Gandhi Bazaar v. Walmart

I just read on CNN that Walmart is looking into expanding its business in India. This is awful news to me. I can't imagine what Walmart would do to India.

When I was in India this past April, I loved going to the markets. My favorite market is Gandhi Bazaar in Bangalore... what a beautiful place! Fresh vegetables, fresh flowers of every color woven into long beautiful garlands, open shops everywhere with shopkeepers trying to keep your business... it's such a vibrant place with an energy that cannot be found in any retail store anywhere in the world. There's also Loi Bazaar in Vrindavan, which is SUPER cool. In that bazaar, you can find beautiful silver shops, people making fresh sweets in the streets in huge vats of oil, and saris of every style.

When I was in Delhi, my cousin took me shopping and the first places she took me were to some of the new malls that had opened close by. I would walk into these malls and for a split second, I would completely forget that I was in India... they looked exactly like an American mall. The only difference was that these malls carried Indian clothes in some departments... they even played American music at these malls like Nelly Furtado and the theme song from The Breakfast Club!

I hated these malls. To make matters worse, they were completely overpriced.

Towards the end of my stay in Delhi, my cousin finally took me to the local market, where you walk into a clothing store and the shopkeeper shows you his merchandise according to your budget and taste. The best thing about shopping in these small stores is that you walk up to a table in front of the shopkeeper and the table is clean and empty. And then all of a sudden, the shopkeeper pulls fabrics from the shelves behind him, unravelling them before your eyes and spreading them across the table in front of you. And it's fabric after fabric after fabric. Silk and cotton, then a cotton-silk mix and synthetic, and finally chiffon. There's skirts, and salwars and sarees, layered on top of each other. At the end you have a pile of color that measures a foot high.

I have to admit that this is not always the most efficient way for a customer to choose her wares, but boy it is fun for me. I told this to my cousin and she said, "Oh why didn't you say that before... I thought you would prefer the malls!" That couldn't be far from the truth.

When I hear that Walmart might go to India, I just hope that this big, ugly corporate giant of American doesn't ruin the experience of market shopping in India.

The premature flash of blood

So it turns out that having Dr. Yonker quiz me on the structure of succinylcholine in the bleak, blood-stained halls of Ben Taub's OR right before I intubated the right main bronchus under his direction was completely worth it today. I, Devika Rao, just finished placing an IV in a premature newborn! I'm really excited about this because a premie's veins are small. And I don't just mean small, but SMALL, even though I just wrote that in capital letters, ironically... When I mean small, I mean draw-a-line-using-a-pen-and-measure-the-width-of-that-line SMALL.

Ok, so I better explain so that I, the writer, do not lose my reader: I learnt how to start a bunch of IV's on my 2 weeks of anesthesiology (and I believe there's even a former blog entry regarding this experience), and today, I drew upon that experience to start this IV on the premie I admitted to the intermediate care nursery. Because I had some experience, I felt pretty confident doing it today... and that makes a world of a difference! I wasn't timid with the catheder or with gripping the baby's wrist. I wasn't discouraged if I didn't see a flash of blood right away when I first advanced the catheder, but I just kept trying different angles until I got my flash. I'm so happy! This sure is a good way to end my first month of residency. I hope it's a good omen of things to come in my next 35 months that I have left :)

I suppose it sounds a bit trivial that I'm writing about just starting an IV, but my attitude with this experience today is that it just makes me more confident about myself and my career choice and my abilities as a pediatrician. I'm going to try and be more proactive and make myself available and willing to do more procedures around the nursery so I can get better and better at this stuff.

Quote of the day

"I've never had a baby before, but I say go for it!"

Famous last words from my colleague and former Renesselaer Polytechnic Institute cheerleader Dr. Emily DeBoer who told me about a first time mother who was afraid to clean the vernix off of her daughter (vernix is that nasty wax-like substance that covers newborns after they're born) because she was afraid of hurting the baby. Emily, on the other hand, would not have a problem cleaning off the vernix of her non-existent daughter.

You ROCK Emily!!!

