Renal Fellowship: End of Chapter One

Today was my final day of the 1st year of my Renal Fellowship!

I will still have some clinical duties after this, but over the next few years, they will be relatively minor: one half-day of clinic a week, one Saturday a month in the Dialysis Unit, and whatever I decide to do for moonlighting in order to help pay the bills. For the remainder of the next 2-3 years I will be embarking upon another round of lab research (more on this in a subsequent post).

Joke's On Me

Within moments of completing the last blog entry, my pager went off.

A few hours and one dialysis catheter later, I'm at long last in the hospital call room about to catch some zzz's before work tomorrow. It's 3 a.m. I have to say that I called this one. Might as well take care of my blogging duties while I'm up.

It always takes longer than you think to do something like this. First you have to talk to the doctors in the ICU to get the story. Then you have to call your Attending and give them the heads-up that somebody is going to start dialysis. Then you have to call the dialysis nurse and convince them to come in. Then you have to call the patient's husband/wife to get permission for the procedure you are about to do and give them a bare-bones tutorial on why it sucks when your kidneys stop working. Then you have to drive into work, gather supplies, and bring the ultrasound machine to the patient's room. Actually putting in the catheter doesn't take all that much time, but all this other stuff adds up.

That's it for now--I'm going to sleep for a few blessed hours.

LAST CALL

Tonight is an epic night...my last call night of this year's clinical fellowship...it will certainly not be the last night that I am on-call in my life, but at least for the next few years, the time that I spend on-call will at least be (1) of my own volition and (2) paid.

Will I make it without getting called in to dialyze somebody in the middle of the night? History says no--often on the last night before I'm on vacation, before a weekend etc. are the times most likely to get the call according to my own personal superstitions. I'll let you know tomorrow...

Ipswich Jaunt

We made a last-minute decision to head to "the beach" today.

Not knowing exactly where on the Massachusetts coastline to go, we opted to try out Crane Beach in the town of Ipswich, about 40 miles north of Boston, based on a colleague's recommendation.

Nice beach, very natural, with some neat hiking trails. However we were relatively ill-prepared for our visit: I forgot my swimsuit (though the water was about 58 degrees and it was cloudy & windy out), we forgot a blanket (and got very sandy), our camera battery was dead, we were surprised by the $22 beach entry fee, and Sophie was crabby all day long even though I explained to her repeatedly that it was a privilege to be going to the beach.

Still better than being trapped in the hospital, though!

Three Musketeers

We had a mini-Gitlin lab reunion last night--myself & Tom (on the left) were graduate students and Iqbal (on the right) was a post-doc in the same lab back in St. Louis as we all happened to be in Boston at the same time.


We reminisced about the good ol' lab days, including the time that I took a picture of myself intentionally setting a lab bench on fire just for some comic hijinx.

Michael Jackson Meets Darth Vader

An Army of Pine Cones

Finishing up the DeCordova Sculpture Park pics--perhaps my favorite work of all was a regiment of "pine cone soldiers" nestled within this small grove of pine trees.



In other news, I'm back at work at the Mass General Hospital--spending the final 2 weeks of my clinical fellowship on the consult service. It's busy as usual, but so much less overwhelming as a end-of-year fellow than as a beginning-of-year fellow. It's dawning on me that I've actually learned quite a bit this year. In fact, my love for Nephrology & Blogging have now merged as I've been working on a Renal Fellow Blog over the past few months and still deciding how best to build on it. For all you Nephrology Fellows who might be reading this blog, check it out.

Sculpture Mania

More sculptures from DeCordova Sculpture Park. Here's Sophie learning to walk up steps in the garden.
Two hearts alone in a field.
Close-up, the hearts are comprised of a number of metal hands, tools, and other objects as Sophie discovers on her own.
Twisty tree.
Tire sculpture.
Hiding sculpture.
Claire checking out this "home improvement"-style sculpture.
My personal favorite photo from hanging out at the sculpture park: offering Sophie up to the sharks!

DeCordova Sculpture Park 1

Looking for stuff to do on a Sunday off with no other plans, we had the idea to check out the nearby DeCordova Sculpture Park about 1/2-hour drive out of Boston. We got a late start (had to clean-up and re-group after a successful crepe dinner party we had last night) and braved a series of flash flood-type showers, but managed to see most of the garden during our visit.

I'll post another batch tomorrow.

Sophie finds a sculpture that is more her size.
Cool organic rings.
Nate demonstrates this work of art, which reminds him of a pair of kidneys (my diagnosis: the kidney on the anatomical right has some moderate hydronephrosis; the kidney on the anatomical left is relatively atrophic due to a prior renal vascular injury or scarring.)
Classic silver car.
You've got a lot of balls...

