Saturday, December 24, 2011

Plans and Goals

I'm enjoying my vacation. I just finished 4 weeks of outpatient psychiatry, which was absolutely fascinating, but I've had this whole last week off and will have next week off as well, before starting a 4 week rotation of family medicine.

I love vacation, mostly because of the time I have to do things I want to do. My wife was shaking her head at me, because last Sunday I spent half an hour on the phone with a good friend, discussing how to schedule our vacation time to make the most of it. "We'll wake up at 5am every day, except sleep in on Wednesdays and Sundays." We planned to pray for 5 minutes when we woke up, before doing anything else. Then we agreed upon a Bible reading plan to work through every morning (the plan we're using can be found HERE). After that, I work for 2 hours on the curriculum for the Patient Centered Medical Home that I'm working on, while my friend (who will be starting medical school himself next Fall) studies microbiology. By then, my kids are waking up, so the next couple of hours is loosely make breakfast/hang out with them/read "Polio: An American Story".

Most of the rest of the day is unstructured, and I have been using it to take my son to the park, run errands, catch up on dishes/laundry and watch TV with my wife. Thus, I keep most of my vacation time unstructured and open to spending time with my family. But then, as the evening comes on, it's time to work on my physical goals. I'm planning on running a half marathon in 2012, so I go on a run every other night. I'm up to 4.5 miles! The other nights I work on strength training and working through my karate forms, since I plan to return to my dojo next Fall.

For the most part, I've been sticking to this! It helps having a friend to check in with, especially at 5am. Most of all, it helps to have planned out how to accomplish the goals I want to reach. My Sensei always says this time of year (as we make our New Year's Goals), "A goal without a plan is just a dream." So part of what I will be doing this last week of December, is compiling not just a list of goals for next year, but making plans for how to reach those goals. I hope you'll do the same! :)

Thursday, December 8, 2011

Ask the Right Questions

I made a rookie mistake in clinic recently. Let me give you a little background: for the last few weeks, I've been doing a rotation with a group of doctors who are board certified in both family medicine and psychiatry, since that's the path which I want to take as well. I've sure seen a lot of interesting things! Since the need for mental health care is so great, though, the majority of the patients we see are for psychiatric care. The patient I saw this time was no exception: she had been referred to us by her primary care doctor, because she'd had a hard time adjusting to a death in the family.

I started talking to her, and immediately began to see that there was a lot more going on than that. Her life was marked by transitioning between long episodes of depression and shorter episodes of increased energy, decreased need for sleep and hyperactivity, consistent with a condition known as bipolar disorder (many people have a mistaken idea of what bipolar disorder is, but that's a topic for another post). We talked at length about the problems these were causing her. We talked about the abusive relationship she'd been in, her use of marijuana, her mother-in-law, her financial and housing situations, and all about her kids. She'd been tried on many different medications for her mental illness in the past, and we talked at length about these. We discussed her prior attempts to take her own life, and her interactions with psychiatrists in the past. I probed into her childhood, and uncovered a history of physical and sexual abuse. After that, I found out that many of her family members also have had problems with mental illness, too. Then we started going into what her greatest current symptoms were, and they were actually anxiety. I asked a lot of questions about her anxiety, and how it fit into her extensive history.

That sounds like a great patient interview, right? In a way. My rookie mistake was finding out all of this information for it's own sake. I'm to be forgiven for making this mistake; curiosity is a large part of how I got to this point in my career and my life. When I exited the room, though, I realized that almost an hour had gone by. I was working with several other students and doctors in the clinic, but if I had been the only one, how many other patients would now have been waiting to be seen? I'm a big advocate for spending as much time as you need with each person to deliver the best care, but that then begs the question: did all that additional information really help me to provide better care? It really didn't. Of course, it's nice to have that extra context, and it might be necessary if we were getting into a therapy session. However, to help her with her anxiety and underlying bipolar disorder, I didn't really need to have all that extra background, and the time I spent gathering it could have been spent helping another patient.

