Goodbye St. Louis Children's

Just like every rose has it's thorn and every dawn has it's day, every pediatrics residency has an end, and this is the blog post about mine. It seems like just yesterday I moved to St. Louis to save children and to be hugged by random strangers in the supermarket (see previous blog post). I would say that the time has passed quickly but to be honest the time has passed in drug-aided sleep deprived blur. Its 6:30 in the morning and I'm sitting in the ER with one hour until I walk out of the hospital forever (or until my residency program decides I didn't really graduate).
There she is, a giant concrete Belgian Waffle of top-notch pediatric care. Sometimes I land on top of said Belgian Waffle in a helicopter as sweet as maple syrup. Usually, though, I just ride my bike to work.

It's moments like this when I like to reflect, and when I say reflect I actually mean look back at the last three years on our programs scheduling website to add things up. This is what I came up with.

Past three year stats

In-hospital overnight calls ranging up to 30 hours: 113

Weekend days worked: 126

Night shifts (12-13 hr shifts overnight): 60

Here's the analysis. That's a ton of work. That'll bring you to your knees. It's enough to make a grown man cry (if said grown man were capable of tears as opposed to having the emotional range of a turnip).

After calculating these, I decided to calculate more statistics, and when I say calculate I mean estimate, and when I say estimate, I mean guess blindly at times:

Hot Dogs Consumed, by year

Intern Year: 24

Second Year: 8

Third Year: 0

Mini-tacos consumed, by year (like tacos but smaller and more awesome)

Intern year: 19

Second year: 92

Third year: 211

Here's the graph I made. As you can see, the consumption of hot dogs is inversely proportional to the consumption of of hot dogs. That's a good thing, because if they weren't proportional the graph would look like this:



Broken Knees: 1

Bikes stolen from my apartment while I was asleep in said apartment after having worked overnight call and being really tired: 1

Bikes recovered that had been stolen from my apartment while I was asleep in said apartment after having worked overnight call and being really tired: 0 (zero) (I miss you Bruce, you deserved better).

Times I have said lupus as a possible diagnosis in a large group setting: 62

Number of medically oriented t-shirts I have designed while at work: 22 (including my series of 80s-themed STD-awareness t-shirts)

Number of medically oriented t-shirts I have actually made: 1

Percent of ER shifts I've worked while wearing cowboy boots: 100%

Number of white coats that have been bedazzled by patients: 1

Number of parents or hospital stuff that have independently called me "Doogie": 11

All in all, I can't help but look at these "statistics" and feel a deep feeling of "pride" (I use "quotation marks" to counter-balance the "serious" nature of this last part). In the end, though, a "number" doesn't sum up how great these past few "years" have been. I won't "forget" all the people I've worked with and the kids that I've "met". It's been a great run, but its time to go. I'll see you later, St. Louis. Don't wait up for me.

another arts & crafts night: a study in 21st century imperialism

I've been on night float again for the past two weeks. As was witnessed in my last blog post about the paper doll show choir, I get bored and do weird things at work, especially at night. During the night, I experience a unique combination of boredom, sleep deprivation, and poorly-controlled Attention-deficit disorder that is equal parts random, creative, and beautiful. So its Sunday night in the hospital. The flu and RSV seasons are winding down and we have a lot of free time. This time, my equally random friend/co-resident Umang was around. The floor she was covering was even slower than mine. So of course, we decide to do what seems to be the only natural thing to do as a a grown man and pediatrician training at one of the best children's hospitals in the nation. We decide that we wanted to do some Arts & Crafts. So first, we take stock of our resources. There is a large, cardboard box from a local sandwich shop in which the Chinese food from the night from before was delivered that I kept. I don't know why I kept it, I just knew at the time that there was something different about the box. Something worth keeping. Something special about that box. And little did we know, that box would change our lives forever.

