A Sorta Fairytale

smells like teen spirit

2006-09-19T11:23:00.000-04:00

as an ob/gyn, i know i'm supposed to be thrilled and wildly enthusiastic about the new HPV vaccine. HPV is a virus of many strains, some of which cause genital warts, and some of which are known to cause cervical cancer. most sexually active people are infected with at least one strain of HPV, even though most of them have neither genital warts nor cervical cancer--HPV is entirely asymptomatic in the vast majority of people.

the HPV vaccine, newly released by the FDA and widely advertised to the general public, can prevent infection when given to individuals not yet exposed to the virus. we think that this will prevent many cases of cervical cancer.

yay, right? nobody wants cancer, and most of us would be happy if told we could do something to prevent it.

still, i have a MAJOR problem with the new push to make the HPV vaccine mandatory to girls ages 9-13 years of age. people pushing for mandatory vaccination (namely a group of female lawmakers in Michigan, and of course, Merck, the drug company that makes it) are proposing that all females entering sixth grade should be required to be vaccinated against HPV. of course, the opposing group of conservatives are arguing that it infringes on parental rights and will encourage young people to have sex.

that's a load of crap, in my opinion. the fear of pregnancy is barely a deterrent for most kids who will start having sex, let alone a virtually symptom-less and usually consequence-less STD. i don't even think there are 3 teenagers in the entire united states who will say, "phew, now that i don't have to worry about HPV, i can start having sex."

as for parental rights, well, there are plenty of other mandatory vaccines, so i don't think the argument carries any more weight than for the others.

no, my problem is that making a vaccination MANDATORY should be reserved for diseases that are communicable with casual contact. after all, with those diseases it is as much a matter of protecting ME as it is YOU. epidemiologists refer to "herd immunity" when a certain percentage of the population is vaccinated against a communicable disease. if the critical threshold is reached, then even unvaccinated individuals are protected against infection because there is no source of communication. and when individuals decide not to vaccinate in greater numbers, then the entire population is at risk for outbreak. therefore, it is as much a matter of public as it is personal interest to require vaccinations for diseases such as smallpox and polio as EVERYBODY is at risk. but HPV is a different story--it requires intimate contact to spread. there are some people who will never ever ever be at risk for HPV no matter how many other people have it. people who are celibate or who are monogamous over a lifetime with a monogamous partner have ZERO percent change of catching it. granted, that group of people might be shrinking, but they still exist.

the first rule of medicine is "do no harm." it is non-hippocratic to force a group of people who are at zero risk of acquiring a disease to be given medication to prevent the disease. vaccines are very very safe--but they are not without risk.

the problem is, it is pretty difficult to tell who, at nine years old, will be at risk for the disease. and by the time risky sexual behavior (or let's face it, even "normal" sexual behavior) emerges, it is often too late for the vaccine. i don't have a good answer for this. but i don't think mandatory vaccination is the answer.

my second problem is with the push to vaccinate FEMALES. yes, women have cervixes and therefore get cervical cancer. but males can get genital warts, and, more importantly, males can spread HPV. actually, if all males were mandatorily vaccinated, then no female would ever have to be--the transmission of the virus would cease. (okay, i suppose there would be a certain amount of female-female spread, but i bet it would be pretty low).

and finally, i'm just sick of the government butting its head into my life at every turn. i am all for laws that protect the public from individuals. sure, drunk driving is illegal, not because we care so much if the drunk kills him/herself, but more because we know drunk drivers kill innocent people. we are protecting society from the drunk driver. but what's up with mandatory seat belt laws? if i, an adult, choose to drive without the protection of a belt, who will it hurt besides me?

and why should the government protect me against myself?

for that matter, why in some aspects but not others? 16-year-olds can go to tanning booths. 47,700 new cases of melanoma are diagnosed each year. 7,700 people will die of melanoma each year. compare that with cervical cancer: 9,700 new cases per year with 3,700 deaths. so while all of our young women are protected against cervical cancer with our snazzy new vaccine, we continue to let them grow melanomas one tan at a time (can you hear me, little sister?). where does it stop? smoking in public is illegal in many areas. good: protect MY lungs. but can we outlaw smoking at home? sure, but those donuts and fast food are next. soon exercise will be mandatory. so will multivitamins.

someone make it stop.

i will continue to encourage my patients to vaccinate their children against HPV. i spent quite a bit of time discussing it with parents during my adolescent gynecology clinic yesterday. luckily, most parents are quite open, realistic, and reasonable when discussing their child's current and future sexuality.

let's keep these decisions to be made between parents, children, and physicians.
government: butt out.

blah, blue, and things to look forward to

2006-09-14T12:34:00.000-04:00

i'm in the library killing a little time while waiting to give a pelvic exam demonstration to a group of students traveling to the border to work in a free clinic.

it took me almost an hour to round up the older style of spatula/cytobrush/spray fixative cytology equipment that i knew they would probably be using. most modern clinics (including ours) use liquid base thin-preps, which are much simpler to use, but, of course, accordingly more expensive to process and interpret.

my life has settled into a nice routine of work, sleep, and work again. i'm not in a constant state of panic anymore, and i realize that i do have a few years yet to learn everything, so work is fine. but something is missing in my life, and i'm not quite sure what it is. i mean, it could be any of a number of things, none of which i have the time or energy to achieve. i'm spending a lot of free time reading journal advertisements for OB/GYN positions in alaska, montana, and maine and daydreaming about my future. not that there's anything wrong with planning ahead, but i'd like to enjoy my present life every once in awhile. i feel like all i've ever done is look ahead, and i think it might've caused me to miss out on some things.

right now i am looking forward to teaching the students. they are a bright spot in my otherwise rather boring life. they are youthful and excited and curious. i, on the other hand, am feeling blah. which isn't the same as blue, but isn't that great, either.

things to look forward to:
Ohio State football
sister and nephew visiting
Grey's Anatomy season premiere
Harper Lee's declawing
buying my red couch
finding a really great church (not a merely decent one)
new Bon Apetit and Backpacker magazines
last Harry Potter book
cooler temperatures
planning my 2007 Australia trip with Best Friend
baking Christmas cookies

victory

2006-09-10T00:36:00.000-04:00

as one of Texas' resident aliens, i have just one thing to say:

GO BUCKEYES!

cats

2006-09-01T09:58:00.000-04:00

i love reproductive endocrinology.

now, let's clarify: i love REI, not for the patient contact, not for the medicine, and not even for the surgeries, which can be pretty cool. i heart REI because it is the most awesome schedule that i will see for the next FOUR YEARS. yesterday i went to the vet and the grocery store after work, and i still got home before 5 pm.

for those non-medical folks, reproductive endocrinology and infertility (REI) is the ob-gyn subspecialty that helps women with endocrinological (hormone) disorders and women who can't get (or stay) pregnant. it involves a lot of clinic work, and lots of nice little surgeries with hardly any blood loss. the patients are generally young and healthy, and as a group, extremely compliant with medical care. they also tend to have insurance. it doesn't get any better than this!

now, i find endocrinology as a medical subject rather dry, and i have personal objections to helping certain people get pregnant, so i would never explore this as a career option (plus the thought of finishing residency and than doing ANY more training makes me want to poke my eye out with a sharp stick). but i can see how the lifestyle would draw people in. you make loads of money with a normal human being's workhours. no call. no weekends. research if you want. or not. really, it has the makings of a fine career.

for all my enjoyment of a great schedule, it means i have plenty of time to go home and realize how lonely i am. i finally gave in to salinger's pitiful self-starvation and fur-biting depression and got a kitten for him. her name is harper lee. she is a cute little russian blue approximately 1/20th his size. i guess that makes her a mini-me. or mini-he. anyway, he hates her guts. but at least glaring and hissing at her gives him something to do all day, because i no longer come home to him meowing pitifully at the door. she is destroying my apartment and my reputation, as i have now officially become a single woman with cats. that is cat(s), as in plural. you know that old lady who died and left her house to 120 cats? one day, long long ago, she had a cat. then she got another one. and it snowballed from there.

i will try to restrain myself. in the meantime, i have three more weeks to enjoy my enviable schedule which has but one remaining 24-hr weekend call. i will store up the sleep and homemade meals and clean laundry like a squirrel before winter, because OB days, AKA 'the rotation from hell,' is next.

but i'm not going to think about that.

v.a.c.a.t.i.o.n.

2006-08-26T09:16:00.000-04:00

i'm back from a restful week of doing...nothing.

it was great.

now i'm going to take some of my readers' advice, lay low, and send happy thoughts to the ER in the hopes that they will not page me today.

the day i became a cynic

2006-08-12T08:34:00.000-04:00

i don't know how you keep your soul in this business. maybe it grows back after residency. or maybe you can afford to buy a new one with your attending-level wages. whatever the case, i have found myself rapidly spiraling down the dark tunnel of bitchy intern.

so determined to stay "nice," i began the year all smiles and acquiescence. i was polite and friendly to everyone, never interrupted, went to see every patient the nurses called me for. when an order didn't get followed, or a mistake was made, i had the patience of Job. no temper tantrums here. and what did all this nice-intern attitude get me?

CRAPPED ON.

i firmly believe(d) that you catch more flies with honey than with vinegar--the nicer i was to all the nurses, techs, consultants, med students... the nicer they'd be to me. but i will tell you, that was not the case. instead, my agreeable nature got me about twelve times as much work. i should have realized what a stupid adage that is. i mean, who the heck wants to catch flies, anyway?

the nicer i was to the techs, the more they pushed my patients to the back of the line for x-rays and ultrasounds (one told me, "i knew you wouldn't yell, dr. midwife, so i put dr. meenypant's patient first). the more accommodating i was with the nurses, the more bullsh** pages i got at 4 am. "dr. midwife, this patient never got consented for blood. can you come up and do it?" i once made the EGREGIOUS mistake of discharging two patients for the day gyn team (chief calls me: oh dr. midwife, could you please please please do me this teensy favor...) turns out the patients had incredibly complex hospital stays requiring dozens of phone calls to arrange follow-up care, and yesterday i was unpleasantly surprised to discover that i will have the honor of dictating the charts of these two patients (in whose care i never even participated) simply because my name is all over the discharges. how convenient for my chief. and now i get asked to do it all the time.

last friday i arrived to find hours of work left over from the day gyn and gyn-onc teams (discharges, post-op notes, lab follow-ups) and this even before i got a single page for my "on call." and then, then there was the straw that broke this camel's back. i had to write a post-op note on this patient, but i found no record of the urine output (a very big deal in post-op patients, it gives us an idea of the patient's hemodynamic stability).

me: where can i find this patient's urine output?
RN, not even looking up: i don't do that. ask the PCT (patient care tech).
me: where can i find the PCT?
RN: out there. (waving with her hand as she doesn't even make eye contact).

me, wandering around: are you the PCT?
PCT: yes.
me: where can i find room 12's urine output?
PCT: i just got here. you'll have to go ask the nurse.

me: the PCT says you got debriefed, and she doesn't have the vitals.
RN: well go ask her again. i don't have them.

me, finally getting really really pissed off: no, i need you to stop checking your email, and find this patient's urine output.
RN, grumpily looking at the vitals sheet: i don't see it here.
me, sarcasm getting the best of me: really. i told you that 5 minutes ago. any idea where i can find it?
RN: if it's not here, it probably didn't get recorded.

extensive discussion with PCT and RN leads to conclusion that if urine output did get recorded, no one knows where it is. currently, the patient is 8 hours post-op, with less than 50 cc of urine in the foley bag, which is NOT GOOD. this is where i lose it.

me, in the hall, to the RN and PCT: it is UNACCEPTABLE to have a post-op patient with no urine output recorded. do you see this order? it says: RECORD URINE OUTPUT. not only is it unacceptable for it to have not been done, it is unacceptable for no one to have noticed that it was not done for EIGHT HOURS. now i have a patient who may or may not be oliguric, complaining of abdominal pain. could be normal post-op pain. could be ureteral obstruction. but there is no way to know, now is there?

i didn't exactly yell, but it's the loudest my voice has been since starting residency. i was pissed, and for once, other people knew about it. but i was amazed at the results it produced. RN and PCT suddenly sprang into action, apologizing and measuring urine and offering to search high and low for lost vitals sheets. it was a sobering moment, because i realized that maybe, just maybe my perfect plan to be so nice that everyone loves and respects me wasn't working. being nice has given people the idea that i can be dumped on and walked all over. over the next few days i was more curt on the phone. still polite, but more cut-to-the-chase "what do you want?" i refused to see a consult before the medicine resident did her own pelvic exam (i don't consult cardiology for my cardiovascular exam, now do i?) i told other residents to do their own discharges and post-op notes. i stopped feeling guilty for not answering pages on my way to the bathroom. it feels good to stand up for myself, even a little bit.

in a way, i'm sad that i have to leave that last shred of idealism behind. until i figure out how to be both firm and nice, i'm going to err on the side of firmness, because i can't keep up with nice intern's workload.

and so it has come down to this.

if anyone out there has any suggestions, any magic formulas for being friendly without getting stepped on, please pass them along. i'd like to resurrect nice glorified midwife, maybe for second year.

