Deep breath

Well, cardio is done. Hopefully. I'll know for sure in a couple of days. Really good class, an incredible amount of knowledge crammed into my poor little brain...and then a test that made the proverbial ton of bricks seem like a friendly pat on the back. Ouch. Anyway...let's focus on the positive.

Finished up with my pediatric mini-rotation today. Summary: I love pediatrics. Although that may change when the kids don't want anything to do with me and the parents decide to make my life miserable. I'll deal with that when it happens. The kids I've gotten a chance to see over the last couple of weeks (sorry, no stories...HIPAA, you know) have been phenomenal and it's been a true blessing to be able to work with each of them. The preceptor was tough, very tough, but a terrific teacher who really cared about making all of us better clinicians. Small hit to the ego, big boost to everything that really matters (clinical skills, approach to peds patients, interacting with parents, presenting patients, writing H&P / A&P, etc.). Couldn't have asked for a better experience. Another blessing, no question. Bonus: more clinical time on Friday, this time in Infectious Disease. That promises to be a whole new experience. I should review the adult exam though, huh...probably don't need to ask them about their birth history.

Anyway, there's plenty of other blessings in my life right now, and one of them is the fact that I can go to bed now and not worry too much about getting up at any specific time tomorrow -- I just need to make sure I get to the student lounge before the first-years get out of their exam. Hence, I am going to take full advantage of this particular blessing and get to sleep before I fall over. For any of you who read this, prayers for a couple of special intentions would be very much appreciated.

Peace and God bless!

A couple of really good songs...

Both from the musical Rent.


You can find the lyrics for Seasons of Love here.



And for finale B (Another Day reprise), the lyrics are here. Enjoy!

Peace and God bless!

Stress reduction

With the cardiology exam rapidly approaching (Saturday morning), I've been swamped and a little stressed lately (hence the lack of new posts). Thus, I'm going to steal another idea from Sara (I, uh, may need to start paying her royalties or something...) and spend a little time mentioning some of the people and things I'm really grateful for.

Two and a half days with nothing to worry about but studying -- and incidentally being able to avoid the scary crowds of protesters swamping the city on the eve of the G-20.

Incredibly cute newborns in the neonatology unit and NICU with excellent prognoses.

A PalPittations rehearsal without any disruptive influences...singing is fun:-)

Those little "sneaky God thangs" (tip of the hat to Fr. John Paul) that make me realize 1) God's watching, 2) He cares, and 3) He has a sense of humor.

Friends who continue to encourage me to give things a try despite my lack of confidence.

A trip to the ropes course next Saturday. As much as anything else, it's knowing that this much-anticipated day is approaching that's giving me the motivation to keep studying and get through cardio.

Family and friends that recognize my need to take care of people and let me do that without complaining.

Study sessions with Steve and BA. Part productivity, part comedy act, pure genius.

Notre Dame alums. Constant reminders of why it's good not to take sports seriously.

Phone conversations with my parents keeping me up to date on their lives and what's happening with my siblings. Don't know what I'd do without those.

Knowing that I've got my plane tickets home for Thanksgiving:-D


Yep, I definitely have lots to be thankful for. Back to studying now, but with a little less tension than before:-)

Peace and God bless!

Sola gratia

Some interesting readings at Mass today. The second reading was from the Letter of James and is one that has occasioned much comment.

Jas 2:14-18
What good is it, my brothers and sisters,if someone says he has faith but does not have works? Can that faith save him? If a brother or sister has nothing to wear and has no food for the day,and one of you says to them, “Go in peace, keep warm, and eat well,” but you do not give them the necessities of the body,what good is it? So also faith of itself, if it does not have works, is dead.
Indeed someone might say,“You have faith and I have works.” Demonstrate your faith to me without works,and I will demonstrate my faith to you from my works.

The Gospel for the day (Mk 8:27-35, too long to reproduce here) drives this point home. Christ asks His disciples what other people think of Him before inquiring "But who do you say that I am?" Peter demonstrates his faith by saying "You are the Christ." The best known part of the passage has Him later rebuking Peter ("Get behind me, Satan") for "...thinking not as God does but as men do." This, though, is not the crucial part of the passage. Rather, the critical line is Christ's admonition for one who would serve Him to "...deny himself, take up his cross, and follow me." Belief is not enough; we are called to live the faith we profess.

