Weekend Update

You know, I used to love the aforementioned skit on Saturday Night Live until Norm McDonald started doing it. I don’t know why people find him funny – I really don’t. Anyways, Tina Fey is pretty funny, Jimmy Fallon was tolerable, and the other girl who does it now with Tina Fey is not so bad. So, it is watchable again.

So lets see, this weekend….. I was in the ED for about 6 hours on Friday. Dr. Khine was there as well…. No patients… no surprise. I am beginning to feel that this research is an exercise in futility. Either these patients don’t come it when I am here, or there just really aren’t that many first time wheezers in the Bronx. I have no interviews this week or next week so that’s gonna be 13 straight days in the ED…we’ll see how many patients I get in that span (I am on day 5 now – so far 0), over/under is at 4.

Anyways – some exciting news, Dr. Khine has another study that she ALREADY got IRB approved (thank God) on anesthesia and lumbar punctures. So this research study is a chart review – so retrospective instead of prospective – which is good, b/c then I am not patient dependent. All the patients I will use for the study have already come and gone. Dr. Khine doesn’t have a babysitter this week, but she is going to try to get her parents to baby sit for her on Wednesday so she can come in and get me started on the data collection. She said she had some residents who were interested in doing stuff, but they haven’t done anything yet, so I will get a crack at it. Perhaps I can accomplish something.

Finishing up the research part of the weekend – I was back here in the ED yesterday and holy crap was it busy! Packed to the gills as they say! Even the asthma room! But yet, in the almost 8 hours I was here, there was ONE first time wheezer under the age of two with a family history. And we actually enrolled her! Took me 20 minutes of talking to the mom an grandma, and then to dad on the phone, but everyone agreed to be in the study; we got the consent signed, gave the kid the medication, and she vomited it. Really disgusting vomit. Nonetheless, in the study we planned for this and we waited half an hour and tried to administer the medication again – this time, one of the nurses, Liz, gave it very slowly and the kid vomited it again. So that was it, she’s out of the study. That was a new one.. but at least I was kept busy for two hours.

Rest of the weekend – we were at my parents house in Monsey for shabbos. It was one of their very good friends son’s aufruf, which was nice (big kiddush), and of course, Sammy came to shul. He is soooooo cute. He was extremely interactive this weekend, which was very nice. He sort of rolled over for the first time…. We gave him a little help (a little pat on the butt) but he did the rest himself. Of course, he rolls on top of his arms and then gets frustrated that he can’t use them.

On Saturday night, Shosh and I went to go rent a movie, which is not usually a big deal, except it is the first time we both went out without Sammy since he has been born. I was fine, I think Shosh was a little nervous. Anyways, Sammy made it through the hour we were gone just fine. We rented Hitch – which was pretty cute. Movies, that’s something else I need to write about. I love movies. Regarding Hitch - I like Will Smith ever since his Fresh Prince days, so I enjoyed the movie. Sammy kept distracting us though, but it was okay.

Sunday was the big Chanukah Party at Yaeli and Elnatan’s house… it was really nice. Aside from my family coming, all of Shosh’s “extended family” (The people that her parents have been friends with their entire life) were there and grandma Buzz (Buzzy’s mom) was there as well, which was very nice. Sammy got a ton of presents, which is nice for him (and heavy for me). And the food was very nice, and they did a great job decorating the place, and we had a good time. We slept over at Buzzy and Phyllis Sunday night and then I went back last night after being at Monte for candle lighting and dinner.

And let me mention the 2005 Llamas are the champions of the Fanatics FFL!!!! A 25 or so point victory over Howard Deutsch’s Athletic Illiterates got me the crown, and bragging rights for the next year. Now I begin the arduous task of structuring my team for its championship defense.

And what have I gotten for Chanukah so far, you ask? I got a shower radio, which I have really wanted, a pencil sharpener (which I need), a neat figurine of a pediatrician which is really cool, the Replacements (a fun movie) and, best of all, TiVo!!! By the time I post this I will likely have it hooked up and be totally absorbed in pausing live TV. I’m psyched.

Anyways, I’m gonna go stroll around the ED.

Danny

Wednesday PM addendum:
- FINALY got TiVo working.
- Met with Dr. Khine today, starting retrospective study tomorrow after meeting with Dr. David. More on that soon

D

Today and some random thoughts.

So... another 6+ hours in the ED and no patients. Had a false alarm... first time wheezer under the age of 2 with a family history of asthma, BUT she didn't have a high enough bronchiolitis score - basically, she wasn't sick enough. No point giving medicine to people where you never would clinically anyway. So I sat and read, and wrote 40 thank you cards for Sammy.
Here's a new pic of Sammy by the way:

Yeah, I know, he's pretty cute. He rolled over for the first time today!!! It was very exciting, because both Shosh and I were home!

Anyways, back to research.... well its going REALLY slow... this week the whole ED was slow thanks to the transit strike. Apparantly 80% of Monte patients get to the ED via public transportation. Oh well.. I don't have any interviews for 2 weeks, so I will be in the ED every day and hopefully we will get some patients. Not that I don't appreciate all the time to read (4 books, a lot of daf yomi) and write (2 short stories) and do other stuff (40 thank you cards for my lazy son), but I would REALLY like to get some patients for this study.

What else - I am in the finals in my keeper league!! Playing Howard Deutsch - who by the way, got engaged recently (as did fellow league member David Rubenstein - congrats guys). I think my team is the better team, but Howard (or Herm as a I like to call him) has LT, who plays the Chiefs.. and we all saw how well they tackled Tiki. But I have Grandmama (LJ) so hopefully all will be well.

