I’m in the NICU these days. I can’t stop watching this video. Premies living the phat life.

One of the major call night issues is the issue of odor.  Imagine all the bodily odors you have known (and some you have never ever known), and mix ‘em all together, put ‘em in a box and seal it up real tight…and that is the smell of the pediatric surgery intern call room.  Added to the fact that every time I decide to mosey on down there, there is someone sleeping in the pedi surg intern bed who is NOT the pedi surgery intern (i.e. me), and who is some other surgical resident who likes to take their SHOES and SOCKS OFF.  This only adds to the mix of odors retained in that odor box.  All I have seen of said non-pedi-surg resident is his or her bare feet sticking out of the bottom of the bed. 

That said, I decided FOOT odor is part of the call-room odor issue (in addition to bad ventilation).  I happen to change my socks at least 2-3 times on call.  But THIS TIME, I brought not 3, but 6 pairs of socks to work today.  I figure I should be changing my socks q4-6 hours.  We’ll see if this helps the situation tonight.  That, and hopefully someone won’t be sleeping in my call bed. 

It has been an extraordinarily mild holiday.  Every single kid I’m seeing has been sick with the same respiratory illness.  I almost just have to copy and paste every history I’m taking. 

Business was so slow yesterday that my senior resident and I went to the playroom (yes, a crucial part of pediatric residency, like nap-time, snacks and recess) and played Scrabble and Bop It!  It is an unbelievably annoying and addicting game, like a rhythmic jazzed-up version of Simon Says that requires you to follow all the directions it spews out, such as “twist it,” “pull it,” or “bop it.”  “It” refers to the toy itself, this stick-thing with a couple of knobs and buttons that you can either twist, pull, or bop. 

People have also been bringing in large quantities of holiday food, in the form of pastry or chocolate, so I’ve been managing to get a pastry and chocolate fix every couple hours or so.  It’s been awesome.  I brought in the massive penguin-shaped container of Hershey’s chocolate treats that Joe’s aunt gave us over the holidays, knowing full well it would be devoured very quickly.  It was gone the very next day.

Time for my 10 o’clock choco-fix.

Oh, and I turned 29 today!  It’s almost embarassing to admit that, because what do I have to show for my 20’s except school, school, more school, a crushing number of loans, and lots of work years ahead?  Apparently, Mayor Menino of Boston also celebrates his birthday today, as I heard on NPR this morning, and he’s excited about serving many more terms and hoping to help the homeless and work on education.  I hope my outlook will be rosier at 65 than it is right now.

It’s only half way through intern year and I feel like I’ve already topped out on viral infections.  All you kids with runny noses, cough and fever who are making your parents miserable: stop it.  Please? The winter has barely begun. 

I’ve also topped out on how much I can wash my hands.  Before I see a patient, after I see a patient, between seeing patients just for kicks…it feels like it’s all for nothing when a kid coughs into my face from 6 inches away and a spray of fog and spittle covers my glasses.  My hands are so dry from such frequent hand washing that they’ve started to bleed and crack.  In fact, my whole body is drying away — I forgot how dry the winters can get, and I’m getting these eczematous patches all over my extensor surfaces.  I’m going to itch myself away to a fine dust if I can’t slather myself in lotion.  Or roll around in a large vat of Eucerin cream.  So itchy!!!

Scheduling for a residency program must be like doing a 100,000 piece jigsaw puzzle blindfolded, and due to some unfortunate missing pieces, I think the scheduling powers-that-be forgot to give me a day off…I haven’t had a day off since mid-October until today, November 10. Actually, I have had a few days off if you include the 24-hour intern retreat (where I proceeded to get totally slammed, followed by a very sobering talk the next morning about “your future in pediatrics,” followed by another call night where my team got slammed (a very different sort of slamming)) and a peds conference I went to where I got to skip out on a day’s work. So it doesn’t feel like I’ve had any days off. Until today. When I gloriously woke up at 5:30 am (5:30 even counts as sleeping in these days), said hello to my husband, whom I haven’t seen since the day before Halloween, did two loads of laundry (the first time in months), went for a run (the first time in weeks), listened to my iPod (the first time in weeks), read a magazine while on the can (the first time in weeks, as well…time to read on the can = sign of leisure), and swept the staircase. And it’s 8:30 am.

