Ramblings of a Med/Peds Resident

NEW BLOG!

2010-03-14T23:28:00.002-05:00

I did it. I started a new blog. I hope you'll follow me there and continue reading. I will TRY to be more diligent in my posts.

Life of a Lubbock Doc

Time for a new blog???

2010-03-07T21:50:00.002-06:00

I started this blog at the beginning of residency (June 2005). I am no longer a resident and have not posted here since April 2009.

Is it time for a new blog? There is a new little girl due to arrive on or around July 12th that will SURELY need her own space.

I still get an occasional email from medical students interested in Med/Peds as a career path and I ALWAYS welcome questions. So I will likely keep this site up, even if it is inactive.

I am now working in Palliative Medicine and as an adult hospitalist, so I could always talk about that.

Is anyone still reading this? Anyone have any thoughts?

Anyone? Anyone? Bueller?

I know, I know...

2009-04-06T00:49:00.002-05:00

Yes, it's been since November since I last posted. But I've been busy! There's been too much that has happened to remember ALL of it, so we'll just leave it at this: Life has continued moving forward and here I am.

So we're on vacation. Beth and I. Just the 2 of us. We have THE MOST GRACIOUS HOSTS IN THE ENTIRE WORLD!!! Friends of Beth's parents from college live in Anaheim and have been letting us stay with then since our arrival Thursday night. Gene arranged for us a rent car AT NO COST, and then they bought our dinner Friday night in Laguna Beach. We will NEVER be able to say thank you enough.

To rewind just a bit, February 26th, I was in a car accident. I was making a U-turn and the first2 of 3 lanes of traffic stopped to let me turn (traffic was slow and backed up). There was NO ONE IN THE THIRD LANE...

UNTIL I WAS 2/3 into my U-Turn and then BAM! I hit the driver's side back door of a mini-van. Of course it was (arguably) my fault. She had the right-of-way, but she WASN'T THERE when I start that turn.

Anyway, I just got my car back THURSDAY April 2nd! It looks GREAT and the reason you pay for car insurance every month is because $7200 worth of damage and 30 days of a rent car cost you a $500 deductible. The body shop picked up the additional rent car days (insurance only pays for 30 days) because "they wanted the work done right" I think it's because the DRAGGED their DANG FEET for 5 WEEKS and knew there was NO WAY I was going to pay for those extra days.

It's like my mom said, after 3 weeks of paying for a rent car while Beth's car was in the shop, and then driving a rent car for ANOTHER 5 weeks while mine was being fixed, 5 days of a free car while on vacation made all those weeks just a little easier to take.

I am currently enjoying vacation in the land of nuts and fruits (and I don't mean the people). Ha Ha! There are pictures posted on my Facebook page. Maybe you can see some of them by following this link. Or this one. Then there's this one to see, too. I'll try them out in a minute to see if they work. Chances are, if you're reading this and the links are still there, they work.

Tomorrow is more L.A. and maybe the Long Beach Aquarium at the suggestion of Kalith. Tuesday we are back to Houston and then Wednesday morning I leave for Lubbock to meet with my future employers and to see the Daltons and my sister and her family.

I have LESS THAN 3 months of residency left. My last day of work before vacation last week was my last day of Internal Medicine Rotations. The last 3 months are Pediatrics. I am going to try to Moonlight in June and save up enough money that I don't have to work in July or August before starting my new job September 1st.

There are some exciting and not so exciting things on my To Do List:

1. Finish Neuro stuff for Internal Medicine

2. START ACTIVELY studying for my Internal Medicine Boards Aug. 24th

LATE ADDITION: We're going to see RENT in Dallas with GREAT Friends in May. We're TOO EXCITED!!! Anthony and Adam are playing the roles they originated on Broadway; Mark and Roger, respectively.

3. SELL MY HOUSE!!!

4. Move to Lubbock

5. STUDY for my boards

6. Vacation with Beth's family in August

7. SELL MY HOUSE!!!

8. Take my boards

9. Start work

There is one cool thing coming up that I hope I can work into the plans. Some of the Tech Choir Alum have decided to put together a reunion weekend for those that studied under Dr. Kenneth Davis. This includes world-renown opera stars, Broadway leads, and doctors like me. (Actually, I am one of 2 M.D.s that I know of that sang in Choir.) There are lawyers and mothers and nurses and teachers and computer people, and well, you get the idea.

I think it's GREAT! I haven't seem some of the people in 10-15 years!!!

There's just one problem. The reunion is scheduled for 2 days AFTER I START working foro Covenant. I'm not quite sure how I'm going to start work for 2 days and then ask for 2 days off. The reunion is scheduled for a Thursday morning through Sunday night. I am assuming that we're going to learn some music and present a concert, but I haven't heard any definite plans, yet.

So we'll see.

I'll keep you posted. And let's face it. It may take me that long before I post here again anyway!

Life is good right now. The time away has been much needed and much enjoyed.

We are starting to say so long to Houston. It is a bitter sweet time for us as we have made (hopefully) lifelong friendships that we're going to have to put some distance between. But we are excited about the challenges ahead. Beth is excited about her retirement (which happens to coincide with her 3_ birthday and my last day of residency.

These are thoughts best saved for another day.

If you know someone who wants to buy my house, DROP ME A LINE!!!!

Before I go, there are a few folks that need prayers. Some I know well, others are friends/family of friends, but I (they) covet your prayers none the less: Christi, Jason, Tom, Adam, Eric L.'s dad are all fighting demons of sickness. My sister's friend's home burned to the ground this last week. It was a family home built in the early 1900s, and they lost everything. No one was harmed, but they must start over, literally, from scratch. I know there are others that at the moment are slipping the mind, those without jobs, those drowning in debt, those mourning the loss of loved ones, those STILL trying to recover from Hurricane IKE. Keep these mentioned in your prayers. Thanks.

Because of His grace,

Jeremy

I bleed Raider Red

2008-11-09T16:04:00.002-06:00

I may have said this last post, but I have been a Texas Tech Red Raider fan since 1995, my freshman year.

I have never been more proud! Regardless of how the rest of the season plays out, I bleed Texas Tech. These guys have poured their soul into this season and have been rewarded with a 10-0 season. Graham Harrell is on pace to win the Heisman and I hope that Michael Crabtree gets to accompany him on the trip.

3 more games to go to get to Florida. ou is next, but...

I believe.

Sorry to the Nuthmans and Pembletons (Courtney at least), but I believe Tech will be victorious in 13 days and prove once and for all that Mike Leach is a genius and put together one of the most talented group of young men this country has ever seen.

GO TECH!!!!!!

A Night to Remember: Wreck 'em Tech!!

2008-11-02T18:03:00.003-06:00

There is no way that I can let this day pass without blogging about the greatest football game I've ever watched. I will watch the last 1:29 for the rest of my life and smile. I will remember standing in my living room, heartbroken, that after watching Tech DOMINATE Texas in every single category all night long, a late surge by one of the best quarterbacks in the country was going to leave Tech short one more time. I've been there before, many times. So close, yet so far away.

But I am a true fan. And I believe.

I knew 1:29 was enough time for Tech to march down the field and score. We'd done it 10 previous times this season. Why should tonight be any different? I was a bit nervous that we were out of gas. We had certainly left it all on the field. But I believed.

How could I not? We have arguably the best quarterback/wide receiver combination in the country. Of course the winning drive/touchdown was going to involve them both. Mike Leach wasn't going to trust this fate to our "stellar" kicking team (sorry Matt Williams (I know you're REALLY new at this) and Donnie Carona, but seriously guys. kick. ball. through. uprights.).

And then that throw, catch, and touchdown that I will remember for a lifetime. It capitalized, highlighted and symbolized a changing of the tide. Tech CAN will the big one. We CAN hold on and not snatch defeat from the jaws of victory.

Our gauntlet is just beginning. OSU will be tough, but they're very similar to Texas, and they haven't won in Lubbock in many years. Thankfully, we have a week off to prepare for OU in Norman.

Last, but certainly not least, the Big 12 Championship game.

I just saw that we're #2 in the BCS. With our strength of schedule, if we win out, we play for the National Championship.

Miami, here we come.

Remember, I believe.

Financial Peace...almost

2008-10-25T11:57:00.003-05:00

Anyone who has been is the same room with either me or Beth in the last 7 months has heard us talk about Dave Ramsey and his Financial Peace University. Well, thank God for Dave. I mean that. 2 weeks ago we took Beth's car in for an oil change and front end alignment. 4 days later, we noticed an oil spot in the driveway. Come to find out that the cooling system was mixing with the engine oil and overflowing.

Unplanned car repair: $430

Thanks to Dave Ramsey Emergency Fund: $1000

Not fighting or worrying about where the car repair money was going to come from AND not having to pay some stupid credit card company even more in interest: PRICELESS

The other thing I did today was stop the RIDICULOUS amount of credit card offers that come from the credit card companies. It's EASY. Take 5 minutes and go to this website. Answer a few questions, print the form out, sign it, and then mail it in. All that junk mail will STOP! Yea!!! I also called my credit card company to get them stop sending those dumb convenience checks. That took less than 5 minutes and I did something positive for the environment.

I say "almost" in the title of this blog because we still have one credit card bill and my car left to pay off before we are debt free. Yes, I'm ignoring my Medical School debt for now. Wouldn't you? But once the credit card and car are paid, we are essentially debt free. But Beth and I have found peace about money in our marriage. We still argue, but not about money.

post-Ike

2008-09-15T15:46:00.002-05:00

I just read my wife's blog and thought I would put my thoughts down on paper as well. It was actually suggested by one of the guys from church that spent the night with us at the church last night. I believe that he is right. We should record our thoughts, now, in the moment, because 6 months from now, we won't remember how we feel.

So my Ramblings are as follows:

My dad was right (he'll LOVE me putting that in writing), I didn't take this storm serious enough and I had no idea that I wasn't prepared.

Looking back, I'm not sure I could have been prepared until I went through it once. Perhaps, it was the near-miss of Rita that left me somewhat apathetic. I never have been the type of person to get excited when there's bad weather. I grew up in Tornado Alley and we practiced tornado drills in school where we would line up in the halls, hunched over, with our hands over our heads facing the wall. I think thunder storms are cool and LOVE, LOVE, LOVE to sleep through rain.

Yes, I knew there was a hurricane coming. Yes, if I had lived on Galveston Island, I WOULD HAVE LEFT ON WEDNESDAY 3 FULL DAYS AHEAD OF LANDFALL. Yes, I THINK PEOPLE WERE COMPLETELY IDIOTIC TO NOT HAVE LEFT! But I live 45 miles from the coast. How bad could it be? Right?

I was wrong, Dad was right. (there, I've said it twice, Dad.)

I am very glad that we left. I would have been fine hunkering down in our house. But Beth was nervous and wanted to leave. Our neighbors talk about how the wind was HOWLING; SCREAMING; Siren-like. I'm sure that would have freaked even me out, the guy who wasn't nervous. Beth probably would have divorced me. OK, I'm kidding, almost.

The other reason that I didn't worry too much was I had no idea what it means to lose power. Sure, we've all been without power for a few hours when a bad storm rolls in or when a car hits the electrical pole. But the house stays cool, the food doesn't spoil, and you can check your email that night before you go to bed.

After this weekend, I understand what it is like to not have power for DAYS. We lost power about 3:30 a.m. Saturday a.m. September 13th. It's now 4:00 p.m., 60 hours later, and I still don't have a home with power. Yes, I slept at the church last night on an air mattress in the a/c, but my home is without power. The food in the fridge was spoiled 24 hours ago and thrown away. I can't wash clothes, cook a meal, watch tv OR check my email (he says with sarcasm).

After fleeing the storm and spending a mostly sleepless night in an apartment with no a/c that was literally suffocating, I can home, unpacked, packed again, and spent another night away from my home against my wishes. This is not vacation. It's not taking a trip and being glad to be home. It's forced evacuation. There is angst, separation, and the anxiety of uncertainty lingering in the air. There's a sense of sadness and the realization that you're never going to be quite the same again. And I've basically lost nothing. Believe me, I am very much aware that there are MANY people who have suffered and who will suffer far more than me. My cousin, JNM, who's not really my cousin (his grandmother and my grandmother were sisters) has (maybe had) a house on the west end of the island. He can't even get there to see if anything's left. I don't even pretend to imagine what he or the others of Galveston Island et al. will endure in the coming weeks and months as they pick up the pieces and try to move on with their lives.

