assorted baloney

A couple of months ago, the majority of my readership consisted of 1.) people in various medical fields and stages of training, 2.) random non-medical people who found my site by accident or who were referred in by said medical people, and 3.) people who knew me. But ever since our announcement a few months ago, my readership exploded almost overnight to include the fourth, huge demographic, 4.) pregnant people or people with young kids. And my word, you parental-types are legion. I've seriously seen my readership almost triple since the fetus came onto the scene, and that's been amazing for me because the collective experience and advice from you all has been invaluable. But I have no idea how the word got out so fast. I mean, it was like one day I announced that I was pregnant, and a week later, everyone was at the party. But how did you all get here? Is there some sort of pregnancy linking network that I don't know about? Is there some sort of underground communication line between parents that no one ever told me about? How does it all work, this so-called "internet"?

(And of course, I must give a special shout out to people who are straddling dual demographics. Hello, medical-types with kids or fetuses! May we someday join forces and form a mighty army! Only if we can coordinate on our post-call days, of course.)


* * *


So aside from going to work and browsing through Ebay to see if anyone is selling a brand new orange Bugaboo Frog stroller to me for ten dollars (and IT COULD HAPPEN, and even though I don't like to take advantage of the clinically insane, I would make an exception just this once), we've been getting everything ready for Joe's dad's big visit this weekend. As you may recall, he is flying in with his special tools and special know-how to help us turn Cal's room (currently an empty whitewashed box) into Cal's Pleasure Palace, albeit a palace without any furniture in it yet. Part of preparing for this visit has been placing a big Fresh Direct order for dad-friendly foods. We already got the tip off from Joe's mom what it is he likes to munch around the house, and promptly ordered those things. In case you're wondering, the list consisted of: baloney sandwich fixin's, Sprite, pretzels, coffee. Simple enough. The one mistake I made was actually tasting some of the baloney. Bologna? Whatever, you know what I mean. Joe ordered two packs of baloney from the store with the intention that we could SAVE BIG MONEY and use some for lunchmeat, so earlier this week I obligingly made myself a sandwich to take to work.

When I was a much younger child, I loved baloney sandwiches. Like, insanely loved them, the way that kids obsess over Twinkies and McDonald's Happy Meals and blow the tastiness of the idealized, fetishized food completely out of proportion with their worship. I could never figure out why no one would buy baloney for me. "Why not some nice turkey for your sandwich? Yum, turkey." But I didn't want turkey, I wanted baloney. So salty, so soft, so good. So...uniformly processed.

Well, sorry to say that after my adult palate downed that sandwich on Monday I cannot stomach baloney anymore. Who knew it was so gelatinous? So artificial tasting? It tasted like eating a hunk of quivering meat jelly. And it made me really thirsty. Baloney, you are dead to me now.


* * *





Now that I just passed 27 weeks, I've almost reached this mystical borderland in my mind set up by one of the NICU fellows that I worked with earlier this year. She and I were at a twin C-section for 28 weekers, setting up the warmers and CPAP and such, and she said to me, "I just love 28 weekers. They're my favorite age to work with."


MICHELLE
You love 28 weekers? Why?

FELLOW
Because they're still really small, but they're so feisty, and almost all of them do do really well.

MICHELLE
Uh, yeah, I guess.


(Keep in mind that a 28 weeker weighs about one kilo and is still three months premature. So that shows how skewed the world of the NICU can be. "Better than a 24 weeker!" And also maybe how good the NICU at our hospital is, something that I merely observe but can take absolutely no credit for. Which is basically the sole reason that I chose to deliver at [University Hospital], aside from the obvious disadvantage that everybody knows me and I might have someone that I'd really rather not ever see my hoo ha have to walk in at an inopportune moment. Well, and I guess the one other advantage is that I know the combination to the pantry and can purloin extra pudding cups if need be. But I digress.)

I'm getting a lot of patients and parents asking me now about the pregnancy now. Most of the conversations go something like this.


PARENT
You havin' a baby?

MICHELLE
Yes I am.

PARENT
How many months?

MICHELLE
Seven months next week.

PARENT
You look good!

MICHELLE
Thanks. I feel like a truck, though.

PARENT
You havin' a boy or a girl?

MICHELLE
Boy.

PARENT
I knew that.

MICHELLE
Really? How did you know?

PARENT
I have a sense about these things.


Variations on the above include "I could tell from the shape of your stomach" and "I could tell from your aura" (which I chose not to question any further). But cuter yet is when the kids ask me about the pregnancy. Like two days ago, I had a mom with two school aged kids come in:


MICHELLE
(Brandishing prescription for permethrin cream)
Now, you really want to apply this cream from head to toe and leave it on overnight...

MOM
(Interrupting)
You havin' a baby?

MICHELLE
Yes I am.

KID
I knew that already! I knew it! I saw it when you were sitting over there!
(Points to chair next to desk in the corner)

MICHELLE
You saw my belly?

KID
(Poking belly with one finger)
I saw it!

MICHELLE
Good for you! (To mom) And make sure you was all your sheets with hot, hot water after the treatment like I explained before, OK?

MOM
Got it. Thanks, doc. (To kid) Say bye to the doctor.

KID
Bye, doctor! (Patting Michelle's abdomen gently) Bye, baby!

MICHELLE
The baby says bye!


And then after they left, I had to run out and wash my hands fifty million billion times, because I had just treated that whole family for an infestation of scabies.

Currently NOT watching: "Felicity," because literally the day after I made that announcement that the Women's Entertainment channel was running old episodes, my basic cable provider decided not to carry We on their roster anymore. Due to the timing, I am suspecting conspiracy.

unprecedented

So not only was it a complete ghost town in the Peds ER today, we were also completely overstaffed, with three Peds residents, an ER resident, two "fast track" attendings, and two precepting attendings all working at the same time during the afternoon. All this manpower, and hardly any patients. So the decision was made that instead of us all sitting around picking our butts, at least someone should have an early day. And somehow the decision was made (probably because I'm working the late shift tomorrow) that the person who should get to go home early this afternoon was me.

