Saturday, July 16, 2005
01:57 p.m.

"people taking pleasure in your pain"

am totally congested, but at least voice is back.
NY wedding was fine, the live band was great, the food was wonderful, the dessert table was even better, and the bride's white-trash sister added extra post-event entertainment by flipping out when informed that due to her disinclination to check in on the night she and other guests were due, their rooms were now gone. loud fuck-yous and ominous shaking of credit cards at exasperated hotel employees abounded.
i stood there for an hour, watching as her fat ass made her own sister-the-bride cry. shit, i don't even feel guilty for enjoying the spectacle. i'm a bad, bad person.
ah, schadenfreude.

the laryngitis is gone, but i'm not fully recovered. this is due at least in part to my fixing of the TV (ok, i attached every cable i could find to the thing, and eventually it worked), and consequently ceasing all non-essential activities. like sleeping.
today i'm back in my own, TV-less place. hopefully it'll help.

i have grown used to, somewhat, being on my own in the ER. oddly, i still run my cases by the staff when he's there during the day, even just to mention what i saw. even if it's just a laceration i sutured or a strep throat i diagnosed.
i don't ask him to see the patient, i don't want to discuss the case. is it just validation? proof i'm getting stuff done? behavior ingrained from med school on?
i'll try stopping.
being on my own in the office, however, is bliss. i'm actually enjoying myself. i'm seeing these people as my patients, i make their treatment decisions, i tell them when to come back. the staff reads about it in the chart. if he doesn't like something, we can discuss it later. but the patient is mine.

darling esca, i'd love to spend new year's at your new place. if surgery will let me. i think they may, but xmas is the priority if i only get to choose one.
i'm seeing you both for camping, right?

have archived blog as requested. please, please keep my theme?

Tuesday, July 5, 2005
10:33 p.m.

doe, a deer, a female deer

driving at night along the scenic route back to my placement, i spied what i assumed was a deer statuette on the front lawn on a house. it had the classic pose: head held straight, one leg raised and bent.
when she lowered the leg and looked at me, my foot brushed the brake pedal, my armpits stung with sudden pinpricks of sweat. there was no danger; she wasn't on the road. but she was somehow so unexpected.

since that night, i've seen a multitude of small, grey-looking creatures with catlike tails scurry into the underbrush as i pass by. or i think i have, because sometimes the play of headlight and shadow along the dips in the road causes slinky phantom creatures to jump to safety from my approaching car. the shadow tails have a particular playful wave to them that the living ones do not.

last night, approaching a curve, i spied through the trees the headlights of a miniature car. as the car quickly traversed the road in front of me, my lights focussed on the sharply pointed muzzle, the brights slid across the body already blending with the tall grass, picking out the color: a red fox.

and today, a sudden storm caught me on the ferry. driving through the rain, the lake on my right, i saw half a rainbow. its upper arc disappeared into the clouds, but where it touched the water it was as if the colors had leaked and the rainbow sprang from a small pool of colored water.
after the downpour, the trees looked greener than they did when the sun was beating down, driving the temperature to 30C. it was the hour before twilight, when the sky is already darkened but the sinking sun still shines on the vegetation, illuminating it almost from below, from the inside. letting it stand in lighted contrast to the dusky sky.

scenic indeed.

Sunday, July 3, 2005
12:25 p.m.

he thinks i'm cute

my new preceptor, that is.

i started my 4-month family/ER rotation in a small town west of here. it's located on an island, accessible by causeway or ferry, by all accounts very beautiful. the population is somewhere between 4-5 thousand.
it swells to almost 20 in the summer. "beautiful" has its downsides.

there is one hospital, with a snazzy dialysis clinic, an OR, a 3-bed "intensive unit", a general ward, and a small maternity ward. and the ER, of course.
my rotation started with an overnight shift on canada day. thankfully it was agreed by the nurses that it was an unusually heavy shift even for the summer: several chest pains that had to be admitted and one that was transferred to the tertiary center, a 3-victim MVA, sepsis.
and, as my preceptor was leaving the hospital, the guy we all thought would die. my preceptor saw him go in and immediately turned around.
our expectations were uniform: he would code. the code would be unsuccessful.
somehow, he defied them. another admission.

i knew the preceptors here would head for home around midnight, leaving me to run the ER. they were a phone-call away, but i still felt nervous.
just last month at the big teaching hospital, one of my preceptors huffed at me for discharging a patient with a corneal abrasion before he had a chance to review the case.
here, it's expected that i won't bother the staff with such simple cases even if they're in the ER, much less when they've gone home. i'll be expected to make much more serious decisions: should this chest pain stay for observation or go home? should i call the XR tech and the lab tech in from home now, or can this wait until morning?
you see, they don't stay in the hospital overnight either. when she said goodnight to me, i thought the XR tech was making a joke.
it got worse: i learned that there is no doctor up in the ward or in "the unit." or rather, there is: me. and my at-home preceptor.
i'm in culture shock.

ah, and my cuteness. he was showing me the on-call rooms. or room, i should say.
it's close to maternity; i heard a baby wailing.
"ummm, so where do the other doctors stay when they're on call?"
"what other doctors?"
"anesthesia? obstetrics?"
he grins and points to the bed he just called mine, casually asks, "you've delivered babies before, right?"
the next morning, he told of my bewilderment to everyone we ran across. my fear is endearing.

culture shock. i've been ripped from the comforting bosom of the academic hospital, where RT's can deal with serious desaturations while i stand aside, marvelling. where a trauma team stands ready when MVA victims are brought in, one by one, strapped onto back boards and complaining of parasthesias. where radiologists or orthos can review the spinal x-rays with me to make sure i didn't miss a fracture. where grumbling specialists are just a page away, where pregnant women are shuttled directly to obstetrics, broken hips to ortho, severe strokes to neurology under the acute stroke protocols.

here, patients with more minor complaints stand up and leave the waiting room without throwing a hissy fit when they see a multiple-casualty MVA roll in. they know enough to come back later, maybe the next day. here decisions to admit or discharge are made without the benefit of fancy tests like d-dimers, which have to be shuttled to a larger center for processing. in the morning. here we don't keep patients in the ER for observation because there's no space; and space in the wards is also limited. the population may swell four-fold in the summer; the hospital beds do not.
here, the nurses address me as "doctor", with a gravity not usually heard in academic centres by completely terrified residents just starting their second year.
here, at night, i'm the only living thing with an MD attached to my name.

Friday, July 1, 2005
04:23 p.m.

lies and the lying liars who tell them

the woman was in agony, moaning loudly, writhing in her bed, retching and vomiting bile every few minutes. my assessment, curtailed to a degree by her inability to straighten out her legs, elicited a story of diarrhea, severe abdominal pain, nausea and vomiting. tearfully, she begged me for something for the pain.
having faithfully skimmed her chart, i also inquired about the medications for her chronic pain. no, she stopped taking them late last year, after going to the pain clinic and finding other means to control the pain. the clinic referral was in the old chart.

ok. i went off to find my staff, impressed with her presentation. i can prescribe treatments and investigations before i go over a case with a supervisor, sometimes i even discharge a patient without speaking to one at all. but i just wasn't sure about this one.

her nurse looked at me in annoyance, and told me to get rid of her. she had already been changed twice, having soiled herself because she was in too much pain to use the commode.
i looked back quizzically. shit is gross, but if she's that sick, who are we to judge? it happens.

my staff heard her carrying on from the corridor between the ER sections, and rolled his eyes at me. i had the impression that i'd missed something important here.
his exam was pretty much like mine. he did, however, ask her which pharmacy she used. and then he told me to call it.
she was on a high dose of a long-acting opioid, prescribed weekly. 5 days ago, she received a double dose, good for two weeks.
i sighed.
and went to confront her.

she gave a rather classic story: someone broke into her house and, magically knowing where they were, took her pills and apparently nothing else. i offered to call the police. she emphatically declined the offer. i asked why she didn't call her regular prescriber. she said he was on vacation for two weeks, which is why she had the double dose.
i called her prescriber, whose idea of vacation apparently consists of hanging around in his office, seeing patients. he sighed too - she had had abuse problems in the past, but the weekly dosing had kept her on the straight and narrow for a while now. is was she who claimed she was going away, necessitating the two-week dose. "i guess she had a celebration," he said.
the contract was standard too: no matter how the pills were lost, there would be no more until the next regular dosing date.

i related this to her, and offered to call detox to see if they had space. the scornfully declined, stating that she knew they wouldn't give her anything. i said that we wouldn't either, that opiate withdrawal may feel like impending death but that it wouldn't actually kill her. she could go to detox or she could go home; either way, she'd have to ride it out.
she begged for something, "anything." she mentioned a number of opiate derivatives.
she had, i noted, stopped moaning and crying around the time i confronted her with the info from the pharmacy. she was still retching.

finally she went, and i faxed a copy of the chart to the other ER in the city in case she was headed there.

i've read about it, but this was the first time i actually saw full-blown opiate withdrawal. i have to say that i wasn't suspicious at presentation, even though i apparently should have been: "look at the old lady in bed 7," spake the staff, "she has a broken hip. whenever you see someone carrying on in a manner loud and dramatic enough to drown out ladies with broken hips, think 'opiate withdrawal'."
the old chart did not mention the prior abuse issues. at least i console myself with that. meh.
live and learn.

Saturday, June 25, 2005
08:51 p.m.

my very first rectal foreign object!

and here i thought i'd go my whole ER rotation without seeing one.

ok, it wasn't actually my rectal foreign object. the young gentleman had already been seen in the smaller ER, where they had failed to remove it by low-tech means, and send directly to have the specialists with their snakey grabby tools take a crack at it. so i didn't actually do anything.

but i saw the x-ray, and most importantly the removed object.
the x-ray was extremely weird. we knew, more or less, what he'd inserted, but it looked like something completely different on the film. namely, it looked for all the world like a scotch tape dispenser, which it most definitely was not. still, every staff and resident agreed that that's what it looked like, down to a bit of swirl-like tape coming off the dispensing end.

in any case, the specialists and their grabby tools removed it without any drama, and the rest of us spend the night being come-hithered by the nurse to be shown the object. it was...impressive.
it feels like a rite of passage. truly it does.

i almost saw a major multiple-casualty trauma too - the trauma team was all assembled, dressed in our snazzy trauma gowns - but alas, the only patient who made it in alive only had minor injuries. after being cleared he was pounced on by the cops.
MVA. i hate MVA's.

that's pretty much it, except for a warning: don't go to the ER drunk. nurses hate drunks. they roll their eyes at them and laugh with each other about them.
even when said drunk is actually dying (from terminal liver cirrhosis, for example), all they'll say is "well, he drank himself into that state, didn't he?"

Friday, June 10, 2005
12:21 a.m.

