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!
Sunday, April 16, 2006
Wednesday, March 01, 2006
Clinical Judgement
My 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.
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.
And so you do what the senior resident and the attending tell you to do.
And then it turns out that you were the one who was right.
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.
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!
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.
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.)
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.
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.
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.
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.
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.
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.
And so you do what the senior resident and the attending tell you to do.
And then it turns out that you were the one who was right.
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.
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!
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.
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.)
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.
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.
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.
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.
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.
Sunday, February 26, 2006
Another finished object
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.
More finished object to come soon!
More finished object to come soon!
Finished Object
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.
Tuesday, February 07, 2006
In the Peds Army Now
For 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.
Boy, was that a mistake.
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.
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.)
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.
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!
*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...
Boy, was that a mistake.
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.
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.)
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.
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!
*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...
Monday, January 30, 2006
Water Boy
Although 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.
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.
He is one of "my" people, the mentally ill.
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.
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.
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.
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.
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.
Meanwhile, he stands at the nurses station, wondering why he is here, posing problems that we cannot solve. And so we wait.
And he drinks.
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.
He is one of "my" people, the mentally ill.
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.
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.
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.
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.
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.
Meanwhile, he stands at the nurses station, wondering why he is here, posing problems that we cannot solve. And so we wait.
And he drinks.
Wednesday, January 11, 2006
Dena's scarf
Dena's Christmas scarf. It's red. It's short-rowed. It's from MagKnits.
I worked on it while I was at the movies.
It's a knitting doctor's dream. And now, it's the knitted property of another doctor!
I worked on it while I was at the movies.
It's a knitting doctor's dream. And now, it's the knitted property of another doctor!
The Loot
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.
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.
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.
Hi
I 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.
However, I found a bunch of medical blogs, and that's inspired me. Our C/L attending sent me the URL 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.
And then I screw up again and can't believe anyone lets me even talk to patients.
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.
Therapy people don't like statistics.
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.
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.
The possibilites are endless.
However, I found a bunch of medical blogs, and that's inspired me. Our C/L attending sent me the URL 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.
And then I screw up again and can't believe anyone lets me even talk to patients.
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.
Therapy people don't like statistics.
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.
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.
The possibilites are endless.
Sunday, October 30, 2005
The Afghan with No Name
Also known as, "Wow, Kate, that's impressive!" (no, not really.)
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.
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.
Clapotis
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.)
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.
Yet another example of how knitting can make you smarter AND give you more friends.
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.
Yet another example of how knitting can make you smarter AND give you more friends.
Wednesday, October 26, 2005
Rainy Days
We're in the middle of a big storm right now--everyone is calling it the first Nor'easter of the season. I like to think of it as the weather trying to mess up everyone's lives and remind us that it's bigger than we are. As if the hurricaines were not enough, in New England, we have to suffer....rain! Wind! And, in some parts of the state, Snow! At least I finally had the sense to start bringing my umbrella with me as I leave the house.
However, the crappy weather has been helping me to get more knitting done. I am working on a new afghan for the back of our couch. The cats threw up on the slipcover when we first got it (nice kitty) and so there's a spot on the back that we have to keep covered. The old afghan is navy blue, and while that was fine in the old house, where there were navy blue curtains in the windows, it's less good now. So I am making a tan one--knitting it, instead of crocheting. I found a really cool pattern from a book I picked up in Minnesota. The book purchase was funny because I was at a knitting store with my aunt and was looking through the discount section--as is my wont--when I found this book. It's all beat up, but hey, sale! Woo-hoo!!! I can't remember the name off the top of my head, but it's a bunch of patterns that are very much my style of knitting: all one color, with interesting stitch patterns or textures. I still haven't been able to bring myself to try intarsia, or multiple color knitting. (Though I'd better hop to it: the heirloom Christmas stocking that Grandma makes has about 15 colors in it, and the patterns has been passed on to me and another cousin for the future.)
