Mile 12056: First On-Call

Above: Almost a perfect shot on my "adopted sister's" final night in town. Replace that lightbulb, Chicago! November 2010.

SOMETIMES THE UNEXPECTED
JUST HAPPENS.

This week, I began my OBGYN rotation at St. Anthony Hospital in Chicago, IL. There's a group of 10 students working what has been nomered as a q5 schedule. A typical stretch of days include clinic, surgery, more clinic, call, and post-call. Call and Post-Call add up together for a 24 hour time shift from 6:30 AM - 6:30 AM the next day.

And that's exactly what I just went through.

I'll admit that call does have its pros and cons. Let's start with the cons first, because I personally think they won't outweigh the pros. There's less sleep (and odd patterns of it) and an acquired horrible diet (100% fresh pure high-fructose corn syrup in my Crush Orange Soda to start off my day and a nurse offered me chili cheese fries for the night).

Then there's the pros that make call kinda cool: A nifty on-call room (with a comfy bed and a small flat-screen TV). My crush soda (along with the rest of my on-call meals) were taken care of with meal cards. Hanging out with a cool nursing, midwife, and medical staff when there was a long period of downtime. An awesome resident who took the downtime to teach us.

However, the big win of the night occurred early in the morning almost 24 hours after my first call, when my partner shot me a call on my cell phone that woke me out of my trance of sleep in the on-call room. "The doc's here, just wanted to let you know so you won't miss the delivery." So within 10 minutes I was upstairs. I had taken the patient's H&P earlier that night (looked like labor was going to move on smoothly), and hit the sack rather worried about not getting to see a birth that night.

And here I was scrubbed up with the doctor, and the whole experience just went by so quickly. For me as a new medical student, the novelty was definitely there and made every single moment from scrubbing up to catching the baby to waiting for the placenta to come out post-partum exciting. I was glad I had an attending who was willing to trust me to guide me throughout the process. It felt really awesome to participate in the joy with the family & parents that were there.

So here I am, typing up this entry after just ending my shift (a little of editing at home led to a later release). In a discussion I had with my partner in the elevator post-call, we came to an agreement saying that although call is so tiring, a call experience is very rewarding and very cool (although doing too many calls I think makes the novelty wear off). Both my partner and I delivered for the first time today. It totally takes technique and practice, but with the joy brought of making a new boy or girl make it into the world, to me, there can be nothing more motivating to perfect my delivery skills & knowledge as much as I can in the next 6 weeks.

Mile 377: Distortions of Proportions

Above: Sky high in 2007 on my first trip to Dominica. Note the turboprop propeller.

I LIVED THE REAL LIFE VERSION OF
LOOK WHO'S TALKING.

7:10 AM - One of the babies starts to cry. Like I said in the previous entry, I talk and bargain with the little kid. Okay, let's make a deal. I'll cover you up if you're going to cooperate with me when I listen to your heart.

Back up a step...

7:08 AM - I'm practicing a head to toe physical exam on one of the kids in the ward. Now, one of the greatest tools that us doctors have is the stethoscope, designed to amplify sounds within the body wherever it is placed. I'm about to auscultate the baby's chest for lung sounds and heart sounds. However, once placed the flat face of the stethoscope on the newborn, he/she started to shiver. I notice:

Oh shoot... My steth is cold!

I start to rub the base of the stethoscope to warm it up... but it was too late... by the time I was listening to another area of the chest for heart sounds, the baby started to cry loudly. Do the math: Crying + Sound transmission to the chest + Loud + Amplifying stethoscope = "Ouch to my ears!"

7:11 AM - As the baby was crying, I decide to go ahead and carry the baby in my arms to the nearby window to see the snow that was falling down. My "magic touch" includes a series of clicks and gooing sounds I make with my mouth (some of my group mates have called it pretty entertaining). I know the baby can't exactly see out there, but as he/she looked out, the crying slowly came to a stop and the eyes opened. And for odd reasons, that brought a smile to my face.

For some odd reason, I could see this happen over and over again, and I could not imagine myself not smiling at that sight.

And it was then, the babies in the ward started to cry one after another... I felt they honestly were communicating to each other (take that, John Travolta and Kirstie Alley!).

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When I enter through the huge door to the lobby of the hospital every morning, it's like a whole new world. No, we aren't talking about entering some newfound medical discovery, or even into a hospital cafeteria, where - for some - describing it as a "new world" isn't exactly a good thing.

Think about this. Let's say that the prevalence of some disease or condition - and this could go for any of the thousands of them - was 1 per 100,000 in the whole United States (not just the contiguous 48, but also Alaska, Hawaii, and just for kicks, throw in Puerto Rico). That doesn't sound too bad, does it? That's a 0.001% chance of running into someone who has that condition. Well, there's a lot of factors that affect my chances of running into it, but I've already noticed two that have increased my chances of running into them:

1. The Hospital Setting - Think about it, I'm always running into sick people... sick people concentrate in hospitals. Thus, due to a less of a chance of running into someone who's not sick, this could make some uncommon condition much more common to hospital staff.

