Favorite Travel Accessory: Nomad Scarf

If you are like me, then you always carry a jacket in case of cold temperatures, anywhere you go. In the heat of summer, all restaurants and office buildings and subways crank up the air conditioning to offset the elevated outdoor temperatures. I was recently given a FLUXUS. Nomad scarf as a gift (Thanks Aunt Mary) and am proclaiming it my favorite travel accessory.

Jude Law and his Nomad Scarf

Fluxux's tag line is There is life, there is art, and in between is fashion. Well I couldn't agree more. This fashionable scarf to be paired with any shirt/blazer, can be wrapped as a skirt and can even double as a picnic blanket. I love to use it for flights in defense of the cold air or as a soft pillow once on board. It is perfect for any season. Pair it with your scrubs on the way into the hospital for an added bit of style to your daily commute.

Nomad scarf
Price: 48.00
http://fluxusbrand.com/

It is a HOSPITALstyle approved accessory that is a must have for your wardrobe. Even Jude would agree.

Guide to Summer in New York City

Summer is here and that means lots time in the sun getting that perfectly sun kissed skin that has been missing all winter. Days out of the HOSPITAL should be cherished and well spent. Summer in New York City is one of my favorite things ever! People are out, Central Park is full of picnics, and Rooftop bars are the place to be. Take a look at some of my personal favorites...

A couple of my favorite spots that are MUST visits for Summer 2011:

The Peninsula Hotel Salon de Ning (700 5th avenue)
http://www.peninsula.com/New_York/en/Dining/Salon_de_Ning/default.aspx

The Standard Biergarten (848 Washington Street)
http://www.standardhotels.com/new-york-city/bars/biergarten/

The Frying Pan (W. 26th street @ Hudson River)
http://www.fryingpan.com/

La Birreria (200 5th Avenue) Mario Batali rooftop beer garden atop EATALY.
http://eatalyny.com/eat/birreria

Habana Outpost (757 Fulton Street Brooklyn, NY)
http://www.cafehabana.com/

** FEATURED SUMMER SPOT 2011

Willie Wall's

The “Honorable William Wall” is the floating clubhouse of Manhattan Sailing Club.  

 -Anchored in New York Harbor just and north of Ellis Island.  

 -Great views of the sailboat races and skyline.  

-Open Tuesday, Wednesday, Thursday and Friday evenings from 5:30 p.m. until close (usually around 10 p.m.) and on Saturdays from 1 to 9 p.m

-Transportation is provided by Admiral’s Launch.  The launch departs from North Cove -Dock F every 1/2 hour.  The departure times are: 5:30 p.m., 6:00, 6:30. 7:00, 7:30, etc.   There is a $10 launch fee for guests (round trip).

For more Summer Fun check out:

www.bookreportnewyork.com

and download their PDF Summer Guide 2011. 

This summer bring your HOSPITALstyle outside to play...See you in the SUN!

Stories from the ER: The Joplin Tornado Experience

Being from Kansas I grew up around Tornadoes. Now that I am a New York City gal, I seem so far from a world filled with basements and Tornado Sirens...

St. John's Regional Medical Center

My heart goes out to all those affected.

Check out this amazing link where you can read about one ER doctor's experience during the Joplin Tornado. Well worth it!

 http://www.mercy.net/joplin/stories-of-mercy/45-seconds

Congrats to Dr. Kevin Kitka for a job well done! HOSPITALstyle gives two thumbs up!

International Medical Elective In Thailand

My good friend and Chief Resident just did an elective in Bangkok, Thailand. She is someone who very much embodies what HOSPITALstyle is all about; class, professionalism, healthcare lifestyle, and all around good doctoring. She shares her amazing experiences with us. A bit longer than the usual post, but well worth the read! This is what she writes...

ENTER DR. JULIA SUN LEE-
---------------------------------------------------------------------------

Buddha at Ayyuthaya

Being in a four year emergency medicine residency program has its benefits, despite what naysayers might have to offer. One of those benefits is being able to schedule electives into your curriculum that are catered to your interests. Luckily, for me, I was able to set up an international emergency medicine rotation in Bangkok, Thailand at Mahidol University, Ramathibodi Hospital during my PGY-IV year. This came as a follow-up to my PGY-III year elective rotation at Nahr-Bita Hospital in Ghana, West Africa.  

Having a background in Public Health with a focus on Global Environmental Health, I felt that taking the opportunity to schedule a few international electives during my residency training would afford me an invaluable resource in allowing me to connect clinical pathology with what I had learned in my textbooks.  Not only that, but I was able to travel halfway around the world to practice medicine, interact with the locals and cultivate my experiences with the cultures I had previously only read about.  

