Back to Booking

I started re-writing this blog more regularly back in July/August when I started being “the booking resident.” And, here I am, again, being the booking resident. The days are shorter and its much colder.

The 2nd half of the year in residency starts out somewhat dysthmic (it is winter, people), but then slowly becomes more and more pleasant. Everyone knows and had honed their job. The ship basically steers itself.

Things that have happened since I was last the booking resident:

  • I did my first robotic hyst. I was a big robot naysayer for a while, mostly because it intimidates me and I thought docking the Si and then figuring out how to manipulate was going to kill me. Now, that I actually got to sit, I’m like “THIS IS THE BEST!” And, docking the Xi is way easier. [For those not in the know, google “Da Vinci Robot.”]
  • I did 5 weeks of nights.
  • I feel like I became much more confident at making decisions [at work]. Life, that’s another story. Chronic over thinker.
  • I ran a half marathon in 1:45.
  • I have survived a billion bad Bellevue calls.
  • I signed up for the NYC Half, and am going to run it for Every Mother Counts!
  • Tisch got a new cafeteria and it rocks.
  •  I took December mostly off of running and started going to PT for my right glute/IT band/back.
  • I went home three times!

That’s enough. I’m tired of this list. A lot happens in 6 months!

I ran in the park tonight. The cold wasn’t as bad as I thought it would be (20 degrees).

There is something really magical about running in the park at night. It always makes me so happy to live in New York.

There were a surprising number of people out – tons of groups and solo runners. I don’t know why I thought it would be empty. If its true that “there is not bad weather, only soft people,” then New Yorkers definitely aren’t soft people!

I’m putting more effort into truly “training” for this half, as best I can as a resident. I know there are plenty of people out there that can get it track workouts, tempos, and long runs in on a 60-80 hr per week work schedule. I am not one of them! If I get 2/3 (i.e. one workout of any kind and one long run) a week, I’m going to buy myself a Levain cookie at the end of the training and eat it.

Final thoughts. I’m turning 30 at the end of this month. I feel like I’m supposed to feel something monumental about turning 30. Or sad. Or like I don’t want to. I mean, its not like you have a choice not to get older, right?! Plus, your teens and 20s are filled with a lot of uncertainty, instability, and acne- who wants that? I think if you had asked me at 18 years old where I’d be when I was 30, I’d have a very different answer. I guess I’d thought I’d be a lot further along and “settled” in life at this age, which I’m not, but I guess you really don’t know much about life when you’re 18 (even though you think you do! or I did).

The biggest part about turning 30 that I fear is the aging of my ovaries. These are things only gynecologists will obsess about. I see a rising FSH and decreasing AMH in my nightmares. I’ve been wanting to get my day 2 labs checked, but am too afraid of the results. I just want these guys to hang around shooting out hormones and good eggs as long as they can. I think its really unfair that women’s ovaries age. I’m really mad at Eve for eating that apple and committing us to aging ovaries and whatever other suffering came from her succumbing to temptation.

I think that’s all I have to say tonight.

Until next time…

Night night…

Daily coffee tally: 3

Earning Your Stripes

Pro tip: Have friends who are outside of your profession. That way, you can tell them about all of your “firsts” and accomplishments and it seems cool to them.

One sort of “fun” (it you want to think of that way) about medical training is that you get a lot of “firsts” in adulthood. Its like being a kid again and meeting your “milestones.” Sitting up unassisted, grabbing a block, first word is now first C-section, first stat C-section, first hysterectomy, and so on and so forth.

My friend, Jocelyn (whom is my non-resident residency confidante), suggested maybe we should get those sashes like the Girl Scouts and you can get a badge each time. I like this idea. Badge sashes are the white coats of 2016.

Or maybe we could do belts. Like karate. Doctor ninjas with black belts.

[I’m post call and a bit delirious, don’t judge.]

Anyways, last night (or early this morning?) I had one of my “firsts.”

Long story short, terminal bradycardia at the same time as another room was having decels and needed to be delivered urgently. So, there were two obstetric urgencies/emergencies happening at the same time.

Fortunately, as a resident, you are really never alone, but most of the situations in which we’ve “called a stat” have been when I’m with other residents. This time it was just me, the midwife, and the nurse and it felt just a bit more like I totally made this decision, rolled the patient back, and got the baby out. Although I was probably only “alone” for 2 minutes, it felt like an eternity until anesthesia and such got there.

So, I need my “called a stat alone” badge now. Or moved up to the red belt.

