Thursday, November 18, 2004
07:31 p.m.

the doctor will see you when you're dead; is THAT convenient enough for you?

today's post was made from work, in a fit of fury.
i've never before made a post from work because, although most staff are completely computer illiterate, i'm still paranoid about anyone finding this journal where i occasionally say unkind things about staff and patients.

but today i couldn't restrain myself; i had to vent.

the actual entry was posted in the customers_suck community.
because patients are customers.
and sometimes they should just die.

and here it is:
a patient comes in with his wife and daughter, complaining of angina-like chest pain.
i review his history, and note that the last time he came in with those symptoms, he was send over to the hospital and had his heart stented on a STAT basis to prevent a massive heart attack. furthermore, he didn't have angina symptoms after the stenting, but now they were very severe.

so like the nice and concerned resident i am, i manage to track down his cardiologist and lo and behold - he just happens to be in clinic in the hospital across the parking lot from us. and he'd be happy to see this patient right now!

so i copy and prepare his records for the cardiologist and walk back into the room, puffed up with pride that i was able to get this guy an immediate appointment, and with the same specialist he's seen before. and just a few steps away! without the hassle of going through the ER. how lucky could this bastard get?
i tell him the good news, and what do i get? the daughter makes a sour face, and the wife starts complaining that she'll have to cancel her backpain appointment. the guy asks if the cardiologist can see him at a more convenient time!

fuck. i made them go. but i kinda hope they won't, and that he'll keel over from a massive MI. some people just don't deserve to breathe my air.

ah yes. and esca has come out of blog-hibernation.
i will archive, dear. i will do anything, if only you will spare me a few seconds between coffees.

Sunday, November 14, 2004
10:50 p.m.

fallujah and fark

i've been reading fark.com for entertainment, and came across the discussion on the "ass-kicking" video of the fallujah assault.
of course most of the comments are of the "go america blow shit up!" variety, liberally sprinkled with wishes to enlist after seeing all the cool, cool weaponry, and castigation of those who are against the war as wanting american soldiers dead.
but someone posted the following (i'm assuming the source given to be correct):

"Lao-Tse said...

"Weapons of war are instruments of fear,
and are abhorred by those who follow the Tao.
The leader who follows the natural way
does not abide them.

The warrior king leans to his right,
from whence there comes his generals' advice,
but the peaceful king looks to his left,
where sits his counsellor of peace.
When he looks to his left, it is a time of peace,
and when to the right, a time for sorrow.

Weapons of war are instruments of fear,
and are not favoured by the wise,
who use them only when there is no choice,
for peace and stillness are dear to their hearts,
and victory causes them no rejoicing.

To rejoice in victory is to delight in killing;
to delight in killing is to have no self-being.
The conduct of war is that of a funeral;
when people are killed, it is a time of mourning.
This is why even victorious battle
should be observed without rejoicing."

i think it would be difficult never to rejoice at victory at all. but the sheer joyfulness expressed in that forum and elsewhere whenever the soldiers make something even with the ground, the comparisons to a video game for crying out loud, that just turns my stomach.

Saturday, November 13, 2004
09:29 p.m.

patience wears thin

to be fair, i haven't come across too much stupidity in my new rotation, family medicine.
in my previous rotations, i was somewhat insulated from it. on subspecialty internal, the patients who were admitted at least had something seriously wrong with them. they may have brought it on themselves, as in slowly pickling their liver in alcohol, but they had a valid reason to be in hospital. those who did not were screened out by the poor saps on ER consult duty.
in labour&delivery, it's hard to be stupid. sure, some first-time moms-to-be came in for a check every time their abdomen gave a twinge, but they could be dealt with quickly and send on their way. and i got to practice my cervical exams, which is always a bonus.

but now, in a regular 9-to-5 clinic, i have to deal with all comers. the simple boring stuff like prescription refills and BP checks, the annual health exams, the people fishing for doctor's notes to get them out of whatever unpleasantness they want to avoid, the actual illnesses both acute and chronic, the elderly who i swear are just coming in for a bit of companionship.
none of this bothers me too much. after all, this is par for the course for most family docs. it bores me, especially the chronics who really can't be cured or substantially helped and who just want somebody to listen to them complain. it bores me, and therefore i will never be doing this type of work once i'm ready to practice.
but it doesn't bother me. it's educational, and it's 4 months.

no, it's the idiots who bother me. and while i know that every practice, every specialty has its fair share of idiots, the difference is that these are not my idiots. they belong to the staff, and i can't really snap at them and explain that they are being idiots.
a lady came in with her small child, who was diagnosed with possible (too young to be properly tested at his age) asthma.
the lady was really upset with the "label". she wanted me to tell her it was ok to stop using the puffers her child was given.
do they make the kid stop wheezing? yes? then keep using them, you dolt! hell, even if it's just a really nasty cold, they're helping. why would you even consider stopping before he recovers fully?

i was on call, in night clinic. night clinic is our version of emergency, if it's too trivial for an actual ER but can't wait for a regular appointment. night clinic is fun because we see acute illnesses almost exclusively.
woman comes into night clinic, complaining of medication side effects.
a medication she has been on for the past four weeks, with the same side effects for the entire period.
the side effects were dry mouth.
she had a regular appointment in two days for a medication review.
i didn't check what lie she told the nurse to get into night clinic, as i was too busy trying to figure out if it would be worth it to stab her in the eye with my pencil and give her a real reason to be there, or if i'd get into too much trouble for it. she managed to escape while i was thusly occupied.

these and many other stories highlight some of the stupidity currently facing me.
and i've noticed that after two weeks of it, my tolerance for human stupidity in general has gone down considerably. forced to treat my patients with utmost courtesy, i've began snapping at peoples' remarks in my non-work-related real life as well as online.
oh well, i suppose identifying the problem is the first step in fixing it. i have to come to terms with it because it's me that's being affected, not the idiot patients.
i think a massage might be in order.

Monday, November 8, 2004
05:47 p.m.

post-con, intra-boredom

went with the engaged ones to anime con in our nation's capital. it was...small, and they had glitches, but it was the first time they ran it. and the music videos were good (but not enough, damn it).
and engaged ones won a price for their FMA costumes! yay!
and i spent most of the time desperately reading the battle royale novel fiance bought. but then he told me i could take it home and return it later, so there was no need to try to speed-read it after all.
nor, i suspect, was there any pressing need to stay up until 5am last night to finish it, with a full clinic and a group home visit today.

i remember how excited i used to be at cons a mere few years ago. i had no problem at all sitting in line for literally hours at a time to get into some rooms.
everything was so great. being there was enough.
and this saturday, standing in line for the dealer's room (where in the end i bought nothing), i was struck by how incredibly jaded mature i've become. standing behind us were two younger girls chattering excitedly about getting their hands on anime and posters, while esca and i bitched about the wait, the fact that we could get anything they displayed in any regular comic/manga store without lineups, weird ticket discrepancies, residency...

i blame the cons i attended in korea, really. there are no screening rooms or contests, just endless booths with doujinshi artists selling their wares, and great, elaborately costumed groups of fans. much better costumed than anything i've ever seen in local cons. art and costumes. things you can't get in any random store.
so, in the end, esca is to blame for it all.
also, she drugged me. so there.

snow-swept boredom
for some odd reason, clinic today was extremely boring. every single patient was there for some minor follow-up; blood pressure, med refill, routine Pap, test results.
the most exciting thing i saw all day was a blocked follicle in the lower eyelid. and that's just sad, people.
meantime, my fellow resident had two chest pains and got to go EKG's on them.

it also started snowing today. intense flurries, on and off. time to break out hats and gloves, though it's not yet cold enough for my furry hat-of-animal-cruelty.
driving home yesterday, i was struck by the change in foliage. the fall this year was absolutely gorgeous, or perhaps it's normal for this region. it was my first fall here.
but i loved driving to my obstetrics shifts, stealing glances at the trees. they were so vivid, reds ranging from flaming orange to almost purple, greens still valiantly hanging on, and most beautiful of all, the yellows that seemed lit from within even when the sun wasn't shining (oh, but almost bursting with light when it was).
i contemplated getting out my camera and taking some pics once i saw a friend post hers, but i never got around to it. and then obstetrics ended and i stayed put for a couple of weeks.
yesterday, all that remained on the trees were a few shivery-looking brown leaves, clinging hopelessly against the wind, and some clinging still to the memory of flame. and ringing the highway were the constant evergreens, late overshadowed by the brilliance of fall, stepping up to fill the coming winter with color.

Friday, November 5, 2004
06:46 p.m.

9 to 5...or 6...or 7...

at long last, family practice. or, as the docs here like to point out, "what you'll be doing for the rest of your career".
or not precisely, if i stay in the military, since the population we serve leans heavily towards geriatrics, chronic pain, and people dealing with unemployment and many complex psychosocial issues.
still, it's the closest thing for now, and it's the way a family doctor manages issues that i have to learn.

we were discussing the difference with our primary staff today. in internal med, whenever an admitted patient has some symptom or another, we usually throw a whackload of labwork and diagnostics at them and are stuck having to treat many nonsymptomatic abnormalities that result from this overzealous investigation. quite often these treatments result in many other splendid symptoms that need investigation.

in family practice, we learn the fine art of deciding if investigation is necessary, and when it is necessary. it's part clinical picture and part gut feeling, which we new residents haven't quite developed yet and thusly we're forced to rely on the staff's gut for now.
it's also the art of coming to a mutual agreement by doctor and patient. unlike in a hospital setting, where a patient is basically at the mercy of the health care providers, a family practice patient can decide not to take the pills you prescribe. or he can go to a walk-in clinic to get the pills you didn't prescribe. he can go to the ER and pester them for bloodwork or XR that you didn't deem necessary. it's sometimes hard, getting a patient to understand your reasoning, but it's absolutely necessary.
and it absolutely requires understanding the patient's point of view, their agenda, their expectation of the visit.
and yes, sometimes it's incredibly frustrating. it's only been a week and a lightly scheduled one at that, and i've already had patients who i wanted to just whack upside the head or throw out of the office. dealing with them, dealing with my feelings towards them, is part of my medical education.

the good, the bad, and the ugly
well, not really. but we have favorites, definitely.
in my area there are three residents and three staff. the staff come in one at a time and have very different styles.
our primary staff doesn't book patients for himself, unless they're completely unsuitable as teaching cases or very resistant to residents, and those are few. he's wonderful, obviously loves teaching, is always there when the three of us need to run a patient by him; in fact, that's why he's there. with three residents in his clinic, he probably "sees" as many patients as an average family doc.
the other two have their own clinic while the residents also see patients. one of them has a fairly light schedule and can usually be found to discuss a case.
the other books a very heavy clinic. she can't make the secretary book patients with us less than 30min apart (standard for first-years), but she makes us see her patients inbetween if she's running behind. and, since she's usually with a patient when we need advice, she told us to knock and interrupt her if we need to.
we may need to, but we sure don't want to.
eh, at least we work under the primary staff more than under the other two combined. yay primary staff!
anyways, first week survived, and i'm actually semi-excited about this rotation. there's lots of teaching, primary staff is great, and some of the patients are really interesting and challenging.
only i prefer them to be challenging in the morning, not when they're the last patient of the day. try finding a psychiatrist willing to phone-consult after hours, and you'll really learn the meaning of "challenge".

and now i'm off to visit esca and bfie. anime con tomorrow!

Sunday, October 31, 2004
06:46 p.m.

all good things must come to an end

but what a strange end it was, my last obstetrics shift.

i got in half an hour late, due to whatever they're doing to the poor highway. at some points, they'd closed off one lane and appeared to be working. at other points, they's closed off about 5 m of perfectly good highway for kicks no immediately discernible reason and were nowhere to be found.

in any case, i was too late to scrub in for the section, but that was ok. the hospital has a husband-and-wife team on staff, so whoever is on (it was the wife this time) will usually call the other to assist for surgery. that way they both get paid, and they work well together. far be it for me to interfere.
and perhaps having a student doctor wouldn't have been the best idea in this case, as the mother has had a previous stillbirth. those patients are just extra-nervous.

there was an uneventful vaginal delivery with the doc who likes to teach. he was too busy to try this time, which spared me from mini-lectures about the G6P pathways and other chemistry things i'm perfactly happy not knowing about.
he's also the doc who almost forces the partner to cut the cord, no matter how green they look. it's funny how many men will concentrate on the woman's face as if their lifes depended on it, just to avoid looking down there.

weird...not wonderful
and then came another delivery. induced before her due date, and i was too busy with assessments to really read through her chart. i only took a look at what i needed to know for the delivery, all of which was fairly standard.
i arrive at the delivery, and her doc does most of it. that's fine. the cord has a loose single knot in it, which i've never seen before and which therefore is cool to see. the baby boy is perfectly fine, though clearly very unhappy about this sudden change of environment.
the doc mentioned the knot as the placenta delivered, something i didn't really pay attenting to. we mention things like nuchal cords for documentation purposes, so it seemed pretty standard. i was more interested in looking at the cord.

but the mother's reaction to the birth was off. she started crying, not the "ooohhh, baby" or the "i'm so relieved the PAIN is gone" type of crying, but the clearly upset kind. and she started repeating that there would be no more pregnancies.
this is a common thing for labouring women to say while in labor. once the baby is born they don't really say it.
i couldn't really understand her reaction. she was fine, didn't even need stitches or anything. the baby was fine.
we finished writing orders, and the doc walked me outside and explained.
this was her third pregnancy. her first living baby. the other two were stillborn, their blood supply strangled off by knots in the cord.
such knots can't be detected by ultrasound, and they're supposed to be completely random occurrences. some studies have been done to try to find predictive factors, but other than some unsubstantiated hypotheses like long cords (hers was normal length) they're considered to be freaky chance events.
and she had had three in a row, two fatal. this is why she was induced before dates.
no wonder the poor woman was upset, to hear that in spite of overwhelming odds it had happened again.

midwives are evil, spake the docs
in the afternoon, a couple of the docs started complaining about hospital rules. in particular the one where women doing vbac (vag birth after c-section) had to have access to immediate c-section in case of rupture of the uterus, or if that wasn't available had to be shipped out to a tertiary center.
the hospital apparently defined "immediate" in an unnecessarily anal manner.
but that's what got them going on midwives. in our province, midwives get their insurance paid by the government and are apparently allowed to do vbac at home. given that the hospital demands "immediate access" to an OR in cases of vbac on-site, this seems a litte...weird.
then cowboy!doc quoted a study that quantified the acceptable death rate of infants during childbirth, in populations choosing midwives. note that all midwife-assisted births are low-risk.
the percentage was 1%, which is staggeringly high for low-risk deliveries. this wasn't the death rate for midwife-assisted births, it was the rate the population under study was willing to accept.

now i kind of want to do some lit review on this.
obstetricians often have a pretty dim view of midwives, particularly in our province where fully half of births that start as midwife-assisted end up in hospital under a doctor's care. to them, this seems a waste of taxpayer's money, since both midwife and doc are paid.
but i'd like to know, for example, how the population in the study mentioned above was characterized.

and now i will watch DVD's and eat more icecream. tomorrow i start family med, although it shall be nothing but orientation for the first few days.

Saturday, October 30, 2004
09:25 p.m.

so what is the street value of percocet?

32 hours post-extraction, and i'm surviving on ibuprofen. the guy who took out my teeth must be some kind of evil dental genius. the two percocet i took yesterday only made me slightly nauseous and gave me some side effects of being drunk, without the fun actual alcohol provides.
and yet they can go for over $20 per pill on the street.
the mind, it boggles.

you're an adult, for crying out loud; write like one!
i'm considering seeing the movie saw, so i looked up some reviews.
this is a quote from reviewer wesley morris at the boston globe: "it does manage at times to knead your tummy like dough".
knead your tummy like dough?
knead your tummy like dough?
for fuck's sake, this is a grown man reviewing an R-rated feature, therefore presumably aiming at an adult market.
and he decides his best word choice here is tummy? WTF?

anyways, i have good ice cream waiting for me. i will go lick at it and forget about the tragedy of adults with a 5-year old's vocabulary.

Friday, October 29, 2004
01:22 p.m.

my wisdom is all gone

i have no feeling at all from my lower lip to my chin.
the sides of my mouth are numbed from cheekbone to lower jaw, and when i run my fingers over the area it feels slightly cold. not an unpleasant paresthesia at all.
but i have no feeling at all in or under my lip. and it is extremely hard to speak with the lower lip out of commission and the tongue working at 50%, at best.

no IV for you!
the oral surgeon was uncomfortable with the arrangement for my post-sedation care, where one person would escort me from the clinic and another would take over for the actual watch. apparently the dentist i spoke with yesterday told me she scrapped the whole arrangement, but that's not the way i understood it. anyways, miscommunication. it happens.
in any case, he wouldn't do the extraction under sedation without an escort, and i had none. he offered to do it with local only.
i was fairly anxious because of my prior unhappy experiences with local, but they had some kind of dental course going on so the person doing my extraction would be an experienced oral surgeon who does complicated cases, and was on base to teach the local dentists. my case wasn't complicated at all, and he said he'd use a stronger mix of local (about three different "-caines"). i really didn't want to reschedule, so i went for it.
it took the man 10 minutes for all three teeth. no pain whatsoever except for the freezing needles, which hurt like a bitch even with topical. but needles i can stand.
and he only had to cut up one tooth.

i went over to the family med center to thank them for agreeing to take care of me even though it was no longer necessary, and fended off offers to drive me home (a 10 min walk). i promised to call once i got in. damn, i feel loved. it's like having a parent in the city...some kind of hive parent.

now i shall experiment with drinking fluids. i think i've got the swallowing part worked out.

oh, and esca left me for coffee. she left me for coffee before my really minor surgery!
i shall not forget...

***later***
aaand the time has come for the happy pills.

***40 min later***
wow.
when i turn my head from side to side, there's a bit of a lagtime before my brain catches up with my eyes. i get that when i'm pretty inebriated, too.
i hope they don't make me nauseous. that's the number one listed side effect, but it's also the number one listed side effect for nearly all drugs i've seen.
but if i have to take gravol on top of this, i'll be semi-comatose.
time to go lie down.

