Two Months In. One Nerve Out.

I started residency slightly over two months ago. Although I have survived, my facial nerve has not. About three weeks ago, I woke up to find the right side of my face was paralyzed. I couldn’t smile, raise my eyebrow, blink, or puff up my cheeks… all on the right. I thought it quite unlikely I was having a stroke, which left me with Bell’s Palsy as the most likely explanation. At this point, I was juggling a couple of notions in my head.

…. Do I need to go get something prescriptions? There is no medicine that ‘cures’ Bell’s Palsy, but there are a few things that can shorten the length of time and/or improve the likelihood of recovery. Yes, I should get some prescriptions. But… it’s a Saturday, I don’t have a primary care doctor, … I’ll need to go to the ER. Nice timing on these new health benefits / insurance. When should I go? I can’t go now, because…

…. I still need to get to work. I’m still in the Neonatal ICU, and I’m supposed to show up in about 30 minutes. I can’t call in sick for this; I can still write, type, talk, and think… theoretically, that’s all I need to do my job… plus, this won’t go away any time soon, I might as well get used to working with it. I’ll go to the ER after I get off.

…. Why do I have Bell’s Palsy? I don’t remember any tick bites (thinking of Lyme disease). I don’t remember any abnormal ear pain or facial weakness when I was going to sleep last night. I haven’t mysteriously lost weight or anything else that makes me think there’s a tumor somewhere in my skull. I haven’t felt -that- stressed… ugh, if this is the first month of residency, am I going to be in a full-body cast by the end of next month?

So, I went to work. I stopped to get some coffee and a bagel on my way in, and I felt like a sad clown trying to eat it as I quickly found out the amount of lip and mouth dexterity needed to eat/drink anything. Anything more than a tiny sip was more likely to end up on my chin than my stomach (I’m going to need to start using straws.). Eating the bagel felt like trying to land a plane; unless I tactically angled it into my more capable left side of the mouth, it was more likely to crash and mash against my right lip and face (I’m going to be using forks a lot until this is over.). It wasn’t taking long to realize that looking and feeling awkward was but one of several tribulations I’d be facing.

I arrived at work. It went as smooth as work can go when it looks like you’re winking at everybody. A couple of hours later, I was sent to the ER by the other members of the team and told to take the day off. (Oh boy, my first visit to an ER as a patient.). When I told the front desk my complaint, I quickly had my vitals and blood sugar checked then was put in a wheelchair despite unimpaired walking. I was wheeled through the ER and past a variety of people who looked and I felt were in much more distress than I was. (They’re treating me like I’ve had a stroke.) I arrive in a trauma bay. An ER attending and a resident come in. He gives me a quick neurologic exam, then he looks at me and says to his team, “You’re not having a stroke. Let’s get you out of here, away from the gunshots and car crash victims.” His resident comes to the bedside while they prepare to move my bed. She introduces herself and tells me she’s a third-year resident. “I’ve been to this ER three times as a patient. Don’t be embarrassed!” … (Too late.)

It went pretty smooth after that. I had some blood drawn to check for Lyme (came back negative), got an EKG (also normal), got to monitor my own vital signs for a while and then was sent home with a couple prescriptions and a bag full of saline drops I could use to moisturize my eye.

Fast forward to now. The prescriptions are done. I haven’t seen any significant improvement, but it hasn’t gotten any worse. I’ve gotten a lot of support from my family, colleagues, and friends. It’s becoming easier to be lighthearted about, even though I’ve found the asymmetry gets really pronounced when laughing. I’ve gotten a lot of practice at smirking. Outside of the day I was sent home, I’ve been working as usual. I had a couple more days in the NICU before transitioning to the Pediatric ICU. The next couple of months will be a lot easier schedule-wise as I’ll be on Adolescent and Psychiatry (year 1 schedule) and I’m pretty excited to have two of the more heavy parts of the schedule behind me.

I’m hopeful it won’t be much longer before this palsy is behind me, too.

Surviving the NICU, or how I slept an entire Saturday away

Somehow, I have survived the first two weeks of residency.

I've even had time to enjoy Providence since starting. This is from last Saturday, when I was first able to go to WaterFire, a really cool event they throw throughout the summer and early fall. Totally worth checking it out!

I’ve even had time to enjoy Providence since starting. Last Saturday I went to WaterFire, a really cool event PVD throws throughout the summer and early fall. Really cool, going to try and go again soon!

Starting last Monday, there were a couple final hours of orientation* showing us to our respective locations we’d be reporting to on Tuesday, and I’ve been working every day since until this weekend. I thought I had been doing ok on sleep, but then I found myself sleeping in until late Saturday afternoon. It felt good to put a dent into my eternal sleep debt while I could, since starting on Monday I again will work every day until Wednesday, July 16th. Only this time, starting on Thursday night I’ll be working from 4:30-5:30 PM until 6 AM (essentially the opposite of my current schedule). Night call is an excellent opportunity to learn and be exposed to a lot we may miss during the routine day shifts, but completely inverting one’s sleep schedule always takes its toll. Then again, if it were going to be easy, everybody would do it, right?

The Neonatal Intensive Care Unit (or NICU) has been a very… well, intense way to kick off a residency. A lot of the medicine that is focused on is hard to apply to other disciplines within pediatrics (or definitely psychiatry, for that matter) and I personally only spent about 10 hours in a NICU during medical school. That said, unfamiliarity is also growth potential, and I feel like I have learned a lot both about neonatology and staying organized with a variety of tasks (even if some/all are things I have little experience with).

