Saturday, February 14, 2004
05:25 p.m.

meh.
computer not ready yet. should've just paid the exorbitant on-site fee and had it done on thursday.

today, the real estate lady came to look at my apartment. i should be able to sell it for a bit more than the price i paid, which is a good but unsurprising thing. i did get brand-new appliances for the place and it's nicely painted, unlike the grey-on-grey scheme it had when i moved in.
her total commission is 6%, which is apparently high (according to dad, who got all fired up and started looking up commissions in the newspaper). i'll let my parents ask around, since mom is friends with a real estate agent. i guess i am moving, after all.
but match day isn't until late march. damn, the chance of not getting my first choice is pretty minuscule, but it exists nonetheless. i can't list until i know for certain.

mom was kind of surprised that i'll move even if esca goes to another school. but really, i am kind of "waiting". this place isn't permanent, i'm not putting roots down in any community, it's just a matter of being a few hours closer to family and the hassle of moving (which in any case would only be pushed back 2 years).
esca's town is more like the place where i went to undergrad. smaller, with a university core community. and on a lake where recreational activities happen, as opposed to...steel plants.

bah, years later i'll look at all my ramblings and belly-aching about residency decisions and realize i really had no real problems to whine about.
actually, i realize that now.

Thursday, February 12, 2004
05:38 p.m.

involuntary assisted suicide?

approximately 15 min after my last update, fatal disaster struck my computer.
disaster in the form of - me.

i shall relate this tale of utter ineptitude for the general amusement of anyone who might come across this.
beset by the twin impediments of sleep deprivation and mp3 greed, i threw my usual caution to the wind and accepted registration at some evil website offering a bank of songs. it was streamcast something or other, but that is beside the point. the fault was mine.
naturally, a billion pop-ups and shortcuts erupted onto my screen.
equally naturally, i woved to purge my machine of this evil i started. sadly, it was by then very late, and i am very computer incompetent where anything than basic user-friendly functions are concerned.
i initially attempted to hunt down and uninstall whatever it was i let in, but was not fully successful.
so i executed a search for all files created or modified in the last day and...erased them all.
it was late and i wasn't thinking!
and what kind of suicidal computer would let me delete its vital components anyways?

in any case, the kind tech people tell me they can probably recover most of my data and make my computer live again.

i'm seeing a real estate agent on saturday, to price my apartment. even though esca got an interview at her first choice after all (whining will get you anywhere, dear!), i think i will be moving. we won't be far apart if we both get into our top picks, and i want a bit of a change too.

Tuesday, February 10, 2004
11:32 p.m.

the chocolate fountain of residency decisions doesn't flow smoothly

i believe i've come to a decision about my placement. it depends a bit on what happens with esca, but i think i've made the right choice based mostly on what's best for my future.
i feel slight guilt over my self-perceived disloyalty to my own school. their presentation was better, and they were so nice and enthusiastic, and the program rocks of course. and i wouldn't need to move. or move around like crazy for 2 years.
on the other hand, esca's school's program is also excellent. and most of the rotation sites are outside the teaching hospitals of back-up call and scut hell, but within chibi driving distance. and they too were nice and enthusiastic and "what can we tell you to make you want to come here"-like. and they gave us chocolate fondue!
and...maybe...i shouldn't be given so much time before i rank. clearly i cannot remain steadfast in my decision.
well, both programs are really good and i'm deciding mainly on split-hair differences and some personal considerations. eh.

two more interviews to go, one at a former 1st choice. unlikely to change my mind, but who knows. clearly my mind likes being changed.

Saturday, February 7, 2004
12:03 a.m.

because the corpse isn't getting any deader

the above is why pathologists have it better than any other kind of doctor.
want to take out their adoring residents and students to a 1-hour restaurant lunch? no problem, and no worries about interruption. it's not like their "patient" will up and walk away.

tomorrow - my first interview!
esca assures me it wasn't bad.

Thursday, February 5, 2004
05:46 p.m.

face/off

today i witnessed my first autopsy. hospital, not forensic, because nobody died in mysterious enough circumstances while i was there, i suppose.
still, it was something to see. the sheer speed was amazing, after the painstaking 8-hour long resections of teensy liver wedges.
the fact that corpses tend not to bleed makes it less messy, of course.

the tech did the classic Y-incision, cracked through the ribs with the medical equivalent of wire cutters, took out the intestines, then incised above the hyoid and along the spine and lifting the sum total of the thoracic and abdominal organs onto a table announced:
"this is why we call them canoes."
yes, the deceased was splayed and empty.

the most shocking part was when he cut into the tissue just below the occiput and basically pulled the scalp over the face, so it covered the face with the hair to the features.
once the skull was sawed open i could see where the optic nerves exited through the eye sockets.

apart from the one autopsy, today was mostly sitting around reading forensics texts and looking through files. perhaps it's like being inside CSI, minus the TMI-cam and exciting road trips.
still it's exciting in a way to see the body in the photos and know it's not make-up but real lividity i'm looking at.
and yet even that initial sense of gravity and decorum evaporates quickly enough, and as i leaf through the pictures i'm already trying to correlate what little i've read about postmortem changes with the case photos.
i'm excited when i find a correlation; i stop thinking of the deceased as a victim. all in the span of a few minutes.

tomorrow is court. the case folder has enough info to infer a vague relationship among the parties, and allows me to speculate about possible motive.
likely, we'll only be there for the pathology part. i'm sorry to miss the rest.

esca and fiance will come tonight, for her interview. i should clean this place a bit.

Wednesday, February 4, 2004
06:27 p.m.

"not surprisingly, knock-out mice were created."

of course.
every time a new gene function is discovered, research scientists gleefully knock the gene out of poor random mice to see what'll happen.
research scientists are the kind of people who as children probably cut worms in half to see what happens to them. in fact, i have fond memories of cutting worms in half and...hold on, did i miss my calling in life?

spend today at the pathology residents' research day. i didn't eat breakfast because there's usually something provided at these functions, sponsored as they are by the glorious pharmaceutical companies we all know and love. arriving at the hall, i made for the coffee urn, only to discover...it's empty.
a random pathologist standing next to me sadly shakes his head and announces gravely: "the cardiologists got it all."

facing 12 presentations in various pathology topics ranging from "some novel immunologic marker i've never heard of in a renal disease i've also never heard of" to "unusual cells in unusual presentations of a not-at-all unusual type of cancer: we don't know what they are but they sure look purdy" without the benefit of coffee is not something to be attempted by those wishing to retain their sanity.
damn you, cardiologists!
ah, but i exaggerate. it was a nice day and the presentations were for the most part understandable, and then the pharmaceutical company took us to lunch. lunch with cheesecake and drinks.

now to unsubtly switch topics, yesterday i was hanging around the mall, waiting for my cuba pictures to be developed (they turned out quite well, and i incidentally discovered my mom's allergy to the zoom function).
since browsing greeting cards is a good time-killer, i drifted over to the towering red-and-white valentine's day display.
valentine's day cards for lovers, husbands, wifes, parents, children, grandparents, aunts, uncles, sisters, brothers.
WHAT. THE. FUCK.
i realize that card companies are all about the money and would probably make valentine's day cards for pets and new kitchen appliances if they'd sell, but can't they just make another random holiday? "family and barely-acquaintance day", perhaps?
let the lovers have theirs, for crying out loud.

Tuesday, February 3, 2004
12:15 p.m.

hell froze over!

...eh, no, wait. it's just home.

