Deep Breath!

I'm on the down stroke of energy as I've just finished a one month elective at Children's Hospital in the ED. It was a fantastic elective. I saw a great many things, and everyone I worked with was lovely (very willing to teach and offer constructive criticism and they were great). I can't say there was anyone I didn't get on with.

I am now about 98% sure I'm heading into pediatrics. Now... that's not exactly a complete decision since there are just about a million specialties within peds. And I'm not saying that surgery is off the table... but... well... I dunno. I really really love ED. It seems to fit so well. Almost as well as peds fits. So lord only knows what I'm going to do now.

I'm wrapping up my life here in the States and gearing up to head back to Ireland. Final Med... bring it! I'm going to have to hit the ground running on this one since I'm a week late. But, I think I can handle it. Play like a champion... play to win.

Fark this!

While I have many MANY opinions on this "health care reform" debate, I'm not going to lay out my own personal plan as of yet. However, I did see this on Fark dot com and thought I'd share it... because it makes me laugh in a good way (not the way that Fox news makes me laugh... which is a bad way).

"This morning I was awoken by my alarm clock powered by electricity generated by the public power monopoly regulated by the U.S. Department of Energy.

I then took a shower in the clean water provided by a municipal water utility.

After that, I turned on the TV to one of the FCC-regulated channels to see what the National Weather Service of the National Oceanographic and Atmospheric Administration determined the weather was going to be like, using satellites designed, built, and launched by the National Aeronautics and Space Administration.

I watched this while eating my breakfast of U.S. Department of Agriculture-inspected food and taking the drugs which have been determined as safe by the U.S. Food and Drug Administration.

At the appropriate time, as regulated by the U.S. Congress and kept accurate by the National Institute of Standards and Technology and the U.S. Naval Observatory, I get into my National Highway Traffic Safety Administration-approved automobile and set out to work on the roads build by the local, state, and federal Departments of Transportation, possibly stopping to purchase additional fuel of a quality level determined by the Environmental Protection Agency, using legal tender issued by the Federal Reserve Bank.

On the way out the door I deposit any mail I have to be sent out via the U.S. Postal Service and drop the kids off at the public school.

After spending another day not being maimed or killed at work thanks to the workplace regulations imposed by the Department of Labor and the Occupational Safety and Health administration, enjoying another two meals which again do not kill me because of the USDA, I drive my NHTSA car back home on the DOT roads, to my house which has not burned down in my absence because of the state and local building codes and Fire Marshal's inspection, and which has not been plundered of all its valuables thanks to the local police department.

And then I log on to the internet -- which was developed by the Defense Advanced Research Projects Administration -- and post on Freerepublic.com and Fox News forums about how SOCIALISM in medicine is BAD because the government can't do anything right."

One Month Countdown

I can't believe that it's now less than a month until I'm back in Ireland, back at school, back for FINAL MED! AH! It's kinda scary. But somehow, I feel like I'm ready for it. Big decisions though, this year. Lots and lots of decisions. Some I'm not sure I'm ready for.

I started at Children's on Monday. After a bit of culture shock (a bit = head spinning), I feel like I've got my feet under me again and can be productive. Because I'm not actually attached to any one Attending, I've trying to get a feel for what each one wants in a presentation. It's hard since a few just want the problem and my differential (like, forget HxPC/PMHx/Meds blah blah blah). So to them I say, "Room 4, 12 year old girl with a bad migraine." Others want the whole shebang, which I'm much more used to. The strangest thing, in my mind, is the way that we discuss the differential, the diagnosis, the plan... then I magically type the plan in the computer and it happens. I don't actually have to DO anything (no bloods, no lines, no samples, nothing). Granted, probably more efficient... I feel a bit removed though. Oddly enough, there's a Surgeons Doc that works in the ER with me. She's cool. And she's going to sit down for a chat at some point so I can get a different perspective... maybe figure out my life.

So far, I've seen a few interesting cases, a few zebras. Yesterday was intense. Slow to start in the morning, learned rapid sequence induction, then spent the ENTIRE afternoon on one total heartsink case. It was a "Good learning experience" for me (I thought my attending was going to kill someone, probably herself), and it put one mark in the '-' and one in the '+' for peds. The '-' was the 3 hours on what should have been a simple case, complicated by a PCP threatening to call CPS, parents being unreasonable, culture mismatch, and practical issues. We had our social work involved to mediate and it all worked out in the end, but it was insanely frustrating. The '+' is something that I've know about peds for a while. And that is that through this entire annoying situation, I was never once frustrated or angry with the child. It wasn't her fault that she was sick, it wasn't her fault that she was in the ER, it wasn't her fault that her parents and the docs were having these issues. Not being upset with the patient helps me stay level. Because no matter how annoying parents are, you still want what's best for the child. In adult medicine, I sometimes lose that perspective, because it sometimes IS the patient's fault that they're sick, it IS their fault they're in the ER (say, instead of the GP office), and it IS their fault that they're a difficult bastard that won't listen to you. (and yes, clearly, sometimes, it's is the doctor's fault too).

I will tell you this though: "My child doesn't want to..." is NOT a valid excuse. Parents, please, for the love of all that is holy, if your child is 4 years old it is NOT their decision. You are the PARENT. This means that sometimes, you have to force your child to do things they don't want to do. That's your JOB. It includes things like making them go to school, making them brush their teeth, making them bathe occasionally, making them eat vegetables (Oh the HORROR!). They might not like it. They might not like you. Too bad. A little ire at 4 will be easily overlooked when they don't have scurvy at 12.

Ok, I'm done with my soap box... if anyone else needs it, have at. I'm on an evening shift tonight, so I have the morning to collect myself. Good thing too. I've a touch of gastro. It seems that just about all the Residents have had it in the past 2 weeks, and now I have it too. Welcome home, Liz.