The Doctor Will See You Now

How long do you normally wait to see the doctor?

I haven’t been to a doctor (outside of seeing multiple ones every day) since….well, probably since I started residency. The few times I have been (dermatologist, random ER visit to get flu swab) I haven’t waited too long, which has been great. I’m not sure if this is a perk of being a resident (and the person knowing I need to run back to wherever I need to be) or just how the “world works” these days. I remember feeling like I waited hours for the doctor as a kid.

One of the best part’s about my residency is getting to work at Bellevue. Its the nation’s oldest public hospital (I think) and the saying “if you don’t see it here, you won’t” is very true. I mean, there is a clinic specifically for Hansen’s Disease (another name for leprosy) or Hepatitis in Asian Americans.

While there are many things that amaze me about Bellevue (chief among them, how everything still comes together despite some long lines, red tape, and fax machines), one of the most impressive aspects is our clinic. Moreover, how long our patients wait to be seen in clinic.

I’ve never asked specifically, but I’m fairly certain our patients wait hours to even be called back. Our clinical volume is high and, trust me, the doctors/NPs/PAs are usually working double time to see everyone [I’ve learned to eat really fast and look up patients to be seen while shoving down lunch]. The fact that patients will keep their appointments and keep coming back (for years) is astounding to me. Some complain. Many don’t. Many are so grateful.

Last week, I was wrapping up my clinic and one of the PCTs noticed a woman wandering the halls with her baby. Somehow her chart had been misplaced (chart meaning a slip of paper) and she wasn’t in any of the boxes to be seen. She had waited three hours with her 6 week old baby just to be seen for her post partum visit (usually fairly quick and uncomplicated). I felt so awful for her.

[She was seen.]

In other news, I slept approximately 16 hours on Christmas. Thank you, Santa and baby Jesus.

Finally, I was filling out forms for physical therapy. I’ve spoken about forms before. I find these to be hard. I always write little comments on the side like “No, I’m not dying and this pain in my IT band/back/hamstring/adductor isn’t life threatening, but it hurts when I run and running is my sanity fix so, indeed, if may be life threatening” or “I can still do everything, my activities of daily living…so I guess its not that bad…do I still qualify for this?”

I’m also really averse to put me social security number on anything. Anyone else?

Alright that’s all, I gotta sleep.

Night night.

Until next time…

Shortest Day of the Year!

Everybody!

It only goes up from here! The days will only get longer!

Thank God, because I think I’m getting a serious case of S.A.D. or residency dysthymia. There was a study in JAMA recently that said up to 30% of residents have depressive symptoms. That’s quite….depressing. I actually think the true rate is higher. I think one way to ameliorate this would be to put a gym in the hospital. Do you know how much I will kill for 4 miles on a 24 hour call?

Speaking of, Bellevue decided to drop-kick my team this weekend. 36 hours of non-stop “shark mode” working/craziness. Every time we didn’t think the night/day could get worse, it did.

FYI: “Shark mode” comes from the fact that some shark die when they stop swimming. Therefore, “shark mode” means you never stop moving and keep getting work done.

That being said, I’m exhausted. I think its a combination of being on call the last two weekends (so that’s 36 hours of work in the weekend) and the darkness.

I understand now where bears hibernate in the winter. We should really take a note from bears.

Fortunately, “winter” has decided not to happen much, yet. I’m ok with this. It means I can run outside without wearing 16 layers.

Unfortunately, my right leg is really acting up 2011- style with the whole SI joint, IT band, piriformis, adductor, gracilis tightness situation. I’m perplexed as I’ve essentially taken all of December off running (except occasional few miles maybe one a week) and it still hurts. I’m been doing strength and therapy and so on and so forth and it still hurts. I’m perplexed. Is that what your 30s are like?

Tips out there appreciated, as well as voodoo magic sent my way.

The biggest reason I care is because I’m running the NYC Half in March. Its one of my favorite races and I’d hate to miss it.

But, it wouldn’t be the end of the world, either.

Alright, that’s all. I gotta go to bed.

Until next time…

Daily coffee tally: 2 (NOT ENOUGH)

 

Do As I Say…

Simon Says…

Just kidding.

People on occasion ask what I do, as a physician, to, you know, do my best to avoid an early, preventable death.

