Tuesday, January 16, 2007

Pediatric Check-Up: Hours

Current total hours worked: 101.5!
Current days working on this part of the job: 7 days

Saturday, January 13, 2007

Pediatric Check-Up: A Time of Advocacy

From Merriam Webster Online

Support: (1) : to promote the interests or cause of (2) : to uphold or defend as valid or right : ADVOCATE (3) : to argue or vote for

So one of my ideas for my advocacy project was to build a website for the local GLBTQ (gay, lesbian, bi, trans, queer) community. This website would function much like an information and triage desk. It would list available resources, as well as providing enough information to give people an idea of where they should look next to find real people to do things with, such as volunteer, advocate, or just plain drink with.

In speaking with some community members who are active in various organizations providing services in the area, this website is needed, but not only as a website, but as a comprehensive online community. This is interesting to me as this is a variant of what Sunny and I are trying to do with http://poeticpublishing.com and http://davinciconcept.org. While with those sites we've built a site and are trying to recruit members, in this case a group already exists but needs a virtual home. For the online communities we've already built, Sunny and I already have capacity for email, forums, and serving content. To build this one, I would probably use a wiki as well, though maybe I'd use DokuWiki instead of MediaWiki as the collaboration on content would not be the focus of this group. For emailGmail, I would also use and then for listserve management, I would try Google Groups. For community calendaring, Google Calendar, of course.

Why all the Google use? It's free, it works, it's meant for multiple users, and I don't have to host or manage it. Furthermore, the text ads are very unobtrusive, and it's a small price to pay for all the work that I don't have to do myself. Same thing with the wiki use. I'm familiar with DokuWiki and MediaWiki, and though I don't currently understand the nuts-and-bolts of installation and of upgrading these two, I have watched Sunny upgrade this site, the content of which is managed and displayed by DokuWiki.

Now, of course, this online community would not be the same as the real-life community it serves. There are plenty of people without access to the internet and computers. However, I think that the majority of the population have access to either libraries or their own computers, and that reaching out to the less technologically privileged would be a project that can be fulfilled by one of the current organizations.

In terms of this working as my advocacy project, my residency director thinks that it's a great project, and I'm looking over the CATCH grant paperwork to see if they might fund the learning curve that I'll need to undergo in order to do this properly. Let's hope that it does!

Tuesday, January 09, 2007

A Cat's Life: Toilet Training

Cat feces carry a risk to both pregnant women and immunosupressed people. They can transmit the pathogen Toxoplasma, of which cats are not the only carrier. Besides being infectious, cat feces and urine are just gross to deal with, so Sunny and I have been planning to train Ulysses to use the toilet for a long time.

Firstly, I looked around on amazon.com to see what was available, and then read some reviews. I found that I needed a training device, though some people have used plastic wrap, like Saran, for a trainer. Then I needed flushable litter. Though I had a device picked out on amazon, I ended up buying Doogie's Litter Kwitter at the local retail pet store so that I could return it if it didn't work. So far Ulysses is making a mess, since the training seat isn't deep enough to hold a lot of litter, and Ulysses is a big cat. Litter gets all over the bathroom floor, and sometimes there's poop too. Eew. But hopefully the mess will be offset by future freedom from sifting through kitty litter for cat poo. And no toxoplasmosis when I'm pregnant.

Monday, January 08, 2007

Pediatric Check-Up: Sleep, Rounding, and Sign Outs

I've often been asked how much sleep I get as an intern; it's an understandable question because on certain rotations I work 30 hour shifts. What really bothers me, though, is not necessarily how much sleep I get, but when I have to get up. Generally, when I was on the inpatient service in August, I hit the floors around 7AM. However, now that it's the wintertime, I'm really facing a wake-up time of around 5:30AM and an arrival of around 6AM to get the work done in time to present patients to the team for the morning's planning session, generally known as "rounds". It sounds very, very painful to me. I used to be a night owl and still relish staying up as long as I want when I can. Furthermore, Sunny's a night owl too and likes to go to bed around 1AM. I can't do that with a 5:30 alarm bell.

What makes tonight even more interesting is that each team is switching personnel. All of the interns are coming from other rotations to pick up the current team load. Furthermore, the team I am switching to is admitting patients tonight, resulting in uncertainty of how many patients I'll need to see by 8AM tomorrow morning, which is when rounds start. I don't like it, but there's nothing I can do but try to make it in by 6AM, a feat I've never accomplished unless I was already in the hospital.

Pre-rounding, that is getting the data for rounds, is always an adrenalin-laced experience for me, and I don't really like it. For pre-rounds, I record a summary of all my patients' vitals, lab values, and general events from the 24 hours since we rounded last. This includes a bedside visit and exam. For new patients I am generally slow, hopefully due to me being thorough vs. some kind of intrinsic inefficiency.