As my medical knowledge base has increased, I've mostly gotten away from being a mindless data gatherer into someone who asks pointed questions. At first, I would take the above approach to each patient, with medical issues or psychiatric ones. This method involves gathering as much data as possible in hopes of stumbling across the information needed to make the appropriate diagnosis and treatment decisions. As I go on with my training, my mind is becoming more keen to realize what sorts of questions I need to ask. Instead of fleshing out the entire background of abdominal pain, I may ask "Does the pain change when you eat?" If it gets worse after a fatty meal, gallstones is higher on my list of causes. If it gets better after a meal, I'm thinking more about ulcers. I'm getting a lot better about doing this, but I need to apply this same approach to patients who have anxiety, depression or other psychiatric problems. It's fun to get into the whole life story of each patient, but it's in everyone's best interest for me to hone in on what's really important. I hope to get better and better at doing this, while still making my patient's see that I'm listening to them and care about what's going on in their lives.

Saturday, November 26, 2011

Oregon's Death Penalty

Two days ago, I read THIS ARTICLE about how Oregon's Governor John Kitzhaber had just blocked the upcoming execution of an inmate on death row. The article caught my attention, mostly because my own views on capital punishment went through a huge transition a couple of years ago. I identified with the governor's struggle with the decision. According to the article, he has in the past allowed two executions to take place, but stated "I refuse to be a part of this compromised and inequitable system any longer; and I will not allow further executions while I am governor." It intrigues me to read that the governor is a medical doctor, having been trained as an emergency room physician. He cites this background as being a part of the reason why he can no longer condone executions. I can definitely understand that. In fact, it's during medical school that I went from strong supporter of capital punishment, to uncomfortable supporter, to where I am now opposed to it. I had been contemplating a blog post about this issue for the last day or two, but then I saw THIS ARTICLE, also from CNN. It's an opinion piece from a law professor in Minnesota, and I highly encourage you to read it. Many of the comments I've read at the bottom of these articles are very angry at Governor Kitzhaber. They call him a coward, they call for his resignation, etc. However, this second article expounds on the constitutional basis for the executive power of clemency, and I think that's well worth the read. It's interesting to note that he did not grant a PARDON to the man, but merely blocked his execution at this point, leaving the possibility of his execution open under a later governor. Governor Kitzhaber is no coward. It took a lot of guts to stand up for his beliefs, which was obviously a difficult decision for him, especially knowing how much heat he would take for it. I am glad he has realized that the capital punishment system is "fatally flawed", and something that needs to be done away with. What do you think? Agree/disagree? In any case, I think it's an important case to read and think about.

Tuesday, September 20, 2011

It's So Easy, and Yet...

For the last 3 weeks, I've been working as a "sub-intern" on the family practice inpatient service in one of the local hospitals. It's been quite a time! I've sure been kept busy, but learning a lot and seeing a lot. With a moment of downtime, I wanted to share a reflection I had yesterday.

We're all familiar with the glamorous "saves" in medicine. It's the car accident victim that undergoes helicopter evac, immediate surgery and whose life is saved. It's the acute peanut allergy that receives the almost magical dose of adrenaline and is almost instantly better. The list goes on. We're often very succesful at treating these conditions, though sometimes they do die. What I think is a common misperception, though, is that this is the norm in medicine. That most illness is out of the blue, is something that just "happens" to people, that there was nothing you could do. But most medical problems are not caused by being in the wrong car on the wrong day.

What I see day in and day out is complications of simple, easy to manage problems like diabetes, high blood pressure, asthma, etc. These are things that we KNOW how to treat. We know how to prevent complications. And yet, I just had a man last week who required half of his foot to be amputated as a complication of untreated diabetes. I had a woman this week who came in seeing snakes on people's clothing, because her blood pressure was so high it was affecting her mind. Last month, I saw a man who had large amounts of yeast growing in his mouth and groin because his blood sugar (and thus urinary sugar) was so high.

This morning, I'm caring for a truly pleasant gentleman with COPD (bad chronic lung disease usually caused by smoking). He hasn't smoked in the last 15 years, but he smoked quite heavily before that. Even though he's been doing things all right as far as his lungs are concerned for the last 15 years, he has to live with the consequences of his actions prior to that. For the last several days, I've seen him decompensate and gasp for air, feeling like he's drowning, because he can't get the air to move through his lungs like he should. How did this kind old man get to this point?

