tag:blogger.com,1999:blog-131246462024-03-07T21:19:35.839-05:00ResidentKnitterThird youngest in her medical school class. Trying not to twitch when people call her "Doctor." Knitting in her spare time.DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.comBlogger43125tag:blogger.com,1999:blog-13124646.post-49169538670142044172009-03-10T21:40:00.001-04:002009-03-10T21:40:06.798-04:00Mommy and Parker, self-portrait<div style="float: right; margin-left: 10px; margin-bottom: 10px;"><a href="http://www.flickr.com/photos/drkate/3342212059/" title="photo sharing"><img src="http://farm4.static.flickr.com/3637/3342212059_1afc1c5f7f_m.jpg" alt="" style="border: solid 2px #000000;" /></a><br /><span style="font-size: 0.9em; margin-top: 0px;"><a href="http://www.flickr.com/photos/drkate/3342212059/">Mommy and Parker, self-portrait</a><br />Originally uploaded by <a href="http://www.flickr.com/people/drkate/">emtkatydid</a></span></div>Not the MOST attractive photo, but the most up-to-the moment photo!<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0tag:blogger.com,1999:blog-13124646.post-91746210105739471842009-03-10T21:38:00.001-04:002009-03-10T21:38:54.790-04:00Looking at the rocks<div style="float: right; margin-left: 10px; margin-bottom: 10px;"><a href="http://www.flickr.com/photos/drkate/3342211039/" title="photo sharing"><img src="http://farm4.static.flickr.com/3601/3342211039_c64439c810_m.jpg" alt="" style="border: solid 2px #000000;" /></a><br /><span style="font-size: 0.9em; margin-top: 0px;"><a href="http://www.flickr.com/photos/drkate/3342211039/">Looking at the rocks</a><br />Originally uploaded by <a href="http://www.flickr.com/people/drkate/">emtkatydid</a></span></div>Here is my little boy, Mr. P, on a sunny day at the beach. The cold, cold, cold-watered beach. Did that stop him from going in the water? No, sir!<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0tag:blogger.com,1999:blog-13124646.post-8223592376871699532009-03-10T21:35:00.003-04:002009-03-10T21:35:54.237-04:00Late. Late. Late late Kate.I haven't posted in forever and no one is listening. But I had a baby! He's a big boy now! I am getting close to being done with my residency! I just did my taxes!<br /><br />Pictures to follow.<br /><br />Whee!DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0tag:blogger.com,1999:blog-13124646.post-69223169536177678092007-04-29T22:12:00.001-04:002007-04-29T22:12:54.228-04:00My next big project<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/drkate/477720391/" title="photo sharing"><img src="http://farm1.static.flickr.com/225/477720391_046836639c_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/drkate/477720391/">Fetus 12 weeks</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/drkate/">emtkatydid</a>. </span></div>I've been sort of busy lately, with work and all, but Chris and I found time to work on another project that I think you're all really going to like. It's set to go live on November 7th, although there are a lot of us here at FetusHQ who are hopeful that we might be set to go a little earlier than that, although not too early, of course. We have found that if editions premiere too soon they can have a lot of bugs and well, it's just the best for all end-users if the project is seen through to completion. <br /><br />So here's photographic (ultrasonographic) evidence of how the project is proceeding so far. We're happy to report that fingers were visualized, as was a heartbeat and lots of cute little fetal movements. Head to the right, hand above the head, and stomach to the left. Though we ARE hopeful that the final color scheme might be a little less monochromatic....<br /><br />Anyhow, I'm feeling lots better now, and apparently (according to our midwife) the next 3 months will be the best I EVER feel, maybe in the rest of my life? So I'm looking forward to that.<br /><br />So, yeah. Surprise!<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com2tag:blogger.com,1999:blog-13124646.post-24859088185405573642007-04-24T23:14:00.001-04:002007-04-24T23:14:38.279-04:00Old knitting<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/dretak/221548864/" title="photo sharing"><img src="http://farm1.static.flickr.com/64/221548864_f77dc50c7f_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/dretak/221548864/">Mom sweater</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/dretak/">DrEtak</a>. </span></div>I finished this last summer. It's a tunic sweater pattern from the Summer 06 issue of Vogue Knitting. Originally it was done in white, but Mom is much more of a green person. I had to alter the neck to add more length at the shoulder, but it ended up fitting Mom perfectly.<br /><br />The best part? Grandma, the goddess of knitting, ASKED MOM WHERE SHE BOUGHT IT. Whoo!!!<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com1tag:blogger.com,1999:blog-13124646.post-60831881242463369472007-04-24T22:33:00.000-04:002007-04-24T22:56:30.938-04:00On Call...So, I didn't actually die, just abandoned my blog for a while. A long, long while. It just wasn't fitting into life for a while.<br /><br />I don't know if it will keep fitting in or not. I've started work on a new project...with any luck, we'll be finished by early November or so. But there will be more info to come in future weeks.<br /><br />Tonight I am on call. We have a night float system at our program, and we do nights for two weeks. Additionally, we have a PA come in from midnight to 8 am, so we end up doing only 8 hours a night (from 4 to midnight). This resulted from some <span class="blsp-spelling-error" id="SPELLING_ERROR_0">RRC</span> issues about too much service and not enough teaching...golly, those crazy <span class="blsp-spelling-error" id="SPELLING_ERROR_1">RRC</span> people. (<span class="blsp-spelling-error" id="SPELLING_ERROR_2">RRC</span> = Residency Review Committee, the folks in charge of credentialing residency programs and making sure they do everything they are supposed to, including teaching us lots of stuff AND not abusing us too much.) So most night float stretches are pretty good, and even if it's super busy, you usually get to go home at a reasonable hour.