6 measly days in cuba is a horribly cruel fate when you have to return to a snow-laden landscape.
i realized why it wasn't so hard to return the other times i went. both were around may, and we returned to a summery time of vacation. now i return to however many centimetres of snow, a new elective, and the continuing horror that is ethics, while on the misery horizon loom the residency interviews and the exam.

the place we went to was the same area i was at before, with shelly. i even visited our old resort, renamed (no wonder i never could find it again in the brochures) and spruced up; i tried to find our old room but there was too much change and it was too long ago.

the place has it in for me where gastro disorders are concerned. i spend a whole day in bed with fever and cramps, eating tylenol and activated charcoal.
cutting my vacation days to 5, in essence.
5 very good ones, though. highlights included the coral reef (2nd-largest in the world, i'm informed) and the iguana/flamingo excursion. but of course just being on the beach and in the ocean was enough.

if i can make myself go outside once more today (damn, it snowed again!) i'll develop the pics. shelly, she of the long-suffering chibi-caretaking, will want to see them. and i'll also force them on esca when she visits for the interview.

Saturday, January 24, 2004
11:49 p.m.

CRAP!
but...the crap will work out. yes it will!

leaving for vacation mon, but leaving home tomorrow. going through lists of things i might've forgotten.
still need haircut.
and bikini top.
all chibi-related nonsense accomplished today. chibis washed (chibis now hate me). relevant info and bribes snackies left for shelly, the much put-upon.

for reasons known to no one, least of all myself, i bought 9 pomegranates today. they were all for $3 because of their over-ripeness. i was temporarily brain-dead from lugging enormous bags of chibi litter, apparently.
eating 9 pomegranates in one day is hard ;__;

and as anticipated, i am not free from ethics. i will never be free from that guy. i accept this with a curious lack of willpower to resist; i think phd's have that sort of power over people.
i will be writing that paper until kingdom come, which will hopefully be right after i come back from vacation.
unable to find a decent forensic path text in the library, and unwilling to buy a new one for just one month, i am taking my exam prep notes along as reading material instead. i will study, dammit! what else is there to do on tropical islands but study?

Tuesday, January 20, 2004
02:27 p.m.

finally!

yes, my first choice has finally granted me the sought-after interview.
and i was right in suspecting they were reading the applications, instead of sending mass invitations to everyone. my email actually was addressed to me personally; the others all said "applicant".

in other news, the last official obstacle to my tropical vacation has been removed...several days after i'd bought the tickets, but whatever.
i've been briefed and made vaguely paranoid, but that's ok. the rum will kill that.

in sadder, much sadder news, my ethics preceptor has revealed himself to be the incarnation of evil on earth. i am not just writing a paper for a two-week elective, i am writing...well, i'm not sure what it is that i'm writing exactly, but in involves many phone calls to the government, and to fertility clinics in the area, and endless lit searches, and paradigm ponderings, and "scopes of the problem", and other things only phd's think about.
i think that is the problem. phd's like him spend days locked up in their office meditating on the ethics of informed consent. no wonder the poor guy's insane.
so, ethics elective ends on friday. earlier this week, he asks me if we should bother meeting on friday, or if we should wait until i come back from vacation.
until i come back from vacation.

yes, this elective will not end. not ever. it is clear to me that i have to leave this school to escape this horror.
only 4 months to go...

Thursday, January 15, 2004
03:31 p.m.

"you're standing in the way of her dying!"

ah, ethics elective. ethics elective, you were supposed to be easy, and fun, and essentially full of reading about interesting cases. and thinking about them.
how, oh how did you turn into a paper-writing assignment, ethics elective?

today, i attended an ethics seminar about withdrawing dialysis. yes, nephrology residents abounded, and were full of quotable pearls of medical wisdom.

resident1: "in *othercity*, we'd refuse treatment for hopeless cases."
resident2: "that's because *othercity* is socialistic, and here we're capitalistic. we'll hook a corpse up to dialysis so we can bill for it."

resident, during the discussion about a case: "oh, i remember that patient! i finished her off!"

resident1: "...and apart from his multiple organ problems he was also deteriorating because of his nutritional status..."
resident2: "were you guys feeding him?"
resident1: "...i don't remember."

interview update: esca's school still hasn't contacted me about an interview. the others are already organizing social events for us! dear, could you go kick them into higher gear?

Monday, January 12, 2004
10:40 p.m.

respecting my elders

i went for a gyne appointment today, to the same doc i had for about 7 yrs now. he's been in practice forever, and i was always satisfied with him - he was mercifully quick, professional, and didn't argue that i didn't need my precious bcp (like my mother thinks he should).
well, after the kickback-taking, screaming bitch from hell i'd've been happy with anyone, but he still struck me as good and all that.

well, today not so much. he's not affiliated with any teaching hospital, and he doesn't take residents as far as i know. in short, he's been in practice for years and he follows the guidelines from those times.
guidelines which, i'm now in the position to know, aren't necessarily used today. it's not like he wanted to do anything horrible to me, but i happen to know that he can give me my prescription without an exam at this point in time, at the suggestion of which he got a little huffy.
i don't go to the gyne for kicks. i avoid it as long as i possibly can by asking docs i work with to give me their expired pills, but every now and then i do need a new script, and damned if i'm going to undergo any exam beyond what's strictly necessary.

another annoyance is that he hasn't heard of the pills i was considering switching to. i forgot the name but knew the class, which he apparently hasn't heard of.
his response?
"well, they're all pretty much the same."
the only thing missing was the "dear" at the end of that sentence. i asked for a completely different class of drug than the one i was on! how are they the same?

grrr. i left without an exam, with a new script, and with the conviction that before the allotted time is out i'll be getting me a university-affiliated doc.

however, this experience has made me unhappy because i, in all likelihood, will not have a university affiliation either. my school is all over the life-long learning concept, but in solo practice that's hard to keep up unless you have residents around to push you into it. many docs still practice the same way they've been taught despite any new guidelines passed down from the dizzying heights of academia.
as well, i greatly respect those docs working on their own in some god-forsaken community, practicing the kind of medicine not seen in the academic referral-happy environment.

so, i've had one less-that-thrilling experience with my doc, whom i feel more qualified to judge than i was before med school. i'm slightly discontented, which will pass in...probably mere hours. i will still find a new doc, but that is par - i'll be moving. i'll need one anyways.
what i will try hard to take away from today is the importance of staying current. this is the life-long learning lesson taught by experience, and i hope it may make me a better doctor when i myself am removed from the academic realm.

interview update: got all but my first choice. come on, people, get on it already! the tension is killing me!

Saturday, January 10, 2004
12:12 p.m.

oh no. no.
i was generalizing about other med students, not you or i who are clearly evil.
and i never mentioned attendings, dear. attendings are clearly not disposed to compassion. except pediatricians, who are sweet and endlessly patient and ooze kindness and care and have animal sleeves on their stethoscopes.
i imagine they go home and choke their little stethoscope animals to relieve stress. that's why they change them so often.

your attendings sound like fun. i'm jealous.
but i slept for 12 hrs today and have absolutely nothing to do all weekend. are you jealous?

Friday, January 9, 2004
02:54 p.m.

the inevitably annoying guilt of necessary ill-wishing

today i wished retinal detachment on a patient.
sadly, my wish was disregarded by the powers of wish fulfillment, and the lucky guy got off with vitreous detachment, a much more desirable form of detachment (that is, if something has to detach at all).

but this means that i end my optho elective without having seen a single retinal detachment, and if this week has taught me anything it's that things are never what they appear in the freaking atlases.
and i do feel vaguely guilty about wishing ocular emergencies on innocent strangers. then i start feeling annoyed at the guilt.

it's a dilemma for medical students. we're (WARNING: gross generalization ahead) disposed to compassion and wanting to help others, and so should logically feel happy when something turns out to be a false alarm or less than a worst-case scenario.
and yet, in order to learn, we must see a reasonable amount of cases. hands-on learning can never be replaced by reading books and looking at pictures. i'm much more likely to remember and be able to diagnose something i've seen before, and so i occasionally find myself wishing that poor patient whoever's problem will in fact end up being retinal detachment/melanoma/meningitis rather than something more benign.

this is not to say, of course, that i'm tormented with guilt about this. in fact, i'm annoyed that i feel guilty at all.
hopefully this will be resolved once i'm in practice and have my own patients, on whom i will wish nothing but good health.
i'm sure they'll get their share of ill-wishing from my med students, should i have any.

on a completely unrelated note, i tried to donate blood today only to find i have low hemoglobin. actually low-normal, which isn't worrisome for me but too low for them to suck out my blood.
dammit. i never had this happen before, and i always give blood when i randomly come upon a donor clinic...and have nothing better to do...and the wait isn't too long. what gives?

