Labor(less) Day

Wow ... has it really been a month since I last wrote anything? Oops. I can't say that I have a very good excuse for not keep the blog up to date either - my life has been much less busy during the past few weeks. For almost a month now I have been working in Scripps Mercy's outpatient urgent care clinic. The nice thing about it is that it is more like normal business hours - 8 to 5, Monday through Friday, weekends off; the other side to it is that it isn't always quite as exciting or interesting as working in the hospital. Being an urgent care clinic, we should theoretically be seeing problems that are urgent - meaning, too serious to have to wait for a regular doctor's visit, but not quite severe enough to warrant a trip to the Emergency Room. While that is the case for many of the visits to our clinic, there are also more than I prefer of the following kind of visit:

Me: "So what seems to be the problem?"

Patient: "Oh, Doc, I've got some serious back pain."

Me: "I'm sorry to hear that. How long has this been going on?"

Patient: "Oh, well... probably a couple years."

Me (a little confused): "Really? Did something happen recently to really set it off?"

Patient: "No, not really. It just hurts still."

Me: "Oh. Have you seen your regular doctor about it?"

Patient: "Not yet, but I just thought I'd come in here. Hey, do you think you could prescribe me some Vicodin?"

I am beginning to understand why Vicodin is the most commonly prescribed medication of 2008.

Well, one of the nice things about working in the urgent care clinic is that if there is a holiday, you get the day off (not so if you are working in the hospital). Labor Day was a lot of fun this year. My sister was in town with her husband and kids for the weekend - they ended up coming down somewhat last-minute. Unlike some of my dear friends, we spent the day relaxing and doing fun things.

We spent part of the morning with the family at the beach. My dad and sister talked me into actually going surfing again (for the first time in about 4 years). It was beautifu

l weather and a lot of fun. The kids enjoyed it too as you can see.

After the beach, we came home for my parents' annual Labor Day BBQ. We had a bunch of friends over, swam in the pool, barbecued burgers and hot dogs, and generally enjoyed ourselves. I think my niece may have even made

a new best friend. Overall, it was a great day. The kind of day that makes it even harder to go back to work the next day.

I have one more week of work in the urgent care clinic, then I'll be off to ENT.

The Price IS Right!!!

Okay, this is my first attempt at a post, and it's an exciting one....
-Ashley

My college roommate Michelle and I left San Diego today at 5:15am to head to the CBS studio in LA for the taping of The Price is Right! Michelle was heading to Anaheim for an Uppercase Living convention, and some of the ladies got group tickets for TPIR, so we jumped at the opportunity. After LOTS and LOTS of waiting in line (5 hours!), we finally made it to the front of the line to be interviewed by the show's producer. For those of you who have not had the privilege of attending a taping, this is how they choose the contestants for the day's gameshow. Michelle must have impressed the producer with her good looks, quick wit, and charm... they really seemed to love her!

Around noon, we finally got shuffled over to the waiting area for the studio. [Let me warn you, if you ever go to TPIR (which I highly recommend -- it was a lot of fun!), be sure to bring snacks! You are there for a very long time, and there is really no time to leave to get anything to eat. Needless to say, we were starving by around 10am without any options for food.] So, after relinquishing all electronics outside (I hoped to see my iPhone again), we made our way into the studio. A-maze-ing! It was incredible to walk into the studio and see the set of the TV show I had watched all these years. The studio is actually much smaller than you might expect -- not a bad seat in the house. It was very exciting!

After we got to our seats, we were given a brief overview of how the taping was going to work. Before we knew it, the bright lights came on, the "Applause" lights illuminated, and they started the show introductions with Drew Carey (Bob Barker's replacement). Wow - everything happened so quickly! The first step was to select the first four contestants. One by one, Rich Fields (he's the "Come on down" guy) read off their names, the assistants held up signs with the names (since we really couldn't hear much in the audience over all the clapping), and the contestants chosen ran down to their places.

