On Dreams and Discoveries

I have this recurring dream. I am in a hurry, on my way to somewhere. I come across an all-you-can-eat dessert buffet. I try a few things and they are so good that I want to taste more. But I don't have time because I have to be somewhere else. I am filled with disappointment and longing. And then I wake up. Hungry. Weird huh?

It's amazing what you can discover when on your way to somewhere else. Here's a few things I've discovered this summer.

Garlic scapes- These guys look like a cross between a plant and an octopus but are actually the above-ground chlorophyll colored stalk of the garlic bulb that we know and love. They have an amazingly fresh and mild garlicky flavor and you can use them as you would garlic. My favorite is to make a pesto sauce out of them (no need for basil!). If you see them at your local farmer's market, grab some. You won't regret it.

Brown butter- Or Buerre Noisette if you're sophisticated in a way that I most definitely am not. This is actually a way of cooking the butter that completely transforms its taste. Heat butter over medium heat in a stainless steel pan. It will melt, the top will turn white, it will start crackling, then the magic happens. It quickly turns a shade of light brown and that is the time to remove it from heat. You've just turned the milk solids in the butter brown and created a wonderfully nutty earthy sauce. I used it in a blueberry muffin recipe and they were like rich cakey dessert muffins. Mmmm, big fan of this ingredient that can wear a sweet OR savory hat!

Rose wine- Ahhh, the perfect summer wine. Not to be confused with "white zin", the sweet gateway wine that marked my entrance into the wine-drinking world but that now I wouldn't drink if I had a choice between that and Nyquil. A rose is a beautiful deceptive pinkish-red color that surprises your palate by tasting dry like a white with a hint of deep red berries like a red. It is served chilled so is great for toting to the beach or drinking on your porch on a hot steamy summer night. I can't believe I've lived this long without it!

Columbus, Ohio- What a gem of a city! I loved the wide streets, the green trees, the cute neighborhoods, the field of cement corn cobs, and Graeter's ice cream. Let me say that again. Graeter's ice cream. I ventured out of Chicago and discovered that the rest of the Midwest might not be so bad. Who knew?!

The Pediatric Hospital Medicine conference- Have you ever felt like a stranger in a strange land? And then discovered a group of people who thought like you, spoke like you, and had the same vision as you? Then you know how I felt at this conference. I came back intellectually stimulated and excited about my career and future all over again.

On a side note, this weekend is my husband's birthday. When we met, my impetus for moving to Chicago had not turned out the way I planned and I was in a rush to head off to somewhere else. I 'discovered' him while I was in the midst of this transition. Now my reason for being here is completely different (and infinitely more satisfying) than what brought me here. But sometimes, if you're lucky, that's what happens. Take a pause and linger at the dessert buffet. You might be glad you did.

Cool Party Tricks for Cool People

I know, I know, I've been MIA these last couple of weeks. I figured my last overly lengthy post would tide over my faithful readers for a least a good week. I've also been traveling for the past week and have had spotty internet access. That said....I have some good bits of gristle to chew on since coming back and I hope you'll stay tuned!

I visited my good friend in Ohio and we had the chance to catch up on our lives, personal and professional. After a year-long stint as a pediatric hospitalist in an academic center she switched over to the general peds division and did outpatient clinic, adolescent medicine, and staffed the juvenile detention center. In an unfortunate maelstrom of events, the division decided that they could no longer support one physician's salary and since she was the most 'junior' person, she was told that at the end of June her contract would not be renewed. So much for job security! My friend, being the resilient and laid back person that she is, decided to take a 'forced sabbatical' and hang out at her parent's house for awhile to see how the other half lives. Hence my minibreak in Ohio. Let's face it, it's no fun being unemployed by yourself. My friend (let's call her Janet) became my rock during residency and one of the people I credit for keeping me from needlessly clouding my life with regret by acting on completely irrational urges. Everyone needs a friend like that, don't you think?