It's like we all felt post 9/11/2001, or how you feel after someone close to you dies. You're never the same. You have to learn to live in the new reality. The reality of a parent being gone, or a nation and it's citizens attacked. It's why the motto for 9/11 is "Never Forget." Someone much wiser than me once said, "Those who forget the past are condemned to repeat it."

So that's how I feel now. I am learning to live in this new reality. The new reality of having lived through a Category 2 (almost 3) Hurricane that has done millions of dollars worth of damage. My dad and his wife came to visit recently. We went to the Kemah Boardwalk for sea food. Kemah is gone. The restaurants are shells of buildings. The ferris wheel and Merry-Go-Round will have to be completely replaced. Kemah last year was the 6th most visited place in Texas. It will be months, perhaps YEARS, before people can enjoy it again. There is hardly a fence left standing in my neighborhood and most of the cities south of Houston proper. How we managed to escape with only one section coming apart (and I think we can simply nail it back together) is beyond me. Yesterday, we threw away at least $100, maybe more, of food. We almost couldn't get to our house yesterday because the streets were flooded and there are so much debris on the roads that it made them unsafe to travel.

Another bad thing about hurricanes is the anticipation of impending doom. With a tornado, you have 5, maybe 10 minutes warning. We were able to "get ready" for Ike for DAYS, almost one full WEEK. So your mind plays games on you. You get anxious. "Do I stay or do I go." And we all know that the media LOVES a story!!! It's ALL THEY HAVE TALKED ABOUT FOR DAYS. And now that the storm is gone and done its damage, it's all they CONTINUE to talk about. 24 hours a day, 7 days a week since Wednesday or Thursday of LAST WEEK.

And while Beth and I were fortunate, I guess we didn't escape completely unscathed. The church has suffered a significant amount of damage and we spent about 4 hours trying to clean up. It will likely be 4-6 weeks before we are able to worship in the auditorium again. But our congregation is a pilar of faith. I dare you to find a group of people who love the Lord and serve him unfailing more than these folks. There are many who are equal, but none who are more. Their committment to the love of Jesus Christ and his people astounds me.

So let the return to our "new normal" begin. Beth and I are back at work and there's nothing that screams more normal than that. The power will be turned back on, whether it's tonight or next week. And 6 months from now, I'll have to come back here and read this to attempt to remember how I feel.

I guess that's why I started this blog more than 3 years ago. Because we forget the further from the "whatever" we get.

Thanks for letting me ramble (even though it is MY blog) and thanks for reading.

Because of His grace,

Jeremy

Long overdue

2008-08-02T12:07:00.002-05:00

It's safe to say that my postings have been lacking. What can I say, I'm a busy guy. However, I am enjoying my last day of vacation before I start on the Medicine Ward service at LBJ.

So where to start. It's been a busy summer. I am now a fully licensed physician and hoping to be able to start moonlighting in September.

I think Facebook may well be THE greatest invention since sliced bread. I have been able to reconnect with many friends from high school and college. Most recently, I have found a dear friend of mine from middle school and high school. Courtney Hailey!

Courtney and I met in middle school choir. We were fortunate enough to be able to go to Vienna, Austria with our high school choir when we were freshman. That's really where the friendship took off. Her mom also went on the trip and made sure that we got the full experience.

I lost contact with Courtney sometime right after my freshman year of college. So it's been AT LEAST 10 years since we've talked. I tried to find her when Beth and I got married, but to no avail.

Anyway, another friend from Cooper H.S., Tim, found me on Facebook. We started talking and I asked him with whom he had kept in contact. As it turns out, Courtney was one of those people!!! After some delay, we finally talked this past week. It was SO GOOD to talk to her. I actually talked to her mom first. Then, got her cell phone number and sent her a text message.

I made her play 20 questions to guess who I was!!! It was CLASSIC! She tried to call me after asking like 2 questions b/c it was driving her crazy. The great thing about that is, since I got the new iPhone, I hadn't set up my voicemail. The message was still the generic, "You have reached 713-xxx-xxxx. The person you are trying to reach..." SO SHE STILL HAD NO IDEA WHO I WAS!

Since I didn't give in and answer, she HAD to play! It took her 9 questions to figure out it was me! She asked very good questions. Her last question was, "Is this Jeremiah Brown? (that's what she called me) Instead of answering her with a text, I called.

It was GREAT!! The reason behind this little scheme goes back to the 7th grade. According to those around me, I think I threw THE party of the 7th grade. I was Captain Oblivious back then (still am, really) so I had no idea at the time.

Anyway, Courtney was invited. Duh! and she kept talking about her friend "Vera" that she was bringing to the party. We didn't go to school with anyone named "Vera" and IT DROVE ME CRAZY for WEEKS!!! I had NO CLUE who was going to show up to this party with my "friend" Courtney.

The night of the party came and Courtney showed up. Turns out her "friend" Vera was...

wait for it

are you ready for this...?

an ALOE VERA PLANT!!! Absolutely HILARIOUS!!! I don't remember when I've laughed so hard as that night.

Unfortunately, Vera met an untimely end when the family moved to Tyler. Someone dropped her and broke her roots and she died. But I never forgot the TORTURE that Courtney inflicted on me over than plant.

So the 20 questions was a little payback. Yes, that was 19.5 years ago (MAN am I getting old!), but well worth the wait!

I may have said this before, but my personality is one that makes friends easily, and for life. It can be a bit of a curse, but I cherish friendship more than just about anything in this life. Case-in-point: I still know and talk to my 3rd grade teacher. I sang at her wedding and she and her family drove from Abilene to Guthrie for my wedding. I just remembered, I drew a picture of her in the 5th grade when she was pregnant with Sarah. What possessed me??? Only God knows. I still keep up with Eric...my first and best friend in Abilene. There are MANY others over the course of the past 22 years (that's when we moved to Abilene) that I still keep up with.

It's who I am.

I have been blessed richly.

One of my favorite movies is "The Shawshank Redemption." In it, Morgan Freeman it talking about the time after Tim Robbins breaks out of the prison. He says,

" I guess I just miss my friend."

Courtney, I have missed you and I am glad that we are reconnected. You and your mom helped shape who I am (as have many others). Get yourself an email address and stay in touch. That's an order! Michelle, it was an absolute joy to hear your voice again. You guys call when you go to Abilene...we'll see what we can do to meet you.

OK: Beth and I are going to see John Mayer tonight and I need to get some things done.

Thanks for reading.

It's done...

2008-06-14T09:27:00.002-05:00

...and it only took me 31 YEARS! I received word from the Texas Medical Board yesterday (Friday the 13th) that my application for my medical license is complete and will be voted on my the Texas Medical Board during their June 26-27th meeting. I guess that means I can finally do what I've always wanted to do; practice medicine.

Now just to refresh: I am a doctor. I have been since I graduated medical school in May 2005. I started my residency June 24, 2005 in Internal Medicine/Pediatrics (explained in earlier blogs) and will finish June 30, 2009 and be board eligible in both Internal Medicine AND Pediatrics. This latest milestone means that I can now apply for a DPS and DEA number and on months that I'm NOT on call (which is VERY few) this next year, I can moonlight and make $50-60/hr instead of the $9.00/hr I make as a resident (remember, I work 80 hours a week...the math's not pretty)

It also means that for my 4th year of residency that starts July 1, I will be practicing medicine under my own license and not the "Physician-in-training Permit" that I have used for the past 3 years.

Even though we already had last night planned before I found out about my license, Beth and I celebrated the occasion with some dear friends at Cova (with some REALLY great wine) and then some good music at "The Mucky Duck". It was David and Sarah's 21st Wedding Anniversary and we had a really nice time.

Some other updates since my frequency of blogging (as if this surprises anyone) is not what my adoring fans would like it to be (can you hear the hysterical laughing in the background?)

-Beth and I have completed Dave Ramsey's Financial Peace University. We're on Baby Step 2. It has really changed how we manage our household and is forming our goals and attitudes as we prepare to move to Lubbock next year. Dave likes to say, "Live like no one else, so that later you can LIVE like no one else." You will now find us paying cash when we go out (like we did last night). We have delayed some of the things we want (a new car, a flat screen TV) until we can pay cash for them. No more charging, anything really, to the credit cards, and when we get the cards paid off...we're cutting them up. And next month when the new iPhone (I'm so excited I can't stand it) comes out, I'm paying CASH!!! I've been saving my mad money since we started Dave's class.

-Beth has a birthday coming up in 2 weeks and I still haven't bought her present(?s). My mom and her step-mother will both be here. We're are looking forward to their visit.

-We will be going to Southern Illinois at the end of July to see family and to pick up family heirlooms that belonged to Beth's parents.

-Our dear, dear friends the Daltons are leaving us (only temporarily) for Lubbock at the end of this month. We were all going to move to Lubbock together next year when Vanessa and I finished residency, but they have the opportunity to move now and let Vanessa finish in Lubbock closer to family. This is great because Talitha can be near her grandparents, aunts and uncles. We will miss them A LOT in the next 12 months, but we will be there soon.

-Tomorrow is Father's Day, so I have to give a shout out to my dad. Thank you for always pushing me to be the very best that I can. For teaching me that it's never ok to do something half-way. Thanks for being my sounding board when I don't know how to fix something, or move something. Thanks, Dad. I love you.

A GREAT quote

2008-04-24T19:37:00.002-05:00

I just remembered this quote that I in the past tagged onto the bottom of my emails. Don't be surprised if it shows up there again very soon.

"To laugh often and much; to win the respect of intelligent people and the affection of children;

to earn the appreciation of honest critics and endure the betrayal of false friends;

to appreciate beauty;

to leave the world a bit better whether by a healthy child, a garden patch or a redeemed social condition;

to know that even one life has breathed easier because you have lived.

THIS is to have succeeded."

Ralph Waldo Emerson

2 words

2008-02-26T21:37:00.002-06:00

David Archuleta

Help the chilren of my hospital--PLEASE VOTE

2008-01-31T08:47:00.000-06:00

Colgate is offering to build a fun room for one of the pre-selected children's hospitals based on who gets the most number of votes. My hospital, Memorial Hermann Children's Hospital is in the running. We're in third place as I type this post.

So PLEASE!!!! go there and vote. You can vote once a day, everyday, until Feb. 29th.

The link is:

http://www.colgate.com/app/Colgate/US/Corp/CommunityPrograms/show-the-love.cvsp

Click on the city of Houston and then select Memorial Hermann Children's Hospital.

THANKS!!!!

Happy 60th birthday Mom.

2008-01-21T21:30:00.000-06:00

So tomorrow is my mother's birthday. As the title of this blog implies, it's her 60th. We just returned from a weekend in Lubbock at my sister's that served 2 purposes. First, it was to meet the newest addition to the family, Alyxandria Kay or "Xan" or "Alyx" or "Aly" or "Isabelle" as Tori is wanting to call her. She was born on January 2nd, 6 days before her Mommy and Daddy were expecting. She is ABSOLUTELY ADORABLE and looks just like her Big Sister Tori did when she was born...all I can say is that my sister sure knows how to grow 'em.

We also spent the weekend celebrating the fact that tomorrow my mother turns 60. First of all, let me just say, that she is living proof that 60 is the new 50. I'm fairly sure it was me who convinced her to stop dying her hair some 5 or more years ago. If she were to dye it again today, you would swear she's 45. Mom was quite adamant that she didn't was anything new to dust. We thought for a long time about what we wanted to get her. We decided that I would make her a Powerpoint presentation of family pictures and that Kristina would write her a poem. Having a 2 week old in the house doesn't lend one time to being creative...so Kristina has until our April family vacation. Tori has also promised us a musical rendition of something worthy of Broadway. Beth is also going to put together a Scrapbook of pictures from this weekend and give it to Mom. Mom doesn't know about any of these other than the Powerpoint presentation...so HAPPY BIRTHDAY MOM!!

Lastly, I will apologize for my absence. I know it's been too long since I last blogged. Things here are going really well. I am working in a Med/Peds clinic in Pearland that has been a GREAT experience in showing me what a true private practice is like. Beth and I are doing well and hope that 2008 is the year of the baby, more specifically, our baby. We're trying, ok. There. It's said. In Public. Now you all know. And yes, we realize that January 6th was our 7 year anniversary. But James and Shelly waited 15 years before they had Echo, so we're not THAT far behind. But the offer has been long standing. We were happy to have children at anytime before now so long as someone was willing to move in with us and offer to take care of our baby for free. It's amazing...no one is 7 yrs even hinted that they were willing to do that. Anyway, I digress. I am studying for the last part of my U.S. Medical Licensing Exam: the USMLE Step 3. I take it on February 13th and 14th. Then I can apply for my state license and look for moonlighting opportunities. But I still won't write you a prescription for Vicodin or Percocet...so don't ask.