Michelle was called as the second contestant!!! We were super excited, we stood up and cheered, and she ran down to the front of the studio. They filled the rest of the places, and then the show really started. During the bidding stage, Michelle kindly decided to let her competition take on the first two prizes (she was waiting for the really good stuff). I'm sure she didn't want the surfboard and snowboard package, or the set of crystal stemware. It was definitely time to act, however, when the chaise lounge shaped like a shoe was up for bid. She outbid all the other contestants (retail value was $1500!) and ran up on stage to play Bonus Game with Drew. Michelle did really well! She won 3 of the 4 smaller prizes (TPIR video game, toothbrush sanitizer -- everyone needs one!, and waterproof iPod speakers), and then won the bonus prize! You will have to watch The Price is Right on October 27th to see what bonus prize Michelle won (we're sworn to secrecy). Let's just say it starts with dune, ends with buggy, and might look something like this. I'm not sure where she's going to use that thing in Seattle, but it sure makes for a cool story! The only bad part - all winners have to pay taxes on their winnings. Michelle almost made it to the Showcase Showdown - she spun $1.05 (so close!) on the big wheel. The winner (a nursing student from Tennessee) ended up winning a Lexus SUV among other things.

It was an exhausting day, but it was so much fun to cheer for Michelle and just be there to experience the show. I would love to go back - it really pays to go in a group (then you're pretty much guaranteed a spot) - so let me know if you're interested! It ended up being about a 12 hour trip for a one-hour show, but well worth it -- except for the ants in the rootbeer on the way home. Gross. Other than that, it was super fun!

Be sure to watch The Price is Right on CBS on October 27!

1/13th Through

Today is the last day of our first rotation (we switch rotations every month). Since the rotations are 4 weeks each (not actually 1 calendar month), there are 13 rotations total for the year. It so happens that I have the luck of being the last person on call for the block. Presently I am at the hospital in my call room. It has been an uncharacteristically slow day so far (keeping my fingers crossed that it holds out), so I thought it was about time that I start a new blog entry. I'll try and summarize the last few weeks as best as I can.

By way of update to my last blog, the guy who we diagnosed with a brain tumor ended up getting surgery and is doing quite well. He went to the ICU after surgery (standard for neurosurgery), but I was able to go visit him pretty much everyday even though I wasn't responsible for taking care of him while he was in "the Unit." We've developed a really good relationship through all of this. On Thursday, he came out of the ICU and back to the regular medical floor, so I'm taking care of him again. He was really weak right before he had his surgery, but he's recovering a lot now and I'm really happy to see him progress so much. He has definitely been the most interesting, and my favorite, patient so far (... don't tell my other patients, though).

In retrospect, this first month has gone by pretty quickly. I'm sure this year will be long gone before I know it. It hasn't been until recently that I've truly felt like I have completely eased into everything, though. The first week or so was pretty rough - I found myself trying to fight back the nearly constant thoughts that maybe I had chosen the wrong career. Stepping into the role of intern, there is a very steep learning curve just with respect to medical knowledge, let alone the fact that being at a new hospital requires that you relearn a bunch of basic stuff on top of that: how to use a new electronic medical record system, who to talk to for discharge planning resources, where records are kept in the ER when admitting patients to the hospital, what the proper procedure is for entering orders for your patients - the list really could go on and on. It was nearly overwhelming.

I think that it wasn't until I had a conversation with my good friend from medical school, Tim, who's also at the beginning of his internship in Ear, Nose, and Throat surgery out in North Carolina (at Wake Forest, where I'll be next year), that I really started to feel better about things. Tim started his internship in the surgical ICU - even more intense than what I'm doing. About a week after we each had started, we caught up with one another and had a short conversation - I think we were both a little surprised to learn that the other had been going through the same sorts of feelings and thoughts. After commiserating a bit, we each left the conversation feeling a little better. I'm sure it is a common experience among interns to go through those feelings of inadequacy and self-doubt. Having friends to go through it with can be quite therapeutic though.

Tomorrow all of the interns will be switching roles since we're starting a new block. Since I'm on call all night tonight through tomorrow, I'm bridging the two blocks - I'm actually the one intern doing two months straight of inpatient medicine from the beginning. Even though it would be nice to have a little break after this somewhat busy month, I'm glad that I can knock out two of my busier months at the very start. And since the interns that are taking over tomorrow have all been doing something else this first month, it will feel nice to be the "experienced" one for a little bit.