2. Local Prevalence - Depending on where you are, risk factors for conditions are more prominent in one region of the world than the other. One good example was there used to be a higher incidence of goiter in the midwest than by the east and west coast. Why? We just weren't eating enough fish (a source of iodine, a nutrient that prevents goiters). So for many cases, me being in Chicago and in a specific location of the city may increase my risk into running into some special cases. I'd say what I've seen, but I'd probably break HIPAA confidentiality if I did.

So, that's what I mean by walking into a "whole new world." Even in just my first week, I've run into stuff I don't run into where I live (suburbia) but I get to see within the city limits of Chicago. I just find an opportunity to see rare things often very cool.

Mile 253: Newborns of Wonder

Above: If you come at the right time, Chicago will welcome you along with many, many others.

WE JUST CAN'T KEEP SAYING
BABIES ARE OH, SO CUTE!

6:15 AM - Stuck between two trucks in the middle lane of the Stevenson expressway, I'm glad I have my music lineup ready to stay entertained for my drive to the hospital. I've got my Spyro Gyra, David Benoit, and Phish albums (one of these things is not like the other?) queued for the morning drive. I've now become a member of what used to be called the "rat race" - nowadays it's "commuting," or the "morning rush." We're required to be at the hospital at 7:15 AM, and I live out in the suburbs. So, I could either risk hitting a traffic jam but get some more sleep, or just take it easy on the drive and start the trek early. For the past week, I've been waking up at 4:45 AM to prepare to do the latter...

The group of students that I rotate with has come to a great conclusion: we love babies. Our attending expects us to know how to examine a newborn by the end of 3 weeks, and with lots of opportunities to practice, I've learned that I actually love interacting with them. I'll be honest, I didn't think babies and me went together, but with the several that I've interacted so far, my confidence with working with them has increased. I've learned that I have this tendency to have an imaginary conversation with the baby, sometimes late-night-talk-show-host style.

(But... one problem I gotta fix: I keep referring to the babies as "hombres" or "bros." Yes, even if it's a girl. As much as I'm into bro-hood, I gotta respect the female gender.)

A Try This at Home Moment.
Some of my favorite facts I've learned have come from the neurological exam of a newborn. If you know someone who has an infant within 12 months of age, you might want to try these reflexes on them. It's just really cool how these behaviors are instilled and can be triggered by simple stimuli from you. Many of these reflexes occur due to portions of the brain still in development at their age. In case you were asking: Yes, you can have someone attempt to trigger these reflexes in you (but if you notice you're pulling off these reactions involuntarily... that's not exactly a good thing!).

Just note: 1) that the sooner the better if you have a newborn (most of these reflexes will disappear within the range of 4-9 months of age, with the exception of the Babinski below) and 2) these reflexes are best shown when the baby's awake and alert.

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1. Palmar Reflex - If you place an object or a stimulus in the palm of their hand, the newborn will go ahead and grab it, no matter what it is.

2. Glabellar Tap - Go ahead and tap the area right above the space in between the eyes. Initially, adults blink and then will stop blinking as the tapping continues. For newborns, they will keep on blinking no matter how long you keep tapping.

3. Babinski - Your turn. Take off your shoes and socks, sit down on a chair where your feet just dangle and close your eyes. Now have the person trace the sole of your foot from heel to toe, following the outside edge of the sole (it should be somewhat like a C shape). Note which way your foot points (it should go down). Now pull it off on an infant or a newborn (their feet should point up). What's really cool is that development of just a tract that controls the foot (which isn't developed in infants until 12 months of age), is what causes a simple difference in the reaction to this stimulus.

4. Rooting Reflex - Newborns love their moms. They love 'em so much that they have a reflex to be nurtured. Stroke the newborn's cheek with their finger. The baby should move their head to the side where the cheek was stroked. From what I've read, this reflex works to help the baby find the mom when they are breast fed. This reflex works best if the baby hasn't been fed in the past hour or two.

5. Suckling Reflex - Touch the newborn/infant by the upper lip with your finger (or slightly insert it into the mouth - wash your hands!). The baby should start sucking on your finger.

6. The Moro (Startle) Reflex - I've saved the best for last! Three ways to pull this off. There's a mild, medium, and a risky way to do this.

- The mild way is to simply startle the baby with a clap right above their head or surprise them with a loud pre-recorded sound.
- The medium way is to take the newborn/infant and pull them up by the arms, until sitting up and then let go to have them fall back.
- The risky way is to support the baby by the head neck and back and pull them away from where they were lying down. Next, simulate a drop by keeping support and lowering the baby quickly about 2 feet. It's fun, but one needs to be careful here and support the baby properly.

In both cases, the baby should extend their arms and legs outward (looking somewhat like an X) in response to the startle (as if they're looking for something to grab on). The baby may then pull back their arms/legs (flexing them) and perhaps they cry. They're just so adorable when they pull this off!

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And with that evidence, the intellectually derived conclusion is: I think babies are cool. Not just because they're cute, but there's a lot more to them than most people think.