It was truly a life-changing experience, and one that I would recommend to all who have the chance to do so. 

Ramathibodi Hospital

  This past April, I spent a month working in the Accident and Emergency Center at Ramathibodi Hospital in Bangkok, Thailand. The purpose of my elective was to witness the development and advances of the Thai emergency medicine residency program, which is only 5 years old, and to learn about the patient population & pathology that fills their ED.  

After a very long flight with very little sleep, I ventured into the wards of the unfamiliar hospital, confused by the writing and the dialect that awaited me. 

I was surprised to find out that most of the Thai residents and attendings spoke English of varying aptitude, and every single one of them were willing to translate or explain the Thai charting/documentation and presentations to me.  Lectures were often presented in Thai, but written in English allowing me to follow the topics easily. 

Ramathibodi Hospital

The hospitality of the residents and staff was almost overwhelming: from taking me to pray at the Buddhist Temples in the city of Ayyuthaya, to a night time venture in Yaowarat (the Bangkok China Town), to the numerous medical procedures done in the ED – everyone was always helping me to understand their approach and keep me a part of the team. 

I was able to attend their Simulation Labs, perform bedside procedures, run microscopy tests, visit the Thailand Red Cross Center and Queen Saowapha Memorial Institute, (formerly the Pasteur Institute) Snake Farm where anti-venin is harvested.  

Dr. Julia Sun Lee (third from left)

I experienced the Thai culture, not as a tourist, but from a Thai native’s perspective and in this setting, it was quite easy to form friendships quickly in such an environment. After only 2 weeks, a first year resident invited me to her moonlighting job on the weekend where she worked as a single coverage physician at a beach hospital in Koh Larn, an island off the coast of Pattaya. I was also able to visit another hospital in the southern region of Thailand on the island of Koh Phi Phi off the coast of Phuket right after the major flooding in South Thailand. 

I met residents and medical students from all over Thailand as well as Japan. I learned about their medical system and pathway of medical education and was invited to share with them a presentation on the US structure of emergency medicine residency and delve a bit into fellowships offered in our specialty.


The experience I had during my overseas travel was absolutely incredible. It allowed me to see how emergency medicine is practiced in different settings around the world, often in areas of diminished resources and funding as compared to the US. 

It also allowed to me to appreciate the quick availability of our resources that we have here, but causes me to step back a bit when approaching my patients. “Is that CT scan really necessary?”, or “What will that blood test tell me that I can’t already determine from the physical exam and history?”, I’ll find myself thinking. Of course, ours is a different setting and the dynamics of our approach to each patient is subject for another article. 

Ramathibodi Hospital. Bangkok, Thailand

What I got from Thailand was for greater than what I gave. I travelled across the world to help people, but I believe I was the one who received the most. 

I had an invaluable experience that enables me to catch a glimpse into lives that are so different than mine, but share in the same basic needs and emotions, which define the human condition. It gave me the chance to reconnect with the reasons why I went into medicine in the first place…something that often seemed remote back in Brooklyn when I was seeing the patient brought in for alcohol intoxication the third time that month complaining of leg pain and demanding a sandwich.

Having done my overseas electives, I now know that travelling abroad and providing medical care to those in need outside of the US will be a integrated part of my stateside medical practice in the future.  Being able to incorporate international settings into your medical education broadens your mindset and allows you to cater your residency experience to what you are most interested in.   

You’ll be able to form life-long friendships and expand your global network. Not to mention, the food, travel and stories you collect along the way are major bonuses – something you keep with you for life!
-----------------------------------------------------------------------
EXIT DR. JULIA SUN LEE

Julia- Thank you so much for sharing your amazing experience on HOSPITALstyle.
If you would like more information about setting up a Thailand elective, send and email to HOSPITALstyle@gmail.com.

Redefine your coffee break with.... The Mocha Club

In keeping with this week's theme on the BEST WAYS TO GIVE IN 2011, today HOSPITALstyle is highlighting The Mocha Club.

Give up 2 drinks a week at your coffee shop of choice to promote clean water, disease prevention, education and care for orphans.

We drink so much coffee in the HOSPITAL to probably support an entire village.

Find out more @ www.themochaclub.org

Great Ways to Give in 2011: Heart to Heart International

"We must be the change we wish to see in the world". -Gandhi

This is one of my favorite quotes, and this week HOSPITALstyle is highlighting some ways in which we can do just that. On a daily basis we help our patients within the hospital, but what about those we do not come in contact with? They need our help too! Get your altruistic nature into gear and check out these ways you can be a part of something great.