Thursday, October 28, 2004
06:00 p.m.

it's jaw-cracking time

tomorrow i'm having all my wisdom teeth removed (i only have 3; i suppose i'm not very wise).
under conscious sedation, because i couldn't convince the army to knock me out.
my old civvie dentist had agreed, following a couple of extremely unpleasant cavity work on my molars, but the army dentist didn't seem to take my story of problems with local anesthetic too seriously. according to her, i should be easy to numb.
she suggested just local.
i vetoed.
the IV sedation is a compromise. it's not really designed for pain control, but it'll probably prevent me from punching out the dentist if the local doesn't work too well.
oh, and i learned i have crappy thin enamel which makes me more prone to cavities, or at least cavities form faster. i hate my enamel.

this is your home
the problem with IV sedation was the escort i'd need for 6 hours after the procedure. i live alone, my friends here are all residents who are not going to get a day off from work to babysit me. on overnight notice, no less.
the army found someone willing to pick me up and deliver me somewhere, but i'd need someone willing to take responsibility after that.
i went to the family med center where i'll be starting on monday, and where the admin for the FM program is located. and i asked the lady who's program assistant if she'd sign the form and let me stay in the library.
she said, "of course. this is your home."
while i was chatting with her, the doctor who's in charge of the program came in, told me that the army had called about me staying there, and informed me that there would be a room with a bed available if i needed it, and that he'd be willing to stay after the center closed if i needed watching for the full 6 hours.
i feel so loved.

i just came back from a spree of buying soft foods. my fridge is now full of ice cream, rice pudding, jello, jogurt, 8L of soymilk in various flavors, applesauce, not to mention the delicious butternut squash soup i got from mom when i visited the last time.
and i have the perfect excuse for frittering the weekend away, watching movies and eating semi-nutritious junkfood.
but then again, i've never needed an excuse before.

Monday, October 25, 2004
01:26 a.m.

i am the bringer of life!

i had the most perfect delivery my last shift.
it was the lady's second child, she had had some demerol but no epidural. she was screaming a bit, and apologizing for it once the contraction had passed, which is just so endearing. i mean, she wasn't swearing, or even shouting very loudly. she wasn't kicking me in the boob, which has happened to me in the past. she was just expressing pain, but no matter how many times the nurse and i and her husband told her it was perfectly ok, she just wouldn't quit apologizing.
she was also in control, and able to follow directions ("don't push!") through the pain. being able to stop pushing is one of the most important ways of avoiding tearing if it can be avoided (and in some cases it can't), because it allows a slow, controlled delivery instead of a tissue-ripping expulsion.
i was able to take my time and gather my wits, to deliver the baby through the nuchal cord instead of clamping and cutting it once the head was out. because of her control, i felt really in control of the arc-like movement of the baby as i delivered it, and i knew, before inspection, that there was no tearing at all.

a great delivery. but what made it perfect, for me, was the obstetrician.
i arrived first, set up, put on my gloves, and started managing the delivery. normally the doc shows up with or right behind me and watches, does some management, maybe gives me pointers (or in the case of crazy church-obsessed doc, starts manipulating my hands and making me feel like a semi-trained monkey, but i'm not bitter or anything).
they tend to let me handle the delivery if it's uncomplicated, but it's pretty obvious that i'm the apprentice and they the big cahuna.
well, that night i was on with cowboy!doc, and when he followed me into the room he stayed out of sight of the patient, letting me be her only doctor. he only became visible to hand me things once the delivery was complete and i was taking the cord blood.

and after the congratulations, for the first time, a new mother thanked me as her doctor.
oh, i got thank-you's before. usually we all do, the doc, the nurses, me. but it's the doc who is turned to first, who's looked at with trust and gratitude that all went well, that baby is lying safely swaddled in the mother's arms.
i'm not sure if i'm explaining myself well. it's not really about glory or gratitude; for one moment in the eyes of this woman, i had brought her baby into this world.
and i'm so happy cowboy!doc let me have that.

money can't buy me love mutsu apples
yesterday we went to our favorite orchard to get apples. my parents like to gather the ones on the ground, which tends to take longer but of gathered carefully can result in apples just as good as the ones directly from the trees at 1/3-1/4 the price.
plus they like the actual gathering.
i was going to help them with their bushels and just buy my own (because "as a doctor you can afford it", teased my mom), but caught gathering fever and collected a half-bushel of various kinds of red apples for myself.
but when i went to buy my bushel of mutsu - oh horror! there were none!
so i determined to pick them myself. and after intensive searching found about 20. i swear, that's all that was left in the whole freaking orchard. i had to settle for my former favorites, golden delicious.
1 and 1/2 bushels for $17. i'm going to get sooo sick of apples before long.

Wednesday, October 20, 2004
02:29 p.m.

junk foods banned from ontario elementary schools

from CTV.ca:
"Ontario's Education Minister Gerard Kennedy will announce Wednesday a specific list of junk foods to be banned from all of Ontario's 4,000 elementary schools, to combat childhood obesity.

CTV's Toronto affiliate CFTO News has obtained the list of banned refreshments and reports that it includes:
*pop
*fruit "drinks"
*sports drinks
*chips
*candy bars
*cookies
*chocolate covered granola bars

Those foods and drinks that will be allowed to stay include: *100 per cent fruit juice
*milk
*pretzels
*popcorn
*muffins with less than 2 grams of saturated fat
*crackers
*granola"

well, yay.
i mean, i'd like to know how the fuck they'll determine which muffins have "less than 2 grams of saturated fat", and i don't think a random cookie here and there is bad, or worse than pretzels and popcorn. and that thin chocolate coating on granola bars isn't the devil either.
sports drinks are also not exactly fattening. still, they're totally unnecessary unless the kid is a real athlete and is actually doing high-end athletics in school; your average child doesn't need that kind of electrolyte replacement.

but something does need to be done, and i'm glad they're doing it. it's disgusting, what kids bring as "lunch" these days. has anyone seen those "yay, you got LAYS!" kid-lunch commercials? potato chips are not lunch, damn you.
i got a sandwich, milk, and a fruit as lunch when i was younger. and when i was older, i followed that same formula, making it myself. in fact, that's usually what i still take with me to work, replacing the milk with water.

wonder if they'll ban that horrid "lunchables" crap.
or chocolate milk. if they banned chocolate-covered granola, they should logically ban chocolate milk. although i hope they won't.

Tuesday, October 19, 2004
07:04 p.m.


and then this hand came out of her vagina and grabbed me!

i've started running again. it's so damned hard to start, but i console myself with the fact that i'm still in better shape than before the last time i started running.
and i was doing good that time. but then came the insane LMCC prep, and then vacation abroad, and then internal med...so many excuses obstacles.
at least my stress-induced weightloss during GI and resp is holding steady.

obstetrics is coming to an end
only two shifts left, sadly. shiftwork is amazing and i shall miss it once i start a regular mon-fri routine.
a couple of shifts ago i was delivering a baby whose arms were twisted in an odd position for delivery, and when i was checking for the nuchal cord a little hand popped out right by where i was holding the head and grabbed my finger. since this has never happened before, the baby's hands usually being folded across chest or abdomen, i freaked slightly and almost dropped the head.
which wouldn't be too bad seeing as baby was still mostly inside mom, but it would've made me look like an idiot before my favorite obstetrician.

my most recent shift was with the weird ("eccentric", according to the nurses) church-obsessed lady obstetrician.
since she's the chief of residents and will get our evals, i was unable to tell her that i do not in fact attend church when she questioned me in-depth about the subject. i told her i go to a local church here, and one where my parents live that i actually attended before i gave up church altogether.
she was very surprised that i didn't know the location of the chapel in the town where the hospital is located (the town i visit for the sole purpose of working a shift and then returning home), and hinted that i should go with her in the morning. a weekday morning.
sorry, lady. i confine my fake church-going to sundays only.
i also listened as she tried to dissuade the son of a friend from marrying in *name* garden instead of in a church, because "god does not live in *name* garden".
good obstetrician though, i'll give her that. annoying as hell to work with because she micro-manages every delivery and tries to physically guide my hands, which i despise, but good nevertheless.

i'm an apple jellybelly
settlers of catan is definitely my favorite boardgame. when the engaged ones visited this weekend we played 14 games over a day and a half, and only stopped because we were tired (and esca didn't want me to catch up, damn her).
i really can't imagine another game i'd want to play that many times almost in a row.
and it's even more fun drunk!
i know how much we played because we kept track with jelly bellies. and although i lost, i could enjoy eating the representations of the engaged ones once they left. mwa-hahaha! i ate your winnings, and now i've become more powerful!

Monday, October 11, 2004
12:03 p.m.

the wiggling toes of PAIN

three deliveries this shift, all boys.
and a boy on ultrasound, costing the mother-to-be a $100 bet.
the last delivery needed forceps to turn the baby, as it was steadfastly refusing to come out. epidural on board, thankfully, because those things are not pleasant.
but even with the epidural, there is a lot of pressure and stretch that the patient feels. i was standing just behind the doc's shoulder, almost leaning against the lady's stirruped foot.
she was a real trouper. no noise out of her whatsoever, even though it's not easy to forcep a baby in the position hers was lying. in fact, i couldn't tell she was in pain in if weren't for...
wiggle wiggle wiggle
every time he applied pressure, her toes, painted deep red and chipped in places, would wiggle. right next to my head. it was cute.

is that a needle in my pants, or am i just happy to see you?
starting in the morning, i experienced several transient episodes of nausea and presyncope. in two instances i had to stop questioning patients and rush to a chair before i dropped to the floor.
the assessment nurse found me after the second episode and accompanied me to my call room to lie down. i was able to talk her out of using a wheelchair, but she wouldn't let me cross the relatively short hallway alone because, in her professional opinion, i "looked shitty."
labor&delivery is virtually awash in gravol, but gravol knocks me out so the doc suggested some IM stemetil. in the ass.
i recovered after that, but 12 hours later my ass was still sore. how do people tolerate those IM meds we prescribe q3h?

and seriously, esca. how is the me-fish? your silence on this matter is...troubling.

Saturday, October 9, 2004
04:54 p.m.

and the lord god said: "let there be light"

OSCE went pretty well. we had 15 min, 3 of which were to be spent on the management plan.
my patient had rectal bleeding, and her psychosocial issue was fear of being undressed for an exam...or for anything at all.
i rushed through the medical issue, not doing a complete history, because i was waiting for the psychosocial issue to be brought up. and i could have taken a full history. i spend a month on GI, after all.

and there was light
the examiner, watching the videotape, questioned me on why i merely skirted the bleeding.
well, i was waiting for the psychosocial issue. i didn't think there'd be time for both.
silence
how did i know there would be a second issue.
everybody knows.
who told me.
i don't even know. everybody knows it, even residents in other programs.
more silence
well, maybe we need to change the scenarios. make some one-issue only.
good idea.

15 minutes is not a realistic timeframe for a brief new-patient medical, social and family history, full history of the presenting illness, discussion the patient's fears about her symptoms in light of her father's death from bowel cancer, exploration of her psychosocial issue and its effects on her personal life, and a management plan. and the evaluation sheet touches on all those points.
i was told that the resident isn't supposed to be able to get to all those issues. and yet, the examiner pointed out that i didn't do a social history, that i skimmed over the symptoms. i did a great job with the fear of undressing, but...
but what? if we're not supposed to be able to do it all, why have it there? why not trim the scenario a bit, throw out the father's death, change the set-up to a known patient who comes in with new symptoms (thus doing away with the whole social/family/past medical history stuff)? it still leaves the medical and psychosocial issues there to explore, but makes everything more manageable.

i'm actually a bit angry after typing this.
this is not graded. it's purely for our benefit, for the sake of practice. and it is good practice; in fact, i wish we had these things more often. but i'm still angry about the set-up, about the unnecessary complexity of a scenario that can't be done in the timeframe given to us.

and i'm glad i was able to enlighten them about the widespread knowledge of how these scenarios are set up. perhaps it will lead to a change. eventually, for the wheels of academia turn slowly.
but i was flabbergasted when i realized they truly didn't know. everybody knows. everybody. honestly, i couldn't say who first told me, the knowledge is just there.
i learned it by osmosis.

Wednesday, October 6, 2004
11:23 p.m.

i could use a pill...

"you can go from week to week,
you can go from year to year,
not a hand placed on your cheek,
not a whisper in your ear.

you can make it through okay,
you can live and laugh and flirt,
it's quite easy in the day,
it's just the nights that always hurt."
- from I Love You, You're Perfect, Now Change

the chibis curled up by my feet today and stayed there for 2 hours without biting. i was absurdly grateful. how sad.

i'm sick and whiny.
the occupational health people at the hospital gave me some kind of vile cough syrup, after efforts to get some from pediatrics failed. was pissed; peds syrups are far less vile.
plus the occ health people looked me with suspicion, as if they thought i was fishing for codeine. hello, idiots? i'm from labour&delivery. if i wanted codeine i wouldn't have needed to come to you.

the night was a total waste. there were a mere two deliveries during the day, no inductions scheduled because tuesdays are c-section days.
which is why i wanted a tuesday.
of course, what i didn't know was that there already was an assistant, an older doc who just comes in to do what is essentially med student-type work and gets paid for it. so i pretty much had nothing to do.
a lady was there to demo a new portable ultrasound that the hospital was considering purchasing, and it was a sucky day for her too. she only got one doc out of six, but she's there for two more days.
she did scan my spleen (normal) and a nurse's gallbladder (sludge).

there was one patient in early labour, so i went to bed expecting to be called sometime during the night. this is what makes getting a good night's sleep so difficult on-call; somehow just expecting to be woken up disturbs rest, even if it doesn't actually stop me from sleeping. i've woken up far more refreshed at home with much less sleep than i did last night with a good 7 hours.
this morning i woke up annoyed, certain that my pager had malfunctioned again and they didn't bother knocking on my door, only to find that the woman didn't deliver at all. meh.
i stayed past my normal quitting time because there was a morning c-section, and i got there before the assistant made it. so he just stood around and did nothing (still got paid though).

tomorrow there's a practice OSCE. in which they'll be taping us.
i don't mind OSCE's, but i hate being taped. i just can't ignore the fact that there's a camera on me. i feel that i have to face it and talk to it.

esca, is the me-fish still alive?

Saturday, September 25, 2004
03:04 p.m.

i have taught you all i know"

thus spake the ob/gyn who likes to teach, asking me to rupture membranes so he won't have to come into the hospital.
of course, i'd already done that under the non-supervision of cowboy!ob/gyn, so i was more than happy to. in fact, i did two this shift.

i also managed to screw the fetal scalp monitor into what was probably the anterior part of the cervix instead of the fetal scalp. it attached somewhere but we got no tracing.
and it hurt the patient when i unscrewed it, so it must've stuck into her flesh instead of the baby's.
oh well. i want to try it again. the concept's simple enough, but she wasn't dilated enough for me to do it comfortably, what with my massive lack of experience and everything.

the screen has "vagina" on it! my virgin eyes!
the hospital recently started blocking some sites, like hotmail. that makes sense, and in fact most hospitals block things like hotmail because there will always be idiots who'll open any attachment in their inbox and crash the entire hospital's system. so i'm not sore about that.
no, i'm sore about the nanny-ware they've apparently installed. teaching!ob/gyn keeps giving me little things to research and i can't find answers because every site that discusses obstetrics appears to have been blocked for "sex content".
this is a hospital. this is not a public library, a school or a daycare centre; only staff have access to these computers. staff who are adults. staff who are health care professionals.
staff who will not experience a mental breakdown if they see the word "vagina".
for crying out loud, we need to sign in every time we access the internet. if there is a problem with people watching porn (i doubt it, the computers aren't exactly in private areas), then it shouldn't be hard to figure out who's doing it. find them, fire them, allow me to read obstetrics journals since my evaluation may depend on it.
this hospital blocked its own obstetrics site.

Thursday, September 23, 2004
12:18 a.m.

of mice and men

there's a tiny mouse living in my apartment.
i've seen it twice, once in the bathroom at night when i was too shocked by the sight to quickly close the door and trap the little sucker, and again yesterday when i saw it make a mad dash towards the locked door of my bedroom when i released the chibis.
it got out by squeezing under the door. that thing's tiny.

today i finally put together my IKEA wardrobe (ah IKEA instructions, all badly drawn with no written explanations, how i loathe thee), and moved the last of my boxes away to make room for it.
of course, i'd found the little sucker's living place. or at least i figure that was it, given the gathering of teensy pellets of mouse-poo. i haven't actually seen the mouse.
if it wasn't so good at hiding i'd just catch and release it. but i can't be bothered hunting it through my apartment, and i won't release the chibis out of the bedroom because then i'd have to deal with their destructive messes.
i think i'll just end up buying some cheap killing trap. i'd feel bad (it is a rather cute mouse, from the two brief glimpses i caught), except i'm not having that thing shitting in random hidden corners of my house.

today was academic day for all first-year residents. they tried to kill us with statistics. i'll probably be skipping the afternoon part tomorrow; there's only so much "relative risk" and "numbers needed to treat" that my brain can handle at one time.
but it's nice to see everyone in one place. doesn't happen often enough.

Thursday, September 16, 2004
01:37 p.m.

asleep at the helm

busy shift, especially during the night.
usually busy means many assessments. but not this time; we had a section, two vaginal births, a pneumonia that somehow managed to circumvent the ER and get onto obstetrics even though her problem had nothing to do with pregnancy, and the drama involved in sending a 34-weeker in labor to a hospital that had an open NICU.
we do have a specialized nursery and can, under some circumstances, take care of those babies. but those circumstances don't include a family doctor on for pediatrics on the day she'd likely deliver.
in a rare moment of free time, just as i was going off to nap, a peds nurse zoomed by with two babies and dumped one on me and one on my staff to watch while she went for a smoke break *sigh*
at least baby slept. and i was jealous, but restrained my mean-spirited impulse to wake it and make it share in my misery.

as well, a post-partum patient almost crashing briefly. she ended up being fine, but for a while there was a real suspicion of a cardiac event or an embolus.
and i was send to her room post-haste because the ob/gyn on call figured i had more recent experience in getting adult blood gases than she did. yay for being useful.

in any case, i was fighting to keep my eyes open during the drive home. the drive's under an hour long and i decided to get on the road rather than crash at the apartment provided by the school for such purposes, but i won't do it again.
i don't think i was in immediate danger of falling asleep at the wheel, but i was very tired and my attention to the road wasn't all that great. in retrospect it was stupid of me to drive.

help me, doctor! i'm urgently infertile!
the ob/gyn on call related the story of a funny consult she received a while back.
it was for an inpatient hospitalized by another service. ok, most services won't go anywhere near the nether regions and will consult those who specialize in it of a problem arises while a patient is in hospital. nothing unusual.
except, of course, the reason for referral. infertility.
that is, of course, an inappropriate referral. infertility is not something anyone needs to be seen for at a hospital. you do not waste a consultant's limited time and patience on something that is so obviously an out-patient issue.
but it also pays to be courteous to colleagues, so she at least took a look at the patient's chart.
this gets us to the reason the patient was hospitalized. acute alcoholic pancreatitis.
yes, that's right. and her chart had a neat little history of her alcohol use. what the fuck are people thinking when they write consult requests like that? i mean, they're doctors. one would hope that they do think.
ob/gyn's reaction: "i'm not in the business of making alcoholics pregnant. consult denied."