Anyway, we're similar in so many ways except how we view our entry into the world of medicine. Medicine found me on my way to law school. Really. I remember sitting on the floor of my dorm room and brooding over the course catalog and asking myself "Which of these series of classes feels the most right?" In other words, when I close my eyes and picture myself doing one or the other (law school vs med school), where am I most at peace? It felt like a key sliding into a lock and turning smoothly. The answer was clear and I have never looked back. Hearing the answers from my heart was so much easier back then as my voice of doubt had not yet found its stronghold. Medicine was and always will be the career that I chose for myself. The tenet along which I've aligned my life, for better or worse. Such is not the case for Janet. Her older siblings are both in medicine. When she graduated from undergrad she wanted to join the Peace Corps. Her dad told her to wait. So she went to med school. When she graduated she wanted to join the Peace Corps. Her dad told her to wait. So she went on to residency. After that she did a chief year and then you know the rest. Since I've known her, she's always had a sense of restlessness about her. Contrary to some beliefs, you don't have to love medicine to be a good doctor. She is a great doctor and one who practices diligence at a level I aspire to. But she doesn't love what she does. Over a glass of a really smooth Zinfandel she explained to me how she feels about medicine. She said it's the same as how she feels about playing the piano. It's a great skill to have and to pull out when you need it (like at parties, or on an airplane when someone is seizing) but not something you want to do day after day. Hmmm.

I feel like I understand her better now that she simplified it for me. And that makes me all the more grateful for listening to that feeling I had sitting on the floor in my dorm room. As someone who is quickly approaching a crossroads in her career, I only hope that I can sift through the static and that damn voice of doubt (why is it so loud?!) and find peace again when the time comes to make a decision. As for Janet, I hope that she finds her passion. But I think that for now, she's still waiting for it to find her.

A Day in the Life

As I've said before, lots of people cock their head at me when I tell them that I'm a neonatal hospitalist. So, instead of trying to explain what I do I thought I would share with you a little slice o' my life. During my last 24 hour shift, I kept a diary of my time at work. Lucky for me (and you) there was no shortage of activity. Here it is...the first installment of A Day in the Life.

830am: Rounds start and our team gathers around computers on wheels. The resident reads off numbers and tells us what happened with each baby during the day and night before. I enter orders into the computer (so convenient!) and the attending writes their note. Everything is electronic which is supposed to make things streamlined but not without some hair pulling and keyboard jabbing. You know, the harder you hit the enter key, the better the system works.

11am: Rounds wrap up and I'm thinking about what I'm going to have for lunch when I get called into a room because a breathing tube has slipped out of a premature baby who in fact, does need that breathing tube to live. These things happen sometimes which is why we have experienced respiratory therapists who never leave the unit. They have a new tube ready for me before I even walk in the room. Breathing tube replaced, crisis averted. Mmm, now for lunch.

1230pm: We get called to the delivery of a 33 weeker whose mom was induced 2 days ago (yikes!) for high blood pressure. The baby comes out stunned and not at all happy to be born. So unhappy in fact, that she refuses to breathe for a good 2 minutes. I know she'll come around eventually so I support her with positive pressure ventilation (oxygen by bag and mask) while the nurse stimulates her and dries her off. She gets the whole breathing thing down and we put her little hat on and show her to mom before we whisk her away in her isolette (a heated incubator). I get her settled and draw her blood which involves a radial arterial puncture. So far everything is going smoothly in NICU-land.

7pm: The afternoon has been filled with a smattering of issues here and there. Most of my attention is focused on a baby with suspected Noonan syndrome. She has a heart defect that causes her oxygen depleted blood to mix with her oxygen rich blood coming from her lungs. She also has RDS (respiratory distress syndrome) due to being a bit premature and kidney issues. She's currently on a high frequency oscillating ventilator so we are checking blood gases every few hours. Her big brother and dad visit and I answer their questions as best as I can. Her brother asks me if he can touch her and I want to give him a big hug and tell him that everything will be fine. But I don't, because I don't think it will.