Initially, I protested. "No, come on, I'm not going home early!" Again, the group insisted. "You're kidding, right?" No, not kidding. Just go. "I can't leave!" Sure you can, there's not even any patients here to see--just go. And the thoughts that were running through my head were as follows:

Really? Leave two hours before my shift ends? Awesome!

But then will people think I'm a slacker? Will they think I don't work hard?

Why should it be me that goes home early? Why not one of the other residents? Is this just because I'm pregnant? I don't want special treatment! Should I say no?

Will they think I'm not a good doctor if I take them up on their offer? Will they think I'm not dedicated? Not tough? Is this a trick?

Then I realized what I was doing. I was doing the EXACT THING that I tell all of my medical students not to do. In short: if someone tells you to go home at some point during a rotation and you want to go home, JUST ACCEPT THE OFFER. It's not a trick. It's not a trap. It's not a test to separate out the Honors students from the High Pass students. Just go home and don't overthink it.

I WAS DOING THE MEDICAL STUDENT THING, hemming and hawing and making excuses about why I should stay around for no reason, while everyone else was trying to convince me to go home early! HAVE I LEARNED NOTHING IN THE PAST FOUR YEARS?

But I guess I have, because I did end up leaving early in the end. The fact that the doctors were outnumbering the patients by three to one was a little ridiculous, I guess. But my conscience is still gnawing at me a bit. Maybe I should find a nice organized religion to channel all this guilt towards.

Currently reading: "The Working Poor." Almost done with this one. Also reading the article about patient simulations in medical education in this week's New Yorker. Some institutions must really have some fancy simulation models. The one we had in med school wasn't nearly as sophisticated as the ones described. In fact, it was a little surprising how un-sophisticated it was, given how much it cost the school (a price tag of which they reminded us over and over again to impress upon us how we were not supposed to bring food or drink anywhere near the scary, pulsating rubber mannequin).

ready to ride and glide

We had quite a successful weekend baby-preparation wise, and managed to grant Joe's parents' request that we pick out not only a carseat, but a rocking chair for the nursery as well. Behold:



We got the beige one. The blue one on the right was more expensive (It was the next model up), and the blue one to the left, though you probably can't tell from the picture, had this horrorshow "denim" upholstery that looked all scary and acid-washed '80s. What, no neon puffy paint logos?



Joe and Coop trying out the rocking chairs. (Actually, they're called "gliders" these days for some reason--I think it's because the actual rocking apparatus is different from that of traditional rocking chairs, to prevent the unplanned execution of toes and tails.) As you may be able to tell from the picture, the Chelsea Buy Buy Baby is a surprisingly large store by Manhattan real-estate standards. Also, I was giving the stink-eye to the bald guy all the way to the right in the back row, because he was sitting in the chair that I wanted to look at and would not get up for a very, very long time.



Finally, he left. This is the chair we got. It doesn't look like it, but it rocks. Or glides. Whatever. We like it because not only is it extremely comfortable, it actually looks like it could be a real piece of furniture, not just nursery furniture. So in the chance that we eventually move it to another room of the house, it won't scream "STOLEN FROM THE BABY'S ROOM!!"

So we bought the stuff, but we do not actually have any of the stuff in our house yet because we told them to deliver it all with the backordered bedroom set--you know, the crib and all. The bedroom set, which may or may not arrive before the baby is actually born. 14 to 16 weeks was the time frame we were quoted six weeks prior, when the order was placed, but you never know about these things.

Cal is getting super-strong these days, by the way. He was kicking me in the old gut earlier this evening, and I swear to god, you could see my whole abdominal wall bulge and deform with the force of his kung-fu moves. I will refrain from making "Alien" jokes, because that's just too easy--but suffice it to say that it's kind of scary.

Currently reading: "The Working Poor." Unfortunately, I didn't get to read it on my commute uptown today because I left it in the living room by accident. Oops.

fie! fie!

I'm pretty sleepy now, so I'll make this short:

To the VERY BAD PERSON who stole my Gatorade out of the fridge in the doctor's lounge last night, A POX ON YOU. May you be cursed forever with the knowledge that you stole the beverage of a dehydrated pregnant lady working her sixth overnight ER shift in as many days.

Also, I peed in that Gatorade bottle.

Currently reading: "The Working Poor." This is probably a good book for people in healthcare to read. Even if it isn't directly about medicine, it is about a lot of our patients.

nesting instinct, or lack thereof

Last night in the ER was hellish as predicted. At least tonight is my last overnight shift before resuming working days. Unfortunately, my schedule seems to have mostly adjusted towards the nocturnal, and I'm going to have to spend the bulk of the weekend forcing it back. Meh.

One of my tasks this weekend may be heading back to Buy Buy Baby (which I find to be a clever name for a store, if somewhat crass--why not just call it "Plush Pastel Money Sinkhole") to shop for some baby stuff. Joe's parents just mailed us a check which they earmarked for the carseat and a rocking chair, so I might head on over to the Chelsea location and check out the selection. Between being away for vacation and our hectic work schedule lately, we've kind of been slacking off in terms of preparing for baby things, but the other day I realized that we only had 14 weeks left to get everything ready, and therefore should probably get our asses into gear. The baby's room is still as empty and unprepped as the day we moved all the dining room furniture out.

Thankfully, we have some adult help. Joe's dad is coming into town next weekend to help up build some shelves, put up a wallpaper border, and hang the curtains. We were originally going to try and do it ourselves, but Joe's dad insisted. He knows better anyway, being handy like that. Or maybe he just knows that we have no idea what we're doing. To be fair, we did at least try to hang the curtains ourselves, but the wall of Cal's room by the window is made of some sort of some impenetrable diamond-hard concrete that we could not for the life of us figure out how to drill through in order to affix the rod. Heh, I said "rod."

Anyway, I have to go to work now.

Currently reading: "The Working Poor." I decided to go with the non-fiction after all. Think of this as a less irreverent, more depressing version of "Nickel and Dimed."

oy, my sciatica

I feel like a collection of assorted bodily complaints for bringing this up (ai yi yi, my aching back, my aching legs), but my left sciatic nerve is killing me. I was having twinges of it before, but yesterday during my overnight shift it was a lot worse--I was hobbling around like a gimp for most of the night. I wasn't sure how to get the weight off the old nerve short of actually laying down--I tried leaning forward and moving my leg up and around--but nothing really worked. Finally, I took some Tylenol and just tried to forget about it. And that didn't work either. Dang.

