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Residency, Year 1: Day 299

I had a couple of interesting encounters a few weeks ago at clinic.

The first of these patients was a middle-aged woman who came in complaining of hip pain and indigestion. She had had hip pain since getting run over by a driver about 20 years ago. At the time, nothing surgical was done for her and she's had to live with what sounds like osteoarthritic pain since then. She's taken the occasional pain killer for it, but nothing really seems to help. And as far as her indigestion, it's something that she's had for nine months. The only thing that helped her was Prilosec, but she stopped taking because the box warned to only take it for one month at a time. I advised her to continue taking Prilosec at this time and to minimize the use of NSAIDs for her hip pain (try Tylenol instead). She was very dissatisfied with this answer. While I understood some of the frustration on her part after having to live through the pain for this many years, there really are no surgical options at this point. We could give her more pain medications, but she ultimate wish is not to take any pills at all. Because she was so upset at the lack of solution, she walked out of the examination room. That was the first time any patient had ever walked out on me.

Interestingly, the next patient I saw was another middle-aged woman. She was in for a blood pressure recheck. She had been at the clinic a few days prior for another blood pressure recheck with the nurses and was prescribed an additional antihypertensive to her current regimen. Unfortunately, she hadn't started the new medication by the time we saw her back, so there wasn't much we could do except to encourage her with the new medication. She was mostly concerned after reading that she could get dizzy after taking the medication. I explained to her that the side effect of "dizziness" is mostly due to blood pressure changes when changing position and not necessarily due to the medication in itself. It was a really short appointment and I didn't do much for her, but before she left, she told me that I was a good doctor because I listened to her very well.

I thought it was really interesting getting these two opposite patients back-to-back that day. I'm glad I wound up seeing the second patient because I probably would have felt pretty cruddy that day since it was the first time I've had a patient walk out on me. But then I reflected on some of the patient population that we see and how they think they're entitled to certain things even when it's not medically appropriate and I realized that I didn't do anything wrong with her.

Residency, Year 1: Day 297

If I ever decide to do a fellowship, I would definitely consider nephrology. (The other in the running is endocrinology. Although I'm about 99% sure I don't want to subspecialize.) I spent the last three weeks on the nephrology consult service and I have decided that I like being on a consult service. First, the hours are much better. Second, you don't have to be stuck doing admissions and discharges (although I suppose nephrology isn't always a consult service). Third, you have more time to think about your patients. However, I didn't like the fact that you can make all these recommendations and the primary team may decide to not follow your recommendations or not read your notes.

I'm moving onto endocrinology in May, and it'll be nice to see both of my potential fellowship subspecialties early in my training.

Residency, Year 1: Day 284

In March, I spent many, many hours at work. Although I saw many patients with interesting stories, I just couldn't muster any energy to actually write them down. And now that March is over and April (and May, for that matter) is an elective month, I have all the time I want to write, kind of. Except that elective months don't really produce that many stories worth telling. I will say, however, that it makes me immensely happy that I don't have to go to work that early and I don't have to work on discharge summaries and I can catch up on all the TV shows I've missed.

Residency, Year 1: Day 243

Heme ward was worse than expected. And everyone I talked to felt bad that I had heme wards because it's that bad. There are 31 days this month, meaning this month is going to be a really long one, full of leukemias and lymphomas.

I saw a set of triplets who are nearly two years old at clinic today. They were cranky and had fevers and ear infections. I sent them all home on antibiotics. I'm definitely never having triplets. EVER. (As if it's my choice.)

I was so anxious last night about starting a new rotation that I slept only four hours. When anxiety keeps me from sleeping or wakes me up early, that's how I know I'm not sleep deprived. Now, I am exhausted. Definitely going to bed early tonight.

California Dreams

I never thought I'd say this, but I think I want to move to California someday. I've always loved living in the Northeast. I love the four seasons. I love the lack of natural disasters. I love the proximity to Europe. I love how you can cross five states within three hours.

But there's just something about the Pacific Ocean that I love; the Atlantic Ocean doesn't quite have the same appeal. I love seeing the ocean on one side and the snow-capped mountains on the other side. I love the luscious green gracing the landscape. I love the dry, perched deserts. I love the abundance of national parks. I love feeling the sand under my feet. I love the proximity to Asia.

Based on all of that, I might very well love Oregon and Washington too, but I've never been to either of those states. However, I will move them closer toward the top of my future travel list.

Needless to say, I had ten wonderful days in California. It started a bit rough with flight problems, but the subsequent days were great. The 50% chance of rain every day yielded sunshine and clouds, but only rain at night. I was comfortable walking out in a fleece everyday, and sometimes only with a short-sleeved shirt. I felt the same way when I visited Georgia and Florida in the winter several years ago.

I can't wait to explore more of California. Yosemite, Redwood, and Tahoe, I will be coming for you!