The Importance of Being Nurtured

The patient I'm taking care of right now in the Neonatal ICU is 3 months old. She was born at 33 weeks' gestation (normal is 40), along with a twin brother. Her brother has been home with their parents for some time now, but this poor little baby has had to stay in the hospital for innumerable problems, including, but not limited to, a hear that is very messed up indeed.
Now, I've only been seeing this patient for a little over a week now, but in all the time I've been at the NICU, I've never once seen her family at the bedside. This poor little 3-month-old lies on her back day in and day out, largely unstimulated by human contact the way normal babies are. By 3 months old, babies are social smiling, interacting with those around her, and starting to learn who her parents are by face. A lot of the kids who spend many of their first months in the NICU meet these important milestones much later than their healthier peers, simply because they don't receive the normal social stimulation that we all take for granted. This baby was going along the path of many NICU babies before her, and gaining her milestones very, very slowly.
So you can imagine my initial confusion, then subsequent delight, when I realized that, as I examined this baby girl this morning, the strange facial expressions she was making were her way of trying to smile! It was absolutely precious, and I swear as soon as she first took that step, it's as if a switch was flipped, and the baby became much more interactive with everyone who came by her. Seeing that little baby try to smile was probably the best part of my day.

Undergraduate Failings

I'll let you in on a little secret: I'm not really cut out to be a good college student, in all her stereotypical glory. I only just realized this sobering truth in its entirety this weekend, during the Centennial celebration for my lovely alma mater.
In the days leading up to the start of the Centennial festivities, I had whipped myself up into a reminiscent frenzy, thinking back fondly on sun-dappled courtyards and classes full of critical thinking and writing and reading; adrenaline-fueled days and nights of dance practices, performances, and midterms, with little time for sleep or food, but plenty of coffee; and the general freedom to pursue learning in its various manifestations that college affords us. I imagined myself descending upon my college campus (which, I should probably add, lives right across the street from my medical school campus) in a triumphant return, mingling with friends from various circles, both academic and social, and shedding all remnants of the social awkwardness that plagued me through much of my freshman year. It would be wonderful, I thought, and was exactly what I needed after a long seven weeks fraught with frustration and heartache, with small happinesses sprinkled throughout. Take me back to where my young adult self first began, I thought, and my heart and life will flourish once more, invigorated by the tree-filled vistas of college.
Here's what actually happened: I rather enjoyed a talk by a prominent genetics researcher, due partly, I'm sure, to the fact that I was able to sit alone in a large venue for the talk. I tried to ask a question about gene therapy at the end of the talk, but the question period ended before I found my way to the mic. However, the question period did include a woman asking an inscrutable question about seahorses and platypuses (surely the plural of that should be platypi?), and another woman inanely telling the speaker that his IQ must be "as high as a hot summer day in Texas," which was mildly infuriating because, well, a hot day in Texas is slightly above 100 degrees F, and an IQ of 100 indicates average intelligence.
