These days I’m supposedly the teaching resident at Outside Hospital, and while I feel like patients here get super-duper really excellent care, I don’t feel like I’m contributing to the educational milieu or learning much myself.  I need medical issues to arise or at least just plain old problems to pop up in order to learn something and hence, teach about it.  I’m starving for something interesting to arise, and things here have been relatively straight-forward basic stuff. Which makes me nervous about my stint next week as the teaching resident at The Mothership hospital.  I’m finding that I’m only a good learner on “active” problems or cases.  How do I make it a good learning experience for others if I can’t find an “active” case or problem?

Mental starvation aside, I’m also really hungry all the time, and have discovered the breakfast egg-n’-cheese sandwich on English muffin.  Outside Hospital has generally given us meal tickets for breakfast, and I’m spacing out my 8 breakfasts here well, because those tasty, tasty egg-n’-cheesewiches really kick the hunger and keep you going through rounds until lunch time.  So it’s no surprise that I’ve gained 5 pounds in the last week, and I can feel shift in weight distrubution and balance in even the little things, like picking up my bag, or reaching for stuff on a high shelf.  I went to my first prenatal yoga class and I was the only lady there who rolled off her balance ball…and I was the least pregnant one there.  This does not bode well for Gully.

Oh, and we found out Gully’s a girl! Big surprise because I was convinced it was going to be a boy and was kind of hoping for a boy if only because the name game wouldn’t have to kick in.  A boy would have been easier - he would have just gotten Joe’s ridiculously uber-Italian name with a big ol’ “the Fifth” attached at the end.  Not that he’d even be 1/5th Italian, but just 1/8th Italian.  The certainty of a boy’s name was so absolute that it was almost like an unspoken law when we got married.  “What if we don’t ever have boys, then what happens?” I asked once, and Joe very matter-of-factly said, “Well, then I’ll have you beheaded.” 

If that’s the case, then we should name our girl Elizabeth, but we’re actually toying with two-syllable names.  Because we like shorter names, okay? Just because.  And we actually have a “secret” girl name that we’ve liked since forever and ever, which we’re 75% certain might be the name, which might not be so secret soon.  Unless it’s taboo to announce the name…but I think it’s not, right?  That’s just what people do, if they don’t hold out on the sex of the baby, then they hold out on the name, just because they feel like it, right? Not because of some weird fear of a mystical curse or anything right?  Because I hate secrets, and I want to tell everyone the name!  I think we’ll announce it as soon as she has a middle name, too, because she’s getting a Chinese middle name, which my parents are going to figure out.  Right now, our placeholder middle name is “Bing-Bong,” which is ridiculous yet not too far off from my actual given name, which is Bik-Yin (yeah, Miranda is only on my birth certificate as my middle name).  So she’s Gully Bing-Bong Onorato until we otherwise come up with something that sticks a little better. 

Everything makes me cry these days. I would like to blame it on my exhaustion from being on the wards, but I should probably also blame it on the crazy preggo hormones.

That Canadian figure skater’s performance in the Olympics? The one who’s mom died only days before she had to skate? Who I didn’t even know existed before I watched her short performance? Yeah, I cried.

That Pampers commercial they’ve been airing during the Olympics? The one “dedicated to moms”? Big big tears.

And this movie I saw last night.  Best child actors ever.  Sobbed so hard that my face was puffy this morning.

Okay, so all these things kind of feature moms or kids, but then today I was throwing out some old med school notes on reading EKGs so I could use the 3-ring binder the notes were stored in, and reading my old tips on non-reentrant supraventricular tachycardia made me absolutely nostalgic and weepy.

But it’s not just sadness that is set at an extra-high voltage level, it’s also super-omigod-hyper-happiness and incredible-hulk-rage.  Post-call at the vets office looking at all the cute animals in the waiting room? I love the world and all the wonderful pets in it!! Torrential rain outside my window as I’m snuggled under a fleece blanket? Nature is so beautiful and majestic! Crazy parents who insist their child will not be monitored overnight or only allow one needle stick for a difficult blood draw? I will cut you, I really will.  If I were inclined to write poetry, as I was wont to do as a teenager, it would be fabulously flowery and hormonal. In fact, I am inspired to write a haiku:

Pregnancy hormones.
Why, cotton IS the fabric of our lives!
How soft. 

They say that doctors make the worst patients, which isn’t always true, but can be true.  In the case of a pediatric resident doing a genetics elective at the beginning of her pregnancy, this is true.  I’ve only done three days worth of genetics & metabolism clinic, but it’s enough to drive me nuts.  I thought it would be good to do a genetics elective since I’m going into neonatology (and quite a few of the patients we will see in the NICU will have genetic anomalies), but I couldn’t have timed it any worse.

