Trauma Call

What I'm like on trauma call

"You just need a man to figure it out"

Setting: the female fellow and male attending are working to place a new dialysis graft in the patient's arm.

They are trying to figure out how to work with a different tunneler when the attending says, "You just need a man to figure it out."

At another point in the surgery when the fellow was questioning the position and number of the vessel clamps, he again responded, "You just need a man to figure it out."


In both these instances, the fellow half-heartedly laughed in response. Was the attending saying this in a joking manner? Yes. Does that make it ok? I say no.

Just some food for thought.

The Silver Lining

Some days it's difficult being the med student.

You put pressure on yourself to perform well, especially when you're in the specialty you want to pursue. In the process, your nerves are your undoing on something as simple as a patient presentation.

You try and take the initiative and remove a wound dressing, only to find out it wasn't supposed to be removed yet.

You know the answers to all the questions except the one you are asked by your resident.



The silver lining? When your patient tells you you're going to be a good doctor.

Lumbar Puncture

The nurse scrunched up the 7 week little girl into a ball so her spine was curved, exposing her intervertebral spaces.

The resident counted her vertebrae, felt the spaces, and started prepping the area of entry.

I dipped the pacifier into the sugar water again and tried to get her to suck vigorously on it.

The resident sticks the needle into her spine, the end of the needle remains dry.

She screams and tries to wriggle free.

I put more sugar water into her mouth.

We start over.

The attending tries.

I put more sugar water on the pacifier.

Only blood comes out of the  other end of the needle.

The attending calls the hospital director.

We put the baby in the sitting position.

The nurse scrunches her down.

I try to get sugar water in her mouth.

She stops trying to break free and relaxes into my hands

I cradle her little head

Nothing comes out of the needle

Overheard in Egleston

A 7yo boy born with 4 fingers on his left hand: "Some people say God made everyone with 10 fingers and 10 toes, and that's not true."

Same boy, when asked about napping: "Yes. I napped 12 minutes ago!"

A 3yo girl with a pinwheel for incentive spirometry: "Abra Cadabra!"

An 8yo girl when asked about being ready to go home: "I'm afraid of falling and having to come back to the hospital"

A 10yo boy with recurring Guillan-Barre "I'm afraid of dying from this"

10 Fingers, 10 Toes

I've started my inpatient Pediatric rotations by working in the nursery at Grady, a pretty happy place to start :)

Babies are adorable. To celebrate their adorableness, here are some baby haikus.

Babies are cuties
Ten fingers and toes I count
Tiny hand grasps mine

Learn swaddling skills
Wrap babies cozy and tight
Sleep peacefully now

Baby Reflexes
Morrow, Babinski, and suck
Soothe baby, me, both?

Needless to say, this week has been nice... happy moms, mostly happy babies (as long as they're being fed), + happy doctors = happy med students.

Breaking Bad News

I have always thought that it would be too difficult for me to be an oncologist due to the emotional burden of sharing devastating news with a patient and their family. During this rotation, I spent the afternoon with an orthopedic oncologist. He had one of the best bedside manners that I have seen.  With every patient, he just seemed to build rapport effortlessly, and he seemed to have a deep connection with the patients he had treated that were now in remission. I not only saw him interact with the patients that were now doing well, but also patients who faced an undesired disease progression, specifically one patient with stage IV disease.

We walked into the room and he introduced me to the seventy-year-old patient and her daughter. He started off asking the daughter about a tattoo on her arm, and making friendly conversation. He then examined the mother’s shoulder where a tumor was growing underneath. He explained how the CT scan showed spots in her lungs in addition to the tumor on her shoulder, and what her options were for treatment. He explained this all in a calm and straightforward manner. He did not go into the medical specifics and what this meant for her prognosis, but instead discussed in simpler terms how he could help her.  I could tell the patient and her daughter were both shaken up by the results. The patient was trembling while tears formed in her daughter’s eyes. The physician allowed them to process this information with silence and again told her how he could help her in his role as the surgical oncologist.  He also provided a plan of action for them. He encouraged them to see the medical oncologist within the week, and he advised them to contact him with any questions or concerns they may have.

Cancer is horrible. There is no way to alleviate the shock, fear, and pain of that diagnosis. I have never been sure how I would break that news as a physician. Seeing this doctor tell his patient and her daughter about her cancer showed me a good way to do it. He was straightforward with his explanation, yet calm and empathetic in his delivery. He did not promise a cure, yet he did not take away all hope. Although I felt extremely sad for the patient and her daughter, I could appreciate the way the physician handled the situation.

