Not a fairy tale but something like that

Life may not have fairy tale endings of happily-ever-after.

But....

Plus, there is happiness if you know where to look.

I have just two days of medical school left and I recently found out that my first medicine patient is home and no longer on dialysis. This is good news, the best news possible! I expected for him to be on a kidney transplant list or worse by now. But instead he is living his life and his kidneys are functioning well enough to allow him to skip dialysis. He is so young and has so much life ahead of him. I can only hope that he gets to live it.

I also found out that one of my neurosurgery patients is making amazing progress at rehab. Prior to being a neurosurgery patient he was an amazing, smart, able-bodied father and grandfather. And then he fell off a ladder while doing some home repairs. He left the hospital with very limited control of one extremity and was largely non-communicative with a trach and G-tube in place. I  really didn't know know what kind of life he would live again.  However he is now in a wheelchair, wheeling himself around, as well as eating and talking. I saw a video of him yesterday and could not believe it was the same patient that graced the service the entire month I was on.

I am so glad I have some happy patient stories to end medical school with. (I have plenty of not so happy endings to share too, but not today.)

Today is about reflecting on the good.

The amazing, brave and resilient patients I have met.
The thoughtful and helpful nurses and staff.
The dedicated professors and attendings.
The mentors that have taken the time to inspire and help me become who I am today.
My wonderful support system: my husband, my parents, my dear friends.

I did not get here by myself. The end of medical school is around the corner but it is not my celebration alone. I appreciate everyone who helped me along the way. There were dragons and they were slain.

Life may not be about fairy tale endings but my end of medical school is happily-ever-after or close enough to it for me.

"she's a hyper little bird"

Evidently these are the words that my attending spoke about me yesterday as I stepped ran off the elevator. I think it was a compliment?

It was a busy day and we had just finished rounding for the morning when I saw my dear patient's husband (from IM-TSS elective 2 months back) standing in the elevator bank.  CC was one of my FP (favorite patients) and she was on the service the entire time I was a student.  Over the course of the month I got to know her and her husband well. CC is dying and due to a very messed-up health care system will likely spend the rest of her life in the hospital... She was admitted in December so it has already been months despite the fact that a SNF or Rehab Hospital would be much better for her and her family.... They are not ready for Hospice and due to her health conditions would require around the clock nursing services and a hospital bed to go home which her family is unable to provide. She even has "good" insurance but has been denied from 17 different facilities (at last count). I can't even begin to explain how mad this makes me. She sits in the hospital trying not to die from something iatrogenic while we wait for emergency Medical to be approved so that maybe we can find placement. Anyhow, it has been almost two months since she was "my" patient but I still stop by and see her occasionally and check up on her. And I hadn't seen her husband in awhile and wanted to check in with him. So I jumped off the elevator and my attending turned to the other student to discuss my behavior.

But back to Cardiology. I am starting to enjoy the service more now that I only have 8 days left! And it has been busy which I much prefer to the alternative of sitting in the library waiting for my pager to go off. Better just to run around all day and see 11 consults (3 of them solo and before 10am) and be called a "hyper little bird" then to do nothing or pretend to study EKG arrhythmias in the library while not-so-secretly wishing I was anywhere else. Yesterday was busy, but good.

This morning I am reflecting on a number of things but mainly I am just trying to be appreciative of what I have, the experiences I have been blessed with and the life that I get to live.

Time to go to work and live up to my attending's words now... Happy Hump Day to you!

And just because this made me smile. It is a bit late but in honor of the match being over and no more "maybes" enjoy this.

total apathy and mid-night realizations

I have the worst case of senioritis. I am so unmotivated to go to work and once there I really have to try to care because right now I just don't. I am doing a month of cardiology as my final elective and while it should be interesting and good review on reading ECGs I simply find it torturous to be tied to a pager waiting for the next consult to come in. I really don't have much love for CHF or the intricacies of transesophageal echocardiograms. I am going to be a Child Neurologist and I am SO excited to see kids and think about the brain, however adults and their hearts, not so much.