A/C killed my fridge. also, i am god.

my divine presence and healing touch cured two patients today.

first was the lady in atrial fibrillation. she'd been fibrillating away for half an hour or so, and i finally decided that she deserved to be seen. i walk into her cubicle, talk to her for a minute - and lo! she cardioverts and remains in happy sinus rhythm.

the second was a baby with dislocation or subluxation of the radial head (one of the elbow bones). she was unhappy and crying, so i gently examined her and did passive range of motion of her arm, then went off to find my staff.
we come back - and lo! the baby is smiling and reaching up with both arms. i had reduced the elbow by examining it.

so yes, that means you all have to worship me.

blowing stuff up
my divinity does not seem to affect electrical appliances, possibly because they are tools of the underworld.
but it appears that my A/C blew its fuse, that unfortunately also being the one used by the fridge. stupid, life-saving A/C. i switched fuses (light in the kitchen? bah, who needs it) and restarted it. i'll probably need an extension cord for the thing; i don't think i should keep it and the fridge on the same connection.

Wednesday, June 8, 2005
06:44 p.m.

i have A/C! and a date!

urgh. today i finally crawled into my fake window space, rooted around in a year's worth of filth and dust, retrieved my A/C plug and brought it to the hardware store so it could be fitted with a drainage hose.
then i cleaned an inch of dust off the A/C unit, maneuvered it into position, and...realized that i need to be behind it to attach the hose. ugh. the thing is heavy!
in any case, it's finally in position, and working. i hope the fake window gets enough airflow. it certainly seems to get enough, so i'm not too worried about it.
of course it rained today and therefore it's not too hot, but i'm glad to have done with it. it's not hot enough for me yet, but it's getting there for the chibis. i think it'd be better if they would shed their fur every summer, and i don't mean hair by hair. then they'd be cool and i'd have a nice supply of tiny furs to make into a hat or something. a smelly hat.

also have a date for saturday. well, when i accepted it wasn't really a date; the guy is a fellow unattached resident who won a pair of tickets to the theatre and asked me to go with him. he's nice and funny and we hang out together whenever there is a resident social.
but then he called and asked me to dinner as well.
i feel kind of weird because i don't date guys. then again, since i'm not dating anyone and haven't in some time (and don't have a particular desire to at this time), i also don't feel the need or desire to spout off about that. it's my (non-existent) private life, after all.
so yeah, looks like a date. we'll see how it goes.

ah yes, and i've yet again started a comprehensive exercise regimen. with a progress chart and everything. i start them up, go for a few months, and then run into a vacation or, more commonly, a rotation that saps all my stamina and will to live, and it stops.
my schedule is looking good until november, when i start surgery. surgery in clerkship was not conducive to exercise (i fucking have to exercise in the morning, for some reason). hopefully it won't be as bad at a community hospital.

Friday, June 3, 2005
05:14 p.m.

"we need an ambulance!"

me: funny thing to hear standing in the ER.
staff doc: ER? this is a walk-in clinic.

and so it is. there are two main hospitals in this town. the big one with the trauma center, the specialists, the fancy imaging equipment, the cath lab, the 24-hour service.
and the smaller one, with the ER that closes at midnight, the CT scanner that operates only during standard business hours, the specialists who are available only if they happen to have a clinic upstairs.
so patients with "real" emergencies, those needing urgent admission, surgery, angio, get transferred to the other hospital. while we continue to treat and release (and sometimes cast and suture, yay) the non-life-threatening cases.

i prefer the smaller hospital, and i'm glad most of my ER shifts are there. these are cases a family doctor will be expected to treat. these are cases that a family doctor working in an ER will have to manage.
and part of learning this work includes diagnosing the emergencies and making the decision to transfer them to a tertiary center.
i have just learned that during the summer and fall, for the four months of my community family rotation, i will be the ER doctor at night. it's a small community, with a small ER. an ER where the family docs are the staff, and where the staff goes home at 11pm and leaves the resident in charge. back-up may be half an hour away.
i'm excited, and terrified. and glad that i'm getting to learn in an environment much like the one i will have to work in, not a huge tertiary center with everything at my fingertips.

my (lack of) anime obsession
several years ago, i used to be obsessed with manga/anime. it was all esca's fault, of course, but there it was.
i made pilgrimages to the only store that carried silly plastic anime-related imports from japan at ridiculous prices. i bought badly subbed anime on bad-quality VHS, and felt happy to have them.
and i went to anime cons, and was content to stand in line for hours to get into the dealer's room. it was like paradise.

thankfully, those (not so?) many years ago, two things held true:
1. there wasn't all that much anime crap to buy; and
2. i didn't have that much money.

this past weekend i attended an anime con with the newlyweds, shelly and her bf and another couple. it was fun, it really was. it was fun and well-organized and had really good fanart and all that.
but i'm not obsessed anymore. it was a great opportunity to hang out with friends; we missed some panels and showings we had marked as wanting to see, because we were busy making dining arrangements and chatting over food. it was an excuse to get a bunch of people with a common hobby together in the same place.
and thankfully, now that i can buy anime and its attendant junk just about anywhere and have the money to do so, i'm no longer really interested in owning it. the only thing i bought were the cute bunny magnets. they're cute, dammit!

Thursday, May 26, 2005
06:04 p.m.

universal move of the radiologist: the hedge

"findings are consistent with a possible diagnosis of probable refer to clinical."

heee. yesterday was a PAIRO-sponsored day of free fooding and pedometers, and it came with a funny guest speaker who entertained us all with many hilarious songs about dying patients and made fun of several specialties, notably orthopedic surgeons, although as you see in the above (hopefully correct) quote he didn't limit himself to just one field.

tomorrow i depart for the anime convention, not knowing what hotel the room is booked or in fact anything at all. the married ones organized it all (ummm...i hope) before dropping off the face of the earth.
hopefully one of them will have a charged cell so i can somehow contact them.

ugh. i need structure to my days. i seriously just waste them if i have more than a day off.
perhaps i shall decide just how and when i'll be getting my ass to the con. that's not entirely wasteful, right?
perhaps i should take the chibis to the park and let them bite random strangers play. but they have magical leash-escaping powers *sigh*
perhaps i should go out to buy some mangos. but tomorrow i'm leaving for three days, so there's really no point.

fuck it, it's so nice outside. i should go outside and...do...something. perhaps see if those free pedomaters work. i took three!

Monday, May 23, 2005
02:50 p.m.

the bride wore red

esca got married this weekend. and it was beautiful.

it was also the first (and quite possibly last) wedding i've seen that screened funny anime music videos during the dinner.
and the first wedding i attended where the bride was wired - and i mean the kind of wired that needs soldering equipment. her husband rigged tiny xmas-type lights under her gown, and she carried a small battery pouch under her bodice. it reminded me of the glowing queen amidala costume, except that she had small lights under her dress, not large ones on top of it.
there was another wedding going on a floor below us, and she was stopped by their guests so they could photograph her gown.

my duties as maid of honor were severely curtailed by the horrid time-eating and people-dispersing nature of residency and the mad organizing skills of her finace, who pretty much planned the whole wedding single-handedly, getting pretty stressed by the end of it all. all i did was help make and set up the decorations, shop for flowers, and take the bride-to-be for some pre-wedding relaxation.
and make a speech. i write pretty well, although this one gave me far more trouble than the essays of yore. i stayed up as late over the thing as the soldering maniac did over the pretty lights.
but good writer or not, i'm not the best public speaker. i'm basically nauseous from the time i open my mouth to the time i sit down, and i have to stop myself from hyperventilating before i even get up.
and that's just with annoying presentations that don't matter a whit in the end. this was my best friend's wedding.

we spoke of it before, of how things really wouldn't change, of how they'd go on living together like they were now. it was a formality, it was good for the kids that would come along, but that would be pretty much it.
and that's probably right. day-to-day life won't change post-marriage. but that didn't stop me from getting all sappy and emotional as the ceremony progressed, as i saw my father walking her down the aisle, as i witnessed the exchange of rings and heard the (modified) traditional words. it wasn't "just" a formality, it was a united statement of love and intention before family and friends.
ceremony elevates such things. i suppose that's why it endures, why marriage is still seen as a rite of passage while starting to live together really isn't, even in this day and age. ceremony has the power to make people cry, to make a kiss between a couple that has kissed so many times before seem somehow special and new. there's something in many of us that responds to elaborate trappings and dressed-up phrases, no matter how modern we think we are.

while i didn't cry, i think it was mostly because i was concentrating on not screwing up at the procession, and later on trying to breathe normally while awaiting my turn to speak. i did get misty-eyed, i think she did too. that, or her eyes itched ^__^

and now they're off on their honeymoon in the happiest place on earth, and i'm back home, reviewing my pictures and wondering just why my camera insists on screwing up their order when it transfers to the computer.

the bride wore red.
and the groom wore jack skellington buttons on his shirt.

Friday, May 6, 2005
10:59 p.m.

the hitchhiker's guide to the ER

empathy?
moi?
i'll have your job for this, little missy! how dare you.

all right, first things first. i've seen the movie.
and i'll admit i laughed in places. out loud, even. stretching the vogons' bureaucratic sticklery into a movie-long running gag worked for me. and yes, i laughed at the dolphin song too.
i also truly enjoyed the stunning scenery, especially magrathea and the ride through the planet factory.

but i couldn't believe so many jokes were missed. no, you can't cram them all into a relatively short movie. but why oh why would you put in that pointless sidestory about humma kavula instead of, say, going with the incredibly funny exchange arthur dent had with the demolition foreman? to show off the teensy spidery legs? you know, they really weren't that cool.
or how about explaining the towel thing? i felt sorry for the people who haven't read the books; they were probably completely mystified about ford's towel obsession.

and now to the most important thing: WTF was with the love story? why? WHY?
i knew there would be a love story. hollywood is probably incapable of churning out a movie with a man and a woman in it and not have it be a love story. fine, so i expected a little lip-locking, off to the side of the actual, you know, storyline.
but they made it all about the loooooooove! it's arthur's ultimate question! he doesn't care about anything else! oh retch!
seriously, DNA was so good at avoiding crap like that...at least until the fourth book, and at least it wasn't this sappy.
so in conclusion it was a funny movie that left a rather bad taste in my mouth. i wonder if people who haven't read the books will like it more, or less. they probably won't understand all the unexplained jokes and references, but on the other hand they also won't be going in with the same kinds of expectations.

non-emergencies in the ER
speaking of expectations, i was warned that i wouldn't like the ER. that most of the people go in for stupid, non-emergency things. that i'd eventually get bored of the endless parade of mundanities and human stupidity.
but see, i don't mind. and it's all in the outlook. for people in the specialties who have to rotate through emerg, it is the one place where they really come face to face with primary-care medicine, and most of them don't seem to like it. their patients typically come to them pre-screened, with "real problems".

but i'm seeing it from a family medicine standpoint. these are people with no family doctors, and they come to the ER as they would to a walk-in clinic. coughs, colds, routine bloodwork, prescription renewals; this is what our emergency departments have to do because of the scarcity of family doctors. the ER is the primary care provider for these people.
does that make me happy? hell no. it's an incredible waste of money, to see these people in the ER. but it's not their fault that there are simply no family docs in this city who are taking new patients.

that doesn't mean i'm excusing the idiots who wake up at 3am and decide that this is the time to see a doctor about that rash they've had for the past three weeks. if it were up to me, they would be refused entrance into emerg, because too much is too much.
our ER recognizes reality, and therefore runs what is essentially a walk-in clinic for those without family doctors. it operates roughly during those times when a normal office would, and there is an extra person to help out during that time. your stupid rash can be seen then, not at 3am, and we will make you wait for hours and hours and hours to see a doctor if you come in at freaky hours for something stupid. maybe we're dealing with real emergencies. or maybe, at 3am, we're assholes too.