Day after day, I see patients on dialysis because diabetes has destroyed their kidneys. The treatment of diabetes is simple! Some pills once or twice a day, sometimes insulin is necessary, diet and exercise. These are not miraculous innovations! But are they DAMNABLY hard to do.

"Physician, heal thyself" haunts me. As I tell my patients about the importance of eating well and getting regular exercise, I think about how I'm going to grab a Big Mac and a large Coke as I race from the hospital to the clinic. I think about how I'm working 60+ hours a week and have no time to go on a run. I know I've gotten 4-6 hours of sleep per night, most every night for the last several years. I think about all the bad habits I have, and how I have full knowledge of the right thing to do, and what the consequences are if I don't. But sometimes, it just doesn't matter. I do what I know is harmful for my body, anyway.

And this makes me think two things:

1) It makes me compassionate, and humble. There's no point in me lecturing someone about not following the obviously right path. Yes, it's simple, yes it's straightforward...but life isn't always that easy.

2) It drives me to keep encouraging them. Sometimes, we just need that EXTERNAL voice to nudge us in the right direction. We know what's right, but we need a little kick in the seat to push us down that road. I'm happy to be that benevolent kick.

3) Ok, one more. It pushes me into trying to make at least one extra right choice today. Maybe I'll grab a salad in the cafeteria before I leave the hospital, instead of a Big Mac. We'll see.

Friday, August 26, 2011

Quick Peek Into My Life

Alright, here's a quick peek into what's going on in my life right now:

* What you should be most pleased to know: I'm also working on a blog post about the rotation I just finished, namely "ambulatory internal medicine." It was a lot of fun, and I have some great stories!

* It's hard to believe that my daughter is over 2 months old already, but boy is she growing fast! The giggly girl can roll from her belly to her back, and she can scoot herself all over the place...it's scary to think how soon she'll be crawling! My amazing wife always makes sure to take pictures and video...here are a couple:





* Ariel's big brother, Charlie, is sure growing up fast as well. I heard a Brad Paisley song the other day on the radio, and asked my wife to put some pictures of Charlie and me to it. Of course, she did, cuz she's awesome like that:



* School-wise, on Monday I will be starting my "subinternship" month, where I will be doing general medicine in the hospital, and supposed to be acting at the level of an intern. It's scary to have that much responsibility on my shoulders, especially knowing how much I don't know! Sure I'll have people to back me up, but I'm just hoping I don't have to rely on them too much.

* In 6 days, it will be time for me to submit my application to residency programs. This is being quite stressful! I think I know all of the programs I'm going to apply to, but my application is far from complete. I am mostly applying to family medicine, but I am also applying to a combined family medicine/psychiatry program. Thus, I have to write two different personal statements, both of which stink right now. The deadline is fast approaching!

* I'm also working on finalizing my fourth year schedule. It's really hard to believe that graduation is in just 9 months. I will be doing at least one, probably two, "away rotations" back in my home city of Sacramento. These are opportunities for me to see the hospitals that I'm applying to for residency, so I can get a really good idea of what I like and don't like about each one. It will also be a good opportunity for our family to get back "home", grandparents to see grandkids, and all that.

* Which brings me to the fact that we will be moving a month from now...cross-country. 2 adults, a 3 year old and a 3 month old, and 2 dogs. We will stay in California for about 3-4 months, and then we will have to come back to Ohio for 3-4 months so I can finish out my rotations here. Then hopefully we'll be moving back to California AGAIN for residency (Match Day is March 17, 2012!!)

ALL this to say...there's a lot going on right now! I'll update this as I can, but obviously, that's going to be a bit far in between. I really appreciate all who read and respond to my blog posts...it's really nice to know people enjoy the stories! Take care.

Sunday, July 31, 2011

Hiatus

Well hello there! Some of you (ok, my grandparents) have noticed that I haven't been writing much on here recently. There's certainly a reason for that. My daughter, Ariel, was born on June 15, and I've had my hands a bit full ever since.



