucose dump on your body.
2. Whole grains are emphasized over refined/processes grains. This is critical! Whole grains maintain all the nutrients that are necessary for healthy eating AND they contain fiber, all things that are lost in refined grains (like white bread, white flour, the cheap pasta at the store, etc). Make sure to try to make almost all of your consumed grains whole.
3. Make sure to eat small, healthy snacks through out the day so you never feel super hungry. Research has shown that if you sit down to a meal when you are feeling ravenously hungry, you are going to consume way more calories than you need. You will probably also consume those calories with some of the unhealthiest food options available. To avoid this, drink lots of water and keep healthy snacks nearby through out the day.

Eating healthy CAN be difficult when you are facing a beautiful red velvet cake in the face. Being a fat kid at heart (and at the surface), I know how hard it can be. But if we make healthy choices the vast majority of the time and exercise regularly (something I have restarted doing), then it will be OK to have a red velvet as a treat on a rare occasion. The key is not to restrict what your heart desires but to make the best/healthiest choices to satisfy those desires.