Let's Rock-et with Rudy

Whoa. So I'm a little behind the times, but I just realize that I have a huge reason to root for the Rockets now. I know I've been living in Houston for 4 years, TX resident for 8, but I never really got into any of the TX NBA teams including the Rockets. But now, I have a GREAT reason. I just read that on June 28th, Rudy Gay of UConn was drafted 8th by the Rockets!!! How exciting is that! Now I miss Houston even more :( Hopefully I can get to see him play sometime when I go home in the next year. That would be AWESOME.

On another note... we have a mother of a baby on the service who only speaks Bengali. This made me think about the time if we ever got a patient who only spoke my mother tongue, Kannada. I wonder if I would be able to take a good history in my own mother tongue. I definitely know that it would be a struggle to consent a mother for her baby's circumcision in Kannada... hmmm yeah, that would be problematic.

I'm on call today and my throat hurts and I'm tired. I'm going to try and have a decent attitude so I can get through the night. I think I want to find out the name of the Hindu God of sleep so I can doing some serious kissing up.

Oh what a night... MARE!

I had a horrible dream last night. I dreamt that I was really really late for my day on call. In my dream, I got up an hour late, and I getting ready to go to work, but everything kept getting delayed. I almost headed out the door and I realized I wasn't wearing scrubs and hadn't taken a shower. I put some scrubs on, took a shower, and finally got to my car and was driving and realized I left my pager at home. For some reason I was driving to the MARTA station (ATL's version of the light rail), and then I realized I was driving to the wrong station. So all these things kept happening and eventually it became 11:30 in the morning and I still hadn't gotten to the hospital. Five seconds later it was somehow 12:30 pm, and I got a page from the ER attending (even though i'm not in the ER this month... my mind is a lil nuts as you can already tell). So then i decide to fake sickness. I'm in general, a pretty good actressso I told the attending that I had been vomiting up blood and that's why I didn't make it in this morning.

In retrospect, I think it would be mildly amusing if I had said that I started 2 large bore IV's in m yself, but oh well I can't always be witty during nightmares. Anyhoo, the attending was super nice and said they would contact the backup intern on call. The weird thing was that when I was talking to the attending, I was at my temple (God knows why... pun intended) and there was a TON of noise in the background and I was worried that I would be caught. Finally, the attending got back to me later and said they caught an intern who had only worked 40 hours this week to cover for me. The attending said this intern had been lying about his hours, and so it was only fair for him to cover for me since I was sick.

That was my nightmare. Maybe it doesn't sound that bad, but I felt so anxious and worried and really paranoid that somewhere, somehow a patient was dying because of my inability to make it to work on time. This dream has definitely been mirroring my feelings after I come home from work... sometimes I worry that I forgot to do something crucial for one of my patients...

Sometime after my nightmare ended, I woke up to my alarm, took a few sighs of relief, and jumped into the shower for a clean, superlicious call day. I made it on time to work, thank god. I'm thinking about signing up for some yoga classes to try and calm my mind down.

10 things that make me smile during residency

There's a lot that doesn't make me smile in residency, but there are things that definitely DO make me smile. I have left out the obvious, which are the kids that make everything worth it.

So without further ado, I give you 10 things that make me smile during residency:

1. When I meet a nurse who speaks Kannada (like me!) and who offers to bring me puris (fried flatbread) for me on Monday. Can you say SCORE!!!!

2. When I write for an order on a patient who actually needed that order to be written. This makes me feel smart and happy.

3. When the attending tells me that I should go and eat lunch. Boy is it fun to eat :)

4. When the mother of a patient (in sickle cell clinic) tells me, "I'm really glad that you're seeing my son. Last time wasn't fun because first a medical student came in, and then a physician's assistant, and THEN the doctor. It's very nice to meet you Dr. Rao." Little does she know how much closer I am to being a medical student than anything else... but still this somehow made me smile.

5. When the lecturer this morning for Acute Care Symposium inserts farting noises into his power point presentation on Diabetic Ketoacidosis. This made me smile AND kept me awake. I think it kept Stan awake too, and he's a night float this month!

6. When I actually hit REM during call nights.

7. When the Nurse Practioner on call with me brings me cake the day of my birthday (yes, I was post-call the day of my birthday).