I wrote these words a day or so ago and while they were true at the time and remain so there is a small caveat. I think that 90% of why I am "checked-out" other than the about to graduate thing is that I am bored to death. I actually had a real-bonafied, my patient is having an STEMI consult and the ER really did need a cardiologist and I woke up from a dream thinking about my patient. And the fact that I was at work almost three hours beyond the normal pager time didn't even bother me. Because I do like medicine and learning and when I feel important/needed/useful and even more so feel that the patient is benefiting from my time then I am more than happy to be at the hospital. It is just that up until yesterday most of the consults were a waste of time.

Seriously, I've had consults such as: patient with new onset V-tach, non-symptomatic, unsustained for 8 beats in the middle of the night. Please evaluate. Guess what? Motion artifact. You wasted an hour of my time and 10 minutes of my attending's time so that we could tell you that your consult was BS. I guess this was due diligence and now I will hopefully never make the same mistake so I did learn something but this happens all the time!

Surgical clearance consults. Yes, they have to be done but please don't ask Family Medicine to do the consult and Cardiology to do the same consult. We both show up and then feel obligated to do the consult because you asked but we are just duplicating each other's work, wasting time and using resources that could better be used for say that patient that is having an MI or the new admit. And this is all so that maybe you will get your surgical clearance a bit earlier from one of the services. Not cool.

Consults for medical management help. Unless you have actually tried all of the evidence based medicine guidelines for managing said problem and are actually asking for help because the patient is especially complicated please don't consult cardiology for every CHF patient on hospital day 1 that may need more medication. The attending cardiologist will not give you firm medication recs. if you haven't at least tried for 24-48 hours, so why bother to ask?


And in other news... I am thinking of changing blog names and sites. My island days are behind me and residency is around the corner. But if anyone has particular SGU questions or would like a final post or two before I do so, let me know.

I'm off to Houston tonight to hopefully secure an apartment and tour my new city. So that is exciting.

Only 10 more days of medical school left!
Happy Friday!

One week and one day

Until my ROL (rank order list) is due...

This part is torture. The waiting. I went on a second look today and now I have absolutely nothing else to do but hurry up and wait! (31 days until match, but who's counting???)

I pretty much know how I am ranking programs but still that doesn't mean that I don't spend the greater part of each day trying to decide if #3 should maybe be #6 and #5 should move to #3.... Does it matter more where I live or how the adult neuro year is structured? How important is the PD? Do I want to be at an ultra-academic setting or something more service orientated? Resident run or educationally focused?

These are the questions that I am pondering again and again. #1 and #2 are set and have been for some time. #11 and #12 have no hopes of moving up. But the rest of the programs are in limbo and seem to change positions in my mind by the hour.

So that is it. I'm stuck in limbo. Kind of like how several of my patients are "stuck" in the hospital waiting for placement. All I know is that our health care system is very inefficient. Because the cost of staying in the hospital when you have no active medical issues is enormous. But SNFs/Rehab Centers do not want to accept certain insurance plans or Medicaid and thus the patients are "stuck."

I'm worried that one of my patient's is going to get pneumonia and die before she is placed. And there is no reason for this.  Her nurse is mad at me because I dared write an order for her to be out of bed every day (she suffered a stroke and thus needs assistance to ambulate due to severe right sided hemiparesis). And PT/OT should be coming daily to do rehab with her but they do not have the time or resources to do so, thus she sits in bed on neutropenic precautions because she just finished chemo and I'm very worried that she won't survive this hospital admission. Which is now a week too long and looking to last much longer as per case management as she has been denied from 7 SNFs thus far.

And if that isn't enough, I have another patient that is a ward of state, also waiting for placement. She has been hospitalized for over 3 months and the last 2 months are in excess of her medical needs but she is stuck too.

Being stuck kind of reminds me of my Family Medicine Inpatient rotation at this same hospital and this post which I wrote over a year ago. I guess some things never change. Every year students wait for the match and every day patients sit in the hospital waiting for placement... We are all stuck in our own way but at least I know when my waiting will be up which is more than I can say for my patients. So for that I am grateful. I may complain but I realize how much of a privilege and honor it is to be able to wait for the match and to match and I do not take any of this lightly.... And I still have a week and a day to play with my ROL!