Generally, though I know my patients and know exactly what to look for to see if they are getting worse or better. On a switch day, though, the quality of the information from the departing intern tries to fill in for that familiarity. The passage of information is called sign out, and it's a process that desperately needs some troubleshooting.

In an effort to decrease medical errors, residents across the nation have had their work hours limited to an average of 80hr/wk each month. This is similar to work hour limits in fields such as aviation (pilots) and other crucial errors. However, preliminary data suggests that the increased mental rest residents are getting is being offset by errors made by cross-cover teams due to sketchy sign out. I'm still in the process of reading up on this, and I hope that further studies continue not only to track the numbers, but to also test ways of making sign out more efficient and information-laden.

Occasionally, I am irked, as today, with the quality and thoroughness of sign out. One person just left and didn't bother to sign out to me. Another describes a 3 week hospital stay that included an ICU stay as "simple". Such things suggest to me that there is a systems issue that needs to be addressed by a policy statement to clarify things. My current personal policy is that whenever I leave a hospitalized patient for another rotation, I tend to leave a summary of their stay under my care, so that the next person doesn't have to flip through a whole book of notes to try to figure out what happened. I also intend that when I am team leader to clearly verbalize criteria I expect for this kind of major sign out, and make sure all of the team members understand what I am expecting. It might just be easier and less bossy to get the whole caboodle in writing, or find out where it is written, and just email it out.

  • Editorial: Is 80 the cost of saving lives? Reduced duty hours, errors, and cost.

  • Residency work-hours reform. A cost analysis including preventable adverse events.

  • Disclaimer: I'm still reading the literature on this.
  • Writers' Cafe: A Diamond Age

    This Sunday to Monday night marks the transition to the last day wherein I can work on my entry for the 2006 writing marathon I started on Poetic Publishing, the online art development and publishing site that Sunny and I are developing. For my entry, currently titled "The Grotesque", I'm trying to write fiction, a new thing for me, and the piece sits nicely in the genre labeled science-fiction.

    My problem, other than my inability to come up with a plot, is that though I have emplaced my story in a sci-fi world that Sunny and I have been developing on and off for over a year, the world's not done yet. Most irksome for myself as a primarily poetry writer is the fact that we haven't named most of the technology we're talking about.

    In contrast, Neal Stephenson, author of Snow Crash, a book well-known in techie and hacker culture, builds worlds that are not only colorful extrapolations of now but are also well populated with contraptions that are superbly and uniquely named.

    Today I read another book by this author The Diamond Age: Or, A Young Lady's Illustrated Primer. Though off to a slow start for the first hundred pages as Stephenson describes a world saturated with nanotechnology, the plot thickened eventually, and explorations into basic programing, cultural warfare, and parenting provided enough human significance to give the book a rating of 3.5 out of 5 overall.

    Now, though, I feel totally screwed. My main character is a designer whose creations are given life by nanotechnology. It's going to take a while to wash the lingo and made-up tech of A Diamond Age out of my system enough to make me feel that I'm not obviously crimping someone else's style. Then again, the whole point of the marathon was to let go of the editor and just let the words flow. Furthermore, the development side of Poetic Publishing, also known as Poetic Authoring, is private and secure. So, if imitation ends up being the sincerest sort of flattery in this case, no one not of the community will have to see and laugh at it.

    So here's my concise review of A Diamond Age: it's the pleasure of reading a solid writer break new ground in an interesting nanotech world mixed with the pain of being a nanotech writer trying to break into a new area without copying anyone.

    Saturday, January 06, 2007

    Pediatric Check-Up: Crazy Saturday

    I get asked what my life is like fairly often, as I'm undergoing a type of training whose rigor is renowned. In J. Ruth Gendler's book, The Book of Qualities, I like how she describes how some people seek out suffering and are proud of having suffered. Some people avoid it. I sit somewhere in the continuum, but towards the avoidant side. I don't buy the idea that suffering automatically makes the sufferer noble. In my totally unresearched opinion, that's a religious tale they sold to some peasants to make them feel better about themselves. Yet, if an education or an experience is valuable enough to me, I'm willing to work to get it.

    Currently, I'm an intern at the Pediatric Residency Training Program at the University of New Mexico Health Sciences Center, which is a lot of capitalized words. What it means is that I am in my first of three years of training to be a general pediatrician. The curriculum varies somewhat from program to program, though all programs must meet criteria to be accredited, so core facets remain similar across the country. Our year is divided into 13 four-week blocks called rotations. Each block we operate within a different part of the pediatric medical world, going from inpatient (hospital) service to outpatient to emergency to critical care to different types of specialty care.

