First day of adult nephrology today, and WOW those guys are smart. And they are nice too!
Anyway tomorrow I have my moderated poster presentation session at [local conference]. Wish me luck!
Tuesday, May 21, 2013
Conference
Went to the conference again yesterday, and the science was more interesting at least. Also I met with an anesthesiology person who does what I do, which was really useful.
The meeting overall was kind of a giant downer though, and a reminder of how miserable I was last year. Was I miserable last year because I was finishing my dissertation? Because of (some of) the people I had to see on a regular basis? Because I had an infant? Because my husband totally dropped the ball in every possible way?
It did occur to me that it's quite possible that life is actually never going to be better than this, and may actually become much worse. This was mildly horrifying.
Anyway, today I start my first day of adult nephrology. I'm a little worried as I am at the start of most of my rotations that I will look really dumb, but since there's not much that I can do about it short of what I'm already doing, I'm trying not to obsess.
The meeting overall was kind of a giant downer though, and a reminder of how miserable I was last year. Was I miserable last year because I was finishing my dissertation? Because of (some of) the people I had to see on a regular basis? Because I had an infant? Because my husband totally dropped the ball in every possible way?
It did occur to me that it's quite possible that life is actually never going to be better than this, and may actually become much worse. This was mildly horrifying.
Anyway, today I start my first day of adult nephrology. I'm a little worried as I am at the start of most of my rotations that I will look really dumb, but since there's not much that I can do about it short of what I'm already doing, I'm trying not to obsess.
Monday, May 20, 2013
Sunday, May 19, 2013
Grouchy
OMG I was in a grouchy mood when I woke up this morning. I think it mostly had to do with the fact that I had to go to a conference, and was supposed to be there at 8-freaking-15 this morning. A Sunday.
Oh also? I couldn't find anything to wear. I think the last time I went shopping for professional-wear was about 5 or 6 years ago. Did I mention? I haaaaaate shopping.
So, after digging through piles of clothes and discarding several shirts that used to be cute but that now had brown oxidized pit stains, I finally found an outfit to wear. I think maybe I should make an attempt at shopping again. On the other hand, if I'm going to be an anesthesiologist and wear scrubs to work for the rest of my life, part of me is like, why bother?
I need not have worried. The women at the conference were almost uniformly more frumpily dressed than I was. And honestly, if you look too cute as a med student, some people (other women) will hate you, and other people (men) will not take you seriously. But still, I probably do need some new clothes.
Anyway, the conference was fine. I attended a session on communicating and end of life decisions, which could have been good, but eventually devolved into a soliloquy during which a bunch of old white men and one white woman pontificated at length about a) how bad doctors are at talking to their patients, and b) how doctors should talk to their patients -- in their opinion, mind you. Not based on actual evidence.
And I have to say, these types of things irritate the shit out of me. Internists ALWAYS talk about this, with the implication that they -- of course -- are the lone exception, the only doctors in the hospital who are good at talking with their patients. But the problem is, the people who talk about this the most are often the doctors with the worst interpersonal skills. Like cringe-inducingly-bad interpersonal skills.
Throughout this whole talk I found it really ironic that not once was the concept of listening even mentioned. Not freaking once. It was all about how to "educate" patients, and basically how to make them agree to the treatment plan you - the doctor - want them to do.
Anyway. So it was annoying. And then I went to a poster session where I saw a bunch of people I work / worked with, but mostly just felt like a giant outsider. The nicest / most interesting people I talked to was an NP who was doing outcomes research on NPs, and an EM / crit care person doing research on regionalization and resource utilization, both of which are really cool topics.
Then I came home. However on the way home I passed a Banana Republic, and it occurred to me that perhaps I could go shopping after the conference either tomorrow or Weds. So, at least there was that.
Dyls has been super cute. She has been teething like crazy though. This morning we noticed there was blood on her sheets, and that it was coming from her mouth. Poor Pickle! No wonder she has been a bit crankier than usual! She has been bringing me books to read and will come over and sit on my lap as we page through them together. Her vocabulary has been expanding too. This weekend she said cat, duck, squawk, book, stars, baby, night night, and nine. And she has taken more interest in drawing with her crayons, not just in eating them. She can go down the slide by herself too.
She did have a full blown temper tantrum last night, complete with throwing herself on the floor and kicking and screaming. The cause? I put the pink satin cape onto the baby in her play stroller as a blanket. Apparently this was not what she wanted me to do. :-P
I hate to admit it, but it was kind of hard not to laugh.
Maybe my mood today was due to the rain? Hopefully tomorrow at the conference will be better. Tonight we will eat Thai food and I will read about kidneys and then I will go to bed and it will be ok.
Oh also? I couldn't find anything to wear. I think the last time I went shopping for professional-wear was about 5 or 6 years ago. Did I mention? I haaaaaate shopping.