Here are some great ways you can give in 2011. Take some of that Tax return and make a difference for someone else. I dare you!

A Great Way to Give #1:
HEART TO HEART INTERNATIONAL     www.hearttoheart.org 

Named as one of FORBES top non-profits. http://www.forbes.com/2010/11/17/charity-10-personal-finance-philanthropy-10-most-efficient-charities_slide_11.html

An exclusive agreement with FED EX helps them to get medical supplies to the most remote and disaster stricken areas.

Heart to Heart annually promotes health and responds to crises in nearly 60 countries, including the United States. On average, HHI can transform every $1 donation into $25 worth of aid—mainly through utilization of thousands of volunteers and high-profile relationships with industry-leading pharmaceutical and transportation companies.

Historically, they operate on less than a 2% overhead—meaning that more than 98% of contributions go straight to global humanitarian operations.

I have been involved with HHI since medical school. They hail from my home state of Kansas.  Visit their website for more information on volunteer opportunities and ways to give.

www.hearttoheart.org

When you aren't a Chef

Our daily lives are full of books, patients, and eating in hospital cafeterias. If you are like me, unless you have a huge passion for cooking, it does not happen that often. I buy groceries and then find them weeks later when I emerge from a string of night shifts in the Emergency Dept. The milk is usually past expiration date and the fruit beginning to go bad. A lot of times it makes more sense to just order take out.

This past week I had some extra time and decided that I was going to cook a great meal one night. I perused cookbooks and recipes to no avail. Until I came upon Jessica Seinfeld's website www.doitdelicious.com . It is comprised of simple recipes and videos giving step by step instructions for easy meals.

Check out this video on HOW TO MAKE HALIBUT:

 One of the reasons I went into medicine is because I love procedures. Preparing a meal is just like a procedure. However, I found that the thing that is missing in most cookbooks is visual stimuli. I found the videos made by Jessica Seinfeld to be just what I needed to bring the fun into cooking.

My Meal: Chilean Sea Bass (they were out of Halibut), Sweet Potato Coins, Green Beans with Toasted Almonds
Cost: 45 dollars
Time: 1 hour

I was so shocked at how well it came out! Give it a try...

A Caribbean Adventure

A few short weeks ago I was in desperate need of a vacation and I posted an article about how to escape the HOSPITAL by planning a week aboard a yacht in the Caribbean. I am back this week, refreshed, and well-tanned.

British Virgin Islands

A special Thanks goes out to Bruce and Laura (The owners of Amaryllis) for making it a week to remember!! And to Kevin at Mainsail Yacht Charters for helping me organize amidst a very busy schedule in the hospital.

Our Itinerary:

Friday Feb 25: Flight to San Juan
Saturday Feb 26: Jeep rental, drive through rainforest, surfing in Rincon (on the west coast), salsa dancing
Sunday Feb 27: Flight to Saint Thomas, lounge by pool, nap, fancy dinner @ Havana Blue
Monday Feb 28: Board Amaryllis @ noon. Meet friends on board. Unpack. Sail to St. John
Tuesday March 1: Run on St. John. Sail to Tortola and then to Norman Island.
Wednesday March 2: Scuba dive in Norman Island. ( Saw a shark!). Boat to Cooper's Island with Dinner ashore.
Thursday March 3:Run/ Explore Virgin Gorda.
Friday March 4:Virgin Gorda. Dock in Tortola. Dinner & Live Music ashore.
Saturday March 5:  Morning Yoga on the boat (Thanks Steph!). Jost Van Dyke. Snorkel with sea turtles. Dinner and live music @ FOXY's.
Sunday March 6: Morning swim. Clear customs in St. John. Sail to St. Thomas. Bid farewell to Amaryllis. Fly back to NYC.

This was a vacation that surpassed expectations. Having lived and traveled extensively in the Caribbean, this is by far the best way to see and explore the islands. There are many options to consider when planning such an adventure. To see my earlier post about how to plan your own click the following link:

 http://hospitalstyle.blogspot.com/2011/02/sail-away-with-hospitalstyle.html

Neil, Eric, Me, Steph, Courtney, Matt

Virgin Gorda

Aboard Amaryllis

As Healthcare professionals we are always taking care of everyone else and their needs are before our own. Take time to travel, to explore, and to marvel in the beauty of something outside of the operating room. It makes us better for our patients, our families, and our friends. Take your HOSPITALstyle outside to play!