To begin with: it appears that the majority of the anomalies we see and counsel cannot be tested for in pregnancy.  Those three diseases we test for on the early risk assessment - Down syndrome, Trisomy 13 and 18 - are only the tiny tippy top of the iceberg!  About 2% of all healthy pregnancies that are carried successfully will have some sort of genetic syndrome that cannot be anticipated.  And this 2% risk is just the baseline risk.

Still, though, I managed to calm myself down somewhat.  Even if you could test for other genetic syndromes prenatally, the question is…so what?  Having a baby IS taking a risk, and you have to just make a blind leap of faith, genetics and all.  And not everything is entirely genetic - you could have a bad delivery and your kid could wind up anoxic with seizures and a brain injury, and you couldn’t have predicted that.  You can’t predict that your kid will have autism, even though the chances are 1 in 160.  You can’t predict that he or she will be Republican (although apparently, early childhood personality traits can predict political orientation).  You take the good and you take the bad, just like the theme song to that 80’s sitcom “The Facts of Life.”

Joe said that maybe we should have our genetic risk factors sequenced commercially, but I looked at the website and realized that the disease risks they test for and carrier status that they are able to accurately assess aren’t things that matter much to me anyway.  For example: even if Joe might or might not have Jewish ancestry, I’m pretty sure I don’t have any, and I’m even more confident Gully is at low risk for any of the diseases on the Ashkenazi panel, like Canavan disease.  And big deal if he/she ends up having maple syrup urine disease.  It can be medically managed.

Plus, there are things to worry about where the genetics haven’t even yet been elucidated, like the nerd n’ weakling gene that Gully will obviously inherit.

Hello everyone, meet Joe and Miranda’s fetus:

As you can see, black-and-white-grainy-ultrasound-images have become de rigeur for announcing pregnancy in the internet world, and we are only following the fashion.

And now, because this is awkward, a FAQ sheet:

Um, you’re pregnant?

Yes.  As confirmed by $40 worth of pee sticks, and a few official visits to the ob.

Really, are you sure?

Yes.

But that could be a pre-recorded baby on that image!

This is what my dad said when he looked at the ultrasound.  This is what Joe thought when they stuck the ultrasound probe on my lower gut and an image popped up on screen of a wiggly little fetus.  Then he said, “you could just be getting fat.”  Well yes, I could be getting fat, but I’d like to pretend that part of the fatness is related to a fetus inside my uterus.  The other thing my mom and dad said when they saw the ultrasound image: “Looks like Joe.”  Already?!
How did this happen?

You know how this happens.  Geez people, must I explain everything?

When are you due?

Late July.

Oh yay!/Oh shit! That means…

Um, yeah, that means no weird scheduling kerfuffles for residency and residency chiefs, no awkward emails from me begging for scheduling re-arrangements because residency thankfully ends on June 30th.  Unfortunately for my fellowship compadres, that means a big honking scheduling kerfuffle, since fellowship begins on July 1st.  And for that, I am truly, truly sorry.  And truly, truly terrified.  I will be taking terror-inducing ICU call in my last month of pregnancy, and while I am ridiculously deliriously incredibly happy that I am finally starting my career as a neonatologist, I am terrified that this will be occuring so near my possible labor date.  I don’t want my water to break while intubating a 24-week triplet or starting a PICC line.  For those in the non-medical world, basically, I am going to have to learn how to do really hard medical things while my legs are swollen and I have to pee every 2 hours.  Not fun for me and not fair to my patients.

So are you happy about this?

Well, I’m very happy about the baby.  Maybe it makes me a bad parent already to be so worried about my medical career, but after 8+ years of medical training and with a handful more years to go, I can’t help but worry about juggling fellowship and parenthood.  I would like to think that my worrying about starting my fellowship at the same as having a new baby is really just related to the thoughtful planning that has been a classic characteristic of the type-A medicine types.  But really, with a medical career, there is no good time to have a baby.  There might be some times that are better than others (and you can chat amongst yourselves as to when the “right time” is to have a baby while being a physician).  We have been trying off-and-on again to have a baby for over a year, and I didn’t think it would happen like this, without the miracles of science and whatnot.  So there ya go.

Is Joe happy about the pregnancy?

Yes, he is.  To the point where he will occasionally try to talk to my stomach, and in a very gentle voice, say, “Gully, this is your daddy speaking.  What are you doing right now?”

“Gully”?!?! Is THAT what you’re naming the kid?!?