Tuesday, January 6, 2004
05:47 p.m.

my first interview hmmm!

i got my first offer for an interview! at my former first-choice destination no less! wheeeee hmmm.

and today i got a copy of the reference letter written by the valkyrie. ooohhh. so good ^__^
my hair nearly stood on end when i saw "he" in one early sentence, but that appears to be an isolated typo. everywhere else i'm referred to by the correct pronoun. but even if i wasn't (happened to a classmate, though not on something as vital as a ref letter), that letter is good enough pronouns or no pronouns. it's good and praiseful and, above all, personal. it's obvious from it that i've worked with this person and made an impact. i'm so happy hmmm.
i was mildly worried because i didn't ask to see the letters before they were sent. not worried that they'd be bad, but just that they'd be form-type, impersonal letters. although i don't think even those would keep me from an interview, given my supremely non-competitive program.
but it's nice to know she cared. now i don't begrudge those ridiculously expensive thank-you cards hmmm.

and my optho keeps saying "hmmm" at the end of some of his sentences. it's funny.
it's not an inquisitive "hmmm", nor a thoughtful one. it's not long or short, like expelling air.
it's completely without emotional overtone. it's almost a reflex, like clearing the throat. a verbal tic, maybe.
hmmm.

make that two interview offers. oh yeah hmmm!

Monday, January 5, 2004
05:42 p.m.

eyes wide shut

eh, back to the grind. met my kindly opthalmologist today, he who took me on last-minute after the other, wretched one cancelled. met him late, because of traffic due to snow.
yes, it actually snowed.
in winter.
i know, i'm speechless too.

optho: "this pt has ARMD. what do you see on exam??"
me: (ARMD, what should i see in ARMD...aha! retinal atrophy!) "umm, the retina appears pale."
optho: "that's right."

optho: "do you see any signs of retinopathy here?"
me: (can i see any what?!? i'm trying to find the disc! this pt is discless!) "well, the colour of the retina isn't as uniform as it should be."
optho: "that right. see if you can find insert ridiculously tiny sign of disease which is not found on the eyelid where i'm currently shining the opthalmoscope."

optho: "if it doesn't improve in 3-4 weeks, i'll refer you to dr. so-and-so. he specializes in tearducts."
FULL STOP.
excuse me, we have specialists for what now? bloody tear ducts? what does a tearduct want a specialist for? who would want to specialize in tearducts? is there some great tearduct-related excitement i've somehow managed to miss?
tear ducts, the lord preserve us all. can i specialize in the aqueduct of sylvius? the anterior humeral circumflex artery? doesn't "specialist in the arteria circumflexa humeri anterior" sound better than "tearduct specialist"? besides, isn't oprah the tearduct specialist?
how many problems can a tearduct develop anyways? let's see, it can get - inflamed or infected. or plugged...likely due to - inflammation or infection! yay!

i'm in a not-too-great mood, as should be obvious. bemused mood certainly, but not a particularly good one. this is the final stretch before the exam, and i feel i know nothing about...well, opthalmology, but that's because i'm doing it right now. i'm sure i'd feel the same about any other specialty i was working on.
i feel increasingly and anxiously bitter about all the tiny useless things i will have to memorize, only to forget them after the exam. and that's what'll happen after all, because how likely am i to call upon my knowledge of specific subtypes of femoral neck fractures in the future? the function of the fastigial vestibular pathway? the 34 different types of tearduct blockage?

in short, i feel my knowledge base is inadequate, and i definitely need more vacation time. my clerkship-induced bitterness has clearly not departed yet.

Wednesday, December 31, 2003
01:55 p.m.
happy new year to everyone!

indeed, some are having a very happy new year. the lovebirds finally got engaged, and another friend is eloping this fri morning. must be something in the water...

there. i have nothing more to say. the elopement came as something of a surprise about 30 min ago, and i'm desperately searching for something to wear as maid of honour. what do i wear to an elopement?

Saturday, December 20, 2003
01:10 p.m.

over, over, O-VAH!

clerkship is semi-officially over!
officially, the 2 months after the break are part of it, but they're electives. you can't fail electives.

yesterday was full of celebrations at a classmate's party, and it was so great seeing everyone there. in clerkship, we almost never run across one another unless we're in the same rotation, so there were people i hadn't seen for months.

"she's a controlling bitch from hell, that one."
we all bitched about our rotations, but the quote above references the obs-gyn coordinator specifically. it would appear every single rotation had the same problem with her, and we spent much alcohol-fuelled bonding time trying one-up each other regarding the pain she caused us.
for my rotation, she gave us a speech about professional misconduct, and wrote a letter to all preceptors about how deeply ashamed she was of us all after we committed the cardinal sin of leaving the room when a lecturer failed to show up more than 20 min into his scheduled lecture.
apparently, he showed up later, having been given the wrong room.
apparently, he was furious enough to complain to her about it.
now we know why.
in a prior rotation, this most unfortunate man was the victim of asinine scheduling. his lecture was 2 hrs after the preceding lecture, and...nobody was in the mood to wait. so he arrived to an empty room.
it must have been an awful feeling of deja vu to experience it with our rotation, and i feel for him. not his fault, after all. but not ours either.
perhaps that speech is better reserved for those in charge of scheduling. 20 min late because of their failure to communicate, and he was given the wrong lecture topic.
hmm, it seems that i'm still bitter. am i bitter?

"do you want some tylenol?"
also in attendance were drug reps! friendly, off-duty drug reps with their trunks full of friendly, OTC analgesics. i love drug reps.
there were also sx residents, friends of the poor downtrodden classmate-dating jr resident from my gen sx rotation - now thankfully looking much less downtrodden, having finished serving his time with the understaffed team of scut hell.

"she could get us what? but...she seems so innocent."
fascinating to discover the cute little stories people tell when drunk. who got into a fight and beat up who, who in our class can score pot the fastest - i feel so much closer to my class now ^__^

by the time i left around 0400, the remaining partyers were either sleeping on various horizontal surfaces, or talking about hitting some dance clubs.
i was, of course, going to work on carms this weekend, but i think it'll keep until tomorrow. i'm still sleepy, and eh - i don't feel like it now.

also, esca steals cars. she limits herself to her bfie's car for now, but who is to say how far she'll go?
i need a car, dear!

Tuesday, December 16, 2003
10:06 p.m.

they're in! hallelujah, they're all in!

oh glorious day that saw all my carms letters arrive, praised be! only one teeny tiny day late for that last letter, surely all shall be well now.
i have great respect for the kindly people at carms. how late are they working these days? that letter was scanned mere hours ago.

now i shall commence the thank-you cards. companies making expensive thank-you cards should worship at my feet, for i keep them alive.
also, what is wrong with card-making companies? why is it so bloody hard to get a decent, fairly neutral thank-you card that doesn't profess love for the thankee, or make some witty remark, or is "to/from all of us", or specify the thankee's unbelievably narrow field of work, or...or...
yeah, you get my point. blank cards, you are my salvation.

