I really suck at updating this thing now

4 weeks left of internal medcine. My team switches this week, which really sucks. I've had the same intern for the last 8 weeks (at Jeff and Methodist) and he was my buddy, but now I have to get used to this new girl who isn't as nice or as helpful. My resident is switching as well, but at least I know my new one...she was the resident in the ICU at Methodist this month and did the MRAN's for my team, so I already know she's super smart, a good teacher, and a likeable person.

The pateints are really different there. It's our inside joke that the most common test we have to order is a UDS (urine drug screen). South Philadelphia is an interesting place. Historically, it's the Italian neighborhood, so there are a lot of elderly Italian people and their kids and grandkids living there. In the 80's, African American families started to move in there, and in the late 90's to 2000's, Hispanic and Asian families, so there is a very odd combination of people, religions, and values. It's also a relatively poor neighborhood with a large homeless and/or drug addicted population, so we see a lot of people who don't get regular healthcare, are addicted to drugs, and live in shelters. So on that backdrop, we have patients who are mostly hypertensive, have end-organ failure, have diabetes, are HIV+...etc etc. It's a real challenge to treat many of them beacuse they don't know their medical history, don't speak English, or any one of a variety of barriers. But I'm learning a LOT.

One thing: HIV patients are HARD to take care of, and they break my heart. My one patient I have now contracted the disease 17 years ago when she got pregnant with her youngest daughter. She is also on dialysis because she took too much of a prescription medicine for her system (not really an OD, just the wrong dose) and her kidneys failed. She doesnt' qualify for a transplant because of her HIV. Her cell count is really low, so she has to take 4 antiretroviral drugs, prophylactic medications to protect against infections...she's neutropenic, so we have to wear masks when we go in her room and she can't eat fruit or vegetables because she might get an infection. It's hard to know what we can treat her with because of the dialysis...a lot of medicines she can't have. She's also sensitive to a lot of medicines...so it makes it REALLY hard to control her pain (can't have this because of dialysis, can't have that because of allergies, can't have the other thing because it's not strong enough...then what?) This poor woman is ony 40, she never used IV drugs, never did anything wrong and she's dying. So dramatically NOT fair.

So 4 more weeks left for me of Internal Medicine, and I think that I'll keep it on my list of potential specialties. I would really enjoy Hematology/Oncology I believe, or maybe Pulm/Critical Care, but not general practice. It's a little broad of a field for me and I think I would like to have a more narrow focus. Plus, I can't stand nephrology. Kidneys are HARD!

In terms of other life stuff, we're slowly starting to get the wheels turning on starting our family again. There was just an EXPLOSION of pregnancies on the message board we post on (hi , guys ;) and Megan is really feeling the itch to get started again. We're a little antsy about the homestudy issue in our current place/situation...this battle we've been having with our landlord over the apartment (they got mad at us and decided to accuse us of having an "uninhabitable" house, filthy, with dog feces all over...complete bullshit) and we're scared that will get in the way of passing a homestudy. Shit shit shit. So we'll see about that. Part of us isn't ready to give up TTC anyway...I mean, she's 24 fucking years old, you know? argh.

Okay, it's time to go...I'll update part 2 later :D To come: the puppy, more about school, friends, the apartment...Disney of course...