"and present it to him like you don't know what's happening"
an hour before shift change, an hour i could've spend sleeping, i'm called to do an assessment.
the first thing i see is the nurses' mildly annoyed faces.
the patient in question was scheduled for an induction yesterday, but didn't get it because it was too busy on the floor. unlike patients in active labour, induction patients can wait so they routinely get send home to await a call-back when the ward isn't as busy.
she came in with exceedingly vague complaints of "feeling unwell", vomiting up her breakfast and cramping, and her description of her pain nowhere resembled labor pains. nor did she have contractions on the monitor, and her cervix was unchanged.
ah, but she felt "unwell", in spite of looking marvellously comfortable.
of course, we realized what was happening. at 0630 there are no patients scheduled for ultrasounds or NST's, it's close to the time when the day ob/gyns take over their own patients from the ob/gyn on call, and there are usually few or no laboring patients.
her wily ob/gyn told her to come in at that time with a BS story full of vague complains, thus assuring that she would be assessed and the case presented to him instead to the ob/gyn on call, who would've promptly send her home. coming in later would be risky because it does get busy.
tellingly, he wasn't interested in her complaints, her vaginal exam, the monitor strip, her general state or anything else when i called him to report my assessment. just ordered the oxytocin. he knew she wasn't unwell or in labor.
and we knew that he knew. i mean, who wakes up at 5am to have toast? bah, i say.

Monday, September 13, 2004
09:41 p.m.

wherein i learn that the uterus resembles a comic-book villain

love the ob/gyn i worked with last shift.

i'm not sure how to characterize him. "cowboy" comes to mind for some reason but is definitely not quite right; nor is anything else i can think of.
he's funny, cocky, and exudes a liking for independence. not just his independence. mine.
as in, go into the patient's room and independently stick a sharpened stick through her cervix.
i'd never ruptured membranes before, but it had been explained to me by others, and i'd seen it done a couple of times. he didn't ask if i knew how to do it, or if i felt comfortable doing it without him in the room. he expected me to go in and do it.
it was very refreshing, after the hand-holding, "stand back and watch me" attitude that many obstetricians in teaching hospitals have.
i did just fine.

he did hand-hold a bit when i had to suture a relatively small laceration after a patient delivered after, i swear, one freaking push.
but after he made sure the hymenal ring was approximated correctly he wandered off. i got to the end and started looking around, not sure how to finish. he came in again and threw a few options at me, most of which i didn't know how to do, so i just picked the one i was familiar with. it ended up looking well enough.

stuffing the thanksgiving uterus turkey
and to top off an already good night - emergency c-section!
i got to assist, which isn't saying much. sections are done by one person, so i didn't do anything more than retract and staple.
and hold the uterus after it was brought out to be closed.
sleep-deprived, it was all i could do not to giggle at it. it looks like a turkey's backside, and the stitches used to close it are exactly like the ones my mom uses to close our holiday bird after stuffing it.
it only lacked a pair of wings on the sides to make it perfect.
i finally told the doc what i thought, but he disagreed.
in his view, the uterus looks like some comic book character called "mucus-face".

during the section, we somehow got to discussing having kids. like most people he assumed i would be having them in the future, but unlike most he didn't patronize me when i told him i wasn't planning on it.
doc: "hmmm, good idea. i decided not to have more after i found out how much work it was."
nurse: "after having three."
doc: "yeah, well, after i figured what was causing it i stopped."

Friday, September 10, 2004
10:19 a.m.

damned obstetricians. they're like...octopi

the difficulty with being a first-year resident with scant knowledge of obstetrics, working shifts with different attendings every night, is that none of them trust you at first.
if they're not occupied in the OR or mowing their lawn, they'll rush into the assessment room, stick their tentacly appendages into every single patient in 5 minutes flat, and leave you with nothing to do.

eventually last night's attending warmed up to me and allowed me to do two deliveries on my own, while he hovered behind me.
it's hard figuring out how they want me to act. one of them constantly quizzes residents and wants us to get involved. one will teach if we look interested, but is more stand-offish. tonight's seems indifferent to residents, but will teach if asked specific questions, and will let me near a patient if i'm pushy enough. there is one who dislikes residents and, having been warned beforehand, i didn't schedule any shifts with her. and i haven't worked with the other two yet.

show that baby who's boss!
yesterday i saw my first forceps delivery. and of course, as with all the more difficult deliveries i've ever seen - no epidural.
the baby just wouldn't come out from behind the symphysis, and the doc eventually attached the vacuum. still no budging.
she let her push some more, but finally had to go for the forceps. and then she pulled.
and pulled.
and pulled.
seriously, i wonder how the baby's head stays attached. the mother was being pulled off the table by the doc, and baby still wouldn't come.
at that point, the husband started crying and had to leave the room.
she ended up with an episiotomy, and even with that had an extension tear.
it always, always amazes me how new mothers seem to forget pain as soon as the baby is given to them. heck, sometimes if they're in too much pain right after the head is delivered the doc will ask them to look down and see the head, and they'll usually stop crying and start babbling in baby-talk. this lady had a partial third-degree tear, and i swear the doc didn't even need local to stitch it up; baby substituted nicely for pain meds.
ah, as for baby, he ended up being nearly 10 lbs and the mother was a relatively tiny woman. no wonder he wouldn't budge.

just reach in and pull it out!
another teen, this time 14 yrs old. man, that's depressing.
also no epidural - the teens rarely get them, i think they fear the spinal needles. they're young and their tissues are stretchy enough that many of they don't even require stitches with semi-uncontrolled deliveries, but they do not tolerate pain well.
this one, in addition to the usual kicking, actually rolled off the bed sideways and tried to get away.
her grandmother was a most...enthusiastic...birthing coach, however. every time mom screamed that she's in pain, gramma would yell happily, "i know, i know, i was too! this is nothing, it's gonna get worse!"

Monday, September 6, 2004
11:13 p.m.

where did all the pregnant women go?

is what i asked the charge nurse at around 2100 yesterday, 13 hours into a 24-hour obstetrics shift and with two assessments (no admissions) behind me.

obstetrics is very, very boring if there are no labouring women on the floor. our call room has a cable-equipped TV, but it's a small, stuffy room and i don't like staying in it too long.
the internet-enabled computers by the nurses' station are fucking slow, and there is a constant audience of bored nurses besides (they, too, have nothing to do if no patients are admitted).
and there's only so long i can read lange's without passing out.

in the morning there were a couple of ER "consults" for missed abortions, but those aren't really what i think of as actual consults. just a brief history of current and previous pregnancies, and a snapshot of medical and family history. the rest is done by the u/s tech, or by the obstetrician if it's a weekend/night.
in fact, one of them was a six-weeker, so with the rather limited equipment available on the weekend we weren't even able to tell if the thing was viable or not. the doc whispered to me that it probably wasn't, but he wasn't sure. she will need to come back in a few days' time for a proper scan.

one delivery early at night, half an hour from assessment to birth. too late for an epidural, but she had obviously taken prenatal classes and dealt with it pretty well. she did scream a bit, of course, but apologized endearingly every time, and once more after it was over. really cute.

and then, in the wee hours of the morning, all hell broke loose.
at 0630, an hour and a half before my shift ended, i was called to assess two patients. another one arrived in the assessment room just as i got there.
i finished with one, got her admitted, called the doc as she seemed very close, and went to the next in line.
just as i was done with that assessment, the doc walked in...and at that moment we were both called for delivery of the first patient i saw.
another one too late for an epidural, but this one didn't take it that well.
although she was still better than the woman on my very first shift, who actually refused an epidural and then tried to squirm off the table when the baby was coming. took three nurses to hold her down, and she still managed to kick my left boob several times (the doc was staying far back on that one).

in any case, the baby finally came. but the placenta did not, and had to be manually extracted.
manually extracted. from the uterus. without epidural on board.
not pretty, trust me.
and while i've never found placentas to be, ummm, aesthetically pleasing, never have i seen such a mess as the extracted one. ewww.

by the time we were done, one of the assessment nurses came to tell us that the patient i didn't get to assess was in active labor, the one i assessed was dilating further and wanted a c-section, and the one who was induced the night before was sick of laboring and wanted a section as well.
but my shift was over, and i got out of there. labor day, heh.

Tuesday, August 31, 2004
08:08 p.m.

endings

i am done with internal medicine.
ok, i am done with internal medicine until march, at which time i will enter the hell of general IM (multipy number of patients, multiply their problems, subtract number of residents, and you get genIM).
but march is far away, and i have uncanny abilities where the ignorance of far-away unpleasant things is concerned.
after all, i managed to ignore my CaRMS application until it was almost too late.

aaahhh! you jinxed us!
since it was not only my last day of resp but also the senior's and the other R1's (the clerks will switch over in another 2 weeks), the senior, W, took us out to lunch. she got another team to cover us for an hour, and figured that with our low number of floor patients we'd be done rounding by 1000, do our discharge summaries, and go eat at 1130.
the stepdown patient decided to crash at 0815.
by the time he was intubated and on his way to the ICU it was just after 1000. we rounded individually and went to eat.
W was paged twice during lunch, about new admissions. this was unprecedented; over the whole month we only had one direct-to-floor admission (most patients go through the ER and are sorted out by the IM resident on consult), and now these two appear during our only out-of-hospital lunch.
seriously, the powers that be hate any kind of well-laid plans.

when cardiologists attack
tuesdays are EKG rounds, where the seniors bring out some interesting EKG's and make one of us go through them. the formidable and scary Dr. M is there as always, but a couple of cardiologists attend on tuesdays only.
probably so they can battle each other.
it's kind of funny. they sit at the extreme opposites of the lecture theatre and try to out-do each other by re-interpreting each other's re-interpretation of the resident's interpretation of the EKG in question. we juniors usually lose them by the first re-interpretation, but i think some seniors manage to follow until the re-re-interpretation.
by the end, though, we're pretty much all glassy-eyed.

the EKG's vary in difficulty, from the arcanely unusual to the dead-simple. today we had one of the former and one of latter, a classic ST-elevation MI.
after the victim resident went through it and figured out which part of the heart was affected, the resident leading the rounds asked if there was anything else one could do.
his hand moved across the table to grasp another transparency.
one cardiologist stirred.
Dr. X: "there is of course no need for a posterior-lead, 15-lead, 47-lead or anything else. all the information you need is right there."
resident, coolly putting on transparency: "you could get a 15-lead while waiting on the cath lab. but don't do it if Dr. X is around."

the miracles of modern medicine
after lunch, i returned to finish my discharge summaries. i was post-call, but it had been an exceptionally quiet night.
so i decided to wait until later in the afternoon and attend the family meeting where our attending would inform the children of my patient that she was practically at death's door.
the lady has some kind of aggressive, probably metastatic malignancy, but she is already far too wasted to be able to tolerate the tests we'd need to do to identify it, much less to survive the treatment should any be available.
every breath is a fight for her, not because she has anything in her actual lungs but because her muscles of respiration are too wasted away to do their work.
she can not swallow her medications. she has ordered us to pull her feeding tube.
her children were not shocked. they could see what was right in front of them; they were resignedly grieved and stoically level-headed.
i made the necessary calls to transfer her to her home city, to be closer to her family. we can do nothing more.
she came to us not for a cure but for a diagnosis, and we can't even give her that much.

Sunday, August 29, 2004
07:21 p.m.

...and that's what it's all about.

second-last cardioresp call: endless calls about chest pains that turn out to be nothing, medication clarifications which the teams should rightfully handle in the morning, being paged for "family meetings" with the anxious and/or self-important family members of off-service patients that i don't know from a hole in the wall (is the patient stable? yes? ok, tell the family to set up a meeting with the cardio resident or staff tomorrow. no, i don't care how far they drove/flew/swam to be here tonight. no, i don't intend to come down and see them. goodnight), code blues in the ICU which we humble floor residents don't get to attend, the inevitable and pointless questions which arise after every single nursing shift-change.

and an acute ischemic leg.

it was a beauty. it was what call should be all about. it was a chance to manage something none of us have actually seen, a chance to frantically look up the fairly scant information on managing vascular emergencies that we have access to, a chance to fiddle with bedside dopplers in a heroic attempt to get a pulse on the non-affected leg of this obese and significantly edematous patient, to practice our focused clinical exam, to theorize about the etiology based on the patient's history.
it was exciting. it was collaborative - the resident covering vascular came with her clerk, and the cardio senior, seeing the general excitement from his perch in the CCU, joined our little group as well.
it was educational, not only our own on-the-go information-gathering, but the tiny (well, he was in a hurry) impromptu teaching session the vascular staff gave us when he arrived to whisk her off our collective hands.
it was over well before midnight.
i'm not kidding. this call rocked.

what the hell IS that smell?
i must've gotten used to it when i was on GI. i don't remember is being like this.
the cardio and resp wards are on the third floor, the GI ward and call rooms a few floors above; call rooms and cardio being on opposite sides of the hospital.
in order to avoid being seen on the resp ward at night after yet another chest pain call (nurses will find something to ask you if you're seen. they always, always will, even if it's non-urgent, even if they never would've actually woken you up for it. the key is not to be seen), i go up to the call room floor and then have to cross the GI ward to get to my room.
when i was on GI, sure, i noticed the smell when a patient puked or otherwise soiled him/herself in my vicinity.
but good grief, the whole ward is permeated by the constant, low-level foul stench of various human secretions. how do people manage to stand this?
how did i?

Thursday, August 26, 2004
06:13 p.m.

so do i have to get married in 1 or 2 years now?

esca's sis got married last saturday.
it was a very nice wedding. the ceremony was catholic and i expected it to be overlong and boring, but the priest actually had a sense of humor and gave a relevant and sometimes funny reading, and it went fairly fast.
when my cousin got married in poland a couple of years ago, the reading was all about the mother of god and how jesus loved her and performed miracles for her and so on and so forth. not much relevance to marriage that i could discern, and sooo freaking long. esca's sis was lucky with her priest.

the reception was beautifully appointed, the food was good, the bar was open, and the old folks made a beeline for the exits as soon as dinner and speeches were over, leaving the young'uns to our blasphemous dancing. it was fun. i caught the bouquet, after the first throw dashed it against the ceiling.
the bride looked beautiful as well, especially when she was running. away. from the dancefloor. which she did a lot.
but her dress was cut in such a way that she looked very pretty when she ran.
esca made her own dress and it came out looking very good. all the charred bits were hidden ^__^

and now i'm back on resp. wah wah wah.

random meeting at the tuck shop
my senior: "i need chocolate for this PICC line i have to cancel."
me: "i need chocolate for the family meeting i'm going to go do."
random R2: "i need chocolate for this consult."
thus reassured that we were not, in fact, consuming junk food for the wrong reasons, we each paid up and went our separate, chocolate-munching ways.

Wednesday, August 18, 2004
05:40 p.m.

"God will never take me alive!"

no idea who to credit the above to, but i found it funny.

so today, after running errands for myself ("oh, they gave you a men's jacket. why did they do that?" "..." "you'll just have to return tomorrow, we'll exchange it for you." "!") and the boy, i found myself contemplating suicide.
or rather, the one time i thought of it.

and it was to be out of spite.
i was about 12 yrs old and in my rebellious, anti-social phase (now, at 26, i can be as anti-social as i want and nobody thinks that's "rebellious". life's not fair to 12-year olds), and i don't remember the exact circumstances.
probably something to do with visitors with age-matched kids coming over, and my mouthing off that i hated whoever those kids were and that i wouldn't let them in my room. in any case, i ended up in the bathroom, cleaning it (not as punishment; it was my routine chore) and staring out onto the concrete 4 floors below me, thinking something malevolently childishly stupid like "mom will be real sorry when she finds out i'm dead."

i don't think i was particularly serious, but i do recall that my suicide-will-punish-her thoughts went on for a while, and that i locked myself in there and cried. mostly out of frustration at having to face other people, i guess.
my brother had a more normal rebelling period, although his went on longer. he yelled and threw things and painted his fingernails black and stayed out all night.
me, i just wanted everyone to leave me the hell alone.

in any case, my cat had jumped out of the window a couple of weeks before that, for reasons far more amorous than teenage rebellion. we found him and his lady curled up together in the parking lot, and didn't even realize at first that his leg was broken.
he didn't complain that much.
but by the time i had my little bathroom fit, he was walking around with a pretty red cast. i decided breaking my leg just wasn't worth whatever it was i imagined leaping from the window would gain me, cleaned the damned washroom, and probably behaved inhospitably to our guests.

i suppose i didn't have an overly dramatic teenhood. about half an hour of thinking about suicide to punish my mom for inviting people over. not bad, considering.

esca still hasn't replied to my frantic email, asking if she's coming over tomorrow or not. i was going to treat her to a spa massage, but if she can't even be bothered to share her plans with me...
i know, i'll kill myself! that'll teach her.

Tuesday, August 17, 2004
02:46 p.m.

one dress?
don't tell me you've forgotten to make my dress?
cause i really doubt sis will be impressed when i show up in jeans and a t-shirt. get thee to a sewing machine, chop-chop!

Monday, August 16, 2004
06:37 p.m.

