Pediatrics vs. My Immune System

I take pride in my health. Truly, I do. I can't remember the last time I vomited because it was so long ago (elementary school). I love my body and I love taking care of it with plenty of walking, water, the best my med student grocery budget can buy, and the most my med student sleep schedule can permit. The last time I had a fever was my first visit back home, Christmas 2012, after spending 8 months in Dominica. The weather mixed with the surrounding germs proved to be too much for me to handle. I lasted a week before a fever took me down and left me with a Phoebe Buffay sexy voice the remainder of the break. Since leaving the island and experiencing all the seasons in the States, I've fought off the common cold with some well timed DayQuil and NyQuil. Fast forward to this week. My first week in a pediatric outpatient clinic, a cesspool for germs. Wednesday, I started feeling a scratchy throat. By midday Friday, I had chills and no appetite. I slept 10 hours last night with the help of NyQuil and still needed an hour nap after a few hours of studying today. Damn you kids and your filthy habits!

I'll be in this clinic for one more week. My colleague is another Canadian Rossie, Chantal, from Cambridge, ON. She's sweet, soft-spoken, and one semester ahead of me. Our preceptor is a Filipino pediatrician with far too much enthusiasm and sass for my liking. She's great at her job and I assume you need that kind of personality for it. So kudos to her. The kids are a wide range of cooperative to annoying to I want to punch you. The parents are a wide range of even-keeled to over-bearing to I'm worried you actually punch your kids. 

The germs come in all forms. Sneezes and coughs to the face occur far more than a normal human being would tolerate. I have washed my hands in one week more than most have in one month. And yet here I am in layer upon layer, with goosebumps all over and feeling like crap. I'm told pediatricians have the best immune systems because of what they're exposed to on a daily basis. Our preceptor said she only gets sick once a year because she's already fought off every thing else before. I'm a newbie and so it makes sense for me to be sick. It just sucks that I'm only halfway through the rotation. Hopefully I can bolster myself to survive the second half. As a result and also because of general procrastination with regard to this blog, I'm not in the mood to write all that much. Deal with it.

Working the floors

Sunday had me back to the NYC routine of laundry, bagels (I missed them so much), and 5pm church at Redeemer. I'd become so used to going to church in the late morning since leaving New York that I felt restless in the time leading up to church. It's like a whole day passes and then you go to church. It was nice to return to the pared down but expertly played music, and the in-depth sermons. An added plus is gathering with other young adults. It's a large congregation and I rarely sit in the same place so I haven't met the same person twice in any of my Sundays there. It's a good reminder that there are many of us.

This week, I was on the Peds unit in the hospital, which meant the return of 5:30am alarms. How I loathe them. I was with the same guys I was with last week at the subspecialty clinics - Dan from Akron, Ohio and Doug from NYC. They're both a semester above me and really swell guys. Dan reminds me a lot of my brother's friend, Sebastien, in terms of how he speaks and jokes. Doug reminds me of Pleakley from Lilo & Stitch, but way less spazzy and more endearing. It was also nice to work with the same residents and attending for the week instead of interacting with a new person every day like last week.

We had a decent range in patient age, but MOTS in terms of diagnoses. Demographics vastly influence the types of cases you'll see. We're in a poor area with a predominant African American population. People live in shelters or dilapidated structures with mold and dust; large families crammed into small units. Substance abuse, tobacco use, poor prenatal care, premature birth, all of these factors make it easy to have respiratory problems. On top of that, people of African decent are prone to have sickle cell trait/disease. We know that crime and violence can run high in select populations - namely adolescent males. If you were in your mid-teens and didn't have a respiratory or sickle cell condition, you were in our unit for trauma and your story was unbelievable, literally containing statements that were not believable. The residents warned us about that. It just so happened that this week's trauma patients' stories started with similar statements, which backed up the residents' warnings. "Oh you know, I was just walking home from school when out of the blue..." finish the sentence with "...some guys were getting into an argument nearby and I ran away, felt a pain in my hand and when I got home, I saw I was bleeding from my hand" or "...a group of 20 people jumped me and then I fought them all off and when I got home my jaw hurt real bad". Yeah, buddy had a GSW to the hand and champ had a bilateral broken jaw (with no bruises, defensive marks, or trauma anywhere else on his body). We don't question the stories because it does us no good. We offer a protective watch (a police officer guards their room), to remove their name from the patient list so people can't figure out that he's at our hospital, to move them to a room nowhere near the entrances so that he's not easily accessible to outsiders, and of course we treat their injuries. The only thing they take us up on is the treatment. 

