Friday, December 29, 2006

Fat Resolution

I have no idea where the notion that it is socially acceptable, or even someone's right, to tell a family member (or anyone else for that matter), "My, you've put on some weight." came from.

It's no secret that I've struggled with my weight my entire life. I was always the chunky kid, or "the big-boned one", or the fat kid. Take your pick, the labels are what they are. When I graduated high school , I weighed 220lbs and felt enormous. I was able to slim down my first year of college in the spring by playing a crazy amount of racquetball. I don't remember how much I lost, 20-30lbs I think. Of course, I put it back on. But seemed to be slimmer overall, at least in the face. Thanks to a peritonsillar abscess in Aug. 2000, I was able to get my weight to 185lbs. I looked like a ghost. Then I got married in Jan 2001, (it will be 6 years next week) and again put on weight. 2 years ago, 6 months before graduating from Medical School, I weighed 240lbs and resolved myself to losing weight before graduation. I lost 24lbs by graduation. I felt really good, still well above my "ideal body weight", but I was in decent shape, playing racquetball sometimes for 2 hours a day 5-6 times a week. 4th year medical school, especially the Spring, is a light load and allowed for TONS of gym time. I credit my good friend Billy Jordan in helping me achieve this goal.

Well, 18 months later and I have managed to find that 24lbs again and I hate it. I have known for awhile now that I had let myself go and gained weight, and looked bad. BUT I DON'T NEED OTHERS TO POINT THIS OUT TO ME! THANK YOU VERY MUCH!!!!

So Wednesday December 27, 2006, when Beth and I returned from visiting her family in Southern Illinois, was the end. I put myself on a diet that hell won't have. There's no point in waiting for the New Year, the time is now.

I got on the scale yesterday morning and it said 241.6 UGH!!! I have my work cut out for me. It's going to be harder than ever because for the next 5 weeks I am q3 call in an ICU (Pedi ICU until Jan. 2 and then adult ICU from Jan. 3-Feb. 2). And being on call every third day is a nightmare. You're on call, then post-call (you go home and crash from lack of sleep while on-call), then it's your pre-call day, meaning your on-call then next day to repeat the cycle all over again. There's little time for anything other than working and sleeping, much less trying to eat healthy and exercising. Not to mention, but I will, that I am going to be 30 in 6 weeks and my already snails-paced metabolism will not doubt only get even slower. Is that possible??


I managed to eat healthy while on-call yesterday and avoid the pizza, buffalo wings, and Reese's peanut butter cup cookies that the night shift had in the ICU last night. NOT ONE BITE!!! I had grilled chicken, salad, fruit, and water. And more water. And then, yup, some more water.

Oh, I'm giving up sodas. Period. No real Coke, no Diet Coke, no Coke Zero. Nothing, nada, zip, zilch. It's tea or water. And more water than tea. The caffeine headaches that are sure to ensue are going to be horrific. You all do NOT want to be around me for the next 5 weeks. Sleep deprived, hungry, and in withdrawal. Sounds like fun, huh?

Tonight, as we do on many Friday nights, Beth and I went to Outback. Why tempt my new found resolve? Well, I will have you know that I had 3 SMALL slices of bread, with light butter on only one piece, I had a salad, without croutons, and minimal cheese and their tomato vinaigrette (fat free) and then streamed green beans, no butter, and a half an 8oz steak. Beth had the other half. I did not eat one bite of the Bloomin' Onion or Cheese Fries, or ice cream that was put on the table. Not one. I came home and got one the treadmill for 45 minutes. As I sit here I am drinking what feels like my 8th GALLON of water--especially since I am frequenting the restroom every 30 minutes.

So here it is. Laid out in cyberspace. My journey. My quest. My struggles and my accomplishments. My goal is lose 30lbs. But that's a start. Once there, I will need to lose more, but this is the short term goal. Healthy weight loss is 1-2lbs/week. So the time line should be anywhere from 15-30 weeks to accomplish this. 15 weeks from yesterday is April 12, 2007. 30 weeks from yesterday is July 26, 2007.

I am going to find a few old photos and take a new one and post here shortly. I have my 6 year anniversary and 30th (SAY IT ISN'T SO!!!) birthday in January and February respectively, so this is going to be a struggle. But I am determined and want to keep an honest accounting of how I am doing. Maybe that will even motivate me to blog more. Right Becky?

I hope that your Christmas was filled with joy, love, and peace. And I hope that your New Year will find many blessings bestowed on you. Be a trend setter and make your Dec. 29th or Dec. 30th resolutions. Don't wait until Jan.1, that's so cliche.

Tuesday, October 24, 2006

Growing up

Even though I have posted recently, I thought that I would post again in response to Becky's recent blog.

I guess it's official. I'm OLD! Tonight I am going to meet with my financial advisor and finalize my disability insurance. This is something that I've known for some time that I needed, but never stopped long enough to get. Well, that ends today.

As a physician (even while still a resident) my most valuable asset is my ability to generate income. Let's face it...I have over $120,000 in medical school debt alone. Not to mention the mortgage, cars, dogs (they have to eat, too) and not wanting to leave Beth as solely responsibile financially if I'm disabled.

So, as of tonight, I will have long-term disability insurance. It is own-occupation, non-cancellable, guaranteed renewable. That means that if I am disabled to a point where I can't practice Med/Peds completely, they will pay. Most disability policies WON'T pay if you can still get a job at Burger King or Wal-Mart. This protects me from that. They also can't cancel the policy if I do become disabled (can you believe this would actually happen???) I pay them premiums for 10 years and then something tragic happens, I can't work, and just when the benefits start, they cancel the policy. Insurance companies are SHADY! This policy will also give me the option to get more coverage once my income and financial responsibilities increase.

So, I'm getting old. But at least I'm being responsible about it. I even have a life insurance policy (it's not much and certainly not worth someone killing me over, so please don't).

I guess the ultimate responsibility will be when Beth and I decide to have kids. And yes, Mom (and Laura), we will decide to have kids someday. I promise. Ha!

Ok, I'm in the ICU and PROBABLY should be working. So that is all for now.

Monday, October 23, 2006


In response to Eric's comment:

I will also include the link on the side of the page...even if it is lame.