266 bottles of alcohol on my wall...

i started collecting miniature liquor bottles maybe 6 years ago.
now i'm at the point where i already own all the bottles i could buy at the local liquor stores, not counting the vastly overpriced holiday/theme specials they come out with once in a while.
i have bottles from canada, the US, mexico, cuba, jamaica, germany, france, poland, scotland, finland, korea, china, japan, russia, belgium, denmark, italy, portugal, spain, and probably others i've failed to mention.
i blew nearly my entire non-essentials budget on them while on vacation in the czech republic. the friend i went with was astounded and terrified.
and during my first time in korea (on the recent trip i wisely kept to the airport and other tourist traps) i nearly drove esca crazy by insisting that she ask for them in every place that even looked like it had alcohol.
we eventually found a lady in a cosmetics shop who was willing to bring some miniatures she had at home and sell them to me.
i don't think esca was impressed.

my collection was inspired by a friend of my parents', who has a beautifully appointed bar in his basement, and a huge collection in permanently sealed display cabinets installed along the walls.
i dream of one day amassing a greater collection than he. he travels a lot, but i have friends! friends who travel and are always forced happy to bring me some local beauties.

garage sale of drunken fun!
to continue with the theme: this past saturday my father held a garage sale. i drove down to help set up (and bring some junk i wanted to get rid of).
not much to tell, except that the money from the sale all ended up being spent on liquor. it was a heart-warming family get-together, as mom, dad and i rushed bright-eyed and cash-laden to the local store, figuring out who may buy what so we wouldn't go over our garage-budget.
i got a bottle of bailey's. yay me.

and now to continue my vacation with...
there are annoying little things i need to do, which are hard or impossible to get done while i'm working. arranging paperwork for my promotion, getting my uniform, buying furniture, finding a good place for the pre-wedding haircut.
stupid, annoying, necessary things that i will do during this "vacation", while i'm thinking of how else this precious week could've been used if i'd taken it at some other time.
i think i'll get a massage. there is a spa close to my place, and i've never had a massage. i'm on vacation, damn it. i deserve some fun.

Thursday, August 12, 2004
08:00 p.m.

and the award for the most unfortunate vacation scheduling goes to...

well, it was my scheduling choice.
but...but...i didn't know! how could anyone guess?
my current service, respirology, as of tomorrow will have four active patients.
four active patients.
FOUR! active patients.
this, with a senior, two juniors (well, one with me gone), and as of monday two clerks.
this, with our senior on ER duty over the weekend, acting as gatekeeper, funnelling patients away from our service.
this is what i'm abandoning.

our cap, as that of every other subspecialty, is 18. most are running at 20; GI, my previous rotation, had 25 this morning. all week (we started with 9 on monday) we were waiting for the hammer to fall, for the other services to wake up and start demanding we take more cases.
imaginary referring resident: "you have no patients! take this patient!"
our intrepid senior: "but he has renal failure and liver cirrhosis and angina! WTF!"
imaginary referring resident: "also, a cough! he clearly belongs in resp!"

but it never happened, and we just kept discharging and discharging, until we end up where we are now.
seniors take turns in the ER, and decide which services to consult about incoming patients. seniors, of course, will do anything to keep patients away from their own service, so that they don't have to deal with them once they return to the ward (and to make the attending happy).
so it's a given that we won't get a crazy influx over the weekend. she will, naturally, refer clear resp cases to resp, people with COPD exacerbation or malignant effusions or whatnot. but we don't have to take pneumonias, for example; any service should be able to treat pneumonia.

hot potato!
patients don't realize what goes on behind the scenes when they have to be admitted. unless the case it very clear and there's only a single problem (MI to cardio, COPD to resp, renal failure to nephro) there's a virtual war about admitting the patient to a given service.
nobody wants patients. and if the patient in question happens to be frail, elderly, with multi-organ disease, the various services considered for admission will beg, threaten, and cover behind their caps to avoid getting saddled with them. it's funny and frightening to watch: sometimes it will get as high as the attendings, and sometimes they will yell at each other.
that's why so many patients end up in the dumping ground of the hospital: the general medicine ward.
ER resident: "so, we're giving you this patient because he's short of breath and..."
resp: "that's because he's got congestive heart failure. that's cardio!"
cardio: "oh yeah, well his kidneys are failing. call nephro."
nephro: "for fuck's sake, have you seen his bilirubin level? why wasn't GI consulted for this?"
GI: "that bilirubin is due to cancer. here's the pager for the heme/onc resident. bye."
heme/onc: "my god, we knew about this cancer. it's being managed as well as it can be, and it's got nothing to do with his shortness of breath. can you idiots in the ER do nothing right? here, i'll call resp for you."
IM resident (who sees it coming): *sigh*

eh, yeah.
in any case, i'm off. for 10 days.
and maybe i'll get to see a kinda-traditional korean wedding. esca's sister's getting married. esca had to find little white...collar thingies for her dress when we were in korea.

ah, and we played medical jeopardy this morning at sign-in. the formidable and scary Dr. M, who runs them, divided us into seniors and R1's. seniors won by 200 points - but not really!
one category was spelling, and i answered one of the questions (the name of the BP sounds, and spelled correctly). his correct answer ended in "v"; i'd spelled it with "ff".
after consulting with my fellow residents, and the bible harrison's, i and my senior tracked Dr. M down in his office to claim victory for the juniors - i did so spell it correctly! i may not know any medicine, but damn it, i can spell!

Sunday, August 8, 2004
11:44 p.m.

"go west. like saiyuki"

such were my directions for home, after spending the weekend with the engaged ones.
i meant to leave earlier (oh, like then the sun was still up) since this was my first time driving there and back, but i got sucked into playing settlers of catan.
for at least 5 hours.
straight.

esca has a lieu day tomorrow so she can recover from the alcohol game, but i have to get up ridiculously early and go to work. where they'll give me at least two new patients. whinewhinewhine.

and god, that coffee is still in my system. i won't be able to sleep!

Friday, August 6, 2004
07:00 p.m.

and then there were two

the cardioresp R1's call room has its own bathroom. the medicine subspecialty R1's call room does not.
annoying calls about chest pain notwithstanding, i think this will help me survive the next month.
well, and that one-week's vacation won't hurt either.

actually, respirology is pretty damned good. i currently have 3 patients. 3!
that's unheard-of. but we went into a discharge frenzy early this week, and the service is down to 12 patients. we shall, of course, fill up again. but it was oh so sweet while it lasted *gets all choked up*

last night i took my very first cardioresp call.
this involves carrying 3 pagers - my regular one, the backup one, and the code pager. i was having trouble keeping my pants up, damn it. 3 is a good number for the patients i have to carry, not the freaking pagers.
no codes last night, although i did read up on protocols just in case.

had another death, on cardio. another palliative patient, whose next of kin had to be awakened in the wee hours of the morning and informed (i did not, however, repeat the mistake of calling the family doctor at night).
another cornea donation secured.
another mound of paperwork slogged through.
it is very, very easy if the family's not there, if they sound...well, relieved isn't the right word exactly, but grateful that the patient went in her sleep, peacefully.

it's really just a matter of paperwork. i didn't even know the patient, i never saw her when she was alive. i was merely there to put some things in order, to take my best guess as to the cause of death (that is often a difficult task with elderly pallitive patients), and to sign the forms that would allow her body to be moved on to its next destination on its way to the grave.
except for the conversation with the next of kin, i was yawning through the whole thing.

i dont think i grew jaded to death between my first and second time. it's just that this one was so very easy.

tomorrow (yay free weekend!) i'm off to visit the engaged ones, if esca gets around to supplying me with her new address.
surely she just hasn't gotten around to reading her emails.
surely she wants me to visit.
hmmm...

Thursday, August 5, 2004
02:45 p.m.

rabid feminist idiots who need to be shot

my mother is a counsellor at an abused women's shelter.
such places tend to be run "democratically", non-hierarchically (although there is a supervisor and director, the trend is towards "consensus-building"), and above all, non-confrontationally.
all this sounds good on paper, but in reality it turns too often into a model of abdication of responsibility, and fear of confronting others for their mistakes. not only in shelters, and of course i'm not claiming that it happens in all shelters - although it happens in enough. these places tend to draw overly politically correct, overly touchy employees, overly concerned with never offending their fellow sisters even to the detriment of client care.

on to the story. a woman came into the shelter after being released from a night in jail for assaulting her husband. he allegedly tried to choke her, and she defended herself, scratching him. when police arrived, he was the only one with marks of violence on him, and she the one who was arrested.
fair? no, of course not, but that's merely background.
one of the conditions of her release was that she could see her child only in the presence of a third party. the husband was given temporary custody.

the lady is a recent immigrant, and not very familiar with our country's laws. she originally went to a homeless shelter, but was transferred to my mom's shelter, so she could get better services.
so what did the two rabid feminist idiots do? why, they convinced her that she "had her rights", that she should take the child while her husband was out of the house and bring it to the shelter, in violation of the court order.
and she, not knowing any better and listening to the "experts", did just that.

soon enough police in three cruisers arrived at the shelter, ripped the crying child from her arms, and arrested her for kidnapping. severe, yes, but that's the law and none of it would have happened it she wasn't told to break the law.
she is now jailed for a month, and has a snowball's chance in hell of regaining custody. some shelter workers came to her arraignment, when the judge asked if she had someone to provide surety for her. she looked hopefully and expectantly at the workers, who of course could do nothing at that point.
i wonder why they even bothered to go. to gawk at their handiwork? to give her false hope of rescue?

in short order, the ass-covering-up began.
one of the two was initially apologetic, accepting that it was her fault. she was quickly talked out of it, a "teambuilding" meeting was called, and it was made clear that the most important thing for "the team" was to lay no blame where it clearly belonged.
at the meeting someone raised the point that perhaps a case review could at least be undertaken, to provide some structure and guidance so idiot employees would at least have to consult with someone higher up before they gave idiot advice.
no, the executive director said, they have decided to institute a policy of not opening the door to police unless they had a warrant.
what the fuck will that accomplish? they HAD a warrant!

and in a beautiful moment of sisterhood, the director also said, "don't worry about the woman, she is taken care of."
she is taken care of.

i feel the urgent need to stab something.

Wednesday, August 4, 2004
08:59 p.m.

wait til she can stand up, and turf her before she collapses

this month i'm on respirology; just enough time to get used to one service, and then the switch.
i don't mind resp, but it's slower than GI, more elderly long-term patients who decondition in hospital and must be somehow returned to a semblance of strength. enough to be able to leave. as my senior told me, "we're not running a hotel here".
and yes, quite true. there is a shortage of beds. all internal medicine services are running over their caps. this is not a rehab facility.

but there is also a shortage of chronic care beds. wait times for nursing homes are announced in terms of months. shorter-term rehab facilities are overbooked. community care can't keep up with demand and cuts services: is a once-a-week visit to help with a bath and groceries enough?
onto this picture superimpose a frail, elderly patient with a progressive chronic disease, helped up to the washroom mostly because nurses want to avoid falls, seen by physio for perhaps 30 min each day. she lies in her bed or sits in her cushioned chair most of the day because that's easiest, for her and for the staff. her meals are brought on a tray, and the tray is taken away again. her meds are given like clockwork, without her needing to worry about it. her family visits her, sees her dwarfed by the cushions, weak from whatever event brought her into hospital.
how can she possibly be discharged? just look at her!
and yet she will be. and soon. because we can't do anything more for her medically, and her recuperation (should she ever fully recover) will take weeks if not months. and these are weeks she cannot stay here, taking up an acute-care bed.

today i had another of those conversations with my patient. empathetic, diplomatic, but firm. we are having a family meeting tomorrow. we are working on a discharge plan.
we want you to leave.
deja vu, and not a pleasant one, since the day after my last similar conversation with a patient in a similar condition she fell and lacerated her head. she's still there on the GI floor, with physio frantically working to make her ambulate independently; to make her barely well enough to finally leave.

and the paperwork, the supportive services, the calls to community care and nursing homes, all that eating into the days i should be learning medicine.
you will need to know this as a family doctor, they tell me, assuming that a family resident doesn't have as much right to bitch about it as certain other subspecialty residents stuck in internal along with me do.
but no. no, i intend to go career military, and that is the point. i will not have to deal with this. i don't like dealing with it, and i don't intend to burden my future with it. it holds no interest whatsoever, and the sheer amount of bureaucratic hoops i must jump through sucks away any empathy i have for these patients. they take up too much of my learning time.
i want them to leave.

on resp, my senior is female. she's very nice and helpful, understands that i don't yet know about about service-specific things like ordering home oxygen.
she's more reserved that my GI senior, but certainly also has a sense of humor.
but again, i feel that i get along better with men. there's just this sense of easy cameraderie, a sense i feel even around male staff, a sense i don't really have around women. even women i like and admire, and would like to model myself on. even though my closest friends are all female.
it may very well be why the military attracts me so strongly.

Sunday, August 1, 2004
02:13 p.m.

my first death

tonight, for the first time, i declared a patient.
she was from a service i was cross-covering so she wasn't technically mine. she was palliative, so it wasn't a shock. but still, my first.

it was hard dealing with the family, even though i recognize that this was probably as easy as it gets. they were prepared, she was comfortable. they were teary-eyed but stoic, and they asked sensible questions which i was able to answer.
i wish i had known them and the patient. as it was, i came on, skimmed the chart and went in there, a total stranger to the deceased and the family. how much better for the family it must be to see a familiar face at a time like this.
i muddled through it as best as i could, and i think i did well enough. i felt like an impostor actually, until i broached tissue donation, which was accepted. then i felt i had a role, explaining procedures, seeing that this may do a tiny part towards helping them deal with the death.

not surprisingly, in our bureaucratic society a death engenders a slew of paperwork; donation procedures doubly so. paperwork i'd never done before.

actually, i was so frazzled by the end of it that i forgot the rule of not calling the family doc about an expected death until the next day, and made the call in the wee hours of the morning instead. it was on the sheet - notify family doc. i was on sheet-following autopilot by then. but honestly i didn't even think i was calling him, i thought i was calling his answering service.
yes, so i got yelled at for interrupting his "first good night's sleep in so-and-so many days." i could empathize, being sleep-deprived myself. i apologized abjectly and explained that it was my first death, so he stopped yelling and merely reminded me harshly never to do it again.
sigh.

not a good call night, in other words. dealing with death isn't up there with "good" learning experiences, but at least it's a necessary one.
but being yelled at by the end of it, after dealing with the pronouncement and its attendant paperwork for a good 3 hrs on about an hour of sleep in the last 24, just totally did me in.
at least i got to do my first central line, albeit on a dead patient (donor people needed blood samples).

and tomorrow i'm on again, with another oncology patient hanging on by a thread. i feel horrible about even thinking it, but i'm hoping he goes before i start my call.

Friday, July 30, 2004
06:31 p.m.

internal medicine's most dreaded phrase

interesting case.

in the parlance of internal medicine, this translates to something like "WTF is going on with this patient, and why is it getting worse?"
i have one interesting case right now. interesting and complicated (another dreaded phrase, usually meaning "consult other services on this...no, i don't know which ones"), now followed by us, ID, surgery, interventional radiology, and supportive services like nutrition. we all have pieces of the puzzle, but try as we might we just can't fit them together.
we have begun theorizing that perhaps it's pieces of several different puzzles that we're holding, and jamming them together to see the picture just isn't working.
the most "interesting" aspect of the case appears to be resolving on its own. we spent i don't know how much money on fancy tests and imaging to find a cause for it, but have been unsuccessful. now it may go away, and we can only hope it won't recur.
the rest, we'll soon leave to the surgeons. our part is done, or possibly too interesting to continue. we don't know.

for surgeons, interesting and challenging is not a mortal blow. it tends to refer to the technical difficulties of the procedure, rather than to the general cluelessness of what's ailing the patient.

i've had another interesting case, since discharged. we followed her odd bloodwork right to the top, to that most unpleasant diagnostic procedure, the bone marrow biopsy. we involved hematology and oncology, and ID just to cover our bases.
and nothing. or perhaps many many little things, slowly getting better on their own, too small in and of themselves to be found as sole or significant contributors.
she got better. she went home. i laboured over the discharge summary, to justify so many tests for so little gain.

"Medicine is the art of entertaining the patient, as the body heals itself."
-Voltaire

other medical terms, just for fun:
functional - we have not found a cause. we blame your body.
psychogenic - we have not found a cause. we blame your mind.
iatrogenic - we have found the cause. you're looking at it.
idiopathic - not only have we not found a cause, we've given up looking and tried to make sure no one ever looks again.

Wednesday, July 28, 2004
03:10 p.m.

huh. well, of course you don't cry over patients. after all, they're not chain-smoking anime bishies or reindeers.
btw, did you get my email? the one about you still paying for electricity over here?

the proverbial straw

yesterday i was post-call, and it should've been a good day. i got more sleep than on my last call, enough to at least run some necessary chores before collapsing.
i was ready to take on the world (or at least tackle the buying of a bed).
but first, i needed to check email. so i turn on my wonderful, recently diagnostically cleared computer, and...
nothing.
and more nothing.
and still nothing.
damn thing couldn't find its boot record, or whatever. i found its boot record (well, its backup disc) and re-installed my OS, knowing full well that all i had would be lost. but since the last (me-induced) crash there was really nothing vital i needed to preserve.
it seemed to work.
only...it didn't. it refused to recognize my second hard drive, refused to let me re-install sympatico, plain refused to work.
so i had to take it to the computer people, with whom i was already furious for giving the thing a clean bill of health not two weeks ago. if it is a motherboard problem i'm not paying the fuckers, since that's exactly what i told them to rule out in the first place. which they did.

by then i wasn't feeling up to bed-hunting. it's the little things that can turn my mood sour like that, especially when i have free time. it's a feeling of failure, and a reluctance to start anything new until whatever caused it has resolved. it paralyzes me.
not at work. today, in the hospital, i feel just fine. i'm doing my work, cursing family doctors' offices which all apparently close on wednesdays, mentally wishing vengeance in the form of crampy diarrhea on whichever wily resident admitted a heme/onc patient to our service (attending: "so...why is he under GI?"; yours truly: "ummm, he has...gallbladder...problems"; attending: "yes. the problems are cancer. why is he under GI?"), generally going about my business with my usual attitude of hatred for hospital paperwork and endless bureaucracy.
it's when i have free time and some plan doesn't work, or some unforeseen annoyance (god i hate computers) comes up, that i freeze. it's when i can't immediately fix it myself that it ruins whatever remains of the day.
it's just this feeling of...something unfinished, hanging over me. it's supremely annoying.