Sunday, December 14, 2003
10:47 p.m.
well, they caught saddam.
i have a curious lack of reaction to this. i am happy, just not overtly so. i am hopeful that it will make the situation easier, just not very optimistic about it.
mostly, i don't know how to react to the videos of him being medically screened. it just seems so...personal to me. i see the value of having the guy on camera to convince people it's him, but is there a pressing requirement to see his tonsils?

i am emotionally worn out from carms hell and general clerkship fatigue. i have just the hurdle of personal letters to overcome, and then i can rest.
i should also buy presents.
ah crap.

Friday, December 12, 2003
07:54 p.m.

more failure! my goodness, i do suck.

i feel like out-doing dearest esca with reasons to whine. what's your verdict, dear? does what follows in this post give me a shot?

kind email from carms (ummm...heavily paraphrased):
"dear incompetent med student, we discovered you have royally screwed up and given 3 documents the same name. way to go, genius.
for your information, we have specifically told you not to do this in our snazzy manual. we even gave examples, nimrod!

due to your monumental ability to ignore simple instructions, you will not be able to complete this application in the seamless way it was designed to be completed.
now we have to ask our techies to come up with a way to dig you out of the mess you've created. although, by god, we're going to let you stew in fear over the weekend.
or longer.
for you've engendered the wrath of carms, and you shall pay."

on a happier note, i am assured that all of my reference letters have been send out.
which suddenly isn't all that helpful, given that it's the naming of the ref letters i screwed up.

i have decided to finish that bottle of wine in my fridge, for no good can possibly come out of excessive carms-worries.

Thursday, December 11, 2003
12:05 a.m.

success!...and failure!

although they have eluded me many times over the years, i have finally managed to see the arrogant worms in concert.
with shelly and her bfie. in a nice place where we had our own table and could order food and drinks during the show.
wah! the worms were great! funny and interactive and banter-y. hopefully we'll be able to see them again in feb.

now i go back to stressing out over the fact that according to their secretaries, two of my referees have not written my letters yet.
cause they have all of TWO days left, you know.
i don't care about how many more problems your lady patient has. i feel justified in whining about this.
*whine~~~*
*whiiiiiiine~~~*
*whiiiiiiiiiiii...ah, fuck it. i'm going to cry instead.

Monday, December 8, 2003
11:22 p.m.

the insanely expensive hat of furry DOOM!

mwahahaha!
my poor bro...i called him after attending the "one of a kind" show this sat, and informed him i bought myself a hat. and that i'd like it as a xmas gift from him and the she.
boy: "oh. how much?"
me: "$550."
boy: "hahahahaha! really, how much?"
me: "$550."
boy: "no, really."
i hand over phone to mom.
mom: "really, $550."
hands phone back.
boy (whispering to the she): "she bought a $550 hat and wants it as a gift from us."
she (loooooong pause, then whispering): "maybe we could pay 10%?"

heh. of course, no one's on the hook for the hat but myself, but i just couldn't resist traumatising him. my mom plans to tell her co=workers that i was going to take her on a trip to the tropics as a gift, but instead i bought myself a hat.
heh. so much fun to be gotten out of one purchase...although with a price tag like that, some fun is to be expected.
if anyone cares, it's a one-of-a-kind (hence the show) mongolian-type hat made with fox fur, with many frills and such added. it has more personality than some people i know. mom told me i look like a mongolian princess in it...although how she knows what one looks like remains a mystery.

still not finished with carms. and for some reason now leaning towards esca's school for residency, but that may change...again.

Thursday, December 4, 2003
07:08 p.m.

yes, coanteen is so smart! and so incredibly behind on her application, the very thought of it causes her to roll into a little fetal ball and whimper ;__;
that is why i procrastinate. it has gone beyond simple lazyness; it is now a matter of preserving my fragile sanity.

behold, the fruits of my procrastination:
actually, the description isn't bad. and as a bonus i even like olive drab (or was brainwashed by the army to like it, whatever).

Wednesday, December 3, 2003
06:29 p.m.

"he'll just blab and blab and he won't shut up..."

so very true.
my community preceptor for obs/gyn is a great teacher. when i'm with him, he gives little mini-lessons on differentials and treatment options in the guise of talking to his patients.
in between, he draws explanatory pictures on a whiteboard.
the residents love him too. he gave them a little talk, and that entire day all residents within hearing range of the lecture kept coming up and thanking him.

but it drives his nurse insane. the explanations are long and detailed, not something to be desired when you're running a fee per service office.
in fact, he doesn't even take clerks anymore (and since he loves teaching i have an inkling that it's at the "suggestion" of his office staff), but i was originally placed in another city and, carless, begged him to take me on. i did an elective with him a couple years ago, so he agreed.

so obs/gyn is working out well.
on the other hand, i'm coming to hate opthalmologists. i had an elective semi-set up, only to be cancelled.
fair enough, i tried calling all the other opthalmologists in the electives book. most of them appear not to accept elective students. why are they in the book? who knows; perhaps they just like to see their name in print.
one secretary keeps telling me to call only after 4pm, at which time the phone is turned off. is she trying to send me a message?

anyways, today in the office, after yet another fruitless attempt to reach someone:
me: "gah! i hate opthalmologists and everything related to them!"
ob/gyn's nurse: "so if your pts have eye problems, you just won't refer them?"
me: "no. they'll just have to go blind. too bad."

Monday, December 1, 2003
07:23 p.m.

from scrotum queen to delivery inducer!

eheh. the nurses on the l&d ward called me a delivery inducer after i got yet another pt who delived within minutes of being seen by me.
'twas on my last call, and the resident was down in the er with the intern. not quite sure where the doc was, but she was a family doc pt anyways, so the obstetrician on call usually has nothing to do with those pts.
so, lacking an intern or resident to assess her, and seeing she was quite active, the nurses asked me to take a look at her as the "next senior person" (there was a pre-clerk on elective on the ward, so there actually was someone more inexperienced than myself around).

i checked her and - yup, she was fully. so i race to the phone to tell her family doc, who tells me she's on her way and not to push yet. i hang up the phone...and hear "baby!".
the resident manages to make it in time, and we deliver the baby. the obstetrician didn't make it. the poor family doc, of course, never had a chance.
they spent the next half-hour working out who will get to bill for what.

and i wonder if i should use my mighty induction powers for good or evil.

that last call was quite eventful. we had to do an emergency c-section for decels, and on getting baby out saw that the cord had a velamentous insertion (the likely reason for the decels).
it was apparently a beautiful specimen. we took pictures.
it's such a dangerous, freaky anomaly. perfectly fine for the fetus during pregnancy, but since the vessels run in the membranes, then if those membranes just happen to rupture in that spot - dead baby. a perfectly healthy term baby just hours from delivery can die in minutes from a rare but pretty undetectable anatomic variation.
obstetrics is like that. routine most of the time, but when something goes terribly wrong, there's no time to get second opinions - you know what to do, or you don't. that final.

Saturday, November 29, 2003
02:49 p.m.

only one more call to go!

ah. finally.
actually, last night's call was the best i've had in this rotation, sleep-wise. i had three deliveries, and still managed about 5 hrs of uninterrupted sleep.
this was because 2 of my deliveries happened before midnight, and the last one had the sleep-saving foresight not to come in until she was 9 cm. i'm amazed they even had time to give her an epidural.

the resident, and even the intern, had a much busier night (but the intern took off for the whole afternoon to nap, so i don't feel sorry for her).
they need to cover gyne too, and the resident does preemies and other complications, but the clerks only do (mostly) uncomplicated term pregnancies. we get gyne in our community rotation.

in any case, i had another of those miss-them-and-they're-done deliveries. the pt came in 4 cm with membranes intact, and not sure about an epidural though she was in considerable discomfort.
i admitted her, and she was to get more explanation about the epi to help her make up her mind.
but while walking to her room, her waters broke, her cervix popped open, and she delivered 20 min later. sans epi, of course, and was that ever frightening.
i'm thankful she only needed 3 pushes. she's even more thankful, i'll wager, and she did seem happy she managed to go "natural". but the nurses were physically holding her on that bed; she was in so much pain she couldn't follow instructions and was trying to scoot away. natural birth is scary.

but all went well, anyways. i actually like post-partum rounds on my pts, because i get to see their baby in its non-slimy state, and new mothers for the most part are less crabby than any other kind of pt.
i realize i'm getting a skewed view of the rotation, because i don't really see the obs complications, not to mention the gyne cases.
but the rotation was rewarding. the call part especially; the days were still mostly a joke.