* * * * * * * * * * * * * * * *

Ok, my call night is over now. I just thought I'd add one thing to this blog before posting. While I was on call, I was awoken by a phone call from one of the nurses at about 5:30 AM; the conversation went something like this:

Me: "Hi this is Dr. Tower."

Nurse: "Hi, Dr. Tower this is ____ up on the 6th floor. Could you please come up here and pronounce patient so-and-so dead?"

Me: (Long pause) "Ummm ... ok."

Now, this was not an unexpected death - it was a patient who had been really sick and who's family had decided it was his time to go. Regardless of the situation, though, unless you work around death a lot, I think it can still catch you off guard. This patient belonged to one of the other interns, so I was just covering that night - however it was my responsibility to go and perform the death examination. There is a somewhat standard set of things you are supposed to do to determine that a patient is actually dead, and these things comprise the death examination. This was my first experience as a physician performing the examination and declaring, "Time of death - 5:45." I guess officially you haven't really died in a hospital until a doctor declares that you have died. In any event, it was another one of the 'firsts' that I have now gone through since starting internship. I've checked off a lot of those boxes now. I wouldn't be too disappointed if it were also my last.

Mixed Emotions

I find myself already a couple of weeks into my internship now. I meant to devote a special blog to my first night being on call at the hospital, which by the way was pretty crazy and involved me working a 32 hour shift on zero sleep, but that opportunity has passed. In fact, I just finished my second night of being on call with a 30 hour shift. This time was significantly better than the first, though still very busy.

Even more interesting than my experience of being on call, however, is one of the patients I've been taking care of recently. Without revealing personal or identifying information about him, I'll try and give the gist of his story. He is a pretty young guy, somewhere around my age, who has been having progressively more and more problems swallowing for the past several weeks to months. It turns out he has also been feeling sick a lot for the past several months to a year. The swallowing problems have become so bad that he hasn't hardly been able to eat anything for a while and has lost a lot of weight. He had no idea what was going on, and neither did we at first. The more we talked to him, though, the more it sounded to me like it was a neurologic problem that was affecting his swallowing. I wanted to see an MRI of his brain and we ended up ordering one. After a lot of other tests that weren't showing why he was having the problems, the MRI showed that he has a tumor in his brain.

I will say that making that kind of a diagnosis comes with a lot of very mixed feelings - as the guy's doctor, you are happy to finally figure out what the actual problem is, but then you realize that the answer isn't such a great one for the patient. The disappointment in the realization that you have to tell someone that they have a brain tumor quickly overcomes any excitement that comes with solving the case.

This was my first real experience in being the person responsible for relaying some very bad news to my patient. Fortunately I felt I had developed a pretty good rapport with him, which made delivering the news a little easier (and a little harder). Of course, he was completely stunned and in disbelief. Overall, though, I think he handled it very well - a lot better than I'm sure I would have.

The neurosurgeon came to see the patient and is planning an operation soon. We are all hoping for the best. I especially like this guy and feel that in an interesting way we've bonded even more through the experience. I'm trying to stay optimistic - and in the meantime he and his family will be in my prayers.

Disoriented

The one thing that kept me from starting a blog for a long time was the fear that I'd create one entry and then never blog again ... ever. Well, I am happy that hasn't happened, but as the beginning of my internship is fast approaching I worry that my blogging pace may slow down significantly. I feel that I'd better do as much storytelling as I can now before I am soon thrown into the lion's den.

I am now finished with my Scripps Mercy Hospital internship orientation. After the first day and then the ACLS training (see previous post), the pace slowed down significantly. We went from injections of amiodarone and electrical cardioversion to sitting all day long in a squished auditorium listening to people talk to us about everything that we'll ever want to know during the next year of work. They talked to us about the Scripps Mercy mission, employee benefits, information systems, what to do in case of a fire, discharge summaries, infection control, call schedules, and probably a dozen other things that I've already forgotten. Finally on the last day, they gave us our schedules and ran us through the nuts and bolts of working in the hospital. Many of us were very anxious to know our schedules - we had all waited a long time (some of my friends from med school had already been told their internship schedules before we graduated in early June even though they weren't starting until after me).