<br /><br />However, when the PA goes on vacation, another resident comes in from 4-10 pm, and then the night float person comes in from 10 pm-8 am. And...the PA was on vacation on Wednesday, and Thursday, and Sunday! And currently, overnights have not been good for me. It's been much better for me to be IN BED rather than roaming around the unit tucking the elderly into bed, or sitting in the ER listening to the next story of tragedy and horror. This has all resulted in my sleep-wake schedule becoming very altered, which caused me to have insomnia when I got home at midnight last night and could FINALLY sleep. There I was, with a cat under each arm and a husband next to me and....nope. Nothing. At all. *sigh*<br /><br />I'm not quite sure what to say about the Virginia Tech thing. My brother went to school at Richmond, and one of my friends is in med school in Richmond, so I've probably at least BEEN to Virginia a few more times than some people. And being a budding shrink, it seems like the kind of issue I'd be thinking about. I did end up seeing a few patients the night after it happened who'd been destabilized by it. One had an intensification of his psychosis and ended up lying on the floor of his parents' living room, sobbing hysterically in front of CNN. Another approached staff at the homeless shelter and told them they needed to send him to the hospital, because he couldn't see what was stopping him from taking a cop's gun and doing the same thing as <span class="blsp-spelling-error" id="SPELLING_ERROR_3">Cho</span>. So it did affect our community.<br /><br />But I've been intrigued to see the number of forensic social workers and psychologists willing to discuss the man's issues on TV. Without examining the person, but by what small history we have, and by the evidence of his disturbing behavior in classes, people are willing to offer all kinds of diagnoses. Psychosis, schizophrenia, depression, paranoid personality disorder, antisocial personality disorder...we're trying to label this, to put it in a box, to make it "other." This makes the case safe. In effect, we're labeling and extruding him from the community. By labeling him with some kind of named illness (although he is clearly very broken), we both feel we've explained the unexplainable, and insulated ourselves from the possibility that it could ever happen to someone "normal." It is possible that a person could make a horrible choice. People do this all the time. They lie, steal, murder, cheat, sleep around, hurt themselves, and hurt others--all without having a diagnosis of mental illness. In fact, there are people in Iraq who are planning the injury and murder of many more people than died in the <span class="blsp-spelling-error" id="SPELLING_ERROR_4">VTech</span> assault, and we don't call them mentally ill...but we call them radicals, or extremists, and we ignore the numbers of innocent people who die there every day. But people have their reasons for doing things, even inexplicable things.<br /><br />And the point of something inexplicable is that you CAN'T explain it. There's no doctor on earth who can really explain why this happened. Trying just seems so...pointless.<br /><br />Anyhow. This is what happens when a shrink is short of sleep. More info on the project...later.DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0tag:blogger.com,1999:blog-13124646.post-1151982776732673802006-07-03T22:47:00.000-04:002007-03-25T09:15:01.003-04:00Keep Me In Your HeartDear baby F,<br /><br />I'm so sorry. I want to start out that way. I know that what happened wasn't my fault, and I hope that wherever you are now, you're beyond blaming anyone, but...I'm sorry. I'm sorry I didn't push harder for a DHHS referral. I'm sorry we sent you home again. <br /><br />We didn't know what was wrong with you. We didn't know why your mother kept bringing you in to the hospital, and saying that you were choking. When we looked at you, you were a gorgeous baby girl. We did every study we could find, and didn't even find any reflux. We found nothing. We called it reflux anyway and treated you, figuring that at least we were doing something.<br /><br />You never had a choking spell at the hospital. You never turned gray, or even blue. You never dropped your oxygen saturations on the monitors. You smiled at us, and you loved when we fed you, and held you, and walked around the unit holding you, swaying from side to side and humming softly under our breath.<br /><br />Everything you owned was pink, and when she brought you in she always brought a bag full of your clothes, before she turned and fled down the hall. The nurses chased her down the hall, shouting questions at a quickly retreating back and thin shoulders. "What does she eat? How much? How often? Do you thicken her formula? Hello?" Then she was gone, and we had to guess.<br /><br />We stopped having to write new admission notes on you. We called up your last file from medical records and copied the last one, which was only a few days old, and merely added another hospital admission to the list. "Admitted 3 times since 3/06." "4th admission since birth." "Fifth..." "Sixth..."<br /><br />Finally we started to ask hard questions. We had the abuse specialist see you. We x-rayed your bones and scanned your head. There was nothing pathologic there. We knew the visiting nurses were coming to see you, and we thought it was enough. We thought she cared, and we taught her CPR. Just in case, we said to ourselves. We thought we had done enough. We thought you had time enough.<br /><br />The seventh admission was the last one. You hadn't been home long, and--it was the morning again--she called the ambulance again. You weren't breathing, she said. She found you like that, she said. She tried CPR, she said. <br /><br />I don't know how or why, but we brought you back. But we didn't bring you back--not the you that you were. We brought back your brainstem, and your heart beat for us, but that was all. You didn't breathe on your own. You didn't look at us anymore. You were a tiny corpse, kept alive by our persistence, by our unbelief, by our sheer conviction that babies should live, that babies can live, that babies can survive miraculously. You were kept alive by our love.