But what it all comes back to in the end is grace. Faith itself is a gift that we do not, cannot deserve. Not sola fide as some theologians have suggested, but sola gratia. Salvation, by any measure, is not rooted in us but in the benevolence, the grace of a God who love His creation enough to offer that salvation to us. Faith and works are both the products, first and foremost of grace. How great indeed is our God who offers us this gift.

Peace and God bless!

A&P + randomosity = this blog post

Spent most of today trying to craft an actual assessment and plan for a patient I saw yesterday, the first of my young medical career. It's, uh...harder than it looks (especially since it was a patient in the hospital with GI problems -- we haven't done the GI block yet). I spent just about 5 hours reading and researching and putting this thing together...a grand total of less than a page. And yet I don't begrudge a single minute of the time I spent on it, especially since it's probably something I'm going to be doing a LOT of over the next several years, so it behooves me to gain some experience and get better (and faster) at doing them. It was also more fun than I should probably publicly admit...but anyone who reads this already knows that I'm a nerd.

Non-medical thoughts for the day:

I'm really looking forward to Monday. That's when all of the Notre Dame alums in my class will go through their weekly ritual of making excuses for their football team. Former Wolverines, go to town.

Really great, Serena. Look, losing a tennis match is excusable. Losing your cool like that is not. Once again, you're just setting such a TERRIFIC example for budding tennis players everywhere. Get over yourself.

The SEC takes a narrow lead in the "second best conference in college football" standings by virtue of not having any of its teams choke on one of their cupcakes. Lemme give you a hint, Oklahoma State...if you want people to take you seriously, losing by 10 at home to a team that barely qualifies as having a pulse is NOT a good way to go about it.

'Bama needs to start playing with more discipline.

I can't wait to see what Florida does to Lane Kiffin's Vols next week. Better hide the kids.

Gotta love Ohio State. They're always good for at least one major gack a year.

Wow. What a round by Tiger. Was he playing the same course as everyone else...?

Still running into the person I mentioned last time. Hopefully that continues. More time and more conversation are the next goals.

You know, if you want to fix the health care system, we're going to have to spend money. Hope and change aren't free.

Of course, where we GET that money is another issue altogether.

In memory of the events of September 11, 2001, please say a prayer for our soldiers abroad and our first responders at home in thanksgiving for their service and in supplication for their protection.

Peace and God bless!

Random thoughts

When I say "random," I mean "having no rhyme or reason." These are merely comments that I'm typing as they pop into my head. If you're looking for a coherent read, better wait till next time...

Last time I saw my cousin, she was a 10 year old kid. Now she's a married mother with a second kid on the way. Apparently people change over 17 years...

And her husband is quite a chef. Learned rather a lot about grilling / cooking tonight.

Brownies are better when made with dark chocolate. This is not an opinion.

Inpatient pediatrics is not my cup of tea. Much more fun to get them better and send them home than to watch as the kids go through hell and then slowly convalesce. Peds EM all the way.

What a match by Melanie Oudin! I haven't pulled for an athlete this hard since Dara Torres in the Beijing Olympics.

...even though it's slightly depressing to realize that she's a decade younger than I am.

Yeah, the -8 was great, Tiger...classic case of "too little, too late." Something about a barn door and a horse...

In the Hoodie Master we trust...but Seymour to the Raiders? Really?

Yeah, the final score was 34-24, but it was only that close because the Tide were undisciplined, played atrociously on special teams, and only told the quarterback that there was more than one eligible receiver on the field sometime after halftime. It coulda been ugly.

Very impressive, Notre Dame. You beat Nevada. (<-- sarcasm) Then again...

It's better than losing to Appalachian State. Right, Wolverines?

Congrats to Boise and BYU. Maybe 2 BCS busters this year??

That said, the Boise player should have been suspended too.

I keep running into this one person (seemingly) all over the place now.

And each time I find myself increasingly impressed and thinking that I'm not running into this individual enough.

...is that creepy?

Pressure-volume curves are the current bane of my existence. At least the adrenergic drugs make sense, even if I don't remember all of them.

EKGs, on the other hand, make me feel like a kid in a candy store.

