Sunday, October 26, 2008

A Prayer Answered

At church today, with my little girl in my lap, I said a prayer.

First a little background. My (older) brother this year has moved to Texas and is in a sense restarting his life. He's in school, working, and trying to find his place in life. I am proud of him, but I do miss him and worry about him. I cannot talk to him like I used to because his cell phone is broken. I heard he might be coming down this weekend, but I couldn't catch up with him and had not heard from him.

So back to church, during the special intentions (when we Catholics pray for certain things) and the Priest said "Now, let us now add our own intentions in silenc," I said a prayer. I prayed for my Aunt who past away two weeks ago, I prayed for my family, my husband, of course my little girl, I prayed for my enemies, and I prayed for my brother - that if he came down, he had a safe trip, that he is successful in his endeavors, and just for his well being.

As I sat down, someone tapped my back. I turned around to see, guess brother! At home, all in one least for now.

Friday, October 24, 2008

Life is Frustrating...

12 am - baby crying in her crib. I go to her room and get her, make a bottle (I finally weaned), bring her to our room, change her diaper, give bottle, place in bedside basinette, go back to sleep...CNN humming low in the gackground.

5 am - baby crying again. Luckily, husband is awake and in his room (playing video games). At my requests, he gets her bottle ready, I comfort her, give bottle, smell poopy, change diaper, and snooze.

6 am - still snoozing, now through alarm. Morning news is on.

7 am - finally awake. get ready for work while baby sleeps. Discussed investing in the market while it is down with my hubby. back out car so hubby can leave for work. decide I have enough time to make crock pot meal for tonigh (turkey breast with mushrooms). Okay, now I've gotta hurry. I've got two patients in the hospital that need to get seen before 9am clinic. Get Baby Girl Ready.

820 - crock pot is going, baby is ready, and we are out the door. First to daycare.

840 - now in the hospital. My patient with insulin dependent diabetes is stable and ready for discharge home. Wish I could say the same for my other patient from the nursing home. She is a fiesty lady - sweet as candy, but not doing so well. She has heart failure - on of the more challenging illnesses to treat especially in people that also have kidney disease and / or low blood pressure...she has both.

9am - clinic begins, but I'm not there yet.

920 - okay, I am here. Today is a good day. I see mostly patients that I am familiar with - my patients (as opposed to an Attending Physician's or a fellow Resident's). One thing I LOVE about Family Medicine is getting to know and establish a relationship with them and being a part of their lives, helping to diagnosis, treat, and prevent illnesses.

I had a few work-in patients - including two shingles cases in one day (what are the odds). One kiddo (kids always brighten my day) with otitis externa, and a new patient.

1220 - finished morning clinic (a little late) and off to noon conference.

Afternoon - now to recheck on my hospital patient. Labs indicate that she's had a heart attack. Medically manage her and consult the heart doctor. Stress a bit because I have been taking care of and getting to know this sweet lady since the beginning of my Residencty (about 2.5 years) and no matter what we do, even though she feels okay, her labs indicate she just keeps getting worse (renal function, blood pressure, and now...this).

Hang out at the hospital / Resident's lounge until about 6pm. On call (Third year / back up) so my pager is on.

6pm Call hubby to see if he got to pick up the baby. He answers and says "Hold On" and I listen to him order McDonalds. When he finishes, he says he got the baby and asks me how I am. "A little sad now" I say. He asks why. "Well, I made dinner but you are ordering McDonalds" He says "I know you were making dinner...this is just a snack...." We meet at home. The crockpot is ready. I make (instant cheesy) rice. I prepare our plates. Ofcourse he eats maybe two bites of turkey and a bite or two of rice.
WHAT WAS THE POINT OF ME EVEN MAKING IT??? I try to do it all and the main reason I cook, aside from enjoying it, is to keep us from spending money on fast food. UUUGGGGHHHHHHHHHH!

Okay, well, I eat. Baby tries to grab plate, so I feed her. TWO baby food bottles (sweet peas and squash). Then she dozes off for the night. Soon followed by the hubby.

Hopefully my pager will remind silent tonight and I can rest physically and mentally.

Wednesday, October 15, 2008

My Vacation...Finally!!