830pm: We are called to a delivery because the OB is going to use the vacuum to help this woman finally have her baby after 5 hours (oy!) of pushing. The vacuum is attached to the top of the baby's head and the OB pulls and pulls and the woman screams and screams and finally this 10 pound baby is born and is pink and fat and doesn't need us at all. I decide to have an elective c-section when the time comes.

9pm: We get a call from labor and delivery that they are going to take a woman who is 27 weeks pregnant for a c-section because she has a placental abruption and is bleeding. I ask when and they say in the next couple of hours. Thankfully, I know not to trust pregnant women who are bleeding. I rally the troops and get a breathing tube ready, order up surfactant and scan through the mom's chart to see what we are dealing with. Her water broke a week ago and she has been on bedrest since. Uh oh. The longer the mom has been ruptured the higher the stakes for the baby.

920pm: See, a couple of hours turned into 20 minutes. The woman began bleeding more heavily and now they are taking her for emergent c-section. We're ready. The baby is larger than we expected (good!) and tries to take a few breaths on her own. I intubate her on the first try (I must be feelin' it tonight) and the resuscitation goes smoothly thanks in no small part to the team of experienced nurses on with me tonight. We take her up to the unit and prep her for line placement. I insert catheters into one umbilical artery and the umbilical vein. Her first blood gas shows that she's doing well and I don't suspect she'll need the ventilator for very long. The whole process takes a couple of hours but without any issues yet, I think she'll sail through the night.

Midnight: Oh it's my lucky night. The nurses are having a party for the July birthdays and there is a potluck going on in the lounge. A snack is just what I need right now. There's nothing that quite mimics my enthusiasm for potlucks in the middle of the night. Ritz crackers and cheese have never tasted this good.

1am: I'm done with my night rounds and find that the sickest baby needs one of her umbilical lines adjusted a bit. Meh, no problem. I'll do this and then head off to bed. Ha! Famous last words. In the process of mucking around with the line a hole appears and the line starts leaking. Please tell me this is not happening. I ask the nurse what meds are going through that line. She says "everything". You know how people say "you are your own worst enemy"? Well not tonight. I know by the way that nurse looked at me when I told her I somehow poked a hole in that line. I take a deep breath and gather all the supplies I need to replace the line. My plan is to thread a new line right beside the old one so that the vessel doesn't close up when I pull the old line out. Seeing as how I haven't had to do this often, I'm a little nervous. But, what can I do? I have to solve the problem I've created. After an hour and a half of MacGyver-like maneuvers I successfully replace the line and everybody is my friend again. I'm bone tired and sweaty but so relieved I almost skip to my call room to take a well earned nap.

230am: On the way to my call room a nurse stops and tells me the micro lab called and one of the babies has a positive blood culture. Ooohhhh darn. I review the baby's chart to see why the blood culture was drawn in the first place since I knew he had been pretty stable. Turns out he had some apnea the day before and as a precaution the team drew a blood culture and complete blood count. Well, now we know why he had apnea. I ordered antibiotics and did another radial artery puncture to send more blood for testing.

330am: Whew! Everything seems to have quieted down and my eyes are getting scratchy. I notice that my stomach is rumbling again but I have neither the desire nor the energy to go in search of food. We are called to a delivery for meconium. The baby comes out not breathing and covered in poo (for lack of a better description) and I intubate to suck out any that might have dribbled below his vocal cords. Nope, nothing there and the intubation was sufficiently obnoxious to him that he lets out a lusty cry and our services are no longer needed. We clean him off a bit and hand him over.