Thursday, November 27, 2003
10:46 p.m.

the end, she is in sight!

only 3 more weeks to freedom. only 3 more weeks before i get to congregate with esca and her bfie, before i get a much-needed break from the drudgery of this never-ending clerkship, before i wash my hands of carms forever.
which means i need to do carms. only 3 weeks! where will i find the time in my busy procrastinating schedule?
it is likely that if i took a fraction of the time i spend complaining about carms, and actually worked on it, i might be done by now.
likely, but less fun. there's nothing better for the constitution than a good deadline-induced terror-fuelled adrenaline rush.

alas, i shall have no time this weekend of on-call hell. fri and sun. it's ridiculous; i'll be dead by mon, when i'll need to impress my community preceptor (aka the man who will write the final eval).
so off to inadequate sleep i go.

Thursday, November 20, 2003
07:31 p.m.

clerkship conversations

me: "this academic day was pretty good. too bad tomorrow we'll go back to being bored to death in obs."
clerk2: "hmm...i may be sick on mon. just warning you."
me: "yes? hmm...i may be sick on wed. hey, clerk3, when will you be sick?"
clerk3: "what?"
me: "clerk2 will be sick on mon, and i'll be sick on wed."
clerk3: "well, i guess i'll be sick on tues then."
*nod*
*nod*
*nod*

Wednesday, November 19, 2003
08:27 p.m.

(to the tune of sailormoon) "giving birth my moonlight..."

i wonder if there are any studies on how many births take place during the day vs how many at night.
i wonder if there would be any evolutionary advantage to either timing.
i wonder why i have to bother coming in to work if they'll all just drop their babies after i leave.

days continue being boring. clerks and interns do initial assessments. clerks and interns, for the most part, still need their cervical checks double-checked by seniors or attendings. clerks and interns, therefore, are completely expendable on the floor.
we go in to assess if a pt is in active labour.
the obs nurse can tell that just by looking at the pt.

it's frustrating. it's frustrating because after morning rounds we sit around doing nothing. because the attendings, if they're on the floor, tend to do cervical checks without bothering to so much as raise their voices above the whisper level so we clerks, reading in the lounge, can come and join them.
because the lounge computer doesn't have enough privacy protection to work on carms.

because i just want clerkship to be over.

Saturday, November 15, 2003
03:11 p.m.
the "round tuits" are carms-related. you can't deny that!

Saturday, November 15, 2003
02:17 a.m.
obs/gyn ward: the twiddle-thumb rotation

obs/gyn is a weird rotation thus far. talking with clerks who have gone through it already, i also know it's not just weird for us.
some rotations, like gen sx, are non-stop work. some are slow and steady, like psych. some are seasonally dependant, like peds, and i'm sure the current crop of clerks is busier then we were.

but the ward component of the obs/gyn rotation is just - it's a fucking joke. we sit around all day, doing nothing at all. and not the "nothing" that med students usually complain about, like scut and other work not conducive to learning. i mean literally nothing. we can't even follow the residents to their assigned pts, because of the touchy-feely-pt-comfort-is-everything mentality of the floor.
ok, pt comfort is a good thing. but it's a good thing in other specialties too, and we managed to see pts in those. not to mention that pts sign a sheet saying they understand the basic concept of a teaching hospital.
in any case, unless we have pts assigned to us specifically, we do squat. and this past week the number of pts assigned to any given clerk during the day was one or zero. reading is a fine thing, but there's a finite amount of reading i can do at one sitting and still retain the info.

obs/gyn call, on the other hand...i was on call thurs night. in all my previous calls, i was always able to get some sleep. not a lot of sleep, but a couple hrs here or there.
that night, i got to lie down for 40 min. i didn't even bother picking up the key for my room until 3am.
not that i'm complaining. i could see ways to make it better - for example, why even came in on the day you're on call? why not get a nice nap and be ready for the night?
but all things considered it's fairly humane. obs/gyn doesn't require us to stay until noon post-call. and, with all the doing nothing during the day, i found my night on call a fascinating thing.

it's almost frightening how quickly birth can happen. i assessed a pt and found her not to be in active labour. the doc agreed, and we discussed the option of inducing labour, given that her waters had broken.
i have no idea what happened next. maybe the idea of induction scared her into it. in any case, i went into her room to ask a basic history since we admitted her for induction, she seemed in some pain, the nurse asked me to do another cervical check to see if maybe she was in active labour now, i turn around to get gloves, and...the next thing i know the doc's being summoned and, arriving at a run from a few doors down the hall, barely makes it in time to catch the baby.
from latent labour to delivery in under an hour. seriously, you just can't turn your back on these people.

but exciting or not, 24 hrs of being alert got to me. so, finding myself a bit too early and alone in the handover room in the morning, i reclined on the couch to "rest my eyes".
then, startled by hearing my name called, i looked up - to find the lights on, the residents present, and 8 pairs of eyes looking at me in mild amusement.

Saturday, November 8, 2003
08:08 p.m.

a total eclipse of the heart moon

lunar eclipses are beautiful. more beautiful to me than solar ones, which although awe-inspiring somehow lack that element of quiet mystery and melancholy power. the phrase "music of the spheres" comes to my mind when watching a lunar eclipse; the few times i've seen a solar eclipse i've imagined how terrified the poor ancients were of their clearly pissed-off gods.

some time ago, when i was still in undergrad and working as a residence assistant, one of my programs was centered on the leonid meteor shower. i researched a whole lot of legends about meteor showers from various cultures, and prepared for a gorgeously educational evening of narrating them under the burning lights falling all around us.
i'd never seen a more cloudy sky.
we had to settle for the legends. the highlight of the evening was the one in which meteors were believed to be the burning urine of the gods. native american, i think.

tonight the sky is absolutely pristine. the only thing that would've improved the view would be another massive power failure.
the thing is, as i stood shivering on my balcony, i scanned the highrises facing me. i stood out there long enough to look into every window, and i didn't see a single person out on a balcony, or even standing by a window.
i did see quite a few windows with curtains drawn, and the tell-tale flicker of an active tv set. i saw shadows of people going about their business. but not a single one watching. not in those buildings, not on the street below me, not on my side of my own building (i had to lean a out little to see the moon, so they would need to as well; i saw nobody).
this is sad. surely some of those people were at least aware it was going on. it was in the paper and the news, and i cannot believe everybody in my line of sight was ignorant of the event. and yet nobody came. why?
i'm not a get-back-to-nature person. i like my technology, i like a nice warm house in the winter and my special-effects filled movies (matrix: revolutions is good, really!), i don't even lose sleep over the sad state of our polluted world.

but damn it all, i can still appreciate a celestial spectacle when one presents itself in my neighbourhood. what's happening to people?

Saturday, November 1, 2003
11:39 a.m.
and i'm finally caught up! today's entry is - today's entry.

oh, for the love of drugs...

well, peds is almost over. one more week of fairly useless specialty clinics (really, what am i expected to learn from one half-day of, say, pediatric oncology?), and on to obs/gyn.