Sparades

2006-08-03T03:40:00.000-04:00

they said it would happen; i didn't believe them.

but here i am, mere weeks into my Tejas residency and i have mastered...

ta da!

VAGINA SPANISH

i am actually really excited about this. i've spent weeks in foreign countries and never picked up a word of the native language. i took 3 years of german in high school and i only remember how to count to ten (minus the two. i can't remember two). my two closest friends are enviably proficient in spanish, and i am so jealous that they can carry on conversations with spanish-speaking people while i came home from guatemala knowing only how to ask someone if their bum itched (we were screening for pinworm). i have resigned myself to the fact that i am just not good at languages. i wish i was. i will be the first one to sign up for that brain chip implantation.

still, necessity is the mother of invention, and, i guess, language proficiency. when everyone around you is chattering away in spanish--nurses, doctors, patients, housekeeping, the computer tech...you manage to pick up the basics.

i am delighted to discover that i can now successfully introduce myself, evaluate a patient, describe findings of an ultrasound, deliver her baby, congratulate her, and follow-up her postpartum course, all in a really quite inventive combination of bio-linguistics i like to call sparades ("spanish charades"). this is also where my sign-language background comes in handy.

and i can tell i'm getting better, because more often patients are responding with 'si' or 'no' instead of puzzled (or worse, frightened) glances. my vocabulary is expanding to the point where i can actually ask a patient what she would like for post-partum contraceptives, a step-up from asking her what she wanted for "no mas bebes," which is what i was asking.

i could never go to mexico and have any sort of decent conversation with anyone, but stick me in a room with any spanish-speaking pregnant woman--i'd do all right.

Felicitaciones a mi!

dear God

2006-08-01T23:51:00.000-04:00

do not let me cry. do not let me cry. do not let me cry.

if i cry, do not let them see me.

little black cloud

2006-07-31T19:42:00.000-04:00

ah, the joys of ward call.

they say the greatest fear is that of the unknown.

and they would be right.

this week i started my two-week block of ward call, an in-house night float designed to allow one person put out small fires and generally keep people alive and well until their teams return the next morning. i work up any new direct admits, but mostly i am responding to nursing calls for fever, pain, or other odds and ends that seem to pile up throughout the day. i am responsible for the 80 or 90 odd patients throughout the hospital that are here under the care of gynecology, gynecological oncology, anetpartum obstetrics, or postpartum obstetrics.

the joys of ward call are legendary. it's shift work for the most part...you keep people alive from 5 PM to 7 AM and then you get to leave. you get saturdays and sundays off. both days. in a row. and on rare, beautiful shifts, you may even get several hours of uninterrupted sleep between the 10 PM ativan/benedryl/morphine pages and the 4 AM, oh-my-gosh-did-you-see-so-and-so's-hemoglobin level lab pages. additionally, since the ward call clerk is the person responsible for procuring sustenance for the L&D teams, you get to hand off your pager for an hour or so each evening to go on a food run. if you plan it just right, this may coincide with the 6 PM lab pages.

silly me, i was actually looking forward to it.

the truth is a little less joyous. the truth is, ward call is a free-for-all. it's the time when the nurses, smelling fresh meat and naive interns, call you to get all those little things done overnight that they can't get the teams to do during the day. inevitably nighttime is when the patient decides she is Fed Up and want to leave AMA (against medical advice). nighttime is when the painkiller-addicted patients want morphine even though they're on enough fentanyl to down a horse. my carefree week went downhill fast when halfway through my first shift, a sweet little geriatrician here for radiation therapy fell when getting out of bed to use the bathroom. the call from the nurse was something like, "dr. midwife, we heard a loud noise from mrs. so-and-so's room and now she's on the floor complaining of leg pain." foreshortened lower extremity? check. everted and adducted? check. pain throughout the thigh and groin? check and, uh, check. the three-view x-rays were merely a formality. this sweet little lady will be lucky if her cancer kills her before the hip fracture does.

day two brought me a septic patient from the jail hospital. it's a long, scary trek through the corridors and double-barred rooms. day three was my post-op lady with chest pain that turned out to be an acute MI. i've resigned myself to the fact that i am officially cursed. my heart skips a beat every time i get a page; it could be the benign, "can mrs. so-and-so have some phenergen, because she's feeling nauseated." or it could be, "we just started mrs. so-and-so's taxol infusion and her lips are swelling up." my fingers shake as i dial the numbers, hoping and praying for a friendly, carefree voice rather than an anxious, breathless one. i am thrilled to respond to fevers or dangerously high blood pressures. those are the easy ones.

i feel incompetent and unlucky. i'm dreading the day i have to call a code. my plan, carefully formulated, is something along the lines of 1) call the code team, 2) try not to throw up, and 3) walk slowly so i don't get there first.

my education is coming at the expense of my sanity. i'm certain, if measured, my cortisol levels would be off the chart. my circadian rhythm is out of whack and i can't sleep more than 2 or 3 hours at a time. i feel nauseated pretty much all the time. my pager is giving me arrhythmias and an eye twitch.

one more week to REI. three more weeks to my first vacation. God grant me the serenity.

snapshot

2006-07-25T03:05:00.000-04:00

it's kind of pathetic how resigned i am to the fact that my entire life now revolves around work. oh, med school kept me busy, but i had time to catch an occasional movie or a drink with my friends, or at least read the paper a few days a week.

right now it's all i can do to scoop kitty litter on a semi-regular basis. and let's be honest: it could stand to happen a little more often. i usually sleep through my day off.

for all of my working to the point of complete disengagement from the world, let it not be said that i am lacking in education. it's the whole "be careful what you wish for" speech, and i remind myself that one of the reasons i liked this program during interview season was because of the incredible volume of complicated patients. if i am ever to be a solo doc in a rural place, i need to be equipped to deal with any and everything. but try telling me that as my feet swell to enormous proportions during my third (yes THIRD) cesarean-hysterectomy, second forceps delivery, or uterine rupture patient. this all in one night.

some ob's never do a c-hyst in their entire career. it's an awful and gory surgery, and one of our patients is still in the ICU after losing 7 liters of blood. but now i've seen them, and if i must see one again in my career, at least i'll be prepared. and isn't that what residency is all about?

my first two weeks of internship were on the ultrasound rotation. pretty cushy during the week, with a 24-hour L&D bookend. the last two weeks of L&D nights, i've done 11 c-sections, assisted on a dozen more, 31 vaginal deliveries, 2 sets of twins (one vaginal, one c-section), assisted on 2 c-hysts, had 3 vacuum deliveries and 3 forceps deliveries. my last night on, my senior let me crash my first section. two minutes from skin to baby--but it felt like forever. a really good, experienced doc could've had the baby out in 45 seconds, but i think my resident knew how much they could risk. i'm happy to say, mom and baby (and intern) are all fine.

just 204 more weeks to go.

status post

2006-07-16T01:13:00.000-04:00

well, i'm three weeks into my internship. going on my sixth straight day of 16 hour night shifts (yes, i know "day of nights" is contradictory). i haven't slept more than 6 hours per night in the last 3 weeks. i've lost 11 pounds, probably because i have time to eat an average of once per day. i'm lonely. i'm exhausted. i'm scared of the attendings.

and i'm wondering if it's too late to be a kindergarten teacher or starbucks barista.

the honeymoon must be over.

honeymoon

2006-07-14T08:32:00.000-04:00

when you're 15 hours into a shift (technically past time to leave, but you got the requisite "shift change baby"), quietly humming christmas carols (in july) under your mask in the operative delivery room while suturing third degree lacerations, you know your love your job.

nothing is happier than a mom meeting her new baby. nobody is luckier than me--because i get to see it every day.

Sense and Sensibility

2006-07-10T13:24:00.000-04:00

i've been here long enough to sort out the great mexican restaurants from the merely good ones. also to know that it takes exactly 17 minutes (door to door) to walk to work if i'm wearing comfortable shoes, 22 minutes if the shoes are more attractive than comfortable, and up to 30 to walk home if i'm post-call (but only because i tend to miss my street. or my house).

on nights, and i still look around searchingly when nurses call "dr. midwife!" down the hall. i also tend to look over my shoulder, wondering when someone is going to come around and telling me i'm doing everything all wrong.

so far i haven't killed anyone.

the biggest challenge is learning how to be in twelve places at once. the intern is supposed to do all the non-instrumental deliveries, all the primary c-sections, and all the ultrasound in triage. this in between writing 2-hour notes on all the laboring patients, as well as placing all the internal monitors. then there are post-delivery notes, post-delivery orders, M&M sheets, birth certificates, consents, et cetera, et cetera. it doesn't help that our entire patient population is "high-risk," and therefore require more interventions and supervision. (the low risk deliveries are done by the midwives in another wing of the hospital where we step in only if an emergent section or operative delivery is needed.) all my deliveries has been on PPROMs (pre-term labor), Hep C positive, federal prisoners, teenagers (<15), grand multips, diabetics, placenta previas, or multiple gestations. i guess they figure if we can do complicated deliveries during residency, then we can do uncomplicated ones with one hand tied behind our back when we're done.

i've had small triumphs. i'm still thrilled when one of my primips (first time moms) delivers without so much as a first degree laceration. and when i did my first c-section as the primary surgeon, the attending said, "hey, she's a pretty good surgeon for an intern." a backhanded sort of compliment, but i'm clinging to it all the same.

will i always remember every detail of my first surgery? the scrub nurse (mary) who gowned me, and the scrub tech (don) who handed me the scalpel, and the anesthesiology resident (adam) who confirmed twice that my patient's epidural was, in fact, working. it was surreal, 3 a.m., me with a knife in my hand, and realizing that someone decided i was competent enough to cut someone open.

the first rule of surgery is never to cut something unless you're sure you can fix it. suturing all the perineal lacerations over the past few weeks paid off. don handed me all the right instruments, even when i asked for the wrong ones. adam kept my patient relaxed and pain-free. the resident guided my actions and reminded me of the steps, and the attending slipped out of the OR sometime after the baby was delivered... confident in his intern. me.

Fear & Loathing in La Clinica

2006-07-07T14:39:00.000-04:00

i had my first clinic today--this, having waited for years and years to be a doctor with my "own" patients.

um, when can i trade them in for new ones?

the sheer amount of paperwork involved in a clinic visit is really quite astounding. just when you think you can't possibly write out "menometorrhagia" one more time... no wonder doctors use so many abbreviations. bad handwriting seems inevitable, but i've promised my pharmacy-tech mom that i'll keep it legible as long as possible.

my first patient was new to the clinic (therefore no chart), had a complex medical history, and spoke no spanish. three patients were new with no medical records and needed complete H&P's. three required time-consuming in-office diagnostic procedures (which i had never done before). one had recently been hospitalized. four patients probably needed psych referral for various personality disorders. between my own ineptitude and my patients' complexities, it took me SIX AND A HALF HOURS to see and chart for five patients.

i will have to become a tad more efficient if i am ever to make any money on this doctor thing.

oh, and i love nurses. love love love them. they are highly underpaid.

ab incunabulis

2006-06-27T13:06:00.000-04:00

"well, at least we've proven that you don't need to be an obstetrician to deliver a baby." --L&D nurse

"survived" is probably a pretty good description of my first day. i am still here, alive, existing, and having fun in a skydiving sort of way--it would be even more fun if i was totally confident i'd live to tell about it.

clinically, i don't feel completely deficient. all the med school training has a way of kicking in, especially when you're running on auto-pilot at 4 am. and as long as i'm busy, the fatigue is kept at bay. it's those early morning hours after the euphoria of my first solo delivery wears off, i just screwed up electronic admission orders (again) and have to re-do all 84 billion pages, and i can't drink any coffee just in case i have to scrub in on a c-section for fear my bladder will explode. that's when i'll kinda stand in a daze thinking, "what have i gotten myself into?"

my first night, i would tentatively say, was a success. i didn't kill anyone. i didn't drop any babies. the nurses are nice. i didn't quit my job or hurl myself off the building. no one pointed and laughed at me. i still like ob/gyn, though i do miss my internal medicine peeps. and after my first delivery (accidentally solo because i apparently didn't panic loudly enough to alert my senior standing outside the door), nobody told me i should try a new career in fast food management.

i'm betting this day won't be the worst or the hardest or the most frustrating, but it was the FIRST and now it's OVER.

yay.

dr. who???

2006-06-22T16:37:00.000-04:00

feeling inadequate in sooo many ways. i need to learn spanish, pronto. i need to read the stack of ob/gyn books given to me at my program's orientation. i need to take deep breaths and not totally panic about being the first intern on call this sunday.

newly endowed with all the paraphernalia to at least look like a doctor, i am feeling increasingly terrified that someone may mistake me for having any sort of doctor knowledge. all of my fellow interns are bright, went to reputable med schools and seem WAY more experienced than me. and all of them really really wanted to be here. so i have either lucked out by ending up in a super program that i didn't even plan on attending (not that i'll admit it to anyone here...) or i am in deep doo-doo, because i have the feeling that this is going to be one crazy year.

i'll let ya know if i survive my first call.

revelations

2006-06-17T17:41:00.000-04:00

1. i will not move from this apartment before graduation unless it burns down around my ears or is blown away by a hurricane.