I can't really figure out how it happened, but before we knew it we were fully occupied with creating a diorama. And not just any diorama -- a diorama of awesomeness. A diorama of truth. A diorama of extreme liberal bias based on pure nonsense. And this is the greatness that was created:
As you can see, this is the diorama. But it ain't you're momma's "shoebox diorama" you made in elementary school with some rocks and plastic dinosaurs that was an excuse to sniff rubber cement. This is a bold, in-your-face diorama for the MTV generation (even though the MTV generation is in its 20-40s and has no reason to care about dioramas). As you can obviously tell, it is the moon. And of course, on the moon you find the Pink Panther, Optimus Prime, and Marvin the Martian. We kind of randomly decided who would be on the moon. But once thewe got midway through, we realized that there was really only one story that could be told. I wrote the story that is on the side panels and reproduced below, but I really think that it wrote itself. And yes, that is an orchestra pit in the front.

In the middle of the 21^st century, earth’s oil and fossil fuel resources had become depleted by 200 years of automobiles, airplanes, pottery kilns, hairdryers and all-night roller disco jams. The earth’s international superpowers and oil conglomerates, led by the Pink Panther, realized that something must be done. After years of suppressing alternative energy technology and research, clean energy was not online. Deciding against clean energy and the resultant drop in oil conglomerate stock prices, they chose to follow the lure oil to the next closest celestial body – the moon. The moon was the perfect resource. It had large untapped oil reserves. It was close enough that the Alaskan oil pipeline, which extended deep into the depths of the Bering Sea, could be moved and extended to create an easy conduit to transport the black gold. But alas! Upon the team’s arrival on the surface of the moon, they found a vast and complex vacation community built by Martians that dwarfed mid-21^st century Boca Raton. The Martians loved the moon for its rocky and cratery beauty and its expansive views of the earth and other cool things in space. The Martians, ages ahead of the earth’s civilizations in clean energy technology and love of planet, didn’t need the oil. They loved the moon for what it was, a large satellite that may or may not have been composed entirely of cheese. This left the earth’s superpowers with a delicate question – what to do with the moon. They could choose to change, to choose life over death, to create rather than to destroy. But to do such would fly in the face of history, years stained by the blood of the oppressed whose only mistake was being native to areas of great resources. But alas! The momentum of years past is too great, and the decision is made to strip the moon of its oil by whatever means necessary. With any such endeavor, a strong showing of military force is necessary to ensure indigenous compliance. The Pink Panther recruits Optimus Prime and his merry band of Autobots who, having defeated Megatron and the Decepticons once and for all, have little left to do besides race NASCAR and scare small children. The Autobots are up to the challenge and accompany the colonizing party, which ironically is headed by The Pink Panther himself after he steps down as Secretary General of the United Nations and his part time job as pitching coach for the New York Mets. And thus we arrive at the our present scene, one that will surely be remembered by mankind, pantherkind, robotkind, and Martiankind alike. Will the Pink Panther purchase the oil with the blood and tears of the Martians? Will Marvin and the Martians allow themselves to be destroyed or will they fight back, martialling together their collective power to protect their homes (and likely moon cheese)? Will Optimus Prime sacrifice his deeply seated robo-ethics to kick some Martian butt? Hard questions require hard answers, and only in searching our own hearts will we ever find the truth.

And now it all makes sense. The lawn chair and tiki bar. The surprised look on Marvin's face as he is frightened for both his lawn chair and moon cheese. The Pink Panther's smug superiority. The Houston Oilers-inspired oil derrick in the background. In all truthfulness, I hope that people will really think about the message and make steps toward a cleaner future. They don't even have to be big steps, or even real steps. You could start with doing a google search of the Toyota Prius. Look up what Arbor day is. Coast down hills in your car. Wear the color green. Admire a tree. Better yet, make your own diorama trying to get people to change. If this diorama leads to another diorama, which leads to another diorama and so forth, imagine what could happen. The world wouldn't be big enough to contain these dioramas. Everybody would be coloring and taping things. Rubber cement would be flying off the shelves. And maybe, just maybe, the world would be a better place.

Like raising a child or being a village, it takes a village. Many people's thoughts, efforts, and managerial duties went into this project, and I would be remiss if I didn't give credit where it is due.