Anyways, we are going to my parents for Chanukah, and will like come home with about 2000 presents for Sammy. Things could be worse = )

Also... random thought... listening to some music... (i know, i still have to write about this and college /med school friends) Wycleff Jean and in his song, "Perfect Gentelman" I think he has the greatest spin of the saying "don't jusdge a book by its cover" it goes:
"just cause she dances go-go, that don't make her a ho, no" very interesting.

g'night

Yadda Yadda Yadda....

The first part of this post was written on my palm pilot while i was in DC on Monday for my interview at Children's National Medical Center....

Well, enrollment has been going much slower than I think anyone anticipated. Before we started Dr. Khine said they got several patients that meet the criteria each day. Well, so far we have had not nearly as many as expected patients that meet the criteria - i dont know if they just come in when dr. Khine and i are not there, becaue when i have been there i have seen very few first time wheezers, and those that are, a lot dont have a first degree relative with asthma..... Most hhave cousins... Also had a few where the patient got steroids earlier in the day from their doctor. Why is their doctor giving them steroids??? There is no evidence for steroids in bronchiolitis! Thats why we are doing this study!!!!! So frustrating. So unbelievably frustrating. I go to the ED for 7-8 hours a day when im not interviwing, and not getting anyone.

And todays edition.....

First, let me bitch about the strike. I had to wake up early to go pick up Cingy, Sammy's babysitter, from her apartment, which is right near Montefiore, which made it doubly frustrating to be there, drive home, and sit on the shuttle for 45 min to get to work. Not to mention the shuttle driver has the worst case of road rage and will probably kill someone in an accident within the next few months (certainly before I graduate). Anyways, because of the stupid transit strike, it took 45 minutes to get to Monte (usually takes 12). When i got there, teh ED was a ghost town. 2 patients. unbelievable! I sat around for about 7 hours, and then finally, into the asthma room goes an 11 month old. His mom and dad both have asthma. Mom says he started wheezing for the FIRST TIME last night. He also has a cough. I get very excited, take a listen and.... the kids lungs are as clean as a whistle. Perfectly clear! unbelivable! i mean, great for the kid, bad for me. kid wasn't even tachypnic... how disappointing.
another day, 0 patients.
i set up a meeting with Dr. David for next week to make sure everything is cool for my ISP etc etc (i.e graduation).
bah. very depressing.

D

Really Quick Update

Third patient all better. No new patients on wednesday or today. very sad. no one even showed up who qualified for the study!

Brief Update

Well, we now have a third patient in our study!!! I enrolled someone myself yesterday, for the first time - an adorable 3 month old boy, first time wheezer, who's mom has asthma. Mom actually wanted to read all the paperwork before, which I was pretty impressed with. He was doing much better after an hour and a half... I have to call the ED later today to make sure they did come in and follow up. Dr. Khine didn't enroll anyone on her shift over the weekend.... and for the 7+ hours I was there yesterday, only that 1 kid came in who met the criteria. But now we have 3 (maybe mroe - Dr. Khine was on call last night, I don't know if she enrolled anyohe while she was on call). Hopefully tomorrow I'll get 1 or 2 kids.

NYU interview today, Monte on Thursday and then down to DC next week.

D

Update

Well, i spent 6+ hours in the ED yesterday and again, NO ONE who met the criteria came in. Had a good candidate but they only had a cousin with asthma (no first degree relatives), and another good candidate, who after talking to her for several minutes, it came up that this really wasn't her kids first time wheezing - she actually had wheezed and been diagnosed with bronchiolitis when she was 3 months! very frustrating how these stories change. Anyways, due to the snow and the fact that I need to be home early for shabbos, I did not head in today.. Dr. Khine is in the ED today and she says it is very empty with a lot of people there so she will be able to enroll anyone if they come in.
Dr. Khine did enroll someone on Wendesday when I was at Cornell, so now we have 2 patients in our study.

Reading State of Fear by Michael Crichton - very good! Much better than his mroe recent stuff (prey, timeline).

Okee

So, the boards went allright. I had a very eventful day though b/c on my way there, some guy spun out, managed to hit both concrete barriers on the Hutch, ending up perpendicular to the road. I stopped, made sure the guy was okay, called 911 and then explained that I had a test and took off. Pretty crazy morning. Test was okay. Lots more epidemiology than I expected, but whatever.. i get my scores in a couple weeks.

Had LIJ interview yesterday - it was very nice. I like every program I go to.. gonna be a problem deciding which one to go to. Have Cornell tomorrow. Will report.

As for research.... good news and bad news.... The good --> the first patient we recruited last week got discharged from CHAM on Saturday and is doing better. Still coughing, but better, which is good. I've called her home the past 4 nights to follow up and will do so again tomorrow night (hopefully the last time I will need to). The bad news. The study so far constitutes of that 1 patient. Dr. Khine was in the ED on friday and tehre was no one who met the study paramters and I was in the ED today for 7 hours and there were ZERO first time wheezers who came in. Unbelievable! I read an ENTIRE BOOK in the ED today.

i'll be back in the ED on thursday. hopefully, I get some mroe patients.

wish me luck at Cornell...

YES!

Really quickly.. b/c i am taking step 2 tomorrow. On Thursday i was in the ED for around 6 hours, AND..... (drumroll).... we enroleld our first patient... a 3 mont hold first time wheezer, whose mom has asthma. Perfect! She got the study med, I resp checked her every 30 min for 4 hours.... she ended up getting admitted b/c she had been doing q4 albuterol nebs for 2 days before... but she's in the study. There was another perfect subject, except he had orapred earlier that morning. Dr. Khine was gonna enroll someone on Friday, but no 1st degree relative with asthma. oh well.

This is a busy week for me:
Sunday -- boards
Monday --LIJ interview
Wednesday - Cornell interview.

I guess that means 3 days in the ED this week.
better get something to read!!!

Danny