Blazin' around Baltimore/Passing thru Philly/Drivin' from Denver with aStop in Salt Lake/Settle back in Sebastopol

Warning: from here until I get bored with it or run out of ideas (which will probably come first), all titles will be witty (fingers crossed) alliterations.  :)

What a whirlwind the past 6 weeks have been!  At the end of August I flew out to Baltimore to spend time with my Amazin' Amy!  She is studying Cellular and Molecular Medicine at Johns Hopkins (aka she's super smart).  While there reminiscing about our childhood, I did some simple math and figured out that Amy is my oldest school friend.  We started Kindergarten together and 20 years later we're still going strong!  During high school we would talk about how she would be this awesome PhD doing all this research and I would be her clinical physician to carry it out in trial.  It's pretty weird now to realize that we are both doing exactly what we said we would.  Anyway, she's fabulous and I had tons of fun with her and her BF.

Our reunion improved greatly with the additions of more great friends, Rockin' Rachel and Dandy Dan.  They are in Occupational therapy (OT) grad school in Charleston, SC (aka they too are super smart) and just happened to already be in Washington DC.  While Amy abandoned us for her lab rats (aka she had to go to work since it was a weekday), the three of us explored Baltimore.  It was great not having any agenda and just enjoying the day with each other.  I'm so glad that even with the long distance and the busy schedules that these childhood friendships have not only remained strong but have grown and deepened over the years.  It was good for me to be with non medical school friends the night before my physical board exam.  They forced me not to over study and made sure I had everything I needed to succeed.  It was a much needed quick trip with wonderful people.

From Baltimore I took the train to Philly.  Every osteopathic medical student in the country travels here for this one day exam.  This is basically a full day of being a doctor with standardized patients in clinical settings.  You see the patient, take a history, do your exam and treatment and then immediately document it all in the computer.  What makes this the most stressful are the time restraints.  But I survived and just found out that I passed!

After 15 hours in Philly, I jumped on a flight to Denver where I was met by my Mom who flew in earlier that day.  From there we packed up my car with some essentials and road tripped it home.  First leg of the journey was to Salt Lake City where I met up with my "first adult friend" Katie and her new husband Jesse.  They were super nice and let us stay with them for the night; Jesse even cooked a delicious dinner for us.  It was great to see them after so long!  The next day was a big push from Salt Lake all the way home.

Alex's Birthday Dinner

The next was month was spent home taking an online pediatric radiology course.  It was nice to be able to relax a little and keep my own schedule.  I got to catch up with family and friends.  I was able to participate in several things while I was home.  One of those things is harvesting the hops.  This was my first harvest and it was a real interesting process.  I was also able to attend some wedding planning things with my wonderful bride-to-be-bestie Leah.  It was fun to join in.  During this time I also submitted all my residency applications.  Now I am just trying to plan the interview offers as they come in.  This month I travel down to Fresno for pediatric plastic surgery...I'll be sure to let you all know how it goes!          

Wedding Expo

Harvesting the Hops

Trailing through Tucson

I have spent these last few weeks in Tucson, Arizona on a pediatric cardiology rotation at Diamond Children's Hospital and I can honestly say I have loved every minute of it.  The people here at this residency program are awesome!  They have been so friendly and welcoming.  Being attached to a university does have it's pros and cons.  During the past year, I have worked mostly one-on-one with attendings.  I was use to having individual and private teaching.  I was not competing with other students or residents for attention or procedures.  Most of my rotations were great mostly because my attendings were great.  Some though left something to be desired and I felt like I wasn't challenged enough or I didn't learn enough.  Being at a university with residency programs in pediatrics, internal medicine, ER, surgery, and family practice is very different.  There are 3rd and 4th year medical students all over the hospital.  Because of this, every attending is use to teaching and really knows what is important for the students to learn.  Also, the pediatric residents have all been so patient with me.  It might just be the peds environment, but no one in this program is fighting for procedures.  They share taking the lead in patient care and take turns doing the hands on stuff.  They seem to really believe in the statement "sharing is caring".  They also enjoy teaching med students and sharing advice from their med school days (which were more recent than the attendings).  I am constantly being challenged and pushed to think things through to the next step and beyond.

Children's hospitals always have the best decor

I have been exposed to so many kinds of congential heart disease and conduction disorders during this rotation.  I have learned how to read EKGs (which is very different in children than adults) and ECHOs.  I even got to see some fetal ECHOs were the babies' heart defect was diagnosed at 20 weeks while still in mom's tummy.  This helps the doctors prepare appropriately for when the baby is born and some bigger hospitals are researching ways to fix these defects before the baby is born.  I scrubbed in on cardiac catheterization and ablations.  My ears have gotten much better at detecting innocent murmurs verses pathological ones.  I met kids who are thriving with only one ventricle due to modern interventions.  I met adults who had open heart surgery as children who are still followed by a pediatric cardiologist because adult docs aren't trained how to care for them.  The cath lab is one of my favorite places.  It just blows my mind that we can close holes in the heart, redirect blood flow, repair blood vessels and even replace valves all through vessels in the groin!  Most patients can go home the same day as the procedure.  My least favorite part is wearing the lead.  Because xray is used, all people in the room have to wear a lead vest and skirt plus a thyroid guard.  By the end of the case it is so heavy and hot!

Desert Museum trails

Now Tucson, Arizona is pretty cool in its own way.  All the houses are so flat and short.  It's weird to me to see box houses everywhere with rocks and cacti instead of lawns.  The downtown buildings are also pretty short.  There are no skyscrapers of any kind.  But it does have a big university so the college part of town is pretty fun.   I spent one afternoon at the Arizona-Sonora Desert Museum where I learned all about the animals and plants for Arizona.  The desert is somewhat pretty at times though I believe the things that live in the desert have an unfair advantage in life.  They all prick or bite or string or fly.  Totally not cool.  I received my first introduction to cockroaches and I am not a fan.  Turns out they live in bathroom drains...yuck.  You have to pour bleach down the drains every now and then to kill them.  I swear they know when they've been spotted and then they plan their attack.  They hold real still and then fly right at your face when you go to kill them.  Just thinking about them makes my skin crawl.

