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Pediatrics
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hey peeps
how's things?
to take care of business from the last email, the correct answer to my bee
sting sites is 1)belly button, 2)right wrist, and 3)left ear. the wrist swelled
up to where i couldn't flex/extend my wrist. the ear was the worst. i looked
like a semi-dumbo (except i couldn't half fly) for a few weeks. and even after
that for the next 6 months every time i looked in the mirror i saw some asymmetry
in my ears. it took 3 years of therapy to get over that. and much props to
my sister's coworker stuart for passing along an article about a bee attack
in houston last week. "In all, three women and one man were transported
to a hospital with bee stings. Officials said some of the injuries might be
serious." be afraid, people. i don't make this stuff up.
so, new rotation. pediatrics. basically i'm working in a huge cesspool of
all things bacterial and viral just waiting to infect me. and i'm not in corpus
christi as some of you might think from my last email. apparently that rotation
wasn't so good so i found out the friday afternoon before going that it was
optional, and i opted not to. i didn't want to travel far and work horrible
hours and live in a place where everyone's car was broken into if i wasn't
gonna learn anything. but i've really enjoyed the in-patient stuff here. we
have our own little pedi-floor here where i spend all day. it's been great
so far, all the staff people are wonderful, as usual. the attending docs are
all brilliant and have written lots of papers and textbook chapters and been
heads of different things and all that, but they are all here because they
love teaching us and the residents, so they're great to be around. the best
thing, though, has definitely been the kids. some have been here this whole
time. my favorite one is a 23 month old little boy who had hirschsprung's
disease (the lower part of his colon wasn't innervated and didn't work) and
he had some surgery. what's sad is that he's a foster kid. his mom couldn't
handle taking care of him, so his grandma did. but then she got freaked out
when he had a colostomy (it's a 2 part surgery, the first early on is to cut
out the bad stuff and let the other gut heal and involves a colostomy. then
the second part, which he just had, is to reconnect the good colon to the
pooper hole) - which was just temporary- and gave him up to foster care. which
really stinks that she gave up so soon, because now he'll never have a problem
with this. and he's the best kid. he's usually just sitting in his crib, playing,
or the nurses will take him out into the middle of the nurses' station. always
smiling. great laugh. i'm totally in love with him. i'd adopt him if i'd think
they'd give him to an $80,000 in debt single guy who's only home a handful
of hours per day. but atleast i've had this whole week and a half to play
with him and rock him to sleep when i was on night call, and get peed on (through
his diaper, through his pants, through my pants. thankfully it was saturday
and i was wearing scrubs (the rest of the time i have to wear 'nice' clothes)).
another long-termer is this 13 year old punk with cystic fibrosis (genetic
disease, problem with chloride ion transport causing thick secretions and
screws with their lungs and pancreas). he acts like he owns the place and
is always messing with us and the nurses. but we give him a little leeway
because he's stuck in a hospital and he's a cool kid. we also have some other
5-6 day'ers, usually kids with cancer who are in for a chemo regimen. they're
all wonderful to be around just because of their great attitudes through a
junky situation. and one was a little boy who i had seen back on pediatric
surgery (my first two weeks) when we had put a chest tube in him. also lots
of rsv babies. rsv (respiratory syncytial virus) causes colds in grown-ups
but bad lower respiratory problems in babies. and it's very contagious, so
every kid that comes in with a cough gets a rapid rsv test (and a flu test,
since that season is starting too. unfortunately the shots we were supposed
to get last week never came in, so i'm feeling very vulnerable.) my first
night call last monday, we had a 6 week old with rsv and horrible trouble
breathing. she was breathing about 70 times per minute and had huge sternal
retractions (her breast bone would sink in (very deep, almost to her spine)
with every breath because she was trying so hard to suck in air). i watched
her like that for a couple hours and gave her some nebulizer treatments, but
it wasn't helping much. it's the saddest thing in the world watching someone
so tiny struggling for air so badly. then, scary part, she tired out and her
respiratory rate dropped to about 30/minute, meaning she was about to quit
breathing on us. so we took her down to the picu and they intubated her and
put her on a ventilator. she was there for 5 days, but thankfully i got to
see her come up to the floor on saturday and she went home yesterday. there
were a few other sad cases. we have a girl right now who took 33 tylenol after
her boyfriend broke up with her. she just wanted attention and figured tylenol
couldn't be that bad, so unfortunately she didn't tell anybody until a couple
days after and came extremely close to losing her liver. and we had a little
boy who we had to call cps/social services in on because of a strange history
of stuff and probable abuse. i hate people some times (no offense to any of
you who are people)
not much else going on. daylight saving time was cool. i like gaining time.