A Sophisticated Sense of Humor

Right now Sophie's idea of high comedy is a game we play which consists of me running down our long hallway directly towards her, which rarely ceases to elicit a series of high-pitched shrieks of delight.



Just finished my 2-week Peritoneal Dialysis rotation, which was ridiculously easy in terms of work hours as compared to my usual schedule this year. Beginning tomorrow, the party's over, as I finish up my FINAL 2 WEEKS of the arduous portion of this clinical year of Nephrology.

Happy Bastille Day '08

Happy Bastille Day to all you French-types out there.

And a special "Nate's Blog" Happy Birthday to any Rick Hellmans out there as well.

Here are some photos from this past weekend's house-shopping escapade/visit with our friend Clothilde coming from Philly.








Double Trouble!

High Marks for Boston Kidneys

This year's U.S. News & Report "America's Best Hospitals" came out this week.

For what it's worth, the 2 hospitals at which my Nephrology fellowship is based (Massachusetts General Hospital & Brigham & Women's Hospital) did quite well.

Mass General Hospital: rated #5 hospital in the U.S., with the #5-rated kidney program.

Brigham & Women's Hospital: rated #8 hospital in the U.S. with the #1-rated kidney program.

The Top 5 overall were:
Best Hospitals:
#1: Johns Hopkins (Baltimore, MD)
#2: Mayo Clinic (Rochester, MN)
#3: UCLA Ronald Reagan Medical Center (Los Angeles, CA)
#4: Cleveland Clinic (Cleveland, OH)
#5: Massachusetts General Hospital (Boston, MA)

The Top 5 kidney programs overall were:
#1: Brigham & Women's (Boston, MA)
#2: Mayo Clinic (Rochester, MN)
#3: New York-Presbyterian Hospital of Columbia/Cornell (New York City, NY)
#4: Cleveland Clinic (Cleveland, OH)
#5: Massachusetts General Hospital (Boston, MA)

Boston Lobsters

I just found 0ut recently that Boston has a professional tennis team...and I love their team name...the "Boston Lobsters."

In related news, don't you think it would be hard to drive around in this Lobstermobile? The claws and legs would seem to be obstructing some major views...

I'm Walking...Yes Indeed

We Are the (3rd Place) Champions!

Last night was our long-planned "Fried Chicken & Trivia Night" at the Somerville bar "Johnnie D's". Our three-man team of Nate Hellman, Dave Portnoy, and Keith Obstein gutted out an impressive 3rd-place victory despite having the odds stacked against them: only three people (you are allowed to have up to 6), defective air conditioning (the place was literally a sauna), an entire round of questions which were devoted to women's makeup products, and being weighed down with a bucket full of KFC (picture at left showing Keith drinking KFC gravy directly from the container...impressive!)

We were actually in first place going into the last "Final Jeopardy-style" round and could have taken first-place had we known that the state of Louisiana was home to 4 of the 10 longest bridges in the world, and furthemore lost a tie-breaker for 2nd place because we didn't know the atomic number of aluminum.

However we were quite satisfied in the end with our 3rd place finish and the $20 "Johnnie D's" gift certificate we will be certain to put to good use in the future. Congrats to the "Finger-Lickin' Fools" for such a strong showing. A feature-length film portraying this now-epic contest starring Bruce Willis (playing Keith Obstein), Adam Sandler (playing Dave Portnoy) and Harold Ramis (playing Nathan Hellman) is currently in negotiations.

I Am Iron Man

I saw the movie "Iron Man" last night and thought it was an excellent comic book adaptation.

We have now entered the "Golden Age" of movie adaptations of comic books. I remember when I was a kid they tried a few such movies (a really bad version of Captain America starring J.D. Salinger's son comes to mind) with disastrous results; I suppose the major advances in movie special effects have helped make the newer attempts more successful, but it's not only that: the more successful ventures have showed the characteris in a more complex light resulting in more sophisticated, "realistic" storylines.

Where does "Iron Man" rank on the all-time list of comic book movie adaptations? Pretty high on my personal list:

#5: Spider-Man (the 1st one)

#4: V for Vendetta

#3: Iron Man (this one)

#2: Hellboy (the 1st one--haven't seen the 2nd one yet but looking forward to it)

#1: X-Men (the 1st one)

Honorable mentions to League of Extraordinary Gentlemen, the 2nd X-Men movie (I debated with putting on as #5 instead of Spidey), Batman Begins, Sin City, and Superman II.

Duds include The Hulk (though I haven't seen the 2nd version), Daredevil, Elektra, I Am Legend, and most of the Batman movies.

Dad's Shoes

She's only one year old, but Sophie already enjoys trying on different shoes...even if they're her Dad's.