Anyhow, the afghan is turning out very nicely. I'm proud of myself that I have been able to follow the pattern chart...they can be very intimidating when you first look at them, but with work and effort and reading the directions, success is achievable! Plus, it impresses the novice knitters when they come over to practice.
I'm finishing up my pair of red and black socks and will post photos of them soon. I just have to tear the computer from my husband's clutches...he has been playing World of Warcraft religiously, so I'll have to sneak in and use the computer while he's sleeping or something.
More soon!!!
However, the crappy weather has been helping me to get more knitting done. I am working on a new afghan for the back of our couch. The cats threw up on the slipcover when we first got it (nice kitty) and so there's a spot on the back that we have to keep covered. The old afghan is navy blue, and while that was fine in the old house, where there were navy blue curtains in the windows, it's less good now. So I am making a tan one--knitting it, instead of crocheting. I found a really cool pattern from a book I picked up in Minnesota. The book purchase was funny because I was at a knitting store with my aunt and was looking through the discount section--as is my wont--when I found this book. It's all beat up, but hey, sale! Woo-hoo!!! I can't remember the name off the top of my head, but it's a bunch of patterns that are very much my style of knitting: all one color, with interesting stitch patterns or textures. I still haven't been able to bring myself to try intarsia, or multiple color knitting. (Though I'd better hop to it: the heirloom Christmas stocking that Grandma makes has about 15 colors in it, and the patterns has been passed on to me and another cousin for the future.)
Anyhow, the afghan is turning out very nicely. I'm proud of myself that I have been able to follow the pattern chart...they can be very intimidating when you first look at them, but with work and effort and reading the directions, success is achievable! Plus, it impresses the novice knitters when they come over to practice.
I'm finishing up my pair of red and black socks and will post photos of them soon. I just have to tear the computer from my husband's clutches...he has been playing World of Warcraft religiously, so I'll have to sneak in and use the computer while he's sleeping or something.
More soon!!!
Saturday, October 08, 2005
Dear Overnight Charge Nurse;
Was it something I said?
Do you hate me? Is that it? It can't be, because I know you do this to other residents too.
But did you REALLY have to page me at 4 am (right after I had fallen asleep, 1/2 hour after the LAST page) to tell me that the patient has had blood in his urine for the last TWO DAYS!?!?! I mean, I agree that it is something we need to look into . . . but as you said, it's not getting worse (and at 5 am, when I was up again and working on another admission, the medicine resident who's been seeing him said the bleeding was BETTER, and besides, he'd had a traumatic catheter self-removal so actually he did it HIMSELF) so . . . anyhow, why, again, did you need to page me?
Let's talk about this, because if it's like this every time I am on call, I wil be brought to a massive incoherent rage and might be forced to . . . you know . . . say something not nice.
And, you know, you don't want to see me being not nice.
Love, Kate
PS--dear patient whom I admitted involuntarily: 6 am, as I am walking back to the call room to sleep for another hour or so, is really NOT the time to argue with me about whether I am going to let you out. No, really. I'm not kidding.
Do you hate me? Is that it? It can't be, because I know you do this to other residents too.
But did you REALLY have to page me at 4 am (right after I had fallen asleep, 1/2 hour after the LAST page) to tell me that the patient has had blood in his urine for the last TWO DAYS!?!?! I mean, I agree that it is something we need to look into . . . but as you said, it's not getting worse (and at 5 am, when I was up again and working on another admission, the medicine resident who's been seeing him said the bleeding was BETTER, and besides, he'd had a traumatic catheter self-removal so actually he did it HIMSELF) so . . . anyhow, why, again, did you need to page me?
Let's talk about this, because if it's like this every time I am on call, I wil be brought to a massive incoherent rage and might be forced to . . . you know . . . say something not nice.
And, you know, you don't want to see me being not nice.
Love, Kate
PS--dear patient whom I admitted involuntarily: 6 am, as I am walking back to the call room to sleep for another hour or so, is really NOT the time to argue with me about whether I am going to let you out. No, really. I'm not kidding.