<br /><br />We didn't believe the first EEG, which lacked the mountainous pulsations or brain activity. We didn't believe the examinations that showed that all of your baby body was limp and lifeless. We barely believed the second EEG, still flat and serene, but the third one visited reality on us. You really were gone.<br /><br />There were so many of us who knew you. All the nurses loved you, even if they hadn't taken care of you. Most of the residents knew you--most of the residents had admitted you. Your pediatrician had seen you so many times in your short life, and the loss of you broke him. He was kicking things in the ICU, trash cans, cart racks, anything in his way, so angry, so lost. <br /><br />We were all of us powerless to change the fate that awaited you, rustling in the wings, behind the heavy velvet curtain that hid the things we cannot see. We could not see into her heart, into her fears, into her intent toward you. We could not understand the message she tried to give us. She in turn could not understand we would have taken you. We would have kept you. If she couldn't take care of you, we would have. There were so many of us who loved you, and so many families desperate for a sweet, well-behaved, healthy baby. If she had only known...If we had only said...<br /><br />We don't know what happened to you. The autopsy showed nothing, and she said nothing. Anything could have happened. Just anything.<br /><br />There is so little we can do for you, little girl. We can imagine you as a bigger girl...wearing a pink bathing suit, playing in a sprinkler...smiling, your front teeth missing, on your first day of school...blowing out the candles on a birthday cake...lying down to sleep on pink and purple sheets. You sleep somewhere else now, somewhere cold and dark, and our memories and imaginations cannot reach you there.<br /><br />But we can promise you this. We will remember you. We will carry you with us. We will keep you in our heart. That's all we can do for you now.<br /><br />And little baby, I am so, so, so sorry.DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com3tag:blogger.com,1999:blog-13124646.post-1150067664651463782006-06-11T19:11:00.000-04:002006-06-11T19:14:24.703-04:00MY sockpal socks!!!<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/drkate/165213984/" title="photo sharing"><img src="http://static.flickr.com/48/165213984_690baf8601_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/drkate/165213984/">Received Sockpal Socks</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/drkate/">emtkatydid</a>. </span></div>I got my sockpal socks! They were such a nice surprise during a loooong week (I started back to peds last week). They were made by a knitter in British Columbia named Ann, and they are just goregous. She picked a lovely hand-dyed yarn and worked them up really, really nicely. They feel great (and I might happen to have them on at exactly this moment). They fit perfectly and I'm happy happy happy.<br /><br />She also sent an adorable teeny tiny book about knitting, and a pretty card with a woodcut picture of a salmon on the front of it--very Pacific-Northwest-y. Of course the fish reminded me that with all the rain we've been having lately, we may have to develop gills just to survive...<br /><br />Thanks so much, Ann! Yay for new socks!!!<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0tag:blogger.com,1999:blog-13124646.post-1147479142820366522006-05-12T19:53:00.000-04:002007-02-22T02:50:17.796-05:00I am 12. This is my doll.She is smaller than most of the patients here, thin, and not as tall. The only concession her body has made to old age, aside from her white hair and wrinkles, is a rather large rear end. When she sits in a chair, she draws her knees up, or slings them over the chair arm. She eschews the hospital garb--except on days that she has ECT--and wears a knit light blue jacket, turtlenecks, and gingham pants. She always wants to wear the jacket, even when it is dirty.<br /><br />She has lived in psychiatric hospitals most of her life. She has never had a house of her own. She has never had an apartment, paid bills, done the shopping. Yet she insists that she will, and the first day she met me, she pointed angrily. "Rebecca! You're going to take my apartment! Don't do it!" Then she burst into tears.<br /><br />My name is not Rebecca.<br /><br />She carries a doll with her most of the time. It is an incredibly realistic baby, about 1 month old, and if you're not paying attention it looks like a dead baby. Having recently worked on the pediatrics floor, this instantly activates "code brain"--take the baby to the treatment room, airway breathing circulation, call respiratory, do we have access, an IV, anything, what's the cause, respiratory failure, are we intubated yet, what's the rhythym--but it's just a doll. Sometimes she puts it in the basket of her walker and takes it around with her. In the middle of the week she left it in the dayroom for a long time. Today she cradles it like a real infant.<br /><br />Sometimes she says she is not who she is. She says she is 12, or 14, or a boy. Her name is Andrew, or Jessica. She explains her white hair, her wrinkles, so quickly--I dyed my hair, I got too much sun. We are not sure why she does this, if she actually has dissociative identity disorder, or if she is interpreting her reality into what she knows--before she came to us, she was at the state hospital, surrounded by desperately sick teenagers. She was the only geriatric patient left, the only one the state couldn't get rid of.<br /><br />She kept asking the nurse today how old she was.<br /><br />"78," said the nurse.<br /><br />"What YEAR is it?" she asked.