Nooo, but every fetus needs a name before you find out the sex (and that won’t be for another month.)  We were casually browsing the Ikea website for cheap baby crap to get a sense of what this new-baby thing will cost us, and came across a crib called “Gulliver,” although there might be an umlaut over the “u.”  You have to have a ridiculous name.  You just do.  Heck, I know of several children who’s fetal names have actually stuck, and who respond to both their birth certificate names and their fetal nicknames.

So how are you feeling?

Had lots of nausea for well over a month, and have vomited a bunch of times, gotten dehydrated enough to have an IV placed once, tried Zofran, an anti-nausea medication (didn’t really work), but now the chief issue is really bad reflux.  Now that my appetite is back, I am very much aware of the anatomical location of my esophagus because it is burning up like a hot acidic metal rod in the center of my chest.  The ob said that if you have bad reflux at the beginning of pregnancy, it’ll only get worse.  Yay.  I am now popping ranitidine (safe for pregnancy!) before every meal.

So, are you becoming Fatty McFat or what?

Yes, that’s exactly what is happening.  Every time I look down at my gut, I have that weird feeling that people are eyeing me suspiciously, “Could be fat, or could be pregnant.”  I am almost 15 weeks pregnant, and my jeans are too uncomfortable to button shut, my work pants don’t really button anymore, but all the maternity pants are too big and too ugly to give into quite yet.  The other embarrassing thing is that pregnancy has finally pushed me over from the training bra section of the lingerie area at Macy’s to the normal grown-up section that has bras that are actually sized by letter.  It’s like I’ve finally reached Tanner stage 5, which in adolescent-medicine-speak, is bodily adulthood.

So now what, are your Facebook updates only going to be about your pregnancy?

No worries, I won’t get all cheesy on all y’alls.

Slow day on call in the NICU today…had a great Christmas yesterday because the hospitalist decided I was a redundancy, and after rounds were finished and orders entered, she let me go home!  Got to take a mid-morning nap, then visit the Onoratos and the Ips back in Sudbury, eat tons of cookies and ham, then back home to open presents with Joe and fall asleep by 8 pm under a pile of awesome blankets: my baby blanket, newly discovered back at my parents house, my JMP blanket, courtesy of a friend’s mom, and a fuzzy fleece blanket I ordered online. 

Did you know you can read the Bible online?  Not that I’m particularly religious, but I figured I eat the Christmas cookies and open up the Christmas presents, and Christ was born on 12/25, so I figured I should dig around and read about his birth.  And it’s a wacky story.  In almost as many words: an angel came to visit teenage Mary, who wasn’t even married yet, and told her “congratulations! The Lord is going to immaculately knock you up.” And she was suspicious.  Then the angel gave her some more details, and then she was like, “Okay, I’m down with that.”  What if she had said no?  Did she have a lot of time to decide? I mean, did this news come in a 15 minute conversation or did she have days to mull it over before agreeing?  And did she know any better?  She was a teenager!  Her response to the angel implies a choice, but the details are super sketchy, both in the King James version and in the New International version. 

The whole story has left me feeling very uneasy because I want Mary to have had choice in this whole matter, even if it was the choice to carry out a pregnancy in full.  It would have been nicer if she had visited her cousin Elizabeth, been able to discuss the issue with her, seen her give birth to John, and been like, “yeah, alright, this ain’t so bad, I’m okay with it, so yo, angel, you can tell God I’m down with the immaculate conception.”

Do you see the dilemma? I am going back to the conference room to worry about it and eat more cookies.   

Having taken a blow from ye-olde-merry-virus season, I am laid up, febrile and coughing and achy and bored.  My eyes can’t focus long enough to do anything significant, so I decided to organize the ever-growing stack of journals, random articles, and old sign-outs on my desk.  I came across this great article about how hospitalists spend their time.

Hospitalist fun facts from this article: 18% of their time is spent on direct patient care, meaning speaking directly to patients and their families and examining them, whereas 69% of their time is spent on indirect patient care, meaning charting, orders, speaking to other involved medical team members about the patient’s care, yadda yadda.

I think it would be interesting to see how it breaks down for residents.  As an intern, I have really intensely colored memories of working with patients and their families, all topped on a hum-drum backdrop of indirect patient care, i.e. scut…so maybe it was half n’ half?  As a senior resident, I think I spend even less time with patients and more time on paperwork, working with other staff / physicians to advance patient care, more paperwork…a lot of clicking and typing and staring at a computer screen and having arguments with the computer order entry system, the computer medicine reconciliation list, and other computerized computery things that make me go nuts.

Also, I’m a terrible Pubmed searcher, so while there are multiple articles popping up on resident work hours rules and its effects on how residents spend their time, I can’t seem to find anything specific to year of training and it’s correlation to amount of time involved in direct patient care. 