Yay! Vacation! And it is way overdue. I have not had real time off since post maternity leave! This past weekend was spent visiting friends and family in Louisiana and introducing my baby girl to her extended family members! She got to meet her great grandfather who is 91 years old - and in very good health! He is still up and about and can actually drive! She also got to meat her Great Aunt who is, unfortunately, in her last days. She is getting Home Hospice because of multiple strokes that have left her unable to care for herself. She can barely speak or do much of anything and just recently, she completely stopped eating. Although, she did smile when she saw my daughter.

On a lighter note, when we got back home and she saw her Daddy, she got all excited. Then she started saying, "Mmmmm....mmmmm..." kind of grunting like she does when she wants something..."" My little girl said MOM! Ofcourse dad was jealous.

...and today, all should know no matter what she wears that she is a girl because...She got her ears pierced!

Friday, October 10, 2008

From Old Blog - The Big C

The Big C
They were doing an exploratory abdominal surgery where they open up the abdomen to see if they can find what is wrong. And they found it. An adhesion. Scar tissue from a previous surgery. This is what had been causing this 78 year old's sharp abdominal pain. This is what was causing her discomfort, her nausea, her stomach distention. This caused her small bowel obstruction. With the slice of a blade - it was cured. Medicine is truly amazing.
Before closing her up, the surgeon explored the abdomen for any other potential abnormalities. And there it was - a...lymph node. Larger than expected. The path report came back...
Squamous Cell Cancer
Poor lady. While she was in recovery, her family was told the news. Indepth discussion amongst them and the surgeon lead to a decision at the request of the family: Don't tell the patient until the primary source is found and the options are known.
(When a lymph node is positive for this type of cancer, this in most cases means the cancer has originated from somewhere else and has spread into the lymphatic system)
The surgeon called me with the news on my patient.
Squamous Cell Cancer. Primary cancer location unknown. Patient unaware per family's request.
Now that is a tough situation to say the least. I mean, this lady is one of the absolute sweetest patients I've ever had - an absolute sweet heart who came to the hospital for nausea and abdominal pain. Her symptoms improved dramatically after the surgery. Soon, she was eating again, and felt ready to go home.
Further workup the next day and the source was found - cancer of the esophagus...throat cancer.
I talked with the son that evening who assured me that that night was the night. The family had arranged to meet with one of the other doctors on the case and together, they would tell her the news. He couldn't bring himself to do it alone as he originally planned.
I emphasized that it was vital she be informed as soon as possible so that we could get an oncologist (cancer doctor) on board and he could examine her and review her options.
When I came back early the next morning, I spoke with the son who said that the doctor never showed up and she still didn't know. I asked if he'd like me to tell her with him present.
"Yes, please."
Now that I think back on all my patients since med school to now, I cannot remember ever having to tell a person that he or she for certain had cancer. I do remember telling a patient that she more than likely had kidney cancer (but it wasn't confirmed). That was quite similar now that I think about it. I guess it just does not get any easier. I also remember as a med student having a patient with liver cancer, but the doctors told him. In both of those cases, for whatever reason, those two patients died within two weeks. They were really really sick. Their sickness and hospitalization was directly related to their cancer - unlike this situation.
Anyhow, this was me. I was the doctor...I am the doctor. It's up to me to tell my patient that she definitely without a doubt has cancer.
I call the chaplain. I think it very appropriate he be there as I tell this lady...the one who has improved everyday since surgery...this sweet lady who only wants to go home since she feels tell her she has cancer.
I walk in the room with the chaplain. The son is there. He knows the plan...and so I begin.
The one thing I do remember learning in medical ethics is that once you say the word CANCER, the patient likely will not hear anything else.
"Ms. Smith**, I just want to give you an update of what all is going on..."
I take it step by step starting with what they found during the surgery and as soon as I say the C word, she screams, "CANCER!! Oh my goodness! Oh my goodness! No! No!" and she screams and cries, cries and screams. I pause. Thank God the chaplain is there. Thank God her son is there. I give her time as I hold one of her hands. Her son has the other hand. I explain the rest of the findings and where we go from here. The chaplain leads us in prayer.
And just like that, her life is turned upside down. A curveball thrown at her.
Options for her include what's called palliative chemo. Anything palliative means it may help but it certainly won't cure. Her and her family are still deciding what to do.
Makes me wonder.
If she had never gotten the small bowel obstruction and came to the ER for nausea and abdominal pain, the positive lymph node would have never been found, a search for cancer would have never been started, and the fact that she had cancer would not have ever been known.
But was it a good thing that the cancer was found...or would she have been better off never knowing?
(**Names and some details changed to protect identity