and time owes me, there was this time back in college where i was reading
in evans library and it felt like i had been there about an hour (and hadn't
fallen asleep), and all of a sudden it was three hours later and i missed
some classes. true story. weird things happen in that library. someone got
bitten by a bat one time.
oh, and if anyone remembers back from the second bupdate when i related to
you my personal scooby doo mystery of 'the elevator that might have gone sideways
or something', well, i figured out what happened. on the 6th floor, there
are three elevators in a row right next to eachother, but if you follow the
same elevators down to the 4th floor, they are 2 and 1, separated by a wall.
so i had gone up the double elevators and down the single elevator, and so
it looked totally different. hopefully all of you can rest a little easier
now.
well, i got to the end of ecclesiastes and apparently everything doesn't suck.
"now all has been heard; here is the conclusion of the matter: fear God
and keep his commandments, for this is the whole duty of man." and things
are futile and fleeting and all that, but they get meaning and purpose in
the Creator of all things. and i knew that and know that, i just lose focus
some times and get overwhelmed by stuff. but i'm ok now, and just kind of
whelmed (yes it is a word, and not used correctly, but i think you get the
point). and i know that all of the struggles (i'd also add "and suffering"
but i'd be a loser to call anything i'm going through 'suffering' after what
i've seen in other people's lives, especially at the hospital; but i guess
it's all relative) are not random, but purposeful and serve to conform me
to the image of Christ and refine my faith. i was reading some c.s. lewis
this week that was very apropos. i like him because he thinks like i think
but is way more eloquent than me. "feelings, feelings, and feelings.
let me try thinking instead. what grounds has it given my for doubting all
that i believe? i knew already that these things, and worse, happened daily.
i would have said that i had taken them into account. i had been warned -
i had warned myself - not to reckon on worldly happiness. we were even promised
sufferings. they were part of the program. we were even told, 'blessed are
they that mourn,' and i accepted it. i've got nothing that i hadn't bargained
for. of course it is different when the thing happens to oneself, not to others,
and in reality, not in imagination. yes; but should it, for a sane man, make
quite such a difference as this? no. and it wouldn't for a man whose faith
had been real faith and whose concern for other people's sorrow had been real
concern. the case is too plain. if my house has collapsed at one blow, that
is because it was a house of cards. the faith which 'took these things into
account' was not faith but imagination. the taking them into account was not
real sympathy. if i had really cared, as i thought i did, about the sorrows
of the world, i should not have been so overwhelmed when my sorrow came. it
has been an imaginary faith playing with innocuous counters labelled 'illness,'
'pain,' 'death,' and 'loneliness.' i thought i trusted the rope until it mattered
to me whether it would bear me. now it matters, and i find it didn't. bridge-players
tell me that there must be some money on the game, 'or else people won't take
it seriously,' apparently it's like that. your bid - for God or no God, for
a good God or the Cosmic Sadist, for eternal life or nonentity - will not
be serious if nothing much is staked on it. and you will never discover how
serious it was until the stakes are raised horribly high; until you find that
you are playing not for counters or for sixpences but for every penny you
have in the world. nothing less will shake a man - or at any rate a man like
me - out of his merely verbal thinking and his merely notional beliefs. he
has to be knocked silly before he comes to his senses. only torture will bring
out the truth. only under torture does he discover it himself." sorry
for the long excerpt. and, before i go, let me just clarify that being a Christian
isn't all sad suffering for our benefit. quite the contrary. psalm 16:11 "thou
dost show me the path of life; in Your presence is fullness of joy; in Your
right hand there are pleasures forever" psalm 43:4 "i will go to
the altar of God, to God, my exceeding joy; and I will praise thee with the
lyre, O God, my God" john 15:11 "i have spoken to you so that My
joy may be in you, and that your joy may be made full" all the stuff
i talked about last week, wisdom, possessions, pleasures, work, friends, etc.,
are good and perfect gifts coming down from the Father of lights. they aren't
all vanity if you enjoy them in the proper context with the proper motivation
and recognize the Giver.
