New York City

So earlier this month, I flew out to NYC to visit Shari and Jen.

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Friday - Flushing

I flew out on Friday afternoon and landed in LaGuardia, where Jen picked me up and we went to a park in Flushing where the World Fair was held.

We waited until Shari got off work and then met up with her for bubble tea and dinner. After wandering around for a bit, we decided to have hotpot. :-)
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Saturday - NYC (Manhattan)

Early on Saturday, I left for NYC with Jen where we met up with Shari at Penn Station. We walked for a bit, got some bread, and then sat in the middle of Times Square to eat.

After we ate, we went to the M&M Factory before heading over to Columbus Circle and then walked around in Central Park.

M&M Factory

Columbus Circle

Once we exited out the east side of Central Park, we sauntered over to Shari's apartment and the hospital where she works (with the ridiculous spiral staircase).

Then we headed down Manhattan to East Village for falafels and frozen yogurt. Along the way, we crossed The Cube (apparently it's called Alamo) that looks exactly like The Cube at UM-Ann Arbor (because it was made by the same person). We ended this round at McSorley's, one of the oldest pubs if not the oldest.

We then power-walked over to Washington Square Park where we met up with Jen's dad and brother. We enjoyed a couple hours of street entertainers there, including a contortionist guy and Tic & Tac.

Washington Square Park

Street performer in a box.

Tic & Tac

We had dinner at Katz's and walked to Chinatown afterwards for rice pudding before heading to a train station back to Jen's house. It amused me how Chinatown had expanded and cannibalized the surrounding area, including most of Little Italy.
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Sunday - Brooklyn

On Sunday, Shari, Jen, and I went to Green-Wood Cemetery. We saw such features as:

Green-Wood Cemetery entrance

Battle of Long Island monument

Altar to Liberty - Statue of Minerva looking at the Statue of Liberty

Leonard Bernstein's grave

Hillside Mausoleum

Once we finished up looking around Green-Wood Cemetery, we headed over to Grimaldi's Pizzeria for lunch under the Brooklyn Bridge.

Next, we went to Red Hook for key lime pie (clearly this trip to NYC centered around food, lol). We got a nice view of the Ikea ferry passing near the Statue of Liberty.

Then we found some street vendors and bought pupusas (or rather, Jen and I got pupusas, since Shari didn't like it).

After stopping by Jen's aunt's birthday party (where I proceeded to feel quite out-of-place), we went to Brighton Beach and walked along the beach to Coney Island.

Phew! And that concludes my trip to NYC!!
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Backlog: 08-06-10 to 08-08-10

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Peds Externship: Week 8

Last Friday I finished up with my last day of my pediatrics externship. The experience was amazing and I had a great time (for the most part). It felt weird leaving while knowing that I won't return for quite some time - if ever - to those placements.

Peds Externship: Week 8

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Monday

I can't really remember anything that stood out on Monday. It was a pretty light clinic day, and we rounded afterwards until 6pm, grr. Patient 1 from Week 7 was doing very well. She was awake and alert. And asking for food. That's pretty key in kids as a sign that they're doing better. :-) We also rounded on a new patient suspected for Kawasaki's disease. The kid didn't present with "typical" Kawasaki's but had just enough possible symptoms that the attending, Dr. Vo, felt that treating for Kawasaki's was probably a good idea despite not being 100% sure.

Tuesday

The weekly teaching session by Dr. C focused on vasculitides, of which Kawasaki's is counted among them. It was a good session (albeit rather longer) because we saw many cases of suspected vasculitis and such throughout the month. It was weird because these diseases are supposed to be really rare. The last topic touched on during the session was on Kawasaki's, where Dr. C "pimped" pretty much everyone by asking for symptoms of Kawasaki's. The M4 mentioned oral mucosal changes, such as swelling and the classic "strawberry tongue." Dr. C then asked what oral mucosal changes are not seen in Kawasaki's. The PGY2 (2nd-year resident) couldn't answer correctly, but I guessed correctly by saying "mouth sores." :-D So yeah, discrete vesicular changes aren't characteristic of Kawasaki's. Good to know.