Halfway up Mt. Lemmon

The area around Tucson is really diverse.  Desert surrounds the city but mountain ranges are only a short drive away.  I hiked with some residents on Mt. Lemmon which is at 9,000 feet.  It was like being back in Colorado with aspen trees and pines all around.  Rumor is they even get snow there in the winter.    

Top of Mt. Lemmon

Overall I really enjoyed my time in Tucson.  I honestly think I would be happy completing my residency here.  This is my first away rotation so it's too soon to know for sure but it's definitely on my list.  Hopefully I won't have the same problem that I did last year with loving every specialty.  Now it's off to Baltimore to spend the weekend with my friend from home who is getting her PhD at John Hopkins.  While there we will be joined by other hometown friends who are in Charlestons in OT grad school.  So a mini Sebastopol Reunion will take place in Baltimore!  Then I take the train to Philly to take my clinical skills board exam.  On to the next adventure :)

Nicest Resident Ever

         

Where Has The Time Gone?

Oh my goodness has it really been since February since my last post?!?!?!  Where has the time gone?  So much has happened since then.  So let's take a quick trip back in time for an overview of the past 5 months.  March was spent in my second month of Family Practice.  My doctor was known in town as being the family doc that delivered babies.  He probably delivered over half of Pueblo.  He also spent one day a week in the OR doing OB/GYN procedures and surgeries.  I had a lot of fun with him.  He was an older doc who liked to joke around and tease.  He was very professional with his patients but totally not PC every other time.  It made coming to work really entertaining.  He was really easy going and let me participate as much as I wanted to.

April was a challenging month for me.  I worked with an Internal Medicine Residency team.  This was very different from all my other rotations.  I was use to it being just me and my attending everyday.  Now, I only saw the attending during rounds and spent all the other time with residents.  It was challenging switching between the residents from day to day because they had such different teaching styles and expectations of my role.  For whatever reason, no matter how hard I tried some of the residents could just not be pleased.  At times it felt very much like high school with all the drama.  I admit to struggling through this rotation mostly due to the social issues.  Luckily the majority of the residents I worked with were awesome and nice.  The hours were long (5:30am - 7:00pm) and the work was constant.  There were no breaks or downtime.  Even the lunch hour was spent in a noon lecture.  It seemed more difficult than even my surgery rotation at times.  But in the end I survived and learned a lot about myself.  It was a good experience for me because I'm sure there will be times in the future where I won't be completely happy with my work environment.

May was just an awesome month!  I got to do a month of adult Heme/Onc!  There is only one group in Pueblo with 4 doctors.  I rotated between them all.  It was great seeing the different approaches to patient care.  It was amazing!  I loved the patients and office staff.  Everyday I got to meet and work with incredible people who taught me so much about life!  I loved every minute of it, the highs and the lows.  But I do feel the need to step onto a soap box for a minute here...consider yourself forewarned.  Please please please get your colonoscopy at age 50!  Colon cancer is called the silent killer for a reason.  Is it fun? - No.  Could it save your life? - Most definitely.  I don't know about you but I would trade one day of discomfort and misery for 10 more years.  Also, mammograms!  Again, not fun but necessary.  Alright, I'm done and stepping off my soap box now.

At the end of May, my daily routine was thrown for a loop.  As many of you know, I gave myself a pretty nasty concussion.  It was a fluke event.  For unclear reasons, I passed out one night in my kitchen and hit my head on the granite counter-top.  My post-concussion symptoms were more extreme than I would have liked and unfortunately decided to hang around for several weeks.  Because of this, I had to postpone my board exams since I was unable to study.  I was able to go home for a few weeks to heal.  It took some time, but I finally started to feel like myself again after 6 weeks of struggling with headaches, vision changes, dizziness, fatigue, cognitive slowness, and emotional instability.  Really I was probably not much fun to be around.  But my friends and family were saintlike and took care of me through it all.  I'm over the bitterness and anger now and can see the good that has come from this experience.  I was able to go home and see my family which is always nice.  Also, I believe it has made me be a more compassionate person/doctor towards people with head injuries.

So that took up most of June and early July.  I went back to Pueblo for some intense broad prep, took my exams, and then popped on an overnight flight to Tucson, Arizona.  So I'm here now doing a rotation in Pediatric Cardiology at the University of Arizona.  And I'll let you know all about it in a few weeks :)                      
  

No Offense But I Really Can't Stand Adult Patients

I consider myself a good person....most of the time.  But I really dislike dealing with adult patients.  I'm sure you're wondering "Why did it take you so long to figure that out?  Haven't you been dealing with adults in all your other rotations besides Peds?"  The answer to this question is yes, I have been dealing with adults but I was either cutting them open in surgery or caring for pregnant ladies (who come with infant included so have already earned a few points in my book) or they were crazy (which if you read my early posts crazy people can be quite entertaining).  I mean really think about it...I've done general and orthopedic surgery, ob/gyn, psych and peds.  I'm not sure what this really says about me...that I only like you as a patient if you are anesthetized, are carrying a child, or are amusing me with your hallucinations?  I'm choosing not to dwell much more on that...

This month I entered family practice.  And it's just not my favorite thing.  I'm use to working at a fast pace and being go go go all day long.  I mean I pulled over 80 hour weeks during surgery.  And even in my general peds rotation I was seeing at least 18 patients a day.  This last rotation a really full day had 10 patients.  I should be happy for the break and feel less stressed but instead I feel bored.  I know I shouldn't be complaining, but it's my blog so I'm going to.

Most of my patients are older with multiple chronic diseases.  It's all about managing medications and logging blood pressures and blood sugars.  I have a hard time telling the 82 year old woman who is already on 15 different medications that we have to add another one.  It is also difficult and very frustrating dealing with non-compliant patients all day long.  I don't know how many times someone comes in for a high blood pressure check and they don't bring any logs from home.  A very typical encounter:

Me: "Have you been checking your blood pressure at home?"

Patient: "No, not really."

Me: "Are you following a low salt diet?"

Patient: "No."

Me: "Do you have an exercise routine?"

Patient: "No."  

Me: "Are you taking your meds?"