Sometimes you can just tell from the weather report when you're going to have a bad night in the ER. As of 8:30pm, it's 84 degrees outside, and there's a thick layer of smog covering the city. Traumas and asthmatics, come on down!

Currently reading: Various speed-cooking recipes, trying to figure out something that I can quickly eat for dinner tonight before heading into the hospital. Speaking of which--I took a cab to work last night, and when I gave him the address and told him the hospital name, the cabbie asked me, all excitedly, "Is the baby coming?" I was like, uh...no, just going to work.

sense of foreboding

I had to bring a kid up from the ER to the PICU the other day, and up in the unit I saw John, one of the third year residents. He and his wife just had a kid four and a half months ago.


MICHELLE
Hey John, what's up?

JOHN
Meh.

MICHELLE
How's the kid?

JOHN
I haven't slept more than two hours at a stretch for the past four and a half months.

MICHELLE
What? Still?

[In my don't-have-any-kids-yet mind, I have this fantasy that babies start magically sleeping through the night at around 4 months. And also that they are adorable and giggle and flop into piles of soft, fluffy blankets like the Snuggle fabric softener bear. Clearly I am living on Fantasy Island.]

JOHN
(Looking kind of glaze-eyed)
Sleep now while you can.

MICHELLE
So he still wakes up every two hours to eat?

JOHN
Yes. Don't breastfeed if you ever want to sleep again.

MICHELLE
I won't tell the general Peds establishment you just said that.

JOHN
It's true, though.

MICHELLE
Yeah, but you don't have to get up. You don't have the boobs.

JOHN
Yeah, but I wake up anyway.

MICHELLE
Not the same, though.

JOHN
True. I don't know how women do it. Women are strong.

MICHELLE
Is your wife working too?

JOHN
No, she's taking a few months off to be with the baby.

MICHELLE
Oh. That's nice that she can do that.

JOHN
Yeah.

MICHELLE
(Suddenly filled with premonitory dread at the thought of
juggling a new baby and a new residency at the same time)
Wow. This next year is really going to be hard, isn't it?

JOHN
(Flatly)
Yes.


Sometimes when I think about the timing of this whole thing, what with the baby and the switch to Anesthesia and all the assorted other things that come with juggling residency and real life, I start to have a little panic attack and have to sit down and think of nice calming things, like puppies in a basket. But then I think back to medical school, when the idea of being an intern was so impossible, and I watched them dealing with a thousand different things at once on no sleep with this sense of total third-year med student awe. "How do you do it?" I asked more than one of the residents that I'd been assigned to for the month. "I feel like I'll never be able to do all this stuff that you guys do."

And they all said the same thing in response. "You'll do it when the time comes, because you have to." And they were right. I just hope that the "have to" part of it doesn't suck all the joy out of our lives. And all the sleep.


* * *


Hey look, a new pope! And he looks like Hannibal Lecter!

Currently reading: Nothing. Took a cab into work last night, and fell asleep on the subway on the way home this morning. There was a small amount of drooling involved. But, I was sleeping and drooling over an open issue of this week's New Yorker, so maybe technically I was "reading" that.

tough crowd

Remember what I said in that last post about the ebb and flow of the night shift of the ER? Forget I said anything. We got destroyed last night. All night. By the end of our shift, the three of us (myself and the two attendings) were staggering around like that cow in "Old Yeller" that they had to shoot. All this and some sort of subway malfunction that caused my homebound train to be completely packed with surly commuters who started picking fights with each other just to express their surliness.


LADY
(Standing just inside the door of the packed train, screaming generally to the throng pushing to get in)
Ain't no more room on the train! No one's getting in here!

OTHER LADY
(Gesturing to the side)
Move in more! There's room there!

LADY
Can't move no more! There's a bike there!

ASSHOLE WITH BIKE
(Nonplussed, blocking not one but three seats with his stupid mountain bike)

OTHER LADY
Since when do you make the call of who gets in and who doesn't get in?

LADY
Since now!

OTHER LADY
(Sarcastically)
Oh, you have so much power! You make the rules!

LADY
That's right, bitch!

OTHER LADY
(Trying ineffectively to shove into train)

MICHELLE'S INNER MONOLOGUE
OK now, the one cubic centimeter that was left in this train for my lung expansion has now been taken up by a giant pushing shoulder.

LADY
Told you ain't no room on this train!

CONDUCTOR
Standclearuddaclosindoorsplease.
(Doors close)

LADY
(Shouting through the door)
And if you can't handle it, leave New York!


So needless to say, I was standing for my of the ride home. Or propped up against a wall of other passengers, to be more precise about it. Which is fine, except that my back was killing me. Damn this uterus and its assorted contents, it's like wearing a giant heavy backpack 24/7, except on the front. By the end of the night, I feel like an old lady, with my panoply of back and joint complaints. It's the rheumatiz, I tells ya. Now where's my walker and my lumbar support pillow?

Currently watching: "Felicity," which is back on syndication at We, the Women's Entertainment Network. Yay! Not to be embarrassing, but I love "Felicity." This was my fourth year of med school vice, after I had finished all my hard rotations and committed myself to a semester of sloth. And (AND) they're playing two episodes back to back every day! Sweet! I can watch both episodes now, since I'm working the night shift, but I probably won't be able to catch any of them next week when I'm back on days. I wish I had TiVo.

heart of darkness

Hey, that sleep mask really works! I didn't sleep quite as much as I would have liked (which, these days, is about 10 hours straight, though I can rarely swing that)--but still, 5 hours is an admirable block of sleep for the middle of the day. Never mind that Joe walked into the bedroom and started laughing at the sight of me with my giant 100% light blocking apparatus on my face. Though I don't know what's so funny, the kind of stuff that they make their patients wear over their eyes is far more embarrassing.

And so I have begun another week of working the night shift in the ER. There's a definite rhythm to the night shift, and it's broken up into discreet, predictable blocks.