This specific experience provided me with insight into a way to share difficult news with a patient. It is a balance between showing empathy and serving a source of strength and hope. It is explaining the diagnosis in clear and simple terms and taking the time to let the family process in the information. It is not leaving the patient feeling hopeless about their condition, but instead providing a plan of action and reassuring them that you are available to help them. Through this experience, I hope I am similarly able to discuss difficult diagnosis in a way that makes the experience as easy as possible for the patient.

Thoughts on Family Medicine

After 6 weeks on this rotation, I have become somewhat familiar with the practice of family medicine. Ultimately, I've realized you need to be a REALLY good doctor if you want to go into family medicine because you essentially need to have a mastery of three subjects: internal medicine, pediatrics, and ob/gyn. However, due to the reimbursement rates and restrictions on patient care, family medicine doesn't generally attract the top students. Even if you're a pretty good student, it is really difficult to know three broad fields very well. It seems that end result is a "jack of all trades, master of none" situation.

Coming off of the ob/gyn rotation, I think that there is a reason a "speciality" exists for this field. Those doctors are putting in IUDs everyday, talking about birth control options every day, looking at cervices everyday. Therefore, they have a better grasp on diseases affecting those patients. Yes, doing a pap smear isn't very difficult but fully managing a women's ob/gyn needs can be, and I think it should be left to the ob/gyns to do that.

However, I also realized the utility of the "family doc" in rural areas. If you have a good base of knowledge in internal medicine, pediatrics, and ob/gyn, and you're the only doctor for a few hundred miles, it makes sense. However, in the urban setting, I feel that patient receive better care going to the specific subspecialty of pediatrics or ob/gyn.

Overall, I have enjoyed this rotation. It's patient-care focused. There is a lot of preventative medicine. The hours are pretty nice (but you hours outside of clinic are generally filled with paperwork). You see a wide variety of patients. Other times it can get pretty monotonous (for example, having 5 physicals back to back). Ultimately, I don't think it's my passion. I don't feel as excited coming to clinic every day as I do going into the OR.

On Hurting Patients

As the other students in my class, I came to medical school because ultimately I want to help people. However, I didn't fully realize that with the intention of helping people, you sometimes I have to hurt them (ex: vaccines, drawing labs, IV medications, sometimes even physical exam maneuvers).

We had a young women come into clinic the other day because she has tenosynovitis. One of the treatments for tenosynovitis is a steroid injection into you wrist, underneath the tendon sheath. I went into the room, introduced myself to the patient and her family within the room (husband and 2 small children), and explained to them about the procedure. I was working with a resident that day.  As the resident is preparing the injection, she tells me "I'll do the first one and you'll do the second."

Medical school is about learning and that includes procedures, but I had never given a steroid shot before, especially not into the wrist where there are about 20 other things in that small space. This was also the first time the resident was doing this particular procedure. I didn't say anything and just tried to get into the mindset to do it. The resident puts the needle into the patients left arm and starts injecting. The patient flinches and starts crying. The resident finishes, looks at me, and asks, "you want to do the next one?" I am conflicted. I don't want to look like a bad/afraid/uninterested medical student, but I am not comfortable with this procedure and the patient in front of me is crying out of pain. I say, "I'm not really comfortable doing that." The resident gives me a look and does the injection. As we walk out of the room, she tells me that I'm doing the next steroid shot even if I'm scared. I tried to explain to her it was more to do with the patient crying in front of me and unfamiliarity with the procedure than fear. 

The experience made me realize how much I DON'T like doing procedures outpatient. Even though I am a procedurally geared person, I like surgeries because the patient is anesthetized. They can't feel you cutting through their skin; they don't FEEL. I have found outpatient procedures really difficult, especially joint/steroid injections. It's hard to want to try something for the first time when it includes inflicting pain on a patient.

"I've never ridden in an ambulance before"

The reason for appointment read "follow up for cough." Reading through the notes, I see several visits over the last few months for the same reason, cough. Something didn't feel right.

I walk into the patient's room and introduce myself. He looks thin, anxious, fragile. He tells me about his cough, how it's been going for a few months, how thinks he might need some antibiotics this visit. He goes on to tell me how he's developed diarrhea in addition to his cough, how he's lost 25 pounds in the last 3 weeks, how he feels weak, how he has unresolved skin rashes on his sides. Something really doesn't feel right.