Thursday, October 06, 2005
Balance
We knitted only a little last night...mostly we talked. One of the things that we talked about was knitting (of course). Two of the girls, psych residents both, said they were starting to learn how to knit and were frustrated by how hard it was to learn. One of them said, "I just want this to be perfect, like yours is."
So the first thing I did was show her all the mistakes that I have made in my current pair of socks.
Then I told her what I had heard the Amish do in their quilts: they often intentionally make a mistake in the quilt. They feel it opens a space to let God into their work.
Some of my projects have more God in them than others.
But it's something important, especially for med residents to think about. We are so focused on being perfect and working hard all the time...and at the same time, we aren't really MAKING anything. We're labeling people, and we're trying to change their chemistries or their ways of relating to others, but it's a long slow process and sometimes more destructive than productive. At the end of the day, I want to feel like I am making something, besides money and headaches for my attendings.
So I knit. See? There's a med-knitting link. You just have to, you know, stretch.
So the first thing I did was show her all the mistakes that I have made in my current pair of socks.
Then I told her what I had heard the Amish do in their quilts: they often intentionally make a mistake in the quilt. They feel it opens a space to let God into their work.
Some of my projects have more God in them than others.
But it's something important, especially for med residents to think about. We are so focused on being perfect and working hard all the time...and at the same time, we aren't really MAKING anything. We're labeling people, and we're trying to change their chemistries or their ways of relating to others, but it's a long slow process and sometimes more destructive than productive. At the end of the day, I want to feel like I am making something, besides money and headaches for my attendings.
So I knit. See? There's a med-knitting link. You just have to, you know, stretch.
Wednesday, October 05, 2005
Knitting Party
Also, we are having a knitting party tonight. The cats are excited because they will have more people to pet them. Should be a good time...plus, there's going to be cookies, and everyone loves cookies.
New and improved, with knitting content!
Thank you Sara for your nice comment! (that would be my first non-family member comment... how special!) Sara has a good point: WHERE THE HECK IS ALL THIS TALK ABOUT KNITTING? Well, she said it nicer than that. But she is right. Where is the knitting content?
Well, here are the first pair of socks that I made. They are self-patterning yarn, made using the toe-up design from Knitty. I wear them on call. Last week, when I was on call and wearing them, my attending doctor asked me, "hey, did you make those?" "Yes," I replied, "do you like them?" And, because he is a jerk, he said "No." (grrr.) But he was kidding, and *I* like them! I am currently working on sock #2 from the pattern in the Winter 2004 Interweave Knits, Retro-Rib Socks. They are so handy to carry to lectures and Grand Rounds.
I am also working on a pretty afghan, and a basic garter-stitch scarf and hat set for one of the other interns. He is from Nepal and for some reason has no winter clothes.
Once the husband comes back from vacation (he has the digital camera), I'll take some more photos of Finished Objects. Keep tuning in!!!
Well, here are the first pair of socks that I made. They are self-patterning yarn, made using the toe-up design from Knitty. I wear them on call. Last week, when I was on call and wearing them, my attending doctor asked me, "hey, did you make those?" "Yes," I replied, "do you like them?" And, because he is a jerk, he said "No." (grrr.) But he was kidding, and *I* like them! I am currently working on sock #2 from the pattern in the Winter 2004 Interweave Knits, Retro-Rib Socks. They are so handy to carry to lectures and Grand Rounds.
I am also working on a pretty afghan, and a basic garter-stitch scarf and hat set for one of the other interns. He is from Nepal and for some reason has no winter clothes.
Once the husband comes back from vacation (he has the digital camera), I'll take some more photos of Finished Objects. Keep tuning in!!!
Tuesday, October 04, 2005
My First (wearable) Sweater
So, I finally did something with the HUGE spools of yarn that I've had for over a year. I made a sweater! I started with the "Hourglass Sweater" pattern from Last Minute Knitted Gifts and then put on the sleeves and hood from Debbie Bliss' Simply Living book. I also fudged around with the number of stitches because my gague was a little off. But look how cute I am!!!
