a clothed moment

when in Rome

In an attempt to beat the heat, we headed out to the beach yesterday. Oddly, we were not the only people to have this idea. The highway along the coast was bumper to bumper as we approached our destination. After sitting almost still for 20 minutes, so close you could see the water and smell the salt, but still miles from our dream-beach, we pulled off onto the side of the road to sulk and try to quiet the squalling baby (what, you don't like to be strapped in 5-point restraints for 2 hours, kid? What's wrong with you?). We were almost as grumpy as in our own 3rd floor sauna of an apartment. But then peering over the cliff towards the water, we glimpsed a sliver of sand below and a path that was only mildly inappropriate for carrying a child down. We decided to go for it and felt ever so superior to all the goons idling their engines on the road to paradise as we hoisted cooler (with picnic inside), baby, blankets and all other manner of accoutrement for the trek to water. It was beautiful. And it was full of naked people. Yes, we had discovered the nude beach.
And what do you do at the nude beach? Aside from an extra-special good job of applying sunscreen? Of course! The water was freezing, but delicious. Gabriel had a few wee dips, but was mostly excited to crawl around on the sand with the rest of his crab-like fellows. We ate chicken and brownies and had the most marvelous time. I'm going back, I swear, if I can just find it again. Brigadoon of Northern California.

everyone's a critic

Mommy, you're such a good cook. Give me more of that delicious food! Yum....

living, learning, being a dumbass

Well, here's the truth. I'm getting my ass kicked. Right out of the gate. It's not that I thought I'd be all over it, or anything. I just didn't expect to have them waxing the floor with me. Me and the Burmese guy with the not-so-hot grasp of colloquial English. So this morning, I had seen my first patient, a lovely young woman from Africa with TB. I've been waking her up every morning at 7am for nearly two weeks now to ask her about cough, fever, pain, etc, and she's ever so kind about it. Half-way through investigating my second patient (and to me, it all seems like a mystery to unearth each and every morning -- there is no easy way for me, lowly student, to get a succinct report from, say, the primary team intern or resident. Talking to me is a waste of everyone's time. So I have to skulk around, eavesdrop, try other people's passwords to the roughly 31 computer programs that conceal various pieces of patient data. Not that I'm bitter) the resident looks at me (is that a smirk, Dr. Dear?) and says, "Well, we have 5 consults today, so you do this one." My heart sinks just a little, because my last new patient presentation was an unmitigated disaster ("What medications did the patient receive in the ED?" "Umm...." I mean, how does a normal doctor-ish person fail to note that somewhat interesting fact? Well, I was running between floors looking for a computer to look at the lab results and print out the EKG, but still...), but I want to REDEEM myself and here is the opportunity. So in the panicked one hour and twenty minutes remaining till rounds, I finish up quickly with patient #2 (heart failure, hypertension, diabetes, TB, gout, and I think I'm forgetting something) and vow to get all the dirt on patient #3 (HIV/AIDS, chest pain and shortness of breath, probably PCP). And I do! I do! Except for the CT, but that hasn't even been read yet, so you can't really blame me (or can you?). Feeling almost proud of myself, especially when I realize that I have three patients and the real interns on the pulmonary service only have one or two. See, see, I think, I can do this. I'm not going to be a total failure. But pride, as you may have heard, goes before the fall. A meeting later, discussing all the TB patients. One of the public health nurses turns to the doctor and says, "Oh, we can't discharge patient #2 until he gets his pacemaker." Dr. S does a funny (well, comical) double take and said, "Pacemaker?," and then looks right at me. See, I told him this morning that nothing exceptional had happened over the weekend with patient #2, and things were going pretty well (for somebody with a bad heart, bad lungs and gout), because there was nothing in the chart. Really. I had no clue they were going to put in a pacemaker. It wasn't in the orders. It wasn't in the cardiology note. But someone, somewhere knows the plan, and that someone is not me.
You know, writing it out now, it doesn't seem like quite the big deal it seemed at the moment (one of the other attendings said, "Oh, look at her face," as I did a double take of my own). I almost cried. There's a lot of pressure to know everything. Even things you can't possibly know. It's not like I'm the person who's supposed to put in the pacemaker, for god's sake. But, the thing is, of course, that to take care of a patient is to take care of that person -- not just his lungs and the TB meds that will keep them from getting all grody. I'm not sure I'm up for it, frankly. It's discouraging to have to make each and every mistake just in order to learn from it, but it looks like I'm on my way.

