What It's Like to Be an Intern -- Or, I'm Back!!

I have missed this blog. And I simply cannot keep a diary online in my own name. So, in short, I came back! And it feels really, really nice to be back. But there's a small difference, which you might notice in the header. I'm no longer a future doctor lady, but an actual doctor. And that's a scary thought. And given that residency is the equivalent of two full-time jobs, I likely won't be able to write often, but I do want to write. It's been amazing. Very intense, very frightening and at times, incredibly sad, but amazing. It turns out that my dream program really was my dream program.

So how does intern year work? You rotate through various areas of the hospital for a month. Child neurology is two years of general pediatrics, one harrowing year of adult neurology, and then two years of being the child neurology "fellow", meaning senior resident who is called by everyone in the middle of the night for pediatric neurology consultation (ie is this child having a stroke?). Yes, children have strokes.

I am currently rotating through the emergency department. It varies from very slow to really quite insanely busy with a lot of very serious disease. In just day for example, we had one patient with newly diagnosed cancer and one baby with pyloric stenosis, a girl with ovarian torsion, four suicidal patients (boys and girls), and multiple appendicitis scares with a couple of true cases, multiple fractures, children with bad cuts needing stitching, some concussion, and one case of possible abuse. That does not include all the children with asthma attacks, bad viral illness, and croup. It was a busy night. But I have to say, putting a fingertip and nail bed back together is a pretty interesting skill to have :) I don't like as much the heartbreaking conversations with the suicidal patient and her family centered around her gender identity. What I told her is that obviously I can't decide who she is for her, but being true to her values and treating those around her with honesty and kindness will get her through the really tough times. But honestly, what do I know, especially at three in the morning? Luckily there are really great resources for her that will do her more good than I possibly can in the emergency department in the middle of the night.

One thing I really like about the new hospital system where I work is that people don't seem to be quite as sarcastic or angry, even to the medical students :) I appreciate that. I'm thinking maybe having all the children around help the culture -- most people don't want to curse in front of a four year old. The absolute cutest moment of my current rotation this far: I'm discharging a patient home with her parents and they tell her, "Ok, sweetie, say thank you!" And this three year old says "Thank you!" to me and to her nurse, since we were standing together. Then, as she reaches the door, she turns around, bats her eyelashes at me, and says, "Bye-bye, Dr. Nia!"

Melt, darn it.

March Madness! Career and Gender Musings.

Spring is coming, slowly but surely, to the Bay Area. We have such odd seasons here, I have to say I miss the Philadelphia and DC areas with their stormy winters, lush green springs, humid summers, and crisp, vibrant autumns. But here, in California, in the Bay Area fog-basin, we have buds appearing on the flowering trees, days alternating between 45 and 65 degrees Farenheit, and the flu season finally seems to be tapering off. Influenza is nothing to sneer at, which is why they suggest that anyone is contact with the young, the sick, and elders (>65, although nowadays that doesn't seem very elderly!) receive a flu shot. I generally don't get it, because I tend not to get the flu, unless I know I'll be working with patients whose immune systems are more vulnerable (like the young and the old).

March 5th is our deadline to submit our 4th year schedule for consideration by our advisors. Here's what I'm hoping for:

Tentative Schedule for 4th Year: Each block is 4 weeks long. * = HARD, possibly with overnight call every 4th night.

Spring 2012:
Block 1: Finish Research (In year-long CTR pathway right now)
Block 2: 2 weeks' writing up paper; then 2 weeks' child abuse (if offered) or peds critical care, or other available elective.

Summer 2012:
Block 1: Child Neuro (2nd choice: peds genetics) *
Block 2: Peds Sub-internship *

Fall 2012:
Block 1: Peds Pulmonary *
Block 2: Genetics Clinic
Block 3: Away rotation or Bone Marrow Transplant or Medicine Sub-internship*
Block 4: Vacation (maybe with a narrative writing elective; this is interview time)

~Winter Break~  my last one ever!! Hopefully will go on interviews.

Winter 2013:
Block 1: EKG Interpretation or Medicine Sub-I
Block 2: Cardiology *
Block 3: ICU/NICU or NICN *

Spring 2013:
Block 1: Adolescent Med or Toxicology/Pharm (and/or some vacation)
Block 2: Mandatory end-of-school session
Graduation!