<br /><br />Her mouth opened and closed when she heard the answer, opened and closed with nothing to say.<br /><br />The past few days she has cried every afternoon, in front of the nurse's station. She begs for $3, for a hot dog. Two days ago my attending took pity and gave her the money. She promptly lost it, and begged for it again the next day. She shrieks. She prefers injections, but will only sometimes allow them. Her right bicep is a hard lump from the years and years of injections. Calming medications, antipsychotic medications, any kind of medications. <br /><br />Her speech is horribly jumbled and we don't know why. She just can't close her mouth around her words, as though she has a thousand marbles in there, fighting with the words. On days she hates us and wants us to leave, she's more clear, "Get out of here--go away" as she pushes us with her hands. When she feels better, her speech is less clear. Sometimes she will write her conversations with us. <br /><br /> How are you doing today?<br /><br /> I am 12. This is my doll.<br /><br /> He's a very nice doll.<br /><br /> It is a girl.<br /><br /> I'm sorry, my mistake. If you can keep from screaming and do what the nurses tell you today, you can go to the store (i.e. go to the cafeteria and get a hot dog.)<br /><br /> They are not nurses.<br /><br /> OK. Is there anything we can help you with today?<br /><br /> I am alright.<br /><br />So we leave, move on, as she sits by the nurse's station, cradling the dead baby, and stalking us with her eyes. She will never get better. She will never have that apartment--I might as well have been Rebecca the apartment stealing girl. The state doesn't want her back, but we can't keep her here forever. No one wants her.<br /><br />But our attending loves her. He sits with her, holds her hand, leans his head towards her. He figures out any way to communicate with her. He gives her the $3, the allowance, the hot dogs. She is thought about, time is taken for her, pleasures are devised for her. He wants her to be happy. He carries her with him, in his heart.<br /><br />And maybe, for one day at least, that is enough.DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com1tag:blogger.com,1999:blog-13124646.post-1146092145024026172006-04-26T18:55:00.000-04:002006-04-26T18:55:45.033-04:00My new faucet<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/drkate/135594233/" title="photo sharing"><img src="http://static.flickr.com/51/135594233_53f00d5108_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/drkate/135594233/">Faucet Two</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/drkate/">emtkatydid</a>. </span></div>My husband and I are useful. We know how to put new faucets in! This is the "Kate's sink" faucet, the "Chris' sink" faucet is on my flickr pages (www.flickr.com/photos/drkate). It's pretty. Now if only I could make the focus right....I have a lot of work to do with my camera!<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0tag:blogger.com,1999:blog-13124646.post-1146092047686543392006-04-26T18:54:00.000-04:002006-04-26T18:54:07.700-04:00The packaged sockpal socks<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/drkate/135594231/" title="photo sharing"><img src="http://static.flickr.com/45/135594231_8336648b00_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/drkate/135594231/">The socks!</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/drkate/">emtkatydid</a>. </span></div>Here are the socks, all labeled up and ready to go. They have a long journey...I hope they don't get too cold!<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com3tag:blogger.com,1999:blog-13124646.post-1146091972113857952006-04-26T18:52:00.000-04:002006-04-26T18:52:52.186-04:00Sockpal Socks<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/drkate/135594228/" title="photo sharing"><img src="http://static.flickr.com/46/135594228_8496a195d1_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/drkate/135594228/">Sockpal Socks</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/drkate/">emtkatydid</a>. </span></div>They are finally done! I finished them two nights ago, and didn't get around to photographing them until today. (Allow me to digress briefly about how NICE a LOT of the knitting photography on other peoples' blogs is. And how challenging it's been for me to take partially nice photos. Part of the challence is the built-in flash on my camera. When I am close enough to get the interesting details in my knitting, esp. in macro mode, the flash just washes out all the color. I'm looking at external flashes for my camera now. It's getting to that point where I really notice the performance of the flash. So it results in me feeling inadequate about posting knitting photos. Anyway.)<br /><br />So the socks are done, and done BEFORE the deadline, which I must say is pretty impressive for a busy intern! Fortunately socks are just the right kind of project for me, they are easy to transport and not too obvious to work on during grand rounds and lectures. Also, people fuss over them, which is nice. I hope my sockpal loves her socks! They have lots of knowledge knitted in.<br /><br />Now I have to find a few "goodies" to include with the package, and it will be ready to be sent off!<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0tag:blogger.com,1999:blog-13124646.post-1145628419791205992006-04-21T10:01:00.000-04:002006-04-21T10:06:59.813-04:00Scenes from the ER"So, how much alcohol do you drink? A case a night?"<br /><br />"Nooooo, not a case. Not anything like that."<br /><br />"How much, then?"<br /><br />"Oh, only about 10 beers a night."<br /><br />"Uh. Hm. And how's that working out for you?"<br /><br />*******************************************<br /><br />"So what brings you to the emergency room this morning?"<br /><br />"Well, I woke up with this weird rash. And I knew my doctor's office would be busy and I wouldn't be able to see anyone until like 2 pm, and I just didn't feel like waiting."<br /><br />"So. . . you came to the EMERGENCY room?"<br /><br />"Yeah!"