So, after digging through piles of clothes and discarding several shirts that used to be cute but that now had brown oxidized pit stains, I finally found an outfit to wear. I think maybe I should make an attempt at shopping again. On the other hand, if I'm going to be an anesthesiologist and wear scrubs to work for the rest of my life, part of me is like, why bother?
I need not have worried. The women at the conference were almost uniformly more frumpily dressed than I was. And honestly, if you look too cute as a med student, some people (other women) will hate you, and other people (men) will not take you seriously. But still, I probably do need some new clothes.
Anyway, the conference was fine. I attended a session on communicating and end of life decisions, which could have been good, but eventually devolved into a soliloquy during which a bunch of old white men and one white woman pontificated at length about a) how bad doctors are at talking to their patients, and b) how doctors should talk to their patients -- in their opinion, mind you. Not based on actual evidence.
And I have to say, these types of things irritate the shit out of me. Internists ALWAYS talk about this, with the implication that they -- of course -- are the lone exception, the only doctors in the hospital who are good at talking with their patients. But the problem is, the people who talk about this the most are often the doctors with the worst interpersonal skills. Like cringe-inducingly-bad interpersonal skills.
Throughout this whole talk I found it really ironic that not once was the concept of listening even mentioned. Not freaking once. It was all about how to "educate" patients, and basically how to make them agree to the treatment plan you - the doctor - want them to do.
Anyway. So it was annoying. And then I went to a poster session where I saw a bunch of people I work / worked with, but mostly just felt like a giant outsider. The nicest / most interesting people I talked to was an NP who was doing outcomes research on NPs, and an EM / crit care person doing research on regionalization and resource utilization, both of which are really cool topics.
Then I came home. However on the way home I passed a Banana Republic, and it occurred to me that perhaps I could go shopping after the conference either tomorrow or Weds. So, at least there was that.
Dyls has been super cute. She has been teething like crazy though. This morning we noticed there was blood on her sheets, and that it was coming from her mouth. Poor Pickle! No wonder she has been a bit crankier than usual! She has been bringing me books to read and will come over and sit on my lap as we page through them together. Her vocabulary has been expanding too. This weekend she said cat, duck, squawk, book, stars, baby, night night, and nine. And she has taken more interest in drawing with her crayons, not just in eating them. She can go down the slide by herself too.
She did have a full blown temper tantrum last night, complete with throwing herself on the floor and kicking and screaming. The cause? I put the pink satin cape onto the baby in her play stroller as a blanket. Apparently this was not what she wanted me to do. :-P
I hate to admit it, but it was kind of hard not to laugh.
Maybe my mood today was due to the rain? Hopefully tomorrow at the conference will be better. Tonight we will eat Thai food and I will read about kidneys and then I will go to bed and it will be ok.
Saturday, May 18, 2013
Helicopter
I was accused recently of being a helicopter parent because we use a fancy baby monitor that allows us to see what Dyls is doing. This is not the first time this has happened. I think my father has said this several times.
Of course, we could get by without one. However we really like it because it enables us to tell when NOT to go in to get her. I.e. she often complains, sometimes very loudly, when we put her in her crib, or in the middle of the night. If we couldn't see that she was just mad because she couldn't find her lovey, then we might be more inclined to go in and check. The baby monitor allows us to stay snug in our beds while she sorts things out for herself and goes back to sleep. The monitor allows us to helicopter LESS.
I don't know why people care so much about these things. If only it were socially acceptable to reply, "You know, you're being a total asshole. Why don't you continue doing what works for you, and mind your own business," when people made comments like this. Sigh.
I think next time someone makes a comment like this, maybe I should say, "I hear what you're saying, and I think if we had a smaller place we might not need it. However since Dyls's room is kind of far away from our room, it really would be impossible for us to hear her without it."
Just kidding.
:-)
Of course, we could get by without one. However we really like it because it enables us to tell when NOT to go in to get her. I.e. she often complains, sometimes very loudly, when we put her in her crib, or in the middle of the night. If we couldn't see that she was just mad because she couldn't find her lovey, then we might be more inclined to go in and check. The baby monitor allows us to stay snug in our beds while she sorts things out for herself and goes back to sleep. The monitor allows us to helicopter LESS.
I don't know why people care so much about these things. If only it were socially acceptable to reply, "You know, you're being a total asshole. Why don't you continue doing what works for you, and mind your own business," when people made comments like this. Sigh.
I think next time someone makes a comment like this, maybe I should say, "I hear what you're saying, and I think if we had a smaller place we might not need it. However since Dyls's room is kind of far away from our room, it really would be impossible for us to hear her without it."
Just kidding.
:-)
Things
Things are good. Just finished Anesthesia, next week I start adult renal. I have a conference this weekend, and I present a poster on Weds. I'm actually going to go Monday also since my PI is speaking and I am really interested in the subject. I got permission from the renal course directors to do this.