Wednesday, October 18, 2006

2 posts from my MySpace page

Below are 2 post that appear on my MySpace page. One from Monday night and the other from a few minutes ago.

Post #1

Monday, October 16, 2006

Current Mood: Exhausted

So I am in the Pediatric Intensive Care Unit this month. Sick kids...really, really sick kids. Their sickness doesn't bother me. I'm not even that emotional when things don't go good. I've actually been surprised by this. I'm the kind of guys who's secure enough in his manhood to not feel bad about crying at the movies. Hell, I even cry when watching ABC's Extreme Home Makeover (and I believe you're not human if you don't). But the last few weeks in the PICU have been tough. We've had a few kids die and there are a few more that will likely die in the next few days/weeks.

My reason for this post is this. HEAR ME!!! We, the medical community (nurses, doctors, med students, lab tech, unit clerks, respiratory therapist, nutritionists, pharmacists, and anyone else that I've failed to mention) are here because WE WANT TO HELP PEOPLE!!! We WANT people to get well. Especially kids.

When you read in the newspaper about a hospital moving to withdraw support on one of their's not because of money. It's not because we need the bed. It's not because we don't like the family. It's because with all the medical knowledge and in review of the patient's case in its entirety...there is NO HOPE that the patient will recover.

Our hospital has an ethics committee. When a case goes before futility, that means that the hospital is requesting that life support be withdrawn against the family's wishes. That committee is made up of 10 people. 7 physicians (not directly involved in the patient's care) and 3 nurses, also not involved in the patient's care. After review of the facts, the committee MUST be in COMPLETE 100% agreement. The decision MUST be UNANIMOUS!!!! The family is then notified of the decision and has 10 days to find an institution willing to accept care. The hospital will even help facilitate that in some cases. If no facility can be found, support is withdrawn after the 10 days.

No one wants it to come to this, and we're not hoping for anyone to die. But that's not the world that we live in and unfortunately people do die. I can also tell you in most of these cases, that 50 yrs ago, this conversation would never have happened because we didn't have the medicines or the understanding of the physiology or the ventilators sophisticated enough to get to this point.

When I became a doctor, I swore an oath. That oath says to do no harm. I believe that using medicines and machines to keep a person alive who has no chance of doing them harm. To watch as they slowly lose fingers and toes because their body can't maintain the blood pressure necessary to supply their organs and extremities is doing harm. In fact, it's cruel.

I pray everyday that God will give me the strength to get through another day of work...especially in an ICU. I pray for the wisdom needed to provide the very best care for my patients.

I'm not asking for you to agree with me. I only want you to know my opinion. I welcome the chance to know yours.

Post #2

Prophetic, but not in a good way
Current mood: determined

If had known how the next 42 hours would go when I posted my last blog...I wouldn't have.

Yesterday/Last night's call was the worst night of call that I've had since entering the medical profession.

The day started with a patient dying. While not unexpected, a child died, and that's never easy.

I then proceded to admit 7 patients. 7 ICU level patients. Granted a few of them were post-op still intubated observation patients...but there's still a lot of work that goes into getting them admitted.

Once evening arrived, all hell broke loose.

My fellow and I spent the next 12 hours taking care of 3 very sick children. It was so bad that our attending came in from home. Not because we're not competent, but because the kids were that sick.

On more than one occaision last night, I had to go look 2 parents in the eye and tell them that their child was so critically ill that I didn't know if he/she was going to make it through the night.

At 6 a.m. we turned the ventilator off with the child's parents at the bedside. It was the saddest thing I've ever seen.

But I survived. I'm still standing.

If we are never stretched, we never grow. No one ever said this would be easy. I never expected it to be.

Today marks a new day for me. It's a day I will never forget. I have much to learn. There is much to read and much to do.

Right now, though. I need some sleep.

Monday, October 02, 2006


Please don't tell me how long it's been since I've posted. I know. OK.

I thought that since tomorrow started a new rotation that I would at least try to blog now, since it IS an ICU and there's no telling how long it will be before I post again.

So the PICU is the Pediatric Intensive Care Unit. It's my first time in the PICU because it's not a rotation that we do as interns.

I have had 4 patients checked out to me that I will be responsible for in the morning. It will most definately be interesting.

It's getting late and I need that is all for now.

More later. I promise.

Saturday, September 09, 2006

On being Man

I have done much to express my manhood today. First of all, I slept until almost 10 a.m., which given my choice of professions, was a nice change of pace. Then after a little breakfast it was time to get a chore done that had been hanging over my head for a few days.

Beth's garage door was not working right. After talking to the garage door company and several local companies, it was decided that the extension springs needed to be tightened and the control board (computer motherboard-like thing) needed to be replaced. The garage door unit itself also needed to be moved over about 2 inches to be more square.

Since the control board came in the mail a few days ago, I could no longer ignore Beth's broken garage door. So, I took out the old control board, replaced it with the new one, and then had Beth help me move the unit over a few inches.

Then it was time for football! I can, without guilt, tell you that since coming in from the garage (with a perfectly working garage door) that I have done nothing but eat and watch sports on TV. I even managed to sneak in a little nap in my leather man-chair that was an absolute MUST when we moved in here a little over a year ago.

So now as I finish watching the Longhorns lose (which causes mixed feelings of sadness and happiness ((sorry Becky, nothing personal)) I feel it's been a good day.

The feelings of sadness are because I want the Big XII to do well against non-confernece opponents. Especially, in a game as significant as this one against Ohio State. The only reason I have any sence of happiness is because I see what MIGHT be a chink in the armor of the mighty Longhorns that MIGHT mean Tech has a shot at a win this year...especially since we play the Longhorns at home in Lubbock. The thing that worries me is that this Longhorn team is only going to get better and my Red Raiders had better get better themselves.

I love college football.

Monday, August 21, 2006

Dancin' the ?day away!
Brotherly love
Don't tell Mommy!
Am I cute or what!
Trying to post more than one picture at a time!
More Family togetherness
Family Togetherness
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Friday, August 18, 2006

Check this out...NO WEEDS!

Wednesday, August 09, 2006

Maurice Clarett

I just read this article:

It's about former Ohio State running back Maurice Clarett. I'm not here to judge or condemn him, merely make an observation. This kid had the world at his feet. He scored the winning rouchdown in the 2002 Fiesta Bowl and gave Ohio State the National Championship. The way he ran that season, he was on his way to a Heisman Trophy and a successful NFL career.