well, i just finished
up my 3rd week of inpatient peds and i really enjoyed it. again, there was
some happy stuff and some sad stuff. if you remember the little foster care
boy from last week, he was actually supposed to have his 2nd birthday and
get out of the hospital and get adopted last saturday. but last thursday,
he was feeling bad and i was rocking him and he puked all over my white coat
(not too big a deal, they had a washer/dryer on the floor that i used and
it all got cleaned up. and i feel closer to him having had most of his bodily
fluids on me :). anyways, he kept throwing up all day/night and finally had
to go to the picu, which is where he spent his birthday. thankfully he came
back up to the floor earlier this week and has been doing better, but from
what i hear he might not get adopted now because the people didn't want a
kid with 'medical issues'. very depressing. he hasn't had anyone there to
visit at all this week. i don't know if he has any idea how crappy his situation
is, but when you pick him up there is this sad way that he lays his head on
your shoulder (as if he realizes he has no one else), and it just breaks my
heart. we've had a handful of other kids in similar situations, with foster
care and cps and security at the door to keep parents away and all sorts of
junk like that. luckily all of the screwed up kids are also the cutest, so
they get lots of attention from the nurses and docs. i could start a nice
little family with all of the kids i want to take home. maybe i throw my emotions
around too flippantly, but if you smile at me and lift your arms for me to
pick you up, i'm yours. another sad case was a little 3 year old boy who came
in after having a bunch of different kinds of seizures over the past couple
of weeks. it looks like it's probably lennox-gastaut syndrome: basically a
bad form of epilepsy where he will continue to have more and worse seizures
and deteriorating mental abilities. hopefully since it's early, we can control
it with some medications, but they usually become refractory to most treatments
after a while.
all in all, i've felt more doctor-ish on this rotation than any other. i usually
have 4 or 5 patients and i admit them, write the orders for them, check on
them all day, and basically get to see them through the whole process (which
you really couldn't do with surgery, because you only had an hour or so to
see patients, then in the OR the rest of the day). but it's been good to make
me feel somewhat competent at what i do. and it's nice that the parents have
seen me as doctor-like too and come to me with questions or concerns instead
of to an actual md. but the sweetest moment was with a tiny little 8 year
old girl with an asthma exacerbation. she wasn't my patient, but i was in
checking on her and she was having some difficulty breathing. with the sweetest
little voice she asked me to listen to her heart, and i did, and then she
asked 'am i getting better?', and i told her she was, and she had the cutest
smile on her face after that. it's little moments like that that move pediatrics
above anesthesiology on my career choice. but then i had a little boy with
a mass in his lower abdomen, and i got to follow him to interventional radiology,
where we used a ct scanner to figure out where it was, then i got to stick
a needle in it and biopsy it, and my love for poking people came back and
anesthesiology moved back up. so now i'm torn between the two (what shall
i choose, i do not know). the nice thing about peds (at least in the hospital)
is that it's really just glorified babysitting. i play with kids, feed them,
change them; i even helped one kid with her physics homework (angular velocity
and gravitational attraction, good times).
i also got to use my spanish 'skills' some more this week. it seems like i
always get the spanish only people, and then other spanish people come up
to me when they need help and assume i've got some latino in me (i think it's
the dark skin, total stereotype or racial profiling or something). my proudest
moment was when one of the surgical residents i used to work with pulled me
in to explain some stuff to his patient, the topic: anteriorly displaced rectum.
now i was in AP spanish in high school, but i must have been absent the day
we discussed the words necessary to describe this procedure and its complications.
there was a lot of 'uh, tubo de poopoo, entiendes?' and hand motions, but
we got through it.
and i finally got my flu vaccine this week. with the shortage, i had to beat
up some elderly and very young and immune compromised (and senators), but
i was able to get it. they had the new flu-mist too, which takes away all
the fun of needles, but adds the fun of having your nose hairs tickled. so
now i'm probably protected from 3 of the possible strains of flu that some
scientists think may be most likely to be circulating. i feel better.
