Cathedral of Our Lady's Assumption from the Peoria River

Peoria, IL - July 2009

So imagine going through college and your only exam was once a year - one exam for everyone in your major, which you all take at the same time. It occurs on a random day in the middle of the week.

There's no prep or cramming - you're supposed to be studying all year, of course, because this covers every subspecialty imagineable whether or not you have actually trained in it yet. (There IS a study guide based on last year's exam, which the truly test-oriented students actually use.)

Your grade is a mysterious number comparing you not with your whole major but year-for-year with your peers across the nation. Your goal is to hit a general range, improving gradually over your course of studies -sounds almost reasonable, but slightly crazy - because wait - did I mention this exam is 8 hours long?

Yes, internal medicine Intraining Exams are at hand.

Mine is tomorrow - all 8 hours of it. :)

Say a prayer that double vision, spinal cord compression, comatose-like sleep, insanity or other asundry conditions do not set in while surviving the Ordeal.

By tomorrow night, I suspect I'll be doing the classic Kemba-thing (above)!

Jer. 29:11

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On the Road Again... Omaha!

I-74 over the Illinois River, Peoria

It does not seem like a year ago that I took a cross country trip east in October.. This year I have taken the opposite direction, with a little different purpose. Then, it was reconnecting with family and friends. This year, I hopped into a Suburban with Caron Easley and three little Easleys and made a brisk 6 hr trek to Omaha Nebraska. That was Friday afternoon. It was filled with funny conversations from the 2 & 4 yr olds, Henry and Violet, minor dramas from the same department, entertaining commentary from 6 yr old Annabelle, and great conversation with Caron. The scenery was somewhat obscured by pouring rain, but that didn't really dampen the enthusiasm for the journey. I really am looking forward to the trip back for an encore of such good company - it far exceeded making the drive solo in my tired post-nightfloat state of being.

Currently, I've settled into the Comfort Inn in Omaha for a 9-day course on the natural regulation and management of fertility, woman's health and the psychosocial, medical and ethical issues that all play into this. It's challenging and fascinating. There are a group of Ob/Gynes with a special clinic devoted to this - associated with Creighton University - leading this research.
I come with a healthy mix of curiousity and lots of questions. I think I've had such a broad exposure to so many women's experience that I come in with a lot of ideas about ths particular system's benefits and limits. It's a great opportunity to delve into the medical aspect of things for myself and to meet lots of other (young!) residents, nurses, moms & dads, some older doctors too, becoming practitioners - trained experts who will help teach patients how to use this. Tapping their wide experience - from converts to previous patients (with and without underlying problems) - has shed a lot of light on my questions. I think i'll be putting a lot more work into this in the future, partly because I see so many ways it can be applied and how it needs to grow as well.

In the meantime, I mostly here to learn - not dream - unless that's in bed, where I should be, as we actually have an exam on Tuesday so tomorrow night is study night. :)

~ ~~~~~

All About Watermelons

A brief note to all my fellow gardeners - or semi-gardeners - whom I pestered with the question about when to harvest a watermelon... This is what I found. Of note, the famed sound of a ripe watermelon is NOT hollow, but dull (which makes more sense, given its increased water content).

Thanks to the Univ of New Mexico and their agricultural program:

Picking ripe watermelonsQuestion: How can I tell when my watermelons are ready to harvest? Every year I waste several, picking them before they are ready or waiting so long they are overripe. Thumping them doesn't work for me.
Answer: Choosing a ripe watermelon is a challenge. In the field or garden it is much easier than in the store because you will have more clues. The indications to look for in the garden are the drying of the "pigtail" or tendril closest to the melon on the vine. If it dries while the leaves and rest of the vine looks good, the melon should be ripe. The tendril is not available to melon hunters at the grocery store. A second clue, which is available at the grocery, is the color of the "ground spot," the place where the melon rested on the soil. If this ground spot is yellow or a cream-yellow color, the melon is ripe. If it is green or white, it probably is not ripe. The rind at the soil spot should toughen and resist denting with a fingernail when the melon is ripe. Finally, for those with an ear for music or who can easily distinguish sounds, the ripe melon will have a dull thud when thumped, while the unripe melon will have a tighter, ringing or hollow sound.
New Mexico State University Extension Guide H-216, "When to Harvest Vegetables" is available at your local county Extension office. This publication gives guidelines for determining when to harvest 40 common garden vegetables, including watermelons, cantaloupes, and pumpkins.

