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.

Parents, Patients, and Attendings

On one of my last days of community pediatrics, I saw a 4-year-old Tamil girl who came in for a well-child check-up with her parents. I first encountered her in the hallway, where she was getting her vision screening. The entire thing was a tense affair, because she was having some trouble reading the chart, much to the chagrin of her parents. "Try the chart with the letters," they said, "She knows her letters." Dad was helping her cover up one of her eyes at a time because she kept peeking, the way children are wont to do. Mom came up to the chart and was pointing at letters along with the medical assistant, hoping that maybe the child was just confused by someone else's pointing. Yet the child's difficulty with vision persisted. Mom told Dad not to cover the child's eye for her, to let her do it herself. Dad kept saying, "but she's peeking!" Meanwhile, no one but me seems to notice that the little girl's eyes are welling up and she is becoming increasingly agitated by her parents' all-too-evident disappointment.
By the time my attending and I walked into the patient room after all her screening was completed, the little girl had been frankly crying and was wiping tears off her face. My attending asked why she was upset, and Mom admitted that she had been scolding her for her bad vision, that hadn't Mommy and Daddy told her not to sit so close to the television? But she had done it even when they told her not to, and now her vision was spoiled, and it was all her own doing.
I was so distressed by this whole thing. It reminded me forcibly of times I've gone through difficult situations and my parents, instead of comforting me when it was obvious I needed comforting, instead pointed out the mistakes I had made that had resulted in whatever pain I was feeling. (Case in point: when I accidentally backed into a parked car one night in my junior year of high school, setting off a cascade of events including police involvement, which was completely out of proportion to the tiny scratches my car had made on the victim's car, which was already heavily dented, I came home sobbing because I felt so terrified about having my first "accident." My mom's response? "I told you not to go out to that party tonight! Why did you drive home so late? Why were you on that street anyway? Who told you to give your friend a ride home? You shouldn't have done all those things," and, the implication was, your tears can only be blamed on yourself.)
This tendency to blame instead of comfort, to point out wrongs instead of pointing out solutions, is a terrible pattern my parents have demonstrated again and again. I suspect it's common to a lot of immigrant families, especially Asian ones. I wanted so badly to interject in the interview and ask the parents, couldn't they see how deeply their disappointment hurt their daughter? Wasn't it baldly apparent how very much this girl wanted nothing more than to make her parents proud? That it hurt her, probably more than anything else in her short life, to make her parents unhappy? And if they could see that--for who couldn't, who was observing that situation?--why on earth were they continuing to heap blame upon her? Even if some of her previous actions had indeed influenced her vision (which, they probably did not), what was done was done. No amount of scolding could make her vision 20/20 again. In short--what was the point of their displeasure with their daughter?
But even though I wanted to rip into the parents for their behavior, I knew it wasn't my place as the medical student (nor, might I add, would it have been my place as the attending...at least, not if I wanted to keep a good rapport with this family). So I'm standing there wondering how my attending would handle this somewhat awkward, and, to me, deeply painful, situation. Would she point out that the parents were being unkind? Would she be able to do so without offending them? And most important, would she be able to help them accept their daughter's vision and address it accordingly with a visit to an ophthalmologist?
In wonderful-role-model fashion, my excellent attending did all three, simply by suggesting that perhaps the girl had been sitting so close to the television precisely because she had difficulty seeing, and not the other way round. She also pointed out that the patient was upset because she was watching her Mom and Dad act visibly worked up. How could they expect her to even want to wear glasses, if she does indeed need them, if they exhibited such displeasure at the possibility? Both parents literally got looks of sudden realization on their faces, and at least to some small degree, their attitudes shifted and some of the tension in the room lifted. It was pretty masterful, I must say. I don't doubt that when that little girl has her first car accident, her parents will tell her what she did wrong before they say they're glad she's okay. But maybe my attending's small, insightful comment will do something to make those parents think, just a little bit, before blaming their child for all her failings.