I went to Alumni Pub Night the following evening, again anticipating self-assuredness and effortless mingling, a cool beer in my hand throughout. I spent the evening chatting with friends who all still live in the same city where we went to college, and I drank a very sweet cider which, at first sip, I wasn't sure was alcoholic. (It was, I later discovered.) I stood about awkwardly silent at times, unable to muster up the social energy to shout over the loud music just to have small talk with people I see all the time anyway. I saw almost no one I had been friends with in college, but had since lost touch with. I did, of course, see people who had never been my friends in college. I was also mildly alarmed at the number of men there shooting close-lipped smiles at any women who happened to glance their way. One of them asked my Taiwanese friend if she was from Korea as I stood by acting nonchalantly deaf. I feigned my disinterest so well that the next time I looked around, she had slipped away from the entire scene, leaving me frighteningly within range of Mr. Smiley's advances. I retreated post-haste. The night passed by in a vaguely-bored blur, and I woke up the next morning utterly exhausted from having only 5 hours of sleep the night before.
My next, and last, attempt at partaking in the Centennial festivities also fell flat. I headed over to one of the dorm common areas as the sun was beginning to set on Saturday evening, excited to participate in a reunion with both alumni and current students involved in South Asian Society, my extracurricular of choice when I was in college. Of course, I was the second person there, and the other girl there and I sat around coloring (the activity was intended for children of alumni who were on campus for the weekend) for about a half hour before anyone else showed up. In the mean time, we ended up talking to the wife of an alumnus, a dentist, who was spectacularly rude enough (at least in my opinion) to tell me that she thought the idea of being a specialist in pediatric genetics was "depressing," and that being a doctor was "a hard life." Thank you very much, woman with whom I have no connection. I am aware that the life ahead of me isn't going to be easy as pie. I appreciate your words of wisdom. Eventually, other alumni from our club trickled in, and we enjoyed some catch-up conversation before everyone else headed off to the glitzy "Finale" event, held in one of those amazing tents, complete with open bar and tons of free food. I hadn't bought a ticket to the Finale since I had  originally planned to attend the football game earlier in the day, and I wanted to give myself plenty of time to study for my exam coming up on Friday. Sadly, I decided right before the game to skip the game and study in the afternoon instead, and by then it was too late to buy tickets to the Finale. I had originally told myself that I would study on the idyllic campus of my daydreams for a couple hours before watching the light show that was to take place on the Academic Quad later in the evening while my peers were at the Finale, but after watching my friends walk off in their nice clothing, I just felt too defeated by the whole affair to stay around, and instead I bought Taco Bell and went back "home" to watch television online with my Dog-in-Law. I later heard that the light show was was downright breathtaking, but I couldn't bring myself to drive all the way back to campus for the later showings. I just gave up the whole night, and, indeed, the whole Centennial affair, as a bust.
I've realized, as I hinted earlier, that I don't naturally function very well in prototypical "college" situations. I don't like shouting over loud music at bars. I hate talking to random guys at bars. I'm not very good at mingling. I am, at heart, an introvert, and when I'm in big social situations, it helps me tremendously to have one person, be it a significant other or close friend, to cleave to throughout the event. I have a couple people in my life who have played such a role for me in the past, but I don't feel like I've had a huge group of friends who make my heart swell with emotion because they so wholly represent college to me. Actually, I should amend that: I can call to mind a few situations and friend groups who do indeed make me feel that way, but I don't feel like I am able to recall the emotion when placed back in the same friend groups or situations. All of that just seems lost to me. Is it like that for most people? Am I the odd one out? I really just don't have a clue. All I know is, I'm fairly certain I like the idea of college far more than the reality of it.

No, I am not a nurse.

