HAPPY BIRTHDAY KAREN!!!!!

it's 2 am and i woke up and can't seem to go back to sleep. probably just wound up because i'm rounding in the morning for the first time. well, if any babies are born that is. as of last night there weren't any at the hospital i'm rounding at.

as for clinic, i'm getting more efficient. getting out of the office between 7:30 & 8 rather than between 10 & 11! sick season is beginning though and flu season is soon. so i need to get a lot more efficient still!

ian's doing great with his big boy underwear. tom's still waiting to hear from a couple of banks about jobs. heidi (tom's sister) has a job interview at richmond pediatrics tomorrow!

oh, pictures update:

ian getting a treat for staying dry

new haircut & highlights today:

lots to update, let's see... ian had his school picture this week. i'll probably have to edit the photo because he had a big scrape on his forehead! tom's job hunt is going well. he's had a few interviews and is waiting to hear. my job has been great, although more time-consuming than i expected. i've been doing fine at not running behind during the day, so for the most part patients aren't waiting way past their appointment times, but in order to stay on time without being rushed with each appointment, i have to save most of my charting until the end of the day. so i've been there until as late as 10:30, and with going to the hospitals a few times after clinic to see patients i've admitted, i've even gotten home as late as 11:30! last night was my earliest. i left a little after 7:30. i'm going to try and get faster so i don't have to be there so late because it's going to get much busier when flu season hits!

my joints have been really good! i've had barely any joint pain this week. it's been the best week since february! i like the rheumatologist here. she's taken me off enbrel and i'm doing fine just on methotrexate and plaquenil. the most exciting news is that i went for a little jog this week, the first in over a year! and my hips tolerated it fine! i don't know why i'm doing so well but i'm very happy about it!

i went in tonight and finally put pictures up in my office! i have some photos from my trip to africa, all of beautiful kids and babies. i got nice frames and mats for them. and two posters. one is a collage of noah's ark done by a local kindergarten class as a fundraiser, and the other is a brightly colored painting of a chinese market that i received from a professor in medical school for being the top of the class in pathology. all my diplomas are up, although i'm still waiting for a frame for one of them. and my plaque for being valedictorian of my med school.. seems boastful to have up but it's small and subtle and i am very proud of it! there are more things, but pics will show it better. i also got a toybox and a few toys and books to start my collection. it's slowly becoming a cosy and fun room! my desk is a bit of an eyesore.. i'm going to hunt through some used furniture stores, hoping to find an old solid wood one with a bit of character.

spent a while with the family of my little baby in the ICU this morning. i'm still reeling at it all. i was used to rare diseases in seattle, because kids were sent to use from far and wide with strange things; but i didn't expect something like this so soon. i'll probably never see another case of this my entire career.

i want to keep the little boy as my patient. i've very attached to him and his parents after all of this. and they trust me... how can i tell them that i can't see him because we don't take their insurance? it's times like this that socialized medicine seems appealing. i'm going to hope for a loophole, some way to keep taking care of him.

also wanted to write about some happy stuff. ian is still doing well in his underwear. such a big boy! and enjoying his big boy bike. should be a fun weekend!

tonight i went to an art show with a friend. it was awesome!!!!!! i bought two colorful animals made out of gourds (hard to explain but very colorful and fun) - they hang on fishing line from the ceiling and i'm going to put them in my office.

after the art show we went to barnes and noble and have tea, chatted and looked at books. and then when we came out it was raining! we had brought the mini and left the top down. fortunately it had only been raining for a few minutes and not heavily. it started to pour as we put the top up. we were driving home, talking about how lucky we were that it hadn't rained harder before we'd come outside, when all of a sudden the horn started BLARING!!! omg the mini is little but it has a LOUD horn!!!!! i pulled over and we tried to make it stop but couldn't. it kept starting again and nothing we did made it stop! i called the mini roadside assistance number and could barely hear the guy on the other end because of the noise. meanwhile my friend was looking for the fuse to the horn. everyone was staring (we had pulled up to a gas station) and one guy came up and suggested disconnecting then reconnecting the battery. finally the fuse blew and the horn stopped! and we laughed all the way home!!!! it was insane! guess i'll be going back to the dealership but man i hope this time it's under warranty!

so much to update this week! work has been all-consuming. i was there on tuesday and friday this week, even though i officially only work mondays, wednesdays and thursdays. i have a patient who is critically ill in the ICU right now. it's a long story, but i think i'll try to summarize anyway.

