Circ du Soleil

What do you think this is for?

Yesterday, I performed my third circumcision, this time under the direction of my senior resident (my first was supervised by the Attending and a senior who served as my assistant but who had to help after the adhesions I broke turned out to be between the prepuce and the mucosal layer; the second was supervised by the Attending who had to glove up to make my cut a bit longer). This time, I required no extra hands to help; the senior just stood at the ready and offered feedback. My adhesion-breaking technique is getting better and I’m a little more dexterous with the tools but ever since I saw an Attending perform a practically bloodless procedure in less than 15 mins during which the patient peacefully sucked away on sucrose and made nary a complaint, I’ve been on a quest to perform the perfect circ.

Harder, Better, Faster, Stronger – Inpatient Teams, その1

Note – this post was originally created on October 1st but you know, residency.

Residency is no joke! Just when you think you’ve reached some understanding or gained some competency, you’re thrust into a new situation that makes you realize just how little you know. The challenge is handling those situations as if you do know what you’re doing because even though you aren’t realistically expected to know it all (at least, not by one’s senior residents or attendings), you are expected to be on top of things. On inpatient teams blocks (‘teams’ or ‘days’), you are assigned to a max of 8 patients for the duration of their hospital stay (the average pediatric inpatient stay is 2 days but can vary wildly from 1 to 21 or more) and for these patients (and their families), you are their primary physician. The expectations are as high as the turnover rate and while there is the occasional laugh to be had, there were some tense moments, some strange standoffs and (for a crybaby like me), some tears shed.

Purple Pacifier Ire, Blue Babies and LTEs – NICU

http://www.p4c.philips.com/cgi-bin/dcbint/cpindex.pl?slg=en&scy=us&ctn=SCF190/02

If anyone had asked me on July 31st how I thought my NICU block would be, I’d have immediately responded with one word: awesome. Much of my desire to become a doctor in the first place was sparked by my fascination with neonatology; the epic stories my mom would tell about how I spent my first month of life in a NICU probably brainwashed me to the point where I felt like going to the NICU would be like a homecoming. The children’s hospital at which my residency is based has its own NICU where senior residents staff and take call but the interns are sent to the level III NICU of the local general hospital which is run by a team of attendings and neonatal nurse practitioners. It’s a state-of-the-art 60 bed facility where babies as young as 23 weeks are managed and ECMO can be performed if necessary. I remember how brightly I smiled on the first day, thinking of all the deliveries and resuscitations I’d be able to attend, all the tiny babies I’d be able to care for and all the things I’d be able to learn from the attendings. I’d even imagined myself well-prepared because I’d had a 4-week NICU elective in med school. Looking back, I realize how terribly naive I must have seemed. The shock of reality was like icy water in the ear.

Knowing When You Don’t Know – Heme/Onc

note: this post was meant to be published on July 30th

To say that there’s a steep learning curve for Hematology/Oncology is an understatement. As a resident fresh out of the box, I don’t think I could have imagined a more challenging or intimidating service for my first month as a doctor. At the end of the first week, I had a nervous breakdown and cried myself to sleep. I’d never felt more out of my depth in my life.