8. When I get text messages from Gonzo.

9. When I see my colleagues. This doesn't happen often, but when it does, I get happy to see them. Examples: During morning conference, noon conference, during the in-service exam, and today afternoon during continuity clinic.

10. When you get a lecture by an attending who includes the phrase "smart ass medical student" and you realize that it's allll in your past.

Third time's a charm, baby?

It's my third night on call. I just came back from a delivery. What a smelly baby! She was covered in some smelly meconium (baby poop that's black and tarry, which is normal)... not a huge fan of meconium, by the way. She also had bilateral palmar creases, wide set nipples and syndactly (some fused toes). I hope she doesn't have any underlying syndrome to explain her anatomical findings. The parents were Spanish speaking only, so I had to explain to them "este problema con sus pies." I hope I did ok... there were no interpreters around at 12:30 in the morning.

So this week is also my first experience in having medical students, which is scary because I feel like I'm not capable of teaching them anything since I don't know much. They're SUPER helpful though, and I didn't realize how helpful med students are until you are on the other side. Plus they konw more about the Emory system than I do (how to check for radiology reports, where the films are actuallly located). Although one of the students kinda scared me today. Apparently during afternoon rounds, one of them asked the attending about "female circumcision" of newborns. I can't believe someone would actually ask an attending about this. My colleague told me that the attending's response was something like, "We..... don't... do.... those. They're.... ILLEGAL."

The reason I wasn't at rounds this afternoon is because I was taking an in-service exam... to check my baseline knowledge of pediatrics. It doesn't "count for anything." I would argue for the contrary. There a lot of potential fo rme to embarrass my alma mater quite badly. The exam was 200 questions and took me about 3 hours. It wasn't as bad as I thought it was going to be, but that doesn't mean that I aced it. I was joking around with Bheru before the exam that I was going to ace it... that I was going to get every question right. Doing that reminded me of something Chirag Parghi would say before an exam to ease the tension :) Miss you Chirag! Oh, and here's a shout out to Chirag and Anu... I got an email from one of my co-interns who regretfully wrote that he wouldn't be able to attend my birthday festivities. And he addressed me as "Devo"!! I thought that was awesome. I still haven't told my co-interns about my blog. Maybe I'll do that soon :) Poor Camden didn't make the exam today cuz he misplaced his male purse and his keys. I hope they'll let him take it tomorrow...

Other thoughts... I hope my attending doesn't think I'm a moron.

Six times four equals...??

I know others have commented on this in their blogs and have spoken about this to me on the phone or in person, but it still does not cease to amaze me when I write an order and it gets done without a cosignature.

Yesterday, I was finishing up some paperwork in the term nursery and a nurse rushes up to me and says, "Are you the resident here today?"

I've gotten to the point 5 days into residency where I don't catch myself starting to stay, "No, I'm just the medical student." Instead I say, "Yes, that's me" while thinking, "Oh God, what's next..."

"This baby's mom is HIV+," the nurse says, "and there haven't been any meds ordered..."

Yikes. Well, it wasn't that bad actually because I actually knew the dose for AZT in newborns: 2 mg/kg q6 hours.

"I think I can write for that," I say. And then I decide to make sure that I have the right dose. We were given Newborn Nursery manuals the first day which coveres pretty much all the protocols for anything. I look under Infectious Disease and HIV. It says 8 mg/kg/day. Unfortunately, it has been about 6 years since I took Calc II in college and it took me about 5 minutes to figure out that this was the same thing as 2 mg/kg q6 hours. This was after I wrote for AZT and after the nurse convinced me that the pharmacy would call me if it wasn't written for correctly. I think I might try and find a Mathematics for Dummies book next time I'm in a bookstore.

One down, 87098275 to go...

My first day of residency and my first night of call are over. I'm glad I got it over with, and I'm glad I'm still in one piece. It wasn't bad, except for the last stat C-section we got called to go to this morning at 7 am... the baby came out limp, not breathing, not crying... covered in meconium (baby poop). It was not fun... for reasons I may expound upon at a later time. But right now... I just want to sleep and dream of pretty flowers, sunshine, brilliant stars and if my mind wants to throw in a cute boy, then that's fine too. Peace out from Hotlanta.