This begs the second question, does more face time with patients make you a better doctor?  I can certainly say that qualitatively, the brief interactions I have with patients and families feels somehow better, even if the minutes are fewer.

This is tiring me. Thinking too much about one subject while my arms and tummy and knees and hair follicles hurt is really really exhausting.

Residents are good at complaining about their lives, and I’m really good at complaining.  However, that does not make me a good resident.

Last night, I was on call at one of our “outside hospitals,” meaning a community hospital.  “Outside hospitals” have a less-than-perfect reputation among housestaff, but don’t get me wrong, there are fabulous “outside hospitals,” as I am living proof that you can be born at Outside Hospital and live to tell the story.

Every resident has “a system,” by which they keep track of the patients and action items that they need to follow through on while they are on call, and 99.9% of the time, this system is kept on “the signout.”  Sign-out is when one resident passes on information to the next resident on call about what they will need to know about patients and patient care when the former resident goes off-duty and the latter resident starts call.  It usually consists of a verbal report of patients and agenda items that need to be taken care of, and a piece of paper on which all of this is outlined that is usually typed in miniscule font with various check-boxes scattered throughout.  Residents have their own systems on the paper sign-out: some like to order their events chronologically, writing down everything that needs to happen at every-hour-by-the-hour on their list of stuff to do.  Some like to just put check-boxes next to each item that needs to be addressed.  Some just like to use multi-colored pens to organize their thinking about what’s important (RED for important stuff to do now, BLUE for “just watch and follow,” GREEN for lab data, BLACK for everything else.)  Some incorporate all three techniques.  I am a check-box kind of resident, as are 95% of residents, and on busy services at busy hospitals, I will use the multi-colored pen system as well.  And always, on what I anticipate to be busy nights or potentially terrible nights, I will make myself an agenda item and put a check-box next to it: [ ] Am I having a good time? And it is usually written in blue.

Last night, I went wild, and decided to change my personal agenda item to: [ ] Be an awesome doctor!

That was my first mistake on call last night.  Because being an awesome doctor doesn’t necessarily mean being an awesome resident.  If you imagine a Venn diagram, the two spheres overlap to varying degrees, depending on what stage of training you are in and what your responsibilities are.  And at Outside Hospital, where any interesting, chaotic issue can present itself, the two spheres might not even be overlapping, as was the case last night.

Last night, I spent the majority of my time trying to help this poor patient and these poor nurses who were dealing with her, as she was having pseudoseizures.  After a little while, we were able to get the patient off the floor and into a room and eventually get a set of vital signs but this whole process took about an hour because (1) I couldn’t get into the unit because the unit does not have a working doorbell, and it is locked, and no one knew I was banging on the door outside trying to get in, (2) there were no gurneys or wheelchairs available to get the patient to a more ideal spot other than the floor, so we had to use an office desk chair with wheels to slide her into a room, and (3) the only reason we needed a room is because the room had equipment like oxygen, a thermometer, a blood pressure cuff, and there was no way to get any of this stuff to the middle of the hallway where she was pseudo-seizing, and (4) I guess I was called to this problem because the girl was kind of big, and the two nurses weren’t enough to help her off the floor and they didn’t realize that she was also congenitally deaf, so it was hard to communicate.

Regardless, it felt inordinately bizarre because it wasn’t a situation in which you needed a doctor.  You just needed someone, anyone, anyone at all with common sense, to take charge.  Really, people just needed to be told what to do, because it was confusing, but it wasn’t life threatening, and no one was really sick.  From a medical perspective, she was okay - I just wanted a basic set of vital signs (temperature, heart rate, respiratory rate, blood pressure, oxygenation) to make sure she was okay, and even this was hard because (5) there were no working adult-sized blood pressure cuffs on the floor.  And she was a big girl with big arms.  It was clear this was a patient in a lot of distress, and these were nurses who were at their wit’s end, and this was a psychiatry unit with not a whole lot of technological functionality, but no one was acutely ill, so I felt somewhat at a loss.  Be a good doctor?  How?  Be a good resident?  Okay.  That involves: finding an accurately sized blood pressure cuff to take a good set of vitals on this child; communicate with her by writing things out on a piece of paper and letting her write back; flipping through her chart to find out what her underlying medical and psychiatric issues were; helping the nurses get her to a safe place in the room.

The whole night was like this.  I was dealing with complaining parents, overwhelmed interns, sad patients, confused staff members.  And I realize, there are really very few moments in your life when you need to be a good doctor, in the traditional sense of, oh, saving lives - you just need to be a good resident.  And that only means: make the medical system work in your own small way.

Waking up next to Joe this morning at 6:00 am, I mentioned that I got to see Amy and Chris’ dogs and how funny and strange they are, and any mention of animals throws us into a variation on a conversation we (oddly) often have:

ME: I miss the cats - right now they would see we are awake and Manzie would walk up onto me and sit on me.  Walk walk walk.