I submitted a manuscript on Thursday. It was submitted to a bit of a reach journal, so I'm expecting it to get rejected, but I'm hoping I'll at least get some useful feedback.
Yesterday I was ob anesthesia, and it was fun. The labor floor was pretty quiet, so we spent a bunch of time waiting for women to request epidurals in the work room.
I thought I was all on top of my residency application stuff, but then we got an email telling us that we had to do like, 15 extra things, as MD-PhD students. I got some of them done, but of course that is hanging over my head. I also want to attempt to remember something about kidneys before I start Monday's rotation.
Dylan's new thing this week is that she all of a sudden has gotten more interested in books. Like, A LOT more. She'll go and pick out a book, and then come and sit on my lap and ask me to read it to her. She is even starting to replace nursing before bed with a book.
This weekend, not sure what we're doing besides the usual. I will probably go to the conference tomorrow and try to get a little work done though.
I submitted a manuscript on Thursday. It was submitted to a bit of a reach journal, so I'm expecting it to get rejected, but I'm hoping I'll at least get some useful feedback.
Yesterday I was ob anesthesia, and it was fun. The labor floor was pretty quiet, so we spent a bunch of time waiting for women to request epidurals in the work room.
I thought I was all on top of my residency application stuff, but then we got an email telling us that we had to do like, 15 extra things, as MD-PhD students. I got some of them done, but of course that is hanging over my head. I also want to attempt to remember something about kidneys before I start Monday's rotation.
Dylan's new thing this week is that she all of a sudden has gotten more interested in books. Like, A LOT more. She'll go and pick out a book, and then come and sit on my lap and ask me to read it to her. She is even starting to replace nursing before bed with a book.
This weekend, not sure what we're doing besides the usual. I will probably go to the conference tomorrow and try to get a little work done though.
Tuesday, May 14, 2013
Reservations
My main reservation about doing anesthesia had been this: One of my favorite parts of medicine is talking to patients and families. Making them feel more at ease, helping with their frustrations, fixing things for them. I was worried that most of my anesthesia patients would be a) asleep, or b) unconscious in the ICU and that I wouldn't get to do that.
However today we had student presentations, and I did a presentation on the use of regional anesthesia in chronic pain. It was a Cochrane Review, but nonetheless a summary of a bunch of crappy studies, and I felt like I did a so-so job on it.
But, we got to talking about the physiologic mechanisms of chronic pain after surgery. And it turns out that the popular hypothesis of disrupting neural pathways doesn't make a lot of sense when you consider a) the magnitude of the odds ratios presented in the studies (regional anesthesia was HUGELY protective, which.... is pretty implausible), and b) the fact that after the regional anesthesia has worn off, the patient is still injured and has tissue trauma, so nerve impulses continue to exist, and c) the protective effect occurred regardless of when during the peri-operative period the regional anesthesia was applied.
So what's going on?
We talked about the mechanisms behind chronic pain. The physiologic ones, but then also the psychological. How drawing someone's attention to pain with the words you choose during a particular procedure can make them remember the experience as more painful than if you use better words. How making someone feel less anxious can reduce the incidence of chronic pain.
And I started to feel like: YES. This is the field for me.
Not only can you do physiology in real time. Not only are the research questions a perfect fit for my interests. Not only are you THE advocate for the patient in the OR. You are the person who can most influence how they feel during and after a procedure. During and after what can be one of the most frightening things that can happen to a person.
It turns out that how you talk to the patient is incredibly important in anesthesia too.
I am almost 100% sure that this is what I am doing. I am so excited.
However today we had student presentations, and I did a presentation on the use of regional anesthesia in chronic pain. It was a Cochrane Review, but nonetheless a summary of a bunch of crappy studies, and I felt like I did a so-so job on it.
But, we got to talking about the physiologic mechanisms of chronic pain after surgery. And it turns out that the popular hypothesis of disrupting neural pathways doesn't make a lot of sense when you consider a) the magnitude of the odds ratios presented in the studies (regional anesthesia was HUGELY protective, which.... is pretty implausible), and b) the fact that after the regional anesthesia has worn off, the patient is still injured and has tissue trauma, so nerve impulses continue to exist, and c) the protective effect occurred regardless of when during the peri-operative period the regional anesthesia was applied.
So what's going on?
We talked about the mechanisms behind chronic pain. The physiologic ones, but then also the psychological. How drawing someone's attention to pain with the words you choose during a particular procedure can make them remember the experience as more painful than if you use better words. How making someone feel less anxious can reduce the incidence of chronic pain.
And I started to feel like: YES. This is the field for me.
Not only can you do physiology in real time. Not only are the research questions a perfect fit for my interests. Not only are you THE advocate for the patient in the OR. You are the person who can most influence how they feel during and after a procedure. During and after what can be one of the most frightening things that can happen to a person.
It turns out that how you talk to the patient is incredibly important in anesthesia too.
I am almost 100% sure that this is what I am doing. I am so excited.
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