8pm - 11pm: The After Dinner Specials
"Hey kids, we've all had dinner, we're all still awake, what say you we take a big family trip down to the emergency room for no sound medical reason whatsoever?" "Yeah! Great idea, dad!"

11pm - 2am: Baby Mama Trauma Drama
Now that the weather is starting to get warmer and people are starting to get a little more...rambunctious...every single chart that lands in the box between this time period is some sort of trauma. Lac repairs, car accidents, and my personal favorite, kids falling off of things. Last night, I think every single kid in the neighborhood under the age of three fell off of something high. Fell down the stairs, fell off the bed, fell off the bed at the top of the stairs. Which teaches me an important lesson about parenthood: keep your kids strapped down to the floor with heavy nylon cords at all times.

2am - 6am: The Auto-Triage Zone
I don't know if this is as true for the adult ER, since it always feels like a zoo in there, but in the Peds ER during the non-winter months, this is a relatively quiet stretch of the night. Basically, the early hour weeds out all the actual healthy patients (which for us, feels like about 75% of the patients we usually see), and those kids who actually do make it in to see us are usually legitimately sick. Unfortunately, it's kind of hard to evaluate these kids sometimes, because when the parents tell you at 4am that the kid is "acting sleepy," you can't tell if he's septic or just normal.

6am - 8am: The End-of-Shift Gold Rush
They're somewhat sicker than the After Dinner Specials, but weller than the kids who come in during the Auto-Triage Zone. Maybe their parents want to squeeze in a quick visit to the ER before work, or they have a fetish about coming to the ER in their pajamas. Equally frequently, they're also the frequent flyer/chronically ill patients that know enough of what to do for their kids overnight, but also know that they will have the shortest wait time if they come into the ER before 8am. Unfortunately, this is also the point of lowest work motivation for overnight ER staff. Couldn't you have waited 45 minutes more before coming in, AFTER my shift ended?

(When I was working the day shifts, I also noted a block prior to The After Dinner Special that I call The After School Melee. This is when we see all the neighborhood teens come in with all bruised and bloodied because they got jumped after school. And not just guys, either. I've had more than a few girls coming in after getting mauled by what sounds like some roving all-girl gang, like something out of "Faster, Pussycat! Kill! Kill!")

Well, that was fun. Gotta go get ready for work now.

Currently craving: This is a real Chinese People thing, but I can't get enough of those Ching Kee Cookie Rolls. They're like these eggy, flaky, tube-shaped tea cookies, and they make more crumbs than any other cookie on the planet.

strategies to ace my glucose tolerance test

1.) Studied for weeks.

2.) Did not eat any breakfast the morning of. My OB said it would be OK to have half a bagel or an english muffin, but there was no way I was giving up those precious blood glucose points for no reason.

3.) Pounded the drink. This is the strategy I tell most of my patients to use for drinking something nasty but medically necessary--CT contrast, for example--but most people insist on taking slow sips, making disgusted faces, then taking a few more sips. Why prolong the misery? Chug that thing. Actually, I am pleased to report that the GTT solution is actually surprisingly palatable. It was refrigerated for one thing, which helped. And there wasn't really that much volume, just a bottle the size of one of those mini soda cans you can sometimes see at receptions or on airlines. Actually, between the light carbonation and the orange flavor, it tasted almost like an orange soda. I had about ten minutes to finish, but guzzled that thing in about a minute and a half. When I returned the empty bottle to the nurse so that she could start the clock, she looked surprised. "Wow, that was really fast."

4.) Brought some light reading (in the form of US Weekly) to keep my mind and body in a Zen, insulin-receptive state. Some pop culture updates from within:

• Britney Spears is pregnant! No, for real! And her boobs are huge!

• Charles and Camilla got married! And Camilla wore a funny hat with feathers on it!

• Julia Roberts was in New York! (Her New York apartment is actually right near our neighborhood.) And she went to Home Depot to buy a shower curtain! And she was wearing big sunglasses!

• Jessica Simpson and Nick Lachey are totally in loooove! And they don't know why all the tabloids keep printing stories to the contrary, just because they act as though they're filled with barely suppressed contempt and loathing for each other on their reality show!

• Desperate Housewives something something blah blah blah (I didn't pay attention to this "article," as I don't watch this show.)
  

5.) Continued to think Zen, blood glucose-lowering thoughts during my routine exam. Blood pressure? Good. Urine? Good. Heartbeat? Good. (Cal's, not mine.) Talked with my OB about my concerns that Cal, having no knowledge of my scheduling interests, would decide to hang out in there significantly past my due date. Given that I have only 5 weeks of maternity leave, having the baby come even a week overdue could be a real drag. She said she understood my position, and that if nothing was happening au natural by the Monday after my due date (I'm due on a Thursday), we could start thinking about induction. But hopefully, it will all just happen by itself and in a timely manner, because I don't want to be looking at that failed induction/C-section route either.

6.) Got my blood drawn. Did not say anything as the nurse approached the vein at an overly acute angle and totally speared right through it, because I'm polite like that.

7.) Finally, finally, ate lunch. The GTT solution filled me up for a little while, but by the time I got home I was famished. Decided that I probably don't want an orange soda to go with that lunch. In fact, realized that it would probably be a long, long time before I ever wanted to drink another orange soda.


So that's that. Hopefully the results will be good and I won't have to go back for the three hour test, because word on the street is that the glucose solution they make you drink for the three hour test is nasty. My OB said to call her receptionist on Monday for my results, but who are we kidding, I'll probably just look it up myself during one of my ER shifts this weekend.

Currently reading: "Epileptic," still. But I think I've now reached the point with this book where I just want to hurry up and finish so I can start something new. Up next, it's a choice between "The Namesake" and "The Working Poor." I'll have to see if I'm in a fiction or non-fiction mood, I guess.

is that a uterus under your shirt, or are you just fat?

