Thursday, July 30, 2009


During the first two years of medical school, we are taught volumes about disease, pathogenesis, presentation, and a little about treatment. Often, the diseases we learn about are obscure and rare, but illustrative of a particular physiological principle. There are certain vanishingly rare metabolic diseases which every student learns about, but will never see because only a few dozen people in the world have them. I used to groan and gripe about how these obscure diseases were worthless, that I would never see them, why should I learn about them? Well, I am now formally eating those words. Here is a list of the unusual conditions that I have seen on outpatient pediatrics, usually in the specialty clinics.

Cutis aplasia
Hypomelanosis of Ito (I diagnosed this one!)
Congenital adrenal hypoplasia (not hyper)
Diabetes insipidus (nephrogenic)
Gordon's syndrome
Congenital Central Hypoventilation Syndrome (Ondine's Curse)
Hypoplastic Left Heart Syndrome (in my NICU time)
4 umbilical hernias in 1 day (apparently they are more common here than elsewhere in the country.)

Bonus points for the readers who at least look on Wiki what these things are.

Saturday, July 25, 2009

Enjoying the moment

We are having a Saturday night at home. Our baby is ready for bed and in his jammies. I wish you could see how happy he is right now. He is thoroughly enjoying this evening's pre-bed activity: dancing with Mom & Dad. So far, we have bebopped to "Sing Sing Sing" by Benny Goodman, waltzed to "So She Dances" by Josh Groban, rumbaed to "Fallen" by Lauren Wood, and we're currently swaying to "Anything You Can I, I Can Do Better" by Bing Crosby and the Andrews Sisters. He especially loved the slightly awkward three-person waltz and the big twirls under his daddy's arm. I hope that I can play this scene back on my life-reel when I die and remember my sweet little 9-month-old baby, his fat dancing body, and my happy little family.

Thursday, July 23, 2009

Outpatient = Impatient

So going into medical school I had a suspicion that I wouldn't care for outpatient clinic very much. I didn't ever have anything to base this on, but it's what I thought would happen. Sure enough, it's true. At least based on my 3 weeks of outpatient pediatrics, I don't care for clinic very much. The most excited I got for school this week was the morning I spent in the cardiology clinic reviewing echocardiograms and following up on catheter procedures. Outpatient peds interventions are just much more long-term and lifestyle oriented. Vaccinations, lifestyle, diet, safety, and prevention are the mainstays of successful health, but they just don't get me fired up. I'd much rather be the guy guiding a cath or anesthetizing someone. I'm a pretty control oriented kind of guy, and I'd rather have the outcome of a patient depend more on my own skill and knowledge than on their willingness to follow through on my instructions.

Monday, July 20, 2009


Spiff and I went on a date on Saturday. An actual date! We went somewhere, the two of us, just for fun. My awesome friend, Maggie, watched Gunner so that Spiff and I could go to the new Harry Potter movie. We haven't been on a date since we had the baby nine months ago. Well, we did go for a twenty minute walk while we were on vacation in June, after Gunner had gone to bed and my parents had agreed to listen for him. Can we count that?

I had a great time, and Spiff cooks up a great date. We went to a really cool theater that was originally a Shriner's Temple and has been converted to a single-screen venue. There is a balcony, ornate decor, chandeliers, and a dome in the ceiling. The crowning glory of the place is the floor seating...rows and rows of plush leather couches! Yes, we watched Harry Potter cuddled up together in front of the big screen on a comfy leather love seat. Very cool! I liked the movie a lot, and I loved my time with husband.

The weird thing is that while I enjoyed my time with Spiff, and some freedom from mommy responsibilities, I found myself missing Gunner. After being engrossed in the movie for a bit, I found myself looking around, expecting to find Gunner rolling around on the floor in front of me. Or I would look at my watch and think to myself, "Gunner should be up from his nap any moment," and then I would prepare myself to pause the movie so we could go get him...before realizing that he wasn't with us at all. I guess that's what happens when you spend almost every moment of the last nine months with a baby attached to your hip.