Otherwise, everything is fine. Chris is on a little vacation for the week, visiting some friends of his in the Pennsylvania-Maryland area...and for anyone watching The Amazing Race this season, yes, Pennsylvania IS a state. My aunt and I would know that...we continue to insist that we would kick ass on TAR. And we are sooooo right, until of course I got all worn out and started to cry a lot. As I do.
I'm working on a cabled afghan for the back of the couch now, and I'm also finishing up a pair of socks at work. I've ALSO been named the Webmistress of our residency program's website (along with Important Major Consultant, My Husband) so I've gotta get cracking on that as well. Hope everyone on the internets is doing well.
Thursday, September 29, 2005
Emergency Room
So I made it through the month of August, doing pediatrics ward work--or, as I like to call it, "sticking needles into babies." It was fun and interesting and I will talk about it sometime soon. I have been spending this month on emergency psychiatry. We have our own part of the emergency room, to keep those bad crazy people away from the "legitimately sick" people. Actually, it is nice to have our own space. Believe it or not, sometimes the people who we have come in are upset or agitated. (Can you believe it?) And so, it's a nice thing to be able to have a place where they can be that has locked entrance and exit doors, and no monitors or oxygen nozzles on the walls for them to break or injure themselves with.
Aside from the near-constant threat of physical violence (just kidding mom!) it's been fun. It's so interesting to see how people get to the point that they need to come to the emergency room, and the stories they tell when they are here. Some of the biggest shockers have been people telling me about all the drugs they do ("I do as much cocaine as I can." "How do you get the money for that?" "Food stamps.") and the fact that people lie. To doctors! They lie! I'm shocked and horrified. ("I don't drink that much." "But your alcohol level was .460 when you came in last night. I'd be dead!" "Well, I just had a few drinks.") Meanwhile, I've been working with very talented social workers and nurses who have been helping me a LOT. The nice thing about having the social workers there, ASIDE from the fact that THEY can evaluate patients, write up the eval and SEND THEM SOMEWHERE (i.e. to a hospital) is that they know a lot of the "frequent fliers." They have specific plans for when Ms. BR comes in saying she is suicidal but realls just wants a sandwich. They know when the patients are looking for attention and when they are really sick. So that helps a lot.
But it's kind of scary. I'm seeing people here at their lowest. They want to die. Alcohol or drugs have taken control of their lives. The voices in their head just won't go away. The voices are telling them to kill themselves. The television is telling them they've already killed someone. The radio and X-box are talking to them, but the X-box speaks a different language so no one knows what it's saying. Their partner just died. Their cat just died. Their television just died. Their dad brought them into the emergency room to hospitalize them to "teach them a lesson." They want to die. They want to die. They want to die.
And you sit across the room and look at them. You listen to them. You try to help. You try to give hope. Things can get better, you say. There are a lot of treatment programs. I can see that you're a smart person, you're a survivor. You have a lot of skills. We want to help you. We want you to get better. We want to send you to the hospital where they can help you. The frequent fliers scoff at that. They don't help me there, and sometimes you believe them. Sometimes you wonder what we can do. Then you send them to the hospital anyway, and they spend a few days there, or a week, or a month, and then they get sent home with follow-up appointments they don't keep, therapists they don't see, and psychiatrists they don't call.
And then a few nights later, they come and see us again.
Anyhow, tomorrow is my last day in the ED. I start the consult service on Monday, where we help out medical and surgical services with the psych issues of their patients. We have an interesting attending so I know I will have some fun stories!
I have some knitting content to put up too. Will happen soon, I promise.