Basic Owl Time...

Everyone knows I am apt to go MIA for months at a time. This summer proved to be no different despite hopes to the contrary! Most recently I have been working the nightfloat shift, 7pm-9am for 5 days a week, aka "Basic Owl Time." (So-dubbed by Julie.) I thought perhaps there would be quiet nights where I could caught up on important things, like medical records and blogs, but these proved to be rare and elusive. In fact, when the quiet hour hit I was just happy to catch up on the work from earlier in the night or catch a catnap. The latter happened a grand total of 3 times.

My team had a lot of fun together, though. Entertainment ranged from talking the midnight chef into making fresh French fries (my intern Maxine's specialty) or making coffee & chocolate cake runs, calculating how to correct low sodium levels or run fluids for DKA (diabetic ketoacidosis), or laughing at how our sleepy dictations turn out when the hardworking transcriptionists attempt to guess at what we were mumbling. There have been some choice mistakes - have you ever tried "teething" the details of a situation out of a patient? (I meant teasing out the details.)

As proof that Basic Owl Time is amenable to cross-country travel, disregarding time constraints and zones, I did manage to get out to Maryland to see Julie, Stephen & the boys...

(Speaking of entertainment!!)

And I made it to Chicago for Amy & Clif's wedding, complete with many friends.

In retrospect, perhaps one trip would have been plenty as I have now contracted one of our malignant, nosocomial, highly contagious and persistent hospital viruses. But life does not wait on residency schedules and the trips were well worth it....

So, on we go.... Heading of to Omaha, Nebraska next! I'll keep you all posted.

Today I admitted a 55y-o type 1 diabetic and went suddenly into diabetic mode. ... Then I got wistful about the great outdoor time at camp and all crazy insulin calculations I can now do in my head. (no calculator! My gradeschool teachers would be amazed and proud.) General adult medicine is complex and thoroughly brain-fatigueing in the hospital, but it's almost fun for the same reason. If only we named our teams after Wild West characters. :)

Half-Way Through!

This July 1 marked the official half-way point for the med-peds residents in my year! Of course, it's a momentous day by all accounts since all the new interns start, the previous interns are catapulted from a junior position to senior responsibilities, and the 3rd year "categorical" pediatric or medicine residents have a momentary pause as everyone now greets them with "12 months left!" - likewise the fourth year med/peds residents like my roommate Kate.

Before we hit that day, the pediatric and med/peds residents had a retreat day off to themselves to catch our breath. It started with some standard, but pretty funny, team-building exercises. We learned some interesting things, such as that our quietest resident Marte (middle above) was a rugby player in college (!) and Jane (below left) who wants to do clinic medicine because she's not a crises sort of person started out in emergency medicine.


You may also be encouraged to know that if you happen to get stranded with Lena, Marte and myself (above) in Northern Canada in the winter, when your plane crashes and leaves you with a very limited number of supplies - you're very likely to survive according to the special forces Army whiz that put this together. You'll have to build a fire, wear Crisco as face protection and maybe even eat it.... but you'll have good company. (It helps to have lived in Minnesota and met -40 degree weather.)





On the other hand, if you get stuck with this team of Jane, Chris and Zain, your chances are somewhat slimmer. You'll either have to hike 20 miles by compass with a map that is of questionable value since you have no idea from where you started, or you'll die in rapidly after chocolate-whiskey fondue has given you a temporary high, followed by alcohol-induced vasodilation, causing you to rapidly lose all your body heat. Nonetheless, you'll STILL be in good company... :) (They took this defeat with good humor.)



On to more serious things, Drs Javed and Edwards discuss the merits and demerits of private practice vs pediatric hospitalist work.... Dr Javed is our newest neonatologist and the assistant residency director for pediatrics. Dr Edwards heads up the pediatrics hospitalist service.

Dr Schultz - head of the pediatric ambulatory clinic and newborn nursery service - taking in all the banter and commentary on how times have changed!

The Drs Nulty -

the truly delightful husband & wife team that head up our combined internal medicine / pediatric program. They fall into the category of relatively few people who qualify as being both admirable and imitable!