Or perhaps more accurately, like a chemist with a shiny new NMR.

Amazing how much peace can be derived by just sitting quietly in the chapel.

Even more so in front of the Blessed Sacrament.

Is there a reason people keep assuming I'm married? It's happened several times already this year, and I can't figure out why.

Gray hair is worth its weight in gold on the wards...patients' (and parents') willingness to accept what you're telling them seems to be directly proportional to the number of gray hairs on one's head.

I'm thinking research study.

White coats can be another variable.

Ok, that's enough randomosity for tonight...class early tomorrow.

Peace and God bless!

Research and journalism

There's an article in last week's issue of Annals of Internal Medicine that compares retail health clinics to primary care physicians, urgent care centers, and hospital emergency departments. It arrives at the conclusion that these retail care clinics provide care statistically equivalent to that given by PCPs and urgent care centers and superior to that given by emergency departments in cases of otitis media (middle ear infection), pharyngitis (sore throat), and urinary tract infection (UTI). This article was reported on today by MSNBC; you can see that story here. There are, to my mind, enormous problems with both of these pieces, and I want to address some of them here.

I'll start with the MSNBC article. The egregious error lies in the author's assertion that "To track the quality of care, the researchers studied outcomes for three routine illnesses..." This is incorrect. The study does not (and does not claim to) measure outcomes. Rather, it uses quality metrics based on standardized instruments and professional guidelines. Outcome has absolutely nothing to do with it. The reason that this is such a serious lapse is that "outcome" is, essentially, the bottom line for any patient encounter. When all is said and done, how did the patient do? By carelessly using this term, the author effectively creates an illusion that patients "do better" in one setting than another. In this case, yes, one word makes THAT much of a difference.

For the Annals article (written, ironically enough, by an UPSOM professor and his colleagues), I also take issue with a number of things. Most of these issues stem from a single gripe: the emergency department is not a good choice for a comparison group in the study. EDs, unlike retail clinics, PCPs, and urgent care centers, must by law accept all comers. They tend to have higher average acuity (EMERGENCY, people!). They tend to be starting from scratch rather than from an established diagnosis. They don't generally do follow-up visits or chronic care; they have you follow up with your PCP. Many times, in non-emergent situations, after ascertaining the lack of immediate danger the emergency physicians will get in touch with the primary care docs and allow them to manage the course of treatment. And most of all, they are not designed or intended to deal with minor issues. Translation: THE ED IS NOT THE PLACE FOR DIAGNOSING AND TREATING OTITIS, PHARYNGITIS, OR UTIs (or vaccinations, Pap smears, colonoscopies, mammography, or really any preventive health interventions -- all metrics used in this paper). Also, the article does not make it clear what kind(s) of EDs provided data for this research. Were they large academic centers? Children's hospitals? Small community hospitals? It makes a difference. Another point: the study compares the costs of care at the different health care centers, and the ED is by far the most expensive. Why? Because if you have insurance, you're basically paying for all the people who come into the emergency department without it. I wonder how much the numbers would change if they factored in the patients who received full ED services gratis. Anyway, the long and the short of it is that the emergency department was a poor choice for a comparison group.

Of course, the point of the article is that the quality of health care (as defined by the metrics, and in these three particular illnesses -- the latter is a rather severe limitation) is no worse at retail clinics than in other settings and that the retail clinic costs less. Great. Maybe they can start taking all of the patients that don't belong in the ED. But the numbers (and the conclusions) must be taken with a good-sized grain of salt, especially in the comparisons between health care providers. Anyway, read the article (by Mehrotra et al) and tell me what you think.

Peace and God bless!

All I can say is "try it."

My original intent was to post something about prayer. I actually got pretty deep into two different versions, both variations considering a line about prayer from C.S. Lewis's The Screwtape Letters. Both were heavily academic, and you'll notice that neither one appears here. Why? Because they just seemed inadequate while I was writing them. Prayer isn't an academic thing, and it's not something that I'm capable of elucidating right now. To understand prayer, you need to...pray. So instead of wasting copious amounts of virtual ink on something I can't yet hope to explain adequately, I'm going to go pray Compline...and then sleep, since 6:30 will get here mighty early tomorrow. Oh well.

God, come to my assistance!
Lord, make haste to help me!

Peace and God bless!