Residency Fate Day Countdown

Just 14 days until rank order lists are due and 37 days until Match Day! Very exciting. And kind of scary, but mostly exciting.... In a month and a week I'll find out where I matched and where we will be living for the next 3-5 years. And then before I know it intern year will be here and I'll be doing what I have only dreamed of up to this point.

Right now I'm doing at IM-TSS (Internal Med, Teaching Selective Service) in Cali and trying to remember all the adult medicine that I have not had to practice or use in months! I think my brain has atrophied during 4th year. It is truly sad how little I remember. I know that I used to know all about CHF, Renal Disease, Liver Failure, you know, the bread and butter adult medicine stuff... but I just don't have the immediate recall and end up having to look up EVERYTHING. Kind of embarrassing as I'm a big, grown-up MS IV. Yet it seems my medical knowledge is a file cabinet that has to be opened and indexed constantly, it is not a ready to read book like I want it to be. Not yet. But I guess that's why you have to do residency... to learn what you have learned and to practice and practice.

On the bright side I love, love, love talking to my patients, explaining diagnosis, getting code status confirmed, calling consults, writing order and just generally acting like a doctor. IM-TSS is a Hospitalist run service with no residents which means the MS IVs are the acting residents. It is like a sub-I without resident support. But I love that part of it. And the taking care of my patients part. I don't love it when my patient ends up needing to be intubated and upgraded to the ICU. But he is okay and I don't think I could have done anything differently or prevented his intubation... Medicine is awesome and I am humbled daily to be reminded that this is what I get to do with my life.

Residency Fate Day countdown is underway.... 37 more wake-ups to go!

Up in the air I go...

One more interview, one last trans-America trip, one concluding night in a strange hotel, one final trip exploring a new city.

I am at the airport ridiculously early because I opted for one of those group Shuttle van services to the airport and I guess I'm flying at a not very busy time because I got my own personal town car ride to the airport for fraction of the cost of a cab... and I'm more than two hours early, which is after I cleared security! Less anxiety provoking than leaving my house at this time and taking a cab, two trains and a shuttle bus to arrive in the same spot when boarding is already in process. And I even managed to score one of those comfy SW lounge chairs/charging stations at my gate, so I really cannot complain.

It will be nice to be done with interviews and finished with traveling. Of course the ranking and waiting part is going to be torture but still, it will be nice to have this part behind me. And then I can actually stay in Miami and enjoy it for almost two whole weeks before I am headed back to Cali for the remainder of fourth year.

My Genetics rotation continues to be awesome. If you are at all interested in Medical Genetics or Pediatrics then I recommend this rotation. Miami Children's is wonderful and it is a great place to spend a month. I had to apply for the rotation over 6 months in advance and follow up via emails and phone calls ad-nauseum to ensure I got the elective but it was more than worth it.

I have lots of thinking and ranking and pondering to do, but I'm waiting until this interview is over to really start.... stay tuned!

What I am doing

NOW

Reading-
Behind the Beautiful Forevers by Katherine Boo, as well as Although of Course You End Up Becoming Yourself: A Road Trip with David Wallace Foster by David Lipsky (The subject of the NYT Book review from which I have previously quoted here)

Starting-
A Genetics Elective at Miami Children's (I arrived in Miami over the weekend and it reminds me of Grenada which is nostalgia inducing, humid, warm, living with roommates again fun.)

Exploring-
My new city as this is my first time in Miami. So far I've found a great diner for breakfast, the grocery store (IGA!!! just like Grenada) a Spanish Restaurant that serves okay Tapas and a friend from the island that is here this month too. I know my life is just so hard.

Traveling-
Today to Cali for an interview and again on Friday to upstate New York for yet another interview. Only four more to go. Now let's just hope I can take off from my elective for all of them.

Learning to Knit-
(I needed a new project for take off and landing time on the plane when I couldn't read my Nook)
It is not going very well, I think I need an initial lesson with a real person, the read and follow directions in 2D is not working for me... Poor Sancho, he is going to get a very ugly sweater indeed, and he's a dog, so he'll have to wear it!