Lastly, this weekend was the first time that my luggage has managed to NOT make it to my destination with me. Long story short. Delayed 2 hours in Houston. Original flight from Philly diverted to Dallas. New plane to fly from Houston to Dallas. Changed planes in Dallas to original plane from Philly that was waiting on us. The 25 of us from Houston to Lubbock managed to make the plane change. Our luggage did not. We arrived in Lubbock at 11:45, 2 hours later than expected. Our luggage arrived at 10:00 a.m. the next morning accompanied with a $50.00 travel voucher. Gotta LUV Southwest!

We have less than 18 months left in Houston, so if you're going to come see us, the clock is ticking.

When Worlds Collide

2007-12-02T08:50:00.000-06:00

So last night 2 of my worlds collided. It was good. Real good. But that doesn't make it any less strange.

Beth and I came to Austin this weekend for several reasons. First of all, she's been like 4 times in the last 3 years without me because I am working all the time. Secondly, our dear friends Kalyse and Jackie live here. Thridly, one of my oldest friends from Abilene just moved back here from Florida. Now, she was supposed to stop on her way back to Austin from Florida in Houston and have dinner with us, but she got stuck in traffic in Baton Rouge and it was 9:00 p.m. before she got to Houston and she thought she just HAD TO GET TO AUSTIN so she didn't stop...but, whatever!! (I kid, I kid)

So last night Becky came over and we all went to the Capitol Building to sing Christmas carols and watch the lighting of the Christmas Tree. Then, we went to Matt's Mexican Food and ate some muy bueno food. Followed that with some Scattergories and laughing non-stop and a good time was had by all.

I have known Becky since the 1988-89 6th grade school year at Jefferson Middle School. Sadly, it's been 9 and one-half years since I last saw her. It better not be anouther (that's misspelled for you Becky) 9.5 yrs before I see her again or she's in trouble. We had your typical middle school and high school drama about who liked who or who was going to take who to what dance and meaningless stuff like that. But through it all, the friendship has remained. For that I am forever grateful.

Kaylse enters the picture during college. There's a whole 14 blogs to talk about all of Kalyse and mine's drama over the past 12 years...especially when it comes to her past roommates (think psycho on steroids and you might get close). Jackie comes into the picture because of Kalyse and Beth and I are thrilled to have gotten to know her. And Beth and JAckie can eat all the Sushi they want, while Kalyse and I laugh at them, make vomiting noises, and secretly wonder how they can eat that stuff and not get food poisoning.

And of course there's my Schmoopie, Beth. Next month is our 7 year wedding annivesary. Here's to 70 more!

So several of my worlds collided last night. It's always a little strange, but it's always good.

Beth and I have been blessed with dear friends in our life, both before we knew each other and since. We also got to see Jason and Sarah yesterday...they live in San Marcos, 30 minutes from Kalyse and Jackie. They looked really good and seemed happy and even though we didn't talk about Lily, their baby that died during childbirth about 4 months ago, I hope that they are finding some peace and know that we love them dearly. And they better get themselves to Houston during baseball season so we can go to a game. You have 19 months...so get yourselves there! You hear?!?

As we are in the throws of Christmas, I pray that you remember that Christ was born into this world in a manger and lived and died so that wouldn't have to die, at least not spiritually, and so that you can live with Him forever.

To friends: old, new, dear, forever, and those unknown.

Peace and Love.

Devoted

2007-10-31T21:39:00.000-05:00

There is much of which I can be accused.
-Overeating
-Procrastinating
-Not reading enough (this means about work and medicine)
-Not calling my friends often enough
-Tading cars WAY TOO OFTEN
-Not returning borrowed books, music, whatever in a timely fashion
-Many more I'm sure...

However...
You CAN NOT accuse me of doing Halloween this year half-way. Beth wanted us to be Charlie Brown and Lucy. She had a friend at church make her a dress and she bought me a football and ordered me the Charlie Brown shirt off of the internet. Well, I wanted to do my part:

For the first time since May, 1997, I am without my goatee. Yes, it's been that long. Beth has never seen me without and frankly, I'm not sure that she's going to sleep in the same bed with me tonight she's so creeped out. Anyway, it may very well be the most spontaneous thing I have done in the last 30 yrs. And it may be another 30 before I do it again. So enjoy! HAPPY HALLOWEEN

A Sunday to remember

2007-07-30T17:59:00.002-05:00

So yesterday I am getting ready for church. My pants were "fluffing" in the dryer and I had just leaned over the sink to fix my hair when I felt something running out of my nose. I looked down and it was blood...bright red blood and it was flowing fairly briskly. I've had nose bleeds before, so I got some toilet paper and put it in my right nostril. I waited for a minute and then noticed that the toilet paper was soaked. When I went to change it, there was a significant amount of blood that came out and I was still bleeding...BRISKLY.

I called Beth into the bathroom and told her that I might need to go to the Emergency Room. She said that she would drive me. Since she was teaching Sunday School and making the announcements during the service, I told her that it was no big deal and that I would drive myself. At this point, blood started flowing out of my LEFT nostril (it was the right one that started first).

This is when I said to Beth, "On second thought, you need to call someone to cover you and we need to go to the ER. Now."

So as to not freak my mother or mother-in-law out, I will not tell you how fast Beth drove to the hospital. You see, we live about 35-40 minutes from the hospital I work in. It was important that they go there, because I know they have ENT residents in-house and my ENT had privileges there.

By this point, I had surmized that I had an arterial bleed. The fact that I was bleeding so much and that the blood was so red, told me that it was arterial.

So we're in the car. Now you may be asking why I didn't call 911. Well, as I mentioned, we live 40 minutes from the hospital and I was convinced that it would take an ambulance 20 minutes to get to the house, not to mention the 40 minutes to the hospital. So we got in the car and drove. I get that from my dad. But that's another story.

In the car, with both nostrils packed AND holding pressure, I started swallowing a fair amount of blood. Now even I'm starting to get a little freaked out. I tell Beth to drive quickly, but safely. That when she came to a red light, she was to slow down, check for traffic, honk the car horn and go. Luckily for us, it was Sunday morning and there was very little traffic on the road.

I pick up my cell phone and called my ENT. His office message says that he is out ouf town and another ENT is covering. They give a name and phone number, but I can't very well hold pressure on my STILL BLEEDING NOSE, hold the cell phone, AND write down the number of the covering ENT.

So I called Hermann. I work there, remember. And asked to speak to ER triage. Then, I asked to speak to the attending physician. Luckily for me, it was one of the attendings that I know, and like. I told her who I was, that I had had surgery one month ago, and that I had an arterial bleed. I asked her to call ENT and told her that I would be there in 10-15 minutes.

We arrived at the hospital, Beth dropped me off at the front door, and then went to park. I walked in and asked for the attending. Again, luckily for me, the ER tends to not be a busy place on Sunday morning. I walk in, tell them I have an arterial bleed and that I've spoken to the attending. They get me in a bed, start an IV, and call ENT.

ENT was there within 10-15 minutes. It was soon determined that an artery in the posterior part of right nose was the artery that was bleeding. It was in a place that I couldn't apply direct pressure. That's why it didn't stop bleeding. And it wouldn't have without professional help. This is also how you can believe me when I say that I didn't cause this bleed because I was picking my nose. Digital trauma (nose picking) is still the number one cause of nose bleeds or epistaxis. But in my case, it was an artery in the posterior part of my nose. But I digress.

The ENTs were able to stop the bleeding there in the ER. They had just placed a surgical seal adhesive gauze thingy (yes, that's the technical medical name) when I started bleeding, AGAIN. They were going to send me home, but when I started bleeding again, and given that we live that far from hospital, we decided that it would be best for me to spend the night in Obs just to make sure everything was ok. We also decided to keep me NPO (nothing per os ((mouth)) in case it started bleeding again.

All of this, before noon. 2 wonderful friends from church brought Beth Whataburger and, yes, they ate it in front of me. They left and Beth and I took a nap and she decided to go home, let the dogs out, and would come back later. I called the ENTs around 5:00 to ask if they were going to let me eat dinner.

About 10 minutes later, one of the residents comes into my room holding a consent form. Guess what, no dinner for me. At least not any time soon. It was then that he told me Dr. Smith, my ENT, was on his way to the hospital, and that they were getting an OR ready for me.

Dr. Smith wanted to take me to the OR to cauterize the artery that had bled. He is going out of town this week, and didn't want me to start bleeding. This way, we would take care of it for good.

I called Beth and told her she might want to come back to the hospital sooner, rather than later. I actually felt bad for her, because I knew I would be in the OR before she could get back to the hospital. I did ask the ENT resident to make sure that Dr. Smith talked to her after the surgery.

The surgery went fine. They cauterized the artery and I went back to my room. More good friends from church brought Chipotle...mmmm, my absolute favorite. I slept on and off for the rest of the night and they let me go home early this morning.

Dr. Smith told Beth that he is concerned that I started bleeding this far post-op. The original surgery was one month ago. I should be well healed. We did go swimming Saturday and I did dive in the pool once, but he said that this shouldn't have made a difference. So, this Friday, I have an appointment to go see him and I guess we're going to talk about it.

I'm a little worn out, but no worse for wear. I am also grateful to my friend Mark who was working in the MICU who came down, said hello, held my cell phone while I was in the OR, and came to sit with Beth once she arrived at the hospital.

I must take a minute to brag IMMENSELY on my wife. She handled her self INCREDIBLY WELL concerning the pressure that she was under. She kept it together on the way to hospital, made phone calls that were necessary, and just did everything that you could ask for from the wife of a doctor who's bleeding profusely from his nose.

Double kudos for her having to hear over the phone that I was going back to surgery and that she wouldn't make it to the hospital before I went under. Again, the epitomy of poise and grace.

I'm a lucky man.

Trying to do better

2007-07-16T18:57:00.000-05:00

So I make no promises as to the consistency with which I hope to blog. However, I am going to try to do better.

I am now 16 days into my 3rd year of residency. Which reminds me, I need to update my profile. People ask me how it feels to be a third year and I tell them it's a little scary because now people actually expect me to know something. Huh, the nerve! But then I run across an Intern (whose been a "practicing" physician" for 3 weeks now) or Heaven-forbid a 3rd yr medical student, and I realize that I really DO know something. Because let's face it...they know very little. You might think that July would be a dangerous time to visit a teaching hospital. Actually, I think the opposite is true. In July, EVERYONE is more careful, and the upper level residents (me) are checking EVERYTHING the interns say and do. So feel safe, just keep one eye open when some scared kid that looks twelve and was born around 1981 comes into your room, ask him if he's 100% sure about what he's about to do and then ask him if he asked his upper level (again, me).

I think I've said this is this blog, but my sister is pregnant with #2, so in January, Beth and I will be an Aunt and Uncle x2. We're REALLY excited!

Ciao

No more packing!!

2007-07-05T19:24:00.000-05:00

Just thought I would post a post packing picture. I didn't realize until now, that I couldn't breathe through my nose. It's SO MUCH EASIER to breathe now! I am SO glad that I had the surgery. Thank you Dr. Smith.

I CAN BREATHE!!!

2007-07-03T19:27:00.000-05:00

So I went back to the ENT's office today and he unpacked my nose! I CAN BREATHE!!! AND I can taste food again! I can TOTALLY tell a difference in my breathing pre-sugery and now post-removal of packing. The true test will be to see if the snoring is any better. How can it not be, right?

I am on call tonight and MD Anderson. I am covering any patient with a solid tumor. They don't even tell us how many patients that is because I'm sure it would scare us silly. Basically, I am here to give medicines to sleep, pee, poop, and pronounce anyone who might die overnight.

Beth and I plan on driving to Palastine, TX in the morning when I get off to see my dad. Kristina and Eric and Tori will also be there. It will be a quick trip as Kristina and fam have to drive home and Dad has to go to work. But any visit is a good one.

Thanks for all the support and making-fun-of-me in my hour of distress (Becky) during the past week. There is chocolate cake leftover from Beth's birthday and homemade cookies from Chelsie that I plan on making out with tomorrow when we get home. Why? Because I can, AND I can taste them!

Peace and Love,

J

Beth-a-pa-loo-za

2007-06-29T22:26:00.000-05:00

So tomorrow is the day. The day that the love of my life leaves her 20s and joins me as a thirty-something. It's a bit surreal. I remember thinking that I'd never be 30. That there was no way that I could reach that age. Well, I have...and it's not so bad.