NICU peds: apprehension-rama
there appears to be quite a large number of babies apprehended by children's services in this hospital. not large in terms of absolute numbers, but more in terms of non-apprehended to apprehended ratios.
what i don't quite understand is the mothers who, if i'm reading the charts correctly, always deny any drug use during pregnancy. why? why in the world do such a pointless thing?

druggie mothers of apprehended babies everywhere: listen up! we have your baby. it will be screened for drugs. with the wonders of today's modern technology we can tell not only what you've been taking but at what point in the pregnancy you were taking it.
lying to us just makes you look like a...liar. an incompetent one at that. it's not like we can't prove you did it.

really now. most of these so-called mothers (and i can't bring myself to pity them, having watched quite a few babies go theough withdrawal) try to get their kids back. lying about their health and possible complications is not the best way to impress those authorities in charge of your baby.
one of the babies was apprehended from a mom with multiple previous apprehensions, who apparently had no prenatal care in order to avoid tipping off the authorities about this pregnancy.
yeah. that really illustrates her maturity and obvious concern for her baby's well-being. let's let her keep it!

last night there was no resident on call. 'twas but myself and the attending, but since it was halloween it wasn't busy at all.
children can repress any symptoms of illness until after free-candy day. i predict today's team will get slaughtered.

but while giving handover to the day resident and clerk, we got to talking about residency. my fellow clerk is trying for neurosx, and like most people going for subspecialties doesn't really care where she gets in, as long as she's accepted into the program she craves.
the resident asked what i'm going for.
me: "family. army."
resident: "oh, you come with funding. they'll all be trying to recruit you."
me: ^__^
no stress.

it's kinda funny. the subspecialist-bound ones don't care where they're going as long as they get in, a lot of the family-bound have families and need to stay in one specific area because their spouses have jobs there.
me?
i'm trying to find out if calgary has more or less mosquitoes than are here.
mosquitoes are important, after all.

Sunday, October 26, 2003
11:36 a.m.
the plague of residency indecisions

the conference i just attended gave me my first opportunity to visit western canada, or calgary specifically. and i liked it. i know my current view of the city must be skewed, given that i observed it for all of two evenings mostly in the downtown area, but still i like it. it felt safe, the weather was much nicer than where i live, the people were friendlier in general, there were mountains on the horizon...
i didn't spend too much time looking into out-of-province programs before now, because i just assumed i'd remain here, or at the furthest in esca's city. but i did have the opportunity to learn a bit about the programs at calgary and ubc, speak with residents and students from those schools, and ask the ever-important question: i have chibis. that a problem?

calgary's program is definitely attractive. so is my school's, and esca's, of course. i wouldn't consider crappy programs just to remain in one place.
but calgary is just...it's nicer. definitely nicer than my city, which is half-permanently swallowed in smog. regionally nicer than esca's city, which in itself is nicer than mine.
and then there's the cultural aspect. it's the west. it's something different from where i've lived for the past 13 yrs, and difference is always interesting.

so why not just make the decision to rank it first? this won't guarantee me getting in, but it'll come close enough.
i don't know. i don't like thinking of myself as mired in inertia, even though i joke about it. but this would involve a major change for a very time-limited period of my life.
i own my apt, i can't just give notice and move out. something would need to be done about my furniture, a few pieces of which really weren't meant to be taken apart again and reassembled halfway across the country.
i'm comfortable living fairly close to my family. i'm also incorrigibly lazy in the kitchen and the food my mom supplies keeps me reasonably healthy and happy.
driving several days with chibis in the car isn't a happy prospect either.

these are all valid points, but i know what will happen after residency. i'll be moved wherever the army wants me to go. they won't care about my apt or my furniture or my chibis.
i'll be send overseas at some point, at which time my chibi situation will become critical. for me; army still won't care.

so is it reasonable to deny myself a residency experience that may be more fulfilling than one here would be, if only because it's a change of scenery? is it reasonable to keep brooding on all the perceived difficulties and annoyances involved in a move, knowing that in any case staying here will delay them for a mere 2 yrs?
i suppose i have a little time to make my final decision, but it is just a little. in many ways it would be easier if it was taken away from me, like the decision of what field to apply to was. but this is my decision, one of not too many i have regarding my career at present, and i don't want to look back on it in a year and think, "if only".

Wednesday, October 22, 2003
11:33 a.m.
still not trusting pitas...
gah. the 2 entries i lost were my good entries. not the standard bitching. i hope they can be recovered. i could probably try to reconstitute them, once i get over the feeling that that's "cheating".
ah well, on to today.

community peds: vehicular adventures
there was some sort of accident on the highway this morning as i was on my way to clinic. from the driver's radio system, i learned it was a car in a ditch, but that's merely extraneous info gleaned through eavesdropping.
the eavesdropping is the main point, or rather what i learned of the driver while engaging in it.
he is a good driver.
he is a caring driver.
he cares about his fellow drivers, warning them of the impending congestion before they commit themselves irrevocably to the clusterfuck that is currently the highway. he even suggests alternate routes for consideration.
he cares about his passengers, calling ahead and asking the station to hold the train.
he cares about the station attendants; well, at least he must've in the past, for they recognize his voice and address him by first name. they will hold the train.

trapped in that traffic jam, i felt a strange kinship with the driver. it was almost exciting, eavesdropping on his calls, his periodic efforts to find out exactly what was happening, trying to make out the location of the replying drivers based on what they could see.

once we finally arrived at the station, he wished us all a good day and advised us to hurry, because the train was not running behind as well.
exiting the bus, i almost felt like i was leaving a comrade. i wanted to thank his profusely for making sure the train would be waiting - but then i realized how odd it would look if i left the bus and headed away from the tracks.
i wished i did need to be on that train. but i'd arrived at my destination, and i had no desire to become his "WTF!?! story of the day".

Sunday, October 19, 2003
10:57 a.m.
gah. so. some of my brilliantly written community posts got lost due to server trouble. i was thinking or redoing them, but have by now long forgotten what i'd written.
i believe one of them went something like this:
mom: "the teacher thinks my son had ADHD."
doc: "the teacher is a moron. your son is bright and lovely. have a nice day."
something along those lines.

i am, however, transferring some posts i made on lj while the server was down. therefore, i am messing with the dates on this thing. today is really 01nov03.

damned pitas is down...
forcing me to update here instead, because i will undoubtedly forget anything i wanted to say by the time it's back up again. if it's important, i'll just paste it later.

today, i went through my photo albums, spurred into action by the recent discovery of my baby pics. furthermore, i discovered i was the world's cutest baby. i know many people may think they were the cutest, or that their kids are, but that's just not so.
because i was.
in fact, i was so damned cute that letting me grow up was criminal.

in any case, spend the weekend organizing and describing albums. in fact, spend a significant amount of time on the net, researching just what those pretty pretty buildings in prague were. i knew i should've listened to what kuba was calling them, but instead i concentrated on drinking and learning to speak fake czech (which was greatly aided by the aforementioned drinking).
it also made me severely miss my vacation. it's been only 3 months, but it already feels like it was last year. i can't wait for next summer and its 6 weeks of glory before resigning myself to the humdrum (alternately: mind-shredding stress) of working life.
although who is to know? maybe i'll get a free vacation to iraq or afghanistan? one never knows what joys await one in the future.

also, i've started biting chibiko back when she bites my forearm. this has gone far enough; i've had her almost 2 years and nothing short of covering myself up has worked. kurara can learn, so chibiko damned well can too.
i don't bite her hard enough to hurt her, but she feels teeth. and - surprise! she lets go, and for some time thereafter a snap of the teeth will discourage her.
if you want to train ferrets, think like a ferret. heh.

Sunday, October 5, 2003
05:09 p.m.
i have spent today running a test between my minolta and my mom's nikon. she thought the pics from poland came out better on mine, even though the nikon is supposed to have a better lens. my colors were better.
so today i got the same films, loaded the cameras and proceeded to make identical pictures. then i got them developed.
hers is marginally better on close-ups, otherwise no difference.

the difference, of course, was that my poland pics were developed at a photo place, while hers were done at a grocery store. i could have spared myself much clicking if i'd just taken one on her negatives to the photo place for re-developing.
but that is why it's called hindsight, not when-you-need-it-sight. and hey, i can always use more chibi pictures.
i also took the cutest piccie with the chibi sai you got me. i shall send it, or give it to you next weekend.

the evil children have given me a cold. or a flu. in any case, i'm sickish and drinking neocitran like there's no tomorrow (by which i should be well enough to go back to work, since my body hates me and only gets sick on weekends and post-call days).

also, not working on residency application. i suck.