For a list of preventative health care services you should be receiving for your age (e.g.: pap smears, mammograms), please see your actual doctor or refer to a reputable source, such as the United States Task Force For Preventable Services.

Here is a list of things practical things I do and don’t do to stick around a little longer, categorized into “absolutely never,” “general MBS life rules,” “you may surprised I don’t do this,” and “things to consider.”

ABSOLUTELY NEVER:

  1. Smoking:
    • Every puff is a small dose of inflammation going into your body. It is bad for almost every organ system. If you are smoking, please stop.
  2. Tanning Beds:
    • Unless you are receiving phototherapy for a condition, such as psoriasis, under the auspices of a dermatologist, please get out of these cancer boxes. And, if you say, “I won’t get skin cancer”….no one is immune from wrinkles.

GENERAL MBS LIFE RULES: 

  1. Maintain a healthy body composition (i.e. avoid diabetes, hypertension, hyperlipidemia, coronary artery disease, etc to avoid having a stroke, heart attack, blindness/amputation [from diabetes destroying small vessels and nerves])
    • Eat a “foods from the earth” based diet
      • Try to (key word = try) limit sugar and eliminate fake sugar (aside from gum, oops)
      • Try to keep the coffee:water ratio not 1:1 (again, key = try)
      • Try to eat healthy fats (your neurons are wrapped in myelin, which is made of fat so I tell myself that avocados and walnuts are both giving me faster reaction time and making me smarter)
    • Exercise
      • It is good for both the body and mind. You may quote me on this.
      • It is also one of my favorite activities so this one isn’t a “hard one” for me.
  2. Wear sunscreen
    • Prevent skin cancer and fine lines/wrinkles – two birds, one stone!
  3. Try to never go below 6 hours of sleep a night
    • Ideally, I’d love to get 8 hours of sleep a night. Unfortunately, my job as a provider of healthcare, ironically, precludes this. However, aside from a 24 hour call, I cannot function on less than 6 hours sleep.
    • Don’t pull all-nighters, guys. Nothing is worth that. The first time I pulled an all nighted was in residency. Trust me, you aren’t missing anything staying up for 24 hours except for some serious cortisol secretion from all that stress on your body/nervous system.
  4. Infection Control
    • Yearly flu shot (both required by my job and something I would do anyways)
    • HAND WASHING!
  5.  Go to the dentist twice a year
    • I’m not up on the latest dental and periodontal literature, but, from what I’ve heard, dental/gum health is actually very important for your overall health. I think I even remember something about gum disease being linked/related/correleated (but not causation) to heart disease.

YOU MAY BE SURPRISED I DON’T DO THIS: 

  1. Take Vitamins:
    • EXCEPTIONS:
      • Pregnancy/Trying To Conceive: take a prenatal vitamin!
      • True deficiencies
    • The only exceptions to this, for me, are vitamin D, which almost everyone is deficient in and a probiotic because they come in gummy form and are delicious.
    • I prefer to get nutrients from food. If you eat a well balanced diet, all you are really doing by taking multi-vitamins is making expensive urine because, aside from fat soluble vitamins, you will just pee out the excess water soluble vitamins/minerals.

THINGS TO CONSIDER: 

  1. A zinc lozenge at the onset of a cold
    • There is some research showing that zinc taken within the first 24 hours of a cold helps shorten duration. I figure it can’t hurt to try.
  2. Complementary and alternative therapies
    • They KEY to these, like an healthcare provider, is finding someone reputable and that you trust.
    • My only exception is that I never let any chiropractors touch my neck because I’m fearful of a vertebral artery dissection.
    • A lot of these therapies involve just relaxing, which I think is something we all need more of.

Is 8 pm too early for bed?

I hope not.

That’s all for now.

Night night.

Until next time…

Daily coffee tally: 3 ( I think, but it wasn’t enough. One was from the small cups they have in the recovery room, which are essential null and void for my level of caffeine tolerance so maybe it was really just 2 coffees)

Push It

Today, as Tisch Air Traffic Controller (as I have renamed my role), I took it upon myself to become #1 2nd stage of labor coach this side of the Hudson River. That means I pushed with patient’s most of the day and then called in the intern or whomever to do the delivery.

For those of you not in the know, labor is broken into a few stages. Briefly, they are: Stage 1) Onset of labor to full dilation; 2) Full dilation to baby; 3) Delivery of the Placenta.