<br /><br />*********************************************<br /><br />"I smoke about 2 packs per day of cigarettes, been doin' it for about 20 years."<br /><br />"Have you thought about quitting?"<br /><br />"Yeah, I used the nicotine patch for about a week. Worked good, I didn't want to smoke at all. But I stopped it."<br /><br />"Why was that?"<br /><br />"Oh, it made my chest feel funny. Kind of tight."<br /><br />"Hmm. And how's your breathing been lately?"<br /><br />"Not too good. My doctor says something about. . . emphysema? Something like that."<br /><br />"I guess having shortness of breath and having to wear oxygen for the rest of your life would make your chest feel kind of funny, too, huh?"<br /><br />********************************************<br />(that smacking sound you hear is my hand impacting on my head. Over. . . and over . . . and over . . . )DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com1tag:blogger.com,1999:blog-13124646.post-1145222542296832042006-04-16T17:22:00.000-04:002006-04-16T17:22:22.303-04:00Still life of Socks and Two Paws<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/dretak/129633678/" title="photo sharing"><img src="http://static.flickr.com/55/129633678_89f55f89eb_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/dretak/129633678/">Still life of Socks and Two Paws</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/dretak/">DrEtak</a>. </span></div>Another pair of socks, made (for CA$H) for one of the psych social workers. It took me a while to get them finished, but happily they are now done. And I can GIVE THEM to her.<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com1tag:blogger.com,1999:blog-13124646.post-1145222407965843192006-04-16T17:20:00.000-04:002006-04-16T17:20:08.010-04:00Sockpal Socks<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/dretak/129633675/" title="photo sharing"><img src="http://static.flickr.com/53/129633675_ae71b23879_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/dretak/129633675/">Sockpal Socks</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/dretak/">DrEtak</a>. </span></div>Here are my sockpal socks! Finally, when I finished pediatrics I was able to get started on my socks. They are a nice soft yarn (Sirdar) and the pattern is mostly of my own design, though I think the lace pattern might be similar to Interweave Knits' Spring issue socks. Sock One is all finished and sock two is almost to the heel. I sure hope my pal likes them!<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com1tag:blogger.com,1999:blog-13124646.post-1141201358341309262006-03-01T02:45:00.000-05:002007-03-18T11:34:57.993-04:00Clinical JudgementMy friends and I are at about the point in our internship in which we start to have independent thoughts. During medical school you read a lot, you study a lot, and you accept as gospel the assessments and plans of the residents and attendings. At the beginning of your internship you are too mortified with the idea that you actually are allowed to order medications to really think about what you're doing. (Oh my GOD, I just ordered TYLENOL for this man! And I DIDN'T even ASK the ATTENDING!!!) You rotate from place to place and still can't quite get the hang of everything in one month. But by month 8, you're been back to a couple of rotation sites, and you really have seen a lot, and suddenly you start to have thoughts of your own. And sometimes--sometimes--your thoughts are DIFFERENT from what your SENIOR RESIDENT and even your ATTENDING think.<br /><br />The first time this happens, you are confused. And maybe you want to die, or throw up, or point and laugh at yourself for your sheer impertinence that YOU, a mere INTERN, could POSSIBLY know what is happening with a patient. Ha.<br /><br />And so you do what the senior resident and the attending tell you to do.<br /><br />And then it turns out that you were the one who was right.<br /><br />Sometimes this isn't important. So the senior put the baby on reflux meds, some reglan and some ranitidine, and then the upper GI showed no reflux. And you d/c the order while the attending stands next to you and wonders, "who thought the baby had reflux anyway?" And all is well, and you didn't argue too too much with the senior, and then you don't tell her what the attending said.<br /><br />Sometimes this is very much important. My friend Michele is a medicine resident and had a patient whose hematocrit was slowly trending downward. The attending and seniors told her, "don't worry, it's dilutional, it's from the IV fluids, no problem." Michele could not shake the suspicion that the patient was bleeding into her lungs. She asked again. Again she was reassured. It took large amounts of pink frothy sputum pouring from the patient's mouth to change the attending's mind. Look! Michele has clinical judgement! Michele has instincts that are right! Unfortunately for the patient, now the pulmonary hemorrhage is worse. Good luck, patient!<br /><br />I had an entire day like that last Friday. I have a very complicated 7-month-old who I took care of in August and who I also took care of this past month. He had been clinically doing very well after a number of surgeries and post-surgical complications. He was so well that we were starting to do some pretty intensive PT and OT to get him to start doing normal 7-month-old baby stuff. We were moving quickly toward discharge. Then, Wednesday night, he suddenly took a turn for the worse, and started having a lot of stridor. He was breathing so hard that his poor little body was just covered in sweat. Thursday morning we did the full-court-press of evaluation: chest X-ray for pneumonia/fluid overload, soft tissue of the neck x-rays to evaluate for swelling around the larynx or epiglottis, a nasal wash for RSV--nothing. We tried an epinepherine nebulizer treatment--no change. We gave him double doses of steroids, the attending shrugged her shoulders and said maybe it was post-croup changes, and we went about our merry way.