Peds seems to be an easy going place. The mood is kept fairly light. Even when the attending rebukes the residents, it's with a firm tone, but no yelling or belittling talk. The attending was a kind woman who included the med students and took time to teach during rounds. She was tiny with us towering over her in her heels. Great with parents and kids. Her height and soft voice work to her advantage in this setting. 

The kids that take to me seem to be the ones 3-12 years old. Babies will take to anyone. 2 year olds only want their parents. Teens are fine, but haven't become as enjoyable as my youth group leader days. Oftentimes, I call my friends "champ", "kiddo", and "babe". I'm confident I've used all three on the Deutsch girls, Ali, Chelsea, Deen, and countless others. For kids, I keep "champ" and "kiddo", then add in "buddy". Thus far, it's worked well for the respective groups and I haven't had to adapt too much as a result. Generic terms of endearment are the best!

In other news, New York has yet to decide if it will observe Spring or not. On the day of the spring equinox, it snowed. Just a few inches, but the bone chilling wind is still very much present. Today I had my call shift and the commute to work revealed which landlords and businesses are prompt about clearing their sidewalk. From my stop, the L runs mainly above ground for the commute to south Brooklyn, which means that each stop on the way to work is met with a chilling draft through the doors for a few seconds.
 
Today marked the first day I was allowed to wear scrubs, which is a treat for me. Not that I spend much time trying to decide what to wear amongst my minimalist business casual wardrobe, but it's nice to not have to decide at all and just throw on my FIGs. Tamera also had her call shift and since she wasn't on the floors this past week, I brought her up to speed on the patients. Over the week we had been steadily discharging patients such that we only had 5 on the floor today. After rounds, the attending decided we could discharge 4 of the 5. So we went through cases with the residents, got the last touches needed to complete the discharges, and then we were done. With the early dismissal, Tamera, her friend Naveen, and I headed to Cornerstone Cafe in Manhatten for late brunch. The time would be considered late lunch, but they still served brunch. I'm not complaining. I had two eggs, toast, home fries, side salad, and a large Belgian waffle with fresh fruit and whipped cream. I feasted for $14. I was very happy.

I got home to watch the 3rd period of the Nucks vs. Kings game and that was rather tasty too. It's been a while since I've been able to take in a game with the time change, but I still check my NHL and Canucks apps on my phone daily. With the regular season wrapping up in 4 weeks, our boys are looking good in terms of making it to the playoffs, which is impressive for a "rebuild" season (I'm sure I lost Court by the second sentence, so I'll wrap it up). Since I'm going to be in a hockey loving city (NYC and Chicago) during the playoffs, it was important for me to pack something for the occasion to show my support. Since I'm not due back 'til Christmas and needed to pack light, the jersey stayed home, but White Dad gave me the perfect gift to pack, keep me warm in this "spring" weather, and show my love for my team.

I can rock a solid toque

Back in the Big Apple

With Step 2 CK and the MCCEE behind me, it was time to return to the life of clinical rotations. This year likely won't have me coming home until December, which makes this my longest stretch in my med school journey, beating my first year stretch of 8 months (the first two semesters). There are plenty of weddings happening in 2015, but none I will be able to make or rather am willing to sacrifice time and money to come home for. Court's health isn't where any of us want it to be, but it's stable and the tumour isn't growing. So I don't anticipate making hasty arrangements to return home to be with her. Believe me, we're both happy I can say that. Hard to believe I'm in my last year even though I've been documenting my journey on here for 3 years. I've missed a lot, but I've also been able to be home for important times too. Such is the balance between sacrifice and selfishness in the life of a med student. 

My connecting flight from Vancouver to LA was a good reminder of what I'm getting into again - seizing purposeful moments with people. I've been able to keep my hands on the pulse of happenings back home fairly well with my frequent visits, but now I'm hands off for a while and it's time to return my focus on the people I'm around and work towards being something good to them. I had the pleasure of sitting next to a woman for my flight to LA who happened to be taking notes on a Pacific Dental Conference notepad. Being the daughter of a dentist and dental hygienist, I knew there was a conference that took place over the weekend. I spent the next while getting to know a bright-eyed, glitter-faced (it was discrete make-up) friendly Leanne, a dental hygienist and entrepreneur of a dental staffing company. We talked about passions and taking the time in life to pursue them despite the amount of hard work that's required. She gave me her card and I told her I'd pass the info to my dad. She ended our exchange with "I knew there was something about you. I kept telling myself to talk to you because I know I need to put myself more out there. I'm so glad you spoke to me." As we disembarked, we wished each other well on our pursuits and then I headed to catch my flight to New York.