The best part about slowly becoming more comfortable with it all is that I can talk to the parents of these extremely young babies about what we are doing and why (the babies, for what it’s worth, are far less talkative). The first couple of days I felt like I was just regurgitating numbers or words I’d written down to present on rounds, but with time I’ve been able to start translating those things into terms these anxious families can more easily process. It is really quite humbling and gratifying when I can visibly see a mother be more at ease after talking to them… it’s a gentle reminder that the position we are in, even at the very beginning and bottom of the large residency totem pole,  carries a lot of respect and authority with it … certainly more than it did as a medical student, and I cannot help but have a goofy smile whenever I get to sign something now. It took four years for two letters, but those two letters give my signature a lot more power than it used to have. Feels good.

The fourth of July fireworks in Providence were delayed last night due to thunderstorms related to Hurricane Arthur. I can hear some of them going off outside my window. No matter how harsh work can be, moments like these always bring a smile to my face.

*The same Monday morning, I was also very surprised to have a piece of cake and a birthday card signed by all my co-interns waiting for me. For someone who knew essentially no one coming to Rhode Island, it was very heartwarming to have such a kind gesture from a group I had only so recently met. We are all in this together, however, and I look forward to paying back their kindnesses one day.

mini-update 6/11/14

Move to Providence: complete

Household internet connection: pending (ETA: tomorrow!)

Orientation: also pending (also tomorrow!)

Coffee shop internet access: leeched

Closing on house: delayed but pending (ETA: next Monday!)

Feeling like an actual doctor: not yet (ETA: hopefully soon)

Picture of sea lions covered with sand: included

from r/aww

Update with substance: later

This post: over

Triple Board Year 1: A Closer Look at PGY-1, or Intern Year, or TB-1 ..

I previously briefly described the layout of my 5-year program. Today I am going to elaborate on my first year of residency. It is often referred to as the “intern” year; it’s just a different way of saying “first-year resident” and is a way of constantly reminding interns that they are at the bottom of the totem pole (above medical students, though!). Healthcare loves acronyms and this year can also be termed PGY-1 or Post Graduate Year #1. Next year I will be a PGY-2, I finish as a PGY-5, etc. Medical school is often referred to as undergraduate medical education, so if you think of residency as graduate training or school for physicians, it sort of makes sense.

To begin, my brief PGY-1 monthly schedule is(starting in late June / July) :
 NICU > PICU > Psychiatry > Adolescent Med > NICU > Wards > Wards > ER > Wards > ER > Wards > Newborn Nursery
- All year: weekly
Pediatric Continuity Clinic & monthly Psychosocial Clinic

(More details after the break) (more…)

Briefly, the Triple Board year-by-year

So, when people ask me what my specialty is (going to be), I usually tell them child and adolescent psychiatry because it’s the most specialized part of my training (as it results from fellowship as opposed to just a residency) and it’s a lot shorter than trying to explain a combined program that consists of two specialties (pediatrics and general psychiatry) and a fellowship (child & adolescent psychiatry). If I were to do each in sequence (completing a pediatrics residency [3 years], then a psychiatry residency [4 years], and finally a child/adolescent fellowship [2 years]), it would take 9 years. The triple board program compresses this into five years. This is how mine is laid out (all the other programs are similar but have a few variations here and there):

Year 1: (Intern Year; mainly Pediatrics)
- 11 months of Pediatrics
- 1 month of Child/Adolescent Psychiatry (more…)

Blogjournal: 6-2-14

Long time, no blog. Life’s been moving awfully fast the past couple of weeks, and the internet being out of commission my last couple of days in Memphis did not help matters. Now I am back in northeast Tennessee for a short hiatus before my adventure up to Providence to begin the next major phase of my life and career.

What has happened?

First and foremost, medical school graduation. The title of this blog is no longer premature, and my last name is two letters longer. The University had us go through two ceremonies. The first was in an old church where four years prior we had our ‘white coat ceremony’ where we received our hoods (part of traditional academic regalia), recited the Hippocratic Oath, and – based on the surge of social network updates – became doctors. This involved only the College of Medicine. The second was in the FedEx Forum (or, let’s be honest, the Grindhouse) and featured all the colleges at UTHSC. There’s a lot of tradition, fancy words, and a lot of names called. Mid-way through this is when it really hit me that “Wow, it’s really over.” I received my actual M.D. diploma after this ceremony. Feels good. (more…)

TN Podcast Rodeo, or How I Survived the Trip to Memphis

Memphis at night, from

Memphis at night, from

An incredible fake out to the NBA’s MVP. Good going, kid. I lol’d.

I drove back to Memphis today,

… so in other words, Interstate 40 and I again spent most of the daylight hours together. I will definitely miss Memphis, but the drive to it is another story. It’s that flat and empty expanse between Jackson and Nashville that gets me every time.

To stay sane, I used Stitcher Radio to listen to a number of interesting podcasts (listed below) to help the time pass, though the last hour or so was spent listening to Spotify and then local radio once I re-entered civilization. When I ended up listening to a playlist titled #throwbackthursday … I took it as a sign I had been driving too long. (more…)