I do a physical exam. I don't hear anything in his lungs the first time. Listening again, there is something in his right lower lobe, but it's not typical pneumonia. His chest xray from a week ago was perfectly normal. I continue my exam. He's breathing fast, his heart is beating fast, he is not doing well. I look at his abdomen, the rash is still there. There is fungus on his toenail that just isn't going away. I ask him to open his mouth, so I can look in his throat. My fears and suspicions are confirmed. His mouth is covered in thrush. I try to remain calm and tell him that I will be back in a few minutes with the doctor.

My heart and thoughts racing as I leave the room -- "Oh my gosh, oh my gosh, oh my gosh. My patient has HIV, and he doesn't know." I scan the records looking for a previous HIV test. I don't see one. I tell the doctor about him. We go in to see him together.

She asks some of the same questions. She also asks about his sexual history. He seems uncomfortable talking about it. We measure his oxygen, and it's low. The doctor explains to him that due to his unstable vital signs and low oxygen that we're going to have to call an ambulance to come take him to the hospital. She then tells him that based on his signs and symptoms that he most likely has HIV and a pneumonia caused by the HIV that they will treat in the hospital. She then asks him about which hospital he would like to go to and we leave the room.

I go back in to check on him. I ask him how he feels about what the doctor just told him and if he has any questions, and he replies "Well, I've never ridden in an ambulance before." I don't know if he just didn't process what the doctor had told him or if he was in denial, but he wasn't ready to about it.

Medicine just got real.

Self Reflection – The Importance of Self Care

As part of the assignment for this rotation, we have to write a letter on the importance of self care. When we are in our intern year of residency, the clerkship director will mail these letters to us to remind us to take care of ourselves. I think this will serve as an important reminder during that stressful period of my life -- if I don't take care of myself, it's going to be pretty difficult to take care of patients.

___________________________

Dear intern me,

1. As Dr. X said, if you’re not waking up excited to go to work and see patients every day, talk to someone. Talking to someone can help solve a difficult work situation, or it just feels good to express your feelings and have someone listen and understand. Whether it’s your superior, a peer, a friend, or a therapist, just talk to someone.
2.   Keep exercising. It really is the best way to deal with the stress, exhaustion, and emotional baggage of the day. Even if you can’t make it to a crossfit workout, at least try and go for a walk or a run. You will feel better. I promise.
3. Make time for family and friends. Even if you feel that you have to study, read about a patient, or prepare a presentation, make time to spend with those people who make you happy. It will be worth it. There will always be another deadline to meet or more to do, but those who you love most won’t always be around.
4. Don’t sweat the small stuff. Try and let negativity roll off your back. You never know if someone else’s rude or insensitive comment was due to their level of stress, exhaustion, or personal conflict. Just remember that 99.9% of the time, it isn’t a personal attack. When it is, try and find the good in the situation. In that comment/attack could be something you can improve upon.
5.  Don’t feel that you have to be perfect in everything. You don’t have to be the perfect housewife, perfect doctor, perfect daughter, and perfect friend.  For example if you don’t have time to cook every night, don’t worry about it. Do what you can, and remember you have supportive friends and family who love you, understand you, and want to help you.

 You’ll be fine. You are a strong, capable woman, and you can handle more than you think.

Love,

M3 me

"This isn't The Notebook"

I've been spending some time in the neuropsychiatric ward, the saddest place I've ever been, taking care of some patients. I guess the neuropsychiatric ward is what people thing of when they think "psychiatric hospital." Patients are either so medically sedated that they are just passed out in their wheelchairs, heads on the table, or they are aimlessly wondering around, going into other patient's rooms, and following you wherever you go.

My first time in the ward, a patient came up to me, crying, asking "can you take me home?" It turned out that she was one of our patients. Talking to her was difficult through her broken sentences, confusion, and word finding difficulties, yet I felt I could follow some train of thought she was trying to convey. She pointed to the attending rounding, and said "I know him." I was excited by this -- she recognized her doctor, but when I tried telling the attending that, he dismissed me saying, "She just recognized a white male figure -- she doesn't know who I am."