The n00b Files - Week 3 of Pediatrics

I'm on my third week of Pediatrics, which means I've completed 2 weeks of Pediatric ER, and am on my first week of outpatient pediatrics. I've also fully completed 8 weeks of Psychiatry, during which time I neglected to write down any n00b lessons. But never fear! More lessons await, below:

1. Turns out it's not that hard to look into a lot of infants' and children's ears as I had previously feared. More kids than you'd expect are pretty calm about the whole thing, which makes life a lot easier.
2. On a related note, you know how you're taught to pull a patient's ear back and up in order to straighten out the canal and take a good look at the eardrum? Yeah, with infants and young children, it's a LOT easier to see the eardrum when you pull straight back. Now that was a revelation.
3. The great thing about psychiatry is that you get to spend a LOT of time with patients, just talking to them. I like talking to patients, so I liked that aspect of it. 
4. After seeing a patient who suffered from debilitating generalized anxiety disorder, I'm starting to believe that having severe anxiety may well be much, much worse than having severe depression. I actually felt like crying while talking to said patient, whereas I don't think I ever got emotional while talking to depressed patients.
5. Um, apparently you're not supposed to feed your baby any plain water until he or she is at least 6 months old. Babies are not good at regulating their water balance until then, so if you give babies water, their electrolytes can go all out of wack and then they can have seizures. So, don't feed your infant water!
6. ^Then again, very shortly after I wrote this, I heard my preceptor tell a mother of a 4-month-old that she can give her baby water if they're outside for a long time....so I guess the other lesson here is that the advice that doctors give can vary from doctor to doctor.
7. Subsequently, it's amazing/borderline scary to think how much of my behavior as a full-fledged physician will be directly influenced by the training I receive. For instance, I've learned at school that it's best to hold an otoscope with the handle down when examining ears. My preceptor last summer said that holding it upside down was the "weenie" way, and I had been taught well. Then last week, another pediatrician demonstrated a really adept way of examining an infant's ears...holding the otoscope upside-down. It was just crazy to realize that, more than likely, the way I ultimately do things (including the advice I give parents on some topics, the way I do physical exams, and probably more) may well be determined simply by the last way I was taught to do said things.
8. You can learn a LOT by watching the way your superiors interact with difficult patients and other medical teams. I was super impressed by the way one of my psychiatry attendings handled small and large annoyances. That dude had an amazingly cool head.
9. Psychiatry can really be a very amusing rotation. When I was on inpatient psychiatry, my team and I had many a laugh-filled morning of rounds while discussing some of the unusual things our patients said. For instance, this exchange:

                    Did you sleep well tonight?

                    I was 14 once.

          Or this one:

                    Can you tell me a little bit about your childhood?

                    Absolutely not. 

          ...Okay, so maybe you had to be there.

Ticking Time Bomb

In roughly the last week, I've lost my apartment, a great deal of my freedom, and my boyfriend. (To be perfectly honest, I "lost" all three of the above mainly of my own accord.) To say that it hasn't been an easy week would be a great understatement. Then yesterday, a male, Mormon, future OB/GYN classmate of mine and I were talking about childcare, and he asked me if I have a significant other. I said no, and he assured me that it was "okay" that I didn't have one at the moment, that I have "time" to find someone, but then again, my ovaries are "a ticking time bomb" because, hey, those things poop out eventually, and who knows if I'll still be fertile by the time I find someone with whom I want to procreate? (Again, to be perfectly honest, this is actually a really nice guy, and I don't think he meant any malice by what he said, none at all.)

The weirdest part of the whole exchange? His comment didn't even bother me. I don't know if that reaction was due to something awesome, like the idea that I'm well-adjusted and modern enough to know that even if I couldn't have biological children, I'd still be equally happy with adopted children; or something not-as-awesome, like I am just completely numb right now. Maybe it's just that I feel as if lots of people around me have been encouraging me to find a guy to marry/settle down with in the near future, for various reasons, and this is just another ludicrous one being presented to me. If I want to have biological babies, I better delve into the finding-a-life-partner thing with gusto!

I just feel like my life is changing rapidly, and the short-term future taking shape resembles a life I never thought I'd live, and that makes me deeply uneasy in ways I find difficult to explain. I'm glad I'm currently on a rotation that I really like, so that going to work can at least bring me some satisfaction instead of more frustration.