Tuesday, May 3, 2005
07:14 p.m.

doctor death

i'm old? dear, you're my age and getting married in three weeks. you're practically a matron!

i am done with internal medicine forever. for-fucking-ever!

those last two weeks were pure hell. all my patients decided to up and die. i may be exaggerating, but that's how it felt.
i'm not an "aggressive" doctor. i don't see the point of bringing a near-centenarian gentleman who stopped all his meds a few years ago in the hope that his next stroke or heart attack would kill him into the hospital for treatment. he knew what he wanted; shit, unlike most people in his situation he even had a psych consult on file stating that he wasn't depressed and knew just what he was doing.
but no, of course he gets brought in. at least his family was being reasonable and not fighting his DNR order, but the poor guy (unable to communicate at this point but still aware) just looked so trapped. i wrote his admission orders (i don't have the power to refuse admissions), and i made it very very clear that i wanted just the antibiotics and minimal supportive treatment, like IV fluids and some oxygen by nasal prongs for comfort.
i come back the next day and what do i find? dude's in the stepdown unit, on bipap (an oxygen mask that forces oxygen into the lungs, a step away from intubation) and a crapload of heart meds. holy shit. some doctors just don't know when to stop. they really, really don't.
i have some family meetings with the man's nice, reasonable family, and in the end we palliate him. he dies comfortably, instead of being tortured by our snazzy resuscitation equipment.
it's the nurses and other docs on my team that drove me nuts. he spiked a temp! look at his heart rate, we must do something about it!
no, we must not. so he's having some heart attacks, leave him the hell alone. let. go.

but because i'm so "good" at talking with families about these issues, because i don't avoid it and ask the staff or the senior to take over that task as i actually could do under the rules here, i end up with the patients most likely to need palliation. and just by sheer luck also with a few who just crashed on us.
so in the end my team just turned to me each morning and asked which of my patients died that night. and i gave handovers to the on-call resident along the lines of "and mr. x is on his way out, probably tonight".

i'm honestly not sorry for the patients. they were suffering, and had no hope. we have an excellent palliative care team that helps us make sure the patients are confortable. i actually felt relieved when one particular patient died.
i felt sorry for the families i had to speak to. i felt sorry that i had to force a decision from them, that i couldn't give them false hope. i felt angry that others had apparently never discussed end-of-life care with them; these were for the most part not acute issues, it was clear the patients wouldn't survive long before they got to the hospital for the last time.
i felt angry that some members of my team are willing to treat no matter what, they they can't seem to bridge the divide between curative and supportive treatment, that they're willing to appear optimistic in front of the patient and families until literally the last minute. it's ok if there is hope, but really, sometimes there so obviously isn't.

so those weeks were a roller-coaster of emotion. the death of each individual patient wasn't all that hard, it was the piling up of deaths that got to me. i felt alternately depressed and cynical. i was amused by the "doctor death" jokes my team made, and i even encouraged them; black humor is my favorite coping mechanism.
senior on consult call: "so what do you think we should do with this new patient?"
me: "does it matter? i admitted him, he'll be dead soon anyways."

and now it's over. out of my long list of patients just two were left to hand over to the new team; one will never leave the hospital. yes, of course, some were discharged, but the dead somehow overshadow the ones who recovered. and so i'm somehow left feeling like all of them died.

and yet...
i live on an amazingly level emotional keel. i never have severe ups or downs, and even during those two weeks i never cried, never felt the need to "talk it over" with anyone. yes, it was hard, emotionally draining. but one day out of the rotation the memory's already fading, and i'm looking forward with excitement to my ER rotation.

in fact, my first shift was yesterday. i had a blast.

this shit will kill you
just a random thing: two of the non-palliative patients who crashed on us basically died of constipation. don't get constipated when you're old, people! it's like shit-cancer; it kills. it really fucking kills.

Tuesday, April 26, 2005
11:24 p.m.

the fun was over and i went back to...hell

ok, so i have decided to finally complete my vacation journal.

as it turns out, poor grandma was left alone yet again after i returned from krakow, because my friend the newlywed had a performance in a nearby city.
he's a theatre actor, recently graduated from...errr, actor school. not sure what that involves.
the play was a minimalist thing about suicide, a woman at the end of her rope and two angels trying to talk her out of it by telling her things will get better, and finally scaring her with the apocalypse. my friend was playing the young up-and-coming angel who was angling for the older angel's job of soul-saving, jumping into the conversation and spewing latin and such. i thought he was very good.
the actress, however, was not good. she giggled throughout her performance, and for half the play i thought she just couldn't control herself for some reason. then i finally realized that she was doing it on purpose, but if just felt so very off. it wasn't dark, cynical, hopeless laughter. it was giggling. WTF.
after the performance there was a short discussion, so i asked about the giggling. she gave a spiel about watching a video about a woman who had overcome major depression and was able to talk about it without much emotion, and i guess that was her "research" for the role. i also guess that she was too stupid to recognize the difference between a woman who had, some years and many therapist appointments ago, overcome her illness, and a woman on the trembling edge of suicide. hell, i've talked to suicidal patients, and have gotten everything from hysterical crying to laughter in the interviews, but for crying out it wasn't happy girlish giggling.
eh. i left it, because my friend and this chick are in the same company and there's no point making his life more difficult by calling her on her idiocy.

i also learned a bit of intersting trivia on that trip - apparently townhouses are referred to as "canadian houses" in poland. i found that fairly hilarious.

the next day (my last in poland) i devoted to grandma, going out for a walk with her, talking and talking, staying for all meals. yeah, i felt a bit guilty. but i wouldn't have done things differently; in cases like that, guilt really is an inconvenience.

my train left for prague just after 0100, and i was more than happy to buy a bed in a sleeping compartment. i had it all to myself, so i could lock myself in with a chain and sleep without worrying about my stuff being stolen.
i had intended to leave my luggage at the train station and take a last stroll around the old town square in prague, maybe do some last-minute shopping, but clearly my brain wasn't functioning at its best when i made that plan. not much shopping to be done at 0600, on a sunday.
plus it was raining anyways, so i buggered off to the airport. and eventually made it back home in one piece.

does anyone else have morbid "if the plane engines failed now we'd all die on impact" thoughts? i have them on landings - not on the final approach actually, but when the plane's circling and the ground becomes clearly visible.
it's not some phobia, i actually love flying. but i always have these thoughts *shrug*

back in hell
as soon as i came back, i was swept into the horror of call. i was on-call the day i came back to work, and on the weekend.
and the weekend? it sucked. the old clerks were done, the new ones wouldn't start til monday, and i was all alone. weekend calls overlap - post-call gets off at noon, but day call starts at 0800. so when it comes time to round on the on-service patients there are at least two residents from each internal med team, plus typically a clerk, and if not the R2 or R3 will come in for 2-3 hours to help round.
well, we had no clerks. and in a very, very rare occurrence caused by vacations, no other R1 from my team was scheduled that weekend. our R2 was also on vacation, and our R3 was not coming in because of academic priorities. so there i was, expected to round on 20 patients by myself. on saturday; on sunday we were post-take, so we had an extra 6 patients, some very sick, some still being worked up.

the staff, being nice, came in to help me. but one doesn't split the list with the staff; one rounds with the staff. helpful with the unstable patients i can't handle on my own, less so with the stable ones i just want to get through quickly so i can get the hell out of there.
yeah. i got out at 1500 on sunday. and all day on monday people kept asking if i was post-call because apparently i looked like shit. hah! i was on-call on monday.
happy birthday to me.

Thursday, April 14, 2005
04:10 p.m.

the seat of power

turns out the second room in "my" apartment became occupied while i was out. not realizing it, i was pretty startled to hear the door open around 2300.
they were a nice english-speaking couple who didn't seem to mind that my laundry was all over the bathroom. ah well, we're all adults; surely they've seen underwear and bras before.

today i went to explore wawel, the castle that was the seat of polish kings from the mid-11th to the early 17th century. i didn't have time to take in the cathedral and the royal tombs, but we did that two years ago (when we didn't have time for the castle itself).
there are three main exhibits (and damn it, exhibits seem to be the only places that honor my ISID. the rails laugh at it), the state rooms, the royal treasury and armoury, and the private apartments, currently also housing the "art more precious that gold" collection of medieval and renaissance art.

the state rooms were stunning, each room a kind of jewel and some actually sparkled. the walls either had friezes running just under the ceiling, depicting battles or concepts such as "the life of man", or were covered completely in thin, beautifully embossed and colored leather. there were huge paintings of kings and queens, other important personages, and battle and biblical scenes. the wooden furniture was intricately carved, the chairs covered in embroidery.
but the most stunning to me were the arrases, huge wall hangings as large as 480 square feet, most from the collection of king sigismund II augustus and dating to 1553 through 1571. they also show battles, hunts and biblical scenes, as well as landscapes with animals. some of those are funny - the european animals are well done, but exotics are a bit...off. giraffes with large central horns, predatory cats with lng, almost snakelike necks, some strange moose-like creatures from africa (judging by the landscape) that look very much like dinosaurs.

the private apartments were pretty similar, only a bit smaller and i suppose less ostentatious even though they too were covered in arrases and paintings, and occasionally the leather. but this tour was guided, and i learned that those tapestries, of the best silk, wool, gold and silver thread, took one year per square metre to make. of course lots and lots of people worked on each one, but it's still a long time.
and i also got an explanation for the shortness of medieval beds - those people slept in a half-sitting position, because lying flat brought one too close to death, and also messed up one's elaborate hairstyle. and imagine if you messed up your hair and then died - death would probably put you in with the peasants or something.

in the royal treasury i saw beautifully chased gold and silver cups in the shapes of all manner of fowl and beast, a bunch of gold decorations and clothing clasps that looked pretty damned heavy, and decorated royal swords, all this stuff from the 14th century onwards.
i liked the elaborate horse trappings the most - the ones that were gifts to the king and survived beautifully, and the captured ones that have definitely seen some use.

regarding use - the armoury, among evilly spiked medieval weapons, also exhibited dome 17th century cannons. these, commissioned by this or that king, were intricately worked with crests and latin script. but there were others, found at some battle sites according to the descriptions, that had no or minimal decoration. i wonder how much was just for show - were those commissioned cannons actually just status symbols?

alas, i must now hurry to catch my train (after deciding what delicious dessert i will have. it's so haaaard!), and return to wroclaw. i'll spend the last two days with grandma, taking walks in the park and slowly getting myself ready to go. and tracking down those stupid multivitamins my brother inexplicably wants.