Wednesday, October 1, 2003
06:13 p.m.
hm. the army won't pay for my conference unless it's mandatory, which of course it's not. i've had to fight hard enough for the right to skip an academic day in order to attend, so no way is anyone in the MD office signing on the dotted "mandatory" line.
damn. it was a slim hope, but hope nevertheless. now i have to scour the net for dirt-cheap flights.

peds is...very, very unlike surgery. our team has one attending, 2 residents, 3 (!) clerks and currently 15 pts. each of us clerks has 2 pts, one baby and one kid. my baby is super-stable, so the only work is checking how much weight it's gained and how well it's feeding. feeder-grower.
and a nice, calm one too. we used it to demo baby physical exams, 3 inexperienced clerks poking and prodding for nearly an hour, and it didn't cry once.

the only time it gets busy is when our team covers ER, which we do on even days. like tomorrow, so i expect a bit of action then. not that i'm complaining, but after the hell of surgery, today felt almost coma-inducing.

at least there's ample time to get some paperwork done, as i'm now at the hospital where the MD offices are located.
only i'm not so much doing the paperwork as complaining about it not coming in. my family eval, specifically. the rotation was several months ago, and nobody in our group has received theirs. apparently this state of affairs isn't enough to tip off the "eval coordinator", whose job description, title aside, appears to be "filing monkey".
sure, at our school we're responsible for tracking down our own evals, but if a whole group (and one for which the main evaluator role was experimentally switched from tutor to preceptor, only to be switched back for the following rotation) is missing the final evaluation, something just might be going on. what exactly do you coordinate, filing folder colors?
admin is frustrating. never more so than during residency applications.

Saturday, September 27, 2003
11:03 p.m.
it's pomegranate season again! i rejoice!

i also rejoice in the final, complete end of my sx rotation. today the junior let me off call early, allowing me to leave in the evening instead of staying overnight. i felt grateful and guilty. i wished some other resident were on call, someone i didn't care about and could leave without a second thought.
but the junior and i...we've been through so much together. so much scut, so much crap, so much venting about everyone from nurses to staff.
ah, the venting. it was good.
i'm happy that the team's getting 2 clerks starting mon. they really need more scut workers the help. and i can't believe this, but i'm actually starting to miss the team, or at least some of its members. and the concept of the team itself, i suppose.
peds will be divided into a week here, a couple of weeks there, and so on. not enough time to develop an affinity for one's "team", if indeed there is one at all. and i like such affinities, which probably explains the attraction of the army in the first place. comradeship, a group with a common cause...in the absence of training, the sx team provided some of that. in hellish, endless, sleep-depriving, mind-numbing ways, but it still provided it.
to return to my day: i assuaged my guilt through the gifts of food, fancy coffee-place drinks and the divertion of a consult to GI, and left. i was free, and free to wallow in my maudlin sentiments if i chose.

instead, i chose to watch some tv, where to my horror i discovered that "iron chef" is ending (upon consideration, i remember seeing posters about its end, but sx had erased them from my sad, abused mind).
still, how could they do this to me? i have an unaccountable lustful attraction to chairman kaga, after all!

Friday, September 26, 2003
07:09 p.m.
like dear esca a day ago, i'm doing the skipperoo today.
actually i fully meant to attend that conference. after all, it is marginally interesting, and right on my doorstep unlike two years ago, when i had to travel for hours to see esca attend it.
but in the evening, exhausted after watching ER, i decided to leave my alarm off. if i got up in time for the conference, i'd go. if i didn't...
obviously i didn't.

i did manage to drag myself out of the house in the afternoon and finally accomplish a bunch of overdue paperwork-related things (what do you mean i haven't paid my taxes in over a year?). i made a little list for them. i crossed them off the list.
lists are great. i feel like i've done so much after i finish tasks on a list, even if they're sad pathetic tasks like "phone about camera" and "email rotation coordinator". things just seem so much more important if you bother putting them on a to-do.
and so, though i didn't really do all that much today, i manage to feel accomplished. because i finished my list, dammit!

Wednesday, September 24, 2003
06:21 p.m.
it's over.
it's over and only guilt keeps me going now. all exams are done, i'm stunned at the giant gap of knowledge i discovered in myself regarding ID (was the ppi really composed of only ID and obs/gyn, or is it just my imagination?) and i hate my school for buying a sx exam wholly, utterly, completely inappropriate for our sx rotation, but at least it's over.

while i could just slack at this point, and deservedly so, i can't in good conscience let the junior carry this load alone. especially not this week, what with the sporadic absence of the chief (who seems to show up for interesting procedures and leave right after them. some sort of twisted sx vacation or something).
i can stick it out, dammit. only 2 more days, and what will hopefully be a half-call on sat.

my chibis have been living on chicken for the past 2 days. i ran out of food for them, and wasn't able to get anywhere near a pet store during business hours. so, they've been getting my good chicken. disgraceful. i'm sure there'll be a rude awakening when they get dry kibbles tonight.

Monday, September 22, 2003
10:57 p.m.
whew. day of insanity.
came on rounds today to find the situation as follows: the chief has gone for the week, leaving us with 1-day notice of his absence (although i suspect some attending was in the know). 2 OR's were about to get going. the junior and i had 25 pts to round on. 2 consults were waiting in the ER, and i had my oral that morning as well.
somehow, with the help of some off-service fellows in one OR and a locum covering the ER (and somehow managing to lure and admit for same-day OR every single acute chole pt in the catchment area), we got through the day. we ran late and were crabby, but we got through the day. go team.

by the end of the day, i forgot i even did an oral.
which went rather well, except for the last question, which was a painless jaundice with wt loss/anorexia scenario.
i'm on the hepatobiliary team. one attending seems to do nothing but whipples.
me - pancreatic tumor! CT! CT!
examiner - err, you did well in all the other questions, but i'll give you a "marginal" here because you should really do a hx and physical, and umm...bloodwork and such.
me (already jittery enough about oral and wanting it over with) - ok, thank you.
~takes look at oral eval sheet with scenario titles~
me - gah! it was pancreatic tumor! who needs a physical!

i was also curious how every nurse on every floor was able to tell i was on the sx service. usually they look at me and demand to know where i'm from. today was pleasantly different. i thought they started recognizing my face, until it dawned on me that i was still wearing my surgical cap, and the mask was hanging around my neck.
yes, long day.

Sunday, September 21, 2003
08:45 p.m.
i was freaking out for a while there, what with 3 tests (sx oral, ppi, sx final) in the next 3 days, but now i'm oddly calm.
of course this may change in the course of the day, since my freaking out was a bare 3 hrs ago.

thing is, i went into the hospital to photocopy some stuff about hernias from my poor fellow clerk who's on call, and then we got to chatting with her senior who sits on interviews for sx residency positions.
just talking to him made me much calmer about the application process. he said that all the frou-frou stuff like "president of this" and "research assistant of that" are there just for two reasons:
- to show that the applicant is "well-rounded", and
- to show that the applicant can handle the time management during residency.

so they're not there to intrinsically impress the admissions board, unless you happen to have worked with someone well-known in some super-competitive field you're trying to get into.
and i'm confident that i can show my time management skills and all that junk. of course i'll still put the conferences i attended on there, and it'll be great if the funnies get published, and i'm aware the sheer paperwork will still drive me insane as it's already doing to poor esca, but at least i'm not feeling inferior anymore.
go senior!

now, as to my uncoming tests, the senior did nothing to put me more at ease. so i don't know why i'm so much less worried about them. i probably should worry, especially about that oral tomorrow.
level of anxiety...rising...rising...