Judy greeted me at my Brooklyn apartment with a "Hi Sweetie!". I contacted Judy earlier in the year to see if there would be a vacancy when I returned to Brooklyn. She had her basement suite available which came with its own entrance and bathroom and no housemates to share space with. It would be $50 more per month than what I was paying last time. So it seemed like a sweet deal, until she contacted me a few weeks later letting me know that one of the rooms upstairs had become available. Not my original room, but GiGi's. A large room for the same price as my old room. While it'd be nice to have my own space, I remembered enjoying getting to know the former tenants, particularly Neda (who has since added me on Facebook). It didn't take long for me to tell Judy I'd happily move upstairs and share that tiny kitchen and bathroom with four other adults again. Polly is still in my old room, Victor is still next to her, Sean (who took over Neda's room) is still there, but Sabrina had left. Instead, a new med student, Don, had moved in. 
Sunday, I was completely oblivious to the time change and assumed that I got a solid 9 hours of sleep when in reality I got 8. It was a bright sunny day and I enjoyed soaking in the sun in the crisp air as I headed out on various errands of getting groceries, toiletries, and a metropass. Sizeable mounds of snow lined the sidewalks. Landlords are prompt in shoveling and salting the sidewalk in front of their property. The sun is working its magic too in the form of large puddles on the curbside. I had planned to go to Redeemer Presbyterian for church, but the 5pm service was cancelled due to a previous scheduled event at the Salvation Army. No harm. I continued following the Reality LA series on Job via their podcasts. 

The familiar walk home with some white stuff on the side

Monday morning I got to know Don as I prepped my bowl of cereal. Nice guy. He's from another Caribbean med school who's in the middle of his first rotation - Internal Med. Headed out and made the familiar walk to the L line and decided to take the bus to the hospital instead of walking from the subway station. Tamera from my IM rotation is also in Peds. Malini's friend Daniel (whom I met that one night we all went out in New York for late night Chinese) is also there. Joanne passed through the office en route to her Cardiology elective. She gave Tamera and I each an envelope with our names on it. Inside was a save-the-date magnet for her and Albert's nuptials in October. While the "new to Brookdale" students went for their EMR training, Tamera and I caught up over breakfast.

Peds at Brookdale is broken up into various shifts: one week in sub-specialty clinics, two weeks in an outpatient clinic, one week on the floors, one week in ER, one week in NICU. My first week was the sub-specialty week with delightfully late start times of 9am. I was able to experience sub-specialties like neurology, GI, cardiology, infectious disease, and immunology. I knew we're in a rough area and expected to see some tough cases that are more prevalent in low socioeconomic populations. It's hard to stomach and there were many cases that stuck with me from IM in adult populations, but seeing the trickle down effect on kids who couldn't have a say in cards dealt them, well that's depressing. Pediatric Infectious Disease clinic should basically be renamed Kids with HIV. That's all we saw. Kids who got HIV from their mothers who weren't treated when they were pregnant. I don't know how you explain to your child that you're responsible for them not being able to live the life most people lead. Pretty heartbreaking. Fast forward to Cardio clinic when as soon as I enter, a kid runs up to low five, high five, and jump five me. I'm soon directed to a room with a 6 month old with VACTERL association and observe the cardiologist examine her. My friendly fiver was the next patient for cardio clearance before being prescribed medication for ADHD. Upon exam, we discover a generalized sandpaper like rash, white exudate from his tonsils, and learn that he recently had a fever - classic signs for Scarlet Fever. The glee of recognizing the diagnosis so quickly was rapidly replaced with the fear for my 6 month old previous patient. Did I touch her? Did he high five everyone in the waiting room? Did he touch her family? Did he touch her? A quick scan of my memory reminded me that I didn't touch her, her belongings, or her family, but I have no way of answering the other questions. I just hope the answer is no. 

An old childhood friend, Kyle, happens to be in New York for the month. Kyle is a doctor doing a traveling fellowship which is far too complicated to explain. Someone recommended that he check out Sleep No More and so we decided to go Friday night. Sleep No More is an interactive "play". You walk through dimly lit floors of the McKittrick Hotel, which is actually three adjoining warehouses in the Chelsea district. You are free to explore rooms, belongings, or observe actors as they perform, who for the most part are mute. You have to wear a mask and are not allowed to speak. It's an adaptation of MacBeth set in the 1930s. The "play" runs on a cycle and you are free to stay as long as you like, taking in multiple cycles so that you can observe and follow as many characters throughout the production. It's unlike anything I've ever taken in with regard to performance art. 