2. i will never move furniture again. i will happily pay burly men enormous sums of money to do this for me in the future.

3. it is freakin' hot here.

4. holy shit, i have to do doctor stuff soon.

5. my cat is not good company. i need a dog. or a friend. i'm not picky.

now, to go fill out more paperwork until my fingertips bleed. and i don't even start getting paid until monday :)

movin' on

2006-06-12T22:23:00.000-04:00

i gave away my car's ice scraper today in a purely symbolic gesture. actually, it was a christmas present from a former boyfriend. yes, folks, i have dated guys who give ice scrapers as gifts. he was in the army and i thought that made him "manlier" than the artists/musicians i usually dated. (turned out, he was just as immature as the artsy ones, except he could dismantle, reassemble, and fire a semi-automatic weapon in under 20 seconds. this i know this from personal experience.)

my car is crammed full of my stuff, i've hugged my goodbyes, and i have my granola and snapple iced tea stashed behind the driver's seat. road trips make me want to eat or smoke, and i quit smoking a few years ago.

wait, smoking other people's cigarettes doesn't count, right? or the time i drove from seattle to houston in a week? but other than that, i've totally quit.

i've come to a peace this week. i've finally realized that i am (much to my surprise/dismay) the type of person who could live in the same place my entire life, down the road from my folks and childhood friends, staying the same and living a simple life. i used to be so judgemental of people who did this, considering them small-minded and frankly, boring. but it's so comfortable and easy. change is hard. new places are scary. none of these discoveries are unique or earth-shattering, but all the same, i've been slow to accept them. fate (or God, more likely) has decided that i won't stay here, that i won't be comfortable, if stagnant. i'm just supposed to experience more of the world, i guess. and deep deep below the fear and loneliness (it's already setting in...), i know i'll be happy that my life forced me out into the world, away from the comforts of home. or like Sister said, away to a new home.

I've lived in this place and I know all the faces
Each one is different but they're always the same
They mean me no harm but it's time that I face it
They'll never allow me to change

But I never dreamed home would end up where I don't belong
I'm movin' on

At last I can see life has been patiently waiting for me
And I know there's no guarantees, but I'm not alone
There comes a time in everyone's life
When all you can see are the years passing by
And I have made up my mind that those days are gone
i'm movin' on
~ Rascal Flatts

check

2006-06-09T10:30:00.000-04:00

the devil is in the details, and i'm consorting with the enemy. for some reason, it is infinitely easier and more satisfying to compose vast and numerous lists filled with the minutiae necessary to pack one's crap up and move a life across the country than to mentally and emotionally prepare myself for said move.

my cat is newly emasculated, having acquired both a collar and a humiliatingly feminine bell. ever since we moved home, my family is really bad about letting him get outside, and he now fancies himself and outdoor adventurer (one without claws or a clue). he's gotten increasingly stealthy and nimble-toed and the bell, i've found, is helpful. he also has a shiny tag with my new address engraved on the back. if he escapes in galveston, i really don't want to chase him down the street.

i'm busying myself with such tasks as "cancel bank account" and "contact billions of people re: new address" and "consolidate loans" and "send thank-you notes" and "find out where mom hid my coffee grinder." in the meantime, there is living to do, what with Niece the Sequel taking her first steps and having a birthday, Nephew trying his first baby foods, and Niece and i having friendly battles with the backyard sprinkler. there are too many "one last" events to count...girls night out, dinner at my favorite restaurant, seeing Best Friend, babysitting sisters' offspring, cooking one last meal with Sister and going to the outdoor market with Mom.

my dad took me shopping for tools the other day. he thought i needed my own stuff since he can no longer fix my household problems with a 3-hour drive. it was sweet, but you could see the frustration building as i shrugged over each item he grabbed. how the heck do i know if i'm going to use needle-nosed pliers, let alone a collection of 5 in all different sizes?? the hammer and tape measure i can figure out. i can even use a screwdriver. but anything else is woefully beyond me. i'm not one of those feminists who think i can do anything a man can do--i can't and frankly, i don't care to.

so for now i'm returning library books and carefully sorting shoes and clothing into various colored totes. i do this purposefully, pretending i'm not terrified about moving and starting internship. lists i can do, and do them well. but if you held a gun to my head, i'm not sure i could definitively tell you that a uterus was retroverted or anteroverted on your standard bimanual exam. heck, i'm lucky if i can find the cervix every time (you try searching for a cervix on a lady who forgot to tell you she had a hysterectomy).

but for a few more blissfully ignorant days, i don't have to think about that.

boxes and lists.

check.

Cousins

2006-06-06T20:02:00.000-04:00

had a last "girls night out" with my three sisters. only with family can you tell the same stories over and over, bicker about the details, and still laugh your ass off. i'm gonna miss them more than i care to dwell on right now. it's better to pretend we'll just be too busy to get together in the near future than to contemplate the reality of a vast expanse of land between us.

growing up i spent summers in ohio on my grandparent's farm. my mother and her 8 siblings, their spouses and children (spread across the states from new york to florida, from virginia to arkansas), always gathered for the week of july fourth, up to 45 people crammed into an old house with one bathroom, no air conditioning, and endless supplies of mystery casseroles with cornflakes spread on top.

it was always the best week of the year.

there was a group of cousins close in age, 6 of us evenly divided by gender and personality. we played endless games of monopoly, pit, risk, red red rover, and flag football. we crushed numerous pennies on train tracks. our parents dropped us off at the lake to swim all day and eat watermelon laffy taffy and get second-degree sunburns.

one year we converted an old flat-bed wagon in the barn into a giant bed and had slumber parties where we could be as loud as we wanted. Cousin re-told the shining (most of us were too young to have seen it) and scared us out of our wits. she also told really good stories involving sharks and severed limbs; i used to think she made them up, and just as i write this, i realize she was probably retelling jaws.

we climbed the apple, cherry, and peach trees, ostensibly to retrieve enough fruit for one of grandma's amazing pies, but usually ended up eating the selected fruit long before it hit the kitchen. we rode grandma's old bikes through country roads, perfecting our hands-off technique far from traffic or adult witnesses. we twirled on the rope swing buried into the oak off the front lawn, until years later, one twirl too many, and it snapped. the new plastic swing wasn't the same. we gathered up all of Aunts' and Uncles' old college textbooks from the hot and dusty attic and played "school;" we built cities from wooden blocks our parents played with as children; we watched grandpa's old movies, and we ate endless cones of ice cream from the varied selection in grandma's freezer. at least one person a year got a finger stuck in grandma's old-fashioned clothes wringer while pretending to be a pioneer woman.

these days, our group convenes on our own, sans the extra 40 folks and with amenities such as air-conditioning and drivers' licenses. we are bonded by idyllic childhood summers, yet minus a member to early passing, and another to the military. we sit and compare parental aggravations--after all, the stubborn and judgemental streak that runs through my mother is also reflected in the blood of my Aunts and Uncles. instead of playing and doing, we mostly talk and reminisce, in many ways like our parents did each year.

grandma had to sell the farm after grandpa died. i'm so sad thinking my kids will never get to play hide and seek in the corn fields, or sleep in the little attic room with the sloped ceiling. i wish someone would have stepped up and kept it in the family, but nobody wanted an old old house in the middle of nowhere, especially one that involved so much upkeep. i have inherited grandma's pie recipe, horrified to discover that her delectable pie crusts contain a substantial amount of lard. i've tried to recreate the pies with the less distastful crisco, or even butter, but they just don't taste right. apparently, lard is the key ingredient. and so i'm left with the memory of grandma's amazing pies.

the four of us still break out the board games, now adults, three with professional degrees and one a happy wife and mother. and sometimes i feel like a dork--26 and i love nothing better than playing trivial pursuit with my cousins while on vacation in florida. but as we try to outdo each other, dredging up the most obscure memory of grandpa or that one year, or the time we did..., i decide we're very very lucky. after all, we're dorks with family and history. and i bet we have as much fun as anyone.

what goes around...

2006-06-03T17:21:00.000-04:00

after sitting through a god-awful three-hour awards ceremony (that i was planning to skip until Best Med Friend guilt-tripped me into coming), i have decided that i feel sorry for all 81 of the people with whom i went to elementary, middle, and high-school.

watching other people get about 8 million awards and give 8 million identically lame speeches is only slightly better than watching the same 3 people get 8 million awards and give 8 million speeches. and i'm sure those 3 people are really really smart and got all the best grades. i'm not sure they'll be the best doctors, but then what do i know?

see, in primary school, i thought awards days were the best day of the year, cause i was the one that got them all. and i didn't see anything wrong with that. after all, i worked the hardest and got the best grades. i deserved them, right?

but now i realize that there were probably a good number of unrecognized people that worked at least as hard, if not harder than i did, just like i worked at least as hard as ms. "i'm going into peds, but i got the ob-gyn award anyway, sucka."

lots of things in life award "first" and not "hardest-working", but medicine (luckily) isn't usually one of them. sure, i missed out on the oh-so-cool plaques and envelopes stuffed with checks (hey, if i had known there was cash involved, i might have studied a little harder...), but i know i'm a damn hard worker, and that will pay off in a million other ways in the future.

and now i can throw away all those meaningless awards from grade school--one less box to drag to texas, and a lot less ego to go along with it.

stomping grounds

2006-05-22T09:33:00.000-04:00

this was a weekend of reunion and celebration. i had to plan my requisite graduation party around everyone else's graduation parties, birthdays, and dance recitals, even though it felt weird to have it before my actual graduation. whatever--the only thing standing between me and my M.D. is a (rather important) piece of paper.

my third grade teacher stopped by. i haven't seen her since high school graduation. she says that i am the first female in her history of teaching to become a physician. she had a guy graduate from med school 15 years ago, but no one since. that just tells you what a crappy school system they have out here in the sticks. other than Third Grade Teacher and High School Physics Teacher, all the other teachers are newly graduated, wide-eyed optimists who ditch the sticks for jobs that actually pay as soon as they learn to handle 30 kids at a time. (it seems to be getting worse--there is no other way to explain Baby Sister's great AP grades and her abysmal ACT score)

but it was neat to see people genuinely excited for me. i don't know how it is with my peers, but my journey from high school to this point was truly a group effort. i clung to every nugget of encouragement or confidence directed my way, no matter how trite. and when push came to shove, i was able to remediate gross anatomy rather than ditch med school all together--i can honestly say my friends and family had a lot to do with it. as frustrated as i can get when it feels like they "don't understand" the stress i'm under, they have been my support system as much as any of my fellow cell-mates, just in a different way. they were the ones who reminded me that there was a world outside of medicine, that people weren't only "healthy" or "sick", and that there was no way in hell i could pay off my med school loans with a bachelor's degree in psychology.

sunday i met a college friend at my undergraduate stomping grounds. it's been 3 years since i was in her wedding. now she's a mom with a master's degree, and i am in awe of her. she is glowing and happy with her beautiful baby. there needs to be a word to describe the emotion of nostalgia and happiness and sadness all rolled up in your stomach. we walked around campus and i wished i could do it over again and really really relish that wonderful time.

but i can't go back, and i probably don't really want to. my good pals will probably always be scattered across the country, and i'll probably never again have such a concentrated yet diverse group of friends, but the good ones will still be there for me, regardless of geography. when conversation flows like three years was only last week, you know it's for real.

stilts

2006-05-13T17:55:00.000-04:00

i spent the better part of the week negotiating the disturbingly intermingled ghettos and historical districts of my future island home, and trying to internally negotiate the necessities of closets vs. air conditioning. the cool thing is that many of the old houses in downtown galveston were built in the late 1800s/early 1900s and therefore retain the charm of the era. the bad thing is that they also retain the technology (or lack thereof).

things i learned this week:

~people did not have closets until 1960 or so it seems. before that they probably only had 2 outfits (regular and sunday) and one pair of shoes (horror!) so i guess they didn't need them. but i (and my shoes) DO.

~instead of moving to say, a place that DOESN'T flood on a regular basis, people like to build their houses on stilts. nothing freaks me out more than a house on stilts.