Aside from the near-constant threat of physical violence (just kidding mom!) it's been fun. It's so interesting to see how people get to the point that they need to come to the emergency room, and the stories they tell when they are here. Some of the biggest shockers have been people telling me about all the drugs they do ("I do as much cocaine as I can." "How do you get the money for that?" "Food stamps.") and the fact that people lie. To doctors! They lie! I'm shocked and horrified. ("I don't drink that much." "But your alcohol level was .460 when you came in last night. I'd be dead!" "Well, I just had a few drinks.") Meanwhile, I've been working with very talented social workers and nurses who have been helping me a LOT. The nice thing about having the social workers there, ASIDE from the fact that THEY can evaluate patients, write up the eval and SEND THEM SOMEWHERE (i.e. to a hospital) is that they know a lot of the "frequent fliers." They have specific plans for when Ms. BR comes in saying she is suicidal but realls just wants a sandwich. They know when the patients are looking for attention and when they are really sick. So that helps a lot.
But it's kind of scary. I'm seeing people here at their lowest. They want to die. Alcohol or drugs have taken control of their lives. The voices in their head just won't go away. The voices are telling them to kill themselves. The television is telling them they've already killed someone. The radio and X-box are talking to them, but the X-box speaks a different language so no one knows what it's saying. Their partner just died. Their cat just died. Their television just died. Their dad brought them into the emergency room to hospitalize them to "teach them a lesson." They want to die. They want to die. They want to die.
And you sit across the room and look at them. You listen to them. You try to help. You try to give hope. Things can get better, you say. There are a lot of treatment programs. I can see that you're a smart person, you're a survivor. You have a lot of skills. We want to help you. We want you to get better. We want to send you to the hospital where they can help you. The frequent fliers scoff at that. They don't help me there, and sometimes you believe them. Sometimes you wonder what we can do. Then you send them to the hospital anyway, and they spend a few days there, or a week, or a month, and then they get sent home with follow-up appointments they don't keep, therapists they don't see, and psychiatrists they don't call.
And then a few nights later, they come and see us again.
Anyhow, tomorrow is my last day in the ED. I start the consult service on Monday, where we help out medical and surgical services with the psych issues of their patients. We have an interesting attending so I know I will have some fun stories!
I have some knitting content to put up too. Will happen soon, I promise.
Saturday, July 30, 2005
Indentured Servitude
Also known as, Residency.
Today is my first 24-hour call for psychiatry. And my first weekend call. It's been interesting. I have certainly been learning a lot: we've covered some consult patients (tell other services about their crazy patients), we sent someone to our other psych hospital (tell the patient that she's crazy)--against her will (take away the rights of the crazy person)--and we've answered some calls about outpatients (help soothe crazy people). Meanwhile I have been hanging out with the nurses (we are all crazy people here).
It's been interesting, although I have really started to hate the sound of my pager.
I have spent the last month on our geriatric psych unit, which is actually the only psych floor in the main hospital. It's a unique kind of set-up, different from Vermont: the elderly and medically complicated patients stay here, and any other kind of patient (children, adolescents, and medically stable adults) go to the off-site psych hospital. We rotate there second year of residency. It's almost like we do most of the "medically complicated" stuff our first year: our geri floor, medicine (or pediatrics) floors, and the ED. After that we get to start forgetting everything we know about medicine: antibiotics, chest X-rays, anticoagulation, IV fluid rates, etc. It's kind of sad, in a way, although we start learning more and more specific psych information. I guess we can't know EVERYTHING--it's why we specialize, right? A pulmonologist probably forgets what he knows about renal, too. But it's still kind of weird, and sad. Chris definitely wants me to hang on to my medicine knowledge, and while I am using it, I know I will. And when I am not using it? Well, there's always my palm pilot. And the internet, of course.