We get to keep the masks we had to wear at Sleep No More

Upon entry into the "hotel" I opted to head to the top floor which appeared to be an insane asylum. No actors on the floor, but so much to explore. There's a wooded maze in the middle of the floor that I was exploring when I heard a scream and a person in white run by, followed by a flock of masked patrons. I followed suit and found myself exploring other floors and trying to figure out what was going on. There were choreographed fights and dances and because I was catching things midway through, it wasn't making a tonne of sense. Then I ended up on the bottom floor where most people were gathered to watch all the actors in a dinner scene. Turns out that was the end of one cycle. I opted to follow a nurse, whom I saw hiding in the back corner, for the next cycle. I learned that she was the one in white running in the maze and I was hot on her heels when I followed her up to the wooded area. I watched her undress another actress and bathe her naked body. I was thankful that I couldn't see the looks on the male spectators' faces, and I'm sure they were equally as thankful for their masks. Keep in mind these actors are trained dancers and have physiques that any human being would appreciate. Followed the nurse to her office where she unlocked a box containing a scalpel with which she used to stencil out an abstract shape from a page in a book. I felt a bit tense in that moment, but relaxed after she ripped out her carving and locked up her scalpel. Then she went to another room where a desk brimming with medical supplies was. I watched her meticulously align q-tips in a row, evenly spaced. Once she finished with the q tips, she moved to other supplies to carry out other OCD tasks with on the desk. It was at that moment that I realized I had attached myself to the wrong actor. Damn you, medicine! That's the last time you intrigue me and take up my precious time and money...

I walked down a floor to find one of the male performers lying in bed. Then the previously bathed actress entered the room, undressed, redressed into a nightgown, and then had a dance in bed with the male performer. I don't mean "dance" as a euphemism. It was a literal dance, though the literal dance was a euphemism... (If you don't understand ellipses, you won't enjoy this post or it's probably for your own good). I decided I'd follow the guy as the female seemed content to lay in bed. I followed him to another floor to watch him smother another man in his sleep, wash his hands with blood, return to the girl to be stripped naked and bathed by her, then leave and kill someone else. Long story short, I saw a lot of fake murder, and real boobs and penises. Not far off from Roman Polanski's blood & boobs count in his cinematic take of Macbeth. I had to watch it in high school and the witch scenes didn't help me appreciate the female form. Altogether, the "play" was unsettling and I wasn't in the mood to endure another cycle to observe other characters. 2 hours gave me enough blood, boobs, and penises to last me until my surgery rotation where I'll continue to see more than my fair share of MOTS. If we were keeping count (which we're not), I'm pretty sure my numbers rival porn addicts. I'm not proud of that. They're probably not either, though for different reasons... . Needless to say, I was relieved to take my mask off and reunite with Kyle. We lost each other about 10 minutes into our experience, but I definitely exceeded my exercise goals on my FitBit that night. So there's that.

I've known Kyle since elementary school. Every now and then, he'd join us on Summit Crescent to play street hockey, but didn't hang out as much as the rest of us did. Always a smart kid. Never seemed to struggle with anything academic. You knew he'd be a doctor of some kind. Hard to tell if he's changed from what we thought he'd be. Physically he's still short, but Asian genes will do that to you. His personality has grown and he's more outgoing and confident which is nice to see. I'm not sure what my friends thought I'd be when I grew up. Doctor was definitely on the list, but so was counselor, and to some, so was musician or music producer. Every now and then when I bump into someone from back then, they'll ask if I'm still involved in music (it's actually a bit amusing when that happens). We'll call it being well rounded instead of lacking direction. Physically, I was a late bloomer and didn't finish growing until 2nd year college. Now I'm taller and more "endowed" than what most expect from a skinny Asian, though my feet and hands insist on remaining ridiculously tiny. And while I'm technically in med school, no one (not even I) could have predicted the journey I took to get here. Personality wise, I never had a confidence issue. I think I'm less silly, or at least I'll save it for when I'm around close companions (if you saw me on my last day at the Deutschs, you'd see me crack up twice over a book called "The Redbreast", I'm giggling as I type this - so there's still room for improvement). 

I suppose as objective as I'd like to be, I wouldn't be the best judge of whether my personality's changed. I do know I am very comfortable with who I am and how I have led my life. I feel firmly rooted and stable in my identity. I know what I am passionate about, and I know I am pursuing those passions with clear conscience. Let me be absolutely clear though. As wonderful as my life is, this is by far the most willing I've able to hold it with open hands. I walked along the beach with Mac during my break and I don't know how we got there in conversation, but I said that if God decided I'd die the next day, I'd be fine with it. I don't care that I'm the healthiest I've ever been or that I'm so close to finishing my degree. I wouldn't try to negotiate more time. I'm 28 and at complete peace with what I've done with that time and I'm confident that I'll be able to make good use of whatever time I have left. It actually makes life exciting when you're already content with it and ready to make something happen when an opportunity presents itself. I highly recommend giving it a shot.