The wacky thing about this time of year is that I forgot that it gets cold, not just slightly nippy like in the Bay Area, but the kind of cold that merits a puffy jacket and a hat. I put on my ski hat this morning to go outside and felt appropriately yet ridiculously over-dressed — when have I ever put on a hat except to go skiing? Ridiculous. In my mind, hats and warm Gore-tex jackets are associated with a long four-hour drive into the mountains and chair lifts, not just going outside to pick up the mail. I have become such a soft, mushy California bum.

One of the great things about working in the community hospitals is that you have time to pee. Funny how I consider that one of the added bonuses of life nowadays, but it’s true — having a bladder the size of a kumquat and a caffeine requirement the size of Guatemala, I appreciate having some flexibility in my schedule after rounds to take a two minute break to take a whiz. But today, as I unbuttoned my pantalones and sat down, I heard something go “plop” in the toilet, and I was confused because I didn’t feel like I was doing a number two, and wasn’t anticipating the sound of a number two, and it didn’t actually sound very number two-ish. It was all very discombobulating, so I turned around and saw my NICU drug dosing card floating in the toilet. Then I was extraordinarily confused because how did I poop out a whole NICU card?! Then I realized I had tried something very foolish today, which was to stuff into my back pocket (1) my housestaff handbook, (2) my antibiotics handbook, (3) my PALS card, (4) my sign-out sheet, and (5) my laminated NICU drug dosing card. The outermost thing in my overstuffed pocket was the NICU card. I fished it out with one nitrile-gloved hand and got rid of it, feeling very fortunate that at least it wasn’t my pager.

The other day, I came home post-call to see this on the counter:

I feel like I’ve either missed out on a great party or Joe’s asking me to clean the house a lot.  Or both.

The best part about being post-call is the feeling that you can do anything you want during daylight hours, free from the shackles of responsibility. (Unless, of course, you have a real life, i.e. kids.  Or uber-demanding pets.)  This morning, I missed the exit off of I-95 to get back to Somerville/Cambridge, so I went straight to the mall instead.  And splurged on a ridiculous vente white chocolate mocha Starbucks creation when I got there.  And went to Pottery Barn where I proceeded to lounge about and feel up every single item of furniture.   And then promptly fall asleep on one of the display beds.  In scrubs.  And then (I swear it was only a few minutes after I shut my eyes) a saleslady came over to very politely ask me to leave.  So I left.  Probably safer for me to be lounging about and spilling mochas on my own furniture at home.

It’s been over 3 months now since I started work, and I still haven’t figured out what my “cloud” is. And what is this cloud I speak of? Well, here’s the theory: everyone in residency has a “cloud” and it can be either black or white. When you warn your colleagues on a call night, “I tend to have a black cloud,” it means that you have bad luck - you get nineteen admissions at 3 o’clock in the morning, a crazy mom on whom you have to call security, three patients that you need to transfer to the PICU, and two of your patients will code on you…at the same time. Sometimes, a resident will confess, “I totally have a white cloud,” - and they’ll end up tucking all their patients into bed at 8 pm and getting a full night’s worth of sleep.

So far, my cloud seems to be sort of gray. It’s a weakish, hypotonic cloud that is heavily dependent on the larger, more dominant cloud of my senior resident. Or, perhaps I have a moderator cloud: maybe it keeps my senior’s cloud in check. Maybe my cloud is a very impressionable juvenile, heavily influenced by hip-hop/gangster one day and all preppy and Lacoste-clad the next. What if my cloud becomes so dark and large and black that I totally lose it this winter? Or what if my cloud is so lily white I never end up learning how to run a code? As you can see, these are things that keep me up at night.

I had my “in-service exam” today, which is a test we have to take yearly to see our annual progress, how much we’re learning, and how much we’ll need to prep for the boards. It was basically a four-hour long joke, considering that I was making highly ill-informed “educated” guesses for 99% of the 200-odd questions (I’m 2 weeks into residency: basically all I know that a newborn is roughly smaller than an adolescent). At least the exam was semi-humorous. One question could be about furosemide-induced renal calcinosis in a pre-term neonate, and the next question could be about a 4 year-old who likes to make jokes about poop.