Patient: "Sometimes."  

I then walk out of the encounter throwing my hands up thinking 'why do I even bother?  What's the point when they don't listen?  Why should I care about their health when they clearly don't?'  I get that you can only do so much and that whole 'you can lead a horse to water but you can't force them to drink' but job satisfaction is very low with this mindset.  I'm just not cut out for family practice and that's ok.  There are people out there who are and I for one am grateful for them.  God bless those who enter family medicine!  But it for sure won't be me.   My calling is pediatrics.  I have endless patience for children and their ridiculous behavior.  I have less patience for adults acting like children.  The highlights of my day are when there are kids in the office.  Every now and then there is a well child check or an acute complaint.  It quickly became known around the office that I like working with kids and so all of them were funneled to me.  I called those encounters my little moments of happiness.  I also got to deliver a few more babies and unlike with Ob/Gyn, I was allowed to follow the infant to the nursery for the newborn exam.

So now that I'm done whining, it has to be said that overall I had a really good experience this past month.  My attending was really smart and very nice.  She taught me a lot and let me do a lot.  I got to perform many procedures by myself.  She really took the time to teach me.  And we share an Alma mater!  She graduated from DU the year after my mom did.  One of those 'it's a small world' moments.  Everyone in the office was nice and I enjoyed my time there.  They even surprised me with having lunch and cupcakes brought in on my birthday.  It was really sweet.

Pretty flowers!

Speaking of my birthday, I am now 25 years old.  Half way to 50...  It was a good day.  There were many small surprises throughout the day.  It also happened to be my last day of this rotation.  It was like all the patients knew it was my birthday and they behaved.  As I already said, the office had a small lunch celebration for me.  My parents had flowers delivered to me at the office.  I had no plans for the night since most of my med school friends had an exam the next day.  Around dinnertime a grade school friend who was transferred to Fort Carson up in Colorado Springs a few weeks ago called me up.  She insisted we do dinner together.  So I drove up to the Springs and we went to the Melting Pot with two of her housemates.  I was very surprised when we were shown to our table and there was a gorgeous bouquet of roses and a Happy Birthday balloon waiting there for me.  It was so sweet of her!  And totally unexpected!  We had an amazing dinner and had our first sleep over together since high school.  It was fun reminiscing about the "old days" together.  It was a perfect day.  A big thank you to everyone who helped to make it a special day!    

 

The Best Rotation Ever (aka CLARITY!)

So it's official....I want to be a pediatrician!!!!  Now I know some of you are rolling your eyes right now just thinking to yourself "Well of course you do Danelle.  You have only been telling us this since you were six years old."  But some of you know how hard I struggled with this decision.  Though I come across as calm, cool, and collected, for the past few months I was panicking inside.  I fell in love with Ob/Gyn in October and for a while there I could really see myself doing that forever.  Then my pediatric rotation in Texas just confused me more because I didn't absolutely love every moment of it.  I was disappointed that my first day walking into the Children's Hospital a choir of angels didn't light up in the sky singing "Alleluia".  I mean I thought my life calling would come with some sort of grand sign.  But alas, it didn't.  So I spent the last few months making lists, thinking about what I really wanted and how I pictured my life in the future, and doing some serious soul searching.  And then I finally had that moment of clarity where a choir of angels dropped from the sky singing.  Ok in reality giant stuffed animals dropped off of shelves to the melody of screaming babies.  But it was just the sign I was waiting for.  And it all happened at a pediatric clinic at home...

I was extremely lucky to complete an elective rotation at home.  I lived with my parents for the month of January and worked in Santa Rosa at a general pediatric clinic.  Back in October I thought I had a rotation all set up but then it unfortunately fell through due to legality reasons.  The amazing doctor I was coordinating with for that rotation then took it upon himself to find me something else in Santa Rosa.  He felt that it was unfair for legal reasons to hold me back.  That's how I ended up at the best clinic ever.  The director there took a chance on me and I will forever be grateful for that.  It was there that I fell in love with pediatrics.  I never saw myself doing general peds, but I loved everyday in clinic.  I have to work with children.  They are just amazing little creatures.  They are candid and funny and speak whatever is on their mind.  You can't help but smile working with them.  And they are so smart!  I learned so much from the munchkins.  One of my favorite interactions was with a little four year old girl who needed her Kindergarten shots.  I start every encounter with "So tell me why you're here."  She just sighed and said with a very serious and brave face "I need shots."  She then continued "I'm ready.  I'm prepared."  She looked shyly up at me and asked "Do I still get a sticker if I cry?  I'm going to try really hard not to but I might cry."  I wanted to give her all the stickers at that moment.      

I got into a nice routine while home.  Every morning at 5 am my parents and I would go to Boot Camp together.  After sweating for an hour and questioning "why am I doing this?", we'd come home.  It seemed so much easier when I was in high school getting up for 5 am ice time at the rink.  Now that I'm all old and stuff my body protests getting up before the sun.  But I pushed through telling myself that if my parents could do it without complaint then so could I.  Once home, Dad and I would get ready for work while mom made breakfast and packed our lunches.  It was like being in school again.  I was spoiled for sure.  Then dad and I would carpool into work.  He would drop me off at the clinic and pick me up to head home.  Mom would have dinner ready and then the evening was spent studying with an early bedtime to do it all over again.

This pediatric clinic mostly treats the under-served community and is open until 9 pm five days a week and then until 3 pm on Saturdays.  The majority of the families are Spanish speaking only.  Challenge number one - learn Spanish, fast.  I got this app on my phone to teach me.  My dad and I would practice together on our way into work.  My favorite was to try speaking with the 5-8 year olds because they thought I sounded funny but would correct me and teach me.  The parents were too polite to tell me I was saying things wrong.  So I now know many medical words and can ask very personal questions in Spanish like "How long have you had diarrhea?" (cuanto tiempo ha tenido la diarrea?) and "Does it hurt when you pee?" (le duele al orinar?).  Wonderful everyday conversation, right?  All the providers and MAs were bilingual.  The MAs were also super helpful in teaching me Spanish.  The key to a successful clinic operation most definitely starts with good MAs.  They work hard for very little praise.  They were always there to assist the doctors with whatever they needed.  The MAs at this clinic totally rocked and were really nice to me.  They helped me out several times without making me feel like a complete idiot.  