JOE: I would rather be a dog than a cat, because cats are always worried and dogs just have to do one thing and they’re happy.

ME: …

JOE: (rolling over in bed with eyes still closed, smiling) All you have to do is love your owner and if you had a great owner, then it’s nice, and that’s it, that’s all you have to do, love them. And then you’re happy.

ME: Yeah, cuz that’s his job.

JOE: (still sleepily smiling) No, it’s not a job, it’s his soul.

ME: (pause) I want a job that’s my soul.  Like a dog.

It’s just some guy who zoomed by while I was taking the picture at Shoreline Park on Sunday. It came out ok.

My cat has inflammatory bowel disease!

Supposedly.  Solo is typically a 15-pound cat (his “ideal body weight”) but has most recently slimmed down to a sad 11 lbs 12 ounces because he has been throwing up.  A lot.  Necessitating frequent Resolve-cleaning of our rugs, followed by frequent vet visits, blood work, x-rays, ultrasound, and now finally, a special prescription-only venison diet, pepcid and steroids! He takes 5 mg of prednisolone daily, mashed into his half-a-can of venison.

I can’t live like this.

You don’t ever expect to become a special-needs cat owner, unless you’re really into cats, and as much as I love my cat(s), I didn’t expect this.  I didn’t expect to be taking him to vet appointments on an almost-weekly basis; I didn’t expect to be mashing pills into his food and feeding him an expensive food regimen (more expensive than my own weekly grocery bill, but then again, I eat cheaply); but, I apparently love him, and love knows no bounds, and I want him to feel better in his tummy.

So this is what it means when they say love hurts.  This is what it means when a parent has to see their neonate go through a sepsis work-up.  Perhas I trivialize parenthood when I compare cats to infants, but still…I want Solo to feel better!

Haven’t been updating much because life lately has been all work.  And sleep when I can.

Okay, so I whine about how tired I am, and of course, on my one day off this week, I wake up at 5:30a and can’t fall back asleep.  This is what happens when my body adjusts to crack-of-dawn awakenings, and so I ended up getting up and doing all the stupid things that aren’t fun and that I can’t do during my week: pay bills, take out trash, clean litter box, go jogging (only because I’m bored, and it fills some time), start laundry, shower, groom my eyebrows, then decide to groom the cats (or rather, chase them with a brush and fail to actually groom them), and damn, it’s only 11:00a.  Then I realized I could clean out the refrigerator.
A week ago, Amy shared this picture show documenting the refrigerators of people, which I found fascinating.  So, I decided to take stock:

This week, the refrigerator looks like a relatively normal person’s, but only because I haven’t had time to cook much, and hence, leftovers aren’t ballooning out of tupperware.  Notice the stockpile of caffeinated diet sodas.  And to balance the acidity that caffeine brings, I think I compensate with milk and kefir and yogurt.  And there is actual fruit in there!  Although it’s partially rotting because I come home, take one strawberry out, wash it, eat it, and thus I end up throwing away a significant portion of rotting fruit. Way in the back, there were some rotting chickpeas and an open bottle of wine that’s been in there since January or February.  Lucky for you, you can’t smell this photo, either.

Here’s the thing: I would like to be all worked up about California and prop 8, and I would like to be ardent about Sonia Sotomayor’s nomination, but I’m too tired to get my panties bunched up about these things.  I get home and I read cheesy chick lit or recommended stuff from Oprah’s book club.

And yes, it has made me dumber, but I am too tired to care anymore.  I didn’t realize how tired I was until this morning, during rounds. In the mornings, we walk-round in the PICU with COWS, which are “Computers on Wheels” - essentially, laptops on wheeled stands that we can roll in front of ourselves so that we can type notes and enter orders as we go from room to room talking about patients.  This morning, I was leaning on my COW with my head down, and while my co-residents were busily looking up the diverticulum of Kommerell, and updating discharge summaries and entering orders, I was sneakily reading xkcd comics on my computer.  Life is just too much to bear these days.

I think part of my tired-ness is due to my shoes.  Rounds hurts my feet, despite the fact that I wear the clog-wear that is standard for most residents.  I think I need to wear sneakers.  Too tired to care anymore.

Joe isn’t at home right now, so I can eat whatever I want.  We have very different tastes and very different takes on food.  What I’ve realized is not only do I eat much less when he’s not around, but I also manage to plough through the leftovers and pantry foods because I don’t mind leftovers or pantry foods.  Also, I like grains such as quinoa, and he doesn’t.  I have had two very good “leftover creations” in the past week that weren’t half-bad:

Tuna-Asparagus-Quinoa Medley

Ingredients: 1 can of tuna, a quarter-bunch of asparagus, 1 cup of quinoa, 2 tablespoons chopped Italian parsley, half of stalk of green onions, half-handful of chopped walnuts, stone-ground mustard, mayonnaise, salt and pepper to taste.