Am I too idealistic? Am I biased in working with my patients with dementia to hope for the best, to only see the good? I have another patient with progressive Alzheimer's dementia with receptive and expressive aphasia, meaning she has trouble understanding and using language. Yet, I try and talk to her and understand as much as I can. I ask her name, and she tells me, "Penny*." I ask her where she is, and she tells me, "hospital." Every time I talk to her, I feel that I can see the person behind the confusion -- if I'm patient enough, I can understand what she's trying to tell me. When discussing her with my resident, I reported that she knew who she was and where she was, and that I thought she might know more than we give her credit for. My resident responded, "This isn't The Notebook. She is confused and doesn't understand us and doesn't know where she is."

It might not be The Notebook, and I understand Alzheimer's is a progressive disease that doesn't have periods of improvement/return to normal function, but that doesn't mean we shouldn't try and find the remainder of the person left inside.



*name changed for patient privacy

"Ethical Erosion"

I read an interesting article in the New York Times today. It discusses how the third year of medical school with block clinical rotations lead to the "ethical erosion" of medical students -- how medical students stop being patient focused and start being disease focused.

It's hard not to fall into that trap. Just earlier today, I found myself talking about my "schizoaffective patient" and my "depressed patient" instead of "my patient WITH schizoaffective disorder" or "my patient WITH depression." I think as long as I try and stay aware of how I am talking ABOUT patients, how I am talking TO patients, and how I feel about patients, it will go a long way to preventing this "ethical erosion."



P.S. On a less serious note, this blog is a hilarious insight into the last two years of med school

"They're trying to kill me"

I've started my psychiatry rotation this week at Wesley Woods Hospital.


1)
I've talked to my first schizophrenic patient. This Modest Mouse song, "World at Large" reminded me of him.


Went to the porch to have a thought. 
Got to the door and again, I couldn't stop. 
You don't know where and you don't know when. 
But you still got your words and you got your friends.


I know that starting over is not what life's about. 
But my thoughts were so loud I couldn't hear my mouth. 

2)

coun·ter·trans·fer·ence/ˌkountərˌtransˈfərəns/

Noun:

The emotional reaction of the analyst to the subject's contribution. (google dictionary)

3 days in and I'm definitely feeling it. I have felt unusually anxious the last few days, and it's not "the crazy rubbing off on me." Rather, I think it's the effect of talking about these incredibly personal details of people's lives and having to remain stoic and objective about it. It's sad. It's draining.

This sounds like a pretty negative post, but I am actually excited about the rotation. I think I'll learn a lot, but I also think it's going to be difficult.

3) 

I learned my "tell." 

Today we had to practice the psychiatric exam with a partner in the class. The clerkship director said he would be coming around to give us feedback and specifically let us know what our "tell" is -- what gives us away when we're nervous. He said by knowing our "tell," we could work to not let it show during patient interviewing.

My "tell" is that I flush -- my face and neck turns bright red. Awesome -- because I can really change on working that, ha.

When you start dreaming about hemorrhagic ovarian cysts

you know have been on ob/gyn too long ;)

This last week marked the end of my ob/gyn rotation...ending on a high note with gynecologic surgery (gyn surg).

The last two weeks have been my favorite of rotations thus far. Yes, you have to be at the hospital early. Yes, you have to present patients to intimidating attendings. Yes, you will mess up and get yelled at by scrub/circulating nurses. Yes, people can be grumpy for no reason. Yes, you will be on your feet for so long during surgery that you put ice packs on them when you get home. BUT IT'S SO MUCH FUN. I can honestly say that I've enjoyed every day that I've gotten to be in the OR.

I love the hands-on aspect. Here is a list of just a few of the things I've gotten to do the last two weeks.
--sewed up a patient with a subcuticular suture
-- cut a fibroid uterus in half (after it was removed to be sent to pathology)
--biopsied a lesion on a cervix
-- played with hysteroscopic tools
--closed fascia by tying knots

Surgeries I've seen:
-- total abdominal hysterectomies
-- supracervical hysterectomies
-- ovarian cysts removal
-- ovarian mass removal/omentectomy/bowel resection
--laser ablation of vulvar lesions
-- cystoscopies
-- dilation and curettage

I also just started feeling more comfortable as an M3 by the end of the rotation. Some residents are nice, some residents are mean -- same with attendings. I don't know if I have just gotten used to being the bottom of the totem pole, or if I've just become a more competent M3, but these last two weeks I have felt good about where I am.

A Haiku: Gyn Surg

Uterus, pregnant?