Patient 1 was well enough to leave the PICU and was transferred to one of the ward floors for the next few days at least. It was pretty amazing seeing how Patient 1 bounced back from the precipice of near-death. The Kawasaki's patient was doing very well and acted like a completely different kid. On Monday she was very fussy and such, but today she was happy and active and cooperative. :-)

Wednesday

Another typical clinic day. Saw many patients, got to talk to some of the patients and families. Followed around the attendings. Clinic days are pretty laid back but also quite rewarding. In peds rheum, you see these kids again and again, sometimes as frequent as every 3 months or more. Their disease course requires so much monitoring and adjustments along the way, but it's good that most of the time the rheumatic diseases can be controlled so that kids lead normal (or normal enough) lives. While the focus of this rotation is supposed to be the clinic, one of the things I like about this rotation is the balance between inpatient and outpatient (aka, clinic). Yes, most of the time on Mondays, Wednesdays, and to a smaller extent Fridays, are spent in clinic; but there are also lots of inpatient hospital time too without being too much. I suppose I like having the best of both worlds.

Thursday

Since it was the last week for many of us, some of us had to give a presentation (but not me, muahahaha - though I did prep one just in case). The M4, the intern, and the senior resident gave pretty interesting presentations. After that, we hung out in the resident's lounge for a bit before being called to the floor to round on Patient 1 - who, by the way, had been doing amazing all week. And since she was the only inpatient kid, Dr. Vo released us at around noon. We bolted out of the hospital, lol.

Friday

After a fairly interesting grand rounds on children's bone health, we headed down to clinic. Alas, we saw maybe 2 patients due to a string of no-shows. We page Dr. Vo to see when and where in the hospital she wanted us to meet her.

First we went to noon conference where one of the physicians in the pain clinic talked about pain management and control in kids. It's almost inconceivable to think that 30 years ago, many doctors thought that newborns couldn't properly feel pain and thus subjected them to many operations and surgeries without anesthesia. Thankfully starting in the 1990s (I can't believe it was only that recent), doctors finally realized that not only do newborns and infants feel pain, they feel it worse than adults! From clinic, I've definitely come to appreciate that pain is pretty high up on the list of complaints. And rightly so! Though we're trying and doing better, there's still plenty of room for improvement.

After the noon conference, we headed up to one of the PICU floors. We saw this teen who was there for cancer treatment but then developed all sorts of weird stuff with his lungs and kidneys. So they call the peds rheum team! While several of us were in clinic that morning, the rest of the team was with Dr. Vo researching possible causes for this kid's issues. And the result? Nothing. At least nothing convincing or useful.

Dr. Vo spent quite some time just reassuring the mom and the grandparents. It was a good encounter to observe, actually. Because nowadays with internet access, everyone scrambles to the internet for answers. But few other than health care professionals can truly understand, sift, and filter the medical jargon even on the internet. And thus Dr. Vo's comment that we had researched possibilities on this kid for over 4 hours and came up with nothing very much reassured the mom. After that, we were dismissed since there were really no more patients to see.

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And thus ends 2 months (8 weeks) of the pediatrics externship. While not always the smoothest ride, it was sure an amazing one. I will dearly miss this experience I think. In fact, while volunteering at a free clinic on Saturday morning, I was so tempted to ask about rheumatic diseases and do joint exams. But that would've been unnecessary and useless to do on adults who only came in for medication refills, lol.

I learned many things from this externship. Not all of it necessarily medical knowledge (that I'm sure I forgot a lot of, but will surely come back quickly), but things such as what I like, what I want, and where I see myself. I can definitely see myself in pediatrics. The people are nice, the patients are good, and the families generally reasonable. What I like are specialties that focus on systemic issues like infectious disease or rheumatology that can affect multiple organ systems. And what I want is definitely where I'm still headed. All signs pointing in the correct direction!

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