Instructions: Cook quinoa according to instructions.  Chop asparagus into 3/4″ inch lengths and steam.  Chop green onion and parsley finely.  Toast walnuts.  Mix all ingredients together.  Serve as is, or on toast.  I think instead of walnuts, this would have tasted good with cashews.

Tomato-soup-black-bean-quinoa medley

Ingredients: Boxed tomato soup, canned black beans, 1 cup quinoa, shredded Monterey cheese, salt, pepper, Italian chopped parsley and Tobasco sauce.

Instructions:  Reheat tomato soup.  Drain black beans, rinse, and reheat. Make quinoa according to instructions (I already happen to have a stock of this).  Mix together and season with salt, pepper.  Top with shredded cheese and parsley.  Wish I also had some edamame to toss in.

I have found myself surprisingly busy on call-free elective, but not busy enough to not notice this picture on one of my favorite gossipy websites, people.com.  Okay, I don’t even know who these people are but they are complete morons.

They are “Heidi Montag” and “Spencer Pratt” — self-important reality-TV idiots or maybe soap opera stars, I have no idea, vacationing in Cabo San Lucas.  And they are doing this in the middle of the swine flu epidemic, while all “non-essential” travel to Mexico has been recommended to be suspended by the U.S. government.  First of all, I am not sure if a “pre-honeymoon vacation,” which is what this trip was described as by my illustrious internet news source, counts as “essential” travel to Mexico.  Maybe it’s important for B-list celebrities to do such “essential” business travel.  Second of all, they are wearing “protective” masks while near-naked on a sandy beach.  As if that were going to save their lives as local indigenous workers who lost their farms and had to get a job at this energy-sucking resort are coughing into their margaritas.  Oh, and that towel-boy who handed you your towel as you stepped off the beach into your private cabana-suite?  His mom just died that day of swine flu.  Third: what the frak are you doing prancing about on vacation in skimpy clothing while the country around you is dealing with a pandemic?  I am overwhelmed by the magnitudes of error in this tableau.

In matters related to popular culture and music, I am usually three or four seasons behind, and in most cases, I am never caught up.  For example, Rihanna? I’ve heard about the whole domestic violence thing, but other than that umbrella-song, I haven’t heard much of her music.  “You have to listen to her stuff really loud,” Joe announced to me one day.  The he demonstrated his back-up dancer moves to “Push up on it.”  Not sure if that’s the title of the song, but that phrase is a main element of the chorus.  Thanks to Joe, we own her latest album.

I will be traveling a lot this month, and after realizing that I can only tolerate “Spy Kids 3″ and other airplane movies so much, I decided to download the whole first season of “Battlestar Galactica.” Yes, I realize the series is over, and yes, I realize it was AMAZING, but the series started during med school, and I only caught a few episodes of the first or second season before I descended into the gory depths of Step 1 and my clinical rotations, so tant pis pour moi.  Until now.  I watched the first two episodes on the flight home from Tahoe, and then proceeded to watch the rest of the season through the week.  After this weekend I polished off the miniseries that proceeded the Sci-Fi channel series.  And finished the first three episodes of season two.  What’s missing in this picture?  Nothing, except my sleep.
The problem is, almost every episode ends with a cliffhanger.  I need to know that Commander Adama pulls through!  I need to find out what happened to the pregnant Cylon-Sharon! When will Starbuck and Helo make it back to Galactica?  Why don’t we know anything about the other twelve colonies?  How did Number Six get into Baltar’s brain?  Not only is it serialized in a deliciously tantalizing way, it’s well-written, it’s plot twists are complex and engaging, it holds a mirror up to what would have been the current events of the Bush era, and it’s as nuanced as any good text.  Like all science fiction, there are obvious loopholes in it’s “science,” but it’s easy to suspend disbelief because of all the humanistic (and humanoid) drama.

Of course, BSG isn’t considered as pop culture-ish as other things I know little about, like “Dancing with the Stars” or those yellow rubber Livestrong wristband thingies (I assume a lot when I say these count as “mainstream”).  It’s more like periphery-pop culture.  But who cares, it’s really fracking good.  My only worry is that after I complete my BSG binge, I will feel hollow and lifeless inside, much the same way I felt after watching the complete “Lord of the Rings” trilogy in one sitting, or even after reading Twilight in one sitting.  Can life go on after BSG?  I need to find out.