I do feel somewhat bad for Beth. This surgery of mine has put a bit of a damper on the normal week(month)-long Beth-a-pa-loo-za Celebration. Even though I can't taste food and have basically lived in my recliner for the past 5 days, I do still have a trick or 2 up my sleeve.

I would tell you here, but so far Beth hasn't managed to figure them out. WHICH IS AMAZING!!!! because the woman can smell a surprise for DAYS!!!

There will be some celebration tomorrow, but also, we are going to save some for once I am unpacked (my nose people, pay attention...or at least read that last 2 posts) so that I can enjoy the taste of a nice steak or a bottle of Spanish wine.

Now to the toast:

To the most amazing woman I have ever had the joy/pleasure of knowing and loving:

Welcome to 30. It's an amazing year and the beginning of the rest of your life. The past 29 have taught you many lessons that most of us spent a lifetime learning. You have handled them as well as anyone could expect. With grace and dignity. The thing that amazes me the most is that regardless of what life throws at you, you pick yourself up, dust yourself off, and keep going.

You are one of the funniest people I know. You are always making me laugh. And you laugh at me, I mean, at my jokes, even when they're not funny or when you've heard them 1 million times.

So this guys walks into the Psychiatrist office wearing
nothing but saran wrap for underwear...

You are fiercely loyal to those you call friends. You would give your right arm, without hesitation, to any in need.

You are talented beyond belief. Your knowledge of pop culture, alone, stops me in my tracks. You love music and art and poetry and the theater. Our kids will be blessed to have you for a mom. I'm quite sure you'll be the cool mom and I'll be the dork dad. I've been a dork a long time. It's a role I'm very comfortable in.

Your scrapbooks are unique and your talent flows all over their pages.

And your faith...you intimately know the God you believe in and serve. Your faith is your own and not some superficial feel-good. Your parents (all 3 of them) are to be commended. You are a faith giant and a prayer warrior.

Thank you for loving me and allowing me to share in this journey with you. It's been one heck of a ride over the last 8 years. I treasure each moment that I've had with you and smile with anticipation of those moments yet to come.

You give me reason to wake up in the morning and to come home at night. Your blue eyes mesmerize me and and pierce me to the core.

May you have the desires of your heart.

143.

Crash by Dave Matthews
You've got your ball,
You've got your chain
Tied to me tight, tie me up again.
Who's got their claws
In you my friend?
Into your heart I'll beat again
Sweet like candy to my soul
Sweet you rock,
And sweet you roll
Lost for you, I'm so lost for you

Oh, and you come crash into me
And I come into you
And I come into you
In a boy's dream
In a boy's dream

Touch your lips just so I know
In your eyes, love, it glows so
I'm bare-boned and crazy... for you.

Oh, and you come crash into me
Baby, and I come into you
In a boy's dream
In a boy's dream

And if I've gone overboard
Then I'm begging you
To forgive me
In my haste
When I'm holding you so girl,
Close to me

Oh and you come crash into me, yeah
Baby, and I come into you
Hike up your skirt a little more
And show the world to me
Hike up your skirt a little more
And show your world to me
In a boy's dream
In a boy's dream

Oh, I watch you there
Through the window
And I stare at you
You wear nothing, but you
Wear it so well
Tied up and twisted,
The way I'd like to be
For you, for me, come crash into me, baby
Come crash into me, yeah

Crash into me...
Crash into me...
Crash into me...

You know, I'm the king of the castle,
You're the dirty rascal, crash into me.
Please crash into me, baby...

Oh, no no no...
Yes, I see the waves
Come and crash into me.
See the waves come and crash into me.
Crash into me.

This is the pits

2007-06-28T10:39:00.000-05:00

The next time I tell you that I want to have an elective surgery...SLAP ME (but not on my nose). I don't know what I was thinking when I agreed to do this, but I must have been temporarily insane.

I can't breathe through my nose. It's constantly dripping. I can't smell, which translates into I can't taste. I have a constant dull headache. And everytime I swallow, my ears pop.

I go back to the doctor on Tuesday and in the meantime, I have to figure out how I am going to go back to work without freaking out my patients.

Here are a couple of pictures for your viewing pleasure.

Post-Op Day 1

2007-06-26T09:33:00.000-05:00

Let me begin by saying "OUCH!!"

When I awoke from the Anesthesia yesterday, I decided that I had changed my mind and didn't want the surgery after all. And then the nurse introduced me to Fentanyl. YEAH!!!

According to Beth, since I don't remember much immediately after the surgery, the bone spur was a alot bigger that Dr. Smith first thought. I don't know if that contributed to all the bleeding, but I bled so much that he decided to pack my nose, which he said he doesn't like to do. I now have 2 strings coming from both nostrils taped to my nose. I get to go to work looking like this! Even more YEAH!!

Beth still thinks that there's no way I will feel like taking call on Thursday, but we'll see. I already feel 10000000% better. I will spend the day in my recliner resting and getting better.

Oh and by the way: It's Beth-a-pa-looza! She turns 30 on Saturday.

Maybe I will aim for a post a day since I have a few days off to recover.

Maybe.

This doesn't count

2007-06-19T21:25:00.000-05:00

I know that I haven't posted in FOREVER and that this really doesn't count. I just wanted Becky to know that I am still breathing. Although, I am beginning to wonder if she's mad at me because I sent her some info and haven't heard from her. Not that I need constant praise and adoration, I don't. Just a little reciprocal, "Hey, I'm still alive, too."

I am working on a presentation about Inflammatory Bowel Disease and Crohn Disease. So I have to get back to it.

p.s. and by the way...I am having my nose broken (yes, on purpose) by an ENT on Monday, June 25th to fix my deviated septum and help me breath better. Come to find out, I have a bone spur on my nasal septum. I didn't even know that was possible. And though I am sure to be in pain and annoyed at the fact that I can't blow my nose for a week...I am going to blog. I want to post some before and after pictures. Then I can say I have something in common with Jennifer Aniston. It may very well be the ONLY thing that she and I have in common.

3 months...really

2007-05-06T21:54:00.000-05:00

OK OK OK!! I admit it. I have SERIOUSLY dropped the ball on blogging. I have plenty of excuses, but none of them are very good. I just haven't stopped long enough to type. Plenty has happened since the eve of my turning 30. I did that, turn 30, and didn't feel much different than I did when I was 29.

I have completed my 6th month of ICU since becoming a doctor. Only 2 more to go in the next 26 months. That's VERY exciting to me!!

I took a job in Lubbock, TX, home of the Texas Tech Red Raiders (my Alma mater in case you haven't been reading long or don't know me very well). This, too, I am excited about. I didn't think that I would ever leave Lubbock. But the medical school match and other events in my life gave me the opportunity to get out and see the world. I'm now about to finish my 6th year here in H-town. My how time flies when you're having fun. But I digress.

Back in August or September, I heard that a hospital group in Lubbock was recruiting primary care physicians (Internist, Pediatricians, and Family Practitioners) because they were going to encounter a shortage in the next few years. Because of this, they were willing to offer monthly stipends and sign on bonuses to residents who were willing to sign an employment contract and come work for them when they finished their residency. It sounded too good to be true. Extra money for the next 2 years to do the same thing that I'm going to be doing for the next 2 years anyway. I job locked up. A place to live. And good friends that are going to do it too. Well, as of April 30, 2007, it's official. On or before September 1, 2009, I will be one of Lubbock's newest physicians. Beth and I are TOTALLY excited. We have AMAZING family and friends in the area, the Daltons are moving back with us (pediatric residents with whom we spend an insane amount of time), and I get to be a true Med/Peds physician in a clinic that it yet to be built and practice medicine. Too cool. Way too cool. I think my mom may be even more excited because she hopes that there will be another grandchild who she can spoil just as rotten as the one she currently has. Kristina, that means you, ha ha ha.

Last, but not least, is my friend Becky. Even though it took her like 2 months to acknowledge my turning 30, I would like to say a few things about her here and now to help her commemorate this occasion. I'm a little fuzzy on some of the timing, but I know it happened.

I don't remember when Becky and I met. I know that I was invited to her birthday party in the 6th grade, I guess that would have been 1989. She had THE PARTY OF THE 6TH GRADE. The details are completely junior high and silly. Let's just say that it's a night I won't ever forget.

As for 7th grade...well, it came and went.

We found ourselves in choir together. I'm sure there were other classes, but it would be choir that would carry us through for the next million years or so. We were also both brass players. She the French horn, me the coronet. And Mr. Anderson...boy was that guy uptight! We made it to high school and...did you go to the Tech Choir camp after 8th grade??? I don't remember. The top choir (which we weren't even allowed to audition for) was going to Vienna, Austria right before Christmas. Mrs. Perkins gave us freshman an opportunity to raise money and go since it was a once in a lifetime trip (even though they went back a few years later). Becky and I were on that trip. Along with Courtney and James Norvell and a whole bunch of other people. 9th grade is the year that we started taking voice lessons together from Ms. Walker. Remember the time you were playing with her pepper spray at HSU and set it off? We had to clear the building because we were choking. Good job. We also went to Tempe and played in the Fiesta Bowl Parade. There are still things that happened on that bus (not between us) that should NEVER be mentioned again! That was a year of trips. Seriously? Seriously.

10th grade is a little fuzzy. It was the summer after that I moved to Tyler. We both ended up in Lubbock in our college years...and well...things happened. We lost touch until it was time for our 10yr high school reunion. I found a website and decided that even though I didn't graduate with you guys...that you're the group I call home. Family. Friends forever.

I have said this before, but I will say it again. Part of who I am today is because of Becky, Eric, Rachel, Courtney, Chad, Jason,...and a host of others.

Thank you Becky for your friendship, your laughter, your phone calls after 10:00 when my dad answered. Thank you for "Joe's Bar and Grill, this is Juanita speaking how can I help you" Thank you for the 6th grade skating party, and the 7th grade Halloween party, and choir and band and voice lessons, and all those times that you were there for me. Thank you for continuing to be a part of my life. While I've not been near as elegant as you in some of your birthday posts, I hope that you know you are one of my dearest friends. Thank you that we have weathered our storms and still remain friends. Thank you that our craziness can still make the other laugh. Thank you for allowing me to be a part of your life. Thank you for sharing your story. Thank you for being you.

I am so excited that you are about to be an aunt. Being an uncle to the cutest 4 yr old on the planet, I can tell you it's one of the greatest joys on Earth.

Welcome to 30...may the next 3 decades be at least as much fun as the first 3.

May the Lord Bless You and Keep You.

Always,

Jeremy

p.s. I came across this picture a few months ago and I can't resist posting it here. It's a good picture and not near as bad as some of mine (which hopefully you don't have and won't repay the favor). It doesn't have the year on it. When was this??

29 years, 364 days

2007-02-10T22:46:00.000-06:00

In about 70 minutes, I will no longer be able to call myself a Twenty-Something. I will be a Thirty-Something. It's hard to believe. I can remember when I was younger thinking that being 30 was something almost unobtainable. I had no idea what my life would be like.

I'm a lucky man. I have parents that love me and have tried every day to make sure that I had everything that I needed and quite a few things that I wanted. I am still friends with people that I have known since 3rd grade, and I love them dearly; even the ones that came along a few years later. I feel a sense of pride and accomplishment that we've been able to stay in touch and that we continue to share in each other's lives. I can't name them all, but much love to Eric, Becky, Rachel, Lara, Jason, Chad, Courtney (wherever you are) Martha, Carol, Chris, Paul, Rhonda, Kevin, Joe, Daniel, Chris, Jeremy, Billy, Wes, Mark and several more whose names don't immediately come to mind.

I was blessed with the opportunity to sing in choirs throughout my life that have taken me to New York, San Diego, Vienna, San Antonio, New York (again), and all over the state of Texas. I finished my last 2 years of high school in Tyler, and while there, in fact, 12 years ago tomorrow, I turned 18 while singing with the TMEA All-State Choir. I attended Texas Tech University where I sang in the University Choir, the Madrigal Singers, and started the journey towards Medical School. In 1999, I met the woman of my dreams who would soon become my wife (that was 6 years ago). She knows me like no other, and though she may seem like my exact opposite, we fit together perfectly. I love her and can't wait to spend the next 30 years with her by my side.

Medical School brought new memories, new friends, and new challenges. Now in my second year of residency, the challenges still come.

