Nica

I just noticed that this blog has WAY too many medical/school-related posts. True, that's where my brain spends 95% of its waking hours, you know, when it's not thinking about coffee, or thin mints, or Britney Spears, or cosmos, or...you get the idea. The point is, I actually care about Other Things. And do Other Things. So...a bit about the beautiful country of Nicaragua.

Almost two years ago I went to Granada and San Juan Del Sur, a town on the Pacific coast. Granada is gorgeous, and it's an old colonial city, with a beautiful main square (whose cathedral is pictured at left) and houses that are colorful and all have holes in the roofs. It's on Lake Nicaragua, the largest lake in Central America. The picture at the end is from the island of Ometepe, which is in Lake Nicaragua. I stayed with a family in Granada, and they were amazing. The family consisted of Goyita, the matriarch, her two daughters, and her oldest daughter's two daughters. They were very warm and welcoming and fed me lots of fried rice and fried cheese with cheese on top (seriously). This is a picture of Goyita, Marta, and Triana:I could write about Nicaragua for pages and pages, but I'll spare you. In short: the people are really friendly, everything is super cheap, they speak highly comprehensible Spanish, and the country is beautiful. I will write more about it some other time, but until then, I leave you with this serene image: (I wish a camera could capture sound and smell.)

Would you want a computer program deciding your fate?

Well, it's that time of year again. No, not the first day of spring (though that it is), but Match Day. Match Day is quite the event in the world of medical education, though it is possible that people who don't have a friend or loved one going through the process (or will go though it soon themselves) have never really heard of it. (What? How could you have not woken up this morning with a start, already feeling the excitement in the air?) Anyhoodle, what is this 'match,' you may be asking yourself. Well, basically at 12pm eastern time on the third Thursday in March, all the soon-to-be-graduating medical students gather at their school, get an envelope handed to them, and find out where in the country a giant computer program has placed them for the next 3-7 years of their life. Fun, right?? Lest you think that the computer can send you anywhere, all the applicants rank which programs they want to get matched to, in order. For example, if you want to go to BU, Harvard, and NYU (as your 1st, 2nd, and 3rd choices), the computer will first look and see if BU ranked you on their list; if BU didn't rank you, then it looks to see if Harvard ranked you (it probably didn't). Then they go to the next one on the list, Tufts, and if Tufts has ranked you then that's where you're Matched. Get it? I don't either really, but that's the story they give us of how the system works, anyway.
So instead of spending the afternoon diligently caring for my patients (my friend Rachel: "If one starts bleeding, they'll page you"), I instead pored over UMass' match list. Some interesting tidbits:
-It appears that the majority of MGH's pediatrics program will be comprised of UMass grads, many of whom seem to be going there
-A whopping 19 people out of 104 are going into pediatrics. I think it'll be even higher next year (at least partly because of that wacky and charismatic peds attending we all know and love).
-Zero people are going into dermatology, which is kind of surprising, considering derm is so popular (though it is competitive).
-About half of the grads are staying to do residency in MA. Surprising or not? I dunno, but it's interesting to think about since all the students are from here. Perhaps this cold and snowy winter has pushed people further south and west than in other years, like when the third snowstorm in a week hit right in the middle of interview season. (The pediatrics residents told of interviewees who got stranded in Worcester and couldn't get back to Logan on more than one occasion: applicants from California who likely ended their interview day curled up in the fetal position in a snow drift on Route 9.)
I thought that going to the Handing Out Of The Envelopes today was pretty fun (my senior resident: "Come on, team, we're going on a field trip!"), but seeing it all made me wish I were going through it next year, instead of in two years. Hey, even though I made the choice to extend and graduate in 2010 doesn't mean I'm not allowed to whine about it sometimes. :)

addendum: Our very own soon-to-be-Dr. Brant has matched at Tulane in internal medicine, her first choice! Yay!! :) Though we in the north will certainly miss her.

Fun on the wards

So I started inpatient pediatrics this week, and while traipsing around 5 East listening to stuffed animals' hearts and lungs and placing bets on which pregnant resident is gonna pop first, I've started playing a little game (in my own head...yes, I'm easily amused) I like to call, "Pediatrics and Surgery: same or different?"

For example, our senior resident was gone yesterday, but left us a paper to fill out about newborns as "homework." She came back today (she's very cheery and blond...just painting a picture of the peds residents for you) and said, "So, guys, did you do your homework?" and we said, "Why, yes we did," and she said, "Great! We'll go over it during ice cream tomorrow." Because, you see, Friday is Ice Cream Day on 5 East. So for this one the answer to my game is: different. There is no Ice Cream Day in surgery. Instead, sometimes if you're really lucky you can swipe Lorna Dunes while you're doing a consult in the ER.

Round two: My (blond, cheery) intern seems to have something of a policy of doling out no less than 18 warm fuzzies every minute. Like, I retrieve one piece of paper (that I probably should have had in the first place), and she'll say, "You're doing such a great job!" or the other student and I might, you know, see our own patients for 5 minutes, and she'll say, "Oh my goodness, you two are just so fantastic!" I think you can guess the answer to this one: that's right, different. The surgery residents don't have time for warm fuzzies. Maybe inside they think we're doing a great job, but their outside is too busy saying, "This is a lap pad!! I wanted a four-by-four!!!!" or, "Cut! I said cut here!!!!" to really tell us out loud.

