In which our heroine tries to keep her patients alive, and free of infectious diarrhea

So I almost gave my patient C. difficile colitis today -- ordered ciprofloxacin po as directed by my Sanford Guide to treat her UTI.  Then I reevaluated my thought process, determined she did NOT have a UTI, and found an old note from the time she got C. diff from a course of cipro.  I discontinued the antibiotic I never gave.

I guess that's a win?

If you don't count my breakdown this morning over her continued refusal to let me take a history or examine her, and then my blankout at how to manage her hyponatremia.

But we got her sodium up and her confusion resolved.  And I found a cool physical finding that will unfortuantely remain nameless because I don't want to take a chance that she become identifiable.

All in a day's work.

Oh, and I'm supposed to teach a medical student?  Thank goodness she's enthusiastic, smart, and talented!  I think maybe she'll teach me!

Sleepy intern say hi

...and that's about all I have energy for today, folks.  Three days into my internship I could barely drag myself out of bed on my day off.  Inronic that my senior resident commented on how much energy I seem to have!  I'll try to elaborate on what it's like to play doctor later, but it's a beautiful day outside, so I am making a cup of tea and relaxing on a lawn chair.  If I can keep my eyes open.

Welcome to Internship!

Apologies for the long break in posting.  It's been a busy several days.  We started orientation to residency, and I've been trying to take care of as many errands and get the house as organized as possible before residency -- especially since my first rotation is general medicine wards, and I am on call the first night!  Clearly when he created the schedule, the chief resident confused me with somebody who actually knows what she's doing.  The program director promised us that we will not kill anyone, and my mentor told me I am "more than competent," but I am afraid I will prove both of them wrong.  I guess I'll just do my best, and pray that my patients do okay.  On the plus side, my co-interns are really nice, and I enjoyed meeting many of them at orientation and at the welcome picnic.  We're a melting pot of American, Indian, Persian, Arab, and more.  I wish there were more women interns, but I guess that just means we are so good, we're worth twice as many men :o)  Several interns have families, and the little ones (I met them at the welcome picnic) are so adorable!  One intern brought his seven-year-old little girl, who is adorable and has such a cute, exact way of speaking, and his four-month old infant, who made me want to pick her up and hug her.  But the Vice Chair of Education beat me to the punch and wouldn't let go of the baby for almost an hour, so I didn't get a chance.  I think somebody is dreaming of grandmotherhood!  Another intern brought his three-year-old and eighteen-month-old boys, who ran around and were also adorable.  They look almost like twins -- the elder has Down's Syndrome and so is small -- and had a great time playing with the hammock.

We had some sadness Friday night, which I would write more about, but it'll have to wait a few more weeks for reasons that will later become clear.  I will simply say that Husband and I are trying hard to stay positive, count our blessings, and remind ourselves that any heartache we experienced along the way will be altogether insignificant if -- no, WHEN -- we hold a baby in our arms.  At least I hope and pray it's "when...."

In Which our heroine uses her physical exam skills, walks many miles, and enjoys beautiful summer weather

Oh, glorious summer!  This vacation is passing far too fast!  I am not at all prepared to start internship.  Couldn't they give us another month, or two, or three...but I guess not.  I spent the majority of yesterday enjoying the outdoors and walked a total of ten miles!  Not at once -- I walked four miles in the morning listening to a Medical Knowledge Self Assessment Program (MKSAP) lecture about diabetes while basking in the bright sunny day.  I originally planned to stop at the library and fill in the gap in my Russian Literature with Anna Karenina, but I forgot my library card.  So after a very nice lunch with my grandmother, sister, and cousin at Mongolian Barbecue, I set out again, because aside from trying to exercise I am trying to "be green" and driving to the library -- a mile away -- is NOT green and also a sin when the sky is blue and the sun is shining and the birds are chirping and the temperature is just perfect.  So I walked to the library, but it was so nice out that I ended up extending the walk, so it turns out that three miles later I was back at home with Tolstoy as the literary guest du jour.  I started making dinner, finished with help from Husband, and then he wanted to take a walk.  As he definitely needs the exercise, I agreed to another walk, so three miles and a lovely visit to my grandmother later, we returned home.  Total: ten miles!  I really enjoy walking with Husband not only because we get our exercise, but also it gives us a chance to talk without a television or other distraction.  We had a nice conversation last night about raising children and I learned some interesting history about his step-siblings.