Wednesday, April 13, 2005
07:34 p.m.

mmm...salty

today i actually got up early (0600; i've been sleeping til 1000 or later) and caught the early train to krakow, leaving my worried grandma behind. she's worried because unlike my brother a year ago, i do not have a pre-planned, color-coded sheet detailing my train schedule (with pre-bought tickets) and sleeping reservations. i saw the thing; i think he may have scheduled in toiled breaks. it was insane.

i set out without having a place to sleep, and without making a decision when i will return. it will be weather-dependent. but i'm a woman, travelling alone, and without a plan. so she worries.
i arrived before noon, and was approached by some people offering places to stay as soon as i stopped to look at hostel advertisements. deciding that i wanted a room of my own rather than a hostel - they're fine as long as you can look them up online and read reviews, but i wouldn't pick one sight unseen - i chose the offer of an apartment room about 15 min walk from both the station and the main square. turns out it's a private 2-bedroom apartment with nobody in the next room, so i have the whole place to myself for the equivalent of about U$23.
i decided to drop off my bag and head to wieliczka, but before i left i visited my private toilet - whereupon i discovered that i needed to provide my own private toilet paper. o cruel world!
a frantic search of the place revealed nothing usable, but then i remembered that yesterday i had an icecream and was still carrying the crumpled napkin in my coat pocket. ah icecream, saviour of bladders.

that particular adventure over, i set out for the minibus pickup area, telling my brain to periodically remind me to buy tissues.

at wieliczka i joined a tour group and saw the mine. it's absolutely stunning, and i really don't remember having been there as a kid. i know i was; my parents bought me a salt block and licked at it for weeks. but i don't remember the mine itself.
the tour follows several caverns at a little more than 100m underground, although the mine itself goes to over 300m. the caverns illustrate how the mine was worked, with statues of poor toiling miners and such. there are also several chapels, and these were not designed for tourists. they were for the miners who, facing death from random methane explosions, were very religiously minded (although who wasn't, in those days).
we also saw live-size statues of famous people who visited the mine, including copernicus and the pope. they were of course made of salt and i wanted to lick them, but i didn't. i did lick the walls though, and they were salty. i wonder how many thousands of people licked those walls before me...ah well, salt tends to kill bacteria.

the most beautiful cavern is a huge one with a chapel at one end, and beautiful salt reliefs of scenes from the bible carved on the walls. damn, i wish i could just post pics now. anyways, if you have enough money you can arrange to be married in that place. and see, now i kind of want to get married there, even though i don't actually want to get married. stupid salt cave.
on teh way out we went past several lakes that have a salt concentratin of over 40% (the dead sea is less than 20%, i believe). there used to be little boat tours on the lake until a bunch of soldiers got drunk and fell in, and drowned because they couldn't get out from under the boat. apparently because of the microclimate down there you don't feel drunk either, until you leave the mine - and collapse. heh.
anyways, i totally wanted to float in the lake.

eventually the tour was over and back we went to krakow, but not before buying a bunch of pretty salt stuff. the salt from wieliczka is kind of greyish, but they also have salt from a nearby mine that's pink and blue; some kind of refractory illusion apparently, because it's white when it's ground up.

back in krakow it took me an hour to find that elusive moving milk bar (milk bar! you people don't have milk bars, and this should make you weep!) and finally get dinner, and then i was drawn like a moth to the flame towards the nearest internet cafe. curse you, internet!

tomorrow i'll decide whether to hang round on the square or to go up to wawel castle. i'll also decide when to go back. grandma will worry.
ah yes, and i bought tissues. in case anyone's worried about me ^__~

Tuesday, April 12, 2005
03:21 p.m.

polish weddings

i seem to go to poland for weddings - my cousin's two years ago, my friend's this time around. his sister is now joking that the next time i'll come over will be for her wedding next year.
polish weddings, traditionally, are huge festivities. they go on until morning - this one went until 5am, although i bowed out by 3am because some people got me drunk on vodka - with "poprawinki" the next day. poprawinky are when the wedding guests come together again to eat the leftover food and drink the leftover vodka. i'm told country weddings can last three or more days.

the food is also served differently. yes, it starts with soup or maybe a salad, then dinner, then dessert, but it doesn't end there. throughout the night several more main courses will be served, full hot courses with soup and everything, served like the first dinner on large platters so guests can pick what they like. there are also cold meats and various other appetizer-like things always on the tables, and platters of cakes. it gets to be ridiculous - you're so full already, and here comes another platter of something you absolutely want to try.
for this wedding there was also a "country table" set up - a huge table with bread and homemade sausages and roasts and "bimber", a very strong (and not so very legal) homemade vodka.

in any case, other than eating and drinking too much (how can you refuse, when they're asking you to drink a toast for the young couple's health...once again), it was amazing. there was a live band playing some popular english and polish tunes, but also a lot of traditional polish country songs that are very danceable. and my friend got up there and sang several songs to his new bride; quite well, he's a theatre actor with a crapload of vocal training.
there was another tradition, one i didn't know before. it was called "oczepinki", where the newlyweds start dancing together, and guests can butt in by paying a fee to the best man (for dancing with the groom) or the maid of honor (for the bride). doesn't sound as fun in writing, but it was a blast.

ah well. so he's married now (in the church of st. valentine, by the way) and gone home, carting more food than their fridge can probably hold. the food, being paid for, is all packed up and given to the family of the newlyweds after the festivities are over, so i estimate that neither they nor their respective parents (and siblings) need to cook for the next two weeks. it was a lot of food, and it's perfectly fine that so much was left. what's not fine is if the guests manage to eat everything, because that apparently shows that the wedding was cheap. traditional hospitality and all that.

and i'm back in wroclaw. today i went to the town square, rynek, and met a cousin i haven't seen for years. it's so beautiful here, with the river running through the city, the cobblestone walkways, the old buildings, each a different color. i don't blame my mother for wanting to return for good each time she visits.
tomorrow morning i'm leaving for krakow and wieliczka, the salt mine that's one of the UN heritage sites. the weather forecast states it will rain; it doesn't matter in wieliczka because it's all underground, but i'm rather hoping for a clear day for exploring krakow a bit.

and now i'm off to dinner in a milk bar. milk bar! you don't know what you're missing, people!

Friday, April 8, 2005
08:23 p.m.

my grandmother's house

well, i managed to break nothing else in prague, and consequently kept within my budget. i failed to find the amazing small czech place where we dined two years ago, but with the many changes in cuisine (prague is currently infested with italian restaurants) perhaps it had simply closed down.
ah well, change will happen, even if my mind wants to fix things as they were. i'm sure the locals appreciate this broadening of their foodly horizons even if i don't.

on tuesday i went by rail to kutna hora to visit kostnice, the church where all decorations including a stunning chandelier are made of human bone.
it was beautifully stark, and somewhat awe-inspiring, and very, very cold. very cold. i'll post some pics when i return, but anyone can find pictures of the place on the internet.
wednesday i took in the palace complex and the cathedral, which i missed my last time in prague - we had arrived too late in the day. but first i went up petrin hill to the mini-eiffel tower - modelled after the one in paris but only 60m tall. still quite a climb, especially after climbing the damned hill; the cablecar was out of service for two weeks, just my luck. but the view was great.
and it was just as great from the bridge tower, and the south tower of the cathedral. now i know why there were no fat people in the middle ages - i think i did a month's worth of stairmaster that wednesday.
(yeah yeah, they also didn't eat as much, but still. stairs).

then, after meandering across karluv most and the old town square one last time, it was off to the train station and on to wroclaw.

and now here i am, at the home of the parents of the friend who's getting married tomorrow, hiding from my grandmother and feeling both relieved and guilty.
my grandmother, after the death of my grandfather and the only man in the house, has become stereotypically afraid. she rarely leaves home, and because her friends are similarly afraid (or dead), she doesn't have many visitors.
she watches me constantly, even when i'm looking through pictures to edit out and describe. she complains that i don't eat enough, and that i must not like what she feeds me. she remarks how all the actors and singers of her youth have grown old and ugly - and so has she.
she's lonely and depressed and i'm doing my best to be empathetic, to talk with her for hours on end, to watch those endless hours of the burial ceremonies for the pope, and still i feel nothing but relief when i leave her house. i'm hoping we'll be coming back from the wedding on monday rather than on sunday; i'm planning to extend my trip to krakow from two to three days. i wish my parents or brother were here, to take away some of her attention.

and i feel guilty, and small, and mean. i should be understanding, i should give more of myself to her, i should listen at least with the same blandly sympathetic attention i give to my elderly patients. but my elderly patients don't look in om me when they get up in the morning, don't try to keep me with them for hours, don't make me feel guilty because i don't love them.
i love my grandmother, but i can't handle this unrelenting, anxious attention. even though i know that this will likely be the last time i'll see her alive, i still need space - space to calm down, to unwind, to be able to return to her house and listen to her once again.

Monday, April 4, 2005
09:22 p.m.

bull in the bohemian crystal shop

arriving in prague an hour late because of lousy snowy weather in canada, i was glad to have shelled out the cash for a pick-up from my hostel. such a cheerful sight, the guy with my name on a little tablet whose presence meant i didn't have to negotiate public transportation in rush hour.
i immediately went to ground in my happy little room, sleeping off the journey. at just past 2pm local time i awoke and decided it was time for a little walking about.

i strolled around the old town square and to the other side over the karluv bridge, going into various shops, eating icecream, basically remembering my last visit.
i bought a ticket for a black light theatre show, one of many in prague, but this one was supposed to be 3D. the theatre was located on wenceslas square and i was slowly making my way over there when disaster struck.

i had once again strolled one of the many bohemian glass shops, and asked the saleslady for something specific. she was pointing above my head at the display on the walls, backing up, and i was slowly following her and looking to where she pointed. and then, crash!
i had walked straight into some painted crystal wineglasses that were standing on the floor of the shop, breaking three of them. they were sets of two, so basically i ruined three sets.

the lady gathered them up and went for her boss, while i put on my "sincerely sad but not spineless" face. yes, i walked into them, but they were on the floor and you practically led me into the things.
there was some back and forth with the guy i assumed was the boss, and who didn't speak much english, and who wanted me to pay for the sets. i was apologetic but unmoved - the fault was the saleslady's as much as mine. i would pay for the glasses i actually broke, but not for the whole sets.
then the actual boss showed up. he spoke excellent english, and i again explained the situation. yes, i walked into your extremely fragile menchandise which was sitting on the floor. while your saleslady was moving towards it, pointing out some glasses on the top shelf. i will pay for the broken glasses, but not the full sets. again some back and forth, very polite, both of us affecting the semi-helpless "i'm doing the best i can" look complete with spread arms.

realizing this was getting nowhere, i explained that i was (obviously) not from the czech republic, and wasn't familiar with how such things were handled here. i didn't want to break any laws, but i felt that what he was asking was unfair. could he please call the police, and i will explain the situation and then do as they direct?
suddenly some action. i was from canada, yes? i trust the police. well, in prague police aren't like in canada, if he calls them they may even make me pay a fine, he doesn't want to get me in trouble.
having read in my guidebook that police in prague have a (perhaps deserved in the past) reputation for bribery, but are these days considered honest and generally helpful to law-abiding tourists, i stood firm. call the police, i will do what they tell me. if they say pay full price, i will.

he pulled out his cell, walked away from me and started to whisper. i may not speak czech, but being polish i can often get the gist of a conversation. but not being able to hear him, i can't say if he even actually called.
we wait, he said. you have time?
i did. my show wasn't for another hour and a bit. i walked about the store, avoiding the glass on the floor, looking calm. he cracked first.
ok, ok, pay for the broken glasses only. i did.

if the police had actually shown up, would i have had to pay? who knows. from his attempt to dissuade me from calling them, i suspect that they wouldn't tell me to pay full price. i would either pay what i did, or nothing. but in the end it was U$35, a lesson in carefulness i can definitely afford.

the bone church is tomorrow. my plan: break nothing.