~when you are driving in an unfamiliar yet tiny city with lots of one-way streets, dead-end streets, and streets that change name mid-block for no apparent reason, and you are slowing down a lot to try to read faded and/or missing street numbers on the sides of houses, it is not a good idea to have a conspicuous rental car. bright orange, with out-of-state plates, for example. everyone in galveston now knows me as the "idiot tourist in the orange car."

so i finally have a southern address, after much pulling-of-hair and swearing under my breath (okay, and sometimes out loud).

i really like my landlord, and i love the location. it's an old old house that was turned into 4 apartments right in the center of the historical downtown.

what i love:

-close to work (i can walk), and not too much farther to the beach
-beautiful all-wood floors and great windows/light
-private balcony
-great area of town, close to everything but safe and very well-maintained
-central air being installed even as i write

what i hate:

-the kitchen (a total of 2x1 feet of counter space)
-the bathroom (TINY; generally gross)
-top floor (with narrow halls and hairpin turns-- a total bitch to move into)
-NO storage space (a total of TWO of the tiniest closets in the history of houses)
-shared washer/dryer with other tenants

it's within my budget and should be fine, for at least a year or so. actually, it's a really beautiful place that brings out the inner do-it-yourselfer in me. but it's probably not a great idea to rip out all the kitchen and bathroom fixtures and cupboards in an apartment i'm renting--i can still dream about how i'd fix it up if it were really mine. i really like the landlord, and it's close to work. i think in 6 months, that will mean more to me than anything else.

How Kaavya Got Caught

2006-05-08T20:33:00.000-04:00

my copy of How Opal Mehta Got Kissed, Got Wild, and Got a Life came in today, and i lost no time picking it up and delving in. i reserved it from our local library weeks ago, long before it came out that first-time author, Harvard sophomore Kaavya Viswanathan, had liberally "borrowed" passages from other books. now her six-figure publishing contract has been cancelled, and all copies of HOMGKGWAGAL pulled from store shelves. i was actually worried that it had been pulled from the libraries also, and i wouldn't get a chance to read it.

i reserved the book after reading a review in USA Today, because i thought it sounded fun, and there's the whole '17-year old author' factor that makes it even more enticing. as the controversy stirred--Viswanathan first said that passages in her book that resembled another author's were an unfortunate, accidental "internalization" of books she loved, i sympathized. while waiting for my reserve to come, i read two of the books--McCafferty's Sloppy Firsts and Second Helpings, so that i could form my own opinion. after all, how many different ways are there to describe shallow high-school girls? it seems inevitable that the similar dialogue and themes should emerge.

and after finishing HOMGKGWAGAL, i must say, i'm disappointed in Viswanathan. first, it was a lovely book. entertaining, well-written. funny. but it was obvious that she lifted entire characters/descriptions/scenes from McCafferty's work, near verbatim in some instances. and what's so disappointing is that the plagarized parts were not 1)that great or 2)integral to the plot or the style of the book. in other words, with her talent, Viswanathan could have easily written a great little book without so much as a borrowed word.

so why would an obviously intelligent, talented person essentially cheat, especially when it is so unnecessary? and with such high stakes? i mean, this is a girl who got into Harvard. she must have a brain, if not a conscience.

i was a tutor in the university writing center in college. i'd say 90% of my work consisted of helping undergraduate and graduate students properly cite resources for papers. most of them didn't realize that they needed to cite a resource if they, say, just summarized an idea and didn't necessarily quote directly. others simply didn't care. they'd present the work as their own, and when pressed, would admit that they got the ideas from a web site or other source. and Time and Newsweek have both investigated the "cheating epidemic" in America's school system, revealing that some 80% of honors students admit to cheating and/or plagarizing regularly; what's worse, most of them feel like it's "no big deal." and i have to wonder why this is? why are we 1)compelled to cheat and2)feeling that it's okay? it's no longer the stereotypical "slacker" students who cheat to pass a class--these are honors students who cheat to get a 98% rather than a 92%.

there was a mini-scandal at my med school when a group of students in the third year class was found to have cheated during a clinical skills exam. these students were given a crib sheet by a department secretary that gave them the clinical scenarios to be presented, and the answers expected by the examiners. they would've gotten away with it, too, had not they become outliers in a pretty reliable bell curve. people got pretty suspicious when these 5 students scored higher than any student in the history of the school. when forced to come forward, the cheaters were found to be the "best of the best." these weren't students in danger of failing out of med school--these were the "gunners" aiming for competitive residencies in derm or ortho. and a few percentage points could mean the difference between getting a residency or being shut out.

it scares me that nothing is sacred anymore. you can't even be sure that your DOCTOR is an honest person who earned his/her position. if they are willing to cheat with stakes this high (at most--expulsion, at least--damning comments on school transcripts that will follow their careers for life), imagine what they did to get here!

a few years ago there was an outcry in a school (i can't remember where) when a science teacher failed almost an entire class of seniors for cheating on a major project, and their parents blew a gasket. one parent's comment: everyone does it. teacher was forced by the school board to reverse the failing grades so the poor little students could graduate and go on to cheat in college. she resigned. good for her.

it makes me ill. kids cheat, and learn that they can get away with it. but not for long. administrators are resorting to ever increasing technological methods of detecting plagarism in schoolwork.

so i have little sympathy for Ms. Viswanathan. talent and intelligence mean little when you have no integrity to back it up. in fact, i'd say it's about time someone cheated, got caught, and got punished. for a change.

too bad about the book, though. it was pretty good, in a deja vu sort of way.

can't i just live in the call room?

2006-05-05T12:26:00.000-04:00

it there is anything i hate worse than actually moving, it's looking for a place to live. ugh.

here are my basic criteria:

~allows pets (at least cats, but preferrably dogs also)
~ a porch/deck/balcony/patio of some kind (i need a place for my herb garden)
~within walking distance of the beach
~within walking distance of work
~not in an area i'd be scared to be a SWF
~washer and dryer
~central air (a luxury in the midwest, a necessity in texas)
~within my budget
~won't give me grief over the next year

since having a place both within reasonable walking distance of the beach AND work is geographically impossible, i know i'm going to have to compromise on some of these.

and don't get me started on apartment vs. townhouse vs. condo vs. house. it opens up a whole new can of worms.

my brother already thinks i'm an idiot for refusing to consider buying a place, especially since my residency is 4 years long--plenty of time to acquire some equity in a property. but there are two very good reasons this is not an option:

1) i would rather "throw money away on rent" than be forced to care about the lawn, the roof, the plumbing, and all those other issues that i like to pretend take care of themselves.

2) i simply don't have the mental energy to devote to acquiring a mortgage and a real estate agent, thinking about homeowner's insurance, property taxes, and all that other crap that goes along with owning a home. i'm too busy panicking about all the ob/gyn literature i should be reading instead of people magazine.

so basically, i'm lazy. no, really, i'm just clueless about this sort of thing. i guess i'm hoping i'll eventually have a husband that will take care of that. until Mr. Right or Ms. Personal Assistant comes along, i'm sticking to renting.

so for now, armed with a computer and my cell phone, i'm investigating every habitable dwelling on one tiny island. i think salinger (my cat) would enjoy living on the beach in a box, but it's more of a last-resort for me.

39 days and counting

2006-05-04T09:55:00.000-04:00

within an hour of getting up:

Mom: i don't think you should put "Dr. glorified midwife, M.D." on the announcement. it sounds like you're bragging.

okay, then. i'll just keep letting everyone ask, "so, when do you finish medical school? you're going to be a nurse, right?"

update 5/8/06:
some of you seem to have missed the point of this entry. i realized that it is incorrect to use both 'Dr.' and 'M.D.' at the same time. Mom and i were having a disagreement as to whether the announcement (her idea to put in the newspaper--not mine!) should have Dr./M.D. in it at all. i told her that i would prefer if she did, since 9 of 10 people (minimum) who find out that i'm graduating from medical school ask what kind of nurse i'm going to be. this "quote" was actually a condensed version of several comments from Mom in which she was trying to write up an announcement without actually making it sound like i'd accomplished anything. i'll try to avoid this kind of summarizing in the future, so as to not mislead my readers.

no place like home

2006-05-03T19:52:00.000-04:00

"we hear only what we want to hear."

"it's not what you say, it's how you say it."

if the above are true, and i've found they are, it's a wonder any of us can co-exist in any relationship for longer than 2.5 seconds.

I HAVE TO GET OUT OF THIS HOUSE!!!

living rent free with the 'rents seemed like a good idea at the time... why pay for an apartment that, with away electives and vacations, i was only going to be in about 5 months of the year anyway? i'm finding that i'm more than paying for my "free" living space in grief.

two adult females should not live in the same house.

three (and an almost) adult females really shouldn't.

in fewer than six weeks, me, my cat, and all our material possessions will be 1274.1 miles away, and will darken this doorstep once or twice a year, max. you'd think that would give me the perspective to bite my tongue when Mom makes yet another unsolicited comment about:

my hair --"i was hoping you'd wear it like you did yesterday. it looked nice yesterday."

my clothes--"are you wearing that? i like this sweater on you, but it would look even better if you lost 10 pounds." (note: we still argue about this one. she insists she meant it as a compliment.)

my future husband prospects--"don't you ever want to find a man? it doesn't sound like you do, not with all those feminist opinions you have." (note: "feminist" is a bad word. also, the "feminist" opinions she is referring to are something along the lines of "after working my ass off to get through college and medical school, i may not drop everything to stay home full-time as soon as i pop a kid out.")

my career choice--"are you sure you don't want to be a trauma surgeon? it just sounds so fascinating. i don't know how you can stand the thought of seeing "that area" for the rest of your life." (note: i think "that area" is referring to the vulva, or vagina. i can't bear to actually ask.)

my cooking--"i just bought that chicken. and don't use all the broccoli. i'm saving it. i just bought groceries two weeks ago, how can we be out of everything!"(note: my mom does not cook. ever. she doesn't understand the concept of buying groceries and then actually using them. before i came home, she routinely threw out produce every week, because she kept "saving" it until it went bad.)

my cooking, part II--re: a sesame beef spring roll..."which one has the most meat in it? do i have to eat the outside; it's weird, like skin. these noodles are cold, are they supposed to be cold? is this cilantro? i don't like cilantro. i don't like this, it's bland." (after she proceeded to dissect it and eat only the meat.)

my graduation party--"there just isn't any good day to do this. what a hassle. why did you invite them? no, we can't have fruit salad. i already decided on the menu. i hate doing these things." (note: i specifically told her about 10 times that i didn't care if we even had a damn graduation party. now i'm wondering if i have to come.)

honestly, the first few months i was pretty good at biting my tongue. after all, no rent, no utilities, and clean laundry seemed like a pretty good trade for doing all the cooking. but at this rate, we're barely speaking, and when we are, it's usually to bitch at each other.

today's conversation:

Mom: "are you going to do the dishes? you said you were going to do the dishes."

Sister: "yes, i'm going to do the dishes. we just got home. we'll do them as soon as we're finished with this."

Mom: starts doing the dishes.

Me: "i thought you were going to go on a walk. don't worry, we'll do the dishes."

Mom: keeps doing the dishes.

Me: "mom, really, we'll do them right now. go on your walk!"

Mom: "are you trying to get rid of me?"

since Mom is generally a nice and sane person, i can only assume that having two adult children still living with her is as hard on her as it is on us. so to all you freeloaders out there: get out while you still possess the motivation and wherewithal, so you still want to come back and visit every once in awhile.

i'm thinking maybe thanksgiving, 2010.

sideways

2006-05-01T19:45:00.000-04:00

it didn't sink in over the weekend. i guess i had to wake up late on a monday morning to fully accept it.

i'm done. really done with school. not done like in high school, on my way to college. not done like in college, ready to start medical school. but finished, as in, unless my life takes a drastically different angle (i'm not one to say never), i'm done with formal education.

let the education of life begin.

and it feels weird to be doing this in my mid-20s. i watch my sister with her babies, or my brother in the military, or any of my friends with spouses and mortgages, and think, "wow, they're grown-ups." and lately my student skin is getting a bit tight.

i got invited to go "clubbing" this weekend with a friend from back when. i almost laughed out loud. i haven't gone to a club since college. early college. maybe that makes me a loser. i just prefer dinner and a movie with a couple of friends to expensive, watered-down cocktails and bad come-on lines. i'm similarly over bars, spring break trips to miami beach, and flings with inappropriate men.

so i guess i'm grown up in my own, single, renting, takeout-eating kind of way. i spend way too much money on shoes, and know way too little about how to invest. while companionship is more appealing, the idea of having children is overwhelming. i'm ready to stay in a hotel on my next vacation (my own bathroom!) and forego the familiar 16-bunk hostels with rent-a-towel bathrooms, even if i have met some pretty interesting characters from all over the world. i more often choose merlot over white zinfandel. i even considered buying Niece a savings bond for her fourth birthday, but then decided nobody should ever be that grown-up. i bought her a princess camera and a puzzle instead.

the texas state licensing board sent me a temporary permit to practice medicine. it arrived today, addressed to glorified midwife, MD.

i'm scared, i'm excited, i'm ready. i bet i learn more than i ever did in school.

huh???

2006-04-26T09:54:00.000-04:00

MFM (maternal-fetal medicine) consulted us today for a pregnant patient with high blood pressure. um, high blood pressure=high-risk pregnancy, right? i was half-tempted to write "consult new MFM doctor" on my assessment/plan.

so cynical, so soon.