But something happened. Read the article. Somewhere along the way, he lost his focus, his perspective and decided that he should have whatever he wanted and...I don't know...that somehow he no longer had to work for it.

Apparently he didn't learn his lesson the first time he got in trouble.

Saturday, August 05, 2006

Not ready to say good-bye

My dad's mother, Granny, suffered a small stroke on the evening/morning of July 25th/26th. She and a group of her friends call each other every morning to make sure that things are ok. Well, that Wednesday morning when they called, Granny wasn't speaking correctly. They took her to her doctor who sent her straight to the ER in Tyler. There it was discoved that she had suffered an ischemic stroke on the left side of her brain between the speech and memory centers of the brain. Her speech returned later that day, not 100%, but it came back and she was able to communicate. To my knowledge, there were no physical effects from the stroke. She was in the hospital for 4 days and then released to go home. She still has some trouble getting her mouth to say what her brain is thinking, and she doesn't remember everything, but in all, it was a mild stroke and given her quick recovery, I believe that her speech and memory will return to normal, or near normal in time.

I was able to go and see her this past Tuesday and stay a few days. It was good to be there. I got to spend time with my dad and his wife. And I got to be with Granny. We didn't run a marathon, or even play endless games of Skip-bo...mainly we just sat. I read, we both fell alseep in our chairs, occaisionally we would talk about someone or something. But I got to be there; to spend time with her.

What I realized through my time there is that I'm not ready to say good-bye. Now you may be saying, "Duh!" as you read this, but hear me out. Granny has always been young. Even though she's older than 75 (I might get in even more trouble if I told you her actual age--don't be mad Granny), she's always on the go. She should have moved to Tyler years ago!! She could have bought Trump Towers with the amount of gas money she's spent on trips to Tyler. Anyway, she's emailing on the computer, baking for weddings or other church functions, or any number of things. She's always been young.

Needless to say, this stroke has slowed her down a little. I don't think it will keep her down for long, and I believe that she is going to be just fine...but I'm a doctor. I've seen strokes and the way they can affect people. It was a stroke that took my granddad's life 6.5 years ago. And when I got that call from my dad, it scared me. I didn't know how bad it was a first and naturally your mind assumes the worst. Granny was lucky. This stroke was minor and long-term I don't think will affect her too much. But in the last 2 weeks, I have thought alot about her. And I realized that I'm not ready to say good-bye.

I haven't had the chance to give her a great-grandchild. Sure she has 6 or 7 others and another on the way, but I personally haven't introduced her to one of my children. She hasn't been to Houston to see my house. She hasn't been to church to worship with me and Beth. She's never seen where I work. There are still stories about family that I want to hear. And Lord knows I can't keep up with all the outlaws and in-laws the way she can. There were 7 kids in Granny's family and my granddad had 2 brothers and a sister (I think) so you can imagine how many different families we're talking about. Not to mention her 7 grandchildren and their families (which I did above...see the great-grandchildren comment).

Again, this is all to say that I'm not ready to say good-bye. I absolutely hate the feeling I got that Wednesday when my dad called. I saw his number on the caller ID and remember thinking, "Oh good. Dad. I'm glad he's calling. It will be nice to talk to him." Then, in a heartbeat...the world changed, forever.

Unfortunately, I've had those phone calls before, and I'm sure they will come again.

Call your family. Tell them that you love them. Ask your grandparents how their day was. Call you little brother and find out how his life is. Call your spouse and tell them that your lucky to be married and can't wait to see them again. Life can change in a heartbeat.

Thursday, July 13, 2006

Good news and a few RANTS!

No, we're NOT pregnant. But almost 3 years after leaving, Beth has accepted the job as our church secretary and will give her 2 weeks notice at the state tomorrow. It's an exciting time for her and I am very proud of her and this decision to return to ministry. Her title may be secretary, but she's the front line minister, the one that people first talk to when calling in need of help. Her talents will be better utilized and she will be among Christian people who care about her very much.

Future rant (i.e not enough time to rant now, but this will keep you wanting more...): "Why I think the Texas Right to Life Organization" should NOT be allowed to exist.
You heard me. This Uber-conservative just said a not-so-conservative thing.

Current Rant. Up unitl 10 months ago, my mornings began with listening to Roula and Ryan on a local radio station. Then one day, poof, they're gone. And they were replaced by a COMPLETE dork and an IDIOT sidekick. I was mad, sad, and felt compelled to find a new radio station. I did that and Maria Todd and Atom Smasher became my NEW morning. I was just getting settled into their routine when, yup, POOF, Friday they were pulled from the air. No good-byes allowed. Just gone. Well my sadness turned to bitter-sweet joy when it was announced today that Roula and Ryan (and producer Eric) would be returning to radio. To the station that Atom and Maria were just fired from! It's ironic, and it SUCKS...that in order to get my morning show back, Atom and Maria suffered the same fate that took them away in the first place. Thank you Atom and Maria. I'm sorry that the radio business sucks. But then, I suspect you already knew that.

Final quick rant: Why did you go into Medicine if all you want to do is REFUSE to take care of patients? Huh? Quit argueing (or is it arguing? lazy to spell check) with me and trying to convince me...just come to the ER and admit the patient. It's your job. You agreed to do it. You chose a PRIMARY CARE RESIDENCY. If you don't want direct patient contact, be a radiology or a pathologist (I know these people see don't leave me nasty comments, I've been yelled at enough today)

Friday, July 07, 2006

My crazy Aunt-in-Law

This is for you Becky (not the one in Florida...but I love you, too).

So my wife's Aunt Becky is in town for the Astros-cardinal's series. Last night was game 1 which WE (the Astros) won. Now Becky has been a cardinal's fan since Moses was a small child. I'm quite sure that if you took the money she has spent on baseball games and the things associated with baseball games, as well as her vast collection of paraphernalia (that is drooled over by her nieces and nephews who not-so-secretly wonder what's theirs when she's gone) she has that she would be richer than Bill Gates. But let me tell you why I admire Becky.

She's a true sports fan. She loves her cardinals. She has had weekend season passes forever. She and her sisters (a.k.a a close group of girlfriends) make the 90 mile trek to St. Louis every chance they get. The make at least one out of town game every year. Or at least they try. The last few years they have come to Houston.

