About time.

It's been far too long, I know and I'm sorry. So for those of you who still bother to check my blog - thank you, I have decided that you deserve an update on my life, however brief it may be. Here are some happenings:

-I passed Step 1 of my board exam! With flying colors at that. This was a huge hurdle and event in my recent life. Thank you to everyone that listened to me whine, encouraged me, prayed for me, told me to chill out, etc. It helped - all of it. And I am grateful and relieved.

-I began my clinical rotations with Pediatrics 4 weeks ago. It has been a rollercoaster so far...

• Week 1 was spent in the Newborn Nursery. Basically, I got to hold and play with healthy newborn babies - it was fun, educational, and the hours were nice. I even changed my first ever diaper and it was meconium (that really sticky, tarry first baby poop)!
• Week 2 was spent in a community Pediatrics clinic in Davenport, IA. I enjoyed the pace - we saw a new patient almost every 15 minutes. Lots of ear aches, rashes, and fevers. At this point in my training it was all new, so I enjoyed it. I got the hang of it by the end of the week and was feeling pretty comfortable.
• Weeks 3-4 were spent on the inpatient Pediatrics floor here at the big hospital in Iowa City (University of Iowa Hospitals and Clinics - UIHC). My particular floor was the Hematology/Oncology unit - so lots of kids with leukemia/lymphoma receiving chemotherapy and awaiting bone marrow transplants. My first patient was an 11 yr old girl newly diagnosed with acute lymphoblastic leukemia (ALL). Typically this disease has an 80-90% cure rate. However, she had some unusual complications and died within a week of her diagnosis. I was blind-sided. She was very shy and not very talkative - so I had spent an extra amount of time trying to get to know her and her family over that week. Then things went downhill so fast. What do you say? Her family was lost - it was all a blur and then she (and they) were gone. I mourned for a while, but then you are forced to move on. Her room was filled by a new patient the next day. Needless to say, more processing of emotions is needed. But that's the problem with medicine - you don't get the luxury of time to deal with these things. I've been learning a lot of things, but perhaps the biggest lessons have been about how to simply survive in this culture.
• On a brighter note, I have had some new experiences with procedures. I performed my first LP (lumbar puncture, or "spinal tap") last week. This is a significant and rare privilege for a 3rd med student. It went suprisingly well and I felt like I was walking on clouds as I left the hospital that day. (It's the small things that keep you going at this point.) I also learned how to and practiced placing IV's. Again, not something routinely taught to med students at this point, but we took the initiative and asked one of the nurses to teach us. That's an observation that I have been making recently - when it comes to simple and "routine" procedures - like injections, IVs, bandages, etc - most doctors have very little, if any, experience and expertise. The nurses are the only ones who do these things. In fact, the nurses more or less do everything with respect to direct patient care and contact. Mostly the docs sit around and think, make decisions, and write orders which are then enacted by the nursing staff. I suppose this makes sense and is an efficient way to do medicine - however, I find it interesting and a bit frustrating that we are not formally taught how to do most of the things that we are "ordering". I may know which type of drug a patient needs and how much to give the patient, but I wouldn't have the first idea of "how" to give that drug to the patient. Strange, if you ask me.

-I spent an evening in the Pediatric ER on Friday and loved it. I love the fast pace, patient interaction, duty to treat all who enter, ability to alleviate suffering aspects of emergency medicine. On inpatient medicine, so much time is spent on "rounds" (talking about patients with other doctors) or on the computer system looking up lab values, ordering tests, and writing progress notes, that very little time is actually spent with the patient themself. Not so in the ER, computer time is still necessary, but is much more brief. The focus is to get the patient stabilized, better, and out on their way. I love being able to see someone with suffering and concern, alleviate that suffering and provide assurance, and see them leave better than when they walked in. Could emergency medicine be my calling? I have a long way to go before I'll know, but it's moving up on my list.

-I've been climbing in my scarce free time on the weekends, and otherwise trying to enjoy what little I can of the outdoors. Being in the hospital so much has a way of letting you forget just how much you appreciate the out of doors and how regenerative time spent outside can be.

-I'm currently reading a book called "Three Cups of Tea" about a climber who, after being nursed to health by a village in remote Pakistan after a failed attempt to climb K2, devotes everything in his life to building schools for children in that village and others of the region. I am inspired.

-I watched a movie last night called "The World's Fastest Indian" about a man following his dreams to break the motorcycle landspeed record against all odds. Again, it was inspiring, funny, and feel-good. I would highly recommend it.

-Life keeps on moving on so fast. Two of my good friends are about to become dads, two are moving to Fort Collins, another is moving away from the Midwest, my sister is a newlywed in a new place and I'm missing it all while I spend most of everyday walking the halls of UIHC. I miss and love you all very much and wish I had more time to visit everyone.