on the move

Gabriel is officially mobile. He has eschewed the classic crawl in favor of scooting around on his butt with his left leg tucked under him and his right leg propelling him crab-like across the floor. He's been working on it for weeks now, but had been moving so slow you needed time-lapse photography to catch him in action. My time-lapse brain, however, allowed me to become engrossed in something and look up minutes later to see him at the dog bowl, emptying it out in baby-sized hand splashes all over the floor. Now, however, you can see him moving in real time and it is frightening to behold. His favorite places in the house now are 1) the VCR/CD shelf where he presses buttons (he has figured out how to eject a tape AND put it back in -- the technology gene turns on rather early, I gather) and pounds mercilessly. 2) the aformentioned dog water. 3) any electric cord.
Our house is not exactly baby proofed. I've tried to pick the more caustic chemicals up off the floor, but aside from that, I guess I've opted to be on-my-toes, mostly because I am too lazy to embark on any large safety project. We don't have steps (inside at least) for him to go tumbling down, so if I can keep him from electrocuting himself we should be okay. Maybe.

the surreal life

Found myself sitting in the attending's office waiting for "the team" to assemble to present patients, get beaten down and lectured, etc, on third day of rotation. Dr. S has yet to acknowledge my presence beyond saying when I turned up the first day, "Oh, I have a medical student. Great." It didn't sound THAT bad, though. The minutes tick by and he turns his jaundiced eye to me and asks, "Where did you go to undergrad?" Oh, oh, I know this one! "C---- College*, " I say, then feel compelled to qualify, "It's in Minnesota," because no one here has ever heard of it. "Ah," he says, "Minnesota. It's cold up there, isn't it." "It is indeed," I reply. "My daughter lived in Montana for a while." "Oh, it's cold there, too," I say, desperate for something to add to the conversation at this point, "I have a friend from Montana." "How does she like it?" "I think she likes it a lot." Oh, my God. Stop talking! Mercifully, the interns and resident descend at that moment, whisking attention away from my social imbecility.
That afternoon after grilling every one of the interns mercilessly, especially the guy from Burma with a shaky grasp of English, he turns to me and asks, "Now, what are the major products of Minnesota?" "Umm...farming products?" I stammer, because he can't be serious! "Yes, you should know the major products of the state where you're from." What the fuck!! "Okay, I'll look into that," seething because I am NOT from Minnesota, but don't want to point that out because I have no clue what the major products are from Colorado, either.
So, the next day, random list from Google of major farming products of Minnesota in my pocket, I expect the whole episode to have blown over, but nonetheless am repeating under my breath, "Corn, wheat, rye and sugar beets." After reporting on patients, he turns to me and says, "Now for the important issue. What are the major farming products of Minnesota?" I rattle off my list with aplomb. "You sound like quite the expert," he says. "Thank you," I reply.
I don't think I'll be getting honors on this rotation. But since the attending is clearly mad, I'm going to try not to let that bother me.

*"The Harvard of the Midwest," as M intones everytime they call and ask us to send them money, which is quite frequently.

evidence

So I have something to confess. Prepare yourself. It's pretty heinous.
I walked all the way down to the farmer's market with Gabriel on Saturday and I forgot to put sunscreen on him. No, let's be perfectly honest, shall we? Having hoisted him onto my back and having fastened the buckles on the fabulous Ergo, the thought, "shoot, I forgot to put sunscreen on him," shot through my head. "He has his hat on," I said to myself. "We won't be gone long," I rationalized. And then I left the house.
I know. Terrible, Britney Spears-type mothering. And here is the sad proof. My baby with a farmer's sunburn. Your mother's nothing but an over-educated redneck, kid, and she's fixin' to make you just like her. Poor baby.

ah, the weekend

For those of you watching at home, when we last left our heroine, she was tethered to the toilet at both ends and skipping out on her second day back at school. Would she give up hope and crawl back into bed for the rest of the year like she felt would probably be a good idea? Tempting, but no, she did rally on Wednesday and hauled her wizened-up self in to the hospital. And now she will stop referring to herself in the third person, because that's weird.
So I made it through the first week in the usual progression of things: Monday, pure terror and confusion. Tuesday, sick as dog. Wednesday, dehydrated and headachy. Thursday, pure terror: have to see a patient and write note. Friday: boredom with it all.
This is my first time in a teaching hospital, actually. I'm enjoying it. It takes a lot of the pressure off when you're the medical student in a team consisting of five actual physicians. The attending, Dr. S, is usually badgering them and I can listen and take notes or count the holes in the ceiling tile. In my third year, my hospital rotations were under the guidance of the gruff and burly Dr. A, who grilled the students incessently on everything in his misleadingly gentle Persian accent. I did learn a ton, but I left everyday burdened by the knowledge that I was completely incompetent and would never, ever measure up to the great Dr. A. Standing there (for hours and hours and hours) with several interns and a resident, I realize that I will most likely be ready to move up the next baby step a year from now. There is not so much distance between us. Also, it's intern week, when all the new interns are starting, all over the country (and, consequently, probably the worst week to become sick and require hospitalization), so they are at least as crazed and confused as I am. Misery loves company. And misery loves people in more misery. I get to go home every night this rotation after rounds. No call for me...yet!
I'm glad I'm back though.