Everyday I would work with a different provider.  This clinic has 8 providers but only 4 working at a time and all are ladies.  (Girl Power!)  And from the moment the doors opened in the morning it was busy!  On my busiest day I saw 28 patients!  A "light" day had about 20 patients.  The rule of the clinic was no walk in was ever turned away.  I learned a lot and got to see many different doctoring styles working with the different providers.  All the providers are amazing ladies and great doctors and nurse practitioners.  After shadowing my first day, I was put to work the next seeing patients by myself and creating a plan.  I documented everything I did in the computer.  I learned how to prescribe medication and write school notes and send referrals.  I almost always felt behind but I loved being that busy.  The more I saw the more I learned.  All the providers were super friendly and they have connections with pediatric residencies in California so it was a great networking opportunity for me.
They treated me like one of the team and I am super grateful to have met them all.  On my last day they even got me a cake and sang "For She's a Jolly Good Fellow".  It was so sweet and really touched me that they would go to the trouble!  And for the record, it was a delicious cake!  (Almond cake with apricot filling and white chocolate butter cream - Yum!)  As you can see they also gave a nod to my newly acquired Spanish skills.

Overall this has been my favorite rotation so far.  I think it meant just a little bit more to me because I was working in the community that I grew up in.  I can't express in words what this rotation meant to me.  It made me realize not only my love for pediatrics but my love for my community.  I haven't lived in Sonoma County for 7 years now but it will always be my home.  And who really knows what the future will hold but as of now I would be very content and honored to come home and work in the community that raised me.  It was very special all around.  And the best bonus was being able to spend time with my family and friends.  The older I get the more I realize how awesome my parents and older brother are.  I love them all so much and I cherish this new "adult" relationship we have.  And my grade school friends.  It was wonderful being able to spend time with them again.  It's been so long with all of us leaving for college and now work and grad school.  Even though we have spent more time apart than together these last 7 years, our friendship is as strong as ever.  The month went by too fast but I am so thankful for everything I experienced!

  

         

Holiday Special

I have decided that since every music artist and TV show have a holiday special, I get one too.  And fair warning - this post has nothing to do with medical school.  So if that is the only reason you keep reading, I'm sorry to disappoint.  You can stop reading now, or not....  As Captain Planet says, "The power is yours!"  But let's not kid ourselves, I really just wanted to share all my fun pictures with everyone.  The words are not that important.

Anyways, my family got the pleasure of my company for the holidays!  They were extremely happy.  Especially my parents, for we all know that without me their lives have no purpose (love you mom and dad!)

The holiday season started with a gift exchange party among my college friends in Denver.  I met these five amazing people my freshman year of college.  I am very fortunate that they have remained friends with me through my crazy moods and schedules of medical school.  For the past two years we have had a rotating Sunday night dinner.  We take turns hosting and cooking.  It's been great having them as a consistent support group.  And they know me so well!  I got a lunch box that says Human Organ for Transplant and a doctor nutcracker.  The next week I took my exam and hopped on a plane home.

We of course had the annual Wilson Holiday Party.  Mom and I baked up a storm the day after I got back.  I was extremely pleased with our Christmas tree made out of rice crispy treats.  It was great seeing family and friends again after being away from so long.  And the weather was perfect unlike last year when our party got rained on.  This year the Wilson Family had a Holiday staycation.  We went to a fabulous Christmas Eve party, had a lazy Christmas morning, enjoyed dinner with the extended family.
The next few days were spent doing things local that we haven't done before, like exploring point Reyes and taking CJ to the beach for the first time.  I was even home for my mom's birthday.  We went to the Melting Pot and ate tons of melting cheese and chocolate.  Overall it was perfect.

Christmas Morning

I was real lucky to be able to catch up with some high school friends I haven't seen in years.  My bestie recently got engaged so my other bestie and me threw her and her fiance a surprise engagement party.  We made a pretty good party planning team.  Fall back job for sure if this whole doctor thing doesn't work out.  Boy was she surprised!  The timing just worked out perfectly with everyone being home for the holidays.  It couldn't have gone better and was really fun play 'what have you been up to these last 3 years' with everyone.

The Party Planners

New Years was pretty laid back.  I hung out with friends and played board games.  I learned this new intense game that involved aliens with special powers trying to colonize other people's galaxies...it was confusing, but fun!.  Though that might sound lame to some of you, that's my idea of a rockin' night.

Well, that was my Holiday Special!  Hope you enjoyed it even though it is a month and a half late.    

Psych Psych Psych

Finally, a rotation that is not wooing me in any way!  I absolutely have no desire to pursue psychiatry!  Yay!  One specialty is for sure crossed off my list!  My first week was spent in the Adolescent Psych Unit.  This is an inpatient psych treatment center for children ranging from 6 to 17.  I found this week challenging.  I like working with kids, but I had a really hard time finding common ground with these children.  They were dealing with messed up home lives and issues that I have never had to face.  I just can't relate.  Now the argument can be made that I can't relate to women who are pregnant since I have never been pregnant or children in kidney failure since I have never had kidney failure, but those are situations I can at least imagine.  The kids in the psych ward come from situations that I can not even fathom.  I never was a 15 year old dealing with a meth addiction and bipolar disease and I have a hard time imagining it.  It was also difficult working with such a wide range of ages and problems.  A 7 year old with behavioral issues sits in the same group therapy session with a 17 year old dealing with alcoholic addiction.  And it was frustrating since most of the issues stemmed from the home life and the parents.  A lot of these kids were having problems because their parents were having a hard time actually being parents.  I think some parents had their children committed looking for a quick fix with a wonder drug.  Well unfortunately no such drug exists.  Now this may sound harsh and I admit fully that these opinions are created with the limited view of a 24 year old childless med student, but really how hard it is to love a child and provide them a safe place to grow and explore the world?  But enough with my frustrations.