I have no idea what the next 29 years, 364 days will bring. Hopefully children, a successful practice, more good friends, and deeper relationships with old ones. If I'm lucky, grandchildren will one day be seen. No doubt, more hard times will come.

But I'm a lucky man. God has enriched and blessed my life more than I deserve. I have wonderful freinds and family that fill my life. I love my job. I love my wife.

29 years, 364 days have come and gone.

I'm a lucky man.

A REAL Post

2007-01-11T23:38:00.000-06:00

So the Medical ICU is wearing me out. It's q3 call, which means that I am on call every 3rd day and in the hospital for 30 hours. I'm either on-call, post call, or pre-call (the day BEFORE being on call again. It doesn't leave time for much else (like blogging).

I don't think I posted it here, but on Jan. 2nd Beth and I, along with her brother and his girlfriend were in an accident. We were rear-ended and pushed into the car in front of us that I had to slam on my brake to avoid hitting. The guy behind me was already riding my bumper trying to get me to move over because I wasn't going fast enough for him and BAM! a four car accident when all we wanted was to go to Galveston for some seafood. We never made it.

No one was seriously hurt, but we still haven't heard an estimate on the damages to the Passat. It's been 9 days since the accident and 8 since I first talked to his insurance company. COME ON PEOPLE!!!!!

Worse yet, that same night, the phone rang at midnight, and Beth's grandpa had also been in an accident. A 21 y/o kid ran a 4-way stop at a high rate of speed and T-boned her Grandpa. His friend in the car with him was killed. Grandpa is ok, but has spent the last week in the ICU and should be moving to a rehab facility closer to home tomorrow.

It's been a rough start to 2007, but Beth and I are thankful for our health and the safety of our family.

I am making a mad dash to Lubbock on Sunday (post-call) to interview for a job Monday (pre-call) with Covenant Medical Group for when I am finished with residency in 2.5 years. I'm really excited about this opportunity. Bonus: I get to see my sister and 4 y/o old niece, and Kristina's husband too. So that will be nice. What won't be nice, is the speed of it all. I'll basically be gone 24 hours, to turn around and be on-call (30 more hours) on Tuesday.

I have found several old friends on MySpace and look forward to getting a chance to sending them a REAL email.

Lastly, the scale said 233 today post-call. 8 pounds since 12-28, 15 days ago. I already feel SO MUCH BETTER!!!! But I have a ways to go.

Right now, I have to go to bed. Thanks for reading.

Fat Resolution

2006-12-29T21:47:00.000-06:00

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??

BUT I AM GOING TO DO THIS!!!!!

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.

Growing up

2006-10-24T11:33:00.000-05:00

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.

MySpace

2006-10-23T14:10:00.000-05:00

In response to Eric's comment:

www.myspace.com/utmedpeds

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

2 posts from my MySpace page

2006-10-18T21:40:00.000-05:00

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

PICU
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 patients...it'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 recovery...is 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.

PICU

2006-10-02T22:03:00.000-05:00

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 sleep...so that is all for now.

More later. I promise.

On being Man

2006-09-09T22:13:00.000-05:00

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.

2006-08-21T15:38:00.000-05:00

Dancin' the ?day away!

2006-08-21T15:37:00.000-05:00

Brotherly love

2006-08-21T15:36:00.001-05:00

Don't tell Mommy!

2006-08-21T15:36:00.000-05:00

Am I cute or what!

2006-08-21T15:35:00.000-05:00

Trying to post more than one picture at a time!

2006-08-21T15:31:00.000-05:00

More Family togetherness

2006-08-21T15:29:00.000-05:00

Family Togetherness

2006-08-21T15:19:00.000-05:00

2006-08-18T08:11:00.000-05:00

Check this out...NO WEEDS!

Maurice Clarett

2006-08-09T20:30:00.000-05:00

I just read this article:

http://sports.espn.go.com/nfl/news/story?id=2544230

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.

Not ready to say good-bye

2006-08-05T21:18:00.000-05:00

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.

Good news and a few RANTS!

2006-07-13T22:17:00.000-05:00

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?...to 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 patients...sometimes...so don't leave me nasty comments, I've been yelled at enough today)

My crazy Aunt-in-Law

2006-07-07T11:59:00.000-05:00

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!

Different Name--Same Me

2006-07-02T22:01:00.000-05:00

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.

One Day More

2006-06-22T21:32:00.000-05:00

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, MySpace.com, 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.

Blogger burnout...me?

2006-06-21T22:50:00.000-05:00

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.

Decide NOW!

2006-05-28T00:24:00.000-05:00

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.

Inspired by Barbados Butterfly

2006-04-28T10:10:00.000-05:00

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.

HUH?

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.

? A Day Off ?

2006-04-21T14:30:00.000-05:00

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.

Easter Saturday

2006-04-15T10:29:00.000-05:00

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

Well Baby Nursery

2006-04-03T21:27:00.000-05:00

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?

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

2006-03-13T20:20:00.000-06:00

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 Google.com), 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 sense...it 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.

MD Anderson Cancer Center

2006-03-06T23:49:00.000-06:00

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)...so 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 forever...at least longer than their parents, right? So to lose a child after a lengthy battle with cancer...it 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.

On Vacation

2006-03-01T21:08:00.000-06:00

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.

Mostly Love, but a little sadness

2006-02-14T18:51:00.000-06:00

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.

Press the Red Button

2006-02-06T20:33:00.000-06:00

Picture pages

2006-02-06T19:55:00.000-06:00

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.

February 2006

2006-02-01T17:02:00.000-06:00

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.

Hollow opens for Bon Jovi

2006-01-19T23:08:00.000-06:00

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: http://www.myspace.com/hollowrock

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.

THIS JUST IN!!!!!!!!!

2005-12-30T20:11:00.000-06:00

WOW!!!!!!!

Beth just received a phone call from her brother, Will. He and his wife, Alana, and her brother, Jordan, and his wife Katie, along with a drummer are in a band called Hollow.

On January 14th, they will be opening for BON JOVI!!!!

We are so excited for them and this opportunity. Remember their name, Hollow. You heard about them here first!

Reflections

2005-12-30T16:14:00.000-06:00

It's Dec. 30th, there are less than 32 hours left of 2005, um, wow. So let's reflect.

A year ago I was 15 pounds heavier than I am right now, however, I'm 15 pounds heavier than I was 7 months ago...still -15lbs total.

Match Day came and changed my life. It was settled that Beth and I would spend 4 more years in Houston while I completed a residency in Internal Medicine/Pediatrics.

I graduated medical school and went gambling with my friend Billy. I bet $5 on black 11, minimum bet was $15, he gave me $10 and yup, it hit. $540 and ONE HUGE MISUNDERSTANDING later and Billy and I are forever friends.

Beth and I moved the burbs and have part of the white picket fence scenario (no 2.5 children...yet...unless you count Dante and Picasso). The house is GREAT and when they get done building the one next door (and STOP hammering at 6:30 in the morning) it will be even better.

I was not an MD a year ago and I didn't have the power to write prescriptions. Since then, I have I written orders in the hospital for everything from tylenol to OxyContin, morphine, and Levophed (a medicine to raise blood pressure when it's dangerously low).

I was reminded how fragile life is and how it changes in an instant. Kyle Lake was a guy I knew from Tyler, I wouldn't call us friends because we didn't really hang out and he was about 4 years older than I, but his parents were my Sunday School teachers and we had several conversations over a couple of years and Kyle never met a stranger and was always kind. Kyle was electrocuted and died in Waco seconds before he was to baptize a women into Christ. He left a wife, a daughter (5) and twins sons (3). The world has a little less light in it with him gone.

On a much happier note, I was honored to take part in the marriage of my good friends Vanessa and Jeremy Dalton. Dalton (to keep the Jeremy confusion to a minimum) was my resident when I was an RA in Wall/Gates and Texas Tech. After my taking 2 years to get into medical school, we ended up in the same med school class. His wife is in the year behind us. He's a Peds resident at UT-Houston and Vanessa is going through the match to be a pediatrician as well. Beth and I love us some Drs. Dalton. They are true friends and fellow dachshund lovers.

Christmas was spent at our house and most of our families got to come. We missed Scott, Kristina, Tori and Eric, and Beth's aunts and their families, but we got to spend time with Grandma Shirley, Grandpa Henry, Laura, Will and Alana, my Mom (Frances) and brother L.D., and my Dad even came for a few days. I wish my Granny and Grandmother had been able to make the trip, but much love to them both.

To 2006:

I'm sure you will be filled with love. Sadly, there most certainly will be loss as well. Lessons to be learned and patients to see. Memories to make and pictures to take. The road will be rough, smooth, steep, and have too many forks with too many decisions. Laughter and tears, making new friends and saying good-bye to old ones. There are songs to be sung, and blogs to type. Resolutions to make. And what would those resolutions be if there weren't a few to break. Is this the year the Lord grants us a child? Or are there roads yet to travel and lessons yet to be learned?

May the year be full of health. May the Lord have mercy on us and guide us with His love. May we stand firm in His grace when trials come and rest in His Strength knowing that His will is perfect and there is peace to be found in it. May we have the courage to make the right decisions even when they hurt and aren't easy or safe. May we hold our head high and be proud of what is good. May our dreams come true.

To you and yours,

Happy New Year!

Beth's new blog

2005-12-21T01:02:00.000-06:00

Beth has created a new blog at:

http://www.myspace.com/narnianwardrobe

I may move mine there, eventually...but I haven't had the time to stop and work with it and feel comfortable with everything.

Here's the link to my Myspace.com anyway:

http://www.myspace.com/utmedpeds

2nd post in 2 days

2005-12-17T00:32:00.000-06:00

Strangely, it's a nice night in the county hospital ER. It's 12:30 Friday night (Saturday morning) and there are no patients waiting to be seen. Hmmm. There's always a bit of superstition in the ER that we don't say the "Q" word, or things go down the tube. But we have an adequate number of physicians and no patients. So I type.

For some reason, I suck at sending cards. I did send Thank you notes for graduation, but I can't seem to get motivated about mailing Christmas Cards. And I certainly can't find the motivation to take a picture, put it on a nice card and THEN mail it. COME ON! Beth and I have received several nice cards from friends. Pictures of kids and Christmas trees...and each year I tell her that we're going to send cards to family and a few friends (not everyone we've ever know), but each year, Christmas comes and goes, and the Brown's have managed to once again NOT send a Christmas card. I think that Beth is working on some, and after the Mother's Day fiasco (it's too horrific to even speak about), my mom will most definately get a card BEFORE Christmas.

I do think that we'll manage to get some cards out this year. Beth has already started. So maybe.

Random shift in thought:

I am ready to switch to the Pediatric side of my training. I have mostly enjoyed these past 6 months in Internal Medicine, but it's time for a change. I am also nervous at the same time, given that Day 1 on Peds is in the NICU. Tiny babies that came too early. I will then spend a month at MD Anderson Cancer Center followed my a month in the Pedi ER. I spent a month in the Pedi ER as a 3rd yr. med student and had a good rotation. Again, the switch from adults will be nice. I'm a little leary of kids with cancer...I have no idea how I will handle the saddness. Hopefully there will be more days of hope and joy than loss and despair.

I have found myself constantly humming Christmas carols. Two radio stations here in Houston are playing nothing but Christmas music until Christmas. Not holiday music, not season's greetings music, Christmas music. AND I LOVE IT! Even though I will spend Christmas Eve night and Christmas Day night (7 p.m.-7 a.m.) here in the ER, I still plan on having a wonderful Christmas with my wife and our families.

May this Christmas bring you happiness and joy. May your heart be filled with the love of family, food, and the celebration of Jesus' birth.

God Bless,

Jeremy

For Becky

2005-12-15T00:13:00.000-06:00

My friend Becky (Jell-O Universe) threatened me the other day if I didn't blog...so here it is. Hard to believe my last post was in OCTOBER ( I should be threatened!) but life as a resident is busy. November was a clinic month where I worked only 2 full days and 3 half days a week, sometimes..., so I really have no excuse. But there are others who have dropped the blogging ball, so I don't feel alone. I did get the chance to celebrate the marriage of Dr. & Mrs. Dalton in Lubbock and spend Thanksgiving with Mom, L.D., Grandmother, Kristina, Eric, and (the cutest little girl in the whole wide world) Tori. The rest was more than welcomed.