The Day After

Is this footage from another U.S. airstrike in the Middle East?

No, it the grand finale of the Boston 4th of July Fireworks display which we witnessed from the Esplanade overlooking the Charles River.



Other Pictures: I think all countried realize the importance of having a holiday which affords a good excuse to light off fireworks and eat fried dough.

Although Sophie went to bed just as the fireworks were starting to heat up, she was fascinated by the fluorescent glow sticks and we had to buy her one of her own to keep her quiet.


I like this photo since it kind of looks like a video game field, kind of like Space Invaders.

A Rivalry Renewed

It's July 4th...and we all know what that means...it's Nathan's Hot Dog Eating Contest!

In a classic contest for the books, American-born Joey Chestnut tied with 6-time winner, the Japanese Kobayashi, going dog-to-dog with a total of 59 hot dogs eaten each over 10 minutes. The hot dog showdown went into overtime, where Chestnut narrowly edged his long-time rival.

I wonder if they'll ever make this an Olympic event? They should.

Greetings, Comrades

Here's a picture of Nate--sporting his short summer 'do--outside a cool Russian bar in Cambridge.

I really wish I had brought my camera to work today...we had a lecture today regarding peritoneal dialysis with a "hands-on" demonstration which required all the fellows in attendance to don aprons containing a storage bladder and full catheter to mimic what it's like to be a patient on peritoneal dialysis and to practice exchanging bags in a sterile fashion. You'll just have to trust me that we all looked rather silly during the demonstration.

We're looking forward to tomorrow's Boston-area fireworks show, though I'm not sure if we're really up to getting there at 9am to reserve a spot on the Esplanade lawn for a show which doesn't start until 10:30pm. Hopefully we'll find another spot. Happy 4th!

Fellows Gone Wild

A photo from last night's eagerly anticipated "Fellows Gone Wild" night out, celebrating the end of a wild n' wooly year of middle-of-the-night dialysis catheters and general abuse. It felt good.

As I mentioned in my last post, however, I'm not truly done. These upcoming two weeks I'm on a rotation where I learn about "Peritoneal Dialysis." This is a form of dialysis that is entirely different from the usual hemodialysis--instead, a catheter is placed into the belly and the peritoneal membrane is used as a "natural" dialyzer. Individuals instill a volume of fluid (typically between 2-4 Liters) with a certain concentration of electrolytes and sugar and let it equilibrate with the body over the course of several hours. Although peritoneal dialysis is not for everyone, many studies have suggested that patient satisfaction is greater with peritoneal dialysis than standard hemodialysis, likely due to the greater degree of independence (you can do peritoneal dialysis at home, whereas hemodialysis requires going into a dialysis center 3 times a week on a strict schedule).

Limping Towards the Finish Line

Yesterday was the last day of clinical fellowship for the Brigham-Mass General combined Nephrology training program for the 2007-2008 academic year. It marks a change: after a grueling year of 100% clinical work, being on-call every third night, being required to go in to the hospital to deliver emergent dialysis, etc etc, fellows transition to a lifestyle of lab or clinical research, during which their schedules are largely made by themselves, and involves a real minimum of clinical obligations (next year for instance I will be required to work a half-day of clinic a week plus one Saturday a month for about 5 hours). The individuals in the photo above are those who have undergone this ordeal of clinical fellowship with me this year as well as our department heads and program director.

Before I start celebrating my good fortunate for finishing clinical fellowship just yet, however, it turns out I still have one month more to go than all the other fellows. Why? Fortunately, not because I'm a slow learner, but rather because I started my fellowship a month late due to Sophie's birth in a foreign country. So I still am limping through my final month before the end of the clinical year.

Here are some of my thoughts after such an emotionally taxing year:
1. My tolerance for sleep deprivation and inhumane work hours is decreasing as I grow older. I think I would have fared better had I done this when I was younger. Some of this is perhaps because I now have a family and feel pressure to make it home at a reasonable hour before my daughter's bedtime.
2. The kidney is a complex, complex organ and our therapies, while certainly representing a major medical achievement (we have a machine that can kind of replace kidney function!), are woefully inadequate and there is major room for improvement.
3. Despite my occasional complaints that clinical work is too demanding, I am certain that I will miss it! There is something about the urgency and importance of patient care that I really like, and I will make sure to always keep one foot in the clinical arena. It will be a fine line to walk such that I do enough clinical work to keep me up-to-date, but not so much that I get burnt out with it.
4. I'm not sure how I would have made it through the year without my wife Claire and daughter Sophie--who was always happy to see me when I walked through the door at the end of the day, regardless of whether I was wearing a smile or a frown. Thanks!