Because I am doing a so called "Transitional Year" for my internship instead of a regular internship just in, say Internal Medicine or General Surgery, I will be doing a variety of different rotations throughout the year which is composed of 13 blocks that are each 4 weeks long (though it will be mostly weighted towards Internal Medicine). So, drum roll please .... my schedule (block by block):

1- Internal Medicine (Hospital)
2- Internal Medicine (Hospital)
3- Internal Medicine (Clinic)
4- Ear, Nose, and Throat Surgery
5- General Surgery
6- Internal Medicine (Hospital)
7- Cardiothoracic Surgery
8- Internal Medicine (Hospital)
9- Internal Medicine (Hospital)
10- Radiology
11- Internal Medicine (Hospital)
12- Pediatrics: Special Care Nursery
13- ER

That's it. I start my first official day on Wednesday. I have my first night of "call" on Friday night where I'll be working a 30 hour shift and will be responsible for taking care of possibly as many as 100 patients overnight (my own patients as well as the patients that all the other interns would be taking care of if they weren't at home in their beds sleeping). One of the (many) nice things about working at Scripps, though, is that I'll only have to do those 30 hour overnight shifts once every 10 days instead of once every 4 or 5 days like at some other hospitals. I'm not going to lie to you, it is a little anxiety-provoking to think of the responsibility that is being placed into my hands. I am sure I will be able to handle it, but it is just a little mind-boggling sometimes that I've already come this far. Anyway, wish me luck (or better yet, maybe wish my patients luck)! I'm sure that I will have some interesting experiences to blog about.

Doctor: Day 1

Last Friday was my first day of orientation for my internship at Scripps Mercy Hospital in San Diego. As this marks the beginning of my "official" duties as a doctor, I figured that I should probably summarize the happenings for posterity's sake.

Friday morning I woke up and did my usual routine to get ready for the day. I had been fighting off a minor cold ever since we had got down to San Diego on Tuesday, which I felt like I had pretty much beat. Since I still had a few sniffles, though, I decided to pop a 12-hour Sudafed to clear up the sinuses so that I wouldn't have to be blowing my nose all day long as I met all of my new colleagues for the first time. It kicked in pretty quickly and I was already feeling somewhat better. I finished breakfast, hugged Ashley, then Mom, then Dad and walked out the door as everyone wished me good luck. It was more than a little reminiscent of every first day of school that I had experienced growing up from elementary through high school (with the exception of me being married this time). The only thing missing was the first day of school photo.

The orientation day itself involved meeting a lot of new people, all of us dressed up and smiling and cheery. Everyone was very nice and I met a lot of people that I could tell right off the bat that I will probably get along very well with. The first day wasn't too exciting - mostly just filling out paperwork, getting on the payroll, obtaining ID badges, getting immunizations and a TB test, a preemployment physical, and a definite "first" experience in my life: a urine drug test. In case you haven't ever had the pleasure of experiencing a urine drug test first-hand, allow me to try to capture in some small way what that experience is like. After filling out a short form so they can identify your ... ummm ... sample, you are handed a plastic cup and enter a bathroom. However, since they have to make sure that you're not "cheating" on your test, you are accompanied by a supervising staff member. This must be the least sought-after job on the planet: "Ok, Jennifer, today you will be assigned to the task of making a bunch of new doctors feel completely uncomfortable ... all day." At least they don't enter the stall with you.

After finishing that test, I sat in the waiting room and waited for the physical examination from one of the Scripps clinic physicians. As I sat there I thought to myself, "Hmmmm... I just took a Sudafed this morning about 2 hours before I took that urine drug test. Uh oh." FYI, Sudafed contains a drug that is of the same nature as the class of illicit drugs known as amphetamines. In fact, the company has somewhat recently switched the main ingredient in the unregulated over-the-counter form of Sudafed from pseudoephedrine to phenylephrine because pseudoephedrine can be used to manufacture methamphetamine. Fantastic.

