Friday, July 31, 2009

It's here...

The time has finally come. Residency is over. The post-residency break is over. This Monday, August 3, 2009 will my first working day as a full-fledged physician... after all these years. This past week I was involved in orientation. Although I pretty much know my way around this clinic and hospital, having been a resident here itself, there were still things I needed to learn and being hired as a physician involves some different steps than being hired as a resident.

My fellow orientees were a young dentist fresh out of dental school, a family practice doc fresh out of residency, a research scientist moving to our Research Foundation from Houston, TX where he was faculty, a neurosurgeon, fresh out of fellowship training and a bariatric surgeon. Quite a bunch! It was fun to hang out with these guys who are in the same boat as me: starting their careers as physicians at the Marshfield Clinic.

During the week, I was also able to tour the faclities at the Med-Peds department where I'll be working. I have my own office, with my name on the door. I have my own medical assistant. Monday is a fairly busy first day with 4 patients in the morning and 4 in the afternoon. I know. It doesn't sound like much. But it will be the first time I am seeing a patient in clinic without having to staff it with an attending. I dictate the note under my own signature, not under the supervision of someone else. I don't have to say "seen, examined and discussed with Dr.---" like I'v e done for the past 4 years.

I'm excited and scared. Excited to begin. Scared because I don't want to miss anything. No more is there anyone looking over my shoulder, making sure I haven't missed anything or that I'm not barking up the wrong tree.

Of course, life is not fancy free. I have the Internal Medicine board exams coming up on August 27 and there's a LOT of studying to be done for that (and not enough time).

All told though, I'm looking forward to my real working day and week.

Monday, July 13, 2009

Camp Angel

This weekend (Friday, July 10 to Sunday July 12, 2009), I was privileged to be at the Camp Angel summer camp. This is a summer camp run for children between the ages of 8 and 12 years old, that come from families touched by cancer. These kids have a sibling, parent or grandparent that has or has had cancer. The purpose of the camp is to provide them an opportunity to get away from all that 'heavy stuff' and hang out with kids who have experienced similar situations and just have fun.

The camp is one of several run by the non-profit organization Angel on my shoulder, formed by Lolly Rose (shown standing behind Mr. Chuck in the picture) after she lost her husband to cancer and saw the effect it had on her grandchild. You can learn more about this organization and its camps and other activities at

I really enjoyed the experience. Ostensibly, I was asked if I would like to come and be the camp doctor. Jonathon Forncrook, my program director, had been going for the past 10 years and this was to be his last camp before he moves away to California. I had never been to a summer camp in the U.S. before and I was curious on several levels: how are summer camps run here? how are they different from back home? what kinds of medical care is involved at a camp? what makes a camp for kids with cancer in the family different from any other summer camp?

We left on a Friday morning and made the two and half hour drive up to Camp Luther in Three Lakes, WI. Once we arrived, it was only about half an hour before the bus bringing the campers -- 42 kids in all, would arrive. The groups were divided into 2 girl teams (the bunnies and the foxes) and two boys teams (wolves and bears). Each team had several counselors assigned to them. Each team stayed in a different camp -- the fort, the towers, the treehouse and pioneer city (wagons). Each of these camp sites were creatively constructed and looked like loads of fun.

We had a pizza party that night preceded by some icebreaking events. The Northern Lights Harley biking club came over with their bikes and allowed the kids to get pictures. The next day was spent mostly in water activities, with a ride on a pirate ship, run by the Strauss family in Eagle River, cayaking, fishing, swimming, tubing and such. There were crafts (face painting, rock painting, hair braiding and other such stuff) and a special DJ in th evening for a dance.
Medically, it was quite uneventful (thankfully): just the usual scrapes, bruises, some blocked ears after swimming and some sensitive stomachs. Homesickness was admirably managed by the counselors.
This was my first camp experience and I doubt it will be my last. I plan to go back next year. This organization also has a really crazy event called the polar plunge (read about it on their web site). I'm thinking of doing it!
The only sad event was that this was Jon Forncrook's last camp, after 10 years of service. From the sentiments he stirred up among the kids and volunteers, he will be missed.

Thursday, July 09, 2009

Here it is...

I got my residency completion certificate today. It is a grand thing, already framed. Here it is -- the testimony to 4 years of residency

Physician, heal thyself!

It is a little over a week since my residency 'ended' (my last working day was July 1, but I am still a resident on the books until July 12). Last night was the first night that I think I slept right through. Strangely, during the nights before that, I kept waking up every couple of hours. My body seems to finally be making peace with the fact that I shall be sleeping most every night!

My days are spent studying for boards and ... well, I get ahead of myself.