I actually had to phone a friend today to ask for a same one. She said (and she's right): Pee remains very important. I continue to monitor the urine output of my patients at near-OCD levels, and pediatrics adds the added twist of forcing me to calculate everything in cc/kilogram, exposing my horrendous math skills for all the world to see (sorry, mom). Actually, I never knew I was so bad at mental arithmetic until I had to calculate stuff like: how many teaspoons of tylenol should a 23-pound child get if the tylenol suspension has 160cc/mL and the dosage is 15mg/kg? Oy vey. (Usually I end up scratching my head and blindly pressing buttons on my calculator, until I eventually admit defeat and start rummaging around in the drawers for the acetaminophen dosing chart.)

Anyhoo, all in all this has been a fun game for me. I'll definitely try to keep playing as I'm enjoying a sundae tomorrow, while making sure to keep the caramel sauce off the expensive end of my stethoscope.

Happy International Women's Day!

International Women's Day was first celebrated on March 8, 1909 (well, that year it was National Women's Day), a year to the day after 15,000 women marched in the streets of New York demanding shorter work hours, better pay, voting rights, and an end to child labor. The day is an official holiday in many countries, such as those of the former Soviet Union. You can read more about its history on the IWD website.

On the first IWD of the 21st century, the UN issued this statement:

"...members of the Security Council recognize that peace is inextricably linked with equality between women and men. They affirm that the equal access and full participation of women in power structures and their full involvement in all efforts for the prevention and resolution of conflicts are essential for the maintenance and promotion of peace and security."

The UN has taken on Women's Rights, and specifically the Elimination of Violence against Women, as a major issue in the past 30 years; gender equality is one of its Millenium Development Goals. Two weeks ago, at the opening meeting of the Commission on the Status of Women, the UN Secretary-General said:

"Violence against women is an issue that cannot wait. A brief look at the statistics makes it clear. At least one out of every three women is likely to be beaten, coerced into sex or otherwise abused in her lifetime....No country, no culture, no woman young or old is immune to this scourge. Far too often, the crimes go unpunished, the perpetrators walk free."

Lest we delude ourselves into thinking that women and men live as equals in the United States in 2008, consider an article from today's Boston Globe about a professor of anesthesiology at the BI who is filing a lawsuit against the hospital, its president, and the chief of surgery, alleging years of sexist treatment (the chief of surgery reportedly told a group of nurses that he preferred to hire residents who were "tall, light-skinned, Western-taught men"), at the end of which she was demoted. And although women enter medical school at nearly the same rate as men, they are still under-represented in the upper ranks of academic medicine and in certain specialties such as neurosurgery. It would be naive to think that the dearth of full-fledged female professors in medical schools and teaching hospitals is because women haven't been entering medicine at high rates for long enough. Discrimination, both overt (like that referred to in the lawsuit against BI) and subtle, is everywhere, and the lack of female professors (of all specialties) and mentors creates a dangerous pattern of not encouraging young women to take career paths so often taken by young men after medical school. There was an interesting article in AMSA's magazine this month called Breaking into the Boys' Club. You can read it here.

Ok, enough on this (albeit interesting) topic for today. (*alights from soapbox*)
[But this is IWD, after all. If you can't rant about gender bias today, when can you??]

Fun in the ER

I was asked a question by a parent yesterday that caught me off guard: "Is this one of the first lumbar punctures you've ever done?" And I answered honestly (though sorta lied by omission): Yes. She certainly didn't have to know that her son was the recipient of my very first LP. Sure, I tried to make it look like I'd inserted thousands of long needles into young kids' spines before, but I don't usually hide my panic well. When I had explained to her why her kid needed one an hour earlier, part of my explanation was something along the lines of, "Don't worry! Dr. Attending has done millions of these before!" even though I knew full well I was going to be the one doing it. I couldn't very well have said, "Actually I'm going to practice my first one on your eleven-year-old. Don't be alarmed! I passed my anatomy of the back exam."
[side note: When she asked me that question I had a flashback to the very first Kaplan SAT class I taught, in which one girl asked me if it was in fact the first class I had ever taught. I went with honesty and told her yes: bad idea. I lost them. I might as well have written on my forehead: DON'T RESPECT ME, I'M NEW HERE.]
I mean, parents have a right to know when semi-competent medical students are learning how to do invasive procedures on their loved ones. However, if they truly knew, no one would ever consent to that. Right? I feel like if it were my kid I would have said, "No way! Dr. Attending will be performing this procedure, thankyouverymuch." It's been pretty well-documented that patients receive better care at teaching hospitals (ones with residents and students), but that piece of information seems quite abstract and theoretical when you're in a place like the one I found myself in yesterday. I do feel kind of guilty that I didn't come clean from the beginning and make sure she knew I'd be the one doing the procedure, but I also am pretty sure she would have said no. So what to do??
(p.s. Tap went well. Kid lived. Clear fluid. Discharged home.)

Let it snow

Well, Mother Nature has decided in her infinite wisdom to welcome March with a snowstorm. Actually I was ok with this one, since I didn't have to go anywhere during the 12 hours that it was snowing (heavily). And I went for a walk this morning and took some pictures when it was really pretty. There weren't that many people out, and everything felt very calm. I came thisclose to making a snow angel on the lawn in the center of town, but thought plopping down on my back near a busy intersection might cause someone to wonder if I'd keeled over (since I'm not, you know, 8 years old). Yesterday we had a class on adolescent medicine, and the professor said it's hard to teach people how to recognize when adolescence is over. I think I recognized the end of my own adolescence the first time I saw snow and felt annoyed. I caught myself and was then annoyed that I felt annoyed, when I used to love snowstorms, and how the snow lining all the tiniest tree branches made everything look so magical. God, adulthood is awful sometimes. So I was especially happy that I got to enjoy last night's storm, and not let my grown-up curmudgeoniness (word?) get to me. Nevertheless, I won't protest when spring decides to grace us with her presence. :)

This is the church in the center of my town.

My lovely house in the snow.