Sunday, July 25, 2004
10:34 p.m.

on death and dying

i have not been personally affected by death since the time my baby sister died of an anaphylactic reaction to penicillin.
of course, i didn't know why she had died, not then. for years, i had a vague idea that it had to do with "bad medicine", but no specifics.
nor did i ask, even once i was old enough to understand the cause. i suppose by then i wasn't overly interested.

she was a baby, pre-crawling stage, pre-personality; or at least, she had no personality that i, as a young child myself, could discern. our interactions with her were limited to rocking her and watching the stroller in the garden while mom was cooking or cleaning.

we were coming home from school when we saw our grandfather by the big trashcans in the front yard. i can't remember if he was crying at that time; i don't think he was. i remember very clearly what he said: "a horrible thing happened in the house. *my sister* has died."
i remember i burst into tears, suddenly and explosively. i believe my brother did as well. we raced up the stairs to our home, and most likely threw ourselves at mom. maybe at dad.
i don't remember anything after that.

i think we might have been taken by friends. we probably didn't stay in the house; my mother would've been in no shape to look after us. i remember not understanding, at some later point, why there was no special dedication for her at mass, and being told that at her age she didn't need one, she was an angel already.
i have many vivid memories of my childhood before her. it's not that i was too young to remember. but i don't.
she was too young, really, to matter. too young to be a play partner, too young even to get into trouble. to me, at that age, she was a non-entity, and truthfully i cannot even remember her face.

when we visited her grave the last time we were in poland, i tried to remember, and i tried to cry for her. but i couldn't. instead, i cried for my mother who stood beside me, swept up in grief.
and while i cried for her, a little part of me called me disloyal, that i wasn't crying for my baby sister.

that is my only experience with sudden, close death. my grandfather died eight years ago, while i was on an army course. my parents called to tell me. i didn't cry; i went to my room and reminisced about him, and then continued studying for next day's exam.
he was over ninety, fully competent mentally and physically until about a week before his death, and he died an expected death at home with his wife and priest in attendance. we should all be so lucky.

my brother did experience death up close, at an age when it could, and did, scar him.
he went boating with a friend of the family and his child, at a time of year when it was fairly cold. the boat somehow capsized and all three ended up in the frigid water; only the small child was wearing a lifejacket.
the family friend was unconscious, and sinking. my brother, studying to be a lifeguard (i think he was at the bronze medallion level at the time), tried to help. but he didn't have enough skill yet, the man was too large, the water too cold, and the clothes and shoes too hampering. my brother saw him sink, and barely made it to shore himself.
he quit lifeguard training immediately.
to the best of my knowledge, he never again swam in open water.

so i count myself lucky for my lack of experience. and yet i wonder if i'm missing something, not the experience but the proper reaction to death.
now that i'm a doctor, i have patients who die. my patients. and yet i remain fairly unaffected emotionally. not cold, exactly. i empathize with the family's pain, the patients' fear if they're not too far gone to feel it. i don't want them to die, or alternately i want them to go quickly and peacefully if go they must.
but i don't think about it afterwards. i don't go home and cry. i don't feel the need to "talk about it" with a senior.

i'm sure i'm not the only one. i've never run a code, but i've spoken to those who have. usually, the patient dies, and we're prepared for that ahead of time. we know the statistics.
to my knowledge, nobody breaks down in tears, bangs on the patient's chest begging them to live, keeps going with the resuscitation after being told to stop. this isn't ER.
when asked about the results, the doctor in question will invariably shrug and state the the patient died. matter-of-fact, without pausing for a sad shake of the head; that's reserved for families of the deceased.

i kind of wonder if it's different in pediatrics. somehow, i imagine it is.
i wonder if i'll feel the difference.

Wednesday, July 21, 2004
07:48 p.m.

i have achieved the internet, at last!

yes. nothing much more to report. i have internet at home, and shall spend the evening on it instead of hard at my studies. patients, and possibly my evaluation, may suffer.
but what the hell. i've been deprived far too long, and tomorrow i face the hell of call yet again. i deserve an evening of mindless surfing ^_^

Monday, July 19, 2004
12:42 p.m.

they told me to clear the list, so i did my best

post-call, friday and sunday, subspecialty: GI, heme/onc, neuro.
neuro patients give me no trouble at all. every now and then they need some tylenol, or the nurses need orders clarified (my writing is still neater than a lot of other residents' here, but not by much...and not for long, i'd wager), but otherwise they're quiet all night.

our own patients on GI are a bit more complex this time around, a bit more harder to manage.
a bit closer to death, for some.
we had two such patients, one an elderly gentleman whose family went through the death of his wife already, and once the situation was explained decided to make him DNR, in accordance with his wishes as they understood them. sad, but fairly peaceful; we pulled his tubes, stopped IV fluids and meds and had only a sub-q set for pain relief. i spoke to them several times, explaining what i could, and they seemed composed and maybe even grateful for my semi-anxious hovering.
he was about to be pronounced as i left the ward; not my patient, so once the night is done it was his doctor's duty.

the other is not so easy: a fairly young man, at least in internal medicine terms, a livelong alcoholic and in terminal organ failure. we're still giving him all supportive measures, including blood, but we don't hold out much (any?) hope.
he was awake while i was on call, conscious enough to sign a POA form and consents, but he never improved lab-wise. today, he is worse; it might happen anytime now, and i'm secretly glad he isn't mine. the POA is his barely-legal child, and i would not want to even breach a code status discussion, necessary though it clearly is.

the heme/onc patients are another matter entirely. some are here for chemo, and are doing quite well; others are barely hanging on. i had a code status discussion with one lady and her family, but then again it's easier if the patient is able to communicate, has had the illness for some time, is aware of the prognosis...and yes, is elderly.

with another, i sat up nearly all night, juggling stat blood results, fluid cultures, blood products, clinical pictures, panicky calls to my senior, calls to the consulting services, even online investigations of exactly what could be happening with the man.
he was too far gone to consent to anything, and his family wouldn't be in until daytime; they were coming in from somewhere. and of course, no code status - why is this ever left to the on-call off-service resident? this should never happen.
he survived, at least until today. at least until i could hand over to his own team, and leave them with the unpleasant task of family meetings.

family meetings. code status discussions. decisions on starting potentially toxic drugs, decisions to wake up an attending (from another service, to boot), decisions on when to treat and when to merely follow repeat results. even small decisions such as not going up to assess every single patient, to trust one's judgement enough for a phone order; it is on call, with minimal to no backup for "routine" calls, that i am really a doctor.

but hey, call still sucks. i must be very sleep-deprived, to even try to wax poetic about it.
ah, and i did an ABG yesterday; a tiny highlight in an otherwise miserable night.

Tuesday, July 13, 2004
05:45 p.m.

"it's made a lot of people a lot of money"

on tuesdays we have journal rounds, where three unlucky residents (yours truly goes next week) get to present some recent paper.
they feed us well; the only rounds at which we're fed, in fact. it makes it slightly more tolerable.
today a senior presented a paper on a tool for predicting when people with colitis (crohn's or UC) would need early surgery: a blood test, c-anca and p-anca. afterwards, the wise greying attendings discussed how useless this test is, how expensive, and how the company that came out with it is desperately trying to make a bigger market for it.
it was originally intended to differentiate between crohn's and UC, but the only time that is really necessary is before surgery, and by then it should be pretty obvious from the score of biopsies and radiological tests. there is a small percentage of people with indeterminate colitis - and literature has shown that for them, this test is next to useless.
indeterminate they are, and indeterminate they'll stay; use of the test declined as it was shown to be of no use there.

the company suggested it as a screening tool for children with recurrent abdo pain. that's about 15% of the pediatric patient population; no one in their right mind is going to "screen" that many people at over U$400 a pop, when the diagnosis can be made clinically and radiologically and the looked-for outcome would be so low.

so they struck out, and now this paper.
a "consultant" from the company was listed in the credits.
according to my attending, this test is mostly useless and vastly over-used in the US, to no great positive effect. here we don't use it much, i suppose because we're more money-conscious.
"these people have a financial interest in it; that's horrible".
i think we'd have far less good research if it wasn't for pharmaceutical and med-tech companies trying to find uses for their products. but it does drive it home, how one must be careful when reading even peer-reviewed journals. you have to look for the agenda.

probiotics are trendy again
another paper concerned the use of a cocktail of bacteria (chiefly lactobacillus) in the treatment of hepatic encephalopathy. the results were positive, even if the study did need a couple more arms.
but some of the papers quoted in this new article were from the 60's, and one of the residents chuckled and observed how we're coming full circle, how things tried long ago (in medical terms) are becoming more popular once again.
on the heels of the previously mentioned paper, one attending replied dryly, "well, we have more expensive probiotics today."

furtively typing away
and now i must flee once more before they come; the computer/charting corner is small, and the heme/onc team usually hovers around stabbing at us with their eyes, likely thinking that there are a trillion lab values we must unearth and make sense of before our attending comes and why are you paltry GI people even here you don't care about lab values unless you want to do a procedure and OMGshe'scomingshe'snearlyheregetoffthecomputerNOW!

i don't have to do heme/onc, except for call.
and tomorrow, i may have internet at home.

Saturday, July 10, 2004
02:36 p.m.

once again, musings on residency

i want to blog, but about what?
not sure how to put my residency into words. it's strange to hear myself addressed, casually, as "doctor" by nurses and other health care staff.
patients i'd gotten used to months ago. patients don't know what the heck a "clinical clerk" is, so they'd either call be "doctor" or "nurse". my preceptors would sometimes call me "doctor" - for kicks or to reassure their patients that they're not about to unleash a mere med student on them, i don't know.
but nurses and allied staff always know, of course. so it's the address from them that really makes the most impact.

my current attending is excellent, all i could have asked for. he's a great teacher on rounds, and has a bedside manner i could only hope for. in fact, he won some sort of teaching award last year.
he makes mild fun of my med school and its DIY approach to medicine, but not maliciously. and while i was worried about starting residency with people from other, more traditionally didactic schools, i'm reassured by the fact that they don't seem to know much more than i.
basicaly, none of us knows much at all.

today i came into the hospital on my day off, to take care of my perilously mounting pile of discharge summaries. i prudently tried not to be seen, lest some senior concludes that i have no life and schedules me for weekend call until the end of time.
our team's clerk saw me, but i distracted him with the stunning and unwelcome news that he too had a mounting pile of d/c summaries - the senior apparently having forgotten to tell him that he's responsible for dictating on his patients.

other than that, things are rolling along fine. my apartment is being painted as i type, and computer techies are fiddling around with my machine's innards to see if anything is salvageable.
hopefully i'll be able to blog from home soon.

Tuesday, July 6, 2004
04:17 p.m.

shaking in fear...or is that asterixis?

tonight is my very first on-call as a resident.
the first time when i'll be making the decisions and writing the orders, without any supervision.

it's different on the ward during the day. i can run things be the senior or even the other R1 when i'm unsure; tonight, a senior will be covering the ER while i'll cover the wards.
the wards. not our ward.

i'm on something called "internal medicine subspecialty call". i'm currently on the GI service, and think i can handle what our patients may throw at me.
but i have no idea what to do about the neurology and heme/oncology patients. hell, we didn't even have those rotations during med school. i've never dealt with patients like that in a learning capacity, and now i'm their doctor for the night.

another R1, a classmate from my med school, was on subspecialty call last night. a patient had an infarct, and she had to do the EKG and interpret it, and make the treatment decisions.
am i up to that? possibly. she was, and we did after all receive the same education.
but god, i don't want any infarcts on my watch. give me endless whiny patients in pain, just nobody code!

ah, and to all you non-medical people who may be reading this: try to avoid hospitals in early/mid-summer.
that's when the new residents start their training, and trust me, we know nothing!

Sunday, July 4, 2004
04:48 p.m.

moore reveals: bush is evil incarnate

mom came over yesterday, bringing my chibis and new car.
nearly damaged car trying to wrest chibi cage out of it, but all ended well and they're settled in amongst my boxes and the piles of paper that came out of the boxes.
new apartment is beginning to smell like home...

we caught "fahrenheit 911" last night.
pretty good. pretty scary, actually. even with the obvious slant (the director doesn't even try for a semblance of objectivity), i'd say it's still a must-see documentary. i mean, americans and those watching american tv have had their "war" news slanted in the opposite direction for so long (thanks, CNN and fox) that watching this thing does a small bit to restore balance.
also, whoever watches it and still votes for bush is scary. i fully expect politicians to break election promises and lie to me about money, but this is too much.

still computer-less. will have to look into buying a new one, i don't think it's worth it to just get a new motherboard.
and internet-less. my god, i almost want to go in to work tomorrow, because at least i'll have access.
sad, sad.

Thursday, July 1, 2004
11:27 a.m.

happy canada day!

feeling patriotic, or merely happy that i get an extra day off before starting residency? hmmm...

in half an hour i leave my sweet hotel for my box-filled, non-internetted apartment. i must immediately find towels. and rags for dusting.
and stethoscope.
and, god, an IM or GI book! i start this crap tomorrow. waaahhh!

dear pointy shelly bought a house, and i now own my very first car. a 2000 mazda protege. i will see it on the weekend.

not much to say, i suppose. not much, and too much all at once. i'm terrified of starting on GI, with the senior post-call and leaving at noon. will i survive alone for 5 hours?
will my patients?

Monday, June 28, 2004
10:23 p.m.

PASSED! (how do you say "patient beware" in latin anyways?)

i can now prescribe drugs.

yes, i know.

i'm scared too.

oh, and since esca didn't rush to the computer upon receiving the news (presumably because she has a "life" or some such profanity), i shall inform the world that she passed as well.

while i've had the "doctor" title for a few weeks now, it's an empty title for all practical purposes without a passing mark on the licensing exam.
the horrible, horrible licensing exam.
i mean, i realize they can test on every single aspect of medicine, but the stages of the female orgasm?
that's going a bit far (didn't happen to me, but did to a classmate; i got all the "would you take the patient off life support even though their family strongly believes they'll recover" questions, to which i invariably answered "yes").

everything else is going pretty well too.
i'm staying at a sweet hotel at army expense while they take their sweet time shipping my stuff to the new apartment, i'll likely own a car by tomorrow, and in the morning i meet my fellow residents for the first time.
all the complications of the move have disappeared, partly because i kept waking up at ungodly hours of the night and, unable to sleep because of the stress (and jetlag), kept thinking up "creative" solutions, and partly because...well, some were more perceived than actual in the end.

tomorrow starts a new chapter in my life.

too bad i forgot all of medicine while on vacation.

Saturday, June 26, 2004
06:15 p.m.

supersized nation

well, on the heels of my trip to asia comes the film supersize me, which just started playing in our local cheap cinema, prompting mom to take us all for a night out.

how does this relate to my trip?
in the whole 5 weeks, we saw maybe as many overweight/obese people. not that we were looking out for them...at first.
but at some point we realized that there were none, and it mildly freaked us out. so, we started looking, mostly to no avail.

and i started thinking about what we were eating. out of the meals we ate in korea at home and in restaurants, nothing was processed.
nor was anything in sauces, or sweet; desserts consisted of fresh fruit and/or a tiny cup of sweet tea, and esca's aunt also got us teensy bottles of liquid yogurt for after meals, remembering that i liked them the last time.

we did, of course, eat other things when left to our own devices: patbingsoo (shaved ice with sweetened red beans, fruit and jellies), ho ddak (a kind of pita-pancake thing with a dab of brown sugar in it, which i'm probably misspelling), buns filled with red bean or chestnut paste, drinks from the vending machine.
but the amount of those things was negligible, not even vaguely comparable to the sweet or processed snacks i eat when home in canada. not comparable in quantity, but also not in quality - i'd bet my right arm the amount of sugar (or corn syrup, whatever) in those drinks wasn't anything close to the soft drinks here.
except for the western drinks like cola, which are sold there as well.
in tiny, tiny cans which probably wouldn't fill one child-sized McDonald's cup.

one girl interviewed in supersize me was complaining about the girls in the magazines, the image portrayed to youth, and plaintively said that "it's not realistic."
i've just returned from a country whose citizens could've almost stepped from the pages of those magazines.
not just the young women. the children, the boys, middle-aged men and women: i was hard-pressed to find people my weight (height-adjusted, of course), and i can't even be considered overweight, much less obese. i'm pretty normal, i'm fit enough to pass basic training for crying out loud.

the korean government, i read in one english-language newspaper, is worried about its young people adopting a more westernized diet.
and well it should be.

our first stop on the journey home was the san francisco airport. by then we'd long stopped looking for obesity, so it was a bit of a shock.
standing in a random hallway in the airport, there was no direction in which i could turn without seeing obese people.
not overweight.
clinically obese.

at the airport, i had an iced chai. i loved those, even though i indulged rarely because of the ridiculously high cost of what is after all just a drink.
this time, it made me nauseous. i felt like i was swallowing pure sugar goo.
nor surprising: soon after my first trip to korea three years ago, my mom took me out to a cafe and bought me some overpriced piece of cake.
which i couldn't finish because its sweetness made me want to puke.

but see, i adjusted. as i'll adjust this time around, back to the high sugar content of the average canadian diet, and pretty quickly too.
i'll try not to. without a doubt, i'll pass up the pop and fruit juices, the donuts and bagels and croissants and little cakes they'll give us at orientation next week. i'll keep korea in mind and try to model my diet after that (minus the evil that is kimchi).
but it won't last long, i know that as well.

Thursday, June 24, 2004
04:29 p.m.

but i didn't *mean* to kill the dolphins!

we leave aunt's place in about an hour. esca is napping, and i've got to shower; such mundane things for the last moments in korea.

