anyone out there?

Did y'all know the pl-2's and -3's have their own blog sites. and they actually post. it's crazy, they see each other constantly, and yet, still post. Post!

I know I know. we're all busy studying for boards and acclimating to fellowships, new jobs, new homes, blah blah blah. Can i just say how nice october 17th is looking right now. Well, actually, I'll be here, working. So not that amazing. but Oct 17th after 6:30 pm? awww yeah. who's down for a little post-boards partay? hells, i guess it could be oct 16th. that might feel better. we'll laugh, we'll cry, eat drink. anyone? bueller?

hey, so if anyone has any patients with alopecia areata (shameless plug for my research project): we're looking for patients to sign up for the national registry: www.AlopeciaAreataRegistry.org -> especially kids, minorities, families with multiple relatives w/ AA (not the drinking prob), and esp totalis (all the scalp hair) and universalis (no hair, not even nares). The initial registration involves an online form, then, if they qualify, a site visit to guess who? and a leeetle bit o' blood.

(if any pl-2/3's are reading this- can you keep this in mind at continuity clinic?)

Anyone with questions: call me. I have my own personal line here at UCSF. 415-353-9529. Not for socializing. Really- my office is shared.

CRazY in Chicago

okay. I know I did this whole ICU thing to myself....but this is too much. I have seen more violent crime (i.e NAT, gunshot wounds) here than I have well....anywhere. For instance today we just admitted a 13 year old shot in the head 3 times during a car jacking. It is heartbreaking and I wonder if I can continue to do this...But then I see how much good we have the ability to do. I mean what we do really transcends cultures, languages even geography, our Lesotho colleagues are a testament to that. Kara what you wrote was awesome although I must correct you and say it was Sally Struthers who did the save the kids infomercials..not Sally Field. =) But it sounds amazing. You guys should post more often, better yet I should come there and a do a rotation.
I did ATLS the other weekend and one of the instructors is a trauma surgeon I worked with as a medical student. He has a saying...he asks everyone in the room what the most important part of a doctor is...and he ends it by explaining that it is the heart, because if you really care deeply for your patients, you will do right by them. Unfortunately, it seems like our hearts get broken often, especially in an ICU on the south side of chicago. I hope everyone is doing well. Sorry for being sentimental, I just had to vent.

Hotel room for the boards using a starwood card

I just realized that the hotel for the boards is at a starwood hotel, which means you can use points on a starwood american express card to pay for the hotel for free.

When you open up a card and you get 10,000 points for free after your first purchase. The hotel that is booked costs 4,000 points a night (i think). Since there's only a month until the boards, there is not that much time left. I think you can apply online.

The annual fee is free for the first year.

I've had a starwood card for a year and so far i used points to pay for 10 nights in our honeymoon in Bali, 1 night in burlingame for my mom, 2 nights at the W in seattle and now 2 nights in south SF.

"Blogging" from lesotho...

hello cho family. sorry anu and i have been AMA. we have no internet at home and lord knows i thought "blog" was a made up scrabble word until a few months ago. i'm entrusting deb with posting this message since i couldn't even figure out how to do it myself

we can go by systems perhaps?

1)FEN:

-we have been eating a lot of cheese sandwiches- that's what you get for living with 2 vegetarians.

-i am, in fact, cooking occasionally. anu is cooking too. jeff is....well, he's eating.

-i am drinking the tap water. it's an experiment. so far, so good.

2)CV:

-heart rate and blood pressure have been intermittently elevated driving around maseru (the capital of lesotho where we live) on the wrong side of the road. actually, anu is a good driver. i had my first stick shift lesson, which went, errrr, okay.

3)PULM:

-i've noticed the elevation somewhat- went running for the first time outside in a while. we've mostly been going to the gym- which is 100x nicer than the hospital. priorities.

-inhaling a lot of dust too. the only thing that is green here is my sputum.

4)GI: like i said, so far so good.

5)ID: i mentioned my sputum.

6)GU: deferred.

7)DERM: it's so dry, i've had to apply the chapstick qid.