Today I finished the lectures on diabetes while enjoying another perfect summer morning.  I ended up by my grandparents, and got roped into going to the office with my grandfather for his afternoon orthopedics clinic.  We saw seventeen patients with interesting findings.  I caught an Anterior Cruciate Ligament (ACL) tear.  Both Drawer and Lachman tests were positive, although my grandfather elicited the forward movement of the leg much more easily than I.  I suppose it's a matter of mass and experience.  I also injected a knee with a cortisol/lidocaine combination and correctly identified a ganglion cyst (which felt surprisingly indurated).  This was reassuring, since feel most uncomfortable with my musculoskeletal exam.  ***Note to medical students, residents, and physicians: the NEJM has a wonderful Video in Clinical Medicine about examination of the knee.  Watch it.***  My shoulder exam is still lacking, though.  I haven't properly reviewed it since January and have forgotten too much.  But some I could still remember.  Oh, and we did a nice incision and drainage on a boil which was likely MRSA.  Ebe pus, ebe vacuo.

Aren't I a fun person about whom to read?  It gets worse -- I have also been reading Harrison's the last few days.  Seriously, though, I do have fun.  Tomorrow my sister and I leave for a day and a half vacation in Chicago.  I have one destination in mind, and it is the Cheesecake Factory.  I am mildly obsessed.  Just mildly.  Not as if I already know exactly what I'm ordering or something...dulce de leche cheesecake...We will also see the Willis nee Sears Tower and walk the Magnificent Mile.  Perhaps a museum or two as well?  Fireworks over Navy Pier?  Who knows?  I would never live in a big city, but I love visiting.  Let's just hope the weather cooperates.  I have yet to enjoy good weather in Chicago.  I've done sweltering, humid August, freezing December and January, and June which would have been nice but I dressed for the eighties and it was in the sixties.  This time I am checking the forecast.

Not too much else.  Husband will be working hard through the weekend but promised me a date night Saturday night.  Yay!

Summer Recipe!

Hello all!

While Husband works, studies, and does his project, Dr. Mim continues to work on her culinary skills.  Today the score is Mim: 1, kitchen:0.  (We'll call yesterday's Tuscan Vegetable Pie a tie and Friday's challah a definite win, but pasta a major FLOP.)  Anyway, if you like tabouleh, you will LOVE this:

Tabouleh Chicken Salad

From the recipe book of EWC

Ingredients:

1½ cups bulgur

3 cups warm chicken broth

¼ cup olive oil (haven't tried skipping the oil but I'll bet you can if you're counting calories)

juice of 2 lemons (I go much lighter on the lemon -- half a lemon to maybe a whole)

700g chicken breasts

4 tbsp swet chili

2 tbsp fancy mustard (honey Dijon works well)

1½ cups chopped parsely (I measure before chopping -- estimate, really) 

½ cup chopped mint (I measure before chopping -- estimate, really)

6 green onions, chopped

2 cucumbers with the peels on, chopped (I don't like cucumbers so I add another half tomato instead)

3 garlic cloves, chopped

2 tomatoes

50g pine nuts, toasted

salt and pepper to taste

Directions:

To make the bulgur –

In a large bowl combine bulgur, 1½ cups chicken broth, and lemon juice.  Cover with Saran wrap for at least one hour (until it absorbs all the liquid).

To make the chicken –

Cook the chicken in a pan with the other 1½ cups chicken broth.  Salt and pepper to taste.

When the chicken is ready, remove from the pan and cut into strips or cubes.

Pour out the broth from the pan.  Return the chicken to the pan and combine with the chili and mustard.