Email me HOSPITALstyle@gmail.com for more information on setting up your own Caribbean adventure.

When "the patient" is a member of your family

Every day we step into the hospital and we experience the realities of life. The rawness of human emotion, of pain, of joy, of family, of living, of dying. We have endured years of training in able to cope with these complexities of the human condition. With more experience we learn what to say and how to act. This is how we daily participate in the lives of others, our patients.

My goal as a physician is treat each one of my patient's as if they were someone in my family. This ensures that for each new person that I greet I do so at my very best. The bottom line though is that my patients are not really members of my family. What happens when the patient is? When someone of utmost significance in your life is the one in the gown?

I have seen it in medical school and in residency where colleagues of mine have had to very impressively push through the academic rigor while going through personal devastation with a sick/dying relative. This has happened to me as well. We, as doctors (along with our families), are NOT immune to the very thing that we spend our careers chasing after (PERFECT HEALTH).  Where in all of our training are we prepared to deal with that?

This past week I lost my grandmother to COPD. She was such an example of strength and all that is good in this world. She was an accomplished nurse (trained during world war II) and one of the reasons that I went into medicine in the first place. My mother is also an AMAZING nurse practitioner and human being. These two women have taught me more in my life than most.  It is through watching them, that I have become who I am.

My mother really deserves all of the credit of what I am about to say, because she has lived it these past few months/weeks. As she demonstrated, we as healthcare practitioners, have an advantage for ourselves and our families in that we TRULY understand what is going on. We are realistic and accustomed to facing grave issues of life and death and prognosis and hospitalizations.

However, what I have learned in the past few weeks is that first and foremost you must be there for your loved one as FAMILY. You must remove your MD/RN title and way of being. Listen. Care. Laugh. Cry. Help. Contribute. Ask questions. Be a part of the healthcare decisions, but know when to step back. 

When the patient was my grandmother, all she really needed was for me to put ICY HOT on her legs, and I did just that.

My dear Grandma,
Thank you for your kindness, love, patience, and all the things that you have taught me. You will be missed! XO

I will forever greet each new patient as if they were you...

Sail Away with HOSPITALstyle

If you are in medicine you are likely in need of a vacation, desperately! Some time away from the constant buzz of cardiac monitors and IV fluids, the demands/pain/and high emotions of your patients, and the realities of life/sickness/and death that we deal with on a daily basis.

A HOSPITALstyle approved vacation idea is a week aboard your own YACHT in the caribbean.

Amaryllis

This is a great idea because it is an easy destination to get to from all airports in the US, it can be done in a cost effective manner, you can spend quality time with people you rarely see, you may have your own captain and cook aboard in order to maximize your rest and relaxation.

The good news is...that I am leaving for my sailing vacation aboard AMARYLLIS in less than 2 weeks and having organized this trip in the midst of intensive care rotations I can attest to the ease of making this dream vacation a reality.

• Step 1: Decide when you can escape the hospital
• Step 2: Stir up some interest with friends/family
• Step 3: Set aside some money
• Step 4: Contact the following people with your price range and your dates

 http://www.mainsailcharters.com/  (kevin@mainsailcharters.com)
 http://www.bvicrewedyachts.com/ (cysofbvi@surfbvi.com)

They will email boats who have availability during your dates and then it is up to you to decide.

• Step 5: Send out an email to your friends recruiting them for a week aboard a yacht in the Caribbean (believe me this adventure sells itself).

• Step 6: Decide where you want to sail (British Virgin Islands is recommended for first time sailors. The islands are closer together and the water is calm. I have also sailed in The Grenadines, which are further apart, less populated and more exotic)
• Step 7: Place a deposit, and iron out details on MENU/PRICES/FLIGHTS

I  booked our boat through Mainsail Yacht Charters and Kevin ( a former airline pilot) as been an amazing guide through this process. He is highly recommended. Contact him Kevin@mainsailcharters.com or me @ HOSPITALstyle@gmail.com with any questions.

I set sail on February 28th and will be sure to tell you all about it when I return. Can't wait to escape the Hospital!

HOSPITALstyle Feature: Winter Accessories

It is that time of year when the winter is starting to sink in. Lots of snow on the ground. Less daylight. Lots of fractures seen in the ER secondary to slippery ice. Winter is one of my favorite seasons for fashion. Here are a few winter fashion finds that make the cold a bit more bearable.