<br /><br />Well, everyone went about their merry way except for the baby, the nurses, and me. I was paged throughout the day to rush to his bedside. Nothing that we could do calmed him down. Nothing comforted him. Nothing eased his breathing. He laid in his little crib and watched us all with terrified eyes. He was so very much not himself. The senior thought he was fine. When I signed him out to the night team, telling them about the kind of day he'd had, the night float senior resident simply wrote, "F*%CK!" next to the child's name. (That's not really a good sign.)<br /><br />The next day, the kid was still on the floor--not in the PICU--but was getting worse. I paged the senior resident repeatedly through the day. She kept insisting that he was fine. I kept letting her say that, until finally she told the nurses just to page her and bypass me completely. I had too much work to do, and if all I was going to do was page her--for her to tell me that he was fine--I guess she could say that directly to the nurses. After sign-out on Friday, the senior resident on call actually walked with me down to the patient's room to see him. He looked pretty much the same--terrified, breathing fast, working hard. I kept my fingers crossed, and left.<br /><br />About an hour after I left, he was taken to the treatment room on the floor, where they eventually intubated him and took him down to PICU. Over the weekend in PICU, the ENT docs performed a bronchoscopy, then placed a tracheostomy. Apparently, one of his previous surgeries caused a narrowing in his subglottic space, which somehow had gotten irritated and basically swelled almost completely shut. The poor kid was trying to breathe through a hole the diameter of a pencil. No wonder he was having such a hard time.<br /><br />So--hurray, I have clinical judgement! I have instincts! I can tell if a patient is really really sick! It's a hollow victory. I love this baby and he's been deeply unlucky. And I've also lost my trust in my senior resident. If I ever work with her again, I don't know if I'll be able to trust her jusgement, or mine. Somehow the hierarchy broke for me, and the all-powerful Oz (in the form of the senior resident) was found to be a person behind a curtain, working desperately at the controls and just . . . being . . . human.<br /><br />Meanwhile, it is slowly dawning on me that I might actually be turning into a clinican. Someone who looks at a situation, gets all the information that she needs, and then makes an assessment of her own. I could, possibly, maybe a little bit, be developing . . . independent thoughts. Independent thoughts that are not wrong. Or at least, not wrong all of the time.<br /><br />I might have a medical degree. (OK, I DO have a medical degree. It's hanging on the wall at home and everything.) But it's experiences like this that are turning me into what I have always wanted to be: a real doctor.DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com2tag:blogger.com,1999:blog-13124646.post-1140989091169093082006-02-26T16:24:00.000-05:002006-02-26T16:24:51.176-05:00Another finished object<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/drkate/104847605/" title="photo sharing"><img src="http://static.flickr.com/42/104847605_546bb0d7da_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/drkate/104847605/">Purple Hat</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/drkate/">emtkatydid</a>. </span></div>The Olympics were good to me. Although I did not join the knitting Olympics, I did finish a number of projects, this among them. It's from Elizabeth Zimmerman's "Knitting Without Tears," and iot was originally meant to be a chunky grownup hat. However, knit it in Debbie Bliss' merino and voila, adorable baby hat. The hat and the bunny are going to a co-worker, whose baby is due next month and who is adorably pregnant.<br /><br />More finished object to come soon!<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0tag:blogger.com,1999:blog-13124646.post-1140988938322887512006-02-26T16:22:00.000-05:002006-02-26T16:22:20.656-05:00Finished Object<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/drkate/104847604/" title="photo sharing"><img src="http://static.flickr.com/19/104847604_14ae3f553a_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/drkate/104847604/">Bunny</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/drkate/">emtkatydid</a>. </span></div>This is based (copied) from Jess Hutch's knitted bunny on her website. It was fun and easy to make, and I think it is starting a trend for me. I have a pretty big stach of odds-and-ends yarn, much of which could be convinced to become some kind of toy. This pattern is fun, as well, because I can make it bigger or smaller, give it small ears (=bear), give it great big ears (=floppy bunny), give it pointy ears (=kitty), or even, give it huge ears and make a nose (=elephant). I guess I'd have to work kinda hard to make it a penguin, though.<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0tag:blogger.com,1999:blog-13124646.post-1139357352495802402006-02-07T18:38:00.000-05:002006-02-07T19:09:47.990-05:00In the Peds Army NowFor the past week, I have shed my persona as a mild-mannered psychiatrist and have become--Pediatrics Girl! It's the start of a two month tour of duty on the pediatrics inpatient unit. As a part of our residency requirements, psych interns spend 4 months on some kind of inpatient medicine service. Since my interest is child psych, I requested and received 4 months of pediatrics.<br /><br />Boy, was that a mistake.<br /><br />Don't get me wrong--I really, really love kids. I love taking care of kids. I love being able to tell my patient, "There are farts in your belly and we have to take them out!" Or cracking my world-famous physical exam joke--"Now let's see, did you bring your HEART with you today?" and having it be funny. (60-year-old psych patients don't find that line NEARLY as funny as you'd expect them to.) I love being able to HOLD my patients in my arms, and having them be clean, and smell like baby lotion and baby powder, and seeing my medical students walking our kids around the unit in a stroller. I love how fast kids get better when they are with us. I love how everyone works together to really do a good job taking care of kids AND families. I love how we all get to know our chronic care patients, and how we all follow them even when they aren't ours anymore. I love the peds residents. I even love the nurses.