From Old Blog - No one deserves this

No one deserves this...
My night was just beginning. First, a lady with classic appendicitis. You M.D.'s know what I'm talking about. So often we see "abdominal pain" that turns out to be…nothing…or at least nothing major, but this lady had classic periumbilical pain progressing to right lower quadrant pain, rebound pain, rosvig's sign, mild leukocytosis, tachycardia,..everything. OK, enough doctor talk.
After getting her squared away with the surgeon, the chest pain guy comes in. But this is not the everyday chest pain…nor is it the heart attack chest pain. This is the chest pain of a drunk who's blood alcohol level was greater than twice the legal limit although he says he hadn't had a drink in a few days. A guy who reeks of alcohol yet cannot understand why he passed out.
Then there's the person with a corneal abrasion (eye tear) and one with a nose bleed and a kid with an ear ache, etc.
But the one thing that…caught my attention and actually tugged at my heart in the midst of this ER night…was a girl. Seven years old. The nurses told me - victim of sexual assault - RAPE. Child Protective Services is there. Her mom is there and I can tell mom is holding back tears. Then I see her - a sweet, playful child who looks up at me and, in spite of her situation, she smiles at me. I introduce myself and I ask "What's your name?" She answers politely. She's only seven. Doing well in school. She didn't deserve this. No one deserves this…especially a young, helpless child who cannot defend herself. After examining her I ask, "So do you know what you want to be when you grow up?" "Yeah, I want to be a doctor just like you!"
Precious words form a sweet girl in a horrible situation.
(As always, details are omitted and some facts changed to protect identity.)

From Old Blog - Wrap It Up!

A 25 year old female came into clinic to see one of my colleagues because she was "Just not feeling well"...feeling tired, fatigued, and having a bad sore throat for the past few weeks. On physical exam, her mouth and throat had white streaks. She had a low grade fever. Scrapings of the streaks in her mouth and microscopic view revealed yeast. Yeast in the mouth is very uncommon except in babies and in the immunocompromised (i.e. diabeties or...HIV/AIDS). After my colleague talked with her, she agreed to get tested for HIV.
This young, beautiful female, devoted wife, and loving mother, was...that day...diagnosed with HIV - the virus that causes AIDS. She came in thinking she just had a bad cold and now, her life is forever changed.
The circumstances to how or when she got infected is unknown.
Was it from her husband? How then will she confront him? How long has he had it? Did he even know?
Was it acquired before she was married and she just did not know? If so, how would she tell her family...and is her child infected?
Was it from a lover? How will she now break the news to her husband?
How will this affect her family? Her friends? Her life?
People, you cannot tell by looking at someone if they have something. It only takes one time. Don't ever get so caught up in the moment that you gamble your future and your life! It can happen to you, so, two things...
(1) GET TESTED! Better to know early and start treatment as soon as possible to have a better outcome...

From Old Blog - HUG YOUR MOM!

GO HUG YOUR MOM!!! Current mood: sad
I sit here while on call after a CODE BLUE. Sixty three year old Hispanic lady, mom of seven, admitted to the hospital yesterday, found to have a mass in her chest. While in her hospital room this morning using the bathroom - her heart stops and she stops breathing - CODE BLUE. Inspite an hour of trying to get her back, our efforts are futile.
She is pronounced dead...
...and her family arrives. The first daughter to arrive can look at our faces and know that her mom is now gone forever.
...and she cries
...and cries
...and cries
In my career, I see a great deal of death. Many times it is expected - the man with pancreatic cancer x 4 months; the elderly woman with heart failure, diabetes, and end stage dementia; the man with severe chronic obstructive pulmonary disease (COPD) and respiratory failure; and even when expected it is hard enough. But when one day everything is fine and over the next 24 hours you find out Momma has a tumor in her chest...and before you can even comprehend the fact that it might be cancer...she dies?
It's just hard.
So, hug your mom. Tell her you love her. Tell all those that you love what they mean to you every time you get the chance. You never know when their time will come.
***some details changed to protect privacy***

