Asthma

You thought "asthma" was going to have to do with pediatrics, eh? Well no. I'll get to that in a minute...

But first, for why you come to my blog... Ishie's 30 second movie review of things everyone else has already seen.... Casino Royale!

First impression: Not bad
Second impression: I'm calling sissy. Not for your average movie hero, obviously, but for James Frigging Bond. Sean Connery would have killed everyone Venice had ever loved before the archvillain got one of his socks off. Being tied naked to a chair helplessly before you and your disposable ladyfriend are rescued just isn't in the cards. Even if the aces are.
Third impression, and hence my title: Asthma is one of the least badass illnesses an archvillain could have, possibly topped only by fecal incontinence and a lisp. Even tied naked to a chair, if my tormentor had to take a drag off his inhaler every five seconds before punctuating his threats with inspiratory wheezing, I'd probably start laughing too.

Anyway, there hasn't been much to report in the hospital scene lately because I've spent very little of this last week at the hospital and even less of it seeing children. We have a 'study week' in pediatrics, which is one of the best ideas ever, and finally poses a solution to that endless dilemma medical students have where they're expected to be constantly as the hospital seeing patients, but also expected to study sufficiently to know all the enzymes in a kid that can break (hint: all of them). Essentially, last week, I studied. Which isn't exciting to report on, though I loved it and got a ton of crap done.

Oh, except Monday we actually got off thanks to our heroic clinical coordinator pushing for our holiday time, so Monday, I spent less time "studying" and more time "in a cabin in the snow playing bumper pool and visiting microbreweries." But the rest of the week, I studied.

And this is the point I was at in my post before where the puppetmasters in partial control of my computer decided it was shutdown time.

A little aside on this whole virus thing... I've finally gotten to a point where I'm not tech-unsavvy, which is probably why my computer isn't a smoking pile of plastic (yet), though honestly, this one's been living on borrowed time since I spilled half a bowl of cereal on it in Grenada (d'oh!) a couple years ago. Essentially, this virus keeps reviving itself for the last week, but I've been gradually winning battles if not wars. It managed to disable my ability to restart Windows in safe mode and defaulted to the blue screen of death (*(&(*&!!!) when I attempted it, disabled my internet connection at one point, deleted the essential files for my spyware and malware programs so they wouldn't work, and when I'd restored my internet, defaulted all my google search links to its evil little fake webpages. It also bugged up system restore, infiltrated my registry and a bunch of other stuff that quite frankly, could usually be only be accomplished by Sean Connery's James Bond. If I weren't so earth-shatterly pissed off about the whole thing, I'd be impressed. Fortunately, some experience with the interweb plus an internet phone when my computer *really* went off the rails has proved useful, providing such clues as re-downloading and renaming all the executable files of my antivirus/antimalware so the devil program can't find and snuff them. It's like a witness protection program for bits of code.

To get an idea of this thing's general effect on my life, despite the fact that my downtime tends to consist of either drinking or vegetating, I instead got to spend 7 hours of my Saturday testing how many times my computer could survive a cold boot without the processor grinding to a halt.

But babies. Cute little pink babies. My week's actually been going well. Last week I got a lot done on the study horizon, but could get absolutely nothing accomplished in any other venue. My loan status was unknown/pending, which is something that's had me on edge and driving everyone I know crazy for the last FIVE WEEKS. This one's not actually on the school, but on a medical bill of which I was unaware that got stuck on my credit report like ten minutes before I had to submit my loan application, so I did a lot of runaround, talked to the original billers and found that my insurance hadn't gone through, so resubmitted paid the extra, and was assured they'd take it off. Which they did. So when I called them to go "Uh homies? This shiz is still on my credit report as an open collection", and the lady very nicely told me that it was taken off and I could get a letter from them stating it, but that it could take as long as 30 days for the credit reporting bureaus to take it off.

So my opening statement to people asking how I was doing for that thirty days (which was past tuition due date for my session) was "Oh ya know... probably going to get kicked out of school."

I was also getting blocked at a prescription refill for yet another insurance related reason, and could not figure out for the life of me whose problem it was.

I was also trying to reclaim a locker from someone that put a lock on my locker, removed my nametag from it, and then removed all the notes the clinical coordinator put on it telling him/her to get the crap off and the lock off.

So that was Friday.

Tuesday.... my loan has been approved and dispersed and I'm waiting on the check, my prescription was worked out, and the lock got cut off my locker! And I beat my record time for jogging the 3.35 mile Prospect Park loop by a minute. It's a good time.

Oh, now that I'm back in baby land, I can tell you medical stuff again. I spent the first two days in the newborn nursery. This is a mixed bag...

Pros: the kids are healthy and happy and usually people are glad to see them. You don't see any sick ones because the second a kid even starts to breathe funny, they're shipped upstairs.
-nice doctors
-nice nurses
-scrubs and no white coat. It's a twofer.
Cons: Newborns are squicky. I'm sorry. I know they get cute when they're two, but they're not now.
-Babies scream. A lot. One baby screaming sets off the others. This has been proved by science to be one of the most annoying noises possible. Long exposure to high decibels of baby-scream has caused people's brains to explode out of their heads with some regularity. It's science, people.
-You have to check a lot of things on babies, because they're new to the world, and like a car built by blind people with ADD, you need to do checks most people don't expect. Two of these checks are disturbing. In one, you get to determine whether a boy baby's dropped both his sinkers down, and in the other, you have to make sure the baby's butt is properly connected to the outside world.

If you think there's expensive exhaustive medical instruments for doing those checks, guess again. It involves medical students having to cradle baby testicles and then, worse, peek inside the rear end to make sure there's a hole there, because *sometimes there isn't*. Yes, imperforate anus, possibly a candidate for one of the disorders the next James Bond villain can have!