Credits:

• Umang: taping skills, obtainer of random supplies from hospital floors, set design
• Cheryl: making the chair and tiki bar from nothing, doing medical stuff when necessary to give others protected "craft time", provider of Disney music to listen to during "craft time"
  
• Clay: casting, downloader of things from the internet, coloring, staff writer, cleanup
• Michelle the Med Student: team leader, taping the title at the end, general encouragement, asking relevant medical questions to remind us that we were doctors, reminding us of youtful optimism
  

It was an inspired project and inspiring night. I'm pretty sure I felt just like Van Gogh did at the end of painting Starry Night, if Starry Night had actually been a wicked sweet diorama. And of course, no children were harmed in the making of this diorama. Finally, a few more random pics:


Optimus Prime is ready to mix it up. Turns out, he isn't doing it for the money. He's doing it for the moon cheese. And those craters are in fact paper cups from the cafeteria that I put ketchup and BBQ sauce in.

Poor Marvin, all he wants to do is hang out in his lawnchair and sip virgin strawberry daiquiris while reading the latest issue of The New Yorker. Oh well.

holiday cheer

Hello. I'm back for my "once-every-three-months" post just in time for the holidays. Lately at work, I've been doing a lot of nightfloat. Nightfloat entails going in to work at 6:15 pm and staying until 7:30 am or 8:30. I'm in the minority because I really enjoy it. I get all the good parts of inpatient pediatrics without any of the rounding. I get to supervise interns, admit patients, and do all the cool medical stuff without the grownup supervision of an attending. This means that I can kind of do whatever I want since its a children hospital (immaturity in the name of relating to patients).

First, I must preface this with the fact that this all really happened. So last night, it was kind of slow. I'd already wandered the hospital trying to help out where I could since my own service was stable.Out of nowhere , all of the sudden, from left field, an overwhelming urge came over me. It was the urge to make chains of connected paper dolls. I don't know where this urge came from. I don't think I've ever made chains of paper dolls before and I hadn't been talking or thinking about it. Like much in my life, it was pure inspiration.

After a quick google-search (my go to search engine for all medical and non-medical queries), I figured out the folding pattern and was on my way. After only one misfire when rather than a long chain, I ended up with four sets of paired dolls, I had completed a chain of eight dolls. Looking at it and wondering what to do next, I realized that there was only thing that I could do -- make a paper-doll show choir.

So there I was at the nurses station, drawing tuxedos on paper dolls. Perhaps more surprising was the outshowing of support I experienced from nurses and other nocturnal doctors. Pretty soon everyone was pitching in. I, of course, made the dolls and drew on them. One nurse created the keyboard player for the choir. Another came up with an outfit for the female members of the choir (though I accessorized them). The intern/doctor I was working with got started on a set complete with risers. It was truly a nighttime hospital miracle. Before we knew it, we had created the greatest paper-doll show choir that I have ever been involved with. Here are a few shots of them in their inaugural performance.

That was a shot of the entire choir, its a pretty big group (8 guys, 8 girls, and Keith, the kind-of-creepy middle-aged piano player). This was from their Christmas program where they did a medley of contemporary and classic Holiday classics, including a 20-minute medley of Michael Buble and Josh Grobin Christmas tunes. Admittedly, that part dragged a little.

This is a good shot of almost the entire choir. A couple girls and a boy got cut off from the shot but lets be honest, they were on the outside of the group which is where the weakest performers get put.
There's a picture of Margoret and Keith. As you can tell, Margoret really doesn't have much star-appeal, thus her place on the end. And Keith, well, Keith isn't actually singing so I'm not sure why his mouth is open and why he looks so happy/creepy. He is a great piano player, especially as he only has about 1.5 octaves to work with.

If you look closely, you can really get a feel for each of the paper doll choir members as an individual person. There hair is what really sets them apart from each other. Their identical and sometimes mirror-image bodies with the exact same skin tone is what doesn't set them apart from each other, in case you were wondering.

That's Kay'te in the front. She's spunky and also the lead singer in a punk rock band. One time her band, "The Crystal Lizards", were playing a concert the same night as a choir performance. Can you believe that? Lets just say there were many zany misunderstandings and half-baked schemes that ensued as she tried to make both performances. Pure Kay'te.

More band pictures. The guy in the back, 3rd from the left, thinks he is Zac Effron. His name is Clint. He is the star wide reciever, pitcher, point guard, left-wing, place kicker, mile-relay anchor, and curler in the school. But he still makes time to write poetry and sing in the show choir. What a guy.

