Okay - I've been very neglectful of my blogging. In fact, I've been very neglectful of just about everything that doesn't have to do with medicine, sleep and basic sustenance. But now adult medicine month #2 is over and I am on a very nice rotation - radiology. I get to sleep in till 6 AM (instead of being at work at 6 AM) and get off at 5 PM with no middle-of-the-night calls. I hope to use this month to catch up on life - beginning with this blog.
Winter in Wichita has definitely reminded me I am not in Houston any more! A few days ago, I looked at my thermometer in the morning and it was MINUS 7 degrees Fahrenheit! Apparently with windchill, it was 25 below zero. Surprisingly, the cold hasn't bothered me as much as I thought - probably because I rarely get outside. The worst part is driving to work at 5:30 in the morning. My car heater doesn't even get a chance to heat up before I get to work. So the 10 to 15 minute commute is pretty chilly. And then there's the snow. We have had two big snows. This last one left somewhere between 4 and 7 inches on the ground. At least this time the freeway was very well treated. The snow didn't even stick. The regular roads were an adventure, though. I'm glad I have an SUV, even without four-wheel drive. There were spots where the snow was deep enough I could hear the car scraping over it. As long as I didn't have to stop, things were great. This weekend we finally had temperatures above freezing - in fact it was downright balmy at 50 degrees! More snow expected this week. At least I don't have to drive before sun-up!
The adult medicine month ended with a real bang. I was on call nearly every day of the week - or at least that's what it felt like. I had my first "code" - that's where a patient goes into cardiac arrest or stops breathing. I didn't have to run the code, but I did get to do chest compressions for a while. It was good to see how things work. Next time I won't be as nervous. I also had several patients take a critical turn for the worse over the last weekend. One was in liver and kidney failure and then started having respiratory failure. I had to talk to his family about hospice and whether they thought the patient would want to be intubated and placed on a ventilator (with poor prospects of ever getting off the vent). That was a hard conversation, but by the grace of God, I think it went well and the family felt cared for. Another patient had a massive gastrointestinal bleed from both ends. I got her stabilized and eventually she got an endoscopy and they were able to find the bleeding spot and cauterize it. Finally, another patient began to have crushing chest pain and elevated cardiac enzymes - signs of cardiac ischemia (poor blood/nutrient/oxygen flow to the heart muscle) and impending heart attack. She had an abnormally and dangerously fast heart rate and her heart was already in bad shape. Following my advanced cardiac life support algorithm, we gave adenosine - a drug that slows the heart and watched her heart rate return to normal in a matter of seconds. Whew!! Another crisis averted! I thank God for a cool head and lots of help from upper level residents and attendings. He has really eased me into some of the scarier, more intense medical scenarios. And He has let me see how far I've come - how much I've learned, how much more confidence I have. I have one more month of adult medicine this year in March. I look forward to another leap forward in terms of knowledge and experience.
Another highlight of January was delivering two "continuity" patients. These are pregnant women I have been following in clinic whom I got to deliver. It's so fun to help bring a child into the world when you've known the mom and seen her through several months of pregnancy. One of my patients I started seeing at about 5 months. Her first baby was born at 24 weeks, so she had never really gone all the way through a pregnancy or a real labor and delivery. By 40 weeks she was really ready to have the baby - in fact she had been to the hospital several times for false alarms. We ended up inducing her at 41 weeks and she did great. It was such a thrill to place her little boy in her arms! I also had the privilege of circumcising her baby, and hopefully I will be his doctor. My second "continuity" was a lady who came in already nearly fully dilated. I ended up delivering her baby before the attending physician could arrive, so it was just me, the nurse and the upper level resident. But it all went great, even without an epidural! Praise God for happy moments like these!
This month I am on a radiology rotation for two weeks, then behavioral health (fancy name for psychiatry). I spend my mornings (starting at 8 AM, not 6 AM) reading xrays, CT scans, ultrasounds, etc. at the hospital and my afternoons doing OB ultrasounds at the clinic. I'm getting better at seeing and describing abnormalities on chest x-rays and figuring out what I'm looking at on CT scans. And I can pick out a lot of anatomy on the ultrasounds as well. It's a lot of fun showing a mother the baby's heart, face, hands, feet, etc. Best of all, I'm getting more sleep and less stress!
Well, all for now. I hope to get a few more blogs in this month if there is anything interesting to write about.