They know the players, their strengths and weaknesses, they know who their wives are and what they do in the community. We joked that when the cards finished playing in the old Busch Stadium that the would have to untie Becky chained to the ballpark before they could knock it down. Last year during the cards' race for the pennant, Becky turned up on all sorts of media. She and her girlfriends could be seen on the cards' website wearing these sparkly red wigs. I even saw her on TV (wearing that same wig) while I was in the ICU watching one of the games of the NLCS. Patient care did NOT suffer that night by the way. A nice man let us watch the game on his TV. He was intubated, but we're sure he was an Astros fan.

OK, I'm kidding, the room was empty.

Anyway, I feel honored to be the only male allowed to come to all 3 games of a series with the girls when they've traveled. I am in awe of their love for their team. They have different jerseys for each game. They've made friends with the owner of the bar across the street from MY ballpark (Minute Maid). They are happy to talk to any cardinals fan they meet. And they enjoy good healthy banter between themselves and Astros fans. Just don't get personal. That's rude.

I have to go work on my chicken impersonation, which I will use when the cards decide to pitch around Berkman again because they're scared, even though I'm sure it will never be as good as Aunt Becky's.

Happy Birthday (it was yesterday) Becky, and thank you for allowing me into your family. I love your niece more than words can express.

P.S. When the Astros sweep the cards, I'll buy dinner Saturday night. It will be my pleasure!

Sunday, July 02, 2006

Different Name--Same Me

Yesterday, July 1, 2006, marked the beginning of my second year as residency. I am no longer an intern. Now, I am a Resident. A friend asked me if I was excited. I told him I was, mainly because now I could just say that I'm a resident and not an intern and not have to explain to people the difference between the two. Although, I am still troubled that people don't understand what I do.

A man at church today asked me if I was about ready to trade in my short white coat for a long one. ?huh? This man sent me a graduation gift A YEAR AGO when I GRADUATED from Medical School!

So my quest continues: To educate people about who I am and what I do.

In case you are new to my blog (because you just happen to stumble upon it) or perhaps you've forgotten, I will tell you again who I am and what I do.

I am a doctor, an M.D. I have been since May 28, 2005 and I have the diploma on my wall that says so (that sounds bad...but I'm saying it anyway). For my specialty, I have chosen a primary care residency. I am training in a combined program. I will be Board Certified in two specialties when I'm done three years from now and take the two tests required to be so.

First specialty is Internal Medicine. It is defined as "a primary care physician who specializes in adult internal medicine, specifically the diagnosis and nonsurgical treatment of diseases."

Second Specialty is Pediatrics. It is defined as the "care and treatment of infants, children and adolescents."

Ergo I am training in Internal Medicine/Pediatrics or Med/Peds...hence the title of the this blog, "Ramblings of a Med/Peds Resident (the word Resident has replaced Intern).

When I finish my residency on June 30, 2009, I will look for a job that will allow me to see anyone from birth to death with a non-surgical, non-obstetrical medical problem.

I promise that I will try to Ramble with a little more consistency that in the previous year. I am in the ER at the county hospital this month and will work 18 shifts, so perhaps I will have a little more time to blog.

Thanks for reading.

Thursday, June 22, 2006

One Day More

On June 24, 2005 I began a journey called internship, residency, or graduate medical education. Take your pick. Tomorrow, a leg of that journey ends. Tomorrow is my last day as an intern. Tuesday was my last night of call as an intern. My next night of call, I will be responsible for some new intern (who starts this Saturday, June 24, 2006).

As with the passing of any year, the past 354 days have brought changes. I started to list them off, but have suddenly lost the motivation. Well, here are a few.

1. I legally wrote an order in the hospital for a patient to get OxyContin (which would have been enough to kill me, but he had built up a tolerance).

2. I crashed a 10 yr. high school reunion--moved after soph yr, but went anyway. I had a great time. Reconnected with some dear friends. Even the ones who bailed and didn't show, but will remain nameless to protect the guilty.

3. Good friends moved away.

4. Friends hace divorced.

5. My niece has grown--AND IS TOO CUTE!!!

6. I still don't have children (ok this is the same, but there are some out there that wish this would change...keep wishing for now)

7. The Astros made it to the World Series.

8. Beth went to Game 5 of the 2005 NLCS where Pujols hit s game winning 3-run HR in the top of the 9th with the Astros 1 out away from their first World Series.

9. She left early. She didn't see the home run. That's the night we met Stella.

9a. I survived 11 call nights in the Medical ICU with an idiot for an upper level.

10. Jeremy and Vanessa got married.

11. We had family to our house for Christmas for the first time. It may be the last.

12. I started my first rotation on the Pediatric side in the NICU (neonatal intensive care unit) and I pray daily that I never have to go back. My first Pedi rotation in 2 1/2 years. What a nightmare.

13. I learned the day BEFORE the NICU rotation that my attending "was disappointed and expected more of me." HELLO!?!?! You waited 28 days to tell me this because...?

14. I saw the Lion King for the first time in San Antonio, in a theater that I performed in while in college.

15. I've seen hundreds of patients and went through a dozen pens. As in, ran out of ink and had to get a new one.

16. I've written my name so many times in the last year that there's no way I will EVER forget it.

17. Pharmicist are annoying.

18. Patients lie.

19. I can't say that the parents of my pediatric patients annoy me, because they are my patients, too. At least they can be.

20. I met Roger Clemens this week and got him to sign a t-shirt for me.

21. I will be tired for the rest of my life.

Ok, I will stop now. I'm not sure exactly what the above really is...but then again, the title of my blog is "Ramblings of a Med/Peds Intern". And thus, I have rambled.

Look for a title change in a few days. First, "Vacationing Med/Peds Intern". Then July 1, either, "New Med/Peds Resident" or "Scared out of his mind Med/Peds PGY-2"

Finally, the last thing new this year,, which makes me wonder if I'm some sort of online predator. Just kidding FBI and Mr. Homeland Security. No need to come to my house and confiscate my computer. I'm a pediatrician and I protect kids. You can refer to the 12 or so physician statements I've filled out in the last 3 months for CPS stating whether or not I thought a child's injury was the result of abuse or just some freak accident.