Wednesday, September 17, 2003
06:22 p.m.
o woeful day.

not only did my classmates' ceaseless morning prattle about cv's and conferences attended and research published depress me in light of upcoming applications - me, who spend all this time "only" studying medicine - but in the afternoon the army decided to call a MANDATORY BRIEFING for tomorrow morning.
their caps, not mine -__-;;

of course they didn't decide it this afternoon. they merely decided 18-hr email notice would be more than sufficient, because it's not like we medical (and other) students could possibly be having exams, or be on rotation outside the city, or god forbid not check our emails incessantly.

i was very close to deciding not to show up, pretending i didn't see the summons in time, and write them irate emails about the lack of prior notice after the fact.
but upon due consideration, i instead wrote them irate emails before the time stating that although i would be able to show up, perhaps others would not, for the reasons listed above; and that the timing left me with problems rearranging my clinical day (which is true).
and then i made sure to hit "reply all" instead "to sender" to make my point, which is: damn it, i'm not a "student". not legally, not practically. i have responsibilities, i have my overloaded, under-staffed surgical team counting on me, i am important enough for you to bother telling me about this earlier, and god damn it, i outrank you!

Tuesday, September 16, 2003
06:13 p.m.
now my feet are killing me.
got called in at 1000 to assist in the last 3 hrs of a 5 hr operation - which turned out to be the last 8 hrs of a 10 hr operation: "the resection of everything".
let's see if i can remember. there was the retroperitoneal resection, the anterior resection, the small bowel resection and anastamosis, the nephrectomy, the cholecystectomy, the liver wedge and resection, and the large bowel anastamosis. that's all just off the top of my head, and i'm not even sure if they did anything else before i got there.

those who say case-based learning works must be right - that was practically all of general surgery, in one case no less!

anyways, my feet hurt, i haven't eaten since my stolen liquid meal replacement before 0600, i need to clean up a bit before shelly comes here, and i've just realized i've left my bag back on the ward.
nevermind. shelly will come, and we'll eat taro fritters and chicken hearts and drink bubbletea, and not think about my potentially missing littmann ^__^

Monday, September 15, 2003
09:21 p.m.
barely 3 hrs of sleep on call...again. but sunday call with the new resident actually quite nice nevertheless.
then, as we go down to see a new consult at 0430, i start feeling nauseous. no biggie, i think - just woke up from hardly any sleep, haven't eaten anything, and i sometimes feel a touch of nausea in the extreme mornings.
but it didn't go away. i had to sit down repeatedly, and it got so bad that turning my head from the computer screen to the paper on which i was writing the bloodwork made me feel syncopal. even the nurses commented that i was pale and should go home.

i did, eventually, after a teaching round and seeing one of my designated pts, cutting my post-call day by about 3 hrs.
but of course that wasn't the end of it. no, on the one day i needed to go home, the valkyrie has me paged from the OR and asks me to join (i decided to keep the pager on til noon, out of a twisted and ultimately self-defeating sense of obligation).
someone did tell her i was sick, and it was a question rather than a summons; and since i was already home in bed fighting a bout of intractable hiccups, i demurred.
but damn, why today of all days?
and why, if i have to be sick at all, does it always happen on post-calls and thus ruin my day?

Friday, September 12, 2003
01:06 p.m.
i keep feeling left out of things. in good ways and bad.
bad if of course i don't know something about a pt's history, or i haven't gotten to their bloodwork yet and the attending decides to start rounding on that particular pt first, and such.
but in "good" ways too. the resident i was on call with told me that the valkyrie (formerly known as dreaded lady surgeon) likes me. i discounted it, mostly because i don't really know anything (the lack of study time doesn't help - only 3 hrs of sleep last night) and she's some sort of genius.
but this a.m. in clinic she told her nurse that i'm "functioning at a resident level". i'm deliriously happy of course, but why? i don't really even know anything. i cover the pagers while they're in the OR; the last time i was scrubbed in with her i stuck the suction too near the spleen and she took it away from me with a warning not to perforate spleens. and now i'm at resident level?
however, chances of getting carms letter looking good.

anyways, 3 hrs sleep. no food. meeting adviser, then i'm out of here.

Wednesday, September 10, 2003
08:54 p.m.
eh. got home at 2045 today. although i should resign myself to this, i just don't understand when these people expect me to study.

i suppose i was going to rant more, but then i read esca's entry. she has to deal with all that insanity on top of surgery. i feel petty.
i'm going to try calling you now, dear. if i don't get through, i'll call fri (on call tomorrow).

Tuesday, September 9, 2003
10:49 p.m.
oh god...
surgery keeps getting worse. today didn't start out badly - the usual 0600 rounds, during most of which i was relegated to the virus-infected and therefore sloooowww computer to gather bloodwork. then an ER consult, which was a nice break.
then the usual running around gathering loose ends and tracking down radiologists, while the residents scrubbed in for actual surgery. keeping up to date on my ER pt, who was being observed with the hope of avoiding admission.
then another consult from the wards ("oh look, we just noticed that the u/s results from 2 days ago show possible acute cholecystitis. gee, maybe it's time we got somebody to check it out"). it wasn't acute after all, but that's hardly an excuse.

then the hell started. OR was over and the residents disappeared somewhere. i had to wait around for the staff to d/c my ER pt, and he kept promising to "be there in 10 min" - for over 2 hrs. he's lucky that pt was stuck to an IV, or else i'm sure he'd have walked.
then, for some unholy reason, he decided to round on his pts. yes, he's the slow rounder. no, he wasn't even on call. there was NO reason for this. there was NO reason for him to be bringing up CT scans after i'd already listened to the fucking reports. if he wants to see them that badly, he can well do it in his own office, not waste my time.
oh, and just in case i'm not clear: his residents had disappeared. lucky fucking bastards.
he kept me there until nearly 2000, trailing after him, reading out bloodwork results. he kept asking how i like the rotation. what am i supposed to say? he's my damned evaluator!
near the end, a nurse asked me whether the IV rate for a pt was too high. i didn't know; the resident had ordered an increase, and was supposed to have followed up. only he disappeared. i felt near tears out of sheer frustration - i can't take it out on the staff, i can't take it out on the residents, i certainly can't take it out on the nurses if i'm to survive this rotation. i'm starting to think that the reason clerks have minimal pt contact is so we don't take it out on them.
to end off a beautiful day, the staff mumbles something about a consult tomorrow a.m. i won't be there, it's (blessed) academic day. i tell him this. he mumbles some more and starts writing something in the charts. i go to a phone to dictate for 5 min, i look back up - he's gone. i check the chart - no specific plans. no consult order. so what now? will it be my fault if it doesn't get done tomorrow, even though i won't be there?

i'd made plans with shelly for today, as per usual tues, but i called her and told her that i'd be so late she shouldn't bother coming down.
thankfully, she didn't listen. she came, and she brought pizza and lilo&stitch, and now i feel better. if it weren't for shelly...

i know it's just a stupid rotation. i know it's a very transient thing. i know in light of the crap others are going through, it's utterly insignificant.but there's just no reason for it to be that way. the other team is much better organized.
and although i've had different experiences in my rotations and it hasn't been all sweetness&light, no rotation has ever brought me so low by the end of the day that i felt the physical need to punch something.

Monday, September 8, 2003
07:21 p.m.
this is just a quick entry for layout purposes - yet again, layout courtesy of esca. who else?

in other news, surgery continues sucking, but i'll say more at some later time.
oh, and the lady surgeon gave me a bunch of pens. i'm definitely in love (as esca says, i haven't gotten any in a long time. i'm now apparently ready to whore myself out for pens).