I find a lot of those moments to be both terrifying and empowering. If all goes well, I usually envision myself as Katy Perry on that fake Tiger at the Super Bowl all “I am doctor. Hear me roar.”

That’s all I have to say for now.

Night night.

Until next time…

Daily coffee tally: I can’t remember

 

2015

About a year ago, I wrote a “To Do List” for 2015. I didn’t actually make a true, written down “check-y box” list for this, but, going back, here’s how it all panned out 365 days later…

  1. Contacts: Half a check. I got them in and out for a brief time in September and then got lazy. There’s always 2016. And glasses. And lasik.
  2. Run the NYC Half Under 1:50: I think I ran 1:50-something, which I was fine with. I then ran Brooklyn in…1:53? And then RNR Brooklyn in 1:45. So, I’ll give this a check.
  3. Try a Korean Body Scrub: No, no check. And I regret this. Although I did discover the feet rubbing people down in Chinatown, which was a life-changing discovery. [Thanks to Jocelyn for my many Chinatown discoveries.]
  4. Use Self Tanner More Frequently: Check. Discovered St. Tropez. The brand of self tanner not the place.
  5. Go To Yoga More Than Once: Yes! Lyon’s Den. Not regularly enough but now I actually look forward to yoga. (I know, that’s still weird for me, too).
  6. Try A Dance Class: Yes. Thumbs up.
  7. Eat Less Sugar, Eat More Fat: Surprisingly, yes. Thanks to a push from Jaws, I gave up my nightly dessert habit. And  I cut out a lot of sugar in other places, too.
  8. Read A Book That Is Not Work Related At All: Yes! Several. Favorites included “Running With The Mind of Meditation,” “Big Little Lies,” “Primates of Park Avenue,” “The Birth of the Pill,” and “The Girl on the Train.”
  9. Run A Race With A Friend/Pace Someone To Their First Half Marathon: Yes! NYC with my friend/life mentor/life inspiration, Jaime.

Other things I learned in 2015, in list format:

  1. It is beneficial to slow down and breathe. My friend, Jess, introduced me to a lot of [what I call] “zen” concepts, like breathing and meditating and focusing. And, its helped me. A lot. Changed the way I think of my life/day, in a way. Every day I’m just inching closer and closer to be like a Tibetan monk.
  2. Rest is important. My first and second years of residency, I pushed to do more [exercise] in an effort, I think, to maintain some control over my life amidst the chaos/control of residency. Spin class after a 24 hour call? Yeah, I’ve done it. And, at some point this year, I realized that rest is probably just as important, too. And that its probably even more beneficial for your fitness/health.
  3. You should think of yourself as powerful. Yep, that’s right. I’m getting a portrait commissioned of  me next to Jesus, like Ben Carson. JUST KIDDING (that is crazy). Another concept introduced to me by Jess as well as becoming a bit more senior in my residency. I realized I have some influence, an educated opinion, a mind…and that people will listen to me if I project myself confidently. I’m not really sure how to explain this one, but I guess this year I started to do somethings with a bit more conviction. I’m still pretty guilty of saying “I’m sorry” for now reason and apologizing for everything (“I’m sorry to bother you, but do you mind? or “Can I ask you a question” rather than just asking it). Rome wasn’t built in a day, I guess.
  4. Residency does end. At some point this year, I realized that I one day will actually not be a resident and may regain a normal semblance of a life. Maybe.
  5. Learning from other people is fun and one of my favorite things. I think one of the best things in life is finding people who are good at something and learning from them. I love learning how people got to where they are, how they trained, what they did/thought, and how they got to be an “expert.” If you have an cool hobbies that you’re particularly adept at, hit me up. I’m always looking for new things to learn. In all that spare time I have. [This is also one of the best parts about living in NYC – everyone is good at/skilled at/an expert at something.]
  6. Off-loading the work load from yourself isn’t laziness. I often think that not doing something yourself and, rather, directing/organizing the “show” is lazy. Now, I’m learning its not. Exhibits A and B: getting  a cleaning lady and becoming a senior resident, especially the latter. Just because you’re not checking all of the boxes [intern!!] doesn’t mean you’re not working. Also, teamwork makes the dream work.

 

That’s all for now.

Night Night.

Until next time…

Daily Coffee Tally: 3

PS – If you feel so inclined, you can tell me something you learned or did in 2015. Or your favorite coffee place. Or both. 

 

 

 

 

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