*** timing note ***
this entry was written earlier today; we're currently in the silver kris lounge (wheee!) in inchon, awaiting our flight (booo!).
*** end note ***

when we went to see the pink dolphins in hong kong harbour, the guide lady told us that they were quickly getting killed off (as did my guidebook: "see the pink dolphins quickly before they're all exterminated!").
it's mainly because of "land reclamation" from the ocean for the airport, as well as for disneyland because it's more important to built a disneyland than to have rare pink dolphins. gah, hong kong already has a perfectly acceptable amusement park, with lots of space for new rides.

in any case, one of the stated ways to help the dolphins is to refrain from eating seafood. the dolphins themselves are diva-picky about what they eat, but there's the foodchain and all that jazz to consider.
"no problem", thought i, "seafood is expensive and i hardly eat any even though i like it."
my most memorable meals in hong kong were the two consecutive crab feasts, but those happened before the dolphin-watching. so i was good, right?

since then it seems like i've been eating nothing but seafood.

seriously, i don't know if there was a day in korea where i didn't have something ripped from the sea. fish, squid, octopus, jellyfish, shellfish, seasnot, even shark fin soup.
i didn't order most of these, they're usually found with the communal meal sidedishes, but i sure as hell eat them.
the only respite was in japan, where our food budget allowed "rice and rice accessories."

i would make a bad, horrible activist. i care about the pink dolphins, i do. i kinda care about cows and chickens too.
i suppose i simply don't care enough.

anyways, if you're in hong kong, do see the dolphins. before disney and i kill them all off for good.

Sunday, June 20, 2004
05:42 p.m.

the shogun was "a little paranoid"

time needs killing, and the best killing is done at internet cafes. cheap, cheap korean internet cafes.

i wanted to update from japan, but the army and the moving were a priority whenever i got near a computer, which wasn't often.
the frigging army is going to unpack all my carefully packed stuff, and repack it. god, no wonder the government whines about being broke, if this is the kind of money-wasting nonsense they like to engage in. if they'd give me the cash they plan to spend on my relocation (or hell, half of it would do), i'd just hire someone and have tons left over.

the japan trip was over so fast.
esca claims that all she'll be able to remember will be the shinkansen, japan's bullet trains, and indeed it seems that we'd spent half out time riding them.
but of course i'll also remember the temples and shrines we visited, the gummi sweet rice balls on sticks i ate near the ginkakuji, my dream visit to an onsen, those endless images of kannon in sanjusangendo temple, nijo's squeaky nightingale floors...that enormous intersection at shibuya station...the way we didn't manage to see mt. fuji because of that frigging enormous cloud that just sat there and mocked me.
and, of course, visiting the prototype, who appears normal and happy. we kicked him out of his house so we could stay there.
well, apparently his gf did't want him to stay there. with two women and all...

i think it was a great trip ^__^

on our way back we visited another aunt of esca's, and were taken around to many tourist sites by her cousin and family. they had the most adorable little boy, but esca claims he was only adorable to me because i couldn't understand his annoying stupid questions and therefore tuned out his constant chatter.
we were going to visit esca's old house, but there was only...a field!
her house got torn down. possibly to make room for a driving range, who knows. i took a picture of her holding a shard of what may have once been her roofing tile.

this trip is wonderful for me, army nonsense notwithstanding. esca has to deal with her extended family and their hell-bendedness to make her a "dutiful daughter."
it's unfair that i'm enjoying myself so much more than she is, and getting the rest i wanted before residency.
next time we'll go visit my family, and she can relax. my extended family's only slightly screwy, but i'm sure i'll find something to stress about ^__^;

ah, yes, and meta's blogging again.
meta, WTF? broken windows? we had no windows! massive concrete installation, remember?

Sunday, June 6, 2004
04:51 p.m.

***this entry is posted on 20 june, originally written on 6 june; post date changed***

black coffee? not in this country, girlfriend!

we spent two wonderful nights in sokcho, a town near seoraksan.
on disembarking from the bus and looking confusedly around the sokcho terminal, we were immediately approached by a lady who offered us a two-bedroom flat with a kitchen for 40,000 won/night. it was a good deal, so we took it.
later, after stashing away our luggage, we were repeatedly accosted ("approached" is too polite a term) by other women also offering accomodations outside the established hotels.

on the surface sokcho is geared to tourism, and i remember the incredible hordes of them from my visit three years ago.
however, this time we went before tourist season, so i guess some people were getting desperate. we couldn't even approach a restaurant without the owners running out and nearly dragging us in. and we saw one of the accommodation ladies actually chasing a car down the road, yelling her offer.
if i was in that car, i'd be scared too (i assume they were scared, as they drove away pretty damned fast).

in any case, our accommodations proved excellent, with the exception of the nightly mogi influx.
this is the (too-cute) korean word for the mosquito, and no power on earth could stop them. i'd wake up periodically, helped by my post-drinking binge bladder pressure, to exact bloody vengeance upon the creatures.
next door the engaged ones were doing the same. we added our death marks on the walls to the marks of tourists past.

at seoraksan itself, we chose a picturesque and fairly easy trail leading to a waterfall. it was very beautiful, and we could stop by the stream to rest and cool down in the icy waters.
then we came back and took a cablecar to the peak. hey, no need to exert ourselves too much. we still had a night of drinking to face.
all in all a great little trip.

on our return to seoul, we abandoned fiance in a lovely love hotel and went back to the aunt's. we met him today and saw him off on the bus; we assume he made it safely to the correct airport and will email us from the homeland.

as for the two of us, tomorrow we take in an anime con, and start to seriously plot the japan trip. we started with the counting of the cash, after which it was decided to buy the japan rail pass on credit if possible. cash is such a precious commodity.

ah yes, one more interesting tidbit. in hong kong, whenever (poor, caffeine-addicted) esca asked for black coffee, she was met with either amusement or a blank stare. once, she was told out right that "there is no such thing."

Tuesday, June 1, 2004
04:42 p.m.

***this entry is posted on 20 june, originally written on 1 june; post date changed***

the trip thus far

ah, back in korea, where the weather is reasonable.

the engaged ones and i returned from hong kong yesterday, where the weather was anything but. it was hot and humid, and we still kept getting up at 6 am to explore the city like crazed tourists.
the 6 am thing didn't help either. and apparently it's not even the hot season over there yet.

the trip was quite a whirlwind, and we managed to hit more spots of interest than i thought we would. this was due to esca's fiance's aunt, who took us in hand the day we arrived and ran us ragged around the financial district, the cultural centre, and the harbour.
we were not ready for so much so early...mostly not ready for the weather.
but we took it at a more reasonable pace in the following days, taking a nice day trip to lantau island to see the po lin monastery and the tai o fishing village, visiting victoria peak, taking a cruise to see the pink dolphins...and, of course, going to the markets. i got a cricket cage at the bird market! finally i'll have crickets again (and maybe this time they won't eat one another).
we also visited ocean park, under the mistaken impression that it had some sort of pool. thankfully, it rained that day, so we got wet one way if not another. it was sort of funny, everyone running for shelter while we stood under the downpour with our arms stretched out for maximum cooling.

hong kong's subway system is absolutely idiot-proof. you'd have to try real hard to get lost, which is partly why fiancee and i could skip a hiking trip (really, hiking in that weather?) and go off on our own to do other, less strenuous things while fiance went hiking with his aunt.

we only had one day in korea before hong kong, and that was spent in seoul at a temple and a randomly found world tea convention. and a dash across the city to the singapore airlines offices to collect our U$400 each.
the flight to korea was over-booked, so we agreed to stay in san francisco for an extra day. out of the goodness of our hearts.
and for the money.
and the business-class upgrades.
aren't we wonderful people?

so, today we're just relaxing, preparing for tomorrow's trip to seoraksan national park, and plotting the trip to japan sometime in the coming couple weeks. the air route having proved too expensive, we'll be journeying across by ferry and getting a rail pass for japan.
our old schoolmate on location having informed us that there are very few signs in english (unlike in korea, and definitely unlike hong kong), we're a bit nervous about getting lost.
we'll make our way from the ferry docks in fukuoka, probably stay a night in kyoto, and meet up with school friend near tokyo. or so i'm planning while the soon-to-be-separated engaged ones (fiance needs to get back to canada, to work) are cuddling.
or rather, while he's sleeping.

and how did people ever get anything done before the internet? i spent so much time on school, army and apartment business today. gah.

Wednesday, May 19, 2004
04:07 p.m.

dante didn't mention the paperwork circle of hell

packing.
packing and trying to finish all necessary paperwork.
packing, trying to finish all necessary paperwork, and buy digital camera.

i think this stress is near-instant karma for not taking esca's packing stress as seriously as i probably should've (but i was studying for the LMCC! i have an excuse, karmic powers!).

yesterday i wasted the entire day going to my ASU and clearing out. it wasn't that the clearing out took so long; it's that the bus service to the city where my ASU is located is just atrocious.
after a day of that, i didn't feel much like packing.
so i thought, i'll start the next day!

unfortunately, most of today was spent on pre-trip and pre-move paperwork, banking, and supplying the chibis. and procrastinating researching digital cameras, something my brother should have done for me. but nooooo, he had to fly to poland today with the she.
what kind of excuse is that? clearly electronics are his responsibility!

so, will continue packing. i have so little clutter, how can it possibly take so long?

there's too much to do. i'm not just leaving for vacation: i'm leaving for vacation, coming back to pack up my belongings for the move on the very day i return, selling condo, renting apartment, buying car, switching schools, switching bases, switching professional designations...there's no way i haven't forgotten something.

it's 5pm and the only thing to pass my lips today was aloe drink with honey, which i got while buying many pocky for shell to thank her for taking care of the chibis.
i also bought her a box of collon. has anyone seen those?
they're a japanese candy/cookie/thing, short tubes with filling. they come in cream and peach, but obviously the best and most disturbing is the chocolate-filled collon.

in 2 hrs, shelly will come and we'll have pizza. ah, pizza.

Friday, May 14, 2004
09:29 p.m.

that's DOCTOR coanteen to you

i can't believe it.
i'm officially a doctor. i don't think it's sunk in yet.

my convocation was in two parts: the MD-only oath ceremony in the morning, and the official granting of degrees to the health sciences students in the afternoon.

the oath ceremony was amazing. not overly sentimental, just really powerful.
we had an amazing keynote address from a speaker who's faculty at the school i'm going to (yay!). she's a doctor and a historian, and her speech was about the origins of the hippocratic oath, and our connection with and continuation of the tradition of medicine.

for me it was an especially great speech because the "hippocratic" oath we took doesn't have much to do with the original. when i read translations of the original oath, i feel its power. sure, it requires swearing on certain deities, it's sexist, anti-choice, mentions slavery...but you can feel the force of it. it's an oath.
the modern version (one of many available) tries to capture the sentiment, but ends up sounding like something written by a political committee afraid of ruffling feathers.
i may have been disappointed with the oath itself, but the original's intensity was brought into the occasion by the keynote speech.

the afternoon session was more like any other graduation ceremony. listen to speeches, walk across stage, kneel before the chancellor, receive degree.
it was very traditional and formal, very nice.
but it was all of health sciences - MD, nursing, PhD's, various diploma programs, and the health sciences bachelor degree. it was a lot of people walking across that stage, and we'd already been through one ceremony earlier.

one rather bad thing about the afternoon was the convocation address. it was given by the ruler of one of the emirate countries (it was kind of fun to hear him constantly being referred to as "your highness"). he was very impressively introduced - he has several degrees, is a great scholar, etc.
but the (pretty short) address consisted of telling christians that they and muslims should live in peace, telling us to honor our parents, and warning us not to fall into the arms of the devil.
me, to a colleague: "i didn't catch that. did he say anything about health? or education? or anything?"
classmate: "no, he said live in peace."
me: "ok, so peace and not to fall to the devil."
i mean, it's a nice message and all, but
1) not everyone there was a christian (the speech was addressed to christians) or even religious; and
2) we're convocating here, buddy. care to say something uplifting about changing the world of health with our newly educated minds, or what?
someone should perhaps check the speeches before our honored guests are let loose upon the microphones.

after the convocation, my parents took me out to a lovely dinner (after popping into my place and installing the A/C, for the chibis). and they got me flowers! bird of paradise (my favorite) and large lilies, which my mom hates because their scent is too strong, but which i love.
and tomorrow, esca comes for my formal. and the army's decided to let me go to korea!
a good day, a good ceremony - you really do need a bit of pomp and circumstance on an occasion like this.

i shall leave this with a quote from the dean...or vice-dean, i can't remember which of them said it: "there are patients who cannot be healed, but there are no patients who cannot be harmed."
and then he repeated it, because it was "complex, and contained a double negative." ^__^

Wednesday, May 12, 2004
06:50 p.m.

free-floating hatred...i mean, i'm done! yay!

LMCC was..
it was...
painful?
life-draining?
apathy-inducing?

probably all of the above. and i don't mean the good kind of apathy, but rather the "i don't care if i fail, just get me out of here" apathy.
i finished both sections early, which only made me more paranoid. i saw people around me writing complicated-looking things on their little dry-erase boards, and i wrote nothing. i just went *click* *click* *click* *clickclick* *clickclickclick* through the whole thing.
what does that mean?
probably that i don't know enough, that's what. i don't know enough to actually think about the questions.

by part 5/7, i felt like i didn't know a single question. this test is designed to get harder if you're doing reasonably well, but whether it actually got harder or whether i just don't know anything is still up in the air.
i recognized things again in the last two sections. so maybe i failed section 5 and it got easier.
or i'm reading too much into it.

i was able to kill a significant portion of my paper-patients by pulling life support in any ethics question i ran across, which kept my spirits reasonably high during the M/C portion of the exam.
but there was no killing in the second part. bah!

and then it was over, and i felt...ok.
and then i checked my email and found the nearly hysterical message from my army superiors, who apparently interpreted my wish to go to korea as a statement that i am in korea, and demanded to know who authorized me to go there.
all i needed them to do was move my posting date back a bit to take my vacation into account. i have no idea where they got the idea that i left the country (before my own graduation, at that).

now i'm tense and afraid that they'll start making trouble about the trip, after all the flights are booked and everything.
but it can't be that bad. i mean, they thought i was there already and the sky didn't fall, so it'll probably work out.

i was going to rant more. i was in a really foul mood after the email, but i must have calmed down.
or, more likely, the fatigue hit me.

and i'm happy it's over. i just can't fully feel it yet. i need rest.

Tuesday, May 11, 2004
05:55 p.m.

not happy

not happy.

nothappynothappynothappynothappynothappynothappynothappy.

not happy.

nothappynothappynothappynothappynothappynothappynothappy.

not happy.

i'm too tense.
there's noting i can do. i tried stretching, and putting my warm compress thing on my shoulders.
getting progressively tenser.

wish i could take a flexeril tab tonight, but i have no tolerance. it'll knock me out too much, and i'll end up sleep-walking my way through the first part of the exam.
but maybe that wouldn't make much difference.

i remember when i took a flexeril in korea, and i wouldn't get up for breakfast.
esca told her aunt i was drugged.
ehhh.

not happy.

Monday, May 10, 2004
04:18 p.m.

well, at least i passed something this week

i'm a full driver.

ha. ha. ha. hahahahaha.

i did make some mistakes, the biggest of which was my near-failure to get onto the highway. it was the on-ramp from hell; it split in two, and then the one actually leading to the highway was split again. it was not adequately marked. i've never been on it, and i didn't know where the hell i was going.
so i got onto the right lane, saw the cursed misleading sign, made it back onto the left lane, only to realize i was supposed to be in the right lane all along.
made it back just in time, thanks to light traffic.
the instructor asked what i thought i was doing. i wanted to reply, "a mistake" (duh), but in my wisdom decided it was not the time to be a smart-ass.

but now that's done with, and i only have one more little thing to finish this week.

ha. ha. ha. hahahahaha.

(the above laughter is beautifully tinged with hysteria)

Friday, May 7, 2004
12:22 p.m.

she's in hell and i'm jealous

right now, esca is writing the LMCC.
well, right now she may be at lunch, or just finishing the MC part of it.

in any case, in another four hours or so i expect her to call me, whine in her cute way about the difficulty of the exam, tell me whether drug dosages are in it - and laugh.

such a stupid thing to be jealous over. after all, she had less time to study. i still have time to study (whether i'm using it to study or not is a different matter entirely).
but the stress will be gone for her. she will be done. done.
and she will laugh.

five more days for me. then i can laugh (in a non-hysterical way) at last.

*****edit******

this i just had to include.
from an article on msnbc, about the prisoner abuses in iraq (emphasis mine): "One U.S. official said “because of who we are as Americans…no one could have imagined” soldiers would have committed these actions."

hahahahahahahahahahahahahahahahahahahahahahahahahahaha~!!!
*breath*
hahahahahahahahahahahahahahahahahahahahahahahahahahaha~!!!
*breath*
hahahahahahahahahahahahahahahahahahahahahahahahahahaha~!!!

Wednesday, May 5, 2004
04:28 p.m.

mood and movement...my motor's stalled

today in the psychopharmacology lecture the instructor touched on something mentioned by a friend when we were discussing obesity.
namely that exercise is a good treatment for depression, and that some studies (she quoted them, i didn't write them down; exercise studies will not be on the exam so i don't care about them) show that exercise has more staying power than drug treatment.
she also said something that was rather self-evident, had i bothered to think about it: movement is mood-congruent.
meaning, people who are depressed move less, and manic people move more.

psychiatric disorders are multi-factorial and treatment hard to explain. in reality, we don't know exactly how some of the drugs we use work. in fact, as in the case of buproprion, we don't even know why they work.
so yes, a depressed mood causes psychomotor retardation, and treating the depression with drugs and/or counselling lifts the mood, restoring movement.
but in the complex relationship between body and mind, increased movement can also lift depressed mood. it's a two-way street.

this is especially vital for childhood and adolescent depression, in the wake of studies that show an increased risk of suicide in those age groups with the current mainstay of antidepressive drugs, the SSRI's.
they're not safe for kids, it seems.
tricyclics have a higher number of side-effects; that's why SSRI's are the first-line treatment, after all.
and our nation's youth are too sedentary anyways. so let's start prescribing exercise! it can't hurt, for crying out loud. it probably will help.

too crazy for cancer
another thing the lecturer mentioned is that psychiatric patients seem to have lower-than-expected cancer rates.
odd, especially given that as a whole, they smoke at higher rates than the general population.

and now, for my whining
one week!
one week to the day, and i'll be writing the dread exam. in fact, at this time next week i'll be either finishing or done (done for?).
except for going to lectures, my permanent residence is either my bed or the computer desk. i'm cocooning myself in. i'm definitely experiencing motor retardation, though of the voluntary, anxiety-induced kind.

nice resident whose name i can't remember (did i do a shift with her in peds? obstetrics? where?) told me today that she too felt like she didn't know enough to pass. i suppose that's inevitable. she said to concentrate on what i know: "you just have to pass the exam overall. you can afford to fail internal."
everyone seems to be saying that. i wonder how many people actually fail the internal component.

should call esca today and see how she's holding up. perhaps that'll foretell my own impending breakdown?