I am obsessed with the open finger gloves.
These are from American Apparel (12.00).
http://store.americanapparel.net/ 



UGG Lynnea clog boots. 
Great for navigating snow-laden sidewalks in comfort. (180.00)
http://www.uggaustralia.com/womens/index.aspx

Kenneth Lane Jewelry.
Perfect for adding some color to a dreary day.
http://kennethjaylanesales.com/kjl-the-story/








Stay warm. Stay safe. Stay fashionable.

2011: A New Year for HOSPITALstyle.

Happy New Year from HOSPITALstyle!

I ended 2010 with two months in the ICU. This meant that I had to create a miracle to get time off for Christmas.  In the world of medicine, especially during residency, making it home for the holidays is quite a daunting task.  With that said, let me tell you why.

I had requested the December 24, 25, and 26th off  in order to fly home to be with the people I care about.  The ICU schedule was to come out December 15th and flight prices were climbing steadily so I preemptively purchased a flight for December 24 in hopes that a miracle would take place. Miracle = post-call on Christmas Eve.

When the ICU schedule arrived, I had been granted the 23-25th. In order to make XMAS flight I switched 7 days of my schedule with another resident (Thanks Alex!). This is how it played out..

Thursday Dec. 23rd: Arrive @ hospital 7 am, work all day, on call overnight.

Friday Dec. 24th: Sign out patients early @ 6:30 am, rush to La Guardia to make 9 am flight.

Sat Dec. 25th: Celebrate XMAS.


Sun Dec. 26th: Blizzard in NYC. Flight canceled. Spend night in airport hotel.

Mon Dec. 27th: Supposed to be back in ICU. Rescheduled flight again canceled. Unable to fly into New York City until Thursday December 30th. Fly into D.C. arriving @ Midnight. Take overnight train @ 3 AM into NYC. Arrive in city @ 7 AM. Go directly to hospital with luggage.

Tues Dec. 28th: Work Full day in ICU. Public transport delayed. Walk to 1.5 miles to subway station in 6 feet of snow (uphill..just kidding) with luggage for a 2 hour commute to my apartment (not kidding).

This example is a quick snapshot of my 2010. If you are like me, we are so busy taking care of our patients that there is little time to take care of ourselves.  My goal for 2011 is more sleep, more exercise, more balance.  When we are able to take better care of ourselves, we are able to better care for our patients.

More sleep: Most important time spent outside of the hospital. Get a sound/white noise machine. Invest in a new bed. Set a schedule as if you were still in grade school (8:30 pm lights out).


More exercise: Keep your cardiovascular pump in shape. Quality over quantity. Try and integrate a 30 minute workout/run into your routine at least 3-4 times a week. Mix it up. Go dancing. Go skiing/snowboarding. Try and pick activities to do with your friends outside of the hospital that require activity.


More balance: Less street corner Gyros on your 15 min break during your day. More salads and making healthy meals ahead of time to bring to the hospital. Leave 10 minutes earlier than normal in order to avoid commuter stress. Plan ahead. Take vacation. Avoid being entirely consumed by hospital happenings.

Let's get 2011 started the right way. The HOSPITALstyle way.

5 Tips for Planning a Wedding During Residency

Shauna and Matey

My dear friend Shauna (who I met on an orthopedics rotation) recently married in the last month of her intern year. I asked her to share 5 Tips for those of you who are also planning your big day amidst the craziness of residency. This is what she writes...
-------------------------------
SHAUNA:
Planning a wedding during residency might not seem like the best
timing, but in medicine (especially in my field of Emergency Medicine) we know all too well that life can be unpredictable.  I met my fiancee in my fourth year of medical school, he proposed soon after, and we didn’t have much time to plan a wedding before our big move across the pacific ocean and to New York City for residency.

We wanted our wedding in Hawaii where our families still live and to have it in the summer (during my only vacation). The challenge was ahead... planning a wedding thousands of miles away during my intern year.  Sound impossible? I thought so at first, but it ended up being better than I could have imagined. Here are some tips that I picked up along the way...

1. OUTSOURCE, OUTSOURCE, OUTSOURCE.
As a doctor; you are probably accustomed to not asking for help and handling situations all on your own; however, this is not the time. There is no time to do it all, so I suggest you use your friends and family as much as possible. Get in contact with that friend from college who majored in communications, design or fashion and now, while you are working 80 hours a week, seems to somehow have all the time in the world. The one who is talking about the awesome art exhibit going on, or being FACEBOOK tagged while doing tequila shots at that new bar that you can never make it to.. This allows you to utilize your friend’s skills and at the same time creates an opportunity to see him/her . I had a friend who works in fashion help me scout out the best boutiques for wedding dress shopping, and she also did my alterations for free. Another friend, who majored in web design created our wedding website; and my chef friend designed our menu. Also, get your physically fit friend to be your personal motivator/trainer to stick to your wedding diet and exercise regime. Tell them that their help and time is the only wedding gift you will accept. Make sure to schedule any meetings about wedding details at that great new bar or restaurant they have been raving about so you can finally have a glimpse of their glamorous lifestyle while working on the wedding.