My pledge for the PGY-2 year of my residency (it's 4 total in case you've forgotten)

1. To continue to educate people as to what the heck it is that I'm doing. No one knows what Med/Peds is.

2. To blog more. Especially for my adoring fans who read everyday.

3. To read more.

4. To sleep...SOME.

5. To watch the 20 or so movies that I missed in the last year.

6. To be a better husband. This one should actually be first. There's always room for improvement.

7. To consider having children. Even considering it at this point is HUGE. But that does NOT give you the ok to ask. When it's time, I'll tell you, PROMISE.

8. To continue to strive to be the best doctor that I can.

9. To get more sleep.

It's time for me to go.

More soon. See number 2 above.

Wednesday, June 21, 2006


Is this me of whom you are speaking? (our English teachers would be proud)

Well, in 3 short days (5:00 p.m. CST, June 23rd), I will no longer be an intern. Does that mean that I have to rename the blog? I have been contemplating this thought for several days now. Your input would be greatly appreciated. Changing the title would be easy enough, and I guess the web address could stay.

3 days. My, my my...has it really be 52 weeks ago that I began the journey called internship? Much is left to reflect upon, and being an "upper level" will certainly bring many new challenges.

I will leave this for now, but I PROMISE that in a few short days I will satisfy your curiosity with the brilliance that is this blog.

Now stop laughing, get up off the floor, and get back to work.

3 days.

Sunday, May 28, 2006

Decide NOW!

If you are put in a position and given the authority AND expectation to make a decision...then MAKE IT!!!!!!

Grow a spine and make a decision that might save someone's life!!

And if you're not capable or comfortable enough to do this, then please, PLEASE!!!! get out of my way and let me do it. And do NOT question me when I do!!

Thank you. I am done venting and will now try to get some sleep on what otherwise has been a pleasant call night.

Friday, April 28, 2006

Inspired by Barbados Butterfly

I am in the Well Baby nursery at my hospital. I see all new babies born to the university service and follow them for the duration of their hospital stay. Since I'm an Intern (for only 7 more weeks) I take a ridiculous amount of call. Although, I'm not sure that it will be any different when I'm NOT an intern. When on-call, I have been admitting patients to the general pediatrics service. In light of the conversation Barbados Butterfly shared in her recent post here is conversation that took place a few nights ago while on-call.

It's 3:30 a.m. I've been asleep MAYBE an hour (which is lucky)

Nurse: Doctor, are you covering pt. Doe?
Me: Yes
Nurse: His platelet count is 1.3 million
Me: That's high, we should repeat the lab to make sure it's accurate. How fast can we get the repeat results back?
Nurse: We can run it STAT.
Me: I think that's a good idea. Let me know the results.

1.5 hours later, I haven't heard from said nurse and decide to call.

Me: Hi, this is Dr. Brown. Did that repeat platelet count come back.
Nurse: Oh, we're going to draw that in about 10 minutes.


This critically high platelet count was so critical that you called me in the middle of the night to tell me about it...that you waited 1.5 HOURS to draw the STAT repeat lab?!?

To say I was annoyed is putting it mildly.

I am not dogging all nurses. I take pride in having an excellent working relationship with 99.9% of the nurses I have worked with. I couldn't do my job without them and there has been a nurse or 2 in my life that has saved my back side. So please do not flood my comments with venom and hatred where none exists.

Friday, April 21, 2006

? A Day Off ?

I'm not very smart. I finally get a day off from work with no other obligations and what do I do...I spend THE WHOLE DAY working in the yard. I have been meaning to re-mulch our flower beds for awhile now, but hadn't gotten to it. Well, yesterday was the day. Beth had pulled weeds from the main bed, but hadn't gotten to the 2 beds beneath the 2 trees. (there's still a 3rd bed where the weeds are threatening to take over). So I spent the morning pulling weeds. Then it was time for a trip to Lowe's for mulch and a few flowers. I also stopped by an attending house, she's got an AMAZING garden, for some plants that she offered to share with me. Then to the grocery store for some dinner items and then home to start (what I THOUGHT was going be) dinner. It finished cooking at 9:15 last night. That story in a minute.

So I managed to get the 2 beds around the trees planted with flowers and mulched before dinner. I also managed to plant the ground cover and plants given to me. Then it was time to go in and get dinner ready. Boy was I in for a surprise!

So corned beef, according to the directions, should cook in 2.5 hours. I failed to realize that crock pots don't get that hot that quickly in order to fully cook the meat in that amount of time. So 3 hours later, 6:00 p.m., when it was time to eat; dinner was still raw. Chipotle here we come!!! It also gave me the chance to go back to Lowe's to return the liner I bought to go around the beds as a barrier to the grass. The whole setup was $108.00 and I decided that money could be better spent elsewhere. So I took them back. Then, back home to finish the yard, I still had mulch to get out.

By the time I finshed it was dark, so I have no idea how the beds look. Then this morning, it came a GIGANTIC THUNDERSTORM. It looked as though the flowers and mulch survived, but I'm anxious to get home and see. I guess I will spend my next day off finishing the one last bed on the side of the driveway and all will be complete. Of course, by then, it will be time to mow again and I will spend even more time in the yard instead of enjoying my day off.

The corned beef will be eaten for dinner tonight. I even bought garlic bread (the really good kind from the supermarket with LOADS of butter and garlic on it).

The other bad thing about working in the yard...I always pay for it for the next few days because muscles I didn't know I had, hurt. I feel 90.

Saturday, April 15, 2006

Easter Saturday

So I sit in the Newborn nursery here at Hermann waiting to checkout my patients so that I can go home post-call and get some sleep. Call wasn't too bad. I went to sleep at midnight and the pager stayed quiet until 3:30-4:00 (I can't really remember now).

Anyway, I stood up for myself yesterday in a fashion that I rarely use. Someone said, "G--D-----". I said to this individual, " God doesn't damn anyone. In fact, today is the day he chose to save us." (It was Good Friday yesterday, the day Christians celebrate the death and resurrection of Jesus.)

I REALLY hate that cuss word (I'm sorry to admit that I am more tolerant of others--sorry Mom); because I truly believe that God doesn't damn anyone. He desires that we all be saved (See John 3:17). We make choices, and ultimately those choices may lead us to an eternal damnation, but God isn't responsible, and He's given us salvation and redemption through His son, Jesus.