To be clear, labor = contractions that cause cervical change. That second part is key. You can be contracting, but if your cervix isn’t dilating, you aren’t in labor. This is the sad, terrible news I used to give to women in triage on a regular basis when I did nights.

Anyways, when you don’t have to worry about answering a pager, seeing triages, or doing C-sections, you can go help a patient push for as long as your want and no one will really ask about your whereabouts.

I particularly enjoy “pushing” with patients for a few reasons.

PS – Do not read on from this point if you are uncomfortable with the word  “vagina” or “perineum.”

First, you have to teach them how to do it correctly. This is important, I think, because you don’t want the mom to be wasting all her effort for an hour with ineffective pushing. There are a few ways I do this. If you have an epidural, I usually like to push pressure right on the ischial spines or straight down on the rectum (through the vagina that is) to help the patient feel where to push. That way, I can also feel if the patient is moving the head.

Second, the second stage is when things can sometimes go south, so I like to help keep that stage as short as possible so no one – baby or mom – craps out (a technical term for not looking so good).

There is a unique challenge to coaching a patient to push, at least in my opinion. First, you have to kind of assess what kind of person this patient is. To be an effective pushing “coach,” you have to be able to give the patient feedback. But, I find to do this, you have to know how the patient may or may not respond to your feedback so you can deliver it in a way that will  work for them.

I’ve had patients who love it when I go all drill sergeant on them and others who hate that.

The challenge becomes when you know the patient isn’t pushing effectively, you’ve told her that, you’ve tried multiple techniques to get her to do it correctly, and she’s getting frustrated. If you’ve assessed that 1) the pelvis is adequate and 2) the estimated fetal weight will “fit” through the pelvis, its frustrating for you, too, because you think “this should happen.”

Sometimes patients really want to stick with it. Other times they give up. There have been times I’ve like willed, screamed, prayed babies out – mostly at 4 am when the last thing I want to do it a C-section. :)

So, yes, in my next life, I think I will come back as a second stage doula. Its kind of like being a coach, except the outcome is better than winning a game. You get a baby! Its like being the stork and a coach at the same time.

That will be my name. “Coach Stork.”  My business cards will have a stork in athletic clothing.

On another note, I took a ballet class tonight.

I was actually kind of nervous because, I mean, I haven’t done dance since I was…9? That’s a 20 year absence if anyone is counting. I was afraid I would look like an idiot even though I’m fairly athletic.

Then, I thought to myself, “Would I laugh at someone if they were taking a tennis class for the first time and they couldn’t hit the ball very well?” No.  I mean, tennis takes time to learn.

First of all, the whole thing was like sensory integrative overload for me. There was a pianist. There were other people. There were new terms. There was trying to pick up stuff and put it together. My brain felt the equivalent of a squirrel in Central Park – acorn! runner! tree! At one point, the teacher yelled “sous sous!” really loud and I was like all ready to jump and pounce on something – like a squirrel on a new tree.

Fortunately, I remembered some stuff from gymnastics. Unfortunately, my flexibility from gymnastics has since left me and, thus, lifting my leg even close to horizontal is challenging. I think I had to hoist it up onto the bar. It was super graceful. I’m sure they’ll be calling me for Swan Lake soon.

If you ever have the time, you should go to one of these classes. Its like a great “Humans of New York” experience. It is quite the motley crew. I mean you have people like me, who looked dressed for a spin class, to dudes, to, literally, people in leotards and tights. And everyone is very nice and all like “oh that was so good, new person.” And, teacher, calls us all “dancers,” such as in “oh dancers, that was so nice…let’s move on to an adagio now.”

[I think that was what its called. Ballerinas, correct me if I’m wrong.]

So, yeah, all of that combined and afterwards I was like “I need to go into one of those float tanks and decompress all my thoughts.” Instead, I wrote about it here on this blog.

Things I noticed about myself:

1- Generally a little bit fast or ahead of the music (this is not surprising, at all)

2- I’m better at putting something all together than doing each thing individually, most likely because I think about the one thing individually too much and if you have to string a few things together, I can’t think about one thing for too long.

So, see, new hobbies can teach you a little about the world and a little about yourself.

But, tomorrow I will go back to running…

Does this blog have a point at all? I think I’ve written 1000 words and probably bored you all.

I will stop now.