It's also strange to me that something that was so commonplace to me for so long, such as spending one-on-one time with my husband, has become so foreign. We do spend time together, after Gunner has gone to bed. But we haven't been outside of the house together, without the baby, and I admit that it felt strange to have an empty car seat in the back of the car. I also felt strange about asking my friend to give up her Saturday to watch my son, along with her own two sweet kids. I'm so grateful to her for giving Spiff and me the time together, but since the movie was so long, I felt like I was taking advantage of her. She has definitely earned some brownie points, and some IOU's of babysitting with me.

Thursday, July 16, 2009

The new stuff

I'm nearly done with two weeks of third year, but have yet to post on this here blog.  
Week 1 was spent in the healthy newborn nursery at one of our sister hospitals here.  The day started at 0630 and lasted until 3-4 if we weren't on call, or until 9 if we were on call.  We would do exams on any babies that had been born during the night, write up the H&P, and write progress notes on any babies that we were following from previous days.  At 0830 we would round with the attending, giving him a brief synopsis of the infant's pre-natal history, any significant physical findings, and discharge plans.  I have to admit, we were pretty spoiled because our intern had a sheet that spelled all this out in the order in which our attending wanted to hear it.   The one night of call I had I spent in the NICU.  There was an infant born at 29 weeks gestation who weighed about 2 lbs, and there was another infant born with hypoplastic left heart syndrome. 

 This is a relatively rare congenital heart defect in which there is almost no left ventricular tissue.  In lay terms, that means the heart is not really able to pump blood to the systemic (as opposed to pulmonic) circuit.  As a result, the child can only receive blood from the right ventricle via remnant of fetal circulation.  In the fetus, there is a connection between the left and right atria, known as the foramen ovale as well as between the pulmonary artery and the aorta, known as the ductus arteriosus.   In this infant with a hypoplastic left heart, we keep these open with a substance called prostaglandin E2 (PGE2), until such time as the infant is able to survive the three open heart surgeries necessary to enable life.  Without the PGE2, the ductus arteriosus will close in a matter of days and the infant will die.  

 As an MS3, my role was simply to stand in the background, ask questions, and not contaminate anything.  We resuscitated these infants right outside the C-section room, and prepared them for a brief trip down the hall to the NICU.  It was pretty hard for me to see the dad of the hypoplastic heart baby because he was filming his brand new baby with his iPhone because I knew we were both aware of the fact that those seconds of video could very well be the only keepsake these parents get to have of their baby.  Being in the NICU in general was challenging emotionally because I mentally place Gunner in the little isolettes and had little daymares of terrible illnesses that could have befallen him.  I don't know why we were blessed with a baby who didn't have any problems, but I am grateful. 

Week 2: 
I've been in outpatient pediatrics this week.  Outpatient clinic is a combination of general pediatrics as well as specialty  clinics.  I've spent about half the week in U Peds, our general peds clinic, and about half in specialty clinics.  I've been in the cystic fibrosis (CF), asthma, diabetes, and allergy clinics.  Generally I enjoy the specialty clinics more, since there seems to be greater emphasis on the patient's disease and its management, rather than in Upeds where there are a lot more social issues in addition to any pathology.  I don't consider myself to be anti-social, I do enjoy being with patients and talking with them.  I just don't relish trying to fix all that is wrong with their lives that is not health related.  I realize that there are social workers who can bear most of this burden, but trying to find a car seat for someone or help them get WIC or TANF (welfare) isn't very gratifying.  Thus far, actually, I haven't seen very much pathology, at least that is grossly visible, our work has mostly been well-child visits and maintenance checkups for chronic conditions. 

In other news, I got my board scores back yesterday and I was very pleased with the result.  There should be no difficulty, from a scores standpoint anyway, pursuing whatever it is I choose to do. 