As we celebrate this Easter weekend, I hope that you are able to spend it with family and/or friends. If you can't make it to family, call them and tell them you love them and wish you were there. Remember the death and resurrection of Christ in a way that's meaningful to you.

Pray for a tired Intern who is 75 days away from being an Upper Level Resident and will soon have a brand new doctor (aka me 295 days ago) under their tutelage.

Also, if any of the above doesn't make sense, or if I repeat myself, remember, I'm 30 hours without meaningful sleep.

Happy Easter

Monday, April 03, 2006

Well Baby Nursery

So, since April 1, 2006 I have examined at LEAST 50 newborn babies. Some in the first few minutes of their lives. And I have already spent 40 hours in the hospital (again, this is since Saturday morning at 7:00 a.m.)

It's going to kill me.

10 hour days
30+ hours when on call (7 times this month)
4 WHOLE days off between now and April 30.

Call me in May. Ok?

Monday, March 13, 2006

Life's Lessons: Best (and hardest) way to learn. AKA Strep Throat

So after 7 days of vacation (spent working around the house) I began work in the Pediatric ER at the county hospital. On my second 12 hour shift, I began the day with a four child MVC. 3 siblings and a cousin. Mom (aunt) was in the adult ER and these kids ages 6-13, give or take a year or 2, were all brought in on strechers with C-collars on. Before these collars can be removed, the c-spine must be cleared. That means that the attending must see and examine the child and loosen the neck brace and palpate (or feel) the vertebrae while keeping the head still and in alignment while asking the child (or adult) if there is any pain. If the patient says, yes, there is point tenderness, then x-rays must be done (with the c-collar FIRMLY in place) to rule out a fracture. I digress for my whole reason of this post, these 4 kids were funny, but time consuming.

THEN!!!! We got what we refer to as a five-fer. Often an exam room will have a two-fer; 2 patients for the price of one. Usually siblings with the same complaint and same parent who both need to be seen. It then becomes the job of the doctor (i.e. me) to sort out who has what symptoms starting when and how bad. 2 patients at once is never fun, but tolerable. So, back to my five-fer (which is kind of funny, my high school principal was a Pfeifer--She was GREAT!)
You'll see in a few minutes why my typing is irractic and wandering.

5, fünf, cinq, cinque, 五 (that's Chinese according to, cinco, FIVE children in ONE room (one TINY room) at ONE time, with their mother (who happened to be pregnant with #6)--ages 2, 3, 10, 11, 12. Guess what, they all had the same complaint. Sore Throat, nasal congestion with green drainage, fever.

Strep throat culture: positive in 2/3 kids tested.

So 3 shots of Penicillin for the 3 oldest. The 3 yr old had an ear infection so he got oral amoxicillin.

Now, you would have thought that I was sawing off one of the girls' arms with a butter-knife the way she screamed and carried on while I was giving her the shot in her "hip" (butt, people, it's the butt). I was in that one room for a complete hour seeing those 5 children. By the time I got them their shots and medicines and discharge paperwork, 5 hours of my undivided attention had passed.

That was Thursday.

Friday, I went to the church to help with some friends' wedding taking place on Saturday. I went out Friday night with the guys to Dave and Buster's and played video games.

Long about 10:30 p.m., I started getting a headache and, yup, my throat started to hurt. When I woke up Saturday morning, I had a 102.0 temperature and felt like death warmed over. I stayed in bed, missed the wedding, and finally broke down and took ibuprofen to help reduce the fever. It did and I began to feel slightly better. I did, however, have to call in sick for my overnight shift in the ER Sat. night-Sun. morning. It's the first time I've had to miss work or school because if illness in a LONG time (4-5 years).

The fever returned in roaring fashion Sunday morning about 2 a.m. I was up for 3 hours before I took some more ibuprofen.

Side bar: Fever is not a bad thing. Our bodies raise the temperature to fight whatever
virus or bacteria is attacking us. Bugs like their environment to be just so, not
too hot, not too cold. When you have fever, your body is trying to denature the
proteins that keep the bacteria or virus alive, thereby killing them and helping
you feel better. So ride out your fever: kill a virus or bacteria today.

But fever also makes us uncomfortable, VERY uncomfortable at times. So, like good Americans, we take medicine. My fever broke for the second time about 6:30 a.m. Sunday morning and I was able to get a few more hours of sleep. By this point, I was feeling somewhat better and now had no more fever, so I called and told them I would be at work yesterday for my overnight shift (Sun. 7 p.m. - Mon. 7 a.m.). I was feeling ok by the time I got to work. Early this morning (5 a.m. or so)...I felt a small headache coming on, so I took some more ibuprofen. Then, around 6:30 started sweating again. I guess I had some fever and didn't realize it.

So, I left the hospital this morning and drove straight to my doctor's office. She is the doctor that I saw throughout medical school and she works at Student Health. Since she's on my new insurance--she's a UT doctor, I can still see her. Well, she wasn't in clinic this morning, but one of my Pediatric Attendings that I had worked with in Pedi Clinic was there. She was slightly confused when she saw me. We had only worked together once, so she knew she knew me, but didn't think she had seen me as a patient before. It took her a minute to put it all together. We laughed. Before the doctor came in, the nurse had swabbed my throat for the rapid Strep test. The doctor came in, asked me when my symptoms had started and how they had progressed and then she asked me, "So what do YOU think you have?" Even when I'm sick I get pimped about diagnoses...and like a good intern I replied, "Strep Throat!"

I win!?! Yup, those 5 precious children in the ER had graciously shared their Strep Throat with me. I'm forever grateful, really. And I, too, got to experience Bicillin L-A in the butt, which is my whole reason for rambling (the title of my blog is Ramblings of a Med/Peds Intern) on here. Through this experience, I will never forget that to treat Strep Throat you can give 10 days of amoxicillin 3 times a day, or a one time shot in the rump (TAKE THE SHOT PEOPLE!!!!) and that the shot is 1.2 million units of penicillin. 900,000 units of benzathine penicillin G and 300,000 units of procaine penicillin because the procaine helps anesthetize the injection site. It's an intrmuscular injection and most of the time it hurts.