4am: As I cruise back into the unit a nurse stops me and says that the baby we delivered earlier, the 33 weeker, has a positive blood culture for gram negative rods. I'll be honest, I'm a little deflated at this point and hope that she's joking. She's not. Because this type of bacteria can also cause meningitis in neonates, I have to do a lumbar puncture. Did I mention this baby weighs 1200 grams? No probably not because I didn't expect to have to stick a needle in her back! Now, my tried and true method of LPs in infants involves inserting the needle as slow as you can. And then slower. Doing it this way, I rarely go through the space creating a bloody tap. My favorite NICU attending in residency showed me this and I am forever indebted to him. However, the nurse holding the baby in position is not a huge fan of this method. Sorry, getting spinal fluid trumps your charting. I'm feeling a bit tart at this point in the night, errr, morning. I also do an arterial stick for a repeat blood culture and order up some antibiotics.

530am: Getting into my call room bed as the sun is coming up is pure joy. My feet are throbbing (I need to start gellin') and my eyes feel like they are sunken into my head. I have a sour stomach and even more sour breath. I am sticky with dried sweat. Yum.

620am: My alarm goes off and all I can think of is putting both feet on the ground and moving forward or else I'll roll over and close my eyes against the bright sun and even brighter lights of the unit as the day shift nurses roll in with their freshly washed hair and casual chatter. I feel like a troll. I sign out to the oncoming resident and attending. As soon as we finish there's a call for a delivery. I look at the resident and say "It's your turn now." I gather my things and head for the train that will take me home. Home sweet home.

A Letter of Gratitude

Dear Father Who Thanked Me For Being At His Child’s Delivery,

Remember when you said to me “Thank you for being here” and I just looked at you and smiled and said “Sure thing”? Well, here’s what I really wanted to say to you, only I didn’t realize it at the time. I’m not very good at ‘on the fly’ and ‘spur of the moment’. As I said before, I’m a planner. Anyway, I wanted to thank you for acknowledging my presence at your child’s delivery in what must have been a moment of extreme fear and stress for you. Rarely do parents think to do that and I never expect it. I wanted to tell you that this is why I became a pediatrician. To help parents escort children through life until they can pave their own way. Your gratitude was beautifully heartbreaking and I carried that with me for the rest of my shift. You made me feel like I make a difference each and every time I attend a delivery whether I give oxygen and chest compressions or simply dry the baby, wrap her in clean blankets and hand her over to mom and dad.

Your baby did fine, didn’t even need me after all, but I’m glad we were there. More for my sake than yours. See, you gave me such a gift that night. I’ve been walking a little taller, feeling a little less run down, and generally feeling a sense of peace about my career path that I haven’t felt in awhile. So, although I will never see you again, I want you to know that as much as my presence impacted you that night, yours had the same effect on me. Thank you for being there. Thank you for your unabashed sincerity.

Best,

The Pediatrician At Your Child’s Delivery

New Year's In July

My favorite time of year has always been the Fall. Fall meant that school was starting again and I had another year to prove myself and do things right. I usually started the school year with a handful of resolutions. You know, like ummmm, try to be in the cool crowd. For once. The first few weeks I would carefully model myself after the pictures in my Seventeen magazine and slip into my 'bubbly' persona as soon as I walked into the building for my first class. Year after year I tried this and inevitably would settle into my less-than-cool self which was much less time and energy consuming. But, so much more rewarding. In hindsight.

Nowadays, I have those same feelings in the beginning of July. No not the "please let me be cool this year" feeling. The anticipation of something fresh, something better. A chance to renew my commitment to my profession and make good on those resolutions. Only now they are more along the lines of 1. Read Pediatrics EVERY month 2. Answer my PREP self-assessment questions online weekly 3. Peruse the current literature on clinical scenarios I encounter at work 4. volunteer to teach PBL for the medical students 5. Push myself to teach the residents I work with at each and every opportunity even though I only see them at night and all they really want to do is get through until morning.

I couldn't wait to get to work tonight and meet the new residents. The memory of walking into the hospital at 5am on my first day as an intern is seared into my brain. I love that memory and I love realizing how far I've come. So here's to a new year's worth of resolutions. I just hope I'm more successful with these than with that 'learning how to knit' resolution....