No, big with fibroids, so large

Took out, now it's small

Hysterectomy

Alien head uterus

filled up with fibroids

Scraping uterus

 for too much bleeding, and so

biopsy will tell

Slippery Babies

So much has happened the last two weeks that it's hard to remember everything. Here are a few highlights:

- I have become a placenta delivery expert ;)
- I assisted in delivering 2 babies (with the resident's hand guiding mine)
- I solo delivered 1 baby (and didn't drop it)
- I got asked not to participate in a delivery of a neurosurgeon's wife by the neurosurgeon because his wife was "sensitive"
- I got yelled at by a nurse for trying to talk to a patient in the middle night (not the best idea in retrospect, haha)
- I've become comfortable taking an OB history
- I got to deliver the placenta during a c-section
- I got to close up the skin incision on a c-section -- twice
- I was complimented on my level of knowledge by a resident
- I helped suture a vaginal tear
- I saw a vaginal delivery with forceps
- I saw an episiotomy (the baby had made in through the pelvic canal but couldn't get past the perineum)

More about my solo baby delivery -- I had my hands on the baby's head, going through the maneuvers, but as soon as it was out, I got nervous, so I held it close to me instead of holding it in the proper position. Even though I wasn't 100% successful in catching the baby correctly, it was a good experience.

A few more notes about L&D:
--a lot of poop: I can handle blood fine, but feces/vomiting really grosses me out. Maybe L&D helped desensitize me a little bit to poop...maybe
-- GET AN EPIDURAL! Actually, you can't force patients to do something they don't want to, but after witnessing epidural vs. non epidural births, I 110% recommend getting an epidural. Delivering without an epidural does not make you a better mom, so why suffer? :) Even if the woman can handle labor, repairing vaginal tears with local anesthesia post partum is REALLY difficult because the woman can still feel the pressure of the needle.

L&D was the part of ob/gyn rotation that I was least looking forward to, but I actually ended enjoying it A LOT. Deliveries are exciting, c-sections are fun, and babies are pretty cute :)

Delivering Placentas

Yesterday I started the Labor & Delivery portion of my ob/gyn rotation -- the night shift.

It started and ended on quite an exciting note. As soon as I got there, a C-section was starting up, and I was told to scrub-in (a first!). I was right there in the thick of things -- holding the retractor, dabbing the oozing uterus with a lap, suctioning away blood from the peritoneal cavity. Needless to say, an exciting way to start this portion of my rotation.

Apparently, the ladies of Atlanta wanted to deliver babies last night. It started off with the C-section, then we had 3 more vaginal births, then a twin birth (vaginally, but in the OR in case things didn't work out), and another C-section for a 26wk fetus who wasn't getting enough blood perfusion through the placenta. Oh, and the twin birth, a singleton vaginal birth, and the 26wk C-section all happened at the same time around 5am!

I got to deliver 4 placentas (including the twin placentas -- cool!). I think at Midtown it's harder for a med student to delivery a baby since there are a lot of private docs who deliver their patients there. Hopefully, during my time in L&D, an Emory doc's patient will be willing to let me deliver their baby. Otherwise, I'll just become really good at delivering placentas ;)

"I Can't Believe Y'all Like Doing This"

First week of rotations is finished. How do I feel? Tired. Overwhelmed. Relieved. Behind. 

I've been lucky enough to start on the OB/GYN rotation, which means i get to experience a little bit of everything before being thrown into a rotation with a singular intense focus (medicine, surgery). The rotation is divided into three mini-rotations: 2 weeks of outpatient, 2 weeks of labor and delivery (one week days and one week nights), and 2 weeks of gynecologic surgery. Oh, and while we aren't in the hospital, we are supposed to be reading, studying, and preparing for our end of rotation shelf exam.

On Monday, we had our ob/gyn orientation day. We practiced delivering plastic baby dolls through plastic pelvises. We practiced scrubbing into the OR (I learned I wear 6 1/2 OR gloves). We practiced our pelvic exams on some plastic pelvises. And, we got to watch the miracle of life -- the vaginal delivery of a baby -- in an educational video (scary).

My first two weeks of ob/gyn is being spent in the outpatient setting, which means I get to do something a little different everyday. I started off on Tuesday in a Grady clinic in Bankhead working with a nurse midwife seeing patients for gynecologic and obstetric care. Another first -- giving a depo shot (form of birth control). The nurse midwife asked me "You want to give the next depo shot?" and as I was in the middle of my "uhh...." she said, "Yes, you do." and gave me instructions on where to find the needle and the medication. I also got to use the leopold maneuvers to feel the positioning of the baby in the uterus. Having never examined a pregnant patient before, my performance in this area probably improved about 200%. I also got to do a bunch of pelvic exams, pap smears, and history taking. I left feeling productive and confident. Looking back, this was the highlight of my week.