There were definitely some fun times with the kids.  A typical day started with group session after breakfast were the kids set a goal for the day and how they mean to accomplish that goal.  The psychiatrist would pull the kids out for short individual sessions with each kid during the morning.  This was mostly to discuss the medications being used and looking for side effects.  The psychiatrist at this facility didn't do any psychotherapy and left it all to the councilors or behavior specialists.  Each kid had a family session everyday as well, whether in person or by phone.  These seemed to be the make it or break it moments of treatment depending on how receptive the parents were to change.  The kids had many group sessions during the day and even recreational therapy (aka play time).  I met some pretty special kids that week.

Next I went to the Chemical Dependency Unit. This unit is an in patient treatment for drugs and alcohol.  Some stay just for 3 days for detox while others are there to complete a 30 day program.  Again a wide variety of life stories.  I never really felt like I fit in or that I was qualified to be leading group sessions.  Most of the councilors there were recovering addicts themselves so they had more of a connection to the patients.

My last two weeks was spent on a in patient psych ward.  The focus there was on treating schizophrenia, major depressive disorder, bipolar, any form of suicide attempt and delusions and hallucinations.  These two weeks were more to my liking.  My day was more structured and I was working one on one again with my attending.  Also, this might sound insensitive but I want to be really honest.  Sometimes the patients are just very entertaining.  They talk about the world of their delusions and some are really quite creative.  Also, you never know what they are going to say or do next.  One time a patient just stripped all his clothes off while continuing to answer my questions as if nothing out of the ordinary was going on.  Because the patients were unpredictable, everyone on the ward wore a panic button which I can say from experience works.  This button causes a hospital wide alarm to go off, almost like a Code Blue that you see so much on TV.  Security, nurses, and doctors have to respond until the alert is called off.  There is a tracking devise on each alert so that they know where to find you.  So all the doors on the psych floor lock automatically.  One time I was working in an office with the door open when a patient walked in and shut the door behind him.  Earlier that week this patient had written me into one of his delusions.  He claimed that I was the one hurting him in his sleep.  My attending told me that this was a bad sign and that I needed to avoid this patient until his anti-psychotic medication kicked in.  Well, my avoidance strategy didn't really work once I became locked in a room with him.  I didn't even hesitate with pressing my panic button.  The alert went through the entire hospital and the response time was very impressive.  While it only took less than a minute for help to come, it was one of the longest minutes of my life.  I think for the first time ever I felt in direct danger.  Luckily there was only enough time for this patient to push me into a chair before he was restrained.  Yay for panic buttons!  Overall, this was the only scary thing that happened during my rotation.

While I understand the importance of locked doors on this floor, they can really hinder things at times.  Like when you think you're being a good person and take the stairs up the one floor to the cafeteria.  For some reason you can get into the stairwell but then can't get out.  So I may have had to call my attending from the stairwell on my cell phone to come let me out.  Good news is that there is no way a patient could escape via the stairs!  I tested every door before calling for a rescue.  My attending was really awesome to work with.  I personally think that being a woman in the psych field gives her an advantage.  That, and being a mom.  She didn't put up with all the nonsense and called the patients out when they were making excuses or just weren't listening.  She also stood up for herself and her staff when the patients got rowdy.  She was the attending this month that taught me the most.  Well, anyway, that's psych...and now home for the holidays!  (I know this post is overdue and that the holidays have already happened, but I'm keeping a timeline here.  Up next - Danelle's Holiday Special!)              

The Moment of Truth

So my week hematology/oncology (heme/onc) is done.  I said goodbye to the sand and sun of Texas and hello to the mountains and snow of Colorado.  I had a lot of fun on heme/onc.  The doctors were amazing and the patients were so inspiring.  I loved to witness the relations that were built and to meet children in all stages of cancer treatment.  I even got to follow one child through his initial diagnosis and see all the steps that are taken to start treatment.  It was incredible.                                                                                                                             Monday morning started with table rounds.  All the PA's, nurses, and doctors discussed what had happened with all the patients during the weekend over cups of coffee.  I discovered that a heme/onc office does a lot more than a normal doctor's office.  They have counselors and learning specialists on staff to help out.  They talk to the kid's schools and explain what the family is going through and what support can be given.  There's also this position called Child  Life Specialist.  They are all over the hospital, not just on heme/onc.  Honestly, I might have chosen this profession if I knew about it before I started my pursuit of medicine.  All they do is play with the kids.  They plan parties and outings and gatherings.  They have a closet full of toys and arts and crafts.  I mean who wouldn't want that job?  But alas, I feel like I've come too far now to just switch careers.  (You can breathe now mom and dad; I'm not planning on dropping out of med school anytime soon).  Wednesday morning rounds are dedicated just to emotional wellness and coping skills.  The team discusses how each family is handling the illness and what can be done to help them.  At that meeting a plan was hatched to schedule these two teenagers appointments at the same time so they could meet.  It was thought that they could would be a good support person for each other.   

I was fortunate to work with all three attending hematologist/oncologist, two ladies and a guy.  They see patients as a group meaning patients are shared.  This helps them be familiar with all the patients and their treatment plan which makes being on call slightly easier.  The attending's time is split between making rounds on the hospital floor and being in clinic.  The clinic is always busy.  Some chemo treatments require daily infusions so these kids are constantly in the office.  There is a teen lounge and a kids playroom for them to hang out.  Lumbar punctures and bone marrow biopsies are also done in the office.  I got to witness several of these and actually perform some myself.  One bone marrow biopsy I completed I followed down to pathology to read the specimen with the pathologist.  They had this really cool microscope in the lab where 6 separate eye pieces hooked up to look at one specimen together.  The pathologist was able to point out several teaching points to me and we could even throw it up on a big screen TV so more people could see as well.  