now for random tidbits that don't really mean much but i thought were noteworthy:
when i was driving home from houston last weekend, i passed a cow that had
it's tail sticking straight out. i know they can swish them around, but this
one was sticking straight out, like he had a stick splinted to it or a string
holding it up. and he was just walking around like that. very odd. my right
eyelid has been twitching for the past week. no idea why, but it feels weird.
my eardrums got electrocuted last night. i was listening to my mp3 player
at the gym and all of a sudden there's a sharp twinge of pain in my ears and
the music stops. i wasn't sweating, so i don't know exactly why or even what
happened. and lastly, i ran into the reinisch's (family from college station)
at church today. very random. they moved a couple years ago so mr. (colonel?)
reinisch could work at fort hood, but i didn't know they lived in belton (city
next door) or went to my church.
okay, the rest of the email is for bryan/college station people, so everyone
else can tune out now. i'd like to invite you to be a part of the first annual
'lodge a bob' contest. i'll be doing a rotation down there from december 3
to january 23 and the housing they normally have for med students will be
occupied by a girl, so i'll need a dwelling place for about 7 weeks. since
i realized it would be excruciating to live with me for that whole time, i
figured i'd break it into week-ish chunks and rotate. so if you'd like the
chance of having me over for a week, write back in 50 words or less why i
should pick you (or just write back and say 'yes'). references are available
upon request, or you can email my mom (paulafeaster@worldnet.att.net) and
she can tell you all about the finer intricacies of living with me (and how
to best spoil me). no purchase necessary, void where prohibited, residents
of alaska and hawaii not eligible and all that junk. seriously, no pressure,
but thanks if you can. maybe i can rake your leaves or something?
bobby
TOP
ok, seriously, when is the
rain going to stop? i feel like i'm living in seattle (or atleast the stereotyped
seattle i always hear about with constant rain and high suicide rates). it's
either been raining or foggy or misty here for the past 2 weeks. like living
in a cloud. very dreary. of course i'm indoors most of the time, but it would
be nice to look out a window and see the sun.
this week was nursery/nicu in the morning, specialty clinics in the afternoon
(hematology/oncology and endocrinology). mornings came a little earlier because
i had to round on all of the newborns early (relatively, 5:45ish), but it
was good because babies are fun. i also got to participate in a brutal ritual.
we strapped the kids' hands and feets down, then amidst the awful cries and
screams we jabbed them with various sharp metal objects and basically just
mutilated them for no medical reason. of course i'm not talking about neonatal
hazing, but circumcision (i got to play the mohel. 'Baruch HaBA!'). as far
as procedures i enjoy the most, this wasn't in the top 5, but it it's good
to have a few under my hat. and i'm sure it's great at parties. the worst
part was when the little firemen tried to put me out (metaphorically speaking).
i always seemed to get the peeing ones, but luckily i was able to divert the
streams and never got any on me. and i got to use needles :) we numbed them
up really well (although sometimes they don't at all) and didn't seem to be
in too much pain afterwards. and after doing that, it gives me a different
perspective on genesis 34. that's the story where dinah (jacob's daughter)
is raped by shechem and then wants to marry her. so jacob's sons say 'hey,
you can marry her, and all your men can marry our women, if you all will get
circumcised.' so they think it sounds like a good deal and they all have it
done (without the lidocaine and scalpels, just sharp rocks). then jacob's
sons go in and slaughter all of them while they're all still in pain. i used
to think that was a clever way to get revenge. now i think it's just mean.
hematology/oncology stuff was interesting. still sad though. they have a wall
with pictures of kids that passed away from cancer. i don't know if i could
handle doing that. but it's great to see how unaffected the kids are by everything.
besides being on all sorts of different poisons and radiation for months and
months, and all the side effects of that, they seem like normal kids and don't
let it get them down. and they have to spend so much time in the hospital.
every fever gets them a stay for atleast a couple nights.
endocrinology was also cool stuff to see. basically dealing with diabetes,
thyroid problems, pituitary problems, and short people. the doctor i worked
with for that was great with kids and explained everything really well. that's
a field where medical intervention can make a huge difference in quality of
life for the kids.
on a sad note, we got to see an autopsy (don't worry, no description following).