I think I know how ladies with big boobs feel now, because when I talk to people these days, there's the subtle darting motion of eyes looking from my face to my belly, then back to my eyes again. Sometimes you can just see it in their faces, that they want to ask me if I have a fetus gestating up in there, but that they don't quite dare. Sometimes they do just come out and ask, usually the ladies feeling more comfortable doing so than the men, but I think everyone has a fear of what would happen if I actually said "no". No, actually, I'm an alcoholic, and I'd thank you not to point out my ascites, you BASTARD. Of all the social faux pas, probably the one most ingrained into the minds of the polite gentleman is to make any remarks whatsoever on any part of a woman's anatomy that is increasing in size. So some people don't say anything. They dart glances and look away, and later on, pull someone else aside and ask them if I'm pregnant or not, because they sure as hell can't risk asking me.


* * *


Another busy day in the ER, seeing all manner of patients sick and not-so-sick. Which brings me to the topic of the patient most loathed by most ER physicians--the tagalong. I don't know if it's as common in the adult world, but in the Peds ER, with large families and multiple siblings, the tagalong is the unfortunate byproduct of parents with no childcare and a limited understanding of what the E in ER stands for.

To put it succinctly, the tagalong is the healthy sibling (or cousin, or offspring) of an actual sick patient, who the parents inexplicably feel the need to get checked "since we were coming here anyway." For example, my tagalong today was the younger brother of a kid presenting with chest pain and syncope. The tagalong's chief complaint? He has ringworm. Had he been seen by his doctor? Yes, three weeks ago. Has he been given medication? Yes. Is he taking the medication? Yes. Is it getting better? Yes. So why did you register him for emergency services? Because I figured we were coming here for [older brother's] chest pain, so we might as well get [younger brother] checked out too. Ugh. Hate the tagalong. Do you know how much paperwork your fungus just generated?

Still, the annoyance of having to see a tagalong aside, they were still better than my all time classic MiNERVA recipient (Most Non-Emergent ER Visit Award). Stop me if you've heard this one, but my god people, THERE IS NO EXCUSE. Behold:


TEEN GIRL
I came to the ER because I don't know why I can't get pregnant.

MICHELLE
Wait, you want to get pregnant?

TEEN GIRL
Yeah.

MICHELLE
And you're upset because you're not.

TEEN GIRL
Yeah, me and my boyfriend been trying to get a baby for six months, but it hasn't been working.

MICHELLE
And you're sure that you want to get pregnant too, not that your boyfriend is pressuring you or...

TEEN GIRL
No, no, we both want to have kids. But I want to make sure there's not something wrong with me because it's not working so far.

MICHELLE
You know, this is really more of an issue for your regular medical doctor.

TEEN GIRL
Yeah, but this is important.

MICHELLE
Well, there isn't much in the emergency room that we can do for that, but it's not so busy now, so I'll tell you what. I'll do a routine exam and maybe we can send some simple cultures and blood tests, just so that when you do make an appointment with your regular doctor, she can have something to start with. But an infertility workup, if that's really what you have, isn't something that's done in the ER.

TEEN GIRL
(Impatiently)
Is this going to take a long time? The exam and the tests?

MICHELLE
A little while, why?

TEEN GIRL
I have to go. I have an appointment in half an hour.

MICHELLE
Where? With whom?

TEEN GIRL
With my gynecologist.

MICHELLE
(Hurls self in front of truck.)


Currently reading: "Epileptic." I'm not sure I really like this book. The art is pretty to look at and all, but it's a little wavy gravy for me. Give me a straightforward story any day.

disastrous

We had a disaster drill at the hospital today. A disaster drill is just what it sounds like--sort of analogous to a fire drill in elementary school, only more disaster-y. There's this whole tightly orchestrated hospital-wide game plan that's supposed to kick into play when disaster strikes. I don't know that game plan, but I trust that if some meteor lands in Times Square, there will at least be an overhead announcement that tells me where to go and what to do.

The disaster drill scenario today was that there was a chemical spill on the George Washington Bridge. And man, when they drill, they really act out the whole thing. There was a little decontamination unit out in the ambulance bay, hazmat suits everywhere, patients being transferred, the whole deal. My disaster team got called over to the adult ER to lend and extra set of hands, where I was promptly outfitted with a neon orange traffic vest with a sign taped to it that said "PEDS MD". Which, you know, was cute and all, but I was less than thrilled at being forced away from the Peds ER to act out some fake-ass emergency when I had a real live kid with fever, neutropenia, and hypotension on whom I was in the middle of ordering up dopa. I finally weasled my way out of the drill (it turns out they only needed one Pediatrician on the adult side, and the attending volunteered to stay), but I was kind of annoyed at getting pulled away in the first place. Because as much as I recognize the importance of drilling, I don't see how all patient care in the hospital can shut down just so that we can pretend to be in "The Day After Tomorrow".

Later during the drill, someone wheeled this a 35-year old Asian man in a bright yellow jumpsuit into the Peds ER. "Uh, I was in the accident on the bridge?" He said, trying to read upside down off the triage card pinned to his chest. "I think I, like, have a cut on my head? And I'm bleeding and stuff. Also, I'm ten years old." We stuck him in the corner of the asthma room between a wheezing baby and a puking teenager. He looked horrified.


* * *


So I finally broke down and ordered this sleep mask. After working nights all last week and gamely assuring myself that I could get a solid night's sleep during the daylight hours, no problem, I finally understand now why Al Pacino started to go insane in that movie "Insomnia." (I mean, aside from being HAUNTED BY THE GHOSTS OF HIS TROUBLED PAST and all.) It is very nearly impossible to sleep deeply and well when the sun is shining in your face. I rebelled against getting a sleep mask all last week (I was still mad at myself for not thinking ahead and just keeping the free ones that they gave out on British Airways), but was eventually resorting to either sleeping with a pillow over my head--not so good for the old breathing--or fashioning a ghetto sleep mask out of a sweatsock and an old elastic headband. Don't picture this, it's not pretty. Anyway, I'm back to the night shift next week, and I don't think I can afford yet another week of stumbling around in a daze. So I ordered the sleep mask, which promises "100% light blockage." It was either that, or sleep in the bathroom.


* * *


With respect to that last post about those chisling dentists, my mom seems to have some sort of strategy to deal with getting at least partially reimbursed. I'm not sure I exactly understand all the intricacies of said plan, but I have to trust that she at least somewhat knows what she's talking about, being a doctor enrolled in an HMO herself. So either this plan works, or I'll be selling one of my kidneys. Any takers?