There's a set of parents whose very young infant is cared for by the NICU team I'm on. Now, I'm sure it's very difficult to have your firstborn child be born prematurely, and end up staying in the hospital for months, literally. However, I've gathered from my team that these parents have been exceedingly "difficult."
A number of incidents have occurred between my team and this particular family, including the family yelling at my residents in public, "firing" them for not doing a good job, and many other similar things. I have to say, though, that in my short interaction with this family so far, the one thing that bothers me the most is the fact that they address my residents, both of them, by their first names. It simply drives me up a wall, and I can tell it bothers my residents, both of whom are female, too.
I heard from many female medical students, before I started clinics, that I would more than likely be called "nurse" by many, many patients during my time in the hospitals. Luckily for me, I've actually rarely been addressed that way. Maybe I have some sort of aura that projects medical student-ness. Or perhaps I'm just not that much of a hottie, and let's be real--there's something distinctly "hot" about female nurses compared to many female medical students. Whatever the reason, I'm pretty glad for it. It's annoying enough when, as a brown-skinned person, you have veteran patients assuming you're Arab and apologizing to you whenever they speak ill of people from the Middle East. (For the record, I'm not at all bothered at being mistaken for a Middle Eastern person. I'm just miffed at the sheer ignorance of it all. For anyone who paid a modicum of attention, my name would probably strike him/her as distinctly Hindu.)
You know, call me an intellectual elitist if you want (cause, well, let's be real--I am one), but when I finally get my MD, I'll be damned if my patients address me as anything other than Dr. Spinenvy. By the time I'm a resident, I will have worked my tail off and gone through 21 years of schooling to earn the title of Doctor, and I'll sure as heck be working harder than ever before during residency. I think that at least some deference should be paid for that sort of hard work and commitment, and at least some of that deference takes the form of using the correct title to address doctors. Perhaps more importantly, when your patients do not address you as doctor, you have to wonder how, exactly, they perceive you. Doctors are, generally, respected, and believed to be knowledgeable experts in the field of medical care. If your patients call you "Angel" instead of "Dr. Spinenvy," then do they simply view you as an ineffectual girl? And if they do view you as such, then surely your recommendations and words don't carry the weight they rightly should, as recommendations coming from an MD.
I also have to say that I get extra riled up about all this stuff because there's still a large portion of society that automatically affords less respect to women than to men. Again, I've heard from plenty of female medical students (and residents) that they're referred to as nurse, even as they're wearing their white coats and making treatment plans for their patients, while their male counterparts are called doctor. It's frustrating that, outside of some circles, I'm met with confusion when I tell people I'm in medical school -- "So, you're going to be a nurse, or what?"
No. I'm not going to be a nurse. I'm going to be a doctor. Please call me that.

Disclaimer: I've met a great deal of awesome nurses, and I have to say that they have a type of strength and intelligence that I lack. I could never do the work of a nurse. I just want my patients to address me with my proper title once I've earned it, and I don't want to be relegated to the appellation, "Ms. Angel" simply because I'm female, while my male counterparts get to be called Doctor. That is unfair.

The n00b Files - Week 6 of Pediatrics

I'm almost done with my pediatrics rotation, and I'm delighted to report that I continue to enjoy it. I'm on my second week of inpatient pediatrics, and so far, the experience has been good. More lessons learned:

1. My dad was right all those years ago. I should have learned Spanish. It would help so much with my patients. It's not so bad when you can get a live translator to stand in the room with you and help you communicate with the patient, but using one of those translators via phone almost completely eliminates important, human interactions like eye contact. It's not easy to show a mother that you're just as concerned about her child as she is, when you're both staring down at a speakerphone and speaking into it.
2. It's a good sign when your attending says that every day, rounds will begin with a cute photo of the day.
3. If you ever hear doctors talking about something that sounds like "go lightly," you can bet they're not discussing an Audrey Hepburn movie. 
4. I eat way fewer vegetables and fruits, on a daily basis, than I should. I mostly fill up my stomach and my day with carbohydrates, which are delicious, but empty, calories. This failing was brought into sharp relief for me recently, because I had been spending a lot of time during my community pediatrics rotation encouraging overweight children to have 5 servings of fruits and vegetables daily. It's nice that my "job" helps me reflect on my lifestyle and health.
5. I really, really like working in a community clinic.
6. Conversely, I'm really not that wild about the inpatient setting. 
7. Having an attending who empowers you, as the medical student, to call consults, assist in patient education prior to discharge, and generally do much of the work of residents, is a good thing, even if it means more work. As my new, awesome attending pointed out, if we spend all of medical school carrying no more than 2 patients at once, we'll be completely out of our element when, as interns, we'll be expected to carry close to 10 at any given time. Working hard in medical school kind of sucks, but it's good practice for when your decisions really mean something, after that arbitrary moment of graduation.
8. Life flies by. I just went to an information session about scheduling my last 18 months of medical school. It was both terrifying and incredibly exciting.
9. It's a wonderful thing when you're doing something that makes you happy, especially when you're going through a rough patch in life. I'm so grateful I'm on Pediatrics right now, and that I'm loving it.