Interestingly enough, she was born on the last day of my OB/GYN rotation! What's more, the delivery was so quick that my wife's OB herself didn't make it to the delivery, and I got to help catch her. I was absolutely shocked and humbled at how blessed we were, with how smoothly everything went. We were actually able to leave the hospital 24 hours after Ariel was born (contrasted with my son's birth, where we weren't done with the hospital for 5 days). Ariel was in perfect health, and my wife's recovery was incredibly swift. What a blessing!



Thankfully, we had planned her birth to coincide with the start of my 4th year of medical school. Fourth year includes 3 "flex months"...months that I can take as vacation whenever I want. I took July as a flex month, and I've been pretty busy on my vacation. Changing diapers, singing and rocking, multiple outings to the pool, the park, the zoo and COSI, among other things. I had to make sure to study for my OB/GYN exam, since Ariel was born during when I was originally supposed to take it. I completed that exam on Friday.



Where to now? Well, tomorrow morning I start my first rotation as a fourth year medical student: I'm doing outpatient internal medicine. It should be a pretty similar taste to my specialty of choice (Family Medicine), so I'm really looking forward to it. Hopefully balancing my life as a medical student with my life as a husband and father of now 2 children won't be too difficult. Thankfully, my wife is able to stay home with the rascals!



Well, that's all for now. I hope to have many new stories and observations to write about in the near future!

Friday, June 3, 2011

Privilege and Responsibility

I was just thinking today: I've had my hands buried deep inside a living human's body. I've done this so many times now, that it almost seems routine, no big deal. But I've had my hands inside people! These hands have touched intestines, felt arteries, removed uteri. That is truly awesome...in the older, more profound definition of the word than that commonly used. It truly fills me with awe. Amazement that I would be allowed to participate in such a thing. Thrill at the way we can slice the human body open, manipulate the insides, and then close the body again, leaving it better than when we came.

It brings me incredible joy, but at the same time, it feels like such an honor. I see how nervous people are as they come into the operating table. I see how quickly they fall asleep and limp when the medications are given by anesthesia...how utterly helpless they are to defend themselves. How much absolute trust they give us, to act out of their best interest, and not our own, while they lie helpless in our care.

It just felt appropriate to pause and appreciate that, when it starts to become so routine.

Wednesday, May 4, 2011

Proactive vs Reactive

I was thinking today about the death of Osama bin Laden (I know, weren't we all, at some point?). This post isn't about him, or what I think about his death (This blog post sums up my views very nicely), but the whole scenario got me thinking about how effective Americans are at reacting to tragic events. Calamity occurred on 9/11/01, and so we killed Osama (albeit nearly 10 years later)(has it been 10 years already?!)

This focus on reaction permeates the American society. Kill our citizens, and we will kill you. Commit a crime, and we will imprison you. Become obese, and we will perform surgery to remove your excess fat, or mechanically restrict your caloric intake. Have a heart attack, and we will snake a catheter up into the arteries of your heart and stent them open. Allow your foot to become gangrenous because your diabetes is uncontrolled, and we can amputate it. We have all sorts of fancy, sophisticated means of fixing the problems that we have...once they've happened.

We need to bring our focus to prevention. We must be proactive! This certainly goes for medicine, but in all areas of our society. The entire mindset of our culture must be changed. The discussions in healthcare now are turning towards this, and it's absolutely thrilling to see the potential for the prevention of primary care to be emphasized and recognized for its essential role. That being said, this cannot stay limited to healthcare alone.

We all need to do a better job of helping patients with diabetes manage their disease, BEFORE they start losing limbs and organs to it. The consequences are so preventable! I look at the staggering number of incarcerated individuals in the United States, and I think of so many things we needed to help prevent this from happening, including the (I think) often overlooked problem of grossly insufficient mental health care access. We ALL (myself included) need to take responsibility for better diet and lifestyle, to help decrease the incidence of things like obesity, heart attacks and strokes. The list goes on.

It's so encouraging to be joining the field of medicine at a time where primary care is beginning to become valued again. I'm just hoping that the rest of the nation jumps on the prevention bandwagon. After all, as a doctor I can give you tips on how to take charge of your health, and I can tell you how important it is, but I can't make you do it.