I like this picture for two reasons. One, it really shows off the holiday decorations with the red curtains, green background (patient charts), and reindeer heads. Second, it prominently features Curtis a.k.a. Chops. He thinks he's British but isn't and doesn't realize that most all girls aren't into him or his mutton chops. Margoret has the hots for him, though, but as we established, she lacks star-appeal.

(this is where I was going to put a video of their performance but I couldn't figure out how to with my computer and I lost interest and might come back to later but will probably forget)

So that is an introductory look at the paper-doll show choir. It was really a magical performance. Their voices blended together beautifully (some even said angelically). Their choreography, though, left a little lacking as it seemed pretty stiff. All-in-all, though, they brought their fair share of holiday cheer to the children and staff of St. Louis Childrens. Granted, the kids were asleep since it was 4 am, but I could tell they enjoyed it too.

new love, big decisions

As all 4 of you out there (doubled the amount of people following the blog, yea!) have realized, I've been kind of distant lately. Not updating the blog, not responding to emails. There has been a lot going on around here. Recently, there have been big changes in the St. Louis-Sontheimer family. Somebody has found love. And that someone is Jake.

Now, to answer the questions that have undoubtedly surfaced. Yes, Jake is a bicycle. Yes, I name my bicycles. Yes, I name many inanimate objects in my possession. No, I don't think that's unhealthy. No, I'm not surprised my life has come to this. Yes, I need to get out more.

Back to the story, one fine summer day at the bike racks, Jake eyes an attractive bike at a distant rack. He admires her from a distance, her sharp angles, powder blue paint and pink handlebar tape. Here he is when I left him with her in the distance.

I really didn't think anything of it at the time as I had a busy day of saving babies on the schedule. After a full day of baby saving (or "the usual" as I call it) I return and realize that Jake has taken matters into his own hands. Here he is "busting a move".

I personally think that they make a cute couple. I'm worried, though, because Jake can be pretty impulsive. Sometimes he wants to dart into traffic or dive off the sidewalk into mud puddles. It's just kind of who he is. As a cyclocross bike, he feels entitled to going where he wants. I worry (as any parent would) that he might take things too far, too fast. What am I going to do if I arrive at the bike rack and the other bike is there waiting for us with this in tow?

I know that all we can do is teach our children well and feed them on our dreams. Don't you ever ask them why, if they told you, you would cry. So just look at them and sigh and know they love you.

The Doc Box saga

Here in St. Louis Children's Hospital, we have various resources set up to help make work may manageable. One of these resources is something called the doc box. It is essentially a pink vomit basin that holds supplies that we might need, like otoscope tips, tongue depressors and q-tips. Historically these have been a strange assortment of arcane medical equipment. They were very disorganized and of minimal use. Last summer in a residency wide discussion group, a lot of residents said they wanted to standardize what was in the box. In our program, when you need something done and done right, there is only one place to turn -- to Dr. Clay. I spearheaded the Doc Box committee and with amazing results for awhile.

This is the story of the Doc Box committee. The names have not been changed so as to embarass people who look silly in the minutes.

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DOC BOX COMMITTEE MINUTES
Co-presidents:
Theresa Frey, MD
Clay Sontheimer, MD

Other Members:
none

June 26
First committee meaning. Clay and Theresa began doc box lists, planned timing of filling boxes, made this sheet, tried to recruit Sam Julian and med student unsuccessfully

June 27
Theresa not present, Clay worked more on the sheets and tried to find out where the earwax removers come from

Assignments:
Theresa: come to meetings more
Clay: actually make the boxes

June 29
Clay held an impromptu meeting on his couch while listening to records. Not much was achieved.

June 30
Clay made Dox Boxes for 12W, 8E, 8W, 7E, and 7W. Clay was very pleased with himself and saved the extra supplies for people in Africa. Theresa brought food to the meeting which was greatly appreciated. Discussion was held concerning the coloring scheme for the laminated doc box content cards.

July 1:
Clay was post-call and wasn’t present. Theresa put the Doc Box content cards into the Doc Box

June 30th through July 10: Umang Sood repeatedly states that the doc box should include surgical site marking pens to mark abscess, etc. Clay states that Umang is not a committee member and therefore he cannot entertain the suggestion without going through the proper channels.