<br /><br />What don't I love? Well, I'm not a big fan of being pimped mercilessly on formal rounds. I KNOW I should know stuff. I KNOW I should be reading in my excessive spare time. (nooooot, I get there at 6 am and leave at 6 pm every day then COME HOME and GO TO SLEEP.) But do I particularly REMEMBER the pathognomonic signs of Kawasaki syndrome? No I do not. (Am I incredibly thankful for the med student who admitted that kid, who KNEW the answer?* Yes I am.)<br /><br />I don't love calling DHS about a former preemie brought in with lethargy whose mom is throwing things at the nurses, cursing at the attending, and not allowing any medical exams. That's not very fun. Nor do I love having to talk to a family that lost one son in an ATV accident, and is now taking care of the second son as he recuperates from that accident. I don't love watching our heme/onc patients lose their hair and stare balefully at huge potassium supplement pills and refusing their PO antibiotics and sitting empty handed and empty hearted in their rooms. I hate that.<br /><br />I still like pediatrics--I had a hard time choosing between peds and psych--but it's still not my place. I can't imagine myself as a general pediatrician. I can't imagine myself as anything but a child psychiatrist. I can't imagine not being with "my people." When you come down to it, it's just about a feeling of "rightness," of fit. I fit with the psychiatrists. Generally. The pediatricians are almost too earnest, too scrubbed and pure, too accurate and knowing. I like the uncertainty of psych, of trying things and being gray and being flexible. They can try all they want to recruit me. I'll still choose the smelly dirty guy wandering around downtown with all his belongings in a shopping cart, muttering about how George Bush has implanted electrodes into his brain. His people always come up with something new. There's only so many sepsis workups on 2-month olds that I can do!<br /><br />*Fever, erythematous rash, conjunctival injection with sparing of the iris, palmar swelling, and lymphadenopathy. He did NOT have the classic strawberry tongue, but DID have cracked lips. His albumin was 3.5, which apparently is a good prognostic sign for decreased risk of vasculitis. At least I LEARNED...DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com2tag:blogger.com,1999:blog-13124646.post-1138638888745608832006-01-30T11:22:00.000-05:002006-01-30T11:34:48.770-05:00Water BoyAlthough I have been on an outpatient rotation, I am still covering the wards and consults for the weekends. It's been a bit more call than I usually do in a month--still not too bad--but seeing everyone on the weekends has allowed me snapshots into their lives.<br /><br />We have one man who will not stop drinking. He drinks and drinks and drinks and drinks. He has had seizures because his sodium is too low. He is essentially diluting himself, thinning out the concentration of his protoplasm full of saline, which is all of our inner state. He doesn't have a tumor, he doesn't have an imbalance in his kidney, he doesn't have a problem with his sugar. He is just sick.<br /><br />He is one of "my" people, the mentally ill. <br /><br />He has no understanding that his drinking is causing him problems, or even that it might be related to him being in the hospital. "I know I had a seizure once, but that was years ago! Why do you have to keep TALKING about it?" On admission, his sodium was 109, when the normal level is around 130. With sodium levels that low, free water flows across membranes to areas of higher concentration--like body tissues. Like the brain. More water means swelling in an organ, and a swollen brain means more pressure inside the head, which means seizure, herniation, death.<br /><br />I saw him last weekend, carring around a larg, 24 ounce Dunkin Doughnuts cup. "My wife brought it for me!" he bayed. He held onto it and kept wandering into the dayroom to refill it with caffeine free Diet Coke from the machine. He never let it go. The nurses couldn't take it from him.<br /><br />I checked his sodium. 123. Trending down. I asked the nurses if there was any way for us to steal the cup away. They said they'd try. And they did.<br /><br />This past weekend, there he was again, standing at the nurses' station, bleating for a doctor. He had been out on a pass the day before, where he had drank the largest bottle of Snapple that he could find. He's not gotten any better in the month that he's been with us. Maybe the meds will eventually gain a foothold. Maybe his irritability and mania will soften, cool down. Maybe he will be able to restrain his thirst.<br /><br />But somehow, I can't see that happening. His thirst is unending, cannot be quenched. I fear the day he is discharged, and wonder how long it will be before he is brought into the ED, flailing madly, intubated, and scanned...and then gone. His mind destroying his body, in the most essential sense of the phrase.<br /><br />Meanwhile, he stands at the nurses station, wondering why he is here, posing problems that we cannot solve. And so we wait.<br /><br />And he drinks.DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com8tag:blogger.com,1999:blog-13124646.post-1137011466802742832006-01-11T15:31:00.000-05:002006-01-11T15:31:06.810-05:00Dena's scarf<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/drkate/80002099/" title="photo sharing"><img src="http://static.flickr.com/39/80002099_f816de9e76_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/drkate/80002099/">Dena's scarf</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/drkate/">emtkatydid</a>. </span></div>Dena's Christmas scarf. It's red. It's short-rowed. It's from MagKnits. <br /><br />I worked on it while I was at the movies.