Overall, my last week in Texas was my favorite.  The experience was awesome and I am glad I got to go.  I met several fabulous medical students from other schools.  I'm definitely going to miss them.  But unfortunately, I'm in a pickle.  Instead of clarifying everything and showing me my destined path, my week of heme/onc has only left me more confused on what I want.  I absolutely loved my time with the kids and learned so much from the doctors but I found myself missing the operating room (OR).  I find myself torn between peds heme/onc and ob/gyn.  They are both such awesome specialties with their own pros and cons.  I'm starting an actual list and have added 'soul searching' on my to-do list.  Luckily this decision doesn't have to be made for a few more months.  I actually set up another pediatric rotation back home.  So get ready Sebastopol!  I will be home for the month of January!  And I am counting down the days until Christmas break.  Nothing is quite like a mom and dad hug :-)          

Life in a Children's Hospital

Somewhere in Texas

Finally the rotation I've been waiting for!  Pediatrics!  I'm doing my pediatric rotation in Driscoll Children's Hospital in Corpus Christi, Texas.  Rocky Vista sends two students down at a time and another classmate was heading to San Antonio so we decided to car pool...all 18 hours.  But it was fun seeing New Mexico and Texas.  The hospital provides students with housing and there are several students rotating through at a time.  So I moved into a house with 4 other lovely ladies that is located across the street from the hospital.  Most of the other students are natives to Texas so they've been showing me around and teaching me all about Texas.

Dr. Tooth Fairy

The first week was spent on inpatient at the hospital.  This was my first time working in a teaching hospital with a residency program.  It is very different from the other rotations I've been on.  Also the most routine I've had in my days.  Every morning starts with Morning Report at 7am.  All the residents and medical students are there.  This is where those on call through the night report the patients they admitted.  The teaching attendings are there also and they elaborate on the cases when need be.  Then a teaching topic is presented by one of the interns.  At 8am you head to the floors.  For my first week, I was on the floor that had all the renal and neuro patients.  My second week I was on the cardio and heme/onc floor.  I would follow a resident around while they rounded on their patients.  Then I'd try to get all my notes in the computer before the attendings came and we'd all round again and present the patients to them.  This would take until lunch time.  Lunch was eaten while in Noon Conference.  A research presentation or Journal article were presented during this time.  Then back to the floor where we discharged or admitted patients all afternoon.  Check out occurred at 4:30pm.  The head resident would present all the patients on the floor to the head resident that was on call for the night.  This could be really short or take forever depending on how full the floors are.  Halloween occurred during my first week.  The hospital goes full out.  I went as the Tooth Fairy.  We were all encouraged to dress up and participate in the Pumpkin Parade.  All the children got to parade to every floor of the hospital and were given goodie bags that were full of everything but candy.

During my first weekend, we took full advantage of our time off.  Corpus Christi is right on the gulf coast and the weather makes it feel like summer.  So of course we went to the beach.  I tried surfing for the first time.  It is really hard!  People make it look so easy but I had the hardest time maintaining my balance.  But in the end I got a good photo op and a salt water sinus rinse :-)  We ended the perfect day by the water with some delicious fish and chips while watching the sunset.  It was a great day.  On Sunday it was time for brunch.  To continue with my Texas education I had chicken and waffles.  Interesting combination that actually tastes really good together.  Some other fun things we did as a med school family was take the Ghost Roll Sushi Challenge.  It was a mistake!  After one piece each we were all in tears!  I actually think I burned away some of my stomach lining.  Even after that, none of us can think back on that night without laughing.

Week 2 began with me back on the floors and then onto the PICU (pediatric intensive care unit).  This week was a little more frustrating for me.  I had some difficult patients that really made me ask some serious questions about medicine in general.  One infant had minimal brain function and was on a respirator.  This child has no quality of life and yet everything medically is being done to keep this child alive.  He has been through multiple surgeries and will definitely have more in his future.  When is enough enough?  When does mercy step in and medicine step back?  I admit that I am coming into the picture late and I never had the privilege of seeing this child really alive and thriving.  I am not a mother and so cannot speak with the opinion of one.  I never held him in my arms, have never seen him open his eyes.  Maybe with the hope of having that child back is what keeps this family fighting... I honestly don't know.  I have only seen him sick and what looks like suffering to me and it breaks my heart.  In a situation like this there are no right or wrong answers but it really makes me think.

Another difficult situation I came across was a teenager post kidney transplant.  This child had been given an incredible gift several years ago.  They were given a second chance.  Why were they in the hospital you ask?  Because they were in kidney failure due to rejection and all because they didn't take their anti-rejection meds.  Again, I can't speak from experience and I can image having to take drugs twice daily for the rest of your life can be annoying but really isn't that better than being back in kidney failure?  I was shocked to learn that noncompliance with anti-rejection meds is a huge problem in the teenage population.  Statistics show the highest risk for organ failure due to noncompliance is having an 18th birthday within 3 years of your transplant.  Some physicians are arguing to make teenagers be on dialysis, just to show them how much it sucks, before receiving a new kidney in the hopes of raising compliance rates.  If that isn't a big enough ethical question for you, then how about this.  Do patients who go into organ failure due to noncompliance get the same priority for a second transplant as those on the list for the first time?  Do they get a third chance?  I don't have the answers and I do not envy any member on the ethics committee.

           
 In the PICU I got to care for a lot of congenital heart disease.  There are so many different defects that a heart can be born with and the surgeries to repair them all are pretty amazing.  It's awesome seeing a baby looking really sick before surgery and within 12 hours post surgery they are awake, being held, eating, and smiling.  I was really surprised at how fast these kids recover.  And the babies are all so cute!  They are also a puzzle.  You can't ask a baby what's wrong and how are they feeling.  You have to discover it all for yourself by using clues and your observational skills.  It's a mystery waiting to be solved by me.  It's fun and exciting most of the times.  Sometimes it's frustrating.  Like knowing when a baby is just fussy or fussy because they're in pain.

I have one week left here in Corpus.  And I spend it doing heme/onc.  It's the moment of truth.  As some of you may know I've been telling people since I was 6 years old that I was going to be a pediatric oncologist.  Now we will find out if it's everything I think it is.  Wish me luck!  

  

The Month of Vajayjays....

My name is Danelle Wilson and I have a problem.  I like all specialties!  How am I going to decide?  I always saw myself as a pediatrician, but then I was wooed by general surgery.  And now I'm thinking "I totally want to be an Ob/Gyn."  It's going to be very hard to choose a residency if I end up liking every specialty.  I guess next month on my Peds rotation will be the moment of truth.  Maybe I like Ob/Gyn so much because of the baby part.