2. AS A PHYSICIAN YOU SHOULD KNOW WHEN TO CALL IN A SPECIALIST. 
It is essential that you hire a “day of” wedding coordinator. I initially thought I could get away without one, but I am so glad I eventually came to my senses. Most charge $1000-2000, which seems like a lot to spend for one day of work, but my day-of coordinator was worth her weight in gold. Talk to friends that have hired a day-of coordinator for their own weddings, or find a good one on yelp.com or wedding websites like theknot.com. My coordinator prevented many disasters from happening, and pulled together all the
details of the wedding day beautifully.

3. CHECK IN WITH YOUR FIANCEE AND DIVIDE THE TASKS. Often when wedding planning one person finds themselves taking the reigns, while the other partner may end up feeling left out or under-represented. You already have very little time with your fiancee as it is being a resident; don’t let the wedding become a third wheel. Even if your partner states he or she has very little interest in the wedding planning; give your fiancee free reign over aspects that they find most interesting. For instance, my fiancee could care less about place settings, or flowers, but he wanted to be in charge of the band, the play list, and the alcohol. Make sure that both of you are involved, and try your best not to let wedding details become a source of discontent on the home front.


4. YOU MUST SPEND SOME TIME NOT WORKING AND NOT PLANNING.
Balance is important; you don’t want to expend all of your energy on one day and hate the other 364 days in the process. Your free time is vital and limited; use some of it doing something totally unrelated to work, or
wedding planning to develop the other aspects of your life and relationships.


5. DON'T SWEAT THE SMALL STUFF.
Seriously, you work in an environment where people live and die every day, you have witnessed much more in the last few years than most people will see in their entire lives. Your experience in medicine gives you a unique insight that allows you to see beyond the minutia (to put the inner bridezilla at bay). Yes, you might be a type A personality; partially how you got through medical school, but remember your patient’s need your attention to detail, so let the wedding planning be the more relaxed and enjoyable part of your life.

In retrospect, the time I spent on insignificant details was not really worthwhile at all. I can’t recall what color the ribbons around my roses were. I don’t really remember what font I used for the program, or who sat where and how many forks each person had… what I do remember is the look in my fiancee’s eyes when I walked into the church, the words my dad whispered to me as he escorted me down the isle, and the crazy dance moves that my 90 year old great uncle bill threw out on the dance floor to “sexyback”.

-----------------------------------------------------------------------------

Congrats to Shauna and Matey!
Thank you for contributing to HOSPITALstyle.

(If you would like to write for HOSPITALstyle send me an email to HOSPITALstyle@gmail.com)

The Perfect Christmas Gift for a Doctor you know...

 It is that time of year again, the time between Thanksgiving and Christmas, filled with anticipation and holiday parties. Meanwhile, there are even more patients in the hospital and you are working extra hard with the hope that you will have at least one of the holidays with your family and not on call in an intensive care unit. What do you do with little time to shop? I think that for many of us, online shopping is really the way to go. And for the doctor-(friend, girlfriend, boyfriend, sister/brother, mother/father, son/daughter, fiancee, not really defined colleague) in your life I have the perfect no-fail HOSPITALstyle approved x-mas present.

Buy them a pair of TOMS shoes to wear with their scrubs!


The story behind TOMS (shoes for tomorrow) is that their founder Blake Mycoskie after a trip to Argentina decided to form a company that is socially driven by the concept ONE for ONE. He designed a shoe inspired by the traditional alpargata shoe in Argentina and decided that for every shoe he sells, that he will give away one pair to a child in need around the world.

I have had a pair of TOMS for 3 years and love wearing them with my scrubs. I have given them as gifts and they are always a BIG hit! We spend our lives helping people on a daily basis within hospital hallways, so why not help one more child while shopping for Christmas presents.

TOMS shoes website www.toms.com

TOMS shoes are good for the sole and integrate a great cause into your HOSPITALstyle. They prevent injury to feet, prevent disease, and allow kids around the world to go to school in shoes. The perfect Christmas gift for the doctor you love!