From Old Blog - A Baby Story

Friday, April 11, 2008
A Baby Story
Although I was due to have Baby Girl March 14th, I had to be induced early because of Preeclampsia. Initially the induction date was to be the 13th, however, after some lab work returned, it was decided that Sunday March 9th would be the day. So that morning we were all set and my hubby and I arrived at the hospital at about 8 am. I was extremely nervous and anxious. Although I was excited to finally be meeting Baby Girl, I was scared to death of Labor.
It was a little comforting to already know the nurses and they were all very friendly. So they got me settled and ironically, just before they gave me the medicine to start contractions, I had one on my own. They checked me and my cervix was closed thick and high so I knew it would be a loooooong day. They gave me cervadil and the contractions picked up. I could feel them pretty well though they weren't painful. Shortly after noon, they gave me my second dose and checked me - about 1-2 cm. I went ahead and requested the pain meds before the pain kicked in. As soon as they gave it to me I started telling my hubby how I could feel it kicking in and I was feeling woozy and the room was bouncing…then I was out.
I woke up a few hours later in severe pain and they checked me, I was 4 cm, then they gave me some more pain meds and again, I was out. Thanks Stadol. Oh, and if I hadn't been so out of it, I would've asked for the epidural then. Anyhow, I woke up a few hours later again in severe pain, was checked - 7 cm. I was begging for pain meds and the nurse said I'd get the epidural as soon as the anesthesiolgist was available. Apparently he was in on an emergency case. He finally came, but had a little trouble because I was involuntarily tensing up every time he tried to stick me. He finally got it after 3 sticks - only to have it come out before he taped it. So he had to stick me yet again. Traumatic but worth it.
After that it was smoother sailing. Next time she checked me (around 3 am the next day I believe) I was complete and ready to push! I called my parents, Toney called his, the doctor returned, my mom came in, and about 2 hours later, I just remember hearing her cry as my tears of distress turned into tears of shear joy and then I remember my mom saying, "Oh she's here Juanita! She's finally here! She's so beautiful!…" And I remember looking but I couldn't see her. My husband cut the cord and they put her up on my chest and her little eyes were just were just looking up at me trying to focus. And I just stared at how beautiful she was.
And I nursed her.
Wow, after 21 hours, she was finally here. Heck, after 39 weeks of being in my belly, she was finally on the outside, looking at me face to face. Fascinating! And yes, how beautiful. Head full of hair, golden skin, she did look a little like me - thus she has my middle name.

Born 5 am
March 10th
5 lbs, 10.5 oz
18 inches

From Old Blog - What About My Disability???

"What about my Disability??"
Monday January 7
35 year old male comes to clinic with cough, congestion, fever and further history, physical exam, and work up suggests no sign of serious illness...more like the common cold. Symptomatic treatments are given (no antibiotics). A note for work for that day is given (since he missed work for his appointment). He is to return to work Tuesday...
He questions the receptionist "She must mean next Tuesday right? Return to work next Tuesday?" "No she wrote you can return tomorrow."
He stomps back to where I am, "You didn't mean tomorrow, you meant next week right? Return to work next week?" "No sir." He goes home disappointed and upset but not before leaving short term disability papers he wanted me to fill out so that he can recouperate from his cold.
He returns to clinic today and sees a colleague of mine. Same symptoms. He again brings another copy of short term disability papers for my colleague to complete, then asks, "The doc I saw Monday said I could go back to work now - aint that crazy?" "Um, no" my colleague responds. "You can return to work" Me nor my colleague would complete the disability papers because he did not qualify. He does not have a disablity. I see people working all the time with cough, congestion. I've had the common cold 3xs since I've been pregnant and I'm still working. (Aside: the key here is of course frequent thorough hand washing)
Since when does having a cold or lingering cough equal disability??? Did I miss the memo?
That reminds me of a patient I had last year who wanted disability because she has reflux.
I just don't get it!

Wednesday, October 8, 2008

Short Vent

It is really nice to come home from a 14 hour day at work only to have a crying baby handed off to me and to be treated by my husband as if I've done something wrong.

Sunday, October 5, 2008

My First Post

I am coming over from aol journals where I kept a log of my experiences in Medical School and Residency. Briefly, I am in my third (and final) year of my Family Medicine Residency. I am in the process of getting my license, finding a job, and as always, taking care of patients and assisting Interns and other Residents. And ofcourse, always learning.

But even more importantly, I am now the mom of a beautiful six month old baby girl!

So between my full time job, being a full time mom, and trying to be a good wife, keep house, pay bills, etc, my life can be quite demanding at times. I plan to try to keep this journal updated if time allows.