I sat there contemplating the various possibilities of what might happen when they found out my test results. I figured they probably wouldn't be very happy if one of their brand-new interns tested positive for amphetamines on the first day of the job - especially when they had previously warned us that we'd be getting drug tested. Good thinking, Sean.

Well, fortunately for me when I explained what I had done to the physician doing my physical exam, he said, "Oh don't worry. I'll just make a note that you took some Sudafed so if it comes back positive it won't be a problem." PHEW. I was really worried for a second, though.

The rest of the day went much more smoothly. By the end of the day I was worn out. Even though we didn't have to necessarily DO a whole lot, meeting lots of new people and putting my best foot forward is really tiring for me (I promise I'm not anti-social, I'm just an introvert).

We had the weekend off which was nice because Saturday was Ashley's birthday. We had a fun time going out to dinner at PF Chang's (one of Ashley's favorites) with Mom and Dad, and Brian and Tira. Then we had Baskin Robbins ice cream cake back at home with that crew and a couple more of Ashley's friends that live down here.

Monday and Tuesday I headed back to orientation. These days were pretty exciting for the most part. Both Monday and Tuesday were spent doing ACLS training (Advanced Cardiac Life Support training) and testing to become certified. The training prepares you to know how to respond to any situation where someone collapses and needs emergency medical attention. It goes beyond the basics of CPR to also teach you what drugs to give people in certain situations and how to appropriately use a defribillator if a person develops a dangerous heart rhythm. We spent a lot of our time huddled in groups around a dummy while our instructors ran us through various scenarios and we shouted things like "Give him 1 milligram of epinephrine, STAT!" and "She's in unstable monomorphic V-Tach - prepare to shock her. CLEAR!" Ok, well I may be making it sound a little more exciting than it actually was (they were just manequins after all), but still it was more fun than filling out paperwork. And I also believe that I would definitely feel a little more confident if I were faced with such a situation now in the future. Hopefully not anytime soon, though.

On the Origin of Blogging

Have you ever really wanted to do something big and then thought to yourself, "But where do I even begin? This is such a big project and I'm not even sure where to start." Then you think, "Well if I just keep thinking about it, it will never happen." And then, "Ok, I'm just going to do it." Then it's, "Man, why did I ever start blogging in the first place - this is tough. I can't even find a URL that hasn't been taken." Well, I guess the moral is that sometimes you should start your blog before everyone else has taken the URLs you want. I think there may be a moral about sticking through things that are tough too.

Whew. Ok, we've started. I'm not sure where we've started, but we've started. You see, there has been so much that has happened in our lives recently that it is a little daunting to even consider summarizing it all to bring anyone who actually might read this thing up to date. Here's the short version: finished college, moved to northern california, 4 years of medical school (lots of stories there), got married, got a cat, graduated medical school, moved back to San Diego, and start my first day of orientation for my internship tomorrow. I guess that's it.

Well as you might guess, there are a few interesting stories that we've missed already. We may still enter the Delorean and go back in time to tell some of the ones we'd like to remember. Part of the reason we've started this blog is to document our lives in a fun and (hopefully) interesting way (there was a small amount of coercion from some of our dear friends as well). Retrospectively, we kind of regret not having documented more of our lives up to this point - but hey, better late than never, right?

Will we have any interesting stories to tell? Hmmm ... consider this: young married couple with no kids (yet - right now just a cat), husband just graduated medical school and so qualifies as being one of the least experienced doctors on the planet about to start his first year of residency training (the year-long internship) where the learning curve is steeheeheeep, both husband and wife have just moved back to his hometown for said internship and into his parents' home for an as yet indeterminate amount of time where they'll be sharing the house with the parents and a cousin (and the cat). I feel like our lives have just entered the setup for the newest sitcom on NBC.

Don't get me wrong, we are waaaaay excited to be back in San Diego and love the parents and the cousin (and the cat), but I promise there will be some funny stories along the way. We'll do our best to document them as they happen - Ashley is committed to keeping this blog going too - so stay in touch and let us know what you think.