This month I am in the ER at the county hospital. Why would someone wait 8-9 (NINE!!!) hours to tell me they have a headache?!? Some people are really sick, like the HIV+ patient with a lung mass. Or they lady who came with a migraine, spiked a 103 fever, and left with a diagnosis of pneumonia. I'm happy to take of these patients, but really...you've had chest pain for 2 weeks (maybe because of the cough you have) and you come to me worried about your heart??? If you were having a heart attack...it would have killed you 12-13 days ago. And oh yeah...maybe you should quit smoking. It can't be good for your obstructive sleep apnea, high blood pressure, diabetes, or reflux disease.

I may seem a bit cynical, but it's 12:30 a.m. and I am up for the night. I start working the 7 p.m. - 7 a.m. shift tomorrow night (Thurs.-Fri) so I thought the best way to prepare was to stay up all night tonight (Wed-Thurs). So I have the next 7 hours to try and find SOMETHING that is going to keep me awake. I'll probably play some more games online (Spades, Bridge) and maybe watch some TV, although I don't want to bother Beth. I also desperately need to clean the top of my desk (which I haven't seen in weeks). I would like to think that I could pass the time by reading something medical related that I need to know (anything Pediatrics at this point) but lets face it...medical texts are not the most captive reads; great sedatives, though!

Beth and I are getting ready for Christmas at the Browns'. Her step-mother, Laura, and Grandpa Henry arrive the 22nd. Her brother and sister-in-law are coming...sometime. My mom and brother are coming the 26th. Her Mom's mom and Cousin Kristin are also coming although I have no idea when. Unfortuantely, I am working nights the 22nd, 24th, 25th, and 26th. But then I have the 27th-Jan. 2nd off, which will allow me to go to Dallas to watch Tech play and WIN in the Cotton Bowl.

One (more) random thought...wasn't I alive when Southwestern Bell and AT&T were the same company? And didn't the goverment bust them up after accusing them of being a monoploy? And didn't SBC and AT&T just merge? Hmm...

Sports Central!

2005-10-19T22:06:00.000-05:00

It's official. I'm forever an Astros fan. They are currently 3 outs away from their first World Series. I went to bed sad Monday night after one of the greatest home runs ever hit. My hat's off to Albert Pujols. I may have been even more sad that my WIFE got to go to the game while I watched it on TV. That's for another blog. Even if something goes terribly wrong in the bottom of THIS 9th inning (Game 6), I will still forever be an Astros fan.

The last few years have been tough. I married a Cardinals fan. Her aunt, Becky, whom you could find on the Cardinals' website in a red wig recently, has weekend season tickets. She's been a Cardinals fan longer than I've been alive. Needless to say, my Christmas present last year was a little tough to swallow. It was an Cardinals National League Champions t-shirt.

If the shoe ends up on the other foot this year...I hope she's as good a sport, because that's what she's getting for Christmas. Love you, Aunt Becky.

I am going to sign off now and watch the last 3 outs of Game 6. I have more to say about the Texas Tech, u.t. game this weekend, but I will save it for later.

GO ASTOS!!!!!

No time to post

2005-10-13T20:07:00.000-05:00

I know it's been awhile since I've posted. Sorry. But I am in the Medical Intensive Care Unit (MICU) this month and I am on-call 11 nights. That translates into 308-330 HOURS that I am physically in the hospital when on call. 28-30 hrs per call * 11 calls = 308-330 hours. And that doesn't take into account the 6-8 hours a day that I am in the hospital the day before I go on call. For a bit of perspective, if you have a "normal" 8-5 job and work 40 hours a week, then in one month's time, you work 160 hours. Needless to say, Beth said to me 2 weeks ago, see you in November (which has TEN GLORIOUS DAYS OF VACATION!!!). I have not gone more than 2 days (and only twice have I gotten 2 days in a row) in a row without having to go to work.

I'm not complaining, I'm just telling you why I haven't blogged in awhile. This month is MUCH different from last month at LBJ. The MICU has patients who are REALLY REALLY sick. Sick enough, that at any moment they can take a drastic turn, either good or bad. It's too early to say if it's going to be a good month. There are several factors that will need to be blogged about when I am not here and the potential for people who need to be blogged about are not around. (I'm fairly certain the previous sentence is a run on, and those of you who have degrees in English will anguish at reading it).

I was on-call the first day, Oct. 1, and I was MISERABLE! I had NO IDEA what I was doing. Luckily for me, the nurses here in MICU are OUTSTANDING! I have learned quickly these past 13 days and my confidence level is leaps and bounds higher than it was when I left here on day 2 after a 30 hour stent on-call. As an intern, most of the medicine I've learned in medical school is theoretical. They teach us about insulin, where it's produced, what it does, and how the body can mess that up. What they DON'T teach us is the Mr. X is a brittle diabetic and even the smallest amount of insulin makes him hypoglycemic and unresponsive. Other patients, who give them MASSIVE amounts of insulin and their sugars are still SKY HIGH. That's what I mean by theoretical. We talk about mechanical ventilation and breathing for patients, but we don't talk about the machines and the 45 different ways you can accomplish the same task, inhilation and expiration. It's just not as simple as "in and out" when the vent is involved.

And so I learn. I try to read. And I learn some more. I ask TONS of questions. And I learn. I have had to tell a family that it's time to say good-bye to their loved one and then write the order to turn off the vent. I've seen lab values that are incompatible with life and have the patient tell me where they are. People are amazing. Medicine is amazing. I wouldn't have it any other way.

On a much different note. Beth and I had the pleasure of Rachel's (a link to her blog, "The Wonder Years" can be found to the right) company at our house last night. She was in town for work and came over for coffee and brownies. We had a GREAT time. I've know her since...6th? 7th? grade. Her husband, too. I have yet to meet Buddy, but hopefully that can happen in the near future. Rachel spent about 2 hours with us and we laughed and talked about work and high school (she's a college recruiter) and had a nice time. I'm glad she came and hopefully she will come again should work bring her back to our neck of the woods. Rachel and I decided that we need to have Becky come to D/FW and we can have a mini-reunion with Eric and Christina since neither Becky nor I got to attend Eric's wedding. There was this hurricane that kept me from getting to Eric's wedding. I'm still a little sad about that. I've known Eric since 1986. 19 YEARS and counting. I've been friends with him longer than anyone outside of family. I hated not being there. Sorry, Eric. Life happens.

Well, I better get back to work. There are labs to check and orders to write.

One more comment. Texas Tech beats u.t. and ends their hopes for a national title.

Sorry, Becky, you are still required to love me and call me your friend. But you heard it here first.

Rita is Here

2005-09-23T13:57:00.000-05:00

Time for an update.

So it's 2:00 p.m., Friday, September 23, 2005. My sister's birthday. Happy Birthday Sis! Remember in my last blog that I said it would probably take Beth 8 hours to get to Austin. It took her 28, yes, TWENTY-EIGHT hours to go less than 250 miles. For her it was a nightmare. I was too scared to sleep. Never in my life do I ever want to go through what I experienced in the past 36 hours. There are many, many thoughts and emotions associated with it and Beth and I will spend many hours trying to sort them all out.

For now, the important thing is that Beth is safe. Dante and Picasso (our 2 mini-dachshunds) are safe. I LOVE VOLKSWAGEN!!! and they will get a BIG letter of THANKS from me in the near future. Beth drives a Passat, and when she left our home her gas tank was full. When she got to Bastrop (30 miles outside of Austin) 26-27 hours later, she still had 1/4 of a tank of gas. The batttery in her car is dead due to the extreme heat, duration of the trip, and not being able to go faster than 10 miles an our for 28 hours, but she didn't get stuck on the side of the road without gas. I am eternally grateful.

I am going to be at LBJ County Hospital until the storm passes. We have some critically ill patients that will be our help should we lose power and backup generators.

Regardless of what you may hear on the TV and radio. IT WAS ABSOLUTELY IMPERATIVE THAT PEOPLE LEAVE WHEN THEY DID! If they had started the evacuation 24 hours later, many, many people would have needlessly lost their lives. They system worked. Maybe not 100%, but it worked. We wil lnever know how many people were
spared because they made the decision to leave, even if they did sit on I-10 for 16+ hours.

Time to get down to business. Take care, and I'll again when I can.

Because of His grace,

Jeremy

Rita is coming...and she's not bringing Tequila

2005-09-21T17:44:00.000-05:00

Gulf Hurricane, Take 2

It's Wednesday night and I felt the need to blog before Rita makes her presence known. Rest assured that the citizens of Galveston and Houston and the surrounding areas are taking Rita and her fury extremely seriously. It is taking 5 hours (normally a 1 hour trip) to drive from Galveston to downtown Houston.

Beth plans to leave for Austin tonight in the middle of the night. It will probably take her 8 hours to make a normal 3.5 hour trip. She is taking the dogs and a few keepsakes and heading for higher ground. This storm is so big that I'm sure Austin will get plenty of rain.

Me, you ask? Well, as an intern in the medical field, I am reporting for duty. My team is on-call (admitting patients for the night) starting Friday morning at 7:00 a.m., a few hours before we start to see effects of the hurricane. We have been told that we will stay in the hospital perhaps untilSunday or Monday depending on the storm, since the other residents won't be able to make it to the hospital. Even if I have the opportunity to leave Saturday morning, I won't. Beth and the dogs will be taken care of and I'm sure that they will need help in the hospital.

Say a prayer of us. That the casualties will be few and the damage minimal. Pray for patience as people spend many hours in the car trying to get out of harms way.

Time to batton down the hatches. See you on the other side.

Jeremy

Thank you notes

2005-08-25T20:16:00.000-05:00

This may well be the area of my life that I STINK at the MOST!!! I've NEVER been good at writing them. It's not that I'm not thankful. It's not that my mother didn't teach me better. I am. She did. I'm eternally grateful for the kindness and thoughtfulness that has been shown to me in the past. I just can't (or won't, or DON'T) sit still long enough to write a simple thank you, put a stamp on an envelop, address it, and put it in the mail.

When I sent out graduation announcements I PROMISED myself that I wasn't going to revert to my old habits. That if people were going to take the time to congratulate me, that it was only RIGHT AND PROPER, that I take time to THANK them.

The first 10 gifts I received...thank you notes went out within a week! Then we moved, then I graduated, then I started residency.

You know where this story is headed.

LAST NIGHT...I finished the thank you notes for gifts received for graduation! Mind you, some of these notes have been DONE in their envelops since JUNE!!!!! I just never stuck them in the mail. Do you know how hard it is to find stamps these days??

I'm quite sure that I've forgotten SOMEONE and more than likely I've sent someone a thank you note TWICE for the SAME gift. But at least they're done and not sitting there staring at me. I am going to hand deliver the thank you notes from our friends at church who not only came to graduation, but came over our house that night and helped us celebrate. Billye brought GREAT ice cream, Lorinna made an AWESOME cake, Jenny brought cherries, Gerry and Mary brought pigs-in-a-blanket, Jo brought daisies to plant in the flower bed, and I know there are a few others that I'm forgetting.

I was so blessed to receive cards from friends and family. Some of whom I've known my whole life. Friends of my parents, parents of my friends, and friends I've made along life's journey. I am truly thankful they took the time to write. Thank you. Your continued friendship, love, and support mean the world to me.

Anyway, that task is done and next week I am going to start addressing our Christmas cards. Maybe you'll get your's by Valentine's Day!

Ha!

STOP SPAMMING MY BLOG

2005-08-21T18:43:00.000-05:00

Is there NO shame?!? I have had to alter how comments are left on my blog b/c the wonderful world of spammers have decided to invide my blog. So STOP! This is a place for me to catalog my life as an intern and NOT a place for you to litter my website with your dribble. Does anyone know how to STOP this MADNESS. THOSE comments will be welcomed.

"Primum Non Nocere"---"First, Do No Harm"

2005-08-20T18:02:00.000-05:00

"First, Do No Harm" These words are not actually in the Hippocratic Oath, but that is a discussion for another time. I want to tell you about their application in my life.

EDIT: in the first edition of this post, I had a long story about a pt and surgery. Here's the 2 sentence version.

Chance finding on CT, pt to surgery, pt experienced a complication, different surgery. Now with colostomy (he had a bowel resection after a perforation) intubated and in serious condition with a good chance for a MAJOR infeciton that could lead to septic shock and his death.

I tell you this story because it reminded me that nothing we (I) do in the practice of medicine is without consequence. Pt. X's AAA was an INCIDENTAL finding. If we hadn't done a CT Abdomen, he might have lived the rest of his life (?30-40 years?) and never known he had this. And now, he's fighting for his life in th ICU because we "helped" him. I belive we did the right things for Pt. X and no malpractice has occured. But life is fragile and sometimes even feeding a patient after surgery can be dangerous and not without risks.