Saturday, April 2, 2005
01:15 p.m.

my mother used to ski with the pope

he wasn't the pope back then, he was a cardinal, and an excellent skier. and she wasn't a friend or confidante, just another of the many young people who skied with him. but it provides a personal link.

my parents, both catholics who pretty much make it to church on the holidays, or some weekends when mom doesn't have to work or dad doesn't go fishing with his buddies, cried yesterday as the pope lay dying. they cried because he was the head of the church, yes, but also because he was theirs. he was polish.
i used to be roman catholic - heck, i used to be an altar girl (in germany, since they didn't have those in poland). these days i waver between agnostic and atheist, probably closer to the former. i didn't cry; the pope did a lot of good in this world and, through his guidance of the catholic church, a lot of harm as well. i'm sure god wouldn't have flipped out if maybe, just maybe, the church endorsed the use of condoms if only to halt the spread of HIV.
i didn't cry yesterday and i'm not crying now that the official news of his death has come down. i do respect his choice to die at home, and although i have been known to be critical of him and his vision in the past, i hold no grudges against the dead. i wish him peace, wherever he is now.

preparation for departure
yesterday was hectic and tiring as hell. by the time i was having my hair cut in the evening, the poor stylist probably thought i was unhappy with her work. i couldn't keep my eyes open and answered in toneless monosyllables (the cut is a bit shorter than i wanted, but that's my fault; i told her exactly how much to take off).
post-call days suck, especially when one can't even afford a quick nap.

my last pre-vacation call was exactly the kind of call you'd want: not too many annoying tylenol and gravol orders and calls about old ladies unable to get settled. a patient slowly crashing over a few hours, the acute awareness that he might code or at least require intubation at any moment, the endless reviews of X-rays to check for ARDS and the position of the various tubes i was shoving up his nose, stat blood gases, calling his next of kin to verify code status, the feeling that i was doing something, being a doctor.
in the end, in the morning, he was still in stepdown, having narrowly avoided intubation. and i wasn't even feeling tired (yet).

only the death of a patient and that manicure ruined yesterday's mood. the death of a patient is almost a given for internal medicine floor call - someone has died on pretty much every call i've had. they're DNR, the nurses don't call me until they've passed on and the family needs to be talked to, the paperwork filled out. the only thing is, she was young. young, with a recurrence of a particularly nasty cancer. young, and with a family still in the denial and anger phase. it was hard.

the manicure, my first, was to relax me and make me feel that vacation has really begun. the actual cutting and filing and hand massage were pretty good, although she did make my middle nails look spatulate instead of rounded.
then came the nail polish. i can't really apply polish; on the rare occasons that i do, a q-tip soaked in polish remover is my best friend. she was great at the application, but it was a basecoat, three coats of polish and a topcoat, with no waiting in between. she was very fast.
three hours later, when i was having my haircut, i happened to hold the pad of one finger against a nail and got a perfect, deeply indented print. three hours; am i not supposed to regain the use of my hands by that time?
i went home and removed the semisolid gunk off my fingernails, swearing that next time (i prebought several visits) i'll stick to two coats tops and make her wait inbetween applications.

today is a day of rest and relaxation and good home-cooked food, and tomorrow i'm flying to prague. i can't wait.

Wednesday, March 30, 2005
12:24 a.m.

new wheels

as of today, i am the proud owner of a 2000 toyota camry LE.
i haven't actually seen the thing, but am assured that it is silver and pretty and has more features than my poor dead protege (it better have more. it's costing me $3K more than the insurance paid for a protege of the same year, and it's going to be nearly $5K more with taxes and all annoying fees).
i shall see it by the end of the week.
and it shall bear my old plates. the twin plates of DOOM and DESTRUCTION!

only one more normal workday and one call shift to get through, and i'm free. free!
today i took the chibi cage apart and washed it thoroughly, mopped and dusted the house.

then i thought, "what the hell", and washed the chibis too.
click to see wet and unhappy kurara

(poor chibiko, she is left out. but she just doesn't photograph well, the pale wench).

Wednesday, March 23, 2005
06:17 p.m.

terri schiavo

the ongoing legal battle about terri schiavo's feeding tube (and consequently her life) is impossible to avoid. the msn.ca headline changes every time i check my email - and being somewhat obsessive (not to mention inclined towards procrastination), i check it at least twice during the workday.

not being privy to her medical particulars, i rely on the opinions of the medical professionals who are. and she's certainly had many looking after her through the years, as well as court-appointed doctors to reassess her and make sure that her condition is what it is.
her parents claim that she responds to them, even whispers answers; answers nobody else has heard. her parents are grief-stricken and impossibly optimistic (bordering on delusional?), and it's impossible not to feel sorry for them, in that fairly detached way one feels sorry for far-off people whose lives have never touched one's own.

but this private tragedy has been brought to international media attention by the US government's deluded "culture of life", and now i can't get it off my msn.ca. and every now and then i read something that makes my blood boil.
i'm not talking about the politicians getting involved in a case about which they have no real clue. they do that all the time, and i ignore them.
no, i'm talking about the advocates for the disabled, some of who keep carping that "denying terri her life" is discriminatory, that people learn to live with disability, that no matter what her prior wishes, she may have changed her mind.
she has no mind to change, you lunatics!

yes, some people undoubtedly thought they'd rather be dead than disabled, and upon sustaining a disability realized that life is worth living after all. people adapt very well to new conditions. they tend not to adapt, however, to not having a working brain.

the poor woman is in a persistent vegetative state. that's what she is, harsh as it may sound: a vegetable, a mindless body kept alive by tubes stuck in various orifices.
comparing her to disabled people is an insult, both to the disabled and to the gravity of her condition.

let the poor woman die.

Saturday, March 12, 2005
04:59 p.m.

wine-snobbing ahoy!

my school runs these seminars to help polish students for a professional atmosphere. usually i'm either not interested or on call, but since i'm not working this weekend i did sign up for today's seminar.
it's a 2-hour wine tasting event that is supposed to give participants "a basic foundation of knowledge on how to choose the proper wine for each occasion, whether you are having a business meal with your co-workers, boss, or a new contact."
yay, i'll finally gain some proper wine snobbery knowledge. seriously, my poor mother's at her wits' end regarding my alarming wine ignorance, and the fact that i tend to prefer 0 mixes, or 1's. just can't get into the "sophisticated" dry stuff.

also: wheee:

Dance the night away by karchan85
Name
What you Look like
The Music	Jazz
Quiz created with MemeGen!

internal medicine
our team is large, the patient load relatively small although expected to rise. switching call seems to be relatively easy, so i'm no longer worried about having bought my tickets to prague before i knew if i had that weekend off or not.
and still, shit happens. small shit, like forgetting to adjust some antibiotics for renal dosing.

and big shit, like coming onto the ward in the morning, feeling well because it's a friday before a weekend blessedly free of call, and seeing the nurse point me out to the resident who was on call during the night.
she is an ALC (alternate level of care) patient, no acute issues, admitted a while ago after a couple of strokes. she had recovered as much as she was going to recover, a pleasant, intermittently confused elderly lady.
they found her unresponsive in the morning when they came to do her vitals. blood pressure up slightly - it's been the one thing we had trouble controlling - but otherwise fine. just unresponsive, open staring eyes, drooling out of the corner of her mouth, essentially comatose.

the family was consulted and agreed to comfort measures only if the CT showed a massive bleed or stroke, if she had no chance of recovery. when i left at the end of the day the CT was still not done, although i had called radiology as soon as i first examined her. she was moving her arm a bit, but was still unresponsive.
she is otherwise healthy. if the scan shows the worst, if she can't recover, if we withdraw feeds and IV fluids it will take her days to die, perhaps a week. if we withdraw feeds but not fluids, it will be weeks.
she was a sweet lady who always remembered me when i came into her room. two days ago she asked me if she may have coffee with her breakfast.
and i said no.

Sunday, March 6, 2005
08:43 p.m.

carmageddon 2: cargu

hmmm, a few days after i informed esca of my car crash, she crashed her car. ok, in a parking lot and mostly doing aesthetic damage, and it could've been ignored, if it wasn't for...

esca's friend, who went skiing with us a week ago (and was duly informed of both my and esca's car troubles), just totalled his car in a roll-over. esca's pre-husband and some girl were in the car, and nobody was hurt. but brand-new car, dead.

so now i wonder: it it like ringu, where it's passed from person to person? from me to esca, and from her to the friend?
or am i the cursed one, and the legacy of car destruction is spread through contact with me? i did meet the friend myself, after all.

if it's the latter: warning! don't read this entry!

Friday, March 4, 2005
10:03 p.m.

does she have any quality of life?

q: what does a colonoscopy look like?
a: two assholes connected by a plastic tube.

ah, medical humor. i needed some tonight, and so it was fortunate that a bunch of medicine residents happened to be going out for a drink.
i discharged two patients today, another yesterday. finished my discharge summaries. handed over to the senior, and was about to walk out free, half an hour early. on internal medicine!

she coded as i was walking by her door: an elderly lady, looking at least 10 years older than her age. full code, something we couldn't fathom given her age and health. coding her was something we wanted to avoid under any circumstances, knowing it would probably come to it during her hospital stay.

still, full code was her stated wish, and that of her family. she wasn't my patient, but i stayed, getting chairs out of the way, moving the bed as needed, trying to get a blood gas - unsuccessfully, given that her peripheral vessels had shut down.
we don't really "slow-code". it's an underhanded way to refuse to follow someone's wishes. i suppose in some cases it's done, but i haven't seen it. most of the time we are pretty effective in having hopeless patients declared DNR. yes, in some cases we influence the patient or the family, you could even say we go so far as to pressure them if we think it's necessary.
but we don't slow-code. and so we didn't with her. she was aggressively resuscitated while we watched the cardiac monitor, almost willing the line to stay flat. we could call it after 10 minutes.
her heartbeat, erratic and weak, returned after 5 minutes. intubated, with minimal blood pressure and no distal pulses, with possibly fractured ribs, she was wheeled to the ICU where our team leader all but apologized to the ICU staff for running a successful code.

she almost coded again in the ICU, but somehow raised her heartbeat again. who knows what she'll do overnight. i don't really expect to see her name on our list in the morning, but then again i didn't expect her to regain her heartbeat either.