I’m tired, anyways.

Too much jete, plie, sauté.

Night night…

Until next time…

Daily coffee tally: 2

 

 

 

Happy [Now Belated] Thanksgiving!

Happy Cyber Monday-eve or whatever shopping holiday America has invented!

How was your Thanksgiving? I slept, ran, ordered from Seamless, then went back to sleep.

In residency, it is pretty much guaranteed you will work at least one and sometimes two “major” holidays. My intern year I worked Christmas and New Years. Last year I worked Thanksgiving (two 24-s, Thurs and Sat). And, this year I worked Thanksgiving — Wednesday night (for a 24 hour “shift” Wed) and then Friday in clinic.

I actually don’t mind working Thanksgiving. I find it kind of fun. I feel like Thanksgiving is about being with people you love – your friends and family. Framily. I do love my residency so it sort of feels like family (and I see them more than my family!). I also love my bed and running, so I, too, spent Thanksgiving with my peeps.

I feel like Thanksgiving is also about watching that dog show. I did miss that this year.

I write this blog in an attempt to portray what residency is like (and do have it documented on the internet for myself and for posterity). So, with the holidays upon us, I felt like writing about what you “miss” in residency – life events and such.

Of course, there are many jobs out there where you work holidays (all of healthcare!) or miss big events (being a working person, in general). Being a physician, I won’t be immune to this, given that illness and providing healthcare doesn’t stop on holidays. Its sort of par for the course, something you know when you go into medicine, like getting acquainted with pagers and sleepless nights.

So, yes, I spent 1-2 out of 3 “major” holidays (Thanksgiving, Christmas, and New Years) with my residency family as well as several of the minor holidays (Memorial Day, Labor Day, etc).

We pick our schedules several months before the upcoming “year” (each year starts in July) and you do get to request certain weekends off at that time, which are usually honored. My residency program tries really hard to get people to life events, within reason.

That being said, if you’re going into medicine, you will miss weddings, graduations, and other “life events.” That’s just part of the deal. I missed two good friends weddings and my sister’s pharmacy school graduation. So far, no one seems to hate me for these things.

The nice part about residency, unlike other jobs, is that all this 24 hour work day, missing out of life events stuff as a finite time line – 4 years in my case.

[Attention – any attendings out there reading this. Do not tell me it gets worse. Let me believe my story to myself.]

You might think holidays are less busy around hospitals. Not so!

I did my first stat C-section for pre-term twins under general anesthesia as an intern on Christmas eve. And I think I delivered 5 babies total that night!

Talk about a stocking stuffer.

In other news, I cut my hair much shorter. While I am extremely particular with most things, my hair isn’t one of them. I mean, unless you’re trying to dye my hair purple and give me the Kate Gosselin pre makeover hair cut, I give you artistic license if I trust you. And, I trust my girls (Amber and McKenna at Arrojo!) so much that when I told Mckenna “I like the length right now” and she said “I wanna chop it all off,” I let her do her thing. I mean, its hair, it grows back, and I didn’t go to cosmetology school so what do I know?!

Finally, I discovered that I have too many Christmas decorations to keep in a small NYC apartment. But, Target just makes such cute stuff! I couldn’t turn down this reindeer.

Screen Shot 2015-11-29 at 8.42.20 PM

TARGET STRIKES AGAIN!

Anyways, that’s all I have for now. Jess killed me today at Flex. Literally died. In the best way possible. {Take her class!}

Night night…

Until next time…

 

 

 

 

 

On Filling Out Medical Intake Forms

So, I went to acupuncture today. Acupuncture is magical. Even more magical is the nap you take during acupuncture.

Literally, I would pay good money to just sleep in a quiet room that smells nice and has soothing music.

As my friend, Jocelyn, says, if a yoga class only offered child’s pose and savasana, I’d think I’d gotten my money’s worth.

Anyways, I’ll save the whole “Adventures of a Western Doctor In the Eastern Medicine World” post for a later day because I’m too tired to write it now. However, suffice it to say I’ve tried acupuncture, cupping, Reiki (thanks, Lynn!), and like every form of massage/myofascial release.

Given that the practitioner, is a Traditional Chinese Medicine doctor, there is a medical intake form.

When you ask patient histories essentially a billion times a day, its kind of weird filling out your own.