Wednesday, April 27, 2011

ER Visits and Cost Control

I was quite intrigued as I was reading this article from KevinMD.com. It discusses the mistaken idea that simply disallowing "non-urgent" ER visits will decrease healthcare costs. As it turns out (I was surprised to read), such an idea might actually INCREASE health costs.

I, of course, identified strongly with the last sentence: "Furthermore, by targeting the ER, such policies also miss the true cause of the problem: a profound lack of primary care access." I wanted to take this one step further, though. Primary care docs need to do a much better job of EDUCATING patients. The article includes the quote, "the perception of urgency after reviewing a medical chart is often different from the perception of the person seeking emergency care." I would say this is at least partly on the PCP's shoulders. Patients need to be educated on what are urgent vs non-urgent situations, so they don't unwittingly misuse the ED. A lot of times, people utilize the ED as a means of satisfying themselves that their symptoms are not truly something to worry about. They wouldn't need to do this if they were educated ahead of time.

Of course, the reason PCP's don't often do that, is because they aren't paid to do that. And THIS is one place where healthcare reform is desperately needed.

Wednesday, April 20, 2011

Tele-Medicine

My attending doctor (a neurologist) and I were sitting at the nurses' station discussing a patient who had presented with a "seizure" (who was then later caught crushing up and snorting his Percocet and pocketing his Xanax, but that's another story) when his pager beeped. "Hold on, I have to call this in", he said. I listened to snippets of the conversation. "How long has he been like that?" "How far away is the helicopter?" "Alright, let me run to my office and set up my equipment."

He hung up the phone and got out of his chair while I jumped up to follow. "That was Small Community Hospital," he said. "They have a suspected stroke patient." We jogged down the stairwells and across the skyway that connected the office building to the main hospital, making it to his office in short order. There he showed me the stroke network tele-medicine computer that had been set up there. We fired it up and he put on his headset. Within a minute or two, we had video and audio feed of the ER bed at Small Community Hospital where our patient lay.

My preceptor proceeded to examine to the patient, asking him what had happened, if he was able to move various parts of his body, etc. Turns out the patient had aphasia, or an inability to speak. This was his biggest symptom, though he also had partial paralysis of some parts of his body. We got most of the story from his wife. We asked questions about what had been going on, his past medical history, what medications he was on, etc, while the nurses at the hospital took the blood for the necessary lab tests.

To cut the long story short, we ended up deciding that he was a good candidate for tPA, a strong clot-buster that should minimize the effects of his stroke. Medflight showed up and loaded him up for flight to our main hospital while they mixed up the tPA. Given the age and condition of this gentleman, tPA was required to be given with the first 3 hours after his symptoms began...using tele-medicine, the decision was made in just over 2 hours. If tele-medicine had not been available, he might have exceeded the 3 hour window by the time he had been flown in. With the timely intervention of a large network of healthcare providers working together, there's a good chance he'll regain his ability to speak. Job well done, everyone! Tele-medicine is pretty cool. I'm glad I got to see it in action!

Sorry for the long hiatus from posting, everyone. It's been busy!! My daughter's due date is coming up...June 17!! All else is coming together nicely, and I have most of my 4th year of medical school all planned up. Hard to believe I'm almost in my last year! About time! Thanks as always for reading.

Saturday, March 5, 2011

For Those Interested:

For those interested who read my blog but aren't FB friends: I've created a Doctor Matt's Musings Facebook page. The link is in the right column of my blog page! I normally post links to interesting articles and discussions on my personal FB page, but I'm working on transitioning that to the DMM page. (And of course my blog feed is exported into the FB page!) Feel free to "Like" it!

Oooh, Hi-Tech....

Should I Go There...

...ok, stirring the hornets' nest...how do you feel about vaccines? Pro? Against? Have personal stories of harm done by vaccines or of harm done by lack of a vaccine? Have studies to share? Discuss!! NO ONE should fear an honest discussion!