Even though Ob/Gyn focuses on a small area, the specialty is so vast.  You get to make patient connections and see women of all ages throughout their lives.  You follow a pregnancy and then get to be the first hands to welcome that life into the world.  You get to perform surgeries and can actually make problems better.  You're not just treating symptoms which is very satisfying.  I have learned so much during this rotation.  It was a great combination of patient care and surgery, clinic time and hospital time.  I really like the diversity.

My attending was a super cool guy!  He is from Argentina and completed medical school there before moving to Chicago to complete an American Residency program.  It's real interesting the difference between the two countries.  In Argentina, you don't go to college.  At 18 you start medical school.  The first two years are in classroom and then the next three are in hospital.  And then you're an attending.  There is no residency.  So at age 23 he was a full fledged doctor.  And the best part?  It's all free!  You don't pay for medical school in Argentina.  I'm very jealous of that fact.  Anyways, he was really funny and joked around a lot.  He said he could get away with it because of his accent.

Delivering the babies, when things went right, was awesome.  But when things went wrong, they went really wrong really fast.  Unfortunately I saw miscarriages, fetal demise, and birth defects.  I had one day being on call that was just awful.  I went from a miscarriage to an emergency C-section for a 29 week old fetus of a teenager who already had 3 kids not in her custody.  This poor baby did not have a very good chance of survival and was immediately airlifted to Children's Hospital in Denver.  After the C-section we delivered a baby who immediately went through withdrawal since mom did heroin during the pregnancy.  The inconsolable cry of a baby was just heart breaking.  The worst part of the call shift though was an inter-uterine demise (IUD).  This means that for reasons we don't know, the baby's heart just stops beating.  At 38 weeks a lady came to the ER saying she hadn't felt her baby move all day.  She was declared IUD and an induction of labor was begun.  It was the hardest labor I've been a part of.  This woman, who had done everything right, had a healthy baby one minute and lost it the next.  She then had to give birth knowing she wasn't going home with a baby.  I was really proud of myself for not crying during the process but boy did I lose it later that night.  It was a really bad day and extremely difficult to get through.  That day was full of so much sadness.  I was just hit with it back to back to back.

Luckily that day wasn't the norm.  And the good definitely outweighed the bad.  One of my favorite surgeries was placing a bladder sling.  This woman was having a problem with incontinence for years and it was really making her miserable.  Using a super long, curved needle attached to a mesh ribbon, you thread it under the pubic bone and up through the abdomen.  The woman came for her follow up the next week and she cried because she was so happy with the fix.  I also had some pretty interesting...finds...  You'd be surprised what people stick up there.  I thought about starting a diary.  I would begin with Dear Diary, today I pulled a bag of cocaine out of a woman's vajayjay.  Another entry would be 'today I pulled a Polly Pocket out of a little girl's "secret hole"'  Her mom threatened to take it away if she didn't behave so she hid it.  Another treasure found was cloves of garlic.  The lady read on the internet that it would cure what ailed her.  FYI - it won't.  Don't Do It!  Other gems were carrots and sex toys.  All in all very interesting.  It appears there is a need for a list titled "Things that Don't Belong in Your Vagina".

Anyway...I loved this past month and am super excited for the next!                                  

The Hip Bones Connected to the...

It's hard to believe that another month has come and gone.  I spent it on an Orthopedic Surgery Rotation.  It was very interesting and so much fun.  Bones are so cool!  And joint replacements are just amazing!  The precision and technology that goes into each surgery is incredible.  Each cut is made after several measurements and a blade guide is set up.  I saw several knee replacements, a few hips, and even a complete shoulder.  It is really incredible that the next day these people are putting weight on and actually using their new joints.  The biggest risk with a joint replacement is infection.  Every precaution against infection is put into place.  My attending would even send all his patients to the dentist before the surgery.  For some reason that science doesn't know yet, bacteria in the mouth loves to travel to metal in the body.  This is why people with joint replacements must take antibiotics before any dental work.  Another precaution is the room set up.  Everyone in the room is in a special suit and hood that has positive pressure air being blown down the front of the face towards the floor.  This is like an air trap that germs can't get across.  There is also air blown from the ceiling and out towards the sides of the room at floor level.  These suits are nice for the patient, but a pain for the doctor.  They get very hot.  And its hard to hear one another speaking.  Also, if your scrub pants aren't tired tight enough, the battery weight pulls them down.  One assistant had to have the circulatory nurse pull up their pants and re-tire them.  I was just super happy it wasn't me!

One of my favorite surgeries was piecing together a shattered clavicle or collar bone.  It was just like doing a jig saw puzzle!  We had to be very careful placing the screws because the subclavian artery and vein lie right below the bone.  Knick one of those and the patient can bleed out in seconds.  Another favorite was pinning a broken femur.  Through the smallest incision at the hip, you drill a pin down the center of the bone.  That pin is used as a guide wire for all the drilling.  Xrays are taken throughout to check placement.  This means that everyone in the room wears lead throughout the entire surgery.  Again, really hot and heavy!  A reamer is then used to drill a big hole through the middle of the bone.  A metal bar is threaded down the pin, the pin is removed and the bar is held in place with two more screws.  There is something very satisfying about drilling into bone.  What is amazing is that the patient is weight bearing the next day!  There is no cast or anything like that.  Pretty cool if you ask me.
      
My attending is a younger doctor who is trained in some of the newer procedures and is very up to date on all the latest and greatest.  He was a lot of fun to work with.  Ortho is most definitely a boys world with 91% of all orthopedic surgeons being male.  Luckily my dad and brother trained me well and I can carry my weight with the boys.  After a few jokes and showing some knowledge of golf and firearms, I was in the club.  I was even invited to participate in a golf tournament.  Now I haven't golfed since I was 13 and my grandpa taught me one summer.  But I did well enough I guess since I was invited back.  I was shown that business is still conducted on the golf course.  I was introduced to many business people and doctors from the area.  I also realized that I enjoy golfing.  There is nothing quite like hitting a little ball as hard as you can and watching it soar down the drive.  All in all, Ortho was fun but not for me for the long term.  If I had to choose between General Surgery and Ortho, General would definitely win.  But now it's time to move onto OB/GYN.  Hello babies!