Monday, February 28, 2005
07:23 p.m.

granny's bling

today i got the appraisals for the two rings my grandmother gave to mom and me when we left poland, over a decade ago.
my parents first kept them in a safe-deposit box, them in a drawer with the rest of the jewelry, then...well, i kept asking for them because one was mine and once i grew up i wanted to know what the hell it was, at least. but they didn't even know where to look, as we'd moved 3 times since i last saw the rings.

finally i got them to look through all their knick-knack desk drawers, and the rings were found (it looked uncertain there at one point).

they're large, hand-made rings with stones set in beautifully worked and curlicued 14k yellow gold. the larger, a 29ct yellowish-green oval peridot, extends the length of the entire proximal phalanx, knuckle to knuckle. definitely old-fashioned, not something people wear these days. and almost too loose on my index finger; granny was much smaller than me, i doubt she ever wore this.

the smaller is a 14ct round london blue topaz, half the size of the first ring, almost wearable. i mean that people would probably stare because it's not a size and style usually worn today, but it's not as insanely huge as the peridot. someday, in a really fancy setting, i might be able to pull that one off.

they came in at $2300 for the peridot and $1500 for the topaz O__o
holy bling, gramma!

well, they're destined to be family heirlooms, most likely. i'll probably get some future wear out of the topaz, and then hope my bro will spawn a girlchild.

in other, more horrible news
i'm starting internal medicine tomorrow. hold me, mommy!

also: happy birthday, esca's pre-husband!

Monday, February 21, 2005
07:32 p.m.

faith-healing: god vs satan

so, over time some small studies have been showing up, lending a bit of credence to talk of prayer helping to heal the sick. cancer victims and so on, so we're talking in conjunction with regular medical treatment, of course.

i wonder if a study could be performed where the people agreeing to be prayed over would be randomized into a "god" group and a "satan" group. the patients would not know that there was a "satan" group, only that there were two different religious groups, and they would (purely statistically speaking) not be satanists.

now, i don't think it'd pass the ethics committee because patients do have a right to know what the groups are (just not which group they'll be in), and i can't see a whole lot of, say, christians agreeing to potentially end up in a satan group.
but let's say the study was done, and like in some of the actually conducted (but satan-less) studies the two prayer groups ended up slightly better off than the non-prayer control group.

would that mean that:
a. prayer has a placebo effect on those who believe in...whatever.
b. the lord satan is merciful and invoking his healing powers makes all kinds of sense (especially when you're dying of cancer).
c. god works in mysterious ways, and right now s/he's screwing with your mind.
d. we can't know until we can reproduce the results; then we'll argue over b or c.
e. none of the above.

ok, so i'm bored. we have the day off, i don't feel like working on my evaluations, and i can't even do my major shopping because i'm carless. and when one is doing nothing, one naturally starts to contemplate satan, right?
something about idle hands, i think. was that in the bible? or am i thinking of that movie?

soul-mating and its effect on personal vehicles
my dear beloved esca, i am so glad that your car appears to be predisposed to crashing exclusively in parking lots. what happened? did you slide on some snow?
we had a snowstorm last night. ever since my own crash, i look at snow and ice and frown with anger. bad snow!
with your car, i fear fixing it up to pass your in-laws scrutiny might just cost more than the car's worth. my insurance company will pay me about $9K for my barely-4 yr old car that was in perfect condition before i destroyed it, and it's actually a fair value. didn't bfie's car already have some parking lot-related scrapes in the past?
ah, and will meta come winter-sporting with us?

Saturday, February 19, 2005
01:05 p.m.

my patient-killing endeavours

ah, what a way to end the week.
yesterday my fellow resident spend almost 2 hours trying to figure out why a patient had suddenly gone loopy. turns out it was moi!
2 months earlier, i put him on a drug that caused all this. neither he nor his partner said anything about the fact that he had been on the same drug previously, and had also gone loopy back then. in fact, i saw him several times after that to discuss the medication, and still no peep out of them.
the drug in question isn't something we usually ask about, like antibiotics or opioids. in fact, it's a class that can be bought over the counter; the prescription one is stronger.
nor was he exactly allergic to it, and he was perfectly fine for 2 months. most likely, his kidneys aren't fully up to par, and the medication causes them to konk out a bit.
but somewhere in his chart there was a notation about this, and i missed it back then.
and so i feel all kinds of guilty. not just for him, but for the extra work my mistake piled of the other residents. the supervising staff, on the other hand, thought it was vaguely funny (and told me i wouldn't learn a lesson from it, because there's no way i'll remember to closely interrogate every future patient and go through every scribble in their chart before putting them on normally innocuous medications).

this is news?
referring to this article, a report on a newly published literature review which shows "that the number of years in practice is inversely proportional to quality of care provided."

ummm, yeah. we were warned about this in medical school. physicians who go out into the world, set up their own practices and get busy with the work often have a hard time keeping up with the overwhelming amounts of new guidelines, treatments and articles that continually flood the medical community.
physicians attached to academic centres do much better, since they're responsible for teaching and supervising residents who've just graduated from schools obsessed with evidence-based medicine, who are made to perform annoying practice audits on how their supervisor's practice is stacking up against the most current guidelines, and who like to hear why the staff is doing things a certain way.

we were warned, especially we who are becoming family doctors and are less likely to be academically attached. we were strongly encouraged to subscribe to one of the several evidence-based modules that physicians can work through in order to keep up. we were shown how family docs in shared practices or networks can successfully get together every few weeks and review a given topic at a nice food-filled meeting.

yes, experience is very important. experience is what allows my staff to make a diagnosis and work out a management plan while i'm still searching the database, wondering what the hell the patient's problem is. experience is what gives him the ability to quickly assess the severity of the patient's complaint, to perform successful triage, to anticipate future problems the patient may experience, to offer practical solutions that might not be found in a standard journal. i, like most residents, am woefully lacking in experience at this time.
but experience isn't everything. my own physicians, family and specialist, have not been academically attached. and as i went through medical school, i became aware that i was not being treated according to the current guidelines, that my gynecologist insisted on performing invasive and uncomfortable tests that had no basis in evidence because that's what they did back when he started his practice.

experience is great. without experience everyone would essentially be a resident.
but experience must be coupled with up-to-date knowledge, especially in a field like medicine. as they told us in medical school, you never stop learning.
except that perhaps some people do.

Tuesday, February 15, 2005
07:40 p.m.

when it rains...

it fucking pours.

ok, actually this is sort of funny. funny in a skin-burning sort of way, but still funny.
today i was doing procedures. i had just removed a small cyst, and the staff grabbed it and brought it over to the tray. in doing so, he splattered a few drops of blood on my pants.
no biggie. i remained with the patient, getting ready to suture, while he went off for some hydrogen peroxide to get the blood out.

so there i was approximating the incision while he dabbed the liquid onto my pantleg, when suddenly i felt something. "ummm", i ask, "is it supposed to burn?"
he looks up and frowns, while i redirect my attention to the patient. it wasn't really burning badly.
suddenly, he tells me to wash it off. i want to finish with the patient; hydrogen peroxide won't kill me.
but no. i am to go wash it off now
he accompanies me out of the room, where he reveals a lovely surprise: instead of grabbing the big bottle of hydrogen peroxide, he grabbed the small bottle of 10% potassium hydroxide, a base currently burning its merry way through my skin. great.

i washed it off my (already blistering) leg, and then had to wash my pants. thankfully the nurse found a very strong heater that dried my pants in about 20 minutes, as i wasn't looking forward to going home in winter with one pantleg soaking wet.
the staff was very sorry, and i was...amused, mostly. the affected area is fairly small and the blisters went down, so the burn looks like a road rash. it's not bad at all. i was glad my pants resisted the stuff better than my skin, because they very damned expensive.
however, staff now owes me chocolate.

MVA update
today my poor vehicle was officially declared a total loss. i am to go to its resting place and collect my plates.
my insurance will have my head.

Monday, February 14, 2005
11:10 p.m.

healing broken hearts

well, ok. not broken hearts, or at least not any as of yet. i am on call though, so who knows what may come.

already tonight i got a call about a kid with vaginal area pain. i asked all the proper questions, including history of trauma or abuse, but from my questioning it seemed that it might be urinary retention due to a UTI. well crap, that can't wait until tomorrow, not with the kid in pain.
so i call my staff and we discuss whether to see her or send her to the ER (if it's retention she'd go there anyways to get a catheter, but if it's not we wouldn't want her to waste her and ER's time on something minor). we decide to see the kid ourselves first.
so i call the mom back, and lo! the story had changed. while i was dilly-dallying with my staff, mom found out that kidlet had gotten hold of a bar of soap in the bath and apparently tried to jam it into her nether regions.
kids, i swear.
anyways, mom decided this could wait until morning, after making sure kidlet wasn't bleeding or anything. i told her to make sure she can pee, but otherwise was happy that i didn't have to go out again. it's raining, and icy.
and ice is now my nemesis.

MVA update
i think the "i could've died" thing is hitting me somewhat slowly over a period of days, which is actually good because it's easy to deal with in small doses. i don't have intruding thoughts or nightmares; the worst times are when i talk to my still freaked-out parents ("you want to buy another car? like, now?") or think about it before i fall asleep.

i'm angry at myself for driving, for being on the left lane which was maybe more icy because it was less used, and so on. then i get angry about getting angry, because this was just a stupid accident, pure chance. if i had left 10 minutes earlier or later, if the trucks hadn't been getting onto the highway at the time, spewing snow behind them and making me go onto the left lane to retain visibility, if any of a number of small, stupid things had been different i wouldn't have hit the ice.
and if those trucks had been closer behind me, or if i wasn't spun around so when i smacked into the barrier it was sideways and not head-on, perhaps i wouldn't be writing this at all.
stupid, stupid. bleh.

no muscle pains anymore. i'm perfectly fine, but my pitiful story has scored me some chocolate today. first from a secretary of one of the staff, and then my fellow resident invited me for delicious homemade alcohol-saturated chocolate truffles.
ah, chocolate. it makes all things better.

i would mention the wonderful nuts esca and bfie got me, but she's not working today and i'm on call, so i feel hostile towards her. grrr.