Currently reading: "Epileptic." Also paging through the New Yorker Travel Issue. Is it just me, or is every new piece by David Sedaris about his partner Hugh and how great he is?

the secret lives of dentists

Even though I am indebted to him for scooping the pulp out of my bum tooth, I am mad at my dentist right now. Because despite assurances from him and his staff, I have found out through my insurance company that he actually does not accept my dental insurance at all. And the bill for that root canal? $950. NINE HUNDRED AND FIFTY DOLLARS! And I already paid, because they assured me that once the insurance paperwork cleared, I would be getting it reimbursed. I guess that also explains the credit card bill I received that totally consumes the entire contents of my checking account.

Which leads me to the obvious question--how could you not know what insurance plans you take? I mean, how could you tell me that you're on a plan when the insurance company says you're not? At least his partner, who I saw for a follow up (and whose bill I am now eagerly awaiting) has an excuse--she's on some of the plans that my insurance carries, just not the one that I happen to be on. But he doesn't take my insurance at all. And I just paid him $950! I mean, I'm all for doctors getting paid, don't get me wrong, but that's the reason I have dental insurance in the first place! Does he know how much money that is for a resident? To anyone?

Damn you, dentists. I hope you're happy when Cal is all sad, swaddled in newspapers, chewing on a tin can, and his only toy is a twig tied with a piece of string.

Currently reading: Finished "The Other Boleyn Girl," (that book is quite a fast read, by the way) and now started "Epileptic." OK, that reminds me--can I tell you one thing about America vs. France? (I mean, not THE ONE THING, but one of the things.) People in France love comics. And because of that, comics are much more mainstream there. I don't mean the superhero comics and semi-pornographic manga that dominate the shelves here (though they have a few of those as well), but I mean they love literary comics, graphic novels, historical fiction, autobiographical comics. I walked into a large chain bookstore in Paris while we were there, and no kidding, the whole first floor was devoted to graphic novels of one form or another. I was flipping out with joy, until I realized I couldn't read any of them, as they had all been translated into French. Again, my high school skills have failed me. Anyway, my point being that "Epileptic" is the newest graphic novel that I've managed to get my hands on. The author, David B., is French.

special treatment

Sorry no updates over the weekend. But I was sleepy. And hungry. But mostly sleepy.

It's funny that I was just talking about that book "The Mole People," because I was starting to feel like a mole person myself, all subterranean and pasty, cringing away from the light of day. Now that I'm back on a normal day-night schedule, I feel much more sane--even though I'm now officially back in the ER, which is sure to make me insane, and sick, besides. I don't think there's a time I've ever rotated through the ER for any period of time and not gotten sick. Last time I was there, I caught pertussis. Times before that, a bad gastro, and the time before that, some sort of generalized viral funkiness that lingered for weeks. I can't wait to see what my immunocompromised pregnant self will pick up this time. Maybe Hanta virus.

One good thing about the ER this time around is that, now that it's obvious that I'm pregnant (what with the giant tissue expander I have apparently stuffed under the skin of my abdomen), all the nurses are being a lot nicer to me. Well, not that they weren't nice before, but sometimes some of them, especially the old-timers, could be a little...gruff. Yes, I believe that's the euphemism that I'll use. I never bring up the pregnancy myself (I think I actually have kind of a complex about it, since I want very badly to be perceived as PROFESSIONAL--read: no private life whatsoever) but I've found that once people sort of ask me point blank and force me to out myself, they love talking shop. How many weeks along, boy or girl, what symptoms I have, what symptoms they had, and so on. And now, unlike before, everyone cares deeply whether or not I actually get a break to eat my lunch. Or sit down. Or drink some water. Or go to the bathroom. Of course, like the stubborn mule that I am, all this inspires me to do is to jump up and show everyone how very unencumbered by my gigantic uterus I really am, running from one end of the ER to the other, interviewing families of four puking siblings, discharging one patient while admitting another. But as much as I don't want any special treatment, it is kind of nice to have people care so much.

I still haven't had anyone give up their seat on the subway for me, though. But I'm not holding my breath for that one.


* * *


Oh, and just one general announcement, since I get so many e-mails about this that I have been bad about responding to personally--for now, Scutmonkey Issue #1 is out of print indefinitely. I may print up more copies when I collect enough material for Scutmonkey Issue #2, but who knows when that will be. The main problem with this whole comic business, at least for me, is that it's very logistically difficult to run a mail-order business when your work hours preclude you from ever being able to go to the post office. If I'm mailing a single copy of the comic to an address in the continental U.S., I can get away with just slapping on an 83 cent stamp and throwing it into the mailbox, but larger orders and overseas orders (oh, and Canadian orders--Canada doesn't count as overseas, does it? What sea?) I have to take to the post office or a Mailboxes Etc. equivalent, and they're usually closed before I head to work and after I get off work. So unless I can find a better method for distribution (maybe going through some kind of a third party? I don't really know how that would work) I'm going to have to hold off on a third print run for now. So--sorry everyone! I appreciate the interest, though! And you can still enjoy the comics online! For FREE!

Currently reading: "The Other Boleyn Girl," a recommendation from one of my co-residents, Allison. Not only do we have very similar taste when it comes to new fiction, but her mom is a librarian, so she gets all the best new books funneled directly to her house. I wasn't sure if I was going to like this book, since I'm not really a fan of anything about Victorian times (makes me think of Fabio and bodices ripping), but for some reason, I cannot put this book down. I just can't manage to decide if it's trashy or not. There's a lot of talk of courtesans and saucy flirtations and rich brocade cloth embroidered with gold thread, which all sounds suspiciously like a cross between V.C. Andrews and those soft-porn books that Anne Rice wrote--but who knows, maybe that's just the milieu of the royal court.

night owl, day owl

I'm finally starting to adjust to working nights, which of course means that on Monday I'll be back to working days, doing the 8am-6pm shift in the ER. This month is basically going to be an experiment in molesting my innate circadian clock--a week of nights followed by a week of days, then another week of nights, capped off by a week of days. It'll be like alternating 4 weeks between Japan and New York. But at least in Japan, I'd have better food. All this day-flipping succeeding only putting me in a state of loopy disorientation around the clock. More so than usual, I mean.