Angels & Demons

2006-04-24T17:44:00.000-04:00

in a scene illustrated best by classic Disney, i found myself torn between getting out of work early enough to avoid the worst of the rush-hour traffic, and tying up a few loose ends of patient care.

i was updating the check-out list when my intern innocently asked about a recent lab value on my DKA (diabetic ketoacidosis) patient. i'm furiously typing, well-aware that i have about 3 minutes to finish, get to my car, and get out of the parking lot if i want to beat traffic, so i spat off the value (i had just checked it an hour or so before) and murmured that it was "taken care of." he questioned the treatment plan, and i blew him off, as my resident had instructed me carefully about the orders.

30 seconds later, on my way to the car, i started having nagging doubts as to weather the intern was right; did our treatment plan reflect the new data we had for the patient? should my resident, busily in charge of the entire list, be informed of a questionable development? the answer is, of course, a resounding YES. i am in charge of a mere 3 patients, and while i am more comfortable with patient care than a year ago, i still get lab values mixed up and am at times unsure about specifics of treatment.

angelic gm: you should go back and recheck that value. at least
page your resident and make sure that the plan is still a go.

evil gm: you can't go back--you'll be stuck here another hour.

angelic gm: you can't just leave because it's 5 pm. this is medicine--you leave when the job's done.

evil gm: you've been here since 6 am--let the on-call people deal with it.

angelic gm: this is YOUR patient, you need to make sure things are squared away.

evil gm: you're just a med student. the team doesn't really need you to make sure things are done...they're real doctors.

angelic gm: you have an obligation to meet your responsibilities--and that includes doing the best you can ALL the time.

evil gm: hey, enjoy being a student while you can. you'll have all the responsibility you can handle in july.

angelic gm: the team is counting on you to get it right.

evil gm: the team doesn't need you second guessing their decisions.

i'm ashamed to say, i kept going and made it home in record time. but the nagging feeling in the pit of my stomach has taken away any pleasure i might have gained by beating the traffic.

i should have rechecked. and double checked. and checked again. i should have turned around, gone back to the computers, and looked up the lab value. i should have paged my resident and discussed the new finding.

my interns and residents are sharp. they know what they are doing. and while they expect me to act responsibly and take care of the patients, they will never depend on me in a way that would jeopardize patient care...but that's not the point.

there are a lot of 9-to-5 jobs in the world, but medicine isn't one of them.

incidental findings blogs a lot about finding a balance between medicine and personal life. it is difficult to know where to draw the line between being thorough and being obsessive-compulsive, between caring and caring too much, between being a good doctor and sacrificing every other aspect of yourself to be a great doctor.

but today wasn't even a close call. the glorified midwife learned a lesson today--one i hope i won't soon forget.

We are what we repeatedly do. Excellence, then, is not an act, but a habit. --Aristotle

Squished

2006-04-22T13:14:00.000-04:00

"Daniel-san, must talk. Man walk on road. Walk left side, safe. Walk right side, safe. Walk down middle, sooner or later, get squished, just like grape." --Mr. Miyagi

this was how my senior resident chose to express his frustration after another run-in with the family of one of our "rocks" (patients in the hospital who languish for weeks and weeks). after we finished making fun of him for quoting a cheesy 80s movie, we commiserated.

back in the "golden days" of medicine, patients didn't make many decisions once they were admitted to the hospital. paternalistic physicians evaluated a patient, decided on a course of treatment, and proceeded wholeheartedly (occassionally communicating the plan to the patient, but often not). patients didn't get to choose between medical or surgical managment, between aggressive or conservative treatments, between aiming for cure or merely palliation--the doctors did.

and while i think it's good that we've come so far as to give patients autonomy in their medical decision-making, the fact is, most of them are ill-equipped to make such decisions, and end up basing them on illogical, spur-of-the moment, unrealistic paradigms rather than considering risks, outcomes and feasibility. they also tend to do it half-assed, thinking they can pick and choose different aspects of the treatment plan like a buffet, taking what they want (pain meds, quick-fix surgeries) and leaving the rest (lifestyle changes, physical therapy).

the problem is compounded when the patient is unable to make medical decisions for themself.

put any 4 people in a room and get them to come to a consensus about where to eat for dinner--you'll be there an hour. have these same four people decide what kind of medical treatments to give an elderly family member, and it can take forever.

our elderly patient came in for gastroenteritis (stomach flu) and never got "better" even after all of her symptoms resolved. she was a classic "failure to thrive." she refused all food and drink, and usually most medications. she wouldn't acknowledge any of the staff. she would occassionally protest at an intervention, but more often than not, seemed to be in her own little world. the family was no help--every day they told us that we weren't helping their loved one, that we were doing something wrong. one day we weren't trying hard enough to "make her eat" (this after we begged them to bring in her false teeth thinking this might be the problem, but they couldn't be bothered); then we wanted to drop an NG to feed her that way. they said this was "too invasive." instead, they asked if she could have a PEG tube (a tube surgically inserted through the skin directly into the stomach for feeding).

as her nutrition status deteriorated, she developed renal insufficiency and started to circle the drain. the family didn't want us to place a PICC line ("it hurts her") but insisted she was full code should she crump overnight. we were paralyzed by their inability to pick a side of the road, unable to treat her condition and give her more time, but also unable to simply provide comfort care and let her die peacefully. every day the family threatened to transfer her to another hospital where "they will fix her."

hours before the transfer, she coded. now she's tubed and pegged in the MICU.

squish.

non-ambulatory

2006-04-20T10:40:00.000-04:00

this is day #2, status-post embarrassingly clumsy badminton incident that left me with a sprained ankle and faltering gait. there was no way i could go to work and participate in marathon rounds yesterday, so i was only mildly irritated that i had to stay home and consume questionably safe amounts of ibuprofen and acetaminophen (and naproxen sodium for breakthrough pain), but today i was determined to go to work (or at least get out of the house). so determined that i got up at 5 am, carefully wrapped my ankle, drove 45 minutes across town, and hobbled across the approximately 2.5 miles of parking lot between my car and the hospital. two steps outside the front door, i stumbled and re-injured said ankle. 30 minutes of hobbling back to the car, and i arrived home with less gas, and far less humor.

it's georgeous out, i have a million things to do, and even more i'd like to do, and pretty much all i can manage is logging in serious couch time with my leg propped up and really bad dr. phil episodes on the telly.

the pain might have even been worth it if i had gotten the point. but no, i lost my balance, and missed the birdie. i'm 0 for 2, and the season has just begun.

this. will. be. better. by. monday.

the devil wears prada, and i wear a stethoscope

2006-04-10T20:23:00.000-04:00

i, the ambitious idiot that i am, chose to end my medical school career with an elective in clinical medicine.

for all you non-doc folks out there, clin med at my Community Hospital is an inpatient service for people who either have no 1) insurance or 2) primary care doc, or usually 3) neither.

this means pretty much anything goes, from people who have multiple, serious, untreated medical problems, to people who get bored on a friday night and decide the ED would be an interesting place to visit. all it takes is the merest whisper of "i have chest pain" or "i'd like to kill myself, please" ( you don't even have to play the part, just say the words. you can even say them while filing your nails and reading people magazine.) and you've earned a direct admit to clin med.

i've had at least 4 residents ask me incredulously why the hell i'm taking this elective as a senior. besides the rather colorful/problematic patient population, it is also a burdensome rotation in that there is lots of required call, and rounds 7-days a week. please, i could be doing derm or something. and there is really only one reason i chose to prostrate myself to the clin med gods...

i'm terrified.

i can't believe that in a few months, some moron out there is going to add a couple of letters to the end of my name and suddenly grant me awesome and terrifying powers. so i wanted to enjoy one last month of being a "student," ie. throwing out all sorts of wild, crazy, and usually wrong hypotheses and treatment plans while some poor resident mops up my messes. it's still okay for me to admit that i didn't hear the II/VI systolic murmur, or honestly, i can't really appreciate the splenomegaly. i can practice the neuro exam a few more times, i can run my admit orders by the intern before calling the attending, and i can look up every single medication in Tucson's Pharmacopeia without feeling too stupid.

i'm pathetically grateful that i can do this, that i am still expected to be learning, to be a student. and while residency is still very much an education, i'm supposed to be a functioning physician.

and i just want a little more clin med under my belt before i go.

baby steps

2006-04-08T09:48:00.000-04:00

Best Friend called. it's going to be okay. this is me being grateful.

4 x 4

2006-04-04T20:02:00.000-04:00

i stole this idea from Big Mama Doc. hope she doesn't mind :)

4 Jobs I Have Had In My Life:

ice cream store clerk
cashier
lab tech
writing tutor

4 Movies I Could Watch Over and Over:

eat drink man woman
dumb and dumber
anne of green gables
rebecca

4 Websites I Visit Regularly:

Food Network
MSN.com
Dear Abby
amazon.com

4 of my Favorite Foods :

cool whip
kiwi
won ton soup
mcdonald's french fries

4 Places I Would Rather Be Right Now (never been):

alaska
new zealand
the grand canyon
greece

4 Most Wonderful Places I Have Been :

glacier national park
greystones, ireland
viareggio, italy
my grandma's farm

4 Books I Could Read Over and Over:

the giver--lois lowry
mere christianity--c.s. lewis
wuthering heights--emily bronte
the pearl--john steinbeck

4 Songs I Could Listen To Everyday:

colorblind--counting crows
amazing grace
the wind cries mary--jimi hendrix
precious things--tori amos

4 Reasons I Blog:

i type faster than i write
so i don't feel as guilty taking 2 months to answer email
everyone else is doing it
to be inconspicuously conspicuous

films about ghosts

2006-04-01T13:36:00.000-05:00

the past came back to haunt me yesterday when i ran into my high-school boyfriend. i was helping my sisters get their kids' pictures taken (i've discovered that the necessary ratio of adults to children in any public forum is 2:1. minimum).

he was there with his girlfriend/fiance/baby mama/whatever and 10-month old son. the last time i saw him was senior year, 8 years ago. it wasn't a bad breakup, but i've just never been the type to stay friends with my exes.

times like this i remember why i wanted to get out of the midwest. some days i feel like i know everyone here, and i hate the 10 minutes of chit-chat that seems a necessary requirement whenever you run into an acquaintence in public.

for about 8 seconds i let myself imagine my life had i been like most of my female peers in my small rural high school and gotten married, right after graduation, to this random guy i dated for 4 months. he was still pretty cute. he grinned at me and i was 17 again. we pretended not to notice each other for a few minutes before sheepishly exchanging greetings. he asked how i was. i reciprocated. and though i've always been one to make a decision and never look back, i started feeling wistfully nostalgic. after all, he is obviously happy and independent in a stable family unit with a beautiful child, and i am being forced to move across the country with only my cat, who, because of a recent disatrous trip to the vet, hates me.

but then Baby Mama asked Ex-Boyfriend if he had any more cigarettes, he got nasty with the sales rep, and later i overheard him asking someone if they knew of anyplace he could gamble in tennessee.

and i remembered why i dumped him.

because i may not have been destined for anything more than the life i was born into, but i sure as hell was going to at least try for something more. my parents are good people. they work hard. but they always believed that i could have a better life than theirs. cliche, but true. when i was applying for medical school, secretly knowing that i was nowhere near good enough to get in, mom was already mentally turning down schools for me. when i was accepted to one (and only one. i got only two interviews.) and cried with relief over the phone, mom was baffled at my reaction. it honestly never occurred to her to worry that i wouldn't get in, that i wouldn't be a doctor. and she's still pissed at the other school that didn't take me.

so here i am, 8 years later, allowed a brief glimpse into the window of what my life could've been. and i'm okay with moving away. i think i was supposed to, all along.

my new coconut shampoo helps. it's the smell of my future home. and it's going to be good.

too little, too late

2006-03-29T14:06:00.000-05:00

why is it sooooo hard to apologize and ask for forgiveness, even when you know you're wrong? my big problem (aside from pride, stubbornness, etc. etc.) is that now, even months after the incident that ended my relationship with Best Friend since college, i can still talk myself into believing that i was right.

anyone who knows me well knows that my deepest desire is to be a Glorified Midwife on a Native American reservation somewhere out west. it's been a dream for quite awhile now, and only reinforced by my elective experience in reservation medicine this year. and i was considering how i, hoping to someday reach poor, discouraged, and marginalized strangers through compassion and understanding, could fail so miserably when it came to being compassionate and understanding with someone i already know and love.

it is astoundingly clear to me that being right (if i was, and i'm not so sure anymore) was not the point. Best Friend needed my compassion, not my judgement. and now, the thought of becoming my mother stops me dead in my tracks. haven't i always accused her of being judgemental???

it took me way too long to admit i miss my friend. even longer to admit i made a huge mistake in not valuing our relationship enough to reach out and care more about her than about being right.

it's cold and lonely up here on my soapbox.

the card is in the mail, but i have little hopes for this small gesture. she probably deserves better than me, anyway.

cholesterol-free, high in fiber

2006-03-23T11:37:00.000-05:00

i have been on an absolute literary binge this month. the relative freedom of radiology has given me ample time to catch up on everything i've been wanting to read over, say, the last 4 years. my tastes are so wide-ranging that i've actually gotten a few unsolicited comments from the library people. yes, these are ALL for me. jeez, i feel like the fat kid at a buffet.

people get irritated with me (and i likewise with them) because i lend them books and ask for them back a couple of days later. i forget people don't read as fast as i do. but to be honest, i read fast but not carefully. i figure this gives me the added enjoyment of discovering new things when i re-read books (and i usually do). this has not served me well when reading, say, biochemistry, but who really cares about that, anyway?

a brief summary/review of some of my latest perusings:

Ultramarathon Man--Dean Karnazes (non-fiction/autobiography)
this guy is crazy--runs 100-200 miles at a time, often running all night. he likes to run a marathon on saturday, and then another on sunday. sometimes he runs from his house to the marathon start point (30 miles or so), just for a warm-up. a bit self-congratulatory, but entertaining all the same. easy, breezy read. but be prepared to feel like a lazy slob when you're done.