kind of like cadavers from 1st year, but more real because the bodies aren't
preserved (just like 'csi', but with better lighting and worse plot). she
was a 23 week (gestational) stillborn, probably died of brain problems, but
no abnormalities on physical exam. it was hard to see that happen to a tiny
little person, but i think easier than it would have been if it was an older
child that i could relate a personality and life to. pathologists are a different
breed.
to brighten things up a bit, i bought a pair of jeans this week. i don't know
if you're like me, but a good pair of jeans is my favoritest type of pants
to wear. and i'm deeply in love with these. i've worn them daily this past
week. i even sleep in them. in fact, i'm wearing them now. they're button-fly,
which i haven't worn in a while. when i got my first pair of button-fly back
in middle school, it would take me about 5 minutes to get them on/off. very
tricky if you've never done it.
and lastly, something i was reminded of this past week. i really like 2 timothy
2:11-13: it is a trustworthy statement: for if we died with Him, we will also
live with Him; if we endure, we will also reign with Him; if we deny Him,
He also will deny us; if we are faithless, He remains faithful, for He cannot
deny Himself. i especially like the truth at the end, if we are faithless
(and in the new bobby international version of the bible, "if" is
translated as "when"), He remains faithful. why? because i'm special
or because i did or didn't do something? nope. because He can't deny HIMSELF.
He can deny me all He wants (and it says He will if i deny Him earlier in
the verse) and be perfectly just and righteous. but He's faithful to me because
He's faithful to Himself. He's not a man, that He should lie. and just like
He kept His promises and covenants to all of those in the old testament, He
keeps all of His promises in Christ and in the Bible to me. to do otherwise
would not be in keeping with His character and would profane His name. and
i know that that's comforting to me when i screw up and think that i can't
pray or go to His word and be changed by the truth there. but it's not based
on me, but on Him, and He doesn't change, and He won't deny Himself.
all of that is nicely summed up in psalm 89:
If his sons forsake My law
And do not walk in My judgments,
If they violate My statutes
And do not keep My commandments,
Then I will punish their transgression with the rod
And their iniquity with stripes.
But I will not break off My lovingkindness from him,
Nor deal falsely in My faithfulness.
My covenant I will not violate,
Nor will I alter the utterance of My lips.
Once I have sworn by My holiness;
I will not lie to David.
His descendants shall endure forever
And his throne as the sun before Me.
It shall be established forever like the moon,
And the witness in the sky is faithful.
k, not much going on
as of last friday i finished peds, which means i'm halfway done with the third
year (and halfway done with these for the year; fyi, the "bupdate"
season 1 dvd will be out in time for Christmas :). i really have nothing to
say. the last couple of weeks was all pedi clinic, lots of asthma and colds
and well checks. there's really no way to glamorize that. i liked peds but
i think i might get bored with it after a while (especially outpatient). but
the doctor lady i worked with for the last couple of weeks (who's also the
program coordinator) told me that i wouldn't like family practice and i definitely
shouldn't do anesthesiology, but i'd be a great pediatrician. which stinks
because i totally believe everything other people say about me, so i still
don't know what i want to be when i grow up. the kids were great and fun and
all that, and i had the whole rapport thing going on, but i don't know if
that's enough to choose a job. speaking of rapport, i've always wondered about
what's going on in kid's minds in their relationships. like what makes some
kid i never met before want to sit in my lap and read a book, or tell me about
her dolly, and then scared of other people. or when a 3 year old says that
you're their friend or boyfriend, what exactly does that mean to them and
what qualities or things draw them to one person over another? obviously they're
too young to pick up on my rapier's wit and my musky Victor Mature-like scent.
and speaking of unexplainable, what's the deal with courtroom sketchers? (i'm
watching law & order right now) let me know if you have any reason for
their existence, because i just don't get it. if you want to know what the
defendant looks like on the stand or how pensive the jury is, take a picture.
i can understand doing that before cameras, but now it just seems silly. i
bet it's just some governement program by the NEA to get jobs for liberal
arts majors.
k, i got nothing else. you can use the rest of the time that you'd normally
spend reading my email to write me and let me know what's up with you and
yours (since some of you haven't done that in a while. you know who you are)
bobby out