July 11: Doc Box committee meeting held at West End Grill and Pub. Umang Sood and Paul Houin officially inducted as members into the doc box. Umang’s previous concerns about lack of surgical site marking pens among the official contents of the doc box is considered. Clay considers the matter but no resolution reached. Clay also had a really good ribeye steak with crab on top (I know, sounds weird). Everyone shared some desert toasted ravioli and chocolate cake. All in all, an excellent committee meeting. Theresa arrived very late to the meeting.

July 16 am: Clay performs a surpise Doc Box check on the 7E Doc Box. He lectures Christa Gaschler about the importance of keeping the box stocked, her responsibility as an intern to keep the box stocked, and teaches her where to obtain the supplies. Christa, working with the charge nurse, stocks the box. Clay commends her on her efforts.

July 16: Kari angrily confronts Clay about the otoscope head in the 7W doc box. Clay calmly points out that the otoscope (including head) is not an official doc box item and officially a doc box contraband item and therefore not under the jurisdiction of the doc box. Kari gets embarrassed and apologizes profusely. Clay forgives her for her oversight and magnaminously helps her by providing a functional otoscope.

August 2: Clay begins checking doc boxes informally. While on 7W, Kyle "KyKy" Schulz (future chief) complains that they have to always get an otoscope tip from the PYXIS and laments the lack of a Doc Box. Clay asks Kyle point blank if 7W has a Doc Box. Kyle says no. Clay says that Kyle is wrong and that there is a Doc Box located in the med room. Clay also says that he is very dissapointed in Kyle, especially since he is going to be a chief and has a responsibility to set a good example. Kyle gets embarrassed. Clay says its OK and they hug it out.

August 4: Clay and Theresa hold a meeting. Theresa is very critical of the typo’s in Clay’s work. Clay says that Theresa is both neither the committee proof-reader nor his mother and to get off his back. Then they eat muffins and make the Doc Box infraction sheet.

Mid-August: Clay performs Doc Box checks and is largely dismayed at the results with a few exceptions. The doc box on 7E was in excellent condition thanks to the tireless efforts of Christa Gaschler and her overbearing senior resident (Clay). 7W was also in good shape. It is unclear if it is from the efforts of the interns or secondary to the fact that nobody knew that the Doc Box (see August 2) existed. The boxes on both sides of the 8th floor are in poor condition receiving multiple citations. Some of the interns were especially hostile despite Clay’s open and friendly teaching about the boxes. Of note, Roseann, Margoret, and Bridget were particularly vehement.

August 26: Jamie Spurrier announces upcoming town hall meeting. Clay and Theresa hold preliminary planning meeeting for the town hall meeting. Theresa was particularly interested in making pie charts. Clay says that pie charts are irrelevent in the current situation. Theresa states that pie charts, and pie itself, is never irrelevent. Clay admits that pie is always relevent.

August 27: Stephanie asks Clay where the doc box for 12 is. Clay says its one foot to her left. Stephanie is surprised. Stephanie then gets angry.

September town hall meeting: Clay arrives early to the meeting to ensure that the doc box committee gets floor time. Doc box committee business is bumped from the meeting to talk about other stuff that Clay doesn't think is near as important as the doc box's. Clay gets upset and feels that his work is all for naught. He contemplates the sad state of the doc box's, despite his loving encouragement and, when needed, sharp correction. He wonders if this is what Moses felt like. He resigns from the doc box committee.

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And thus ends the sordid tale of the Doc Box committee. In the end, we learn that idealism is only just that -- idealism. Much like the utopia of John Lennon's "Imagine", some things and places are not of this world and though earnestly sought out, and perhaps briefly obtained, ultimately escape us. In closing, I will quote a poem by Robert Frost, "So Eden sank to grief, and night gives way to day, nothing gold can stay."

My dreams are weird.

First of all, I'd like to thank the collective internet community for the great outpouring of support for "The Nine Shifts: A triumph: The Clayton Sontheimer Story." I'm glad that my continued search for awesomeness was appreciated. A nurse at the hospital told me that she showed her mom the updates and that her mom would always ask to see what happened next. And a co-worker said her husband, whom I've never met, also was a fan. It truly was a magical time in my life and I'm glad I could share it with lots of people I don't know.