And finally –

Combine the chicken, bulgur, and all the chopped vegetables.  Enjoy!

Makes 6-8 portions.  Does not reheat well -- you want warm chicken and room-temp salad -- so if you plan to eat leftovers, either eat at room temperature or keep chicken separate and mix only each time you eat, so that you can warm the chicken separately.

Next up: chicken meatballs, either from EWC or my favorite cooking magazine (על השולחן).

Happy cooking!

Advice for consumers of the healthcare system, or In Which our heroine again battles the hospital billing department, and emerges victorious

If you too are embarking on an infertility adventure, I cannot emphasize enough -- keep careful records of bills paid and what each payment covers!  I received a bill from Northwestern for $3200.00 last week.  This seemed odd, considering that we have already paid the hospital $15,300 and that was supposed to cover the IVF and implantation.  I called the number listed on the bill for enquiries, and -- surprise!  The REI department has its own number.  The operator transferred my call but as nobody answered, she was supposed to forward a message and my phone number.  Either that didn't happen or the REI department was out of the office, because they didn't return my call.  Today I called them and...the bill was a complete error!  The only thing left to pay is $875.00 for embryo cryopreservation.  (We haven't gotten that bill yet, despite it being a month since the event.)

So, the moral of the story is: If you think you received a bill in error, DON'T pay it until you are certain you actually owe them money!  I can only imagine how difficult it is to get the money back once it's theirs. This message applies to any dealing with the health-care system, I suppose.

Moral number two: Big-name, fancy universities have billing departments no better than our own little UPG billing department.  Gives me a sort of pride in my home school.

And in case you were curious: the running total for a ride on the Amazing Infertility Adventure, aka Operation Baby(Babies) has just about reached $100,000 after-tax dollars.  Mazel tov I'm sure.  Mostly, thank you Mama and Daddy and my wonderful, amazing grandparents and everyone in the family who has helped  us out.  I only pray we can pay this generosity forward.

Happy Shavuot! חג שבועות שמח!

apparently I was quite sleepy when I wrote the following, since I accidentally posted it to a blog which I never  meant to use!  But here is my intended post from last night.

...and it's Jewish holiday time again!  From yesterday sundown until tomorrow night sundown we celebrate God giving us the Torah (see previous post), as well as the first fruits of the season.  We read from the Book of Ruth and it's customary to eat dairy and wear white.  Mmmm...cheesecake...I did not actually consume cheesecake today.  But I made a spur-of-the-moment decision to invite the family over for the holiday.  I prepared six homemade pizzas, (okay, not the sauce -- but everything else, including the dough) sauteed spinach, eggplant with tehina, and an Israeli salad of tomatoes and cucumbers tossed in olive oil, lemon juice, and salt, all while listening to lectures on Neurology.  Yes, I was busy in the kitchen!  The pizzas unfortunately looked far more gourmet before baking.  I rolled the dough out very thin because we're a thin-crust bunch, and I roasted garlic and tomatoes and sauteed onions and fancy mushrooms for toppings.  I also bought fresh basil and mozzarella. Oh, how lovely those pizzas looked!  I should have photographed them.  But I didn't put enough flour underneath, and we had a very difficult time getting them onto and off of our pizza stone.  Husband may have had a few (or more) harsh words with me.  But it's behind us, and everyone seemed to eat it, so I guess at least it was tolerable.  A good time was (hopefully) had by all.  After everyone left we hung new posters above the dining-room table and also hung our ketubah (marriage contract).

It's been quite hot today; over ninety degrees!  But tomorrow is supposed to cool off a bit.  I hope so!

Also, I owe a big thank-you to my mama and grandmother for helping with the cleaning -- or rather, doing nearly all of it and not letting me work!  I hate to see them work when I made the party, but I guess I will pay it forward one day, hopefully.

I'm realizing I used the word "hopefully" quite a lot in this post.  I'd say it describes my current state pretty accurately.  Another good word would be "sleepy," so that's it for tonight.