Thursday, July 09, 2009

Cleaning house, Petunia Dursley Style

"The kitchen door had opened, and there stood Harry's aunt, wearing rubber gloves and a housecoat over her nightdress, clearly halfway through her usual pre-bedtime wipe-down of all the kitchen surfaces."  (from The Half-Blood Prince, p. 46)

I used to think that Petunia was obsessive and overboard with cleaning.  I used to think that a daily wipe-down ritual was crazy and time spent on something far too unpleasant.  That's what I used to think...

Until I got home from my three-week vacation to find ants in my kitchen.


Spiff thinks that I over-react to the teeny, tiny little insects I found marching over my kitchen floor.  However, I remember all too well the ant infestation in a house I shared with roommates, that centered around the kitchen sink.  I remember the sight of thousands of little insects constantly framing the sink.  I remember thinking that the kitchen sink was moving, if I caught a glance of it out of the corner of my eye.  I also remember feeling that if I consumed anything that came from the kitchen, the food must also be crawling with little marching creatures.  It still makes my skin crawl and my stomach turn to think of it.

This is why I no longer think that Petunia Dursley is crazy, at least about kitchen cleanliness.  I have taken to wiping down all kitchen surfaces and mopping the floor with bleach water every night.  I also spray any little beast I find swarming over dropped pieces of ramen noodles with Lysol, and then I mop, mop, mop my cares away.

So, if you drop by my house around 8:00 in the evening, you might find me donning my housecoat and my rubber gloves, with Lysol in one hand and a bucket of bleach in the other.  We're aiming for an ant-free kitchen here!


We had a great three-week marathon vacation.  Here's a quick summary:
  • Oregon for a week, where we fit in all the family and friends we could handle (dinners with friends, wedding preparations, bridal shower & bachelorette party, the wedding, and a day on the coast, and even a could bike rides for the boys).  
  • Utah for a few days of the other side of the family, some family pictures, and a whole lot of Wii Mariocart.
  • Home for two days, just enough time to see Spiff's mom (who happened to be in town), and to pack for another vacation.
  • Michigan for a week of fun at the cabin on the lake.  The weather turned out to be unseasonably cold, so there was no swimming, no boating, and mostly just huddling together and trying to keep warm.
We are back from vacation, and I am glad to be home.  Gunner is also glad to be home.  We completely wore him out, and he has spent the past few days sleeping and sleeping.  Spiff is working again.  Our three weeks of freedom were great, and I'm not sure it has hit me that he has started his 3rd year.  It still sort of feels like he's still just studying like mad for the boards.  I'm sure it will feel different tonight when he gets home from call after 10:00, and after being at the hospital since 6:30 this morning.  We have to get used to a new normal for the next few years.  

The highlight of our trip was Spiff's sister's wedding.  She was stunning, the wedding was beautiful, and the party was fabulous.  Check it out:

The happy couple.  She is beautiful!  
(And he looks great, too.  But come on, seriously, all eyes are on the bride on her wedding day!)

Sister Sassy (the bride) herself made these stunning cut-paper centerpieces.  This is only one of four sides, and there were about eight(?) designs.  They were lit from the inside, and absolutely stunning!  My sissy is so talented!

The Cake!
Seven amazing layers of deliciousness.

The Centerpiece.
Mouthwatering Indian food and fruit bar.

The dance floor before the lights were dimmed.
I took these pictures to capture how vibrant the saris were.
Turns out, the whole thing looked even more amazing when the lights were out.

Sunday, July 05, 2009

Third Year

I start my third year of medical school tomorrow.  My first rotation is pediatrics, and the first week will be spent in the neonatal nursery.  Since this year will be unlike any of my previous schooling, I am a little apprehensive.  As the previous post mentioned, I was able to spend a day in the OR with my friend back home. While there, she let me intubate a patient, put in an LMA ( which is another airway device), and start an arterial line (analagous to an IV, only intra-arterial).   I have to say, it was way cool.  Anyway, not much more to say other than hopefully this blog will become exponentially more interesting now that I'm doing more than just studying day in and day out.