Writing-
This.

Reflecting-
On life.
On love.

Living-
Purposely.

Loving-
My life.

Anticipating-
The Match.

The answer I SHOULD have given....

     Are either of your parents physicians? 

     Who else in your family is a physician?

     What do your parents do?

These are all questions that I that got asked at my last interview.... I was a bit taken aback. But I answered in brief.

Are either of your parents physicians? 
No.

Who else in your family is a physician?
No one. I will be the first. No one else has a graduate degree. Just me.

What do your parents do?
My mom is a nurse. Right now she works to help manage an Assisted Living Home. In the past she has worked in home health care, private practice and as a floor nurse in different settings. She has done a little bit of everything.

My dad is the Safety Manager for an Oil Supply Company. He does all of the employee safety training and is the first responder when someone in the field gets injured and needs to be taken for medical care.
---
Yep, this is what I said. Boring... True, but my responses pretty much answered the interviewers questions and they had little else to ask or follow with.
---
However, I have been thinking.... Why was I asked this? What did the interviewer really want to know?

Maybe she really meant....Do I have a role model that was a physician? Do I have any sense of how difficult training will be or what it is like to be a physician? Am I smart enough? Why do I want to become a doctor? Is this a family career or something personal? Why did I choose this career?

I have no idea why I was asked this (repeatedly) during my last interview but it bothers me... It bothers me enough that I will not rank this program as high as perhaps it deserves.

I applied and was granted an interview so someone had to think I was worth the time. So why then should I be made to feel as though I am not up to the task or not good enough to train at this program? Obviously this was not explicitly stated to me, but this is how I ended up feeling....  But I think, no, I KNOW, that I AM capable and worthy and so I am stuck on the WHY???? What was the purpose of this line of questioning? What does it matter? Do my parents define me? If my father had walked out when I was 3 or my mother had died when I was 13 would this change who I am enough to affect what kind of doctor I am going to be? Or was this just a stuck up NewYork style interview?

If you, dear reader, have a different perspective or think maybe I was over-reacting or misinterpreting this line of questioning I would love to hear your thoughts....

Otherwise, this is what I SHOULD have said.


Are either of your parents physicians? 
No. But they were both amazing role models to me. I learned how important it is to care and give back to the community from my dad and I was inspired to enter the medical profession by my mother who worked in many different settings as a RN.

Who else in your family is a physician?
No one. I am PROUD to be the first.

What do your parents do?
My parents do many things.

My dad is a Safety Manager for an Oil Supply Company.... But it was he that taught me the importance of community service. My earliest memories of him are helping to construct a homeless shelter/temporary apartment in our church basement. It was to be a place for an out of luck family to stay in while the parents sought work and got back on their feet. The apartment had a kitchen stocked with food, a desk for the children to sit and do their homework. A living area. Two bedrooms. It was sparsely decorated and very basic but it offered a chance for a family that would otherwise have to separate with dad at one homeless shelter and mom and the kids at another. I remember how much it meant to my dad to be a part of something bigger. My dad cares about people and has made sure that I always thought about others too. He made sure that I not only appreciated the resources and family that I was lucky to have but also that I did something to help those who were not as lucky.

My mother is a nurse. I remember hearing lots of stories about doctors of all kinds from her. She loved some and thought others were rude, arrogant and not good for their patients. She taught me what she knew of medicine and instilled in me a basic love of taking care of people.

My parents do many things, but first and foremost they love me and have done a good job raising me which is why I am  here today. So, have I answered your questions?

Yes, these are the answers I SHOULD have given...

fourth year funk

So it has been a couple of weeks. I am now half way through my NICU sub-I and finally feeling okay about calculating TPN's and presenting my patients on rounds... (tiny, sick, premature babies are different than any other patient. It is a whole new world! But I'm sure come next year I will be very happy to have had the experience of being in the NICU. Not enjoying the 5:30am wake up time but then again, it could be worse. I could be taking care of adults! I do love the babies...)