8) social: work, gym, eat, sleep. then on weekends drink wine and watch movies around a laptop computer. occasionally go to jazz. sometimes mix it up and drink beer.

ok, really though. the clinic is quite modern (baylor/bristol-myers squibbs creation). sometimes in the clinic i wonder if patients have actually been imported and we aren't really in lesotho. we have electronic medical records. (beats CHO!) the patients are awesome. every morning they have a staff/patient morning prayer/singing that sounds like a concert. the patients vary from kids who are doing well on ARVs to kids who are totally wasted and look like they're right out of a sally field save the children commercial. everyday we talk to moms who have just found out their children have hiv. once in a while we get the pleasure of telling someone his/her child is negative. most recently i admitted a 10 month old whose weight was 3.6kg. actually hiv negative! formula fed. this is why we tell moms to breast feed until 6 months at least even if they are positive. day usually runs from 8 to 5 or so.

that's the clinic. then i spent my first 2 days at the queen 2 hospital last week. we'll be spending 2 weeks there every few months. very different but probably familiar to many of you that have worked abroad. reminiscent of guatemala to me. dirty, lots of patients. no ventilators. IVFs measured by drips/minute. one oxygen tank divided in some crazy convoluted manner of tubing among at least 3 patients. deaths everyday. actually few codes since there just isn't much you can do. meds that sometimes are, and sometimes aren't, administered. we are doing nursing and doctoring at the hospital for the most part.

we admitted a 10month old girl with hiv and recurrent PNAs last monday who was in pretty severe respiratory distress. treated her for PCP, bacterial PNA, i tried some asthma tx stuff since she had some wheezing. in many ways, i feel like i am making stuff up as i go along. we gave her a bunch of salbutamol treatments and taped the neb preparations to the bed so the mom could give them herself if the nurses didn't come by at night. gave SQ epi (go dr. jenkins!!!) no terb. no atrovent. found some magnesium and made up a drip of sorts. tried lasix. oxygen is through a feeding tube attached to the main tube attached to the tank and goes into one nostril. when i blew the tube on my arm, i couldn't feel any air coming out of it. but there's no way to get her any more oxygen. just one tank. tried a mask (one mask for everyone). would have been intubated in the US.

pretty crazy to think of the way we spend jillions and jillions on keeping 23 week babies alive (no offense meg) and coding over and over and over again (najiba) kids that have no future when a fraction of that money could be used to buy a few oxygen tanks/masks that might have actually kept this little girl alive. but i guess that's the curse of modern medicine and having the technology that we do. she died last wednesday.

the good part is...there aren't the ICU ethical issues of....should we just let this person go? is it right to keep them alive? because you can't anyway. you just do what you can.

anyway, again, i'm sure this sounds familar to some of you. we are learning a lot...modified versions of what we would be doing in the US. learning to accept what we can and can't do. trying not to feel guilty about going home and drinking wine and relaxing at the end of the day.

on a lighter note, anu and i are working very hard at improving ourselves: both of us have made substantial progress on our nail fungi and anu's hair seems to be thickening. i am also trying to chemically alter my eye wrinkles to turn them from crow's legs back to feet.

we miss all of you!!!! we'll try to keep you updated!

-kdb

Sleeping before the boards

Is anyone planning on staying at the hotel that the Boards folks recommend we stay before the boards? The link is attached. The downside - $175/night! David G. made a reservation at a Howard Johnson, and it costs way less. Check http://www.hojosfo.com/. Isn't that the cutest website addy?

Also, we should definitely plan a party for sometime AFTER the boards!

Bali Honeymoon

I just got back from my honeymoon in Bali. Joe and I had an amazing time.

We got to ride on Elephants, feed crazy monkeys peanuts and bananas, and play with crazy birds. We also did things that I wanted to do- shopping and we went to the spas.

The flight took 22 hours to get there and 19 hours to get back.

On Day 3 of our trip Joe was playing in the water and incurred a 3 cm laceration on the sole of his foot. It wouldn't stop bleeding and it was covered with sand so we had to go into the ED and there they placed 5 sutures. Poor Joe. While the doctor was placing the sutures I kept asking her questions about the Indonesian medical system. Which made the suturing procedure take twice as long. Until Joe said ummm can you please stop talking and just hurry up.

So because of the sutures we couldn't really do very many things that involved the ocean. Which was okay for me because I'm a bit hydrophobic but sucked for Joe because he really wanted to go surfing and Kuta is a great place to improve your surfing skills.


Despite it all Joe and I had one of the best times of our lives. The food in Bali is amazing. The scenery is so beautiful. The culture and art is also really cool. Tourism since the 2002/2005 bombings have decreased to about 50%.

Slideshow below...