Thursday, February 10, 2005
05:19 p.m.

carmageddon

last evening i totalled my car on the highway.

it was snowing, but not badly. my wipers were on the lowest setting, and i had good visibility. it was dark, of course, but i'm used to driving at night.
it had been snowing on and off for most of the day and there was some snow on the shoulders and between the lanes, but the lanes themselves were nice and black.

i was driving in the left lane, as it was near a city and trucks were getting on and spewing snow from behind. i was going maybe 90 kph, not passing anyone; indeed, luckily, there wasn't anyone around to hit or be hit by when i started to skid.
the road was fairly straight, with maybe a slight curve, i can't recall. one moment i was driving along, and the next i was sliding sideways onto the left barrier. that much i saw before the airbag exploded in my face. i think i took my foot off the gas, but i didn't attempt to brake. my hands were on the wheel, but i don't think i tried to steer; if i did, it was obviously ineffective.

the impact of car against barrier and airbag against face were simultaneous. everything went black; since i didn't lose consciousness, "black" merely means i closed my eyes after being airbagged in the face.
i remember, for the few seconds before the second impact, repeating "i'm alive, i'm alive" over and over.
the second impact was against the right-side barrier, where my car came to a stop after bouncing off the left side and sliding across the two lanes. as i said, i was very lucky that traffic was light.

once the car stopped, i opened my eyes and...didn't move. i didn't want to move; i didn't want to find out i couldn't. i didn't feel any pain, but that wasn't necessarily a good sign either.
when i was doing my forensic pathology elective, a girl's body was brought in right from a MVA. the autopsy, at which i assisted, showed that her ribs were broken right across on both sides, and her spine had snapped through in three different places. if it weren't connected by muscle and ligament, that spinal column could've been lifted right out of her body.
i've never forgotten that sight. i've never forgotten that it could happen to me, that i'm not immortal. i'm a cautious enough driver, especially in bad weather.

i became aware of the trucks passing behind me, and decided to get out before someone else lost control and crashed into me, or before my car exploded (i'm a victim of too many hollywood car crashes). i took a deep breath, and felt no pain. i felt my face, expecting at the least a broken nose from the airbag, but it felt normal. i was reminded to look for my glasses, and was surprised to find them in my lap, un-shattered.

i was on the right shoulder, facing away from the highway, front of the car shashed against the railing. i turned off my engine, put on my four-way flashers, grabbed my purse, and carefully got out.
still no pain.

i climbed over the dented railing to be away from the highway, and looked lost until a kindly american motorist stopped to see if i was all right. he put me in his car to warm me up (i was shaking badly, but mostly from shock) and called 911. a towtruck arrived first, and he went to talk to the driver while i did a systems review on myself and concluded i really wasn't hurt.
the policeman who came was very nice too. he took my information and statement, declined a breathalyser test (i thought they were routine in MVAs and asked if he wanted me to do one), and even drove me to a motel and had his dispatcher check train schedules for me. since i wasn't hurt, i decided to go on to the conference i was travelling to; it was that, or go back home and brood.

at the hotel, i stripped and did a thorough inspection. i had a bruise on my left shoulder, most likely seatbelt-related, and bruises on the medial side of both knee joints. i don't know if i hit the steering wheel or just banged my legs really hard against each other. i had scrapes on the back on my hands. no other injuries were apparent.
i called my parents who, after ascertaining that i was 100% ok, went on to berate me for driving in "this weather" when i could've easily taken the train. hindsight, of course, and they drive in "this weather" all the time, but i understand their fear and worry. i'm also going to take that advice. strangely, after i got my car, i never really considered public transport again. stupid, i know. we live in a car-centric culture, and i'm no better about it than most.

today i feel the muscle aches more: the left side of my neck, under my right clavicle, a bit in my back. all purely muscular, and not even as bad as i felt after two days of skiing. the conference is on sports medicine, and as such awash in free anti-inflammatories.

i don't really know what else to say. i think i did feel that i may truly die, when the airbag went off and i couldn't see. and of course i felt profound relief when i realized i wasn't hurt.
but i didn't have any sort of epiphany, a sudden feeling that i should live each day as if it were my last, a rekindling of my childhood faith in god.
my current worry is what my insurance company will do to my rates after this. i'll go on just as i did before, only with more train travel on the horizon.

Tuesday, February 8, 2005
10:47 p.m.

i lost my pap-less whore!

ok, so trying to answer the question of how well our practice is following preventative pap smear guidelines is a lot harder in practice than in theory. also, chart audits suck ass.

first off, assuming it wouldn't be too hard to get the info, we picked the upper limit for sample number, and randomized based on that. so once we realized what we'd done to ourselves we couldn't really go back, because we'd have to throw out all our data and re-randomize with a smaller number.
ok, i was all for just stopping data-gathering halfway through, but some people are into honesty in research and all that jazz. very annoying.

we worked from the end of clinic until after midnight. no breaks, not even for dinner; we ordered some horrid slop from a nearby slophouse, and ate that between cursing at the computers and cursing at the charts.

it wasn't long before we started cursing at the patients. cursing or, as the endless hours dragged on, occasionally laughing semi-hysterically.
and some readers would probably be horrified if they had been a fly on the wall in the final hours of that long, long day, when abrupt statements like "you'd better not have a uterus, bitch" and "WTF, this whore's had a billion chlamydia swabs and not a single pap" began flying left, right and center.

*sigh*
and note, this was only midnight-ish. true, with no downtime whatsoever all day (teaching at lunch), and a task that required a lot of actual attention to detail. it was very tiring.
but imagine any one of our group assessing a patient at 10am, after a whole day on the floor and an entire night on call. every one of us has done this.
imagine the patient is you.

i don't mean to say that we'd be incompetent. i've been on call many times, and i know that there is usually adequate mental downtime, as well as varied challenges that actually stimulate the mind rather than numbing it (curse you, paps). i've survived call, and will survive it again. sometimes i've even felt damned good after an interesting night.
but i think the system will eventually change, move to a shift model like ER and obstetrics. because really, no matter how much ancient staff like to grumble that today's residents are all whiners and that when they were training they were on call 25 hours a day, every day, this isn't a pissing contest to see just how long you can stay up without making a stupid mistake.
it's about not making the stupid mistake because you've been up for 24 hours straight.

Saturday, January 29, 2005
10:08 a.m.

milk-flavoured beverages

i wonder why soymilk and rice milk tries to approximate, well, milk.
not that it does too good a job, mind you. plain soymilk tastes kind of like a too-thin smoothie gone wrong. i always feel there should be a flavor to it; the consistency almost demands it. vanilla, my favorite, tastes like a smoothie gone right, and has become my mainstay breakfast beverage.
rice milk has a pleasant, interesting taste and reminds me of my travels in asia, but no way would i ever peg it as milk-like in anything but appearance (it looks like non-fat milk).

maybe i'm wrong, and somebody will correct me. maybe, unlike vegan meat alternatives, it was never supposed to approximate the taste of the "original".

not that milk tastes like milk here, mind you, and that's why i don't drink it. but that's my own private bitterness, and in april i will once again hit the milk bars of poland.
milk bars, people! i bet your country doesn't have milk bars.

also, i'm on call, and the pager won't shut the fuck up. it actually woke me up this morning. gah, people, stop calling about your god-damned prescriptions! this is not why the on-call system was invented, damn you!

Sunday, January 23, 2005
10:18 p.m.

waiting for february

ugh.
i sit at my computer, staring at the envelope on which i've drawn a little calendar and marked off all my mini-vacations, random days off, and conference leave.
they're beautifully red-striped grids, blending with the friendly red-striped weekends.
they're all in february.
i can't believe it, but february has become my favorite month. i can't wait for freaking january to be over already. curse you, january!

have also booked flight to prague, and am currently torn between booking a room in a pension, or a bed in a hostel. the hostels in kyoto were great and incredibly safe, but then japan is an incredibly safe nation for tourists. not that i'll be in danger in prague.
but i fear slightly for my luggage, especially since it'll be filled with tons of gifts for relatives.
i've decided to ignore the fact that i likely won't get bookend weekends off in internal med, and just booked the flight as if i had them. i'll try to switch call if they schedule me. and if i can't...oh well. i'll deal with it if the problem arises.

recruitment is over, and so are the two days off from clinic we had for the past couple of weeks. but i did get to meet an online acquaintance in person, although i possibly freaked her out initially when i called her by her LJ nick ^__^

Saturday, January 15, 2005
07:31 p.m.

immigration, deportation, resignation

i find nearly everything surrounding the resignation of immigration minister judy sgro to be funny. from stripper-gate to the claims that "enemies' brought her down, it's a rather amusing tale.
most amusing is the current situation, the accusation by one harjit singh that he allegedly made the same deal with minister sgro as the stripper did - help with the re-election campaign, and in return get help in the battle to stay in the country.

the alleged deal isn't exactly pure comedy.
what is comic, or tragi-comic, is the deportation situation itself.
according to an article found here, one of mr. singh's arguments for staying in the country include rather common health problems.
this is a truly great argument. i know you want to deport me and all, but i have run-of-the-mill health issues. surely you beasts won't deport a man with a bad back!

still, it's our dear canadian government that is the looniest player in this drama. this man's refugee application was apparently turned down sometime around 1988, and he's been filing applications to stay on humanitarian grounds ever since. they get rejected, he files appeals. and so on and so forth.
this isn't a man on the run. he's some pizzeria owner, and could easily have been found at any time.

my personal feelings? i don't know if the man's applications have any validity at all, and i don't care. i do believe that any country whose immigration department takes over 15 years to move close to deporting a failed easily-located applicant should be made accept him and furthermore pay him a pension from said department's coffers, as a combination stupidity/inefficiency tax.

squishy update
and in other news, esca and bfie are here.
sleeping.
when they get up, i shall make them try the banana-jackfruit squishie i will debut. it may even taste good!

Saturday, January 8, 2005
07:25 p.m.

masturbation could save your life!

at least for men, if they masturbate at least 5 times a week. and if they're under 20 yrs of age. according to a british study i don't feel like looking up right now.
the "saves lives" thing is because those that do tend to have lower rates of prostate cancer.
when he heard it at this wednesday's academic session, one of my fellow residents sighed and resignedly stated, "well, if it's for the greater good..."
too bad he's over 20, at which point the association seems to disappear.

severely retarded journalist?
the above came from another resident, in answer to the question of why our city doesn't put fluoride in the water supply.
and yes, it's true. however many years ago, the proposal was made to fluorinate the water, and SRJ, owner and editor of the city's paper, led a spirited crusade against this unholy idea.
we reviewed evidence-based guidelines on what it is that keeps teeth and gums healthy. it's fluoride, people. it's not the act of brushing, and flossing is right out. if you paint your teeth with fluoride or use a fluoride mouthwash, you still get the same protective effect. if you brush with some kind of fluoride-less concoction, you're not protected.
but, according to our lecturer, telling this to your friendly dentist will cause him or her to look upon you with pity and scorn. he advocates showing them the studies behind the guidelines. "ask them about it," says he. "and then spit at them!"
ok, he didn't mean that last part. he said it, but i'm sure he didn't mean it.
and he actually does advocate brushing. especially the tongue. for halitosis control.

flipping a coin for genital warts
last week was my first of four shifts in the STD clinic, and i was scheduled with another resident. first we sat in on pre-test counselling, and finally we got to do some of the exams.
the cases weren't too thrilling. but then came the couple with a bad outbreak, and boy, did we both want to see that. daily low back pains and BP checks do take a toll.
we flipped a coin. i lost.
but i've been promised the very next case that walks through the doors on my shift next week. can't wait.

darling, would you happen to know if just under 5 months is enough time to grow a gourd?

Thursday, January 6, 2005
11:08 p.m.

goku? GOKU?

well, at least he's spitting up blood. that's always a plus.

four venipunctures today, after about a year of none. and got each on the first try, even though i went into one girl's arm totally blindly. i rule.

oh yeah...wedding date! squee!