Wednesday is lecture day in the ob/gyn rotation, so I spent my day attending grand rounds, attending lectures, learning how to do a proper breast exam, and learning how to suture and tie knots.

Thursday, I spent a frustrating day in the infertility clinic. Although the material is incredibly interesting (I sat in on an IVF consult --- where the doctor explains the entire procedure to a couple), I felt useless and inefficient. There isn't much of a physical exam component in infertility counseling -- it's much more reliant on the history component. However, I didn't even have the opportunity to take a history. I just acted as a shadow for the resident or the attending all day long. To add to things, one of the doctors in the clinic was not ideal to work with. He never introduced himself, shoved me out of the way instead of asking, and never really tried to engage me in conversation or teach me anything. It is one thing to feel useless, it is another to feel treated poorly. In summary, infertility clinic day left me feeling angry, frustrated, and useless.

After Thursday's experience, I was pretty excited to be spending Friday in the Grady Urgent Care clinic. I expected to see spontaneous abortions, ectopic pregnancies, placental hemorrhages, ...emergency room type events. I expected it to be crazy busy. Instead, I saw three patients with lower abdominal pain. Yes, nothing too exciting, but still way better than the infertility clinic. It probably helped that I was working with a really nice intern and super laid-back resident. I got to do a few pelvic exams, take a few histories, and see some ultrasounds. As we were trying to find the cervix on a particularly heavy patient, she chimes in, "I can't believe y'all like doing this...it's nasty."

um...yeah. 

Here's to one week done, about a million to go...

Getting Oriented

Two weeks ago we had "Orientation to the Clinical Years" where we endured a week of powerpoint lectures on how to use a pager, how to wash our hands, how it's important to dedicate our lives to our patients...yet retain "balance." It felt like first year orientation all over again --- a little bit exciting, a little bit scary and overwhelming, and a little bit like a waste of time. We also got to practice drawing blood and placing IV's in each other (the fun part!). The week ended with us getting our Grady ID badges and being sent off with an inspiring speech by the dean.

I walked away from orientation with the clear message that "Your life is about to change -- get ready."

Let's hope I am.



P.S. A scarily accurate portrayal of the last two years of my life spent in the classroom: video

Moving a "Step" in the right direction

re·lief/riˈlēf/

Noun:

A feeling of reassurance and relaxation following release from anxiety or distress.

(via google dictionary)

RELIEF...

is the biggest thing I'm feeling after getting the news that I not only passed Step 1 of the USMLE boards, but that my score was where I wanted/needed it to be for future career options.

The whole process of studying for the boards wasn't too stressful in itself, but the 3 weeks waiting for my score filled me with anxiety. The day before and the day after the test are definitely the worst, but it's over. I'M FREE!! ... until Step 2 at least ;)

More than epicanthal folds and simian creases

The way we learn to think about Down Syndrome for the boards is as follows:

"mental retardation, flat facies, prominent epicanthal folds, simian crease, gap between 1st two toes, duodenal atresia, congenital heart disease, associated with increased risk of ALL and Alzheimer's Disease. ~First AID for the USMLE Step 1

Nella shows a different side of Down Syndrome...

Nella's video

Dear Patient X, Thank You

As I'm studying for the boards, I've realized how great an impact a face for a disease makes. For every disorder where we had a patient presentation, I remember the specifics of the disorder so much more easily. It makes me appreciate it so much more that Emory incorporates these patient interviews into our curriculum because it makes me a better student and eventually, a better doctor.

Every time I see tetrology of fallot, I think of the friendly woman with the bright green outfit that told us her story about being a "blue baby"

Every time i see pulmonary hypertension, I think of the cute young woman telling us the intricacies of her medication routine.

Every time I see Fanconi's syndrome, I think of the mother coming in with her son telling us about his disorder.

Every time I see ARPKD, I think of Julia and how she found out that both of her kids have this disorder when pregnant with her second child.

Every time I see ALL, I think of those sweet parents coming in to tell us the story of their precious baby girl and the fight she fought for her only 2 years here on Earth.

So, to all those patients who came in and were willing to share their stories with us, thank you.