One Hundred Years of Solitude--Gabriel Garcia Marquez (fiction)
this one won a pulitzer for fiction, but more importantly, it was on oprah's book club list (smirk). often i ADORE classics, but sometimes i just don't get the appeal. this was one of those times. just when i was about ready to give up, someone saw me reading it and exclaimed, "that is my favorite book, ever!" i finished it in an effort to like it also, and thus be a pulitzer-worthy critic. if someone "gets" this book, please explain it to me. i'm still confused.

Under the Banner of Heaven--Jon Krakauer (non-fiction)
read this because i loved his Into the Wild. this one, about fundamentalist mormon sects in the united states was even better. a really fascinating look into church and state issues, aside from the always-interesting polygamist subculture. pretty well-researched.

Forever Odd--Dean Koontz (fiction)
normally a koontz fan; he's always a realiable stand-by for relatively mindless fiction that you can read to decompress after a bad day, though most of his books kinda blend into one another after you've read a few. this one is a sequel to Odd Thomas, which was much better. Forever Odd just felt a little too cheap and easy. for classically excellent koontz, read Lightening.

In Cold Blood--Truman Capote (non-fiction)
had to brush up on my capote before i saw the movie. good book. honestly, i thought the movie was better. true crime just isn't my shtick. i'll have to try some of his other stuff.

Little Earthquakes--Jennifer Weiner (fiction)
classic chick lit. light, fluffy, unrealistic. better than Friends reruns, not as good as Sex and the City reruns. at least i don't feel 10 IQ points dumber after reading it, like i did after In Her Shoes.

Under the Tuscan Sun--Frances Mayes (non-fiction)
this is nothing like the movie, which i love even though it's a chick-flick. true account of the author's experience buying a house in tuscany. probably about twice as long as it needed to be, but i liked the recipes she included, and overall, it made me want to buy a house in tuscany.

A Million Little Pieces--James Frey (???)
i can't understand the uproar over the fact vs. fiction nature of this book. as if every memoir/non-fiction book is true in every detail. this is me being doubtful. we all exaggerate at least, and outright lie at worst. it was still an excellent book, and worth reading. and hey, if it made alcohol and drugs look that much less appealing to a few people, then i say it's worth the fudging of the truth. it's not like the guy was trying to sell a manual or reference book.

Memoirs of a Geisha--Arthur Golden (fiction)
re-read this after leaving the movie theater feeling slightly cheated. i read it when it first came out and was totally mesmerized, and was disappointed that the movie was so fluffy, uber-sexy ken watanabe aside. the book was just as wonderful the second time. see the movie for ken, read the book if you want to be swept into a fascinating picture of japanese culture.

Julie and Julia--Julie Powell (non-fiction)
subtited 365 Days, 524 Recipes, 1 Tiny Apartment Kitchen , this is a fun, if poorly-written summary of a bored new york secretary who decided to make every recipe in julia child's Mastering the Art of French Cooking (Volume I). she kept a blog of her progress and amassed quite a following (as well as a book deal, it would appear). the writing is not the greatest, and i got a little bored toward the end. i guess i would have liked a few more descriptions of the cooking, and less of ms. powell's personal life. oh well. it's a fast read. sounds like something i would do if i had the time, and the inclination to eat organ meats. i have to give her props--i totally would have skipped those recipes!

Garlic and Sapphires--Ruth Reichl (non-fiction)
subtitled The Secret Life of a Critic in Disguise, ms. reichl is the current editor of gourmet magazine (i've been a subscriber for 2 years and i think i've made one recipe...but i can't quit my addiction to pretty food pictures). this is about her experience as the food critic for the new york times. pretty entertaining. one of those "what if" jobs i've always thought would be fun.

The Perfectionist: Life and Death in Haute Cusine--Rudolph Chelminski (non-fiction)
if you're sensing a pattern in my literary choices, it was entirely coincidental. of the 3 "foodie" books, this is the most interesting, about a three-star french chef who committed suicide in 2003 after his restaurant was demoted to two stars. but really it's more of a fascinating look into food culture and one person succumbing to an insanely stressful lifestyle. substitute "doctor" for "chef" and it could be about the medical profession. very well written, well-researched. made me want to buy a michelin guide.

so that's it for now. lemme know if you've read anything good lately--spring break is next week.

...glass...half...full... PART I

2006-03-22T10:34:00.000-05:00

i violated my personal morality code last evening and shopped at Walmart. i'm in f***ing lima, which has got to explain why i spent over $40.

shopping for Niece's upcoming fourth birthday, i was suddenly struck by the realization that i will, in all probability, miss her fifth. and sixth, seventh, and eighth. i was overwhelmed with sadness. don't even get me started about missing Niece the Sequel's first steps or Nephew's first everything. i didn't know that extrication from midwest, family, and everything familiar would be so painful. i'm 26, right? people my age are married, with babies, moving all over the place. going to war. starting businesses. in the peace corps. so to keep this in perspective, i've decided to do what i do best: make a list.

pro: according to galveston.com, i am headed for a "small, romantic island tucked deep within the heart of south Texas." let's be more specific: 40 minutes from houston, 4.5 hours from austin and san antonio, and 5.5 hours from dallas. lots of potential weekend trips there ('cause i get every weekend off in residency, right? right??).

con: 19.5 hours from columbus. guess that's the end of 'girls night out.' and as if going to venice with a girlfriend didn't make me feel like enough of a dork, the last thing i need to do is live 24/7 on a "small, romantic island." gag.

pro: 32 miles of beaches

con: i'm more of a hiking-in-the-mountains than a frolicking-on-the-beach type of girl. i see a lot of spf 45 in my future.

pro: galveston is 32 miles long (but only about half of that is really populated, the rest is state parks and cruise ship docking) and 2.5 miles wide. there is exactly one "freeway" onto the island, and the rest is residential-type roads. this means i can finally put my money where my mouth is and bike more often than i drive. i officially have no excuse.

con: i officially have no excuse.

pro: the temperature on Galveston island averages 80-89 degrees Fahrenheit in the summer, and 52-64 degrees in the winter. guess i can throw out my ice scraper with the broken handle now. this also means i can keep my herb garden and pretty pretty plants outside all the time.

con: um, hurricanes. and an average humidity of about three-hundred and fifty percent ALL YEAR ROUND.

this will be a work in progress. feel free to cheer me up by contributing your own ideas.

Lone Star State of Mind

2006-03-19T13:46:00.000-05:00

rejection sucks, no matter how well-dressed you are when it happens.

i've been pretty contemplative the last few days, status post Big Envelope Event. and although i'm normally the "glass is half-full" sorta girl, i can't help but wonder...why? why didn't all the nice, friendly little community programs want me? and i've heard all the caveats...they were all small programs with few positions, the match is really just a question of chance, God put me where He wanted me, it was a tough match this year, blah blah blah. and it is all true. really, i know that. and i appreciate when people say it, and it makes me feel better. for about 5 minutes. and then i remember all the things i liked about the places i DIDN'T match and more than a couple things i didn't like about the place i DID match. i hate that i'm feeling this way. i want to be excited but mostly i'm scared, and to be honest, a little bummed.

the last time i experienced rejection in so public a forum was over a year ago. a good med friend of mine introduced me to the worship leader from her church (i have a weakness for semi-employed musicians), and we kinda hit it off, exchanging flirty emails and even a phone call or two over the next few weeks. plans were made for a get-together, but never finalized. all of the sudden, no calls, no emails. and i was confused. weeks went by, and i didn't see hide nor hair of Musician Dude. i was busy studying for boards, so i didn't make too much of it. until Friend pulled me aside and sheepishly admitted that she had seen Musician Dude with Cute New Girl around town. i have to admit, as little as i had invested in Musician Dude, it was a bummer. still, i wasn't feeling it too harshly. mostly i was confused about why he simply hadn't told me he was seeing someone else...until Friend told me that Musician Dude admitted he "couldn't bear" to call/email and tell me that he was Off The Market because he "felt so awful" for "stringing me along." and that's when i realized that what i had perceived as simply bad timing was in fact out-and-out rejection.

Cute-in-an-Acquired-Taste-sorta-way Smart Girl out, unquestionably Cute New Girl in. ouch.

now Friend felt bad for introducing me to the guy, Musician Dude felt guilty for dropping me like a hot potato when Cute New Girl waltzed in, and i felt like a loser for feeling rejected by some guy i barely knew. it bothered me for quite some time. (i thought i was over it, until months later i found out they were engaged. then i realized i still felt like a loser.)

and i'm feeling the same way right now. rejected by programs with which i had a brief, flirtatious relationship. when you are rejected by someone who knows you well, you know they at least have good reasons for not liking you. get to know me, and i guarantee you'll have a list of things about me that drive you nuts. i hog the remote and change channels obsessively (i HATE commericals). i have really schizophrenic taste in movies, books, and food (ie. i love the cheap, trashy stuff, as well as the stuff that the critics coo over.) i cook using every pot and pan in the kitchen, but hate cleaning up. i leave dental floss everywhere. i will drive around for hours before stopping to ask for directions (i have been know to cross state lines). i never make my bed (what's the point?). and i correct everyone's grammar even after they're pissed and i promise to stop doing it.

know me and reject me, that i can understand. but to reject me based on a few breezy conversations? one brief, best-behavior encounter? you laughed at my jokes. you complimented my outfit. you told me how good we could be together.

so i'm left wondering...was it all a farce?

or did someone better just happen along?

and it's not like i can ask anyone for answers to all my why questions. that's what sucks.

but i'm done being grumpy, and i'm too proud and stubborn to fall apart over a measly little 4-year change of plans. i'm like one of those hardy pioneer women or garden weeds that can pretty much survive, if not flourish, in any environment. i'm determined to do right by my $250,000 education and become the best f***ing glorified midwife i can possibly be, even if i have to do it a zillion miles from anyone who knows or cares about me.

i can do this.

bring it on.

anyone looking to invest in beachfront property?

2006-03-17T11:22:00.000-05:00

University of Texas Medical Branch
Galveston, Texas

I spent so much time agonizing over my first two choices as well as my last two (picturing "worst case scenarios"), that i completely forgot about the middle ones, did not see this coming.

surprised? yes. i didn't think this interview went so well. and i never really anticipated ending up in a big university program.

on the other hand, it's hard not to be excited about starting a new career in a new place, even if it's not what i was hoping for.

only 3 months to hurricane season!!!

A Sorta Fairytale

2006-03-14T08:51:00.000-05:00

someone, somewhere put my name down on a piece of paper saying, "sure, i'll take her. we think she could be a pretty good Glorified Midwife."

wow.

Quantum Sufficit

2006-03-10T11:10:00.000-05:00

7:35 am

wake up. marvel that the sun has risen before i have. hit snooze one more time, just to be smug.

8:57 am

wander into radiology office trying to decide whether to sleep in MRI or CT reading room today. choose CT.

9:12 am

unable to find CT doc, or MRI doc for that matter; amble up to doctor's lounge to read comics and eat muffins.

9:27 am

finish comics. full of muffins. head back down to CT.

9:33 am

locate CT doc. stifle yawns as she speeds through stat chest films dictating in munchkin voice.

9:41 am

CT doc says, "you must be bored." insist that am facinated by chest CTs.

9:50 am

gossip about Medical School Hospital (CT doc's alma mater). collect juicy tidbits for future reference.

9:55 am

take coffee break at insistence of CT doc. read yesterday's comics.

10:12 am

back to CT. bring muffin for CT doc. talk about nieces and nephew (mine) and kid (hers). debate actual vs. perceived prevalence of food allergies.

10:44 am

"you can leave if you want. you've been here awhile," CT doc says.