i first saw him last wednesday, when he was 3 days old. he was jaundiced so i ordered a bilirubin level (bilirubin causes jaundice in babies, which is dangerous if not treated). it came back very high so i admitted the baby to the hospital for treatment. it was a routine admission. he did great and was discharged friday by one of the other doctors. i next saw him this wednesday. he'd been seen a couple of times by my partners and was still getting phototherapy at home, because his bili was still high. i checked a bili and it was about the same but i was worried because it wasn't really going down, so i sent a ton of labs when i saw him back on thursday. labs still weren't back yet and i called the home to check in thursday night. no-one answered and wow i almost let it stop there. thank goodness though, something prompted me to call the dad's cell phone. i talked with him for a bit and he mentioned that his wife would be home in a half hour. it was about 8 pm by then but i was still at the office doing paperwork. i called the mom and she told me the baby was sleepy. and that he was having more dirty diapers than before. she thought the sleepiness was because he'd had his blood drawn and was tired out. but i was anxious...

i was worried a little bit about a rare problem called panhypopituitarism. it's when the pituitary gland doesn't work properly. the pituitary controls all the hormones in the body. including the hormones that make the kidneys work, and keep the blood pressure up, the thyroid, everything. babies with the problem become critically ill and can die before the disorder is recognised. so i told the mom to take the baby to the emergency room. and i called the emergency room and told them what i was worried about and what labs to draw, and asked that they not let him wait before being seen.

and the labs were all wacked. and confirmed my suspicion. he was still doing well last night, but was admitted to correct all the abnormal electrolytes and for monitoring. but then he got worse today and is in the ICU on a ventilator. i'm very worried about him.

we're doing well! i got a new digital camera (well overdue!) so i have lots of pictures to share! go to my homepage for a link, and i'll upload some to here too.

ian has been going to school in big boy underwear this week! he's had lots of accidents but his teachers say to kust keep sending him with lots of extra shorts so we're keeping at it. he's done pretty well at home so far. probably because he has a little extra motivation in the form of a special treat for every time he goes!

bonnie got a flat yesterday on the way to work. a yellow light came on and i didn't know waht it meant until i got home and checked the manual. sure enough one had zero pressure, even though it was running fine, because of clever "run-flat" tires. it cost $370 to replace!!!!!!!!!!!! insane!

tom and i have a date tomorrow night. he arranged for a babysitter that we've used before and was great with ian. we're going to some combination thai/curry place or something. sounds good!

i'm back on prednisone for the time being. had a little flare up after the first day of work and talked to dr gorman, who suggested going on pred briefly. i'm wondering if i need to try a different anti-rheumatic drug, to see if we can get better control of the inflammation. we'll see.

we've got our new insurance now. the bummer is it isn't nearly as good as the old insurance. just for the enbrel i'm going to have to pay $400 every 3 months, at best, and prescriptions aren't included in the annual maximum out of pocket expenses. bummer.

phew, survived the first day of work! it was pretty much what i expected.. i was slower than i wanted to be because i kept getting tangled up in paperwork, i'm sure i forgot to bill for many, many things! i ran behind but not too terribly so. no-one left in a huff so i suppose that's an accomplishment!

anyway, the rest of the day went well too, and i'm looking forward to next week

it was an ian and mommy and aunt heidi weekend. tom and i were suppposed to go to charlotte, NC, but i was feeling bad so he took ian to heidi's as planned and i spent most of saturday in bed. then heidi came over most of yesterday and played with ian over here. so he had a fun weekend!

this morning i have the appointment with the family dr. then tom should be back, ian's all excited because daddy is picking him up from school today!

today was great.. a bit overwhelming, but great! i spent most of the day at work, asking questions, finding stuff i'll need, getting settled in my office.. hope (my medical assistant) has prepared the charts for thursday already. she is wonderful. we're a good match. so young though! i feel old!

i'm struck by how much i don't know. ack!

here's a recent pic.. it's from when we went out to dinner the other day with tom's parents, sister, and cousin. ian and i were sitting outside after dinner, waiting for everyone else:

tomorrow we're driving down to charlotte. ian's going to stay with heidi for the weekend. it's the first time tom and have gone away overnight since ian was born!

called my old dr in seattle today. was hoping to get a copy of the letter she'd written to the rheumy here, so could use it for the other rheumy and family doc that i'm going to see. as a summary of everything that's happened, all my medical stuff. was also hoping for advice because i'm kind of stuck and not sure what to do.

her receptionist gave me a hard time. you know, paperwork and signatures and send in a request to medical records yada yada. so i asked if she could just have dr gorman call me please. more of a hard time blah blah blah. couldn't get a word in edgewise. i have simply had enough of the medical system making it impossible to get care! i gave up and said never mind. this is ridiculous!