Now, life teaches us the hardest but best because I just typed all of that above without having to look it up in a book. I couldn't do that a week ago. And having experienced it first hand, it's a lesson I'm not likely to soon forget.

One more bit of education. We (doctors) treat Strep Throat not to ease the pain of the sore throat. That will go away on its on whether we give antibiotics or not. The reason we treat Strep is that, left untreated, it can lead to acute rheumatic fever. And Rheumatic Fever can lead one to become susceptible to bacterial endocarditis (inflammation of the heart, vegetations on heart valves, i.e. bad things that antibiotics can prevent) which could lead to all sorts of headaches. So we treat. And the lives of our patients (and even ourselves) are better.

I am still ill, and even though I just re-read this post to make sure that there were no typos (I found TONS) and that I made is possible that the fever is still clouding my judgement and I missed a sentence or 2 that is completely off. Sorry, I will go sleep now and feel better.

Monday, March 06, 2006

MD Anderson Cancer Center

I am nearing the end of my rotation here at MDACC. I am on call and it's 11:45 p.m. on a Friday night. Sadly, death is near. I knew kids with cancer would be hard to deal with...

So it's now March 6th and I'm just now getting back to this post.

I was right. Death was near, but it waited until I left the hospital. One of the kids on the floor died Saturday afternoon after I left. The human spirit amazes me. This child (again, I must be vague for fear the HIPPA police will find me and drag me into the streets and beat me. They won't, but violations are $10,000 apiece and I'm a little short on cash flow right now, ha ha) this child, near death, basically said that they were waiting for a parent and a sibling to get to the hospital. Other family was already there. When the last of the family arrived, they had about an hour's worth of conversation and then this child died. The fact that they were able to hold off death to see family has no medical explanation.

I was sad when I logged onto the computer Saturday night before bed and saw that death had come. I laid awake for awhile thinking about the struggles this family had had. And the paradox that they now faced. One struggle was over, but another began the instant the first one ended. I'm not a parent, yet, (hopefully someday though), but I can't think of anything worse than to sit at your child's bedside and watch them die; whether it be due to cancer, or accident, or anything else. Kids are meant to live least longer than their parents, right? So to lose a child after a lengthy battle with was not lost on me that this family must now pick up, go home and learn to live again. And learn to live without their child. Hospitals get old, FAST. And kids with cancer are in and out of them all the time. An admit for chemo, stay a few days, go home (which is more than likely the Ronald McDonald house or a nearby apartment because kids at MD Anderson come from all over the world for treatment) come back because of fever (which is VERY serious after you've destroyed all the body's ability to fight infection), stay a few more days. Get blood, take pills, get woke up (is that proper English) every 4 hours for vital signs, have a whole host of residents, nurses, pharmacist, nutritionist, child life specialist, nurses, attendings, medical students, other cancer patients, volunteers come into your room at all hours of the day and night. It's exhausting to be in the hospital. A nurse once told me that the hospital is no place to sleep. If a patient wants to sleep, they should go home. Hmm....

So now that routine is over for this family and they must go home and try to understand what their new reality is. It takes time. And it takes time to live again. Beth and I just went through the motions for ? months ? after her dad died. I can't even really tell you how long it was. It's all very fuzzy. Which I think is the brain's way of helping you, us, me deal with such tragedy. I will think of them often and I pray that God will help them find peace quickly, so that they can continue being parents, aunts, uncles, brothers, sisters, sons, and daughters to the family around them.

Anyway, enough rambling. I need sleep for my last day of vacation that I will spend dealing with the builders who built our home and his crew that seems to have damaged my sprinkler system as they were building the house next door. This should be fun. I'll let you know how it turns out.

Wednesday, March 01, 2006

On Vacation

So I am officially on a week's worth of vacation. Now, I could use this as an excuse NOT to post over the next 7 days, but since I haven't posted since Valentine's Day (as some of you have pointed out) this excuse probably won't hold much 9% Normal Saline (lame attempt at medical humor...are you even thinking about laughing?)

So, I will post tomorrow, maybe. There is a post that I started on the 24th while on-call that never got finished because there was a constant stream of issues on the floor to deal with. Not to mention the fact that the code pager went off a few times....more on that later.

So tomorrow it is.

Tuesday, February 14, 2006

Mostly Love, but a little sadness

Happy Valentine's Day to you all.

I have a had a good day. I was joined by my amazing wife for lunch at MD Anderson after a morning of Pediatric Oncology Clinic. (This is also where the sadness comes in, but I will get to that in a moment). Then I was able to leave the hospital relatively early and go to the store to get the finishing touches for an evening at home. I cooked tortellinis, mixed veggies, and we had some TGI Friday's mozzarella sticks. I also found of little cup of semi-sweet chocolate in a microwave-able dish that was PERFECT for dipping the strawberries that I bought for dessert. I stopped and bought some daisies for Beth and some chocolates. And ,of course, there was the bottle of Llano Estacado wine. It was a nice meal. Candles, mood music, and dinner in the dining room (which we have never done by ourselves since we've lived here).

But I want to take a minute to talk about the sadness. During lunch, I'm telling Beth about a Mom that has decided to take her child to an "alternative" M.D. Apparently, this guy is conducting "trials" on alternatives to chemo to treat brain tumors. This mom has decided she is going to try.

I just went into a rant about this guy, but it's not the point of this blog. So I give you the condensed version. He charges $18,000-$20,000 as a down payment and then $7,600 a MONTH for "treatment". "Treatment can take 2 years. You do the math. You will read more about this guy in future posts.

What I wanted to say is this...about the sadness...

As I was talking about this kid, Beth told me that Annette, who lives in Southern Illinois, has decided to undergo Chemo and/or radiation after trying some alternative therapy. I was instantly reminded that it was Annette who called me and told me that Beth's dad, Gene, had died. I said that to Beth and she told me that she never knew that. She never knew it was Annette who called me. And in that moment, I was back in our condo on that November day, on the phone with Annette, hearing her tell me Gene was gone. And the sadness took over. A wash of emotions I neither expected nor knew how to handle. So I cried. Not sobbing, but tears welled up to a point that Beth knew I was sad. And so, she cried. And then we did what we almost never do...we talked about the day her dad died.

