Can't believe I am officially a PGY 4 this week. I was only a PGY 1 like 5 minutes ago. Forget that I was in med school only yesterday! Where does time fly?

I have this mammoth plan of getting up and being in the library tomorrow at 8 AM trying to cram in at least 6 hours of studying before a night shift. Can I do it? Will blog about it tomorrow. Time to go to sleep then.

This week was the graduation for the 09 residency class. It is amazing how time flies. Some of my friends I went to med school or did intern year with are d-o-n-e like DONE. They are out in the real world ready to be on their own and there will be no more 'let me ask my attending' because guess what...they are the attendings. I feel kind of weird because I still have a year left since my residency is longer but what I feel worse about is that I still have not taken Step 3. It sucks, sucks, sucks, sucks big time. I have a phobia of standardized tests and while I have taken the medical boards before I somehow for all of the last three years could not bring myself to be done with Step 3. I registered for the test once and after postponing it three times I just cancelled it. Now I have re-registered for it and I HAVE to take it no matter what. Enough of this nonsense, I have come this far. I have to take control of my life and take care of things that need to be taken care of. Every once in a while I think of all my friends who graduated with me in med school, how they are done even with their specialty boards and are graduating this year and here I am still stuck on Step 3. Oh Lord help me get through this. I think I can. I can.

I had a weird fantasy dream today. It was actually kind of nice involving a foreign exotic location overlooking the mountains, bikes and...pizza! I kept thinking of it all morning on my way to work. When I got to work suddenly the reality hit me. There were angry parents of patients who had been waiting a long time. The night team was leaving so I inherited all the angry parents. Then I sort of had a mini argument with a nurse who was nitpicking over something so trivial that I basically told her off. Honestly I was so glad I stood up for myself because generally I am the kind of person you could walk all over. After I told her off I kept thinking about it and obsessing about it coming up with smarter answers in my head like, "You are neither my mother nor my boss so stop telling me what to do." I am quite a loser sometimes. Work was busy busy. Coughs and cuts. Generally screaming, yelling snot laden kids is not something I look forward to at work but today I held a 4 day old and a 3 day old in my hands and it felt nice. I wondered when I would have one of my own how I would hold it, cuddle it and play with it. Would he/she be the first thing I would go for when I return from work insted of my computer or my TV?

A very sick 11 day old was brought to the ER who needed pediatric ICU attention. I got the lumbar puncture in first shot and that sort of made my day. All day of slogging around was rewarded with being able to take care of one true emergency and legit loggable pediatric resucitation.

Wish I could travel somewhere nice and beautiful. An upcoming vacation will be spent at home. Life is not always hunky dory as expected. There are definitely some lows. On the other hand, I am so consumed with work. I have come to the conclusion that I am happiest in my personal life when things go well at work and vice versa. Isn't that kind of sad?

Maybe one day I will be like a seasoned ER doc and be all "Yeah been there done that, nothing surprises me anymore." But for time being I am constantly amazed by the kind of people I see in the ER, their families, their reactions. Like this 84 year old brought in for right sided weakness, she was completely altered and according to her brother went from having perfectly normal conversation earlier this morning to not being able to talk. When the medics brought her in she was still within the three hour window, I was trying to get her to CT scan ASAP, she did not meet the criteria for lysis, nurses were getting IV in, sending blood works, techs were putting her on a portable monitor. I came out of the room to talk to the family and in response the brother of my patient asks me where the cafeteria is and honestly I was so beyond disbelief at that point, I went from, "yeah she seems to have suffered a stroke, we'll be keeping her in the ICU" to "okay sir one floor down to your left, it's open until 7." Clearly food is a priority. Getting down to the basics, food, water and shelter, screw the rest of the world.

Or the other day I saw this 12 week pregnant 23 year old who just happened to be in a pretty bad asthma exacerbation. She half took some nebulizer treatments but decided to fling the BiPAP mask across the room, did not want the nurses to start an IV, I mean what do you want?? When you called the ambulance to take you to the hospital because you couldn't breathe what exactly did you think was going to happen at the ER? Clowns would come out and start dancing, balloons will fly across the room and I would have a magic wand which I would touch on your forehead and you would magically start breathing nromally. She turned around on the epi drip and we avoided tubing her. Later when she was more stable I went in the room to do a bedside ultrasound to ensure the baby was okay and she refused that too. I don't know what was wrong with her, neither did the psychiatrist who I called to do a consult in the ER.

Living vicariosuly through Lauren while watching the season's finale of The Hills. That girl just has the coolest life ever. She lives in Hollywood, works in fashion, field trips to Paris, goes out every night, has beautiful clothes, always has a tan and many boyfriends.

The most exciting event of my day was when my 1 year old patient's mom brought a dirty diaper to show me the color of the poop...