I was prowling the oncology floor yesterday evening when I saw a posting that a patient I had taken care of last month had just died earlier this week up in the PICU. And I felt bad. Not just because the patient had died, which obviously is sad, but because the last time I took care of that patient, I was kind of annoyed with him. In fact, between the residents, the fellows, and the nursing staff, we all kind of were annoyed with him. And not for any other reason than that he was being loud and demanding and whiny and generally teenager-ish, but enough so that I was only more than happy to foist him back on the day team when they arrived in the morning, with a roll of the eyes and colorful recollections of some of the more trying interactions of the night. I feel guilty because I wasn't all that fond of him, but now that he died, I feel like I should have liked him more. It doesn't make any sense, but it's like I want to atone for something. "Yeah, I mean, I was pissed at the patient that night, but I didn't want him to die or anything." And I know that it's stupid to even think that way, because it's not about me, it's about the family now, and how they feel--but maybe it's part of that syndrome of always wishing after the fact that you could have done more, even if it's something as little as wishing you hadn't groaned quite so loudly that night when you got paged about that patient for the five hundred billionth time.

Currently reading: Just finished my umpteenth re-read of "The Bluest Eye." It's always comforting to read a book that you already know pretty well when your ability to concentrate is shot. I may be in the minority, but "The Bluest Eye" is my favorite Toni Morrison book. Most may lean towards "Song of Solomon" or "Beloved" camp, but I like "The Bluest Eye" precisely because it's less fantastic and allegorical than the others, without people flying off buildings and dead slave babies haunting people and whatnot. But then I was getting sick of re-reads and magazines, so yesterday on the way to work I stopped and picked up a copy of "The Mole People," a non-fiction book about the underground homeless communities in New York's subway system. It's really pretty interesting so far.

you can call me cal




So that's going to be his name. The kid, I mean. We're naming him Cal.

Cal?
Cal.

You mean, short for Calvin?
No. Just Cal.

Is that a real name?
Yes.

What does it mean?
Never mind about that. We picked the name first, then looked up the meaning second. Just like how we decided to name our dog "Cooper" before we even went to the pound to pick her out, which is why our lady dog has such a butch name.

Where have I heard that name before?
Well, there's Cal Ripken Jr. (though I think his real first name is Calvin), and Jerry Seinfeld has a kid whose middle name is Cal. But being neither worshippers of Cal Ripken Jr. or Jerry Seinfeld, this is all more of a coincidence.

So..."Cal."
Cal.

Not Caleb?
The kid's name is going to be Cal.

What is it with you guys and short names, anyway?
What can I say, we can't spell so good.


Currently reading: People magazine. I know, I know. But I'm too tired to read anything of substance. This night shift thing along with the jet-lag is liquefying my brain.

the london eye, and the big two-four

I got home this morning at about 7:30am, and slept from 8:00am until 1:00pm, at which time some damn fool upstairs started drilling something in his apartment and woke me up. Which, ordinarily post-call, would be no big thing because I'd just get up with the intent of getting more sleep later that night, but this kind of planning doesn't work out so well when you're working the night shift every single day this week. Damn you, drill-happy neighbors!

Anyway. So then after Paris, we took the train to London.



The obligatory telephone booth shot. Their telephone booths are different from our telephone booths! However, similar to the telephone booths we have in New York, there were a lot of fliers for porno theaters all taped up inside.



Our first full day there, we went up in The London Eye, which is basically this very slow-moving giant ferris wheel that you get up in for scenic arial views of London.



Like this, you see.



In so many ways, London is exactly like New York. Everywhere we went in London, I kept drawing analogies, like, "This must be the Times Square of London" (of Piccadilly Circus), or "This must be the Greenwich Village of London" (of Kensington). The only thing for which I could come up with no analogy was Buckingham Palace. Because we don't have a palace in New York. That's my sister, by the way.



Here's a shot of the atrium of the British Museum (which, in case you're wondering, is the Metropolitan Museum of London).



Here I am inspecting some Mayan artifact very closely, for some reason.



The only really London-y thing that we ate was fish and chips. I was tempted to try the bangers and mash, but I couldn't stomach the idea of eating all those sausages.



I have no idea what that sign means, "weak subway." London had an awesome subway. They even had padded seats, which I'm pretty sure would get destroyed in short order in New York. Also note that I am eating my favorite dessert of the whole trip--a Cadbury Creme Egg McFlurry from McDonald's. They take crumbled up bits of Cadbury chocolate, squirt in some yellow goo to simulate the yolk (only it's better, because it's not all dessicated, and there's more of it), and then stir it all up. So good. Can we get that over here, please?



Joe in front of the Tower of London. We walked up to it, but didn't go in, because you had to pay the rough equivalent of $30 (USD) to get through the gates, and unless they were planning on giving us some of those crown jewels at the end of the tour, I was not biting.



Joe in front of the Tower Bridge, which looked strangely like a Disneyland site, what with all the gold and blue paint accents.



We walked across the bridge to the Tate Modern, which was kind of a scary modern art museum that didn't have the most extensive collection in the world, but had a little something from most of the major modern artists. Here's a shot from the lobby of the museum. See, scary, right? And you can't even see the part where there's a loudspeaker overhead blaring some guy's voice screaming, "THINK! THINK! THINK!" along with some strange electronic buzzing in the background. I was like, "Don't hurt me, haunted museum."



Walking across the Millennium Bridge away from the Tate, on one of the few sunny days of the trip. Of note, both London and Paris are contestant cities for the 2012 Olympic Games, but Paris seemed to want it more badly. London just had a few halfhearted posters up in the subway, from what I could see, but Paris had giant neon light-up displays over every major monument in the city. I hope one of them wins the competition. As I've mentioned before, New York is also a candidate city for the Games, but I really, really hope it ends up somewhere else.



And finally, a shot of my vast waistline at 24 weeks. Now that I'm actually showing, I have people asking me how far along I am pretty much every day, and when I tell my fellow Peds peoples that I'm at 24 weeks, everyone gives me the big high five. Yay, extrauterine viability. Congratulations, Cletus. But stay up in there.


