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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).
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