Eat When You Can, Sleep When You Can, And Don't Poke The Pancreas

After a month of General Surgery my rotation is done.  I had so much fun!  The human body is amazing and I loved being able to observe it up close and hands on everyday.  It's incredible watching a heart beat inside the chest, feeling the aorta pound with blood right under your fingers, poking the ureters and watching them shrink in response, feeling the small intestines telescope in and out of each other.  Everyday I was just in wonder and awe at God's ultimate design.

While fun was had, I have also never worked so hard in my life.  But it actually felt like my work made a difference.  It was great meeting with the patients a few days after their surgery and hearing how much better they felt, how their pain was gone, and how thankful they were.  Surgery was very satisfying, it has instant results.  Sick gallbladder?  I take it out.  Hernia?  I fix it.  Collapsed lung?  I put in a chest tube.  Necrotizing fasciitis?  I cut it out.  There were solutions to all these problems.  I understand that not everything always goes according to plan and the outcome is not always so wonderful.  I was very lucky to never lose a patient during the month which I'm sure helps to glorify my outlook.  But even so I was never sitting back and waiting...surgery is all about doing something which made me feel better, like I was taking action.

My attending is an incredible teacher.  He spent a lot of time with me and showed so much patience.  He treats me like a colleague and has all the staff treat me like a full fledged doctor already.  (It's very exciting to have people address me as 'Doctor' and ask me what I would like done with the patient.)  I consider myself the bottom of the totem pole at the hospital but he says no.  He expects me to play the part of doctor rather than student.  When I offer to gown myself or remove a Foley or change a dressing he tells me to stop.  He reminds me that my job is surgery and I need to stick to my job.  I don't have time to perform these other tasks when there is someone else qualified to do them.  I understand now how surgeons get a bad rep for being stuck up and non-caring about patients.  But that's really not the case at all.  They just don't have the time to do all the things that are required of them.  This is why we have specialists in healthcare.  No one can do it all.  And also, it's the doctor's license and reputation on the line.  No one sues hospital staff these days...when something goes wrong everyone blames the doctor.  So it makes sense that a surgeon gets frustrated when their orders are not followed out to a tee or when time is wasted or when a mistake is made in the OR by support staff.  I will no longer be mad when my own doctor is late for my appointment.  I understand all the things that need to get done behind the scene and how emergencies can just pop up.  Just imagine if you were the emergency.  You wouldn't want your doctor to tell you to wait so they could stay on time with their office visits.  But I'm stepping down from my soap box now...        

Back to my experience in the OR...  One time my attending just walked out of the room towards the end of the surgery and left me to close.  I just stared at his back walking out the door while screaming in my head "NO!  Don't leave me!  I have fooled you all.  I really have no idea what I'm doing."  My panic died down when the scrub nurse looked at me and asked "Doctor, what do you want to close with?"  And I knew.  I knew what sutures to use and what knots to tie.  After finishing my last suture, I looked up to find my attending watching through the observation window.  So he didn't really leave me alone, which was comforting to realize.  I will really miss him.  Not only was he a great attending, he went out of his way to include me in his family outings and take care of me outside of the hospital.  He took me wake boarding on the reservoir, had me over to his house for dinner, and treated me to may lunches and dinners out.  He even drove me home at 4:30 in the morning after an emergency surgery where I almost passed out in the OR.  After a long 16 hour day at the hospital, I got home at 10 pm, finished my assigned reading and went to bed at midnight.  I was awoken by my phone at 1:10 am.  Turns out our patient had turned septic and we had to operate now.  I walked into the OR at 2:00 am not even realizing I hadn't had anything to eat or drink
since 5 pm the evening before.  We were closing the patient up a few hours later when I started to feel really hot and my vision tunneled a little.  According to my attending I turned sheet white.  He had me step back from the table and sit down right there on the floor where I stayed while he finished up.  He then personally got me breakfast and drove me home promising to pick me up later that morning so he could control when I went back to the hospital.  During the ride home he shared with me the golden rule of surgery: eat when you can, sleep when you can, and don't poke the pancreas.  Well, lesson learned.

With the Da Vinci - you can see my vagina
 repair on the screen in the background

On Friday, my last day with my attending, he told me he had a surprise for me as a reward for all my hard work.  He led me into the last OR room down the hall, one I hadn't been in yet.  Inside was the Da Vinci Robot.  This robot can do the work of several doctors at once.  The trocars (little portals used for laparoscopic surgery to get the instruments in the body) are placed in the pt and the robot arms are threaded through them.  The doctor then controls the robot from a station with a viewing window that reflects the camera inside away from the patient.  Everything the doctor does with their hands and wrists the robot does inside the patient.  Foot pedals are also used.  The robot arms can rotate 360 degrees in the patient.  This is the only one in all of Pueblo and only a few doctors are certified to use it.  My attending is in the last bit of his training and will perform his first surgery with it next month.  Well, I was in awe looking at this robot.  He demonstrated all it can do and set up a manikin and then told me it was my turn.  He let me run the 1.7 million dollar robot!  It is really amazing how sensitive it is to my touch and all the things it can do.  I had so much fun.  Anyway, I'm sure you're all tired of me droning on.  Last thing I want to share is a list of the most important things I learned this past month.  Next week, on to orthopedic surgery!              

At the control station of the Da Vinci

Things I've learned during my surgery rotation:
1.  Tie your scrub pants tight - it's tragic when they come loose while running to a trauma
2.  Always have a granola bar in your pocket.  Or two...two is better
3.  Hand lotion is your best friend - my hands have aged years with the 100+ times I wash them everyday
4.  Fruit chapstick under your nose or inside your mask takes care of most smells
5.  Have multiple pens in multiple pockets
6.  There is a fine balance between staying hydrated and having to pee in the middle of a 5 hour surgery
7.  Scrub caps are a great way to hide that you didn't have time to wash your hair
8.  It's amazing how little laundry you have when wearing scrubs everyday
9.  A good pair of shoes makes standing 12+ hours a day possible
10. Sleep and eat when you can, where you can...you never know when you'll be called in for a 2 am surgery