I think this is part of why I picked the right specialty for me: it can go from the mundane to the potentially really sick so quick. Plus, kids are great in ways that adults are not: they have the capacity to learn, can be distracted with games or toys, are still forming opinions and ideas about the world and therefore are malleable, and generally are not evil.

Actually, I take that last statement back. They can be incomprehensible thugs. But then you can usually relate that with behavioral and learning disorders and poor social environment. I can’t say exactly why these two kids decided to kidnap a baby, but I heard the stepfather of the two arrested pre-teens on television, and he sounded like a poor excuse for a parent, which explains a lot: “Kids will be kids…it just done happen.”

An observation about parenting: I saw a woman scolding her four-month old infant for tearing the paper sheet on the exam table and putting it in his mouth. “No, Johnny (name changed for identification purposes), don’t put that in your mouth, it ain’t food, NO, what did I just say, I said, ‘NO’…Stop that.” I was sort of incredulous. “I want him to understand words,” she told us, without realizing that her words were developmentally inappropriate in many more ways than one. Babies learn by putting stuff in their mouths; babies at that age won’t understand your words; but they will come to associate that tone of voice with disapproval, and insecure attachment could become an issue. Of course, any sort of anticipatory guidance I would be able to provide doesn’t come with the ultimate seal of gold-starred-general-pediatrician-approval: I don’t have kids myself, so how the hell am I suppose to know what the throes of parenting and development are really like? How am I supposed to know that the Ferber-method of sleep training really does or doesn’t work? How am I supposed to know that just because Johnny (Johnny is my pseudonym of the day) isn’t eating broccoli or fish or carrots or bananas this month because he’s decided he doesn’t like them that he isn’t gonna become nutritionally deficient?

“You don’t know, you’ve never been a parent,” my mom laughed at me, and I’m in agreement with her. Unless I’ve actually raised a kid, changed her poopy diaper, cried through her febrile seizure, toilet trained her, watch her spit out every single vegetable, deal with her temper tantrums, see her break a tibia, help her with her homework, send her to college…until any of this happens, I can’t have that conspiratorial smile and that knowing gleam in my eye when a parent tells me, “he just won’t go to sleep by himself,” which all the trusty, knowing pediatricians seem to have. I don’t think being a parent makes a general pediatrician any better, nor do I think being a pediatrician will make anyone a better parent, but that trusty, knowing smile, that sort of conspiratorial look parents get when talking to other parents — it’s like there’s some sort of secret society out there, and I’m an accountant for the society, but it’s unclear what exactly that club does to generate the income that I’m tracking for them. That’s what it’s like to be a pediatrician with no actual child-ownership experience.

Yeah, I know I’m late to the whole Paris-Hilton-got-out-of-jail thing, and so I caught up with her Larry King Live interview. So much awesome idiot dribble coming out of her mouth! For example:

• I just went with the motto ‘don’t serve the time, let the time serve you.’
• I consider myself normal.
• I like to talk in my normal voice.
• I know how I am, so that’s fine.
• I went and found out about myself, so I’m going to continue on that path.

It was actually a very boring interview, so I switched back and forth between her interview and reading about Lyme disease.  I’ve seen my fair share of TB and coccidiomycosis, which are slightly more common occurrences where I trained, but Lyme disease is like the Loch Ness monster of diseases on the west coast: you’ve heard about it, but never seen a confirmed case of it.  Well, la-di-da, my first patient ever as an MD was a patient with Lyme disease.  Welcome to New England!

Well, technically, I’m on back-up call.  And I went sailing today!  A friend took us out as guests at Community Boating, and the weather was warm and sunny.  If call is like this, sign up for full fledged doctorhood! Well, actually, I already know the rest of the week is going to be a little less blissful because the powers that be have called me in to fill in a couple of ED shifts.  At this point, I’m feeling terribly unprepared for what is to come, but totally unable to do anything about it because 1) we don’t have a permanent home yet, and 2) all my crap is in storage.  Alas.