Monday, May 3, 2004
02:29 p.m.

lousy driver exam centres

since i'll be buying a car while i'm in korea (just as i bought the condo while i was in korea; i shouldn't be allowed to go to korea again lest i go bankrupt) i've decided that it would be prudent to have a full driver's license.
and tried to book a test in the short, short time between my exam and the flight.
was i able to? of course not. now my test is two days before the exam, and if i fail it i'll think myself unlucky and go into the exam in a lousy state of mind. &$*&%@ driving centre.

mom came by today to give me food. she phoned yesterday and told me she made involini (sp?), and i complained about how dad gets all the good food, so she said she'll come by and bring me some.
naturally, i thought she was screwing with my head.
but no, she wasn't. she came and brought them and some other food, not to mention some legal papers i needed. what a wonderful mom.
why am i moving to esca's city, for crying out loud? it's too far for her to drop by with goodies!

i want to keep procrastinating, but i have nothing left to say. so unless evita is on TV for the third time, i guess i've no option left but to study.

Thursday, April 29, 2004
05:09 p.m.

o__O they pay for everything

really, absolutely everything.
i've finally contacted the relocation agency the army will use to relocate me. and i've been going over their benefits.
they'll pay me for the trip i took to find my new apartment.
they'll pay all fees associated with the sale of my condo.
they'll pay for the carpet cleaning of the condo, which was necessary to de-chibify it.
all dis/connection fees for utilities.
all expenses involved in the actual move.

it gets better. these aren't things i'll need, but they would also pay for childcare, pet care(!), penalties involved with breaking a lease/mortgage, rent for the new place for the time period of overlap with the old place (i don't think i'm eligible because my overlap time is my vacation, alas), rental agency finding fees, reimbursement if the original residence is sold at a loss (wow, no need to worry about the market tanking), ATM charges for some weird reason, and sundry other things i didn't want to keep reading about.

of course, i should be studying instead of reading this. but i...just...can't.

Wednesday, April 28, 2004
04:00 p.m.

"there are no stupid questions. only stupid people who ask them."

army wisdom at its finest.

the funny psychiatry lecturer was back, assuring us all that the LMCC exam is written by entirely stupid people.
question after practice question, his comments (captured on video for posterity) echoed through our lecture hall:
"i hope you don't get a question like that";
"i'm not even gonna tell you how to answer a question like that";
"you're going to be really upset at this answer";
"they write these questions just to annoy you"; and finally the simple
"this sounds like a really stupid question."

two hours of this today. i am not exactly filled with confidence about taking the exam.
the lecturer was in fine form though. taking a break from castigating the LMCC question writers, he lit into the pharmaceutical companies and their quest to pathogenize every human behavior:
"are you nervous about peeing in front of your boss at a public urinal? you may be suffering from social anxiety disorder!"

i'm skipping tomorrow's plastic surgery. i know wound healing and the body area calculations, nothing else will be on the exam.

esca dropped off the face of the earth. possibly eaten by the dalai lama?

Sunday, April 25, 2004
02:00 p.m.

it's my birthday! and my tumah!

ok, it's not my tumor; not anymore.
but yesterday, i spend eight hours playing a patient with a right-sided cerebeller astrocytoma for the residents' OSCE.
i even learned to convincingly fake a lateral nystagmus with the fast component towards the side of the lesion. man, i'm good. my eyes hurt, but i'm good.

precious shelly came on friday, bearing the continuation of the alita series and the first book of english-language saiyuki. i was incredibly impressed with the latter in terms of the quality of translation (and non-translation, as they left some terms alone. good).

my parents called this morning, waking me from slumber.
me, groggy: "hello?"
mom, cheery: "happy birthday! you're not allowed to be grumpy on your birthday!"
me: "huh? no...i'm not grumpy. i'm not awake..."

less than three weeks to the exam.
less than a month to vacation.
and wah! i'm old! i'm older than a quarter-century! century!

Thursday, April 22, 2004
01:11 p.m.

"it's always a good idea to have an absence of structural brain abnormalities"

psychiatry, for all its disproportionately large weight on the exam, is at least manageable. and taught by a very entertaining lecturer.
he told us that for axis I disorders, a 10-15% suicide rate is always a good bet.
classmate: "so if a question asks which disorder has a 15% suicide rate, depression or schizophrenia, what would you answer?"
lecturer: "i wouldn't. i would just remain paralyzed and not answer the question."
definitely the best lecturer yet.
another funny quote i was writing down when i should've been concentrating on the material:
"so you think that if you say it louder, you'll get it right?"

and of course, like most lecturers, he thinks his own field is the most important. but he doesn't just mildly run down select specialists like orthopedic surgeons or dermatologists. oh no, he doesn't discriminate:
"those of you who went into specialties other than psychiatry will now realize how pusillanimous your treatments are compared to the magnitude and glory that is changing suicidal behavior in major mood disorders."
man likes his work, gotta give him that.

a beautiful mind
my wonderful classmate with the truck, he who drives me to lectures at the other school, related his own tale of the joy that is psychiatry.
his preceptor told him to interview a little old lady being considered for admission. and assured him that the interview would be...interesting.
"interesting" is not necessarily a term one wishes to hear from a psychiatrist.
my intrepid classmate got down to it. to his surprise, the lady was well-groomed, articulate, pleasant and cooperative. she didn't seem to have any significant problems in her daily life, got along with her neighbors, wasn't on any psych medications.
believed there were alien clones living among us.

she could recognize them, and looked out for them, but they didn't bother her too much. they had their lives, she had hers. she supposed there could be problems in the future, but right now they didn't seem to be doing anything too harmful.
according to her chart, this was a fixed delusion going back 15-20 years.
imagine, this nice, friendly, cooperative old lady functioned perfectly normally in her daily life for 20 years, all the while firmly believing that alien clones were among us. her neighbor's 6-year old kid was one. some of the cashiers who served her were too.
the human mind is an amazing thing.

all this gnashing of teeth for nothing
for the past two weeks, we've been on a steady diet of financial company food and misdirections.
people are falling all over themselves to sell us disability insurance. NOW! we need it NOW! we need to insure our precious earning potential.
of course, each company tries to subtly run down the other, with the end result being that no-one in my class trusts any of them and everyone's now looking for the lesser of the many evils.
but after tearing out my hair reviewing all the plans and wondering in just what ways these people are looking to screw me, i find out that i'm pretty adequately covered by the army already. it's not the best plan of course, but hey, it's mandatory. so might as well go with that.

Tuesday, April 20, 2004
10:52 p.m.

patient-doctor privilege? no such animal

the LMCC lectures i attend at the other school are in their last week. our own lectures will continue up to a few days before the exam, which is dumb.
dumb because no one in their right mind will attend a vascular surgery lecture less than a week before an exam that might or might not have all of one question on that topic.
this state of affairs makes me feel sorry for the lecturers, probably because at our do-it-yourself school we've been conditioned to feel pathetically grateful to anyone willing to give us an actual lecture. and fearful that offending a lecturer with low attendance will result in no lectures for the following fifteen or so generations of future students.
that's my reason, although esca claims it's because i don't have enough problems of my own.

lies, damned lies, and statistics
today at the other school we went through epidemiology and brain-numbing statistical testing, things i used to know about but seem to have forgotten.
things like relative risk, type II errors, attributable risk, odds ratios...
the lecturer did liven things up by showing us how stats are twisted in medical advertisements.
now i too can lie with statistics!

"protective privilege ends where public peril begins"
the tarosoff ruling, from california. apparently canada has something similar.
contrary to all the law&order-type shows i faithfully watch, doctor-patient privilege appears to be a legal myth. the only such privilege that is legally recognized is the attorney-client one.
of course, that doesn't mean a doctor has the right to randomly spill the beans on a patient. privacy still applies.
but it does explain how, for example, it's legal to have mandatory reporting of certain diseases. or why relevant medical records can be used in court. or how papers can publish the disease status of some individuals and not get themselves and the individual's doctor sued into the ground. privacy, unlike the attorney-client privilege, is not a sacred legal cow.

medicate all your children!
today's morning session had an interesting story of some scary medical thinking.
the lecturer, a child psychologist, was presenting a study on the efficacy of peer mediation teams in middle schools on rates of schoolyard aggression to a bunch of U.S. psychiatrists. the study showed a greater than 50% reduction in aggression in schools that used the teams.
U.S. psychiatrist: "so you put all those kids on medication?"
lecturer: "...no...that's mediation."
U.S. psychiatrist: "ah. well, those would've been great drug results."

Sunday, April 18, 2004
11:40 p.m.

notes on the hunt

spent the weekend at esca's, or more precisely, in her city.
desperately looking for a place to live.
her city is strange and utterly centralized; it has a downtown core of a few blocks, located on one street. both hospitals are walking-distance from there; outside the core, there is...a place not ventured into by students or residents, apparently. for our purposes, those few blocks are the city.
the city is also older, and many houses there are...old. and rented and re-rented to students for what seems like centuries, so in obvious need of upkeep.
the few apartment buildings are very expensive.

clearly, this made the hunt interesting to say the least. it was much more than a matter of finding an adequate apartment in a reasonably located building, like i more or less expected. esca's place, occasionally maligned by her in many a conversation, started looking really good after a fruitless day.

eventually, through persistence and total disregard for people's weekend privacy, a place was found.
despite missing a living-room window (a fact that's apparently beyond my mother's understanding: "all rooms have windows! they just do!"), it's the only place that's actually got me excited and planning furniture layouts.
well, not quite. there was another, occupied by one of esca's inexplicably rich classmates. ah, budgets.

but this one, i feel, will work out. if i can get parking.

truthfully, i don't think i appreciated my bay windows until now. i don't need windows that large, and in any case while working i tend to leave close to sunrise and return after sunset. it's just that when i walked into that first apartment we looked at and beheld its tiny, tiny jail cell-like window high up by the ceiling, i was seized by a gripping home-sickness.
my place was the one and only i looked at before getting it. it was...ok. i liked the location. it took work to get it to look as good as it does now, but now that i have it i think i somehow expected all the places i looked at to compare.

ugh. it seems i've found a pretty good home for the next two years, in any case.
thanks to esca and her bfie, our uncomplaining, occasionally lost chauffeur.

Tuesday, April 13, 2004
11:01 p.m.

seeking closure

ok, she accepted.
i have (conditionally) sold my place. if everything goes through fine, the deal will be finalized in just over a week.
meanwhile, no more strangers in my apartment.

LMCC review lecture schedule has gone into overdrive. 12-hr days, with a couple hours in breaks here and there, during which we run around from office to office and try to get all our paperwork in before the graduation deadline.
yes, it'd really look pathetic if i didn't graduate because i forgot to hand in last july's elective evaluation form. argh.

this weekend i'm off to esca's, to look for rentals in her inexplicably expensive city.
saturday good for lookings, dear?

Monday, April 12, 2004
11:01 p.m.

point, counterpoint

well, i got an offer today.
according to my agent it was a "decent starting point", and furthermore rejecting offers is rude. just a point of interest regarding real estate manners.
in any case, we countered with what was originally going to be the asking price, before we pushed it up a couple thou to gauge interest.

i'll know if she'll accept tomorrow. her agent thinks she might. it'll be great if she does: it will stop people coming into my home and driving me paranoid, it will give me ready cash to buy a car, and it will be a third more than i originally paid.
no crazy bidding war for the place, but still. i love the market ^__^

it's interesting to see the real estate process from this side. when i was looking for a place, and when my parents were buying their house, i didn't give a thought to the seller's feelings regarding strangers parading through their home.
and when i made my offer on this place, i felt somehow powerless. i felt that the seller had all the power, was probably stringing me along, trying to take me for as much as possible. i was happy that i bought it, but somewhat angry at the process.

well, now that i'm the seller, i feel i have control, but not exactly power. either party can walk away, and i'm anxiously awaiting the potential buyer's decision. i'm not trying to string her along, and the selling price is within the range of the last few similar apartments sold in this building. this time, i was able to see the two agents bring out their respective listings sheets and discuss why this apt went for less than i'm selling, why that one went for more than i'll get. it seems orderly enough, even fair. on me, there is no pressure this time; i'm not in a hurry to sell, at least not due to circumstance.

i wonder if she'll feel that i'm trying to cheat her.

Friday, April 9, 2004
04:16 p.m.

back to the knife under the pillow

good friday.
i don't think we celebrate that. well, i don't think my family does; our big day is sunday.
however, it's a school holiday, and that's all right with me.

i think i'm getting increasingly more paranoid since the apartment showings started.
it's not just that i don't like people going through my stuff. it's that at night, when i'm ready to turn off the lights and take off my glasses (effectively rendering myself blind in the process), i hear the building settling and imagine someone hidden in my home.
logically impossible, given the utter and complete smallness of my apartment.
but that didn't stop me from cataloguing everything in my room, trying to decide which object would best serve as a defensive weapon. or from waking up in a cold sweat two nights ago.

can this possibly be related to exam stress? i'm not normally a fearful person, i don't have any history of being attacked that could be screwing with my subconscious, i'm perfectly comfortable walking alone around my mildly sketchy neighborhood after dark.
i don't know. i think it's the stress combined with the knowledge of strangers tramping around my place while i'm gone. it's unsettling.


the army send me confirmation of promotion, effective at the start of residency.
also information about who to contact regarding relocation. every now and then, the amount of paperwork involved in army life hits me. i'm completely insulated from it in med school.
i just assumed i'd rent a truck at my expense, like every other schmo who's moving for residency. but apparently not.

ah, and various people keep feeding us. financial management firms give us lunch for the priviledge of taking up an hour of our valuable, increasingly scarce time.
and, because the LMCC lectures aren't officially part of the curriculum, pharmaceutical companies are allowed to sponsor them. the last one even brought us good-luck cake and champagne.
champagne.
naturally, most people grabbed their little plastic glass and left quickly. my ride was still talking to someone when i realized that people had gone and that there was still a lot of champagne left.
ah, champagne...

Wednesday, April 7, 2004
10:26 p.m.

"people with big boobs would get in the way of that sort of technology"

it's a really strange feeling, coming home after my apartment has been shown.
various closets are open, doors are closed, the blinds are pulled halfway to the side. strange to have had strangers in my home and not know what they did here.
i start to worry: did they look in my underwear drawer? did they open my fridge and touch my food? judge my messy shoe collection? the paintings of naked women? the yaoi posters?
did they sit on my toilet?

i want them to come and bid on the place.
but i don't want them to do any of the above. i want an offer, and i want this over with.

today we had a cardiology lecture, with a doctor who kept going on tangents about his kids.
he did, however, provide us with a few words of wisdom, such as the causal argument that "we know that we die in beds, yet beds don't kill us."
frankly, i suspect that they do. prove me wrong, doc.
and for the depressed among us, yet more reason to be depressed: "the interesting finding is that people who are depressed by their heart infarcts...die."
the title refers to his musings that soon we'll have temperature-based nightvision goggle-like inflammation detectors to help prevent heart attacks.
and by "we", he clearly excludes the silicone beauties.

Saturday, April 3, 2004
12:52 p.m.

i don't want to move

the place looks better than ever.
the carpets have been cleaned (the process blew two fuses before we finally hooked the shampoo/vacuum things to the stove), the bathtub is re-caulked and shiny-new looking, and this morning i attacked the the stove burners with nail polish and a knife. my windows are now open on a permanent basis, to discourage any iota of chibi-small taking hold.

tomorrow we'll finally replace the foyer lights that broke two years ago. all the things i always meant to do, and now i'm doing them just to make the place look good for potential buyers.
this had better get me the price i want.

i'm starting to feel the exam panic. mildly still, but it's there. it started when april began.
so i guess i'll start studying more. i don't expect it to hit full-force until mid-april.

now i'm off to see shelly at the one of a kind show.
and try desperately (very, very desperately) to stop myself from buying yet more jewellery.

Wednesday, March 31, 2004
12:13 p.m.

real-estate woes

ugh.
selling this place is so involved. carpet cleaners come in tomorrow to de-chibify the carpets as much as possible (my real estate lady informed me delicately that "there's a bit of a smell." no, you don't say?), and now i'm looking for someone to re-caulk my bathtub.
at one point she suggested replacing the bedroom windows. no way in hell am i doing that, but i might have to clean them.
the chibis also ate through my screen door at one point while they were still allowed to roam freely. but it's just a little hole!

meanwhile, i'm looking for a rental in my hometown-to-be. i have esca on location, i should use her to do all the legwork.
i mean, it's not like she's doing much of anything these days, just some internal here and there ^__~

Tuesday, March 30, 2004
03:12 p.m.

it's the child-drowning championships!

i usually agree with toronto sun editorial writer peter worthington. he's a no-nonsense kinda guy who writes a lot about the sorry state of canada's military, which i read with ever-increasing worry.
today, his article was about the 7 east european nations which just joined NATO, and how "it is significant that all these countries are pro-american to an extent that "old" europe is not."
he goes on to the standard whine about france and germany's opposition to bush's war, and then has the gall to say that to "east europeans, it was clear why the war was justified. weapons of mass destruction be damned - saddam's crimes against humanity more than warranted his ouster."

peter states that after all, NATO itself used the human rights justification when it intervened in kosovo.
well, fuck you, peter.
yes, NATO did that. i also recall that it did not lie about it until it literally could lie no more, it didn't try to create non-existent links between kosovo and the threat to the safety of the free world, nor did it try to suppress an honest inquiry into its justifications.
i will also note that the USA doesn't seem all that keen to liberate other oppressed peoples. what of north korea, for example?
no oil?
or is it just that human rights don't matter that much to bush if the country violating them just might have the capacity to effectively defend itself?

i shall make note of one last thing it peter's little diatribe: "isn't it curious how countries that've lost their freedom and then regained it are almost pathologically pro-american?"
got that? "almost pathologically pro-american."

from the american heritage dictionary, 2000:
pathological:
1. Of or relating to pathology.
2. Relating to or caused by disease.
3. Of, relating to, or manifesting behavior that is habitual, maladaptive, and compulsive: a pathological liar.

i wonder which definition peter meant?


well, on to other things.
yesterday's ER lecture was given by a well-known ER chief. he peppered his LMCC review talk with pearls of medical wisdom, such as:
"as time goes on, you will find it harder and harder to care about your patients"; and
"the diving reflex is like the child drowning championships: 'we had a kid submerged for 35min, and he recovered!' 'oh yeah? we had a kid submerged for 40min, and he recovered!'"