That's right! I'm going for either Child Neuro or Pediatrics +/- eventual fellowship (meaning a sub-specialty like endocrine or cardiology). Also interested in health policy/advocacy. I still have time to change my mind, but I don't think I will. I'm so excited about working with kids AND parents. I think we would be a better society if we listened to children and parents, encouraged them to contribute, and invested in them. Parts of the US really do not have a parent-friendly culture (though I hope celebrity babies will change this mindset), which causes people who happen to be parents to either feel very defensive and that they have to be aggressive advocates for children, or just plain unsupported.

However, I knew I was excited about this choice of fields when they had a Forum discussion on the radio about raising girls to be freer of gender stereotypes (are we STILL talking about pink Barbie/Disney princess dresses? Seriously?!) and I got so riled up I emailed them a comment. They had entirely failed to mention how playing sports has really changed the process of growing up female, and what Title IX (thank you, Congresswoman Patsy Mink) and the subsequent support for female athletes did for our society.

Here are some things that our parents did that rocked my world (and hopefully my brother's) and taught me to be a strong woman. Clearly, we still need to have this conversation. Sigh:

Seven Things My Parents Did Right (and So Can You):

1) Turn off the TV. Limit screen time on weekdays, and turn off the TV. This was a strong policy in our home. Weekdays were workdays, hence no TV. Have computers and TVs in public spaces in the home, not in bedrooms. Getting hooked on teen soaps exposes you not just to the twisted messages of these 20-year-old-playing-teen shows, it also exposes you to all the advertising aimed at the target audience. Tell kids to get outside: it saves their eyesight. The healthiest TV show is still less healthy than going out and living your own life! And then their friends will realize that not *everyone* watches these things, so you'll affect more than just your child! Summers were also more fun because TV was for summer.

2) Criticize Sex in Advertising. Avoid stores that use sexualization to sell stuff. Teach your kids the difference between sexualization and sexuality, and the difference between being admired and desired. Abercrombie & Fitch keeps getting into trouble for this stuff aimed at middle-schoolers. Call these stores names: gross, disgusting, and perverted. Show them the not-very-attractive board of managers and CEO.

3) Avoid Gendered Marketing. Avoid stores that have girl sections and boy sections: for example, substitute your local toy store for Toys 'R' Us, and buy things in unexpected places: a lot of hardware stores have toys. My mom hates TRU and loves the others. Bookstores are also great (although they are dying a slow and painful death). For older teens (driving age), tea and coffee culture is strong and can supplant alcohol (and caffeine is not as bad for teenagers as it was once thought). If you can tell what gender a toy is for (pink beach shovels?), don't buy it. Vote with your wallet and explain why.

4) Treat Kids Like Kids. If you have a girl, treat her like a kid; if you have a boy, treat him like a kid. Give him dolls and animals; give her a log cabin building set. Give them both art supplies. Teach the males how to cook and the girls how to repair things effectively. My brother and I had no concept of things we couldn't both do. Essentially, check your own gender bias at the door. If they have gender bias, remember it's a phase and do your best to be a countercultural rock. It's okay if they turn out different, as long as they understand whole hog what they're getting themselves into.

5) Keep Them Busy. Encourage alternative fun. Let them play sports, get creative, be involved in after school activities -- and, oh, yeah -- study! My dad enrolled me in baseball; my mom gave me a tool kit and indulged countless plays/art projects/choir performances. Let children derive their identity from their skill set, and/or being busy all the time. Not what they look like.

6) Know Their Friends. Make sure they are good friends. Know and care about their friends; invite them over. I remember my dad hosting (by himself) a crazy sleepover party for eight 10-year olds. That's dedication. Teach your kids to care for their friends; then they'll know if their friends don't care for them. If your kid needs helping choosing appropriate friends, teach them how to choose BEFORE they're 16 and sullen and think you're so lame. It will make a world of difference if they have peers they can really lean on in their high school years when things get rough.

7) Have a Career. Take it seriously. Take your kids to work (on acceptable days or weekends) so they can see how adults roll and what you're doing all day while they are at school.

I know each household is different and parents all have different values, but these worked for us. My brother is a very kind, respectful man; I am a very strong woman. We are both good at things that are not stereotypical (he's a great cook; I am good with science and machines). We are still close to each other and our parents. Yay!