The morning of this second surgery, there was ALOT of confusion when he came back from surgery. He was dehydrated and evetually required 17 liters of fluid. His family was there asking questions that didn't have an answer. I had come to know X's wife, because he's been in the hosptial for several weeks. I noticed that no one had gone out to talk with her.

So I went.

I couldn't give her a prognosis, I could merely explain what had happened, what the surgeons had done, and that all we could do at this point was wait. We had hit a bump in the road and things were going to be rocky for several...?days? I felt completely inadequate, like ANYONE other than me should be the one talking to this family. But I was the one who had rapport with them and felt I should go.

So I went.

His wife started crying, which meant that I started crying. She hugged me and we cried a little more. It was good. I don't mind admitting to you that I cried. I was scared, she was scared, neither one of us knew what was going to happen in the coming days. I'm glad that I went. I believe that I made a small difference in this family coping with bad news. The day I can't cry at something tragic and sad, is the day I need to find a new line of work.

Call

2005-08-06T17:58:00.000-05:00

I have managed to survive my second night of call as an intern. Let me explain. I am on a rotation in the CCU--the Cardiac Care Unit. The patients we admit either have a previous diagnosis of heart disease, or they are being admitted to our service because they have experienced "chest pain" and need to be "ruled out" for having a heart attack or MI (myocardial infarction--fancy way of saying heart muscle injury). Monday, Aug. 1st, was my first day in the CCU, we change rotations on the first day of each month. I was on call. My first night of call as an intern. Call means that we show up to the hospital at 6 a.m. one day, see our current patients, and admit any new patients to to the cardiology service to our team. We do that all day and all night until 7 a.m. the next morning. Then we round with our attending (see previous post for hierarchy of doctors) and go home (hopefully) by noon, 18 hours after we entered the hospital. We go home, sleep and show up at 6 a.m. and start all over. Call is q4, meaning that every 4th night this month I will spend the night (not that I get to sleep there, mind you) in hospital admitting new cardiology patients and taking care of small issues with our current patients.
Call #1: Aug 1st. Starting a new rotation was ALWAYS unnerving as a medical student. Your grade depended on how well you performed and how well the attending and residents liked you. As an intern...It's worse. You show up at 6 a.m. and have 4-8 patients that assume in 5 minutes you will know their entire medical history, what brought them to the hospital, and how best to take care of them and send them home...All before the first (of many) bottles of diet coke has had time to settle in your stomach. And to top it all off, Day #1, I'm on call and carrying the CODE PAGER!! That's right, if someone in the hospital codes (their heart stops beating or they stop breathing on their own, or both) and a code blue is called, the code pager (I'm carrying one of many such pagers) goes off and alerts me (and a whole bunch of other epople) to the patients room number, where it is expected that I will show up in a matter of seconds and begin resuscitation efforts on that patient.

In case there's any doubt in your mind, this is one of the scariest things about being an intern. We all have to take ACLS (Advanced Cardiac Life Support) and learn how to "run a code," but until you show up and see one in progress and have someone asking you (me) what drugs to give to get this person's heart beating again...You have no idea what to expect.

So, of course, at 2 a.m. my first night in the CCU, my first night of call, the code pager goes off. Thankfully, I was not the first doctor there and therefore did not have to make any decisions. I would like to tell you that I put on my Superman cape, ran into the room, and in a moment of brilliance saved a person's life. It didn't happen that way. This patient was being well attended to by the time I got to the room, but I might as well have been 3 years old...I had no idea what to say or do. I don't know if I've ever been more intimidated in my whole life. I never went to a code as a student and like anything you do for the first time, you don't know what's expected or what to do or how to handle the situation until you've been there. [This is the main reason people without children (myself included) are so STUPID (again, me included) when they start talking about how they could raise someone else's child better, or how they would NEVER let their child do this or that] (This attitude has probably ensured AT LEAST 2 or 3 temper tantrums in Wal-Mart or a museum from children that I hope to have someday...Sorry Mom and Laura, that's not today, or even this month, really, not even this year. The next code I go to, I will be a bit more prepared for and hopefully will handle the pressure better.

Call #2: As I type this, I am post-call. I went to the hospital yesterday at 6 a.m. and got home around 12:30 this afternoon. I would like to say that in a city of 4 million people, no one got sick, no one had chest pains, and that no one came to the hospital. ALAS! None of that happened! Was it a full moon last night? I went to the ER about 3:00 a.m. and it looked liked a rock concert gone bad. There were people EVERYWHERE! Thanks to the same ER last night, and the nurses of 3 Cullen (the main floor where the cardiac patients go) I got a grand total of 30 minutes of sleep last night, and fortunately, not all 30 minutes were at one time (insert sarcastic voice here).

There's so much more I could tell you about last night, but let's face it, I've had little sleep and rambled on enough, even for me. Regardless about what (or how) you read the above...I'm loving it! I am doing what I've been waiting my whole life to do. I have MUCH to learn, but man, this is good stuff.

p.s--As I went back and read the above verbage, I realized how vulnerable saying these things can make me. It's hard to admit your failures or weaknesses and there are some who would say that they would have handled the code much better than me. And they would be correct. But they've been there and done that before. My friend, Keith, from medical school, who is currently in Iraq serving his country, was a paramedic before medical school. He ran TONS of codes on the back of an ambulance. As a 3rd year student, Keith happened to be outside a patient's room as they coded. Keith stepped in (as a 3rd year STUDENT, mind you) and began to run the code in spite of his attending and others there who were "??more qualified??" than he was to run the code. I was not there, but the story goes that someone asked Keith's attending (as Keith was performing CPR and yelling at nurses to push drugs) if he was capable of "running a code". The attending very matter-of-factly said, "Yes. And probably better than you or me." I will be in a code situation again, and by the time I finish my intern year I may not be a good as Keith (this guy is amazing) but I will be better at handling codes.

Lost

2005-07-24T10:56:00.000-05:00

No, not the TV show (which I've never seen). My wedding ring. It disappeared Wednesday night or Thursday morning. I have no idea. Beth and I went to dinner with my Aunt and Unlce and my mother's 2nd cousin (apparently he and I are not related at all, no 3rd cousins, no 2nd cousins twice removed). He is related to my mother and my mother is related to him and his father, but he and I are not legally related. That was an interesting conversation. I had no idea. But I digress. I remember having my ring at dinner. When we came home that night I put everything (at least I think I did), my keys, wallet, watch, my Alpha/Omega ring from Beth for graduation and my wedding on the "bar" ledge from the living room into the kitchen. I leave for the hospital early in the morning and often get dressed in the dark. So, I left everything in the living room. I got up Thursday morning and went to work. I don't remember NOT putting my ring on. As I was speaking to a patient's family member, I went to play with my wedding ring. It wasn't there. I have gotten into the habit was playing with it more lately. It's loose and comes off easily. At that point I thought I had simply forgotten to put it on that morning when I was getting ready. I knew it would be there waiting for me.

It wasn't.

It's been 3 days and no sign of my ring. Fortunately, Beth has NOT flipped out. I have. It makes me very sad. I know it's only material...but still, I wasn't planning on throwing it away or trading it in any time soon. One thing is for sure though, I will have to get a new ring soon. I can't stand the feel of there being nothing on my left ring finger. I hope that as soon as I do get a new ring, the old one will show up.

If you happen to find it, let me know.

I crashed a High School Reunion

2005-07-17T21:21:00.000-05:00

It was my high school reunion...sort of. For those of you who don't know, a brief explanation. I lived in Abilene, TX from Feb. 1986 (3rd grade) until July 1993 (end of soph. yr). This weekend was Abilene Cooper's 10 year reunion. I went. I only spent 2 years in Tyler and I can only think a 5-6 people who will be at that reunion that I would want to see.

On the other hand, this weekend in Abilene, I had the extreme pleasure of seeing some of my oldest and dearest friends. Friends who taught me how to laugh, how to love, how to cry, how to be me. I AM SO BLESSED!!! Many of these friends I had lost contact with after leaving Abilene. For some, it had been 12 years since I had seen them. This weekend, I felt like we were 16 again and that nothing had changed. NOT that I would want to BE 16 again! We had an absolute BLAST this weekend. Even Beth, my wife, who basically knew no one (and LOATHES these sorts of things) had a good time. As she will tell you, "Two makes a family." Looking as most of my former classmates, Beth and I are WAY behind in the baby department. Some had 3, THREE, kids. We have 2 dogs.

I had such a great time this weekend and I want to thank the "true" Abilene Cooper Class of 1995 for letting me continue to be a part of them. And thanks for helping Beth feel like a part of the gang.

Becky--your name is mud for not showing up. I hope you're ok.
Rachel and Jason--I'm sorry I didn't get to meet Buddy (name changed to protect the innocent) but I love you guys--see you soon.
Eric and Christina--Christina I'm glad I got to meet you, see you at the wedding. Eric, I hope that we always stay in touch--
Lara--your husband is a riot, I think he and Beth bonded (should we be scared?). I'm so glad you're happy. You look GREAT!
Em--you sure know how to throw a party!!!! It was SO GOOD to see you! Next time, I'll help!
Leya--I never knew your mom liked me so much, HA! I could have used that...your little girl is beautiful. Best of luck to you and Brian
Ann--I vote you, "THE ONE WHO STAYED MOST THE SAME" and I LOVE IT!!! You look happy, confident, and at peace. You're an amazingly talented woman and I expect great things. Perhaps the Mrs. and I can make it to AZ to see you!
Alison--you're too cool for words. Not many have the gumption to show up to a reunion unemployed! Best of luck...we need to have a mini reunion in D/FW (since almost EVERYONE from our class lives there!)
Shea--you're one of the funniest people I know. Don't worry, it's a good thing. I'm glad that you came and that you're doing well. Good luck with grad school. Hopefully you can join the mini reunion.
Rachel H-M--you're a dear friend--good luck with the one of the way. Your boys are too cute and I know that they'll love having a new brother/sister. Call us ANYTIME you're in Houston. Until next time, there's always email.
Ben-We have too many mutual friends NOT to keep up! Taiwan will be a challenge. Good luck with Mandarin
Andy--I'm sure we'll keep up through IM. I'm sorry it had been so long before this that we had talked.
Jackson and Erin--you guys look great, I know that you're already FABULOUS parents. Jackson, I know that you're patients are in GREAT hands. Good luck whereever life leads you.
To the rest of the Class of 1995, Emily L., Dave B., Tiffany H, Sherry S. Zac and Bru, Jurel, Emily C, Christy, Justin, and whomever else I've left off this list. Thanks. I can't wait to do it again 5 years from now.
To those from the class that are missing and that couldn't make it. You need to be found, and you need to show up in 2010. It really isn't the same without you.

I go to sleep tonight happy. Happy because this weekend I was able to relive some of the best years of my life with some of the best friends I've ever had. I'm a lucky man. Call me anytime.

End of the First Week

2005-07-04T08:23:00.000-05:00

I guess it's safe to say I survived my first week of internship. And no one died. At least none of my patients. I did feel bad for one intern...they came in one morning and one of their patients had died overnight. No, the intern didn't kill this patient. They were very sick and died of natural causes. But imagine how the intern must have felt. No one called to let them (I'm being gender neutral so there is no HINT of a HIPPA violation...I'll explain later) know that the patient had died. The last few days have been interesting.

In hospitals, the team of doctors taking care of patients changes every month on the first of the month. For me, this year...I will spend 5 weeks on the Renal Ward Team because interns started 1 week earlier. That meant that on Friday, me and the other intern got a whole new upper level staff. The resident was post-call from his June month, so he was at the house asleep. The Renal Fellow, who just finished her Internal Medicine Residency, was day 1 as a Fellow. And the Attending was new as well. Not a new attending, but new to the service. Let me explain the higherarchy that is Medicine.

Medical Students--what I was 2 months ago. Basically, can't do anything legal and therefore help their intern AS MUCH AS POSSIBLE!!! They are usually the ones running to x-ray or finding out lab results. We call this kind of work SCUT. And medical students are affectionately called Scut-Monkeys.

Interns--that's me--Graduated medical school 1-2 months ago. New MDs.
Interns are in their first year of their residency (3-5 yrs. depending on the specialty). Interns report to the Resident.

Residents--2nd,3rd,4th...yr of residency. They have supervisory responsibilities of the interns and medical students. Residents report to the Fellow (if there is one) or to the Attending

Fellow--done with Residency. A Fellow has chosen a sub-specialty--cardiology, Nephrology, CV Surgery, Oncology, etc. A Fellowship is 2-4 yrs and most always involves research. Fellows report to Attendings.