Now that residency is over, I did an assessment of my lifestyle with the help of my brother with whom I had lively discussions on the matter during my family's visit for graduation. The results were not good: at a BMI of 28.1, I am overweight and with a resting pulse of 80, clearly not fit.

I guess it is time to make some life changes (since completing residency set that in motion). I have pledged myself to regular exercise, healthier eating and weight loss. I also made appointments with my doctor for a complete physical and the dentist for cleaning and treatment. Studying for the internal medicine boards (my occupation these days) has only re-inforced to me that I am overdue for these changes.

However, having recognized the problem and put a plan into place (and kept to it for the 1st 2 weeks now), I am hopefully on the way to a healthier me and to heeding the command of the old adage: physician, heal thyself!

Thursday, July 02, 2009

Can't sleep

Yesterday was my last day in residency. I was on call during that night so I came off at 6:00 am this morning. After attending a meeting and shopping for ingredients for breakfast, I came home. Since I hadn't slept in 30 hours (for the last time as a resident), my eyes drooped as I ate lunch and I went to sleep by about 3 pm.

So here I am. It's 2 am and I am now wide awake. Whaaa? Why can't I sleep? I am not on call. I am done. I have about 3 weeks off before I start my new job as an Attending in Med-Peds at the Clinic. I guess my sleep cycle is screwed up from the call. It'll sort itself out soon enough. It usually does.


It's 2 am in the morning and I can't sleep. I called the PICU and the Peds floor to get updates on the little girl I admitted last night. We don't know why see siezed, but she's better. Oh well, I guess that's what counts.

I know it's wierd that I called the hospital, but I can't sleep and I was curious. How wierd is that?

The last day of residency

June 30, 2009: this was the last day of work in my residency in Med-Peds.

I began residency on July 13, 2005. Technically, that means I should work until July 12, 2009 to complete the four year program. However, I saved up some vacation time during my last time so that I could end on June 30. During the month of June, I was doing a rotation in Pediatric Hematology-Oncology.

Something special happened on this morning: as I drove into work, I saw a beautiful complete rainbow arc across the sky. It was a complete rainbow from horizon to horizon. One end of it dipped into the horizon just at the location of the Marshfield Clinic. Okay, I'm not going to read anything into this, but it was really cool and special, being my last day of residency and all. :-)

My last day began with Morning Report in Pediatrics. The ward team presented a case of a 4-year old with a rash and fever and we talked about rashes. It was nostalgic to be sitting there as a resident for the last time.

The morning was spent rounding on the 2 Heme-Onc patients we had. I then had an exit quiz in my attending's office. That went well. Interesting how one learns during these rotations. It's like when you look at yourself in a mirror everyday and can't see the changes accomulating daily. Someone else, seeing you after a period sees them immediately. The quiz gave me perspective on my learning in Heme-Onc.

After lunch, I sat down with the program coordinator and went through the exit list. A day before, I had got to hand over my resident's pager. However, since I am staying on here, it was simply replaced by an identical appearing but newer pager. Kind of an anti-climax: I had heard stories of people being so grateful to finally hand off the pager that had 'killed' many a night of sleep. Somehow, I never felt that way. Each page was an invitation to an adventure, a thrill.

Instead of the exit interview being a simple handing over of everything, it was more like a replacing of 'resident' stuff with 'attending' stuff.

The afternoon was not so busy. At 4:30 pm I went to the Pediatric ICU to get report on the patients I would care for during the night -- my last night on call as a resident. There were jokes about how after midnight, I might switch off my pager or simply tell the caller to page the 'resident' instead of me.

My last night on call was wonderful. I ordered pizza for everyone. Instead of wishing for a 'quiet' night, I actually wanted cases. My wish was granted. It was quite busy, with different, interesting admissions and call issues. I admitted a 20-month old female who had had 5 seizures that day. Her parents were both family practice docs. At 3 am in the morning, I did a spinal tap on her. My PICU attending made me a little plaque to wear on my back for the night that said 'After midnight, the bucks stops here!'.

It was poignant to spend my last day in residency on call. When I signed out at 6 am the next morning, I was officially done. The ward team to whom I had signed out were busy sorting out the admissions of the night. Since it was the start of a new month, it was a new team and you could tell they were a little nervous. Everyone had new roles: there was a fresh intern at the table -- his first day in residency; the second resident at the table was now a 'senior' resident -- he was an intern till yesterday, and the Ward Chief was starting his first day as a third and final year Peds resident and Chief Resident at the table. The PICU resident was busy gathering numbers in anticipation of morning rounds. Until yesterday, she too was an intern, and now she was a senior resident and the PICU resident for the month. And me, I was done.

I walked away from a busy floor of activity, everyone trying to step into their new roles, while attempting to provide continuity of care to our precious little patients. Life, as usual, goes on.