10:51 am
in my car, heading home.

and if i die before i wake

2006-03-02T16:16:00.000-05:00

i have a really good reason for not posting in awhile. really. i have been lulled into dreamland a la sleeping beauty via hours upon hours in a 4x6 darkened cubicle staring at 2-dimensional human anatomy in greyscale. billions of films. i'm on fluoroscopy, so i even get to periodically leave this small room for actual patient contact, where i cruelly pour multiple consistencies of barium down throats and into various other orifices.

barium paste smeared on a graham cracker looks deceptively like 2/3rds of a s'more. it does not, however, taste like one. i know this intuitively, and not because i actually tried just a teensy tiny piece. promise.

all this rotation is doing for me is convincing me that i really really need a full body CT scan followed by PET to be really really sure i don't have pancreatic cancer.

i am truly amazed at my newly discovered ability to sleep while answering various pimping questions incorrectly at 10-minute intervals. usually i have to be awake for that.

various radiology haiku (s?):

glowing screen of doom
reveal your pathology
four more hours to lunch

first, barium feast
epiglottic snap--hooray!
successful swallow

oh, sweet kerley B
my worthy foe mocketh me
thy twin, fibrosis

'til death do us part. no, really.

2006-02-23T14:04:00.000-05:00

what does it say about the completely pathetic state of my love life (and social life in general) that i'm just a smidge jealous of two of my patients, a dear married couple who live together at the ECF (nursing home) and were admitted to the hospital within days (he first for pneumonia, and she later for syncope). then on the floor (sharing a room), one started having respiratory distress, which apparently distressed the other one, and now both of them are happily puffing away on vents in rooms next to each other?

they are two 80-year old peas in a pod. She got a little bradycardic, and for company, he followed suit. he became a little oliguric and bumped his creatinine, and an hour later, she decided to join him. they even have the same bug growing out of their sputum. (i'm going to pretend i don't know how that happened)

i don't even bother distiguishing them on rounds anymore--they're on the all the same meds, and have vitals trending pretty much in parallel.

now that's love.

on the flip side, it's my last day in the micu. i'm off to lima to spend a month in the dark recesses of a county hospital learning how to read films with a guy who plays in a band named "spleen" on the weekends. they play pink floyd covers.

now that's a party.

great expectations

2006-02-22T13:32:00.000-05:00

i think it would be fun to be a patient in the micu. doctor and nurses get excited about the little things other people take for granted. we're kinda like new parents in that way.

a) colorectal surgeon to the s/p hemicolectomy complicated by extended post-op ileus: did you pass gas today, hmmm? just a little, hmm? you did? GOOD JOB! KEEP IT UP! you are doing great!!!!!!!!!

b) respiratory therapist to the COPD exacerbation on a vent times 13 days: mr. b did AWESOME on his spontaneous breath test. he kept his sats above 92 for 2 1/2 hours with no pressure support. he looks GREAT!

c) neurologist to the nurse who is taking care of our previously comatose DKA: he tried to strangle you while pulling his foley out with his feet? and security had to put him in four-point leather restraints? AWESOME! now we can d/c the c-collar and cancel the MRI!

we are proud of our patients when they

a)fart
b)breathe
3)move their arms and legs

which means that if you are reading this, you'd get a gold star from any critical care doc around. along with a one-way express ticket to step-down.

self-diagnosis

2006-02-21T14:38:00.000-05:00

a little knowledge is a dangerous thing. and i must stress, i have very little knowledge.

rumor is, every student of medicine diagnoses his/herself with at least one major medical problem. i think this might be a graduation requirement. cuts down on health care costs.

my running differential for nagging right subscapular pain:
1. cholelithiasis
2. lung cancer (like my unfortunate patient whose lung cancer presented just like that)
3. pancreatic cancer obstructing the bile duct, which is causing pain but curiously not causing jaundice. could happen.

while my medical mind tells me that given my habitus and habits, #1 is most likely, my emotional self screams, "ahhhhh! i have pancreatic cancer!!!!! i have 6 months to live!!!!!"

and with that motivation, i watch another episode of iron chef america.

one i've already seen twice.

ming tsai=yummy.

but i digress. the major motivation for this thread is that i feel lately i could diagnose myself as rapidly cycling bipolar.

sunday could have been a manic day.

~elevated mood--check. what else could explain why i was cheerfully admitting my fifth patient at 4 am while catching up on nurse gossip and thinking, "i love my job."

~decreased need for sleep--check check. monday i took a 2-hour nap (after working 36 straight hours) in the afternoon, and then 6 hours of sleep before work today. and how many hours did you sleep?

~more talkative than usual--er, this one is difficult. i usually talk a lot. i'm not sure "more" is possible.

~flight of ideas--check. jon keeps giving me weird looks, as if he has no idea how i got from discussing room 21's latest troponin level to showing him a picture of the puppy i want to buy to complaining that the olympics this year are stupid and my toe itches. in one sentence.

~increase in goal directed activity--check. on saturday i decided to assemble a scrapbook for all of my photos accumulated over the past 26 years. now i'm trapped somewhere between cutting all my photos into creative shapes, getting scrapbook glue and double sided tape stuck to everything, and debating whether or not i should cross-reference the pages since, technically, some of those pictures from heather's wedding could go into "weddings." or "medical school." or "friends."

so i think i could probably be DSM-able for at least a hypo-manic episode since my 3 cup-a-day habit has been stable enough not to account for this sudden change in behavior. now, to explain why my scrapbook project is now a towering inferno of colorful crap on my living room floor and not yet a scrapbook, let's move onto the not-nearly-as-fun depressive side of bipolar disorder. this would be starting today.

~decreased energy--check. today i sat in a patient's room for at least 5 minutes before i could work up the energy to copy down his overnight vitals. all of the sudden, the thought of lifting my pen seemed like too much effort. plus he has a swan-ganz and he's on a vent. that's at least a dozen more vitals.

~diminished activity--check check. i skipped lunch rather than walk all the way down to the cafeteria. 2 floors down? nah. stale crackers and diet seven-up from the call room.

~loss of interest in pleasurable activities--check. my crush spent several hours in the conference room with me and i didn't even stare at him. he tried to make conversation and i couldn't work up the enthusiasm to engage in any witty repartee. none. and i called him a jerk. i can't remember why, but it was probably justified.

~feelings of sadness, worthlessness, and despair--check. i looked into a mirror today and thought, "boring." nothing special. that's it. wondering why i shouldn't just go home and not be a doctor. what's the point? we all die anyway. why prolong the inevitable for a few people every day?

i'm trying not to give these feelings too much weight, but when two people ask you "what's wrong, are you okay?" for no good reason, and another asks, "hey, are you post-call?" it's kinda scary. cause all good residents (and med students) know that there's nothing worse than looking post-call, especially when you aren't.

upside of being bipolar, self-diagnosed? i know if i just ride it out, another fun manic episode is waiting around the corner.

ciao.

silver lining

2006-02-16T05:33:00.000-05:00

great things about being on call:

~no commute

~you can start writing all of your notes at 4 am

~sundowning delirium can be lots of fun

~you have an excuse to be slightly "off" the next day: "oh, sorry, i'm post-call!"

~nurses break out all the good snacks after 10 pm

~don't have to worry about pesky grooming habits like bathing, flossing, and changing your underwear

~first dibs on all the procedures. nothing better than line placement at 3 am, baby

iatrogenesis imperfecta

2006-02-15T14:31:00.000-05:00

so, i survived v-day unscathed, partly because of the big plate of chocolate chip cookies the other med student brought to the unit, and partly because i got to work with my crush all day. while it sucks that my crush is not with me, i find solace in the fact that he's not with anyone else, either. i realize that at 26 and very nearly a "doctor," i probably should have grown out of that stage where i am affected by crushes, but after months of resisting, i've given myself over to the giddy girlishness of crushing bad. he's wonderful and i love him, so ppttthhhhhhh!

i realized something today: i'm not scared of my patients anymore. it's epiphanies like this that convince me that i've actually travelled that road toward becoming a physician, instead of being merely a very stupid imposter who knows some of the language (which is the way i feel the vast majority of the time).

i come from a family of non-doctors. i've never been a paramedic; i didn't volunteer in a nursing home. sick people scare me, or at least they used to. why the hell do you think i'm going into ob/gyn?!

my first rotation, general surgery, was at a small community hospital in defiance, ohio. while my classmates bitched because the attendings didn't let them "do anything," i was relieved that mine never once asked me to see a patient by myself. until the day he did. i stood outside the door for at least 5 minutes, willing myself to knock and enter.

medical students feel like such fakes. we have the white coat (the important distinction being that they are hip and not calf-length), the stethoscope, and the abbreviations: a fib, Abx, CBC and CXR... but also the knowledge that we are novices. standing outside a patient's room, i felt that i had "MEDICAL STUDENT" blazed across my forehead, which the patient would immediately notice and send me cowering from the room, demanding to see a real doctor. histories and physicals that should've taken 5 minutes took 30, and if i finished in 5, it was only because i couldn't remember half of what i needed to do or ask. until i presented to the attending, and they would invariably ask "how much does he smoke?" ..."how long has he been seeing blood in the toilet?" ..."didn't her mother and two sisters have breast cancer?" ...hmmm... good question.

if i was scared to talk to patients, i was doubly scared of touching them. if they had a wound dressing or an iv, i stayed at least 10 centimeters from the site. if they were in pain, well, heaven forbid i elicit it (i didn't want to hurt them). i didn't want to embarrass them by asking personal questions, and i didn't want them to think i was annoying or nosy or stupid or clumsy. i "examined" several retinas with a broken ophthalmoscope because i couldn't admit i didn't know how to turn it on. i "listened" to heart sounds in all the wrong places. i was sure that if i lingered long enough to actually hear the murmer, my patient would detect my incompetence and declare it to the world.

a year of clinical medicine forces you to overcome these fears. one missed physical finding brought to light during group rounds will cure you of any temptation to "fake" or skip parts of an exam. same with inconsistencies in medical or social history. you never want to be the one who finds out on rounds that your patient is a homo prostitute who smokes crack when you just presented him as a swell guy who has no clue why he has this nagging cough. now the attending has to get a TB test and he is pissed. or you present ascites as a physical finding, and then the attending asks you to demonstrate to the group the abdominal fluid shift during percussion. and you don't even really know how to percuss. damn.

but even when i stopped being scared of patients in general (this happened sometime during my ED rotation--once you start seeing 40 patients a shift, you learn how to talk to them), and learned how to say "i don't know" and "i forgot to check," i was still wary of very ill patients. i steered clear of the iv. beeping machines scared the hell out of me. i wouldn't dare move a line, tube, so much as a foley because i was terrified that i would dislodge some vital life-sustaining force that was keeping that particular patient on earth. and forget vents. i examined those patients from the doorway.

on a ID rotation early in my fourth year, i had to do a consult for a patient in the MICU. i wandered through the unit, trying not to look lost, seeking the familiar shelves of charts prevalent on every other floor. the nurses looked so proficient and urgently busy that i didn't dare bother any of them with my naive and silly questions. and i sure as hell wasn't going to actually see my patient without spending an hour arming myself with paperwork. so it took me 45 minutes to figure out that all the charts were in the patients' rooms.

it had to be the worst H&P i ever presented. my patient had at least 3 iv bags hanging, which meant i couldn't examine him from the left side (lest i get within a foot of the iv pole and accidently bump it), and he was vented, which eliminated the possibility of touching him, period. and then there was the ever mysterious nursing flow sheet, notated in jargon that my medically inexperienced brain couldn't begin to unravel. i couldn't even find the damn blood pressure. i scurried away to the comfort of a conference room, clutching a chart, and pretty much copied it into my H&P. thanks, guys.

today i calmly transferred 4 iv bags to a new pole so i had room to start TPN on one of my patients. without thinking, i dumped the foley to measure output, and i went so far as to suction a patient's ET tube because he was coughing and his sats were dropping. i touched the machine. another patient was in a fib (again) and i couldn't think with the damn alarm beeping, so i turned it off before going back to writing the note. i rip off dressings to examine incisions, i take out staples and packing, i ask the nurses to help me turn patients so i can hear all 6 posterior lung fields. i run down families to ask about gaps in the medical history, i quiz patients on their sexual practices in astonishing detail. i run to the codes (no longer lingering lest i be the first to arrive and be expected to know how to help or something), i talk to nurses and respiratory therapists and consulting physicians and *gasp,* even my own attendings.

i present and i disagree and i conjecture and i suggest and i look like a fool.

sometimes.

but sometimes i don't. and i'm not scared of my patients anymore. and i'm not scared of being a doctor. and that's pretty cool.

i heart the MICU.

almost as much as i heart my crush.