<br /><br />It's a knitting doctor's dream. And now, it's the knitted property of another doctor!<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com1tag:blogger.com,1999:blog-13124646.post-1137010831764602342006-01-11T15:20:00.000-05:002006-01-11T15:20:31.793-05:00The Loot<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/dretak/80013319/" title="photo sharing"><img src="http://static.flickr.com/40/80013319_c2e0d7b99a_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/dretak/80013319/">The Loot</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/dretak/">DrEtak</a>. </span></div>These are the wonderful knitting books I got from my wonderful mom. They are, from left to right: Candy Blankies (crocheted baby blankets, nice color groupings and adorable patterns); Knitter's Book of Finishing Techniques; Ann Budd's Knitter's Handy Book of Patterns; the classic Knitting Without Tears by Elizabeth Zimmerman, Alterknits; and Handknit Holidays.<br /><br />In medical land, I got a book on behavioral treatments for explosive (irritable, dysregulated, "uncontrollable") kids; and a hand puppet in a white coat named Dr. Moody.<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0tag:blogger.com,1999:blog-13124646.post-1137010296085406642006-01-11T15:01:00.000-05:002006-01-11T15:11:36.103-05:00HiI haven't published here in forever. I could pretend that I've been busy, but mostly I've forgotten about it. I didn't think I had that much to say, either.<br /><br />However, I found a bunch of medical blogs, and that's inspired me. Our C/L attending sent me the <a href="http://www.intueri.org">URL</a> of a resident psychiatrist in Seattle. She writes the way I wish I could, a "literary blog," one might say. I have many nights during which I lie in bed, waiting to fall asleep, and imagine the things I'd like to write. There's so many patient stories to tell. In the past six months, I've seen and done things that have made me cry, made me laugh, made me hate everyone, everywhere--and sometimes, it's made me feel like a doctor. <br /><br />And then I screw up again and can't believe anyone lets me even talk to patients.<br /><br />I presented a journal club today on the treatment of depression in teenagers. It was an actual controlled, randomized clinical trial, which is hard to find in child psychiatry. It also had real statistics, which was difficult, I am sure, for some of our residents. We seem to be somewhat split between the biologicall-minded, science-background folks and the therapy and psychosocial understanding and treatment kind of folks. <br /><br />Therapy people don't like statistics. <br /><br />I like statistics. Or, at least, the kind of studies that you need statistics for. I like the idea that there's some evidence to support what I'm about to do. Otherwise, why did I go to medical school? I can say things to people because "it seemed like the right thing to do," but who knows if I'm helping them? Of course, I know very little about therapy, so I'm not familiar with the literature and the supports for doing certain things. I'll learn.<br /><br />I've been knitting some. I got spoiled with a bunch of knitting books for Christmas, so I'm trying to rush and finish the current projects so I can start on some new ones. I also got a bag of yarn odd-balls from my grandmother. Maybe I'll knit a stethoscope cozy. Or I'll get some tinfoil and knit my patients some protective hats.<br /><br />The possibilites are endless.DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0tag:blogger.com,1999:blog-13124646.post-1130696957476468012005-10-30T13:29:00.000-05:002005-10-30T13:29:17.486-05:00The Afghan with No Name<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/22047437@N00/57602360/" title="photo sharing"><img src="http://static.flickr.com/29/57602360_76b599d7bf_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/22047437@N00/57602360/">Tan afghan</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/22047437@N00/">emtkatydid</a>. </span></div>Also known as, "Wow, Kate, that's impressive!" (no, not really.)<br /><br />This is the tan afghan from the textured knits book that I bought for cheap in Minnesota. It's fun to work on because it flows pretty quickly and looks really neat when I show people. I'm making it in an acrylic yarn--I just can't justify using expensive yarn on large projects like this. Maybe when I am a rich doctor I will be able to make cashmere blankets, but not quite yet.<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0tag:blogger.com,1999:blog-13124646.post-1130696746741077742005-10-30T13:25:00.000-05:002005-10-30T13:25:46.796-05:00Clapotis<div style="float: right; margin-left: 10px; margin-bottom: 10px;"> <a href="http://www.flickr.com/photos/22047437@N00/57602358/" title="photo sharing"><img src="http://static.flickr.com/32/57602358_9e2732f4e7_m.jpg" alt="" style="border: solid 2px #000000;" /></a> <br /> <span style="font-size: 0.9em; margin-top: 0px;"> <a href="http://www.flickr.com/photos/22047437@N00/57602358/">Clapotis</a> <br /> Originally uploaded by <a href="http://www.flickr.com/people/22047437@N00/">emtkatydid</a>. </span></div>This is the very popular Clapotis pattern from knitty.com. I did it in a green wool with flecks of yellow in it, so it's not as soft and it doesn't curl up as nicely as the sample one in the pattern. However, it's interesting and super-warm. The cool thing is that I worked on it all though the new resident orientation weeks at the end of June, and it certainly helped me to stand out as a different kind of resident. (As if I needed more help to stand out.)<br /><br />Anyhow, it's known at our house as the "residency scarf" and actually prompted the development of some friends, as well as helping to keep me awake.<br /><br />Yet another example of how knitting can make you smarter AND give you more friends.<br clear="all" />DrEtakhttp://www.blogger.com/profile/10439906840428622241noreply@blogger.com0