I feel like fourth year is stretching out and will never be done. I'm in a funk. There is really no other way to put it. I should be excited to interview and I am. But I'm also just so tired. It is exhausting to be "on" and answer the same questions over and over and while I am oh-so-grateful that I have double digit interviews lined up I'm exhausted by the thought of the process of traversing the country again and again... I'm already "done" and it is WAY TOO EARLY to be in the that mindset. I think being away from Dr. Boyfriend and not knowing exactly what I'm doing after February is weighing on me. Fourth year was "set" and then my schedule was thrown off and now I'm waiting for things to be scheduled and I hate having things up in the air.

I have interviewed twice since A. Neither B nor C compared but I think that nothing will... they were both good alternatives and certainly rankable. I could probably learn to be happy anywhere, I have that ability but neither B nor C spoke to my soul like A. Then again I've always struggled with high expectations but really I am going to be at a place for the next 3-5 years so I want it to be right. However, it is too early to torture myself now, after all, there are plenty of other options. Interview season is far from over so I should feel encouraged and hopeful. And thankful, it is November after all!

But honestly, at the moment I'm just here. Fighting the fourth year funk and wishing it was March 15th already. I think I need to go bake something, drink wine and try to get into the Thanksgiving spirit... wish me luck!

Interview A

A most perfect interview.... No delayed flights or lost bags. An on-time shuttle shuttle and easy ride to the hotel. Fun, good dinner with happy residents, followed by day of interviews with super nice,  down-to-earth faculty and then the afternoon off to explore and relax before doing it all again.

Today and the residency program seem too good to be true. I'm smitten and wish I could simply profess my love and sign on the dotted line. It is so strange, this interviewing for a spot. Well 2 spots. There are at least 30 applicants that have/will interview and then they will rank us and ultimately take just 2. (Hey A- pick me!)

Interview A is half-way over and at this point I don't think they could tell me anything that would change my mind about this place. Community- check. Education, research, travel- check, check, check. Beauful facilities, seemless electronic medical records, state of the art everything! Matching here would be a dream.

Yes, it may be a tinsy weeny cold in the winter. And yes, the nearest size able city is an hour + away but these hardly seem like sacrifices when given the opportunity to be at a world class institution. At least this is my thought process at the moment. 

I'm looking forward to tomorrow. Now time for sleep while I dream of A.

Recant

So... yesterday I blogged about how I just didn't "heart" medicine, or at least adult medicine and while that may still be true so much of how I feel on wards is a product of the team dynamics.... Today our team got a new resident and new attending and both are great, rounds were extensive, exhaustive but invigorating... I got a new patient and kept my old one and learned and thought more today then perhaps in all of the past 9 days combined. Today I was actually a sub-I and it felt good. Being a "kind of sub-I" was boring... Too bad that tomorrow is my last day. Of course! But I do have to come back and finish my sub-I, two more weeks of it, so hopefully those two weeks will be closer to today than the last week and half.

In other new, three more rejections today. Yes, the tide has turned and my interview to rejection ratio is now skewed more toward the later.... But I'm still waiting to hear from 30 Child Neuro programs and a bunch of general peds programs so I'm okay with my 9 scheduled interviews thus far...


Time to pack my bags and head back to San Diego and Sancho and Dr. Boyfriend and I can't say that I'm sad about that in the least. :)

crickets here...

Welcome to my silence here in blogworld. Not because I don't have anything to say but in perspective all I've wanted to write about seems small and not really worthy of complaining about.

I am just about done with what is a 2 week medicine sub-I rotation (it was suppose to be ambulatory care but due to paperwork snafus it was decidedly not.) I don't have any great love for adult medicine (hence my going into peds) and I haven't been at my best these last two weeks but it is almost over and back the peds world I go (NICU) after a short break for my first interview and my dad's upcoming mitral valve repair.

I am nervous to start interview season but feel good about the number of programs I've heard from and interview offers thus far. It is still early but I hope others are feeling the same. Best of luck and positive thoughts to my classmates starting the interview season.

Hopefully I'll be more inspired to write soon.

Life Updates

I found a new great spot in the city to lounge/read and free WiFi. Color me happy!