Tuesday, February 8, 2011

AMA Lobby Day

I’m writing this in the airport at Washington, DC. You have to pay for the Wifi here, of course, so I’m writing this in Word and I’ll post it later. I’m headed home from the American Medical Association’s Lobby Day. I left my dear family Saturday morning, and headed into DC, and I’ll be flying back tonight, Monday.



Saturday was sight-seeing day! First I had brunch with a former classmate who is now going to medical school at theUniformed Health Services college in Maryland. Then, I went around and saw the monuments, and the White House. I haven’t been to DC since the Boy Scout National Jamboree in 2001, so it was really interesting to see these sights with the eyes of a 24-year-old, and remember looking at them through my awkward 15 year old eyes. Such a difference, but both are so memorable. In the late afternoon, I went to the Freer Art Gallery at the Smithsonian. I didn’t realize admission was free!! There was a large Japanese art display that was simply beautiful. The attention to detail was impressive! It struck me as pretty nifty that, down the street from the seat of power of this nation, was a huge gallery dedicated to the humanities and arts. For humans are not just about cold, hard facts, and laws and regulations. We can appreciate beauty and emotion! Anyway, when I post this, I’ll try to include some pictures from my trip :D Finally, an old friend who works in DC picked me up and we had dinner and hung out at his apartment for the night.



Sunday, my friend had to teach a class at the Pentagon, so he dropped me off at a Starbucks near the US Capitol. I sat and got some studying done for my pediatrics shelf exam while I waited for the conference time to approach. Then I walked over to the Washington Court Hotel, where I checked in (paid for by the AMA!), dropped off my bags and headed down to registration.



We had a lot of meetings on Sunday. We had a few hours of “leadership training”, which seemed to be a lot of random verbage about staying positive even when you make a mistake, not giving up but continuing to practice skills, etc. I guess it was supposed to encourage us to not be nervous when we met the members of Congress! Whether it accomplished that goal or not, it was at least an interesting talk. We then settled in to discuss the issues.

We talked a lot about the cap on residency programs, and how the number of medical students graduating is increasing, the shortage of doctors is increasing, but the number of residency slots has stayed the same since 1997. More medical students does not mean more practicing doctors, if those students can’t get residency training anywhere! We discussed the “SGR” (Sustainable Growth Rate), which is the formula by which doctors get paid (and how we are constantly under the threat of looming massive pay cuts, because of short-sighted legislature in the 90s, that needs to be reworked). We went into medical student debt (a topic near and dear to my heart). We also talked a fair bit about malpractice lawsuits (“tort reform”), which is particularly relevant given the “Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act” or H.R.5 that is currently up for debate in the House of Representatives, which addresses that issue. To name a few! (Then most of us went to watch the Superbowl. I went back to my room and told my family goodnight via webcam, and got some studying done!!)



We had a full plate of speakers this morning! After a delicious continental breakfast, we heard from two formers US Representatives, and the Director of [Healthcare] Coverage Policy for the Department of Health and Human Services, and a few others. Then, we all marched over to the Capitol building and took a picture in front of it, of course! We then met with our respective Senators and Representatives. I didn’t actually get the opportunity to meet my Congressmen, since they were out of town, but I met with their legislative directors, and that was a wonderful experience, because they advise the Congressmen on the issues! They were incredibly receptive to what we had to say, and even were asking us further questions. What an awesome experience! I certainly felt like I was involved in actively advocating for my patients and my profession. How amazing to live in a country where I can just walk up to the seat of government and give my viewpoints and stories to the lawmakers!

Now I’m just waiting so I can love on my family some before I have to be in the hospital at 7am tomorrow. My flight should arrive around 9:30 tonight! Ahh, the life of a med student. But I wouldn’t trade what I do for nothin’!!

Wednesday, February 2, 2011

Hesitancy

I realized last week one of the hardest mindset transitions that I'm having to make as a medical student. It has to do with not really feeling like I belong, and the need to really make my patients...well, MY patients!

As a medical student, you can actually function reasonably well without ever having to ACTUALLY see a patient. You can read the chart, read what the nurses wrote, read what the nurses and doctors who saw the patient thought, evaluate the vital signs that are charted, look up their lab results, etc, all without ever stepping foot into the patient's room. Based on that, you have a pretty good chance of getting the diagnosis right! You can look great on rounds when presenting the patient, and even write progress notes.