Priorities

2006-02-11T15:42:00.000-05:00

best feeling in the whole wide world #1:
coming home after 33 hours in the unit, peeling off my legionella- and MRSA-ridden scrubs, and soaking for 20 minutes in the hottest shower i can possibly stand

best feeling in the whole wide world #2:
having a delicious (ie. anything that can't be purchased in a hospital cafeteria or vending machine) home-cooked meal waiting for me after stepping out of said shower

next best feeling in the whole wide world about two miles below either #1 or #2:
the best sex you've ever had

the older i get, the more i realize that what i desire in a husband is companionship. someone i can cook dinner with and sit down to share a real conversation with during the meal. i want to be able to work really really hard at my job knowing that i have someone to come home to with whom i can enjoy my precious few hours of free time before going back to work really really hard the next day. if this person were great looking and/or rich, cool, but those are not characteristics that even register anymore. great sex is nice, but hot showers and good conversation--that's worth waiting for.

to be or not to be

2006-02-09T20:57:00.000-05:00

NRMP rank list time...

actually, i've submitted and certified and changed my list at least a dozen times. i keep switching my #1 and #2 ranks. i'm torn between the life i have and the life i envision. is a bird in the hand really worth two in the bush? what if the bird in your hand is a finch and the two in the bush are macaws or flamingos, or other such interesting and exotic birds? are you really willing to settle for your finch and give up the chance of catching one of the really cool birds?

the truth is, there are choices we all have to make in life that will profoundly influence our future. where i choose to work and live in the next 4 years may ultimately dictate whom i marry, what kind of medicine i practice, and where i live the rest of my life. it may forever change my relationships, both current and future. if you're happy with what you have, does it make any sense to trade it away for the hope of a different kind of happiness? and honestly, i AM happy in columbus. i'm surrounded by my family, who are frankly, pretty cool people. i have nieces and a nephew who i get to see grow up. i have my favorite restaurants and a familiar freeway system. i know the charting system at the hospital, most of the nurses, and all the important door codes and phone numbers, and where to find clean scrubs in my size. i even know where to find the twizzler stash and which coffee stand has the freshest half-and-half. if i need a consult, i can call up one of my surgery resident friends and discuss the case and not sound like an ass in front of the attending. i know which x-ray tech has a crush on me, and will therefore be at my patient's room in less than 10 minutes for a stat scan. and let's not forget buckeyes football. the entire time i was in texas, every time i mentioned "osu" people thought i was referring to oklahoma. that was really annoying.

do i really want to trade all that for getting stuck in rush-hour traffic in an unfamiliar city, lonely weekends trying to find someone to see a movie with, paying outrageous prices to park until i find all the hidden free spots? having the inevitable run-ins with nurses and attendings un-accustomed to my sarcasm or immune to my flattery? new computer systems and fans of the wrong football team?

argh.

fact is, i've spent most of my life wanting to be somewhere else. and now that i have the chance, i realize i just might want to be where i am.

#1 and #2 choices (and i'm not saying which is which) are both awesome programs. they are both small, close-knit, have top-notch creog scores and surgery numbers, and super people whom i would quickly grow to love. one is home, here in columbus. the other in the great unknown: houston, texas. how cool would it be to live in texas? how exciting and fun would it be to discover a new city and meet all new people? to step out of a comfort zone and force myself try different everything. who knows who i would meet or how i could change? in some ways, i'm afraid that i'll always regret not being brave enough to try something new. not taking the chance on the unknown and making a unique course for myself instead of simply settling for what was in front of me. in texas i would be an adult on my own. i never pictured myself as someone who would live in ohio all my life. i've never even contemplated that possibility.

i really don't know what i want.

i've decided it doesn't matter.

i will be where i am supposed to be, and i don't think my ranking will matter much. i have come to a peace where i can see the exciting possibilities in either outcome. if i stay in ohio, i'll get to live with my sister/best friend and get a big dog. my dad will be close enough to come over to unclog the sink, i won't miss any of my nieces' dance recitals, and i'll be able to spend my vacations traveling to exotic places. if i move to texas i'll get to be the mysterious "new girl." i'll get to learn how to be a doctor, with all the frustrations and mistakes inherent in that endeavor, in the privacy of my own state, and i'll avoid the already painful transition from daughter/sister/student to professional (and avoid those conversations where my mom yells at me to pick up my clothes off the floor, and then asks when she should get a colonoscopy.) i'll get a cute little studio apartment and save money by spending all my vacations visiting my family. i'll have the new stories to tell, i'll be the one that "escaped", i'll have the fun of being the one that was brave enough to try someplace new on my own. either way, i truly believe that my life is already planned by Someone wiser than i. it's going to be fun; i can't wait to find out where it starts:)

p.s. wouldn't it be a great joke on me if i got my #5 or #6 choices? i haven't even dissected the pros and cons about moving to new mexico or austin yet!

Commission

2006-02-09T16:38:00.000-05:00

Isaiah 6:1-8

In the year that King Uzziah died, I saw the Lord seated on a throne, high and exalted, and the train of His robe filled the temple.

Above Him were seraphs, each with six wings: with two wings they covered their faces, with two they covered their feet, and with two they were flying.

And they were calling to one another: "Holy, holy holy is the LORD Almighty; the whole earth is full of His glory."

At the sound of their voices the doorposts and thresholds shook and the temple was filled with smoke.

"Woe is me!" I cried. "I am ruined! For I am a man of unclean lips, and I live among a people of unclean lips, and my eyes have seen the King, the LORD Almighty."

Then one of the seraphs flew to me with a live coal in his hand, which he had taken with tongs from the altar.

With it he touched my mouth and said, "See, this has touched your lips; your guilt is taken away and your sin atoned for."

Then I heard the voice of the Lord saying, "Whom shall I send? And who will go for us?"

And I said, "Here am I. Send me!"

note to self

2006-02-08T20:02:00.000-05:00

it's hard to remember that the "outside world" is listening with a different set of ears. i've been accussed by my family of being un-compassionate, rude, mean, uncaring, cold, etc. etc. etc. when unloading a story or two after a long or particularly frustrating day. and i get so defensive. my sister's baby daddy had the nerve to tell me that he doesn't believe that my patients or their families don't tell me to f*** off. when i tried to explain that i don't actually talk TO my patients the same way i talk ABOUT them, he demanded that i "show him" by acting out a scenario "like i would with a REAL patient." screw you.

all day long i stand around with attendings, nurses, and residents discussing the intricacies of patient managment. imagine the weirdest most ornery member of your family. then make them really sick, tie them to a hospital bed, and surround them by 10 of their closest friends/family members that have equally, er, interesting characteristics. it's inevitable that at the end of 14 hours in close proximity with dozens of ill people (each with their own entourage) a person might skip some of the more common euphemisms and just tell it like it is.

"mr. b likes to be called DOCTOR because he's a f***ing podiatrist. his heart's shit because he smoked like a chimney, never takes his blood pressure meds, and frequents mcdonalds more than ronald himself. he also status post ex lap for dead bowel and will try to die tonight. max out the levophed and keep mrs. b away because she's a pain in the ass and will ask you a billion completely irrelevant questions and try to interpret the ct scans. DON'T FORGET TO CALL HIM 'DOCTOR'. oh, he's a FULL CODE.

"mrs. o is about a million years old, she's trying to die but her family won't let her. she must've been a horrible mom or something, because they want to scope her from head to toe for a gi bleed even though the surgeon laughed when i asked for a consult. she also has myasthenia gravis and bradys down for some unknown goddam reason if you give her more than 5 of lopressor for her tachycardia. got pegged and trached today; she'll probably try to arrest at least once tonight. family insists it's a full code."

"mr. v has f***ing raging metastatic melanoma. they emergently intubated him in the ED for respiratory distress and fractured C1-C3 because of bony mets. now he's got a c-collar on, is quadriplegic, and he bradys down and codes if you turn his head to the left. f***ing cancer all over the left carotid. he's full code, for some goddam reason. DON'T TURN HIS HEAD TO THE LEFT."

this is a typical icu sign out at the end of the day. it's 6pm. we've all been in the unit for 12 hours taking care of 32 patients with an average age of 89 who have an average of 3 major organ system failures apiece. we are not going to sit around and bullshit during check out. we just want to know what we're going to get paged for during the next 12 hours on call. at 3 in the morning, mr. v is the head you can't turn to the left, and mrs. o is the myasthenia gravis lady. they are medical problems and loss of sleep. we all understand this, and can speak the language with ease. nobody looks at another resident and calls him "uncaring" because he thinks mr. v's full code is bullshit.

it's hard to explain to my family. i think, deep-down, they know i'm a nice, caring, person, but if i try to tell them a little about how my day went, they look at me like i'm jeffrey dahmer or something. i have to pick it up, dust it off, and wrap a pink bow around any anecdote before it's presentable to the outside world.

but that's not all. see, i really do care. all doctors do. that's why we're doctors. right in the middle of sign-out today, "mrs. a, kinda sad, she's only 58 and she went to her PCP a month ago for a cough, he sent her home with zithromax, and she comes in through the ED 4 days ago with raging bilateral pneumonia. now she's in f**ing ARDS, her f****ing kidneys are shot to shit, LFTs through the f***ing roof, basically every system is shutting down. she's maxed out on 3 pressors, now getting atropine like nobody's business. family isn't ready to let go, wants full code. guarantee she's going down tonight, and sooner rather than later."

and two patients into check-out later, the familiar code bell told us she had. the first ring hadn't finished sounding when a dozen of us ran full speed through the unit to the opposite end where our patient was coding. we ran the code. 10 minutes. 20 minutes. asystole. epinephrine. chest compressions. 30 minutes. dozens of people focused on one thing: get her back. she was our patient, and she died. and at least three grown men, and as many women, had tears in their eyes as they filed out of the room, past the family already grieving for the loss of their loved one. she should've died on sunday. a team of dedicated, tenacious doctors gave her three more days. but there was only so much we could do.

we got back to the conference room, picked up our papers, and continued with check=out. we're doctors, that's what we do. we reduce our patients to diseases and treatments because we HAVE to. we can't go through our day thinking about each patient as if they're our favorite uncle. every once in awhile one slips in, a special patient who you check on more often or pull up a chair for a bedside chat. but mostly we save our caring for late at night, before we fall asleep. that's when i think about the people i meet each day, most of whom i will never see again, but some for whom i will be the last person they ever see. and i care.

and the wind whispers mary...

2006-02-07T19:07:00.000-05:00

my sad blue-eyed copd-er died last night while i was on call. his whole family was there, and for the first time in weeks, they all agreed to follow his wishes to go quickly and without extreme measures. it was kinda beautiful in a way. i love ob/gyn because i get to witness new souls entering the world, but for the first time, i saw the beauty in leaving the world as well.

Pi

2006-02-06T18:16:00.000-05:00

i am a very lucky person. i have worked long and hard to obtain the education i need to do the work that i love. still, i love it in a very different way now than i thought i would, daydreaming in childhood of being a doctor and "changing the world." usually i'm too tired to change my scrubs, let alone the world :)

it's satisfying work. the kind that uses more than you have, that forces you to garner all your resources, yours and your peers', that asks you to remember what you'd rather forget, that never lets you give an easy answer because every situation is two standard deviations from the one depicted in harrison's. at the end of a day, i'm tired in body and soul. that's the other part i didn't expect: i didn't expect to care so much about my patients.

my 93 yo LOL, who has medical problems too long to list here, but the first thing she asks me when she wakes up from her ativan coma is, "did alito get confirmed? that bastard! get cnn up on that tv, girlie." my copd-er who, every day working harder and harder to oxygenate his wispy lungs, looks up at me with his sad blue eyes. he hates his bipap--he says he's kinda claustrophobic. but yesterday he wore it all afternoon so he could have it off for the superbowl. it'll be the last one he sees--i couldn't have cared less about the outcome, except he is a steelers fan, and for one rotation in the micu, so am i.

Pass the Imitrex, Please...

2006-02-03T20:31:00.000-05:00

why is that the people you love most--your family--always know the exact WRONG thing to say? mothers are especially good at this, at least mine is. most of the time i can ignore the ever so slightly pointed comments, but today, after a good 14 hours in the unit, coming home starved and kinda pms-y, i was in no mood to just let it pass. and this after a drive home, sitting in sucky friday evening traffic on the 'loop, where i was listening to burlap's 'anybody out there' on the stereo and feeling sad and nostalgic for home (even though i AM home). i would diagnose myself as bipolar if i believed in psychiatry (~note glib sarcasm here~)

extubation

2006-02-03T14:44:00.000-05:00

during rounds, one of the nurses today looked at me blankly and said, "i can't draw labs; he doesn't have a line in." ummm....first of all, you're a critical care nurse and you can't do a venipuncture for a CBC??? and second of all...why didn't you tell me this FOUR HOURS AGO WHEN I ORDERED IT??? all of the other nurses on the unit are wonderful and brilliant and have saved my butt multiple times. this one redefines "laziness."

Northern Overexposure

2006-01-31T19:41:00.000-05:00

though i've never managed to keep a journal for more than a few months, I love reading other people's blogs. i check them regularly, keeping a running commentary in my head, complete with clever and insightful comments from yours truly. somehow the vast emptiness of my very own space is a little intimidating.

still, match day is mere weeks away, and the very real possibility of moving thousands of miles away from any living soul who knows me as more than my social security number, class ranking, and USMLE scores makes me wonder if i will soon be grateful for another form of communication.

real life (you know, the one i've been waiting for these past 26 years) is soon upon me, and i have a feeling it'll be harder than ever to stay connected with those who know me outside of my white coat.