A 15 minute Workout fit for medical residents

We preach to our patients on a daily basis that an exercise regimen is an essential element to living a healthy life. I have partnered with my good friend and fitness model Amanda Russell to bring easy to do workouts to the medical community. Having competed in marathons and triathlons prior to residency, I know find that my workout is the first thing to go on an extensive to do list (on my days outside of the hospital). I no longer have time for the endurance workouts I have done in the past. Amanda's entire fitness message (The AR Program) is about achieving a runner's body without running all the miles.  Having worked out with her on many occasions I have come to agree with her vision of quality over quantity. Check out this video on a 15 minute rejuvination workout, that any resident can make time for. Also check out her website at http://www.amandarussellworkouts.com/. Glad to have a workout that can keep me and my HOSPITALstyle in shape. Thanks Amanda!

5 Tips for Marathon Day

It is marathon week in New York City. The banners are hung. The race route scouted out. The city of New York is ready to welcome thousands of international runners and spectators. I will be working the medical tent at mile 24, so if you are around please come say hello! Having run the marathon in the past I have 5 tips for a successful and healthy marathon.

1. Avoid NSAIDS (like ibuprofen) which can precipitate electrolyte imbalances during high endurance athletic events.

2. Drink no more than 1 cup of a sodium containing sports drink every 20 minutes to avoid hyer-hydration and hyponatremia (low sodium) see attached post: http://hospitalstyle.blogspot.com/2010/10/hyponatremia-in-athletes.html

3. Pace yourself the first 13 miles (run slower than you feel you can, the good race depends on the second half). There are often pace bands that you can keep on your wrist and check each mile marker.

4. Increase salt intake 3 days prior to race (unless you have high blood pressure). Bring a packet of salt to take around mile 20 to prevent muscle cramping. You can pick this up at any local fast food establishment, or deli around the city.

5. Keep warm before the race. There is an area to throw off your extra layers at the start and they then donate these items to charity. Stay warm. Help others.

On marathon Sunday in NYC the best parts of the city are on display. It's sense of community. It's energy. It's inherent value of achievement.  It's beauty.  Run hard. Run fast. I will be there cheering you on!

Why higher suicide rates in Medicine?

There was a recent article published in the NY Times about the increased risk of suicide in medical students and doctors. 

http://www.nytimes.com/2010/10/07/health/views/07chen.html

This article displays the EXACT reason why I started this blog about healthcare lifestyle. The truth is we need it. We need balance.  There is an interesting dichotomy that while we are devoted to others, we often forget to take care of ourselves.  The stressors we face on a daily basis constitute a psych consult for ourselves.  However, there are many colleagues who are experiencing the same situations day in and day out to whom we can turn if needed.

Ever since reading this article, I am not quite sure (having been/going through) the process of the cause of this increased risk of suicide in doctors.  I have seen burn out, but I have also seen some of the most committed, driven, and intelligent people I have ever met who meet obstacle after case after problem with a calm demeanor.  Perhaps it is not the type of people, but the process which entails hours of isolated study, numerous examinations and continuous evaluation until your 30's, lots of medical student debt that continues to accrue despite earning probably less than minimum wage throughout residency, meanwhile managing your patient's emotions, sickness, and death along the way. 

Medicine is a field in which we need to prove ourselves over and over day in and day out.  There is always a looming lawsuit around every corner.  Our hours are irregular and often offset from the rest of the workforce.  Despite all these things, the type A personality, who is achievement driven can escape victorious in having conquered all of the aforementioned demons along the way of becoming a doctor.  And I truly believe that it is worth it. Maybe that means I am crazy, or maybe it means that I believe in the true value and calling of what our profession stands for and strives for.  Maybe the arduous road is to weed out those who do not belong among us, but at what cost? I think that we must do more for eachother.  We as doctors need to figure out why our suicide rates are higher and we must do something about it. Now! We cannot spare another colleague's death.

The ART of saying Thank you.

If you are successful, it is because somewhere, sometime, someone gave you a life or an idea that started you in the right direction. Remember also that you are indebted to life until you help some less fortunate person, just as you were helped."—Melinda Gates  

Thank those who help you.  Receive thanks by those whom you have helped. And the cycle of gratitude will continue.

One of the joys of working in the healthcare field is that we get to have a real impact on real people and are blessed with the opportunity to make a difference on a daily basis. On the other hand there are many people who have had an impact on us.  Our journey is long and therefore our teachers are many. Our attendings. Our residents. Our nurses. Our patients.  In the era of Facebook, Twitter, and Gmail we are often so busy that the ART of saying "Thank you" has been somewhat lost, despite the fact that it is easier. 