After nursery this week, we have different specialty clinics each day. Yesterday was child advocacy clinic (re: child abuse) which was really interesting and the only two cases we saw had a minimum of soul crushery, so that was nice. The stories the director told though, geeze. People are freaks.

Today was pediatric heme/onc, which like child advocacy clinic, was way less depressing than I expected. The attending was really cool and let us interview the two kids that came in for check ups. Since peds heme/onc is an area with a lot of path, they had a monster microscope in the back with a ton of slides so at downtime, I asked if I could play with it and was promptly tied up with playing with iron deficiency slides for the next hour while trying not to break them. Damn 100X lens!

As I was back in the lab, I was overhearing a patient interview, significant in that it concluded with a ton of people making a ruckus in the hall. I poked my head out in time to see a pretty blond woman accompanied by a guy in a giant fox suit lean over to the last patient and say "Do YOU like basketball???" to which the child responded "Um... no?"

See, moments like *that* are when I love children. Not when I'm having to examine their nether regions. So the woman, undeterred, said "Well, you will!!!!"

Apparently we had a visit from the Nets. As an Ovarian American, I had no idea who the heck they were, but they were passing out signed baseball hats and we got a picture with the mascot, so cool. Unfortunately I don't think they realized that despite the potential for changing some frowns to smiles in a place called "Pediatric Heme/Onc", all the sick kids were downstairs and we had two kids, both of whom were perfectly fine and only in there for ten minutes for a follow up visit. And one of them doesn't like basketball.

Well, good night!

Justifications for violence

I have a nice long blog out there waiting for you people, but it's put on hold because of the above, and the recurrence of a virus I've been fighting off solidly for three days and off and on for a week has made a sick and cowardly surge that severed my connection briefly, so I will, be brief...

I prefer to live in a civilized society where people settle things with discourse, and barring that, insults against the opponent's mother. That being said, the unique creators of Internet Security 2010 virus need to be hauled out of their mothers' basements by an angry mob of syphilitic wolverines, otherwise known as the closest thing to women these f*tards are ever going to get, have a team of angry medical students rip their naughty bits asunder with lemon-tipped dull scalpels, and then get beaten to death with the same buggy Dell computers they've rendered useless in their relentless pursuit of my credit card information before having their corpses spit on with smug satisfaction by all the mac users saying "Oh, our computers don't get viruses".

I'm reasonably sure that if I can televise the demise of the Internet Security 2010 virus assembly crew, I will make enough off the proceeds to buy an insanity plea AND a sparkling new Macbook.

So, off to sleep so I can head off to another day of working with children. Let that one roll around in your heads for a while.

Children and zebras...

Okay, for those of you who watch House (hopefully all of you), you've heard the medical cliché "If you hear hoofbeats, think horses, not zebras" which pretty much summarizes the syndrome medical students have where we want to diagnose people who have diabetes as being infected with a silver-bellied Peruvian brainworm. And the only reason we have this syndrome is because we've been infected with a silver-bellied Peruvian brainworm.

Thing about kids is they have zebras. Obviously I can't go into strategic detail because HIPAA doesn't have a clause to make exceptions in privacy settings for crap I think is cool... though they totally should, but since starting peds a week ago, I've probably seen 4 kids that have syndromes that were filed in medical school under "Why do I have to learn about stuff that only affects 1 in 40,000 people?" Oh, because those 40,000 people are more likely to go to the hospital than others, and when they're kids, they're still ironing out the details of how to manage the condition, so bam, hospital.

And then there's the kid who has, at present, stumped everyone on the floor, required consult by a specialist whose contribution included not having seen a case like this in umpteen years of practice and that if we had any thoughts, we should feel free to input them because f- if they know. So they're running more tests.

What I'm liking about peds is that in peds so far, they seem way more interested in puzzling out what they're dealing with. I don't know if it's because they like kids, like medicine, or just watch as much House as I do, but it's refreshing. And the stuff they're dealing with is frequently really interesting, which helps.

Then there's the seventeen thousand babies with bronchiolitis. But then those kids don't tend to present with the spectrum of baggage adults have so their cases are fairly straightforward. They're also far less inclined to yell at me for taking too long during an examination before demanding drugs.

And so far exams on kids hasn't been too bad. The sort of expectation of crying helps, but then they don't really hold grudges, and they're easy to placate afterward. And what's wrong usually shows up as what's wrong rather than oh, these skin lesions are from an untreated fungal infection, and there's existing diabetic peripheral neuropathy and blah blah blah.

Of course, the fact that kids are being less difficult than I expected means it sucks when they get really sick, so that can be a stone cold bummer.

And I'll talk briefly about the staff... while I can't count myself as being someone described by anyone as "someone that loves kids", the people that choose to go into pediatrics seem to, which seems to instill a refreshing position in them of being patient advocates, so I think we all get slightly less cynical as a result of it.

Though no worries; surgery will beat it straight back into us.

And lest anyone think I've gone soft on path for peds, recall that one of the reasons I'm liking the crap out of peds (minus the hours) is because I get to see weird stuff, which is not really the motivation most parents want their pediatrician to have.

New Year; New Rotation

Greetings people-recently-incarcerated-on and people-recently-freed-from Grenada! And all you other lovelies as well.

I just started my pediatrics rotation which is screwing me up by being way more difficult than I thought, while having attentive and interested attendings and residents, which makes me actually want to try hard at it, despite my love of things that are dead and jammed under a microscope, while this rotation has an abundance of loud squirmy pink things. That all have bronchiolitis. I'm giving myself about 3 days before I'll inevitably catch the upper respiratory tract grown-up version of it from the little tykes.

But now, it's my fabulous roomie's birthday, so yet again, I'm off.

Hope you're all having a wonderful new year!