Some of my friends have moved into the “Expectant Parent” category of life now, and as if they weren’t already getting a boatload of unsolicited advice from parents, friends, and random strangers in the grocery store who want to touch their pregnant bellies, they have very kindly been asking me advice on how to choose a doctor for their child.  First of all, mazel tov! Second of all, please get some advice from someone else as well, preferably someone who has meaningful advice.  Because I am only a second year pediatrics resident, someone who has not yet completed training, someone who does not have “FAAP” at the end of their title, someone who does not have years of kiddie-wisdom stored behind graying temples.  With that caveat, here are some pointers:

Get a pediatrician, not a family practice doctor! To all my family medicine colleagues out there, sorry.  Unless your mom, your dad, your brothers and sisters and your brothers’ and sisters’ children have all gone to the same beloved family doctor for 35 years, and she’s wonderful and kind and intelligent and resourceful and has never-let-you-down, you will want someone who has had specialized training in the illnesses of children.  A family medicine-trained physician has about 3-6 months of formal training focused on children, whereas a pediatrician has at least 3 years of formal training focused on children - and unless your family doc has been taking care of children for generations, they will not have seen the volume and range of illness a pediatrician has seen.  Unless you have a trusted family doc already, I would say you have a much better chance of finding your child a good doctor if you narrow your selection to the kiddie-pool, not to the “general swim” pool.

How much experience should they have? I have heard complaints on both ends of the spectrum.  You don’t want someone who is naive enough to think every rash needs a biopsy and a derm referral but you also don’t want someone who is so old-school that they aren’t keeping up to date with the most recent evidence-based medicine (e.g. docs who still think it’s okay to lower temperatures by giving alcohol baths).  They should be board-certified by the American Board of Pediatrics, too.  I think what’s telling is not so much the individual experience of a practitioner but more the collective years-of-experience the whole practice has: how many pediatricians are in their group practice, what the range of experience is amongst all of them, how many total children does their practice serve? More likely than not, your child is not going to see the same pediatrician for all their sick visits unless it’s a solo practice, and more likely than not, if there’s something unusual about your child’s case, they will likely bring their colleagues in to examine your child, too, or at the very least, use their partners as a sounding board for management advice.

Find out about how they handle 24-hour emergencies.  If you call at midnight with a question, will the phone service direct your call to a nurse triage line, will they page the physician on-call for you, or will you just get an automated voice message that tells you the office is closed, please call during business hours, and dial 911 if it is an emergency? At the very least, you want a practice that uses a reliable phone triage system, that has one physician on-call every night (your particular pediatrician might not be on call every night, but might have a group practice where they rotate through call nights), and that has good recommendations for which emergency rooms to use because each emergency room will have varying levels of experience with pediatric patients and different admission policies.

Find out about office hours and how easy it is to get in contact with a pediatrician in your practice.  You will need a practice that can accommodate your schedule: do they hold office hours at night or on weekends, when most parents get off work? Are the pediatricians available by phone or email?  (A lot of pediatricians aren’t, because they’re seeing patients all day; they do not have time to sit at the computer and respond to email questions all day long).  The other thing I’d be suspect about is how long you have to wait in the waiting room — do you get there for a 3:30 pm appointment that isn’t really until 5:30 pm?  This isn’t fair to the patient, and it is telling of how well an office functions or how overbooked it is.

How do they refer patients when they need a specialist? Do they work with university or children’s hospital specialists? How do they handle children with special needs?  Not that your child may ever need this, but it’s important to know if they have a reliable and often-used network of specialists they can rely on, because it means they are that much more aware and up-to-date with the resources around them.  Also, you don’t want a pediatrician who will just hand-off your child’s special needs to a specialist and not follow-up on management issues.  You want someone who actually reads the letters that specialists send to them after they see your child, and at your well-child check-ups will ask follow-up questions and make sure you understand the care plan or tests that the specialist has requested.

If you can afford the time, interview pediatricians in your community before picking one.  This is the most important thing I can think of.  Most will not charge you for it, and most welcome it, because it’s about finding the right fit for your family’s needs and for your personalities.  Bring a list of questions.  See if they will offer you the chance to talk to other parents who use them, because it will be mostly by word of mouth that you find someone who is right for you.  You might have specific questions about vaccination schedules and holistic medicine practices and beliefs around co-sleeping or breastfeeding or whatever, and you will want to hear your pediatrician’s take on all of it.  Most importantly, you will want someone or a practice who will be an ally in helping you raise your child.
It is excruciatingly hard to find a “good” doctor - it’s not like finding a reliable store to buy pants (although that is hard, too), or a dependable dry cleaners because there are so many factors that make finding a “good” doctor hard, including just having information available.  What’s “good” to one person may not be considered important at all to another person.  And I know parents worry.  One careless comment or suggestion can make make parents stay awake with worry for nights on end - at a delivery I went to, as a father came over to snap pictures of his new baby, he asked me why the baby’s head was cone-shaped and I said, “And all babies who spend a lot of time in the birth canal have heads shaped like this, it’ll just take some time to straighten out.”  It was only later when the pediatrician told me that the dad spent a significant portion of time worrying over exactly how long it would take for the baby’s head to no-longer be cone-shaped and whether it would be cause for developmental delay that I realized that the lifelong worrying of parenthood begins immediamente.