After a session on legal topics (really nice ones like depositions and being called to court), lunch with the attending panel discussion on Life After Residency (closer for some than others!), we headed out bowling.

Only three of our 7 med-peds residence made it this far in the day, but we scored quite well, Randy and Zain (behind me) making up the bulk of the points! I think I came in not-exactly last.

That rounded out June, my month on the floors. It was a tough but interesting month. I directed a team of two juniors and 2-3 medical students. For the medically or encyclopedic minded, our cases ranged from central line sepsis in a baby with congenital nephrotic syndrome (of the FINNISH type, mind you), failure-to-thrive in a baby with caudal agenesis / sacral regression syndrome who wieghed 1kg above her birthweight at 9 months age, to respiratory failure in a little girl with only one patent nostril ("choanal atresia"), a floppy airway and Freeman-Sheldon Syndrome (one of 15-20 described cases world-wide of this musculoskeletal disorder). At one point every child on our team of 12-16 patients had a complication of a syndrome or cancer - no "average" asthma or diarrhea cases! (Those came later.) We also had some great cardiac cases (all repaired with little post-surgical idiosyncracies)- such as transposition of the great vessels, Tetrology of Fallot and hypoplastic left heart. It was like a board review up close & personal all in four weeks... if I'd just gotten to read about everything instead of working madly to keep up with the lab results!

I was pretty tired by the time July 1 rolled around, but it's a great feeling to come through a hard month pretty well. Like a well-run marathon.

At the end of the month, my friend Rebecca (and her baby Sarah) and I hosted a baby-shower for one of our pediatric interns, Morgan...

It was a fun afternoon to indulge the craft & girlish side of the doctors involved!

So lest you worry when I lapse into long silence, there's always two sides to life in residency. :)

July 12, 2009

Rain & Shine

After all the late winter and spring rains that kept the Peoria River well above the flood level for three months straight, we have finally settled into a gorgeous cyle of showers and sunshine. It's been a lush time for the yard, and work has forced some early risings, so I get to enjoy it at its best! My favorite morning start has been sitting on the front stoop to soak in the sun and a little quiet time...

One morning last month a huge storm had just rushed through. There was such a rosy glow outside that I stepped out to catch some of the post-downpour freshness... and saw this vibrant rainbow!

Immediately, everything running around my mind went quiet. I was in the midst of an especially crazy week on the pediatric wards, somewhat understaffed for the time of year, causing some of the residents to wear multiple hats at once. (Multitasking is not my favorite passtime.) The image of the rainbow cutting through the tangle of powerlines struck me - and all day stayed with me, reminding me of how faithful the Lord is in the midst of the most mundane or self-contrived chaos.

To save my sanity I've put in alot of time in the garden, often before work. There's a great deal of entertainment some mornings, depending on who is up. This particular morning, Kemba came out with me and calmly watched all I did. Being one of the most gregarious cats I know, Kemba's main fault is getting under foot and hand while I'm trying to weed. Occasionally he things sitting ON the plants is the best way to hold my attention. It is, briefly - while he is ousted.

With Kemba's antics comes an audience of blackbirds and - this morning - squirrels. They hover on the power lines and comment on every move he makes. The squirrel, well out of reach of anybody, proceeded to give me a half-hour earful on what he thought of Kemba - loudly, with all sorts of pitches and possibly expletives, punctuating certian points with a bounce and emphatic gesture of The Tail. I had to capture it (though poorly) on film because of his singular perch and opinion, all alone in the expanse of sun and blue.

As of yesterday, the garden is voluminous and very happy. Quite by accident, I located a large zucchini as I was doing a last survey before dinner. We already had the grill going for chicken and veggies, so on went fresh zuchini - with onions and peppers! The results were excellent.

Today has been a pleasantly rainy day. I went into clinic (where I'm supervising the interns this month, teaching them the basics of the clinic routine), only to find there was no work to be done, no interns so teach. It's a new schedule that I'm still trying to learn.... So I wrapped up some paperwork and headed back to my attic retreat for a few hours. That's why your getting this blog update today! :)

With the exception the a few interruptions by the airforce jets, it's been deliciously quiet.

I love raindrops.... on windows, on umbrella's, and especially on flowers, so I went on a browse in the garden...

Then the sun returns...

It's a great month in Illinois.

July 8, 2009