Speaking of pregnancy stuff, I just heard the news yesterday that someone that someone I kind of knew (more like "knew of") who was pregnant just lost her baby very, very close to term. I don't really know the details, but just in general, that really freaks me out. I mean, obviously, right? You really can never stop worrying. It's strange--in the NICU, we're surrounded by stories like that every day. Full term kids with anoxic injury, traumatic births, cord accidents, what have you. And it's sad, of course, and scary when you're going to have a kid of your own, but there's nothing like hearing that it actually happened to someone you know. In medicine, you start to think that you're immune to the bad stuff (except in the hypothetical), but it still gives me the shivers when the bad stuff grazes dangerously close to home.

Anyway. Breathe in, breathe out. Serenity now. Tomorrow, I'll tell you the real name that we picked out for Cletus.

Currently reading: About the news that Peter Jennings has lung cancer. So sad. Aside from my first thoughts, which tended towards the grim and sympathetic, I couldn't help but think that the guy does not look 66 years old. Early 50s, maybe. Actually, none of the big three anchors look as old as they really are. They are gifted with Bob Costas syndrome, in which they age in slow motion compared to the rest of us.

stateside

We got back from London around 2pm yesterday afternoon. Business class rocks the block. Not only did they have eighteen (18!) channels from which to choose in-flight entertainment--I watched "Meet the Fockers" and "Shall We Dance," the J.Lo/Richard Gere incarnation, neither of which were as terrible as I had anticipated, which is to say that I could watch them without wanting to kill myself--but the chairs were comfy and recline-y with a little lumbar support button, all Sharper Image-style. Also, there was plenty of leg room for me to stretch my flex my calves obsessively, because you know how I fear the DVTs. (This is not just some crazy idle fear, by the way. I had a patient as a third-year medical student who developed a DVT on a flight over from London. And she was in town for the marathon, so you know, she was all young and fit and such. And while I may be young, I am definitely not fit, at least not in that elliptical trainer, Pilates sense.)

So I was trying to get some rest during the day today, because I'm working a 7pm-7am shift this whole week, but I'm so jet-lagged and generally screwed up sleep-wise that after lying in bed ferociously willing myself to rest for the past hour and a half, I decided to just get up and post some vacation pictures. Here are a few snapshots from the first half of the trip, which we spent in Paris.



Joe at the Arc de Triomphe. Don't even talk to me about my French spelling, if there are mis-spellings, because 10th grade French class was a long time ago, and any such knowledge that I can dredge up from those times has been irrevocably corrupted by my pidgen medical Spanish. There were a lot of shady pickpocket-types around this area, probably due to high tourist density.



The obligatory shot of me at the base of the Eiffel Tower. No, we didn't go up, because the line was crazy long. Because of the angle of the shot, I decided to make an unflattering photo slightly less unflattering by pulling up my coat collar to hide the double-chin action sure to ensue from looking down into the camera. Also, it was cold.



Joe in front of the Paris Opera House. Our hotel was right next door, which made it very easy to find.



Joe in front of Notre Dame. It was all church-y inside.



Me outside the Louvre. It was all museum-y inside. Man, I didn't really notice it before looking at the pictures, but the weather was really kind of crappy those first few days.



Of course, we had to do all the obligatory drive-by photos of the Mona Lisa, Venus de Milo and all. Because we are tourists. At least we weren't clutching copies of "The DaVinci Code" while coasting through the museum. By the way, when I saw this exhibit, all I could think of was that Simpsons episode with the gummy Venus de Milo, where Homer is accused of sexual harrassment for grabbing at that "sweet can." You know what I'm talking about, don't play dumb with me.



Just so we weren't total tourist drones, we also checked out the extensive Egyptology exhibit at the Louvre as well. Because we are so scholarly.



Me dragging my carcass up the steps to Sacre Coeur. There were many steps. Many. And normally, I would not have had a problem, I swear, but let's see you climb up all those steps while lugging an extra 20 pounds on your bod without getting all winded. There was also a trolly that could take you up if you didn't think you could manage the climb, but I didn't want to be a total wuss about it either.



See, I made it up there alive. Coming back down was easier, obviously. The strangest thing about the neighborhood around Sacre Coeur, once you left Montmarte, was that it was totally surrounded by this porno red-light district.



Joe decided that he had to get his hair cut while we were on vacation, because it was "too long," and therefore driving him crazy. He is Hank Hill. I suggested that he wait until he got to London to get his haircut, so that he could at least, you know, communicate with his barber, but he was insistent that we get it done that very day. But I guess there's no real way to go wrong with hair that short anyway. I mean, unless they gave you an army flattop or shaved a word into you head or something.



The best thing about Paris was the bread. So tasty. And people really do go around carrying giant loaves of french bread. I thought that was just in cartoons, but nay, I am here to report that it is true. Also, I am here to report that I think that these low carb diets are a crock, because people in France are stuffing themselves with bread all the time, and they're skinny. So go figure.



Other tasty french delights: street crepes.



And escargot.



And hot chocolate. This stuff was so chocolate-y that I highly suspected that it was just a melted chocolate bar.



And this thing that they had at the McDonald's in Paris which was inexplicably called "Le P'tit Oriental."



Not so good food: fondue. Maybe it was just the restaurant that we picked. Joe had warned me that I was probably not going to like fondue, but I'd never had it before (being born at the tail end of the 70's), and was really curious to try, because oh, how cute, a little cauldron with forks in it. People, this it may look adorable, but be warned it is just meat dipped in oil! Or, worse yet, meat dipped in cheese, which we did not order, because we wanted to live beyond our 40th birthdays. Guh. No more fondue. Ever. See how Joe looks all mad here, like he's regretting having let me choose the restaurant that night.



Why don't we have cute streets like this in New York? We have sidewalks too. We should use them.



I love a city with a good subway system, though. We took the subway everywhere. In London, too. Either that, or we walked.


Anyway, I really should get some rest or I'm going to be useless tonight. I'm doing a week of being "second senior" on the wards, which basically means that I'm there primarily for backup, doing admissions or helping to put out fires on any of the sicker patients on any of the four ward services. Tomorrow, or whenever I get around to it, pictures from London.

Currently reading: The New Yorker article about Edward Albee.