Recommended resources for how to choose a pediatrician:

Your Baby’s First Year has a good checklist for what to look for when selecting a pediatrician.
Visit the American Academy of Pediatrics to search for a list of board-certified pediatricians in your area.

I hadn’t really noticed the flowers starting to bloom amidst the April showers n’ all, because the telling sign of spring in the city is the arrival of Peeps at the drug store!

Joe’s comment on this picture was: “What is Mr. Fur staring at?  Notice that he’s not interested in the peeps because they aren’t food.  (Eat food.  Not too much.  Mostly plants)”

We decided to take two days of snowboarding lessons, and my butt, knees and wrists are now very sore.  I’ll spare you images of these sore and bruised bodily regions but here’s a humorous bum we saw at The Naked Fish, a sushi place in South Lake Tahoe:

There were lots of good sunsets while we were up there:

And a few good powder days:

Lunch breaks are also email breaks:

And here’s a sign that Joe stopped to read, since he apparently does, in fact, read signs:

All in all, a good snow vacation.

Plus, I learned a whole new way of describing snow.  Eskimos have multiple terms for snow, as do bonehead skiers/riders.  Freshies refers to newly fallen, powdery snow; The Goods refers to new snow, usually in the trees; powder, of course, means light, dry snow; spring conditions is when the snow is hard in the morning and slushy in the afternoon.  When we got back to the Bay Area, we decided to go ahead and buy beginner snowboards on clearance (no reason to ever buy full price).  I am very excited about learning to ride next season.

So we managed to get out to Tahoe for some spring skiing, and the moral of the story is that I am old and confused.  Joe caught an edge and sprained something in his calf muscle, and so he took the rest of the afternoon off, and I decided to go skiing by myself.  I did a few practice runs down Olympic — an easy, uncrowded trail.  Then went over to ski some trail that I had fallen on before, and after satisfactorily making it down without falling, I felt like I could call it a day.  I called Joe at the bottom of some lifts to tell him I was ready to go.  He asked me: “Do you know how to get back?  You need to take the California Trail.”  I glanced at the map behind me and identified some trail marked “California Trail.”  “Yeah, sure, I can do it.”  “Okay…” he said, sounding only half-convinced, and we hung up.  It was almost two hours before I finally was able to meet up with Joe, and it was because of this:

Apparently, my stellar sense of direction, combined with my amazing map reading skills only took me all over the mountain before I was able to find the gondola and call Joe to tell him to pick me up.  I accidentally went down Mott Canyon (how does one accidentally go down a run that has about twenty warning signs that say “expert only”? It’s easy when you apparently don’t read signs) and managed to sprain my thumb on the way down (not exactly sure how that happened, either.)  Vowing to never do that again, I found myself at the bottom of some lift called “Sky Express” about three times.  This was supposed to magically transport me to a clearly identified “California Trail,” which I think I managed to be on about 40% of the time but always ended up back at the bottom of “Sky Express.”  The problem, I think, was two-fold: one, I refused to go on any trail that looked super-flat, requiring me to push myself along in the spring slush, and two, afraid that I would encounter super-flat stuff at slow speeds that would require me to push and walk, I probably managed to ski past well-marked signage that would have led me in the right direction.  Actually, the main problem is that I don’t read signs or maps very well and I have no sense of direction.

“How do you get on in life?” Joe asked me in a sort of incredulous tone.  I have often times wondered that myself.  I have no internal map of any sort, and apparently, external maps are of little help.  This is obviously a brain problem.  Even with the navigation system in our car, the little computer says “re-calculating route,” about every 10 to 15 minutes, indicating to me that I am always making wrong turns, and it turns a 30 minute drive into a 45 minute one.  The other thing is, I am perfectly content not knowing where I am.  While skiing, I am happy just spotting a pretty view of the lake or making it down a steep patch with nicely linked turns, and I really don’t care where I am.  In driving, I am satisfied that I shifted well on a hill, or pleased to discover a new KFC that I hadn’t noticed before, nevermind the fact that I am in Dorchester and not near West Roxbury where I need to be.