My first day as a pediatrician

It's 11 pm EST, and I'm on call at Grady Memorial Hospital for the first time of my life as a real pediatrician. Well at least, that's what I'm supposed to be, but in many ways, I definitely still feel like a medical student. I've been paged and called about a lot of minor issues already, and I usually tell 'em, "I'll call back and let you know." I then ask my upper level (who is really awesome by the way!) and then call the page back.

Earlier I had my first beep of the delivery pager... that was pretty exciting. Peds got called for a baby being delivered by a mother with intrapartum fever, which increases the risk of sepsis and infection in the baby. We were all ready for the worst, but the baby looked fantastic. The best part was seeing the father's face after we completed our exam - he had the biggest smile for us as the pediatricians after we put the baby in his arms. I was definitely really excited to be on "our side" rather than the OB-Gyn's side - I know that everyone has their preference, but that was definitely mine. Later on in the evening, I got to tell a hispanic family (in spanish! go me!) that their baby's bilirubin was good enough so that the baby could go home. That was fun too. Of course, right now, everything is a bit exciting for me as a first-day fresh intern. I wonder how long it will take for me to get jaded, if I will get jaded...

One irritating thing about today!! We were getting oriented to our service - term nursery which basically involves healthy babies with only minor issues if any issues are present at all. Ohhhh baby.... we rounded till 2:30 and didn't break for lunch. I don't think I've EVER done that as a med student, even when I was on surgery. I always was able to grab a bite to eat, and would often times be told by the attending to get something to eat. I couldn't believe that the first time that I wasn't "allowed" to get lunch was on pediatrics... term nursery, no less where we have to make sure that our patients are feeding and growing! I guess there is a first for everything. Finally, I had my "lunch" at 4:30. I was really happy to open my 'lil tupperware container (dubba as we say in Kannada) because I spent a couple of hours yesterday evening making massive amounts of sambar and cauliflower, potato, and peas vegetable. It was yummy.

Another thing, and this is super important! I never believed in jinxing myself till today. I think of myself as a non-gunner, good lil resident. Don't know how the following words came out of my mouth, but it was around 6 pm, and my delivery pager had only gone off once and there were already 10 babies born the whole day according to the database online. I began to worry like an intern on her first day should, that somehow my pager wasn't working and I was supposed to be at deliveries I didn't know about. My upper level was in the room, and I expressed my thoughts out loud, being the dumbass intern I guess I'm supposed to be on my first day.

My upper level said, "Don't jinx us!!!"

What happened next? You guessed it! Not 60 seconds elapsed before my delivery pager went off.

"See! You jinxed us!" shouted my upperlevel.

I felt like such an idiot, like I guess I'm supposed to be on my first day of internship.

We ran to the delivery and while getting the equipment ready for the baby at the bedside, the delivery pager went off AGAIN.

"See! You jinxed us!" shouted my upper level. I felt like more of an idiot. I am now a FULL true blue believer in what every one has ALWAYS said about talking about quietness when it's perfectly quiet. Why ruin a good thing?

I usually have a theme, a thread, if you will, when I write these blog entries. I guess I don't have anything super creative to add today, but I'm hoping the drama of my first day carries this entry through. For all my former classmates reading this, I miss you guys a lot and I definitely think about how y'all are doing. I have another 12 hours to go on my first night of call, and I'm making it better than I thought I would... of course the night is still young... But, if I can do it, I'm positive that any of my classmates are pulling through with flying colors. Today was my first day introducing myself as "Dr. Rao", which is CRAZY when I hear it coming out of my mouth. I hope I haven't let anyone down.

One last thing... I promise. I realize that I love medicine. I have been doing NOTHING for the past several months, and today I've been busy all day pretty much till now. And I'm having a great time seeing, examining babies, even making sure labs are ok, and following up on issues. I do feel that this is what I'm meant to do, and that is a great feeling, one that I hope will carry me through the next 3 years.