So, it's been going okay. I am starting to get to know everyone. I like most of my fellow interns. There is one psych intern whom I do NOT like. I'm working on that and trying to be gracious and understanding and etc, etc, etc, but when my friends who are interns on OTHER services say, "We can't believe how you have to put up with this person," well, then it's harder. One thing that made me upset, though: when she first had her name badge made, she didn't put her last name on it. I have seen nurses do this sometimes on psych, especially if they are rotating in from other services. It's like there is this idea that in some way, putting your last name on your badge makes you vulnerable: that somehow, a "crazy" person (and crazy = bad, of course) will find your last name out and then, like, STALK you. Why is this a problem to me? Well, first of all, there is that stigma thing. As a "mental health professional," I am deeply interested in decreasing the suffering of my patients. This includes the societal and psychic suffering that comes from being judged because of one's illness. And second? For right now, most of my patients are so out-of-their-mind demented that they can't even remember my FIRST NAME, much LESS be interested in my last name. One of my patients has given up and just calls me "Red."
Plus, it's cool to be introduced as "Dr. Brownlowe."
So, life is going pretty well right now, and I am working hard and learning a lot and doing well. Chris and one of the new interns, Amam, have been hanging out today and brought me dinner: Afghan food! No, not made of a blanket, but actually Afghani food. It was tasty and rice-y. It was also nice to not have to eat a hamburger for dinner.
Next month (as in, on Monday) I start on pediatrics. More fun stories from the OTHER end of life. So you'll hear from me then. I promise.
Today is my first 24-hour call for psychiatry. And my first weekend call. It's been interesting. I have certainly been learning a lot: we've covered some consult patients (tell other services about their crazy patients), we sent someone to our other psych hospital (tell the patient that she's crazy)--against her will (take away the rights of the crazy person)--and we've answered some calls about outpatients (help soothe crazy people). Meanwhile I have been hanging out with the nurses (we are all crazy people here).
It's been interesting, although I have really started to hate the sound of my pager.
I have spent the last month on our geriatric psych unit, which is actually the only psych floor in the main hospital. It's a unique kind of set-up, different from Vermont: the elderly and medically complicated patients stay here, and any other kind of patient (children, adolescents, and medically stable adults) go to the off-site psych hospital. We rotate there second year of residency. It's almost like we do most of the "medically complicated" stuff our first year: our geri floor, medicine (or pediatrics) floors, and the ED. After that we get to start forgetting everything we know about medicine: antibiotics, chest X-rays, anticoagulation, IV fluid rates, etc. It's kind of sad, in a way, although we start learning more and more specific psych information. I guess we can't know EVERYTHING--it's why we specialize, right? A pulmonologist probably forgets what he knows about renal, too. But it's still kind of weird, and sad. Chris definitely wants me to hang on to my medicine knowledge, and while I am using it, I know I will. And when I am not using it? Well, there's always my palm pilot. And the internet, of course.
So, it's been going okay. I am starting to get to know everyone. I like most of my fellow interns. There is one psych intern whom I do NOT like. I'm working on that and trying to be gracious and understanding and etc, etc, etc, but when my friends who are interns on OTHER services say, "We can't believe how you have to put up with this person," well, then it's harder. One thing that made me upset, though: when she first had her name badge made, she didn't put her last name on it. I have seen nurses do this sometimes on psych, especially if they are rotating in from other services. It's like there is this idea that in some way, putting your last name on your badge makes you vulnerable: that somehow, a "crazy" person (and crazy = bad, of course) will find your last name out and then, like, STALK you. Why is this a problem to me? Well, first of all, there is that stigma thing. As a "mental health professional," I am deeply interested in decreasing the suffering of my patients. This includes the societal and psychic suffering that comes from being judged because of one's illness. And second? For right now, most of my patients are so out-of-their-mind demented that they can't even remember my FIRST NAME, much LESS be interested in my last name. One of my patients has given up and just calls me "Red."
Plus, it's cool to be introduced as "Dr. Brownlowe."
So, life is going pretty well right now, and I am working hard and learning a lot and doing well. Chris and one of the new interns, Amam, have been hanging out today and brought me dinner: Afghan food! No, not made of a blanket, but actually Afghani food. It was tasty and rice-y. It was also nice to not have to eat a hamburger for dinner.
Next month (as in, on Monday) I start on pediatrics. More fun stories from the OTHER end of life. So you'll hear from me then. I promise.
Sunday, July 03, 2005
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