So I'm back in action here in the hospital, no worse for the wear. I'm on call which means, of course, that its time to update the blog. For this entry, I decided to search the archives of my google mail account and pull out past dreams. I used to email a friend of mine about my dreams hoping that she would be able to find some meaning in them. In the end, there was no meaning, only frightening randomness. I think most of these dreams come from mid-2007. As they say, it was a good year for dreams.

1. I had a dream that I was on a bridge with balloons full of almonds floating above and I tried to pole vault high enough to get the balloons but couldn't so I decided to try to build a robot to try to get the balloons.

2: I dreamt that I kept doing yardwork in this big field next to a warehouse where people were shooting guns at each other. I had to do yardwork everyday, and for a few days, I would daily find a sick baby in the field. They were typically pretty bad off -- one had a kidney problem, some were malnourished, and they were all abandoned. Each day I'd turn the baby into the authorities (though I'm not sure exactly who handles babies found in fields). One day I decide that if I find another baby in the field, I'm going to adopt him/her. So that day I'm doing yardwork and I find this baby in the field. The baby is about to die so I jump into action and save the baby's life and then adopt it. I didn't really fill any paper-work out or anything but just kept the baby. It was a little girl and I called her Kris, short for Kristin. All of my family and friends were really supportive of me adopting this kid. My mom came and was helping out and teaching me what to do. I remember having some misgivings as I'm pretty busy and don't know if I should adopt a baby but thought that I'd already made a commitment and was going to stick with it. Also, this all took place during the first day of a conference and I didn't really get to do much since I was busy with yardwork and adopting babies. I also remember thinking that I'll have to figure out how to date women while being a good father in a single-parent home.

3: I'm in a classroom but not the actual teacher. The teacher writes the word pirates on the board. I interrupt and say she wrote it wrong. I proceed to take the dry erase marker and make a skull and cross bones as the dot above the "i". Then, I erase the r and write R really stinking huge while making an "RRRRR" pirate sound. Nobody laughs at all and I get confused because both in my dream and in real life think its a freakin' hilarious joke.

And there you have it, a brief yet harrowing look into my psyche. And its full of almonds and pirates.

The Nine Shifts: Shift 9

Pre-shift 9: I had a dream that I was at a church meeting and out of nowhere I was awarded the Stanley Tool “Against the Grain” Award for Excellence in Respiratory Care. I felt it a bit ironic at first but happily accept the award. I also dreamt about lupus. Checking my email after waking, I find my friend Jenny has sent me an MP3 of “Eye of the Tiger” in commemoration of Shift 9. I am grateful and listen to it repeatedly. I shadow box as well.

Shift 9: At this point, success seems a foregone conclusion. Nothing short of dismemberment will keep me from completing my shift. I wonder if the greatest accomplishment of The Nine Shifts is that I spent 9 shifts or 108 hours in the children’s ER without coming down with any kind of illness. To wade waist high in gastroenteritis and viral upper respiratory infections and kids spewing forth pure contamination from every bodily orifice without getting a fever. Not even a runny nose. I feel my immune system so strong that I could lick the counter tops in the ER and come away healthy. I decide to not put that theory to the test. I am awarded my diligence with one more shift in the 3-6’s, by far my favorite pod. The ER fates, once my enemy, have now accepted me. No longer trying to destroy me, they give me in parting a final peace offering. They give me ear infections. The bread and butter of outpatient pediatrics. I see more ear infections in my last hours than I did in a month of ER. Every one of my final patients has an ear infection. Whether they came in for fever or diarrhea or cough, they are revealed to have ear infections. Even as it is happening I realize the surrealism of it all. I am surprised to learn that our cafeteria periodically has a Cajun food bar. While a strange thought, I learn the jambalaya has an even stranger taste. In my final moments, I rejoice in the moment. My friend Melissa presents me with a certificate for my achievement. We take commemorative photos of the final moment of victory. The moment is one of completeness. I walk out of the ER like every night before for the past 8 but this time to not return, my victory complete.

Post-shift 9: I ride my bike home in the cold for the last time at 1:30 am. I drink an orange soda and eat a candy bar while watching TV, the sugar and high fructose corn syrup not as sweet as the sense of accomplishment. I fall asleep on the couch watching the Cosby Show.