    This block I'm doing is called PARC: Pediatric Advocacy, Rural and Community. It's a relatively light block in terms of hours required. Scheduled activities are half-days at the most, with the rest of the time for self-study. The goal of the block is to educate pediatric residents in the process of advocating for our patients. This is a fluid target. "Our patients" could involve a specific patient, a family group, a certain ethnic or minority group in the area, or even creating change on a national level. "Advocating" can involve helping find resources to pay for a patient's chemotherapy, or making seat belt laws physiologically make sense for children, or writing a column, or teaching children how to safely approach a dog. Pediatricians as a group tend to be active advocates, though the issues and the populations we speak for may be very diverse. This month rests us (interns) from our labors, broadens our education, grounds us back in who we are, and gives us quality time with whatever we choose.

    During this month, we also cross-cover (meaning serve where we are not working full time) the hospital urgent care clinic. Whomever covers the clinic also takes phone calls from worried mothers at night. Normally Saturdays are pretty light in clinic as we are only open from 9 AM to 2 PM, and I think that most patients don't know that we're open and don't want to go to the doctor on a weekend anyway. So what's a Saturday in the life of a resident like? Today, there was a rush of patients from opening to closing, and I was taking phone calls during clinic hours as well. I bought a coffee and biscuit for breakfast at 9 AM, ate the first bite while standing up at 11:30 AM, at the last bite while standing up at 3 PM, and left at 4:30 PM while starving for some linguine. The unpredictability of patient care is why I never commit to anything during work days when the time I leave is scheduled as "when the last patient is done". Not even food, my first and foremost romantic partner on some days, is exempt from this. I estimate that the last patient left around 5PM. I'm still taking phone calls. Crazy.

    Friday, January 05, 2007

    Skin and Bones: Car Seats

    Today, Consumer Reports released a paper saying that the car seats they tested failed side-impact testing. These were rear-facing, snap in car seats. For those of you with children, you may be really mad at me because I've been having the following conversation with my patients' parents all year long:

    "Do you have a car seat for your baby?"
    "Which way does it face: the trunk or the engine?"
    "The trunk."
    "Perfect! Is it in the front seats or the back seats?"
    "The back."

    The testing did not compare rear-facing car seats versus seats facing any other direction. So I'll continue my little quiz and recommend car seats over flying babies.

    Thursday, January 04, 2007

    Dictionary Day: Baraka

    From the Merriam-Webster Open Dictionary Project:
    baraka (noun): [ba'ra-ka] [arabic] - a state of heightened consciousness or grace achieved through religious fervor involving prayer and dancing; a blessing that can be carried and transferred from one person to another or from an object to a person (usually one who has made the hajj); the blessedness possessed by a person of character, courage, and selflessness
    Muslims who have completed the fifth of the five pillars of Islam are often endowed by Allah with baraka that may transmit to those around them. —christopher j moore, book In Other Words: A Language Lover's..., 2005.

    Dance! Dance is one of my favorite art forms, and one I don't hesitate to participate in. Give me tango, waltz, cha-cha; jive with me during some happy hardcore, if you can, or let's jump around to some dark progressive house music. Give me some vocals; add a little electronica, spice it up with some South Indian beats and a good soprano, and we are set!

    While I am not someone with decades of experience in Modern dance or ballet, I do have a background in studying movement that comes from decades of experience in the martial arts on top of my amateur ballroom dance studies. In the realm of my own experience, dance can endow the participants with a state of exhilaration and even ecstasy, without recourse to drugs, legal or otherwise. My current theory is that the effect of fervent movement and the joy of expression is akin to the phenomenon known as "runners' high". Add strobe lights, and it's a potent experience.

    Where does that leave those who join religion and dance? Religion is a private matter, and I don't engage in such activities, since I prefer to spend my energies dealing with reality and real people. Dance is a beautiful set of activities on its own, with meaning assigned by choreographers, ravers, and your own personal self. Religion and faith don't have to be part of the equation for it to be a transcendent experience full of the vigor and ecstasy of enjoying life. So, love, live, and dance!


  • http://en.wikipedia.org/wiki/List_of_electronic_music_genres

  • http://www.m-w.com/dictionary/transcendent+ I meant definition "a" or "b". Kant likes to make his own mental Möbius strips, and I don't participate in that.
  • Wednesday, January 03, 2007

    Dictionary Day: Agoraphobia

    From Merrimam-Webster Online:

    Agoraphobia: abnormal fear of being helpless in an embarrassing or inescapable situation that is characterized especially by the avoidance of open or public places

    In psychiatry, one can have panic attacks with and without agoraphobia on top. People stop going out into public places because they fear that they might have a panic attack in public.

    Personally, when I'm at a place where I can spend an extensive amount of time at home reading, studying, and writing, I notice that I also start avoiding the public. This is especially odd for me to experience as I work in an industry known for public exposure: medicine. However, I am more on the introverted side of the Myers-Briggs scale, and at times, public exposure tires me out. I thought that this would qualify me as an agoraphobe, however, as I'm not actually afraid of being helpless, it doesn't count.