ERAS applications are due Sept 15 so that is exciting. My list is currently at 86, not sure if it is growing or shrinking at this point. I'm applying to general Peds and Child Neuro and that's about all I have to say about that.

And speaking of child neuro, tomorrow will be the end of my first week on my child neuro rotation and  I NEED TO STUDY! So far this week I have seen, Becker's Muscular Dystrophy, Global Developmental Delay,  Failure to Thrive, Febrile Seizures,  Plagiocephaly, GBS Meningitis, Recurrent E.coli meningitis, and some other stuff that I'm forgetting at the moment. It has been a good week. I heart peds and child neuro and clinic and babies and cannot wait until this is what I get to do with my life.

Oh, and I'm going camping this weekend. Very fun!

And my bike ride is 10 days away. You should sponsor me, see last post.

And that's my life at the moment. Life is good.

On second thought...

There will be no additional entries for my child advocacy elective journal.

Child advocacy is sad, depressing and I have cried enough tears these past three weeks without reflecting and writing about it. This will be all.

But I do want to say that I have the utmost respect and appreciation for those who work in the field day in and day out.

To the 18 full time detectives in Brooklyn whose sole job it is to investigate child abuse cases (both physical and sexual), I raise my glass to you.

To the medical doctors and nurse practitioners that act as consultants, giving up their nights and weekends to review pictures, talk to the detectives and perform physical exams and complete rape kits for forensic evidence when needed, I applaud you.

To the lawyers and judges that sit in court and review the cases and sentence the perpetrators, my thanks.

To the social workers and others that visit the homes and interview the parents, my hat goes off.

It is a difficult, sad, situation when a child is abused. Sometimes these children have no one else, their parents have failed to protect them and so they require an advocate. I don't know that we always get it right, the entire field is shades of gray to me... but to those who spend their careers as advocates I am grateful.

I suppose I am glad for the opportunity to witness these dedicated individuals hard at work. It has been educational and enlightening to meet and talk with them.  And while it is heart-breaking to meet the children and hear about the cases I am glad to now know a bit more about what happens once a mandated reporter call the state registry.

It has been a good but emotionally difficult elective. I won't be sad when it ends... I've cried enough tears already. I cannot wait to go back to the hospital and the smiling happy children in clinic.

Child Advocacy Elective Journal- Entry 1

Yesterday I met Dr. Ajl and got orientated to Child Advocacy in NYC. And by Child Advocacy I mean child abuse and neglect. Sure as a physician you may see or suspect abuse and you are a mandated reporter to the state. But there is SO MUCH more that goes on. A phone call is simply the beginning. And so this month I will learn about ACS, CPS, Family Court, legal guardians, Special Victims Unit, forensic evaluations, foster care, the Medical Examiner's Office, etc.

There are three of us in the elective this month and I actually know both of the other students so that is nice. Yesterday we toured the Brooklyn Child Advocacy Center and met the NP that has devoted the last 16 years of her life to Child Advocacy. And she truly is devoted, like most of the people I think we will meet in this field.

We were given a packet with numerous agencies and contacts and thus I spent most of the morning calling and emailing to set up appts for the month. So far I don't have much booked but I'm sure people will call back, eventually. In the mean time I have a lot to read. And learn. Did I mention I'm so glad that I am doing this elective?

At the end of the month we have to put together a group project to reflect on what we have learned and while I am happy to contribute to something for the group I also want something for myself. I think this month will be hard emotionally and I need a place to process those emotions and think about what I get to see and experience. So this blog will be my space. I will not post cases here or discuss what I see in details because these children must be protected. But my feelings will not be censored. Here what I share will be my own. So stay tuned.

And if you have any reading suggestions, feel free to let me know. I'm taking all suggestions for serious fiction and Child Advocacy related topics.

Summer in the city, Sancho updates, Camp is Magic and other random things...

Don't you just love NYC in the summer? I do. I took this photo shortly before I left the city on one of those hot, humid nights when all the hydrants were open to cool off the kids and city.

Anyhow... I'm back from my whirlwind of Teen Adventure MS Camp and trip home to NM to visit my family. It has been quite the two weeks and everything was great but I have to say I am happy to be back in NYC and back in my bed. 