Attending--Staff--done with training. Could operate in Private Practice. Board Certified in their filed of training. Eligible to make more money than me, which is less than $40,000 during residency for 80+ hours/week.

So, it's a new month with a new team. My fellow intern was given 4 days of vacation around the 4th of July and won't be back until Thursday the 7th. In Internal Medicine, we all get 4 days vacation around a holiday...he just happened to get the 4th. That stinks for him. Mine are around Thanksgiving in order to attend the wedding of my friend and fellow (not Fellow) Pediatric intern, Jeremy Dalton. So, for the next 4 days, it's me, the resident, and the Fellow on the team. That translates into more work for me!

Happy 4th of July! I will work until noon and then go home and get ready for a little grill time.

In His grace.

Day 1, OVER

2005-06-24T19:18:00.000-05:00

Well, I guess you could say that I've survived my first day as a doctor. I actually had a nurse call me and ask what to do about a patient with chest pain. And let me just say...I've not often had quite so odd a feeling as I did today when I wrote a prescription for pain medicine for a patient to take to Walgreens or CVS, and signed MY NAME to it. Uh, that's weird.

Day one as a Med/Peds Intern began at 6:00 a.m., that's when I arrived at the hospital. I was up at 5:00! Thanks to the modern advances of technology, I was able to look up SOME information on my patients last night from home. Please understand that when speaking about patients or things I MIGHT have seen, I must be vague and general. HIPAA regulations guarantee patients the right to privacy and I personally could be fined THOUSANDS of dollars if it's found that I violate that privacy. So I won't. Anyway, I began to see my patients, introduce myself, and write notes in their charts that will forever, good or bad, be a part of their medical history.

It's all a little surreal. Today was not a bad day. Yes, it could have been better. Yes, I wish my resident had held my hand a little more..he didn't even check the prescriptions I wrote...we just sent the patient home...but at the same time, it's here. It's real. The chance to make a difference.

I covet your prayers that God will watch over me and guide me. That He'll make His presence felt, especially in those dark hours that are sure to come.

Please don't email me and ask for narcotics. The answer is no.

Jeremy L. Brown, M.D.
Internal Medicine/Pediatrics Intern
364 of 365 days as an intern to go

2005-06-09T20:23:00.000-05:00

Graduation cake made by Lorinna Hopping
Posted by Hello

Life moves on

2005-06-09T19:45:00.000-05:00

It's been 6 weeks or so since I've lasted posted. MUCH has happened! I will briefly recap. Beth and I moved into our new home on May 21. My dad came to visit on 3 days later and I don't know that he's EVER going to come back. After giving Lowe's Home Improvement store more money that I should have, we spent the next 4 days hanging celing fans, mini blinds ( a WHOLE house full) and 2 garage door openers. We didn't even get to the surround sound. We bought a lawn mower and weed-eater...after all the yard isn't going to mow itself. And then I HAD TO HAVE a grill, which will be used for the first time this Monday. Mary Fritz and I planted flowers. The splinkler system was installed and grass laid in the backyard. THEN family came. We ate, ate some more, went to my graduation from MEDICAL SCHOOL (yes, you can call me doctor), ate some MORE, then came back to the house and threw a party for 50-100 of our closest friends and family. It was more than a little nuts around here. Did I mention that Beth's friend from Oregon flew in Saturday afternoon about an hour before those 50-100 people showed up at our door? Jo Sandifer brought more work, in the form of Shasta Daisies and some Mexican Hair Grass which is now planted in the flower bed, which I LOVE! One of Beth's favorite flowers is the daisy. I can't wait for them to bloom. Billye Sims brought some fine ice cream and Jenny Fagg brought cherries. Mom and Grandmother brought banana punch (until the glass ladel broke and it had to be dumped out), banana cake and banana bread (do you sense a theme here...who knew I liked bananas so much!) Lorinna Hopping made an AMAZING cake...which I will post a picture of here when I'm done rambling. Mary Fritz brought pigs-in-a-blanket which were gone in 5 minutes. Someone in my family (at my request) brought wings from Hooters. (Please hum "These are a few of my Favorite Things" quietly to yourself. I'm sure that there are others that brought something that I have forgotten. Please DON'T shoot. I am grateful for EVERYTHING EVERYONE did to help out. Kristina and Eric were kind enough to bring my precious niece, Tori, to see us on Thursday at which time Dad quit working. She played and we all fell in love with her all over again. Please see rosesareredheads.blogspot.com for my sister's blog about, yup, the red-headed Tori. Laura, Will and Grandpa Henry came to help us celebrate and we are SO thankful for them and their help. I don't think the entertainment center would have gotten finished without Grandpa Henry!
I just got back today from a 1700 mile road trip that took me to Southern Illinois to my mother-in-law's house. She gave me and Beth Beth's Dad's desk. It was hand-made by a family friend. It's GORGEOUS! It's HUGE! And the only way to get it to Houston was for me to go get it. It took 13.5 hours to get there, we spent the next day and then loaded up to come home. When I say we, Chris H. went with me. I'm not sure 1700 miles was his idea of a good time, but I know it beat the alternative. You know how 16 year-olds get in trouble, right? Well, he did, and rather than sit in his room staring at the ceiling...he rode with me for 1700 miles listening to me sing everything from Evanesence to Simon & Garfunkle to Rent. Someone should tell his parents that he's been tortured enough and I'm sure he'll never do what it was that got him into trouble in the first place. Yes, I know what that was, but it's not for me to rat him out on the internet. Thanks Chris, I couldn't have done it without you.
It's good to be home. We close on the condo in a few days, I think. The buyer keeps changing her mind. July 1-June 17-July 1.
Training for me starts Tuesday with PALS (Pediatric Advanced Life Support) and then 2 days of Neonatal Resucsitation Program. Then hospital orientations and banquets to honor those completing their residency, and then June 24th is the first day on the job. I'm not even 100% sure where I'm starting. I bet they tell me before I have to be there though.
My 10 year high school reunion is about 5 weeks away. I am going back to Abilene even though I didn't graduate from there. I lived there for 8 years until the summer after my sophomore year of high school and 90% of my pre-college friends are there. So I am crashing their reunion and going back to catch up. I can't wait!

For those I have seen or been in correspondence with lately, your thank you note in soon coming in the mail. Until then, please know how truly blessed I know that I am to have such wonderful friends and family. Blessed that you care enough to call, write, or come and help Beth and I celebrate an important milestone in our life. God is good, and faithful, and he has blessed me beyond measure. More than I could have hoped for. To Him be the glory and may He continue to guide me in this next phase of my life.

My love and thanks to you all!

No Day but Today

2005-04-22T16:29:00.000-05:00

Well, after four years, 8 semesters, 16 Basic Science Courses, 6 3rd year clinical rotations, 9 4th year clinical rotations, COUNTLESS EXAMS (I KNOW I took 66 over the past four years...maybe a few I have forgotten about) Steps I & II, too many call nights to remember (thankfully some I have forgotten) and lastly, today, ACLS (advanced cardiac life support) I am FINISHED with medical school. The first Friday of medical school I ate at Chipotle with my friend Wes. Today, he and I finished the way we began, with lunch at Chipotle. It was poetic.

Medical School has shown me challenges that I never thought I would know at age 28. Struggling with school for the first time in my life. Dealing with the loss of my father-in-law, Beth's dad (he was 51). Trying to balance school, family, Beth (we found out I was accepted into school the day we got back from our honeymoon), hobbies, responsibilities all at once, at times, has left me confused and uncertain. Marriage is not for wimps. Beth and I have been tested and I'm sure that we will be tested in the future. But God knew the kind of woman that I needed and he brought me the most perfect wife. Not that she's perfect (Laura can vouch for me...Scott and Will too!) but she's perfect for me. And I love her. I am in love with her and that love grows deeper every day she puts up with me. She has put her dreams on hold to support me these last 4 years. I cherish her and am amazed that she sticks by this stubborn old mule. If you meet the Gallants and the Turners (Mom and Dad's mothers' family, respectively) you would know that I didn't stand a chance when it came to stubbornness. We are opinionated and we DON'T like to be wrong and we don't mind telling you. Ha! My mom's family reunions are a HOOT! 80+ year old women each telling their other 80+ year old sisters how they should do things. And each resenting the others for saying something. But back to Beth. One thing that will always stick with us...My Granddad Brown (Dad's dad) Thanksgiving 1999, just a few months before he passed away, when we were going around the table saying what we were thankful for, said this, "I'm thankful for my little bride, my little Nell." I may not tell her enough, or show her enough, my I am thankful every day that God brought Beth into my life. We have much left to accomplish...Together!

Many positives have also come out of the last 4 years. I have made friendships that will last a lifetime. I have renewed old acquaintances (who knew Rhonda (the girl next door in Abilene) would show up for an appointment with the doctor that I was working with fifteen YEARS after I had seen her last?!?). I have lived a dream. When I matched into Med/Peds, I realized a dream that I've had for a long time. The dream of being a doctor. Now, my dad will tell you that's been my dream since I was 5--he always wanted me to be here--and never let me settle for second--THANK YOU, DAD. Of course, there are many others who rightly deserve thanks as well. Mom--I remember those nights in Abilene when I waited until the ABSOLUTE LAST MINUTE to START a project. And we'd go up to your work and spend 4 or 5 hours copying, typing, cutting, pasting, and putting the finishing touches on whatever it was. I would read and you type. I would think and you would help me put it into words. For those of you who might not know...My mother is a saint on Earth. God has blessed me richly with 2 parents who've spent everything they had to make sure that their children had what they wanted...Even when we didn't need it. I love you both enormously!

Grandparents and best friends, childhood and college, in-laws and out-laws (you know who you are), ministers and mentors, music teachers and classmates...You have all shaped my life and helped me stand where I am today. I think of you all often and my door, phone, anything you need is open, 24/7 all you need to do is ask. I know that I've made some mistakes in my life. And for those, I am truly sorry. Hopefully none to justify losing a friend over. And hopefully ones that you have forgiven. I bring this up because my 10 year high school reunion is this summer, and I plan on attending...but I will have to blog about that another time. This one is already getting long, and I'm not finished!

The coming days are both terrifying and exciting all at once. There are still many questions to answer. We haven't sold our condo, yet, ergo, we haven't been able to move to our new house. Some of our "med school friends" are moving to different cities to begin their residencies and therefore leaving us without their company. We wish them all the best. There are new friends to be met and made once residency starts. All exciting and terrifying, all at once.

On May 28th, I will enter George R. Brown Convention Center a 28 year-old kid from Abilene, Texas. I will leave Jeremy L. Brown, MD. And June 24th, someone is going to page me and ask me to take care of their loved one. Me, Jeremy.

May the Lord Bless you and Keep you all.

A Whole New World

2005-04-08T15:27:00.000-05:00

So I am taking some inspiration from my beautiful wife Beth and am going to try to blog. This should be interesting considering the world which I am soon entering. That of an Intern.

First let me say a few things about the world today. Michael Shiavo had the right to decide what happened to his wife. I know that his may draw some fire from those around me (aka Mom), but regardless of the money, the affair, or whether or not Terri Shiavo was in a persistent vegetative state, her husband legally had the right to make that decision. For the record, if any of you reading this ever find me in the same condition as Terri was, PLEASE pull my feeding tube! I PROMISE that I will forgive you and not hate you or curse you, even if I know that I'm being starved to death. Terri was in the same condition the day before she died as she was 15 years earlier when her heart stopped and her brain was deprived of oxygen for some amount of time (I don't know personally how long a time this was). Sure, give me 2 months to see what happens, see if there is some chance of improvement, but PLEASE do not feed me through a tube for 15 years. That is not the life that I want. I would rather sing with the angels, than be fed through a tube.

Secondly, I am marveled by the faith of the man known as John Paul II. I have been transfixed ever since the night they reported that he was gravely ill. I even stayed up until 2:00 a.m. watching the latest news. In reading his will on CNN, there is no question that he was a man of God and fought with all his might to stand up for the things that he believed in. In his will, he left nothing because he had nothing to leave. No car, no cell phone, no retirement fund. His instructions merely said burn my personal papers and bury me in the ground. The weight he carried leading 1 Billion Catholics is nearly impossible to fathom. The grace, passion, and faith in which he did it, is remakable.

Graduation is 7 weeks from tomorrow, then this blog truly will be the "Ramblings of a Med/Peds Intern".

Thanks for reading.