What is your height and weight? 5’3″ last time I checked. 126 I think? Let me go find a scale in this hospital…

Do you have problems sleeping? No, my problem is not enough.

Do you have any medical conditions? Do you count being generally uptight and sleep deprived?

Is your job high or low stress? I just put the words “Labor and Delivery with a pager – very high.”

Do you have any allergies? Yes, apparently blue dye. Can you fix this? Because my work attire is essentially unchangeable.

My favorite thing to do before I snooze is to ask all about Chinese medicine. When you’re used to talking about blood pressure and lab values and stuff like that all day, its a little hard to wrap your head around yin and yang. But, its kind of fun.

From what I gleaned, Chinese medicine is a lot about opposites. You have yin and yang. One is flow and one is the energy that drives the flow. If you run around like a crazy New Yorker, such as myself, you deplete your yin. Or maybe its your yang. I don’t know. One of them. I think they talk a lot about blood flow and “stasis.” After a post partum hemorrhage, I’d say you really got rid of that stasis and depleted your yin…

I have no idea how this relates to chi (is that how you spell it?) or the meridians or what not.

As an FYI, the kind of acupuncture I get is more musculoskeletal oriented and not so much TCM acupuncture. Its like trigger point acupuncture. Or something. Like the don’t look at my tongue or talk about meridians because I’m really there to get my IT band back in business so I can run again. This is probably diametrically opposed to eastern principles because I’m essentially trying to get my IT band less tight so I can exercise….more.

Look, I said I dabbled in the complementary and alternative medicine worlds. I never said I was a good patient.

That’s all I have for today.

Night night.

Until next time…

Daily coffee tally: 3

 

Moving On Up

Today, I started back at our private hospital after being at the public hospital since mid-July.

Our private hospital (NYU Langone Medical Center) is undergoing a huge “renovation.” New hospital pavilion, new neuroscience building, and the old hospital building is getting some revamping.

I’m on this wonderful rotation right now called “Tisch Teaching Senior/Tisch OB Chief” I feel I should be renamed “Tisch Air Traffic Controller” because my job, bedsides teaching interns and med students about labor management, pre-eclampsia, hemorrhage, and the like, is keeping the floor moving. [And high risk stuff, too.]

I’m going to ask if I can get a bullhorn and those sticks.

“Intern to delivery in room 4 – I put your boots and gown in there!”

“We got another pre-eclamptic in triage, let’s open a room people!”

“GBS positive, I ordered the penicillin!”

“Pitocin on aisle 1 is available for every one!”

Just kidding, there are no aisle. Labor and delivery isn’t a grocery store.

Given that the floor will survive in my brief absence, I can actually run downstairs to the cafeteria. Its a novel pleasure I’m enjoying as a senior.

I went down and explored the new and improved Tisch.

Let’s start with the gift store. It was magical . There are letterpress cards, candles from Lafco, and a florist person arranging flowers with like…twine. He asked it if I needed help and I wanted to say, “Yeah, only a beta blocker to control my heart rate after seeing these letterpress cards so beautifully placed next to this stuffed bear that I want.” I entered a raffle for $50 at the gift shop. I hope I win.

The cafeteria is like Disney World. Its like Spaceship Earth except there is food. There are multiple kinds of coffee – drip, Illy – you can go nuts with caffeine.

The only thing somewhat lacking is the seltzer selection. If anyone from Tisch is listening, I’m envisioning a section dedicated to everyone’s favorite drink, seltzer. We could offer a full selection of La Croix, Polar, and Poland Spring. I think this would increase patient satisfaction in addition to my own satisfaction. Ok, maybe just my own. You are free to name that corner of the cafeteria, “Smith’s Seltzer Selections.” I’m happy to curate the offerings, should my services be needed. Mr. Langone, call me!

On another note, I bought ballet flats (like for actually ballet, not the Tory Burch kind) today. I bought leather rather than canvas. I thought they are prettier and those canvas ones are like the Nike Frees of the dance world – they feel like nothing. Apparently, leather was a faux pas. I’m sorry but pink is prettier. Fortunately, I don’t think this will make a difference. I mean, when I audition for the Nutcracker, I may not get the Sugar Plum Fairy and only a mouse, but there are no small parts, right people? (JOKES)

That is all I have to say for today.

Until next time…

Night night…

Daily coffee tally: 2