I start my Child Advocacy elective tomorrow and am looking forward to it...

I have so many things to share, it has been a busy couple of weeks but for now I just want to say I'm home (well my temporary home) but once again separated from my husband and puppy. Its hard to be away after a week together. I miss them both but they are also home and Sancho has claimed the living room. Literally. He personally unpacked all of his toys and spread them out as seen here.  He also seems to have perfected the stretch. He really isn't THAT much bigger than when we got him but he seems to take up so much more space (when he wants to.)

My little guy is growing up. Tear.

questions and answers

I am half-way through my first elective of 4th year: Inpatient Child and Adolescent Psychiatry.The following was overheard or asked of me during the week....

Q: Am I in trouble? (asked by a 10 year old new admit who we were about to interview)
A: No, you are not in trouble and no one here in is trouble. We just want to talk to you so that we can get to know you and figure out how to help you. (So that you will stop listening to the voices in your head that are telling you to cut yourself, or at least tell an adult that you are hearing these voices before you do what they suggest.)

Q: Can I have a piece of gum? (asked numerous times throughout the day by pretty much every single patient on the unit)
A: Yes, would you like mint or strawberry?
Q: Can I have one of each?
A: Yes. (Which reminds me I'm almost out of gum, better stock up before Monday.)

Q: When you were a kid did you ever stay in a the hospital like this? (asked of a new patient shortly after I introduced myself and welcomed him to the unit)
A: No. (And I'm so sorry that inpatient psychiatric stays are the norm in your life and that at age 13 you have already had three admissions. I wish I could tell you that you everyone stays in the hospital when they are young and it is normal, but I can't and so I just try to distract you with another subject. But you are too smart and you ask me again, and again until finally I tell you that I was very lucky because I was healthy growing up and my first time in a hospital was when I was working in one. And then you say, "oh" and seem a little sad so we talk about baseball and other things...)

Q: Am I enjoying my child and adolescent psychiatric elective?
A: Yes, but it is bit depressing and I remember why I decided to go to medical school instead of pursuing a PhD in psychology.

Q: If your parents are illegal (aliens) and they brought you here can you be sent to jail?
A: No.
Q: That's good because its not your fault that your parents brought you to the US so that you would have a chance at a better life, right?
A: Right.

Q: Why do I have to stay here? Why can't I go home?
A: Because we want to keep you safe and help you. (And right now you are either a danger to yourself or others.)

Q: Will you color with me?
A: Yes. Always, yes.

Needless to say I have given away a lot of gum, colored numerous pages of batman, spent hours talking about everything and nothing. After a a week I've pretty much decided that these children are simply trying to survive. Children of young, single parents and broken homes. Children that are products of domestic violence and sexual abuse. It is no wonder that they are depressed, defiant, angry, scared. I know that many will never recover but for some I hope that this is simply a respite and that ACS or a new foster family or a new counselor will finally get through or provide the needed structure. My hope is that some of these children may begin to live life and move beyond the depression, the voices, the hurt. I know that many will forever be scarred by their childhoods but I hope that some may show the resiliency that children seem to have and that often amazes us. I have to hope this for them because the alternative is too depressing to contemplate. (I just read this NYT article regarding the adult inpatient psychiatric treatment state of affairs, I think pediatric resources and options are slightly better but still, very sad.)

2:15am

And of course, I'm wide awake. Hello insomnia, you really aren't a friend of mine. May as well blog a little, not anything else going on in the middle if the night. Tomorrow is my last long call/admit day for Medicine. Wednesday is post call and my oral exam. And then I'm down with third year. Kind of crazy how fast it went. Seems just like yesterday when I was standing in the OR and pondering how little I knew. Now I'm almost a real big grown up MS IV. The plan? Napa first and foremost. See family. Drive South. See more family. Settle and study for Step 2. Head to New York. Do a peds sub-I... somewhere, this part is difficult to schedule. But sub-I. Somewhere. Get amazing letter. Head back to Cali. Do some medicine electives. Apply for residency. Yada, yada... Anyhow, it's all good. Napa is in sight, just two days to go... Cheers!