Saturday, March 27, 2004
12:12 a.m.

down with objectivity!

oh, how my school never ceases to amuse.
just today, i remarked to a classmate how our class match results should certainly calm the following class regarding fears about our weird transcripts. especially those trying to get into the most competitive specialties, who really need to "shine", as it were.

my school doesn't believe in class ranking, exam scores on the transcripts...exams at all, in fact in nothing that puts one student in competition with another.
our final transcript is composed of written qualitative statements on each unit and rotation we complete. yes, we write exams and do practicals and yes, we get the scores, but these are not allowed to figure on the transcript. not even in the most innocuous of forms, such as "student x did very well on the surgery exam".
in fact, this odd anti-competitive philosophy extends to the qualitative statements as well. if a preceptor were to say, for example, "student x was one of the best students i've taught", the statement would be taken off the transcript.

it's sort of tragi-comic. student advisors have quit over this issue, but as long as the old guard holds sway in academia it won't change.
that's ok. they'll all die retire eventually, and in the meantime students from my school still manage to shine through the glorious invention that is the reference letter. no biggie.

but today, we got an email detailing the minutes of some evaluation changes for the class after ours. basically, they'll have a numerical and a qualitative evaluation scale, but only the qualitative one will show up anywhere official.
the numerical score is for the sole purpose of helping the evaluator write the final statement, and as some kind of objective documentation in case of dispute.
nothing to fear, right?
wrong. this was a discussion point, according to the minutes:
"Students expressed feelings of added stress due to the implementation of a numerical scale and asked why the scale has to be numerical in the first place."

for crying out loud, you're in med school.
med school!
all of you have gone through numerical scale evaluations to get here in the first place. it's one of the ways you were chosen to attend. and this scale doesn't even mean anything. it's not on the transcript, it won't even be known to your other classmates. it means nothing!
what is the fucking big deal?

seriously, we have too many way too touchy people in our school. apparently that's the reason we turn out so many excellent family docs, but it's entertainingly frustrating to watch.


and on another note, earlier this week we had an excellent panel presentation on the stresses of being a physician, including personal stories of burnout, addiction and illness.
it was actually quite powerful and moving, and generated quite a discussion - though mostly about the dysfunctional personality types who are attracted to the field of medicine.

in any case, the facilitator warned us about some of the pitfalls we may face.
facilitator: "actually, MD's who get addicted typically come from the top 20-25% of their class."
me: "oh good. i'm safe then."

Thursday, March 25, 2004
03:46 p.m.

we're not weak because we're smart, we're smart because we're weak

or so claims this article in nature. very basically, humans have a mutation that makes our jaw muscles weaker than the jaw muscles of our closest (and stupider) relatives.
this, it is hypothesized, freed our brain vaults to grow larger, and with that the brain itself.
the timing of this mutation correlates with the appearance of human-like characteristics in the fossil records.

i like reading evolutionary speculations. mutations take huge numbers of years to become established in a population should they be advantageous, so it's not like the mutation discussed suddenly appeared in hominids for no reason.
and there is no proven cause-effect relationship there. hominids were using tools by then, so they simply didn't need jaw muscles that strong. which, of course, doesn't explain why the mutation happened and why it became so widespread - we have no real need for the hair on our heads, and yet there it is.

evolution being what it is, this one mutation by itself probably didn't have all that much effect on it. but it might very well have been a part of what made us what we are today.


got drunk with my classmates yesterday at various post-match get-togethers. nearly everyone got their first choice, which is great.
and two classmates will go to the same program i'll be attending; it's nice to already know someone in my future class.
actually, my class did pretty well, including in the more competitive specialties (after all that bitching about our weirdo transcripts, it's certainly good to hear). plastics, optho, neurosurgery, ENT - we got people into all of those.
no derm, i think, but then i don't know if anyone was trying for derm.

4 people didn't match. i know who two of them are, and both went for the more competitive end with no back-ups. oh well, it happens. if you're arrogant enough not to have a back-up plan, you only have yourself to blame.

Wednesday, March 24, 2004
11:59 a.m.

matched to my first choice!

elated?
a classmate who's going into psych and i were talking about this before. our programs are so non-competitive, and the likelihood of not matching to first choice so low, that really this feels rather anti-climactic.
i told him that i almost wished i'd match my third choice, because
1) i really, really like their program but they're too far; this way i'd be forced to go there and somehow that wouldn't be bad, and
2) that way the results would provide a real emotional reaction (shock, mostly).

but upon further discussion, we both realized we'd be pissed as hell if our first choices had the gall to reject us.

and so...matched! to my first choice!
now i'll go to our school lunch event and hop around like an idiot with the rest or my classmates, asking questions like "so, what will you be when you grow up?"
^__^

incidentally, while having dinner with the pointy one last night, i met one of the detectives who was at the scene i went to while on my forensic pathology elective.
i didn't recognize him. i mean, i only saw him that one time, and i was more interested in the corpse then.
but he recognized me. so when we left the restaurant and i said goodbye, i said i was sorry that i didn't recognize him.
detective: "it's ok. that's why i'm the detective."
heh. yeah.


esca just called! she matched her first choice too (and therefore she's not in my future school. *sob*)!

Monday, March 22, 2004
01:52 p.m.

i matched! i matched!

no idea where, though i'm guessing my first choice, because i'm just that optimistic ^__^

Saturday, March 20, 2004
12:07 p.m.

our food praised by the french! OMGWTFBBQ!

people are dumb.
it's true, they are. and the media makes them dumber, but it's still peoples' fault at the core: they lack the critical inquiry function that would stop them from blindly believing the media.

today, i stumbled across a few articles about how some french nutrition guide called the big mac healthier than the french quiche lorraine (a pastry shell filled with bacon, eggs, cream and cheese).
the headline on msnbs news, from reuters?
"Want to stay fit and healthy? Two top French nutritionists are telling people to go for a Big Mac and keep their fingers off the traditional French quiche."

so i wonder, how many french people eat quiche lorraine on a daily basis? how many add large fries and pop (and yes, mcdonald's is getting rid of supersize; credit where it's due)?

i have in my hot little hands a 2001 study (rozin p et al) comparing eating trends in france and the US. the question it aims to answer is "the french paradox...even though france's rich cousine contains more total fat and saturated fat than the american diet, their mortality rate from heart disease is substantially lower...30% of americans are obese, compared to 7% of the french".
a comparison of 11 similar restaurants in philly and paris finds the following: on average single servings in philly were larger by 25%, with specific examples like candy bars (41% larger), chinese food (72%) and soft drinks (52%, and that's all sugar, people!).
even the cookbooks in the states produced larger servings.
and the french also sat there and ate their smaller portions longer than the americans spend on their large ones.

so sure, be "fit and healthy". big macs must be the answer!

esca love, you aren't allowed to won't fail! just know your pneumonia, heart failure, and whatever else old people are prone to.
and ignore mom if she's distracting you too much. just...ignore her. can you tell her you'll deal with her after the exam, because you need to stay undistracted?


edit to add: i'm just now watching "city confidential", about something or other happening in boston.
random bostonial pub owner: "we have more historical monuments in this city than...almost anywhere in the world."

the world! boston is the most historical place in the world, people! forget egypt, forget all of europe and asia - why, boston's monuments date back to their civil war! now there's history, don't ya know!
why did evolution give us brains, if we refuse to use them? why?

Friday, March 19, 2004
10:55 a.m.

it's got to do with genitals, and that's important for me

match day is this wednesday. i keep telling myself that i'll get my first choice.
i keep telling myself that even if i don't, my second choice is just fine.
in fact, all my choices are good.
why am i so damned nervous about this? i really have no reason to be.

korea tickets bought. it was a strange sort of rush, completely maxing out my brand-new credit card. i had to keep converting currencies to see if i had enough.
the feeling might be like gambling. without the...gambling.

snow fell on tuesday. outside my window it's winter again, with sun sparkling on ice and confused black squirrels running over white ground. oh, and that house with the never-finished addition and the construction mess that's been there ever since i moved in. i hoped some greenery would cover that up before potential buyers came to see the apartment. damn you, weather!

i should be studying. or getting ready to go to school. we're voting for the valedictorian today, i believe.

Sunday, March 14, 2004
10:12 p.m.

choices, and why we shouldn't have any

i have spend the last two days looking up flight prices to korea.
i have wasted untold hours on one website, only to realize as i was ready to book that i'd need a credit card with a US billing address.
i rebounded and was ready to book again somewhere else, only to be told that i needed esca and bfie's passport information.
i have juggled too many different websites to get flights into the US, flights into korea, and hotels inbetween, and make the timing work.

i hate the internet! i long for the good old times, when people would just go to their travel agent and be justly ripped off. at least they had no choice.
choice: the scourge of our times.

my my, i wonder how i found time to become ACLS-certified this weekend. i pity the fool who comes into the ER when it's my time to run a code.

Friday, March 12, 2004
01:43 a.m.

drunken ramblings of a drunk

drunk. post-OSCE drunkfest of happiness that OSCE is over. nothing stands between me and the licensing exam anxiety except the ethics thing. which will never be over, especially since i've avoided the prof since coming back from vacation.
i only wish i had the foresight to have him fill out my evaluation before going away; then i could just avoid him until i graduate.

ah yes, also final day for ranking. my feeble belly-aching about residency placement doesn't seem too bad now, seeing that many people actually cried. i feel less feeble.

practicals are strange. they're just so artificial. and explaining everything to the examiner while i'm doing it, while appearing to in fact converse with the patient, is hard.
and not made a whole lot easier by the fact that i don't actually know why i'm doing half of these tests. they're just...tests one does for whatever condition.

and the breast exam fake patient we had was unfairly hot. i wonder if guys feel weird when they do breast exams. i just tried to be professional and not to linger, and then the examiner told me i went too fast.
but then again every single one of us got the exact same feedback on that station, so it's not just me. that's reassuring.

i would have profounder thoughts, but i'm drunk.

Saturday, March 6, 2004
08:27 a.m.

a death in the family?

oh no!
poor sanji #2!

perhaps you'd be interested in a pair of newts? guaranteed to be both immortal and completely indestructible?

me, i shall go to LMCC lectures now, for that is the best way to spend a saturday. eh heh...yeah...*sigh*

Wednesday, March 3, 2004
10:52 p.m.

and now everyone hold hands and sing "kumbaya"

we're into the homestretch!
esca called me a few days ago and, catching me at a suggestible time, forced me to finalize my choices and rank her school first. she is greatly powerful over the phone...even a dying phone.

my class is now into a strange pre-exam unit. essentially we have review lectures and some annoying tests, which while completely non-contributory to our eventual passing or failing still have the power to arouse anxiety.
mostly annoyance actually.
but also anxiety.

however, since med schools here aren't supposedly allowed to just give their students time to study, we also have these weird session things twice a week. these are supposed to help us step back and reflect on ourselves and our roles as near-physicians in the wider context of society, or something.
there are also twee assignments, like one-page essays about positive changes some physician wrought in the life of some random person we'll need to interview, and craptastic choose-your-own-theme time-wasters in the form of more essays. or photo collages. or poems. or perhaps dried vomit on a stick - i got the impression that anything goes.
in fact, during our two-day "retreat" we were treated to stimulating activities such as "sit in two circles facing each other and converse" and "make up a little skit/poem/song about your experiences".

now, i've felt incompetent many times in clerkship. i've had attendings who clearly thought i didn't know enough about whatever it was we were treating. i've had evaluations full of "constructive criticism".
but never, ever in my entire med school experience did i feel that anyone was truly condescending to me, not until those two passive-aggressive psycho-babbling idiots started off the unit by telling us how we've grown as people, and proceeded to treat us like kindergardeners.

i'll try to give the sessions a fair shake and attend, because...they're taking attendance. but god, was that painful.
one good thing was seeing the whole class together again, and sharing interview experiences. in fact, that's what we were doing when we were supposed to reflect on professionalism. and share touching turning points in our lives. and discuss the process of positive thinking. and...well, that's pretty much all we did for the two days, excluding complaining about the psycho-babblers.
not a bad retreat, after all.

Friday, February 27, 2004
10:57 p.m.

once again, knowledge brings disillusionment

having completed the forensic path elective, i can now watch CSI from the lofty view of the (marginally) informed - and it is a sad, sad view.
3 posts a day is high volume? in what universe exactly?
why are there no path techs around? or investigating officers observing the posts?
ah, these and so many other things wrong. i suppose i should treat it like (a much, much better) ER now and ignore the discrepancies.
pathologist: "this isn't CSI. we'll fix the brain and give it to neuropath. we should get the results in...3 years."
(yes, he was exaggerating, but the point remains)

speaking of sad things, i know TV programs compete for viewers. i know this extends to the daily news as well.
but damn, it's just sad when one channel is pimping "what canadian teens think of sex...and fidelity!" complete with images of barely-clad bodies, while another screams "next...new developments in the priest sex scandals".

Monday, February 23, 2004
05:16 p.m.

dead man's crotch

back to seeing dead people. 2 autopsies today, an MVA and a hopeless vasculopath who dropped dead after being discharged from hospital.
pathologist 1: "why was that autopsy even ordered?"
pathologist 2: "the family was upset...that he died."

bah. i'm wondering how he managed to live into his 7th decade. i swear there wasn't a vessel in his body that wasn't sclerosed. given all that was wrong with him, the man got a pretty good death; he could just as easily have crawled towards a miserable demise from multiple organ failure.
but the family is upset, so off to autopsy he goes. according to the hospital info and imaging provided, they found nothing acutely wrong with him when he was released. yes, he had an acute event soon thereafter, but that's what "acute" means. it wasn't there when they were looking, and they can't put every patient on perpetual observation. shit happens.

if we weren't living in a culture of lawsuits, we wouldn't be wasting precious health care dollars on autopsies for old, obese vasculopaths.
ah yes, and i got to wash his crotch afterwards (and the rest of him, but the crotch was gross. the tech dissected further down than usual because they needed to check his vessels, and there were those bits of fat stuck in his pubes).

my tenuous link to the kennedys

the (mostly) retired pathologist was in today, and regaled us with hair-raising tales of the botching of JFK's autopsy. the body was stolen from the jurisdiction, the chain of custody was smashed to pieces, the pathologist who screwed up the autopsy wasn't even forensic...and had no experience with that most difficult of homicide cases, the gunshot wound.
retired pathologist believes that the botched autopsy is responsible for the continuing conspiracy theories. he told us that one of his acquaintances did bobby kennedy, and opined that conspiracy theories about that death can't gain a foothold because of the superbness of that autopsy.

CSI redux

pathologist on truth: "the defence isn't looking for the truth, they're looking to get their client off. the prosecution isn't necessarily looking for the truth, because then we wouldn't have false convictions. what we forensic pathologists do is look to the body to tell us the truth."
preach it, gil pathologist!

pathologist on CSI: "it's not like on CSI, where they can nearly tell you the exact time of death. the only way you'd know that information is if you kill the victim yourself, and then look at your watch."
i knew there was something fishy about horatio.

esca love, what that school told you about getting in if you rank them? that's exactly what your school told me.
but i shall wait until match day to list the apartment anyways. you never know.
curse you, SARS delays!
our planning committee organized a 2-day retreat for our class, to kick off the consolidation-and-study unit.
guess where we're going?
guess guess!
you'll never guess!
last chance!
we will go to...
to...
the student centre!
yes, we shall have our 2-day retreat at the exciting and sought-after student centre, located in our lovely campus. aren't you jealous?
i know you are.

Saturday, February 21, 2004
01:18 p.m.

journey by chocolate

i love air turbulence.
air turbulence, rougher seas, something that tells me i'm in motion.
on the way out west, the plane hit the jetstream, resulting in a prolonged patch of turbulence. the plane kept climbing higher and higher to avoid it, and the passengers were grumbling that flight attendants weren't allowed to serve refreshments during that time.
but i really feel there's something wrong if i close my eyes and can't tell a plane from my couch. there should be some motion to remind us.

flying over the cloudless (and thusly visible) prairies, all i could think was, "damn, flat and frozen". there were a few scattered structures, and small clusters of what i'm pretty sure were trees, but mostly it was just white flatness cut into neat rectangles (by fences? irrigation systems? roads?). i saw some small lakes or ponds, starkly outlines and just as white as the surrounding land. everything was still.
it was strangely compelling, in an unnaturally geometric sort of way. i would've liked to stand on the ground and check just how far i could see.

the landscape grew considerably bumpier as we neared edmonton, at once more interesting and somehow less unique. i liked the blank, frozen rectangles extending over the horizon.

in the in-flight magazine, i read about the "death by chocolate" buffet at the fairmont palliser in calgary, so i was anxious to find someone who'd go with me.
but that's later. first came the edmonton orientation and interview, both of which went well. the alberta schools were the only ones which asked me about greatest failures/conflicts/faults, so i'm thankful i prepared for those kinds of questions.
edmonton was great, giving the impression of a highly organized but flexible program. i was swayed, as usual, for the duration of my stay there.
but the program in calgary suited me even more. and of course, i liked the city from the beginning; i decided to apply to the program on my last visit there. damn, they have a great program. and mountains! and they gave us little chocolate cowboy hats!
and i found someone to die by chocolate with me, heh. my first all-chocolate dinner.

i'm pretty sure i'd move to calgary if the residency was longer, and if i didn't have chibis. but for two years, dragging them across the country, having to find someone to care for them if i even want to visit my family for the holidays...not worth the bother. i can always move to calgary later if i really want it. hell, i may not even have a choice in the matter, for all i know.
dear esca's school is probably on par with calgary.
but...mountains...
*sigh*

but there will be the mountains of korea to hold in memory! yay, esca's aunt!

that's all. layout courtesy of esca, and my lazyness (or is it amazing foresight? for surely everybody should realize by now that i can't be trusted with computers).