The ART of saying Thank you is taking the time to write a personal note of gratitude to someone that unnecessarily went out of their way to help you (I prefer hand written, but an e-card will suffice). The acknowledgement of their efforts can be best displayed by taking the time out of your own busy day to give them a thoughtful note. With your style and in your own personal way.

Each time I get a Thank you in any form, my decision to pursue a career in medicine is validated. I feel useful. I feel appreciated. I feel valuable. It is in times like these that I can say all the hard work and sleepless nights have payed off.  If we could bring back the dying ART of a simple Thank you, our world would be a better place. A place of kindness, communication, and gratitude.  I hope you will join me and incorporate the ART of saying Thank you into your daily HOSPITALstyle.

xo Kristin

Hyponatremia in Athletes

HYPONATREMIA: The most serious cause of exercise associated collapse

 A potentially fatal condition that can be seen in endurance athletes when their sodium levels drop too low either from hyper-hydration or from dehydration.

Dehydration = a low blood level resulting in low sodium content

Hyper-hydration = diluting the level of sodium

NORMAL 135-145

MILD   131-134

MODERATE  126-130

SEVERE  Less than 126

Too much H2O (water intoxication) can cause a lethal physiologic reaction where water rushes into cells including brain cells. 

Doctors can misdiagnose it as dehydration and mistakenly treat with IV fluids

How it happens:

During high intensity exercise, sodium is lost along with sweat. Athletes can lose up to 2 grams of salt per liter of sweat.  An athlete who only replaces the lost fluid with water will have a decreased blood-sodium concentration. Sodium balance is necessary for transmitting nerve impulses and proper muscle function.   

Consider a full glass of salt-water. If you dump out half of the contents of the glass (as is lost in sweat), and replace that with water only, the sodium concentration of in the glass is far less and the water is more dilute. This can occur in the bloodstream of an athlete who only hydrates with water during excessive sweating. The result is …… HYPONATREMIA

RUNNER’S PROFILE: Mark Robinson

Completed Boston Marathon at age 27

Drank gallon H2O before race

A cup at every drink station

Drank H20 after finishing race despite vomiting

Collapsed in parents home

Air-lifted to a Boston Hospital

Misdiagnosed with Dehydration, Given fluids

Was in a Coma for 4 days before recovering.

SIGNS OF HYPONATREMIA

Headache

Confusion

Nausea/Vomiting

Cramping

Bloated Stomach

Altered Consciousness

Swelling in extremities (fingers and ankles)

Seizures

Lethargy

FOR ATHLETES: HOW TO AVOID HYPONATREMIA

Use a sodium containing sports drinks during long distance (more than 60-90 minutes long)

Increase salt intake per day several days prior to competition (except for those with hypertension)

Try not to drink more then you sweat

During a marathon a good rule of thumb is to drink about 1 cup of fluid every 20 minutes

Avoid use of NSAIDS (like ibuprofen) medicines that contain sodium during event.

FOR PHYSICIANS: HOW TO AVOID PITFALLS IN THE TREATMENT OF HYPONATREMIA

Do not misdiagnose Acute Hyponatremia as Dehydration and give fluids and cause CEREBRAL EDEMA

Do not use Hypertonic saline in patients that do not have signs of CNS involvement

Do not correct Na greater than 4-6 meq/L and cause central pontine myelinolysis.

ACUTE

When serum sodium concentration falls rapidly

Over 24-48 hours

The compensatory mechanism is overwhelmed which can lead to cerebral edema and brainstem herniation

CHRONIC

Develops over more than 48hrs

Experience milder degrees of cerebral edema for a given serum sodium level

Brainstem herniation has not been observed

The causes of morbidity and death are status epilepticus (when chronic hyponatremia reaches levels of 110 mEq/L or less) and central pontine myelinolysis when corrected improperly.

The distinction between ACUTE hyponatremia and CHRONIC hyponatremia has critical differences in proper corrective therapy.

Acute evolution of hyponatremia (as in marathon runners and high endurance athletes) leaves little opportunity for compensatory extrusion of CNS intracellular solutes.

Hypertonic saline (3%) on a rare occasion may be used to rapidly increase serum sodium level in patients with severe acute or chronic hyponatremia if manifested by severe confusion, coma, seizures, or evidence of brainstem herniation

An increase of 4-6 mEq/L over a few hours is sufficient. Further correction is dangerous and must be avoided unless necessary to correct continued seizures or other severe CNS abnormality

Equation for use of Hypertonic Saline.

Required volume = (Na desired - Na current)(TBW) / (Na Fluid- Na Current)