As horrible as it sounds, I've been guilty of this at times. This was especially common when I was first starting out. The thinking often goes like this: I read that the patient was admitted from the ED at midnight, spent all night being poked and prodded for this test or that IV. And by the time I see them in the morning, they're just finally asleep. And then the rationalization starts, "Oh, just let the poor dear sleep! I'm on a medical student, after all. My physical exam doesn't REALLY mean anything." This week, it was patients on isolation. I had 3 patients to see in the morning. I found the first door, and a big sign was posted, "Contact Isolation". This means, to see the patient, I have to put on a gown, sterilize my hands and put on gloves before I see him. What a hassle! I decided to see that patient last. I went to the next door...same thing! I decided to try the last patient..."Contact AND Droplet Isolation"!! That means I have to wear a mask, too. Do I even have time to see these patients before rounds start?

Even when I do go in to see the patients in the morning (I DID go and see all three of those patients), I don't always do the best exam. If they're sleeping, I've sometimes just timidly asked them if they're feeling alright, do they have any abdominal pain? may I listen to their heart and lungs really quick? And then tiptoe out. After all, what does it matter. I'm just a student.

I had a patient a few weeks ago with severe cerebral palsy...a 23 year old male. That hit close to home. This man, my age, was in a crib, wearing a diaper and playing with a rattle. I'll admit it, flat out...I was scared! I was very uncomfortable, and I'm ashamed to say, my first day as his student, I chickened out, and didn't go in the room. The next day, I worked up the nerve and did my exam. Removing the diaper and seeing pubic hair was a real shock. I tried to be very respectful, but also keep in mind that this was MY patient, my responsibility, my privilege to see and touch and diagnose and heal.

I've come to a point where I never allow myself these excuses anymore. I DO try to be thoughtful of the need for patients to sleep, etc. At the same time, if they're my patient, I go in and see them: Even if the nurse is in there already. Even if they're asleep. Even if they're on isolation. Even if they have mental retardation. No matter what. I'm taking ownership of my patients. What a privilege I have to see these people, to care for them and help heal them. There have been times in the last few months that I have caught findings that went unnoticed by the rest of the team. A new, concerning heart murmur in a child that prompted a visit to the ED when I mentioned it to the attending. Worsening lung sounds that heralded the onset of pneumonia, etc.

I can no longer see myself as "just a student." I'm a part of each patient's health care team, and I vow to devote myself to their wellbeing and recovery. Even if that means waking them up at 6 or 7am so I can push on their bellies and look in their throats.

Tuesday, January 25, 2011

My Munchkin's 3rd Birthday

My baby boy is definitely now my little man. Yesterday, we celebrated his THIRD birthday! It's hard to believe that the time has gone so quickly. He's my little man now.

It almost was a tragedy. For days, we've been telling him that we'd take him to the Kingdom of Bounce for his birthday, a big warehouse filled with various bouncehouses. So, on his birthday, I finished up my work at the hospital, rushed home and got everyone in the truck. My wife and I had both checked their website the week before, and read that "Open Bounce" hours on Mondays were until 8pm. We started driving, and out of the blue, Charlie starts singing the "Birthday Bounce House Song." It was about 5 minutes long, and went something like, "It is my birthday, and we are going to the bounce house, and Mama said, 'We can go to the bounce house'..." We arrive. The warehouse is pitch black. A schedule posted on the front says, "Mondays: CLOSED."

If you're a parent, you know how my wife and I felt at this moment. Thankfully, my wife is quick on her feet! She suggests a movie...Charlie has never been to the theater. BLESS HIS HEART, Charlie was amazingly gracious about the whole thing. He was clearly disappointed, but we explained that it was closed, and we'd try to take him another time when it was open, and that we'd do something else fun. He said, "Well, OK." I can't express how proud I was (and am!) of him.