On this day that we choose to outwardly and openly express love, hear this:

Don't take love for granted. Don't overlook loves in your life. And don't think that you have tomorrow to love again or to forgive love. All we have is today. Call your brother, or your mom. Maybe it's your dad you haven't talked to in years. Maybe there's an ex-boyfriend or girlfriend with whom you need to talk. Not to "get back together" (especially if you're married to someone else). But perhaps to ask for forgiveness. Or give forgiveness. To find closure on unresolved hurt and misunderstanding. Maybe you need to call your best friend and cry because you're sad. Maybe you need them to cheer you up or impart their words of wisdom that always somehow seems to be exactly what you NEED to hear even when it's not what you WANT to hear. Maybe today is the day you let go of the hurt, the pain that love has caused. I'm sure you've learned plenty from it, now let it go. Maybe today is the day you let go of a "love" that continues to hurt. Maybe today is the day that you're finally able to tell love you exist. Or the day you're able to express your love to the fullest, deepest you've ever been able to. The day that you grab onto love and promise to never let it go, no matter how hard it struggles.

A guy a knew in high school was recently electrocuted in a baptistery. His name was Kyle Lake and his death was tragic. Here is an exerpt from the sermon that Kyle was to deliver from the pulpit that day:

Live. And Live Well.
BREATHE. Breathe in and Breathe deeply. Be PRESENT. Do not be past. Do not be future. Be now.
On a crystal clear, breezy 70 degree day, roll down the windows and FEEL the wind against your skin. Feel the warmth of the sun.
If you run, then allow those first few breaths on a cool Autumn day to FREEZE your lungs and do not just be alarmed, be ALIVE.
Get knee-deep in a novel and LOSE track of time.
If you bike, pedal HARD… and if you crash then crash well.
Feel the SATISFACTION of a job well done—a paper well-written, a project thoroughly completed, a play well-performed.
If you must wipe the snot from your 3-year old’s nose, don’t be disgusted if the Kleenex didn’t catch it all… because soon he’ll be wiping his own.
If you’ve recently experienced loss, then GRIEVE. And Grieve well.
At the table with friends and family, LAUGH. If you’re eating and laughing at the same time, then might as well laugh until you puke. And if you eat, then SMELL. The aromas are not impediments to your day. Steak on the grill, coffee beans freshly ground, cookies in the oven. And TASTE. Taste every ounce of flavor. Taste every ounce of friendship. Taste every ounce of Life. Because-it-is-most-definitely-a-Gift.

The night before Gene died, I called him. He had only been home from the hospital 1 day and I wanted to know how he was feeling. We chatted and had our usual banter of small talk. At the end of the conversation (and I didn't know why at that moment), I said to Gene, "I love you." He said, "I love you, too" and we said good-bye.

Remember to love. Remember to be loved.

Happy Valentine's Day.

Monday, February 06, 2006

Press the Red Button

Picture pages

So I can see why some have gravitated away from Blogger. I have grown tired of the picture associated with my profile and I am trying to change it. I have followed the intstructions and there is a new picture when I look at my profile while signed in, but when I navigate to the actual page, it's still the old picture. I am hoping that by publishing this post, the entire blog will update itself. I am tempted to move completely to MySpace, it's much easier to navigate...but I am hearing rumblings that it's primarily for people looking to "hook up"...but I'm not so sure I buy that.

I'll keep you posted. I am some words to say about MD Anderson, this months rotation, but I will save them for a dedicated post.

Rachel, ask me anything, call me anytime. My usual fee is $50/hr, but for anyone I've know since middle school, all consults are free (ask Jell-O) and welcomed. Others consults from other people may be free as well, but they will be adjudicated on a case-by-case basis.

Wednesday, February 01, 2006

February 2006

So it's a new month and a new rotation. Last month in the NICU only confirmed one thing...that I am not meant to be an intensivist. I want to be in the clinic. The month wasn't horrible, but it wasn't great. It was my first month of pediatrics since August of 2003 (THAT'S A LONG TIME PEOPLE!!) and I realize that my skills and knowledge in the world of pediatrics is REAL RUSTY! So, my New Year's resolution (on February 1st) is to read SOMETHING related to pediatrics for 30 minutes EVERY DAY. You would think this would be a given for a guy in my position, but it hasn't been. I was never any good at being disciplined enough to sit and read for hours on end. I'm much more hands on. I learn my seeing and doing. Unfortunately, that can only take you so far as an intern. There's too much to know to be able to wait and see it in clinic or on the floor. So, I will read. Everyday. Something. You can help hold me accountable.

This month is MD Anderson. Pediatric Cancer. Another highly specialized month in pediatrics that isn't going to help me in the clinic. I do hope that through this I can learn at least SOME of the presenting signs and symptoms of childhood cancers, so that if I do see them in clinic I will know that they need an oncologist.

I'll try to be more diligent in my posts, but something tells me I should use the 30 minutes I normally spend blogging...yep, reading something in a pedi book.

Days off this month: Feb 18th-19th---that may mean a quick trip to Dallas. I'll let those of you in Dallas know more soon.

Thursday, January 19, 2006

Hollow opens for Bon Jovi

Although I have no first hand knowledge, I do have on good authority that Hollow ROCKS and they did a GREAT job in opening for Bon Jovi. Beth, my wife, says that their presence was great and that they sounded amazing. If Hollow is fortunate to win the National competition, then they will get to open again for Bon Jovi. This time on the final night of their tour in Giants Stadium and will win a recording demo contract. At least I think that's how it works.

Hollow has a myspace page:

There you can hear 3 of the band's songs and read some of the comments by people who were at the concert. The night before the concert, they had ~40 friends. The night after the concert, they had requests to add over 100 people as friends on their myspace page. I (emphasis added) was on there as a friend BEFORE they opened for Bon Jovi. Of course, one of the band's members is my brother-in-law and I would love him and his wife (and her brother and his wife...I don't really know the drummer, but I can love him too, I guess) (if you're confused, I'll draw you a picture of the family tree later) even if they weren't on the cusp of fame and stardom (which they are). There's also a picture of Hollow with Bon Jovi. How cool is that!?!

I was reminded my 2 friends tonight that I'm not consistently posting...sorry. I actually have plenty to say, just no time in my 80 hour work week to say it.

I will write about the Neonatal ICU (NICU) in a few days. PROMISE!

Take time this week to stop and smell the roses. Dr.'s orders.