We took him to his favorite restaurant: Home Town Buffet! He had "pizza and mac n cheese and jello and an icee and ice cream." And then we went to the movies! Thankfully, the Disney movie "Tangled" was still playing. We grabbed a bag of popcorn (for tradition's sake, mostly) and walked into the theater. Charlie says, and I quote: "WOW, that's the biggest TV I ever saw!" :D

Providentially, Tangled had been out for long enough that we were the only ones in the entire theater. We had our pick of seats, and Charlie was so entranced that he actually sat still for the first half of the movie! Of course, after that he was up climbing around the seats...we decided to let him go up and down the stairs since the theatre was empty...hope that doesn't come back to bite us in the butt later! The movie was actually 3D--we couldn't get him to wear his glasses until the last half of the movie, but when he did, he was actually reaching out and trying to grab things on the screen! He really had a great time.

We got home and had the Caillou cake that my dear wife had made for him. He loved it! Then he called grandparents and great-grandparents. Then we went to bed!! Love my little man...hard to believe he will be a big brother in a few months!! Where does the time go?

Monday, January 17, 2011

Compassion?

My apologies for being MIA for so long...unfortunately, school must take precedence. I do have today off, though, so I'm going to take a quick break to at least write something here...I've wanted to write about so many things over the last few weeks!

My dear friend Robert wrote a piece on his blog last week entitled "Wicked Compassion" which I encourage all of you to read! He talks about how calloused people seem to be these days, and I have to agree.

First, he talks a bit about the tragedy in Arizona: "When I told her that Congresswoman Giffords was a Democrat, all my friend could do was screw up her face and shrug her shoulders in a way that said the life of a person who is a Democrat is meaningless." That kind of thinking seems to be widespread, and is absolutely abhorrent. On the other end of the spectrum, are the bloodthirsty folks who say things to the effect that no death is too good for the shooter. He clearly is guilty, and should answer for his abominable crimes. At the same time, he IS still a person.

The other thing my friend talks about is compassion towards those less fortunate than ourselves. So many people (myself included) often stop at pretty words about how no one should be starving or cold or thirsty, but go no further. My personal struggle with that is not knowing where to "put my buck"...I don't know how to best give with my limited resources, and so I often don't give at all.

My friend takes it to the next step, by calling out the people who are opposed to any government intervention of the social welfare type, while failing to take it on themselves to provide for the welfare of their society. Take the newly passed Healthy, Hunger-Free Kids Act, which will provide $4.5 billion to school lunches while raising the standards of the foods provided. I think it is a wonderful initiative and I hail its passage. At the same time, I've heard some NASTY comments about it. I know someone who links to that article with the comment: "See that chubby little kid over there? Looks innocent, doesn't he. Look again. He's not just a little butterball — he's a "national security threat"! Or so says Recognized Expert (?) Michelle Obama." A comment at the bottom of the article reads "More unnecessary Government Nanny State Spending".

A LOT can be said about the inefficiences and, in fact, heartlessness of the welfare programs. I unfortunately have some firsthand experience that shows how quickly you can be dropped from the program for simply forgetting to fill out a single form. I know people who are looking everywhere they can for work, TRYING to be productive, and are actually punished for that by the welfare system...if they simply stopped looking for work, they'd end up with more money! It can be a cruel, heartless system. I have a Facebook friend who wrote a few weeks ago: "California is like robin hood... only they steal from hard working Americans and give to the poor!" But my response was, "If only Americans would give to the poor of their own initiative...then the inefficient government wouldn't have to do it for them!"

And that's where I think much of the problem is. Many "hard-working" Americans DO try to help out those less fortunate, and indeed ALL Christians are obliged by God to do so (James 1:27- Pure and undefiled religion in the sight of our God and Father is this: to visit orphans and widows in their distress, and to keep oneself unstained by the world.) But, many don't, and in America we have a ridiculous class distinction where there are a handful of INCREDIBLY rich people, who DO give to the poor, but not nearly in proportion to their wealth. Poor people need to eat, and if those with money won't give of their own free will, YES, I believe it should be taken from them by taxes and redistributed. But I'd rather they give of their own free will, for MANY reasons.

Please, everyone...have some compassion towards your fellow man!

Disclaimer: There's a LOT I don't know, about economics, about politics, about everything. Where I'm faulty in logic or just plain ignorant, please, educate me!