Tuesday, January 4, 2005
09:19 p.m.

squishies!

i have succeeded in getting nearly everyone in my work area to refer to smoothies as squishies, as i do. today my work area, tomorrow the world!
also, i have been consuming three 20oz squishies daily (on average) since returning home with my brand-new xmas squishie maker. bananas shiver in fear when i enter the grocery store.

on a sadder note, today i've returned to work.
*sob*
well, today wasn't bad. i felt strangely expansive, and spend more time than usual with my patients. it made me run late, but it's not like i have a life anything urgent to do after work.
it was the 80-year old lady who specifically requested to see the staff doctor who got me started. "you will talk to me", vowed i, and she did. eventually. after i expressed interest in every facet of her medical and non-medical life.
i think she liked me.
this mood won't last once the patients start piling on, but eh. today was nice, and tomorrow's a half-day. with the weekend in sight, i may not get to breaking my semi-resolution until next week.

ferret lady
my ferret sitter worked out great.
i was even able to induce her to come see them on a day she said she was full, because the weather was too horrid for a 3-hr drive just to let them out for a little while. yay ferret lady. now i fear not going on vacation.

and now i'll have to start practicing my push-ups, because apparently i do them improperly as far as the army's concerned (WTF? i push myself up from a lying position. rinse. repeat. leave me alone!).

random factoid: i can't stop listening to "i hope you dance" by lee ann womack. possibly i've been dropped on my head sometime in the past week. whoever is responsible for doing this to me, confess. now.

Friday, December 31, 2004
05:01 p.m.

i resolve to rein in my hatred of patients...maybe

i have a whole new appreciation for the fiendishly hard work of office nurses.
i was aware, and grateful, for the work i see them do with patients. and the help they give us, the clueless residents, guiding us through the morass of paperwork and office protocols only to be faced with a freshly clueless residents as soon as the previous bunch finally catches on to everything.
but never before have i known of the mind-numbing horror that is telephone triage.

i am on call today (and why can my name manage be picked out in the new year's call lottery, but not on any other, better, occasion?), and since the clinic is in holiday-mode and operating with a skeleton crew that sees acute cases, the on-call resident does telephone triage during office hours and then receives pages after the office closes.
and the phones. they would not. stop. ringing.

i am very glad that phone triage involves no actual face-to-face patient contact, because a mere few hours into it i was ready to kill the first patient i saw, just on general principle.
it seemed like everyone in town conspired to not only run out of their allegedly vital medications today, but to forget what these vital medications were. no, "little red pill" is NOT helpful! you are calling specifically for a prescription. you are 30 years old and according to your records not brain-damaged. you are on one medication. fucking learn what it's called!
this necessitated entirely time-wasting calls to clearly pissed-off pharmacists, who i'm sure wanted me dead for not using the nifty voice-mail prescription option i could've used had i known what the bloody medications were.

the winner was the lady with some sort of ill-defined chronic pain syndrome, who wanted a home call today because she wasn't happy with the change in her meds. which happened several weeks ago
chronic, lady. chronic! good luck finding anyone who gives a damn about you today.

i can't believe the nurses put up with this magnitude of human stupidity every working day. and i thought i had it bad.

phone call from the hospital:
dr. x: "hi, i'm just calling to tell you that we're turfing your ancient lady patient with hip pain, just in time for the long weekend. she can't walk anymore. oh, and her blood thinner's cranked too high. happy new year!
me: *suppressing urge to kill with the sure knowledge that in 2 months i'll be in that doctor's place, calling a similarly luckless family resident before a similarly long weekend*


happy new year, everyone!

Friday, December 24, 2004
11:59 a.m.

happy xmas eve to all!

a few more hours of last-minute cleaning and food prep to go, and we'll be on the look-out for the first star to start our traditional supper. looks like minimal cloud-cover tonight.

in spite of the highway-closing ice, it's a beautiful day. actually because of it, since the sun is out and glitters on all the snow and ice that's covering everything. i tried to take a few pictures of our ice-bedecked birch tree, but i don't know if they'll turn out.
nothing else to say. i just wanted to blog on xmas eve.

Tuesday, December 21, 2004
05:42 p.m.

curse you, deceptive mailman!

i had one more xmas gift package coming. it allegedly arrived yesterday, and i got a notice to pick it up at the post office today because of "no answer."
there was, sadly, some problem with equipment, and my package didn't make it to the post office. i am very bitter.

but not because of the equipment failure. that's just bad luck.
it's because i know that nobody rang my apartment bell. i was home sick all day. i didn't sleep; i read and played on the internet.
my apartment bell is loud. it could easily double as a fire alarm. it has a strange, disturbing sound, like a cow lowing in terror and pain. i literally jump every time i hear it.
it is so loud, it can be heard from the lobby downstairs, with both the lobby and apartment doors closed. i hear my neighbors' bells everytime they're rung.

there. is. no. fucking. way. the. mailman. rang. my. bell.

i'll try again a bit later tonight, just before i have to leave. but i'm angry that my friends may not get their gift on time because some asshole wanted to shave 5 seconds off his route.

still...
i'm done!
today was the last day, and i got to remove a sebaceous cyst and a bunch of skin tags. it was very rewarding.
especially the "last day" part.

Monday, December 20, 2004
09:54 a.m.

curse you, deceptive sun!

it is -26^oC out there. that's -14^oF for you americans. i walked home holding my nose, lest it fall off and shatter on the sidewalk.

i walked home because i'm nauseous and slightly feverish. i walked home guiltily, because i'd unloaded my patients on my poor staff and co-residents.

but damn, it's good to be home.

Friday, December 17, 2004
03:00 p.m.

do not mistake this for patience

why must people mangle the english language so?
i had dropped off a necklace for appraisal, and was assured that it would be done by today.
of course, no such thing happened. i was told that it would be ready by wednesday; unfortunately i leave here on tuesday. they'll try to have it ready. i should call on monday.
well, not much i can do at this point. i give a half-hearted smile and turn to leave.
"thank you for your patience."
i know it's just a think one says. but it really struck me, the misuse of the word. patience denotes a willingness to tolerate the situation, even good humor. i certainly wasn't willing to tolerate the delay, much less the possibility, previously unvoiced even though i told them when i was leaving, that the appraisal would not be completed on time.
i was certainly resigned to waiting, but this is because of necessity, not because of anything integral to myself, as patience implies.

stupid little rant, i know. i've said it myself without thinking about the meaning; one hardly thanks people for their resignation.
but eh, it's my journal. it's where my stupid little rants belong, after all.

almost free
two more working days, and i'm free. i almost wish the weekend wasn't here, so i could get them over with and be able to leave.
but at least esca is here, to accompany me to the dinner and dance. it looks like a lot of people are coming, and there may be a chance of hearing our staff sing!
sadly, no chance of him cross-dressing, as he did some years previously. the picture was...scary. to put it mildly. should be fun.

Sunday, December 12, 2004
06:15 p.m.

why do i leave the house?

well, i left it to get my mom's pearl necklace appraised, because buying jewelry over the internet makes me anxious and more mistrustful than my usual.
and now i want to have it re-appraised, because i seriously doubt it's worth as much as the appraiser set it at. if it were, how would the internet pearl people stay in business?
or do the retail stores really jack up the prices so high?
at least i know it's real, and worth more at retail price than i paid. i just don't think it's worth that much more.

but that's neither here nor there.
what's both here and there, wherever there might be, is that i'm fairly certain that i don't really need the bonsai tree currently sitting on my computer desk.
the very expensive 14-year old fig bonsai tree with the really beautiful curving trunk.

why is there nobody in my life to stop me from doing things like that? why?

Friday, December 10, 2004
07:45 p.m.

molemolemolemolemole!

a week and a couple days more, and i'll be free for the holidays.
well, one holiday, because i'm on call on new year's eve. i have been told that i may have one drink at midnight.
*sigh*

freud would have a cigar
next week is full of events, from dinner with staff, to dinner with my seminar group, to...dinner and dance for staff and residents.
hey, one can't go wrong with food. today our staff brought us english chocolate cookies, and at a meeting for those condemned to be in clinic over the holidays we were encouraged to bring in festive food to share.
clearly the entire family medicine department is orally fixated.

she's bleeding from the head? verily, fortune smiles upon us!
earlier this week i was visiting my group home, concerned about a resident with shunted hydrocephalus whose balance was slowly deteriorating.
the plan, after i examined the shunt bulb and verified that as far as i was able to tell it was working, was to ask her past neurosurgeon for a consult. she had been deteriorating and then getting a bit better for a few weeks, so the consult was expected to take some time. neurosurgeons take holidays too.
but as i was about to leave the lady tumbled to the floor and gashed open her head on an unfortunately located edge.
the fall itself wasn't anything too concerning, but the laceration needed stitches. seizing the opportunity, i asked for a head CT as well - she'd need to be sedated for the stitches, so why not get the CT done as the same time. the neurosurgeon would probably want it, eventually.
the neurosurgeon was on call.
the neurosurgeon is now her attending. one of the many shunts was blocked, not anything that would require immediate attention, but as she happened to be in the ER, and happened to get a CT, and he happened to be on call...sometimes the silver lining is bigger than the cloud.

oh, and the highlight of the past week: i removed a mole!
it was a big mole. big and multicolored. it was my most favorite mole of all.
and i clearly enjoy minor procedures more than dealing with the chronic, long-term problems of chronic, long-term patients. i'd never last in a standard family practice.

when worlds planes collide
this story flabbergasts me.
how can someone get out of a mid-air collision between two jet planes with "minor injuries"? it just seems so incredible. i have this movie-image in my mind that those things always explode on impact, which i know isn't true.
but still. minor injuries.

Saturday, December 4, 2004
11:31 a.m.

fluffy snow and shields of steam

yesterday, i woke up to see my world blanketed in fluffy white snow. i celebrated its arrival with a candycane latte, which made me a bit late to the morning teaching session because the coffee guy was in extreme slow-mode. but it was good.

continuing the happy day, i saw one patient in the morning. the usual number is six to seven, and i had two scheduled but one was a no-show. i offered to take a patient from one of my fellow residents because he was running behind, but as i was about to usher him into a room he decided that his other appointment across town was more important than his routine check-up, and he would reschedule. score!
then the receptionist tacked on a last patient just before lunch, a drug-seeker i was duly warned about. this patient has regular appointments with the staff, and a contract that meds will be dispensed only at those appointments; nonetheless there are always attempts to come between appointments or to night clinic with sob stories of stolen meds. i read the history and prepared myself for the inevitable abuse that would follow my refusal to produce a prescription.
45 min after the appointment time, i concluded that this patient too was a no-show, and i had a scheduled group home visit to complete. i left.
apparently the patient showed up about 10 minutes later, and was briefly seen by my luckless colleague; i owe him for the abuse that should by right have been mine, although i may just have refused to see the patient at all. coming in an hour late is bad enough, worse when it's actually lunch-time and the support staff have already left for break. it's time off, and i'm not obligated to see jerks who would just abuse me anyways.

i cleaned the snow off my car with a wad of tissues clenched in a painfully cold hand, stopped to finally buy a snowbrush, and returned in time for a rather relaxing afternoon of five patients.
such a nice friday.

today the snow looks wet and dirty, with tiretracks and footprints imprinted in the rare areas that have not yet melted. the temperature is up slightly and the sand/salt trucks were out in force yesterday.
i have some minor errands to run, but i don't want to leave my apartment. the view through the window isn't inviting.
ah, and i was going to say "cosy apartment", but as the temperature dropped i became aware that my little bathroom window isn't insulated at all. i get a steady breeze of freezing coming from it, prompting me to turn up my heat and run enough hot water through my shower to create a thick shield of steam every time i use it.
i've informed my super. i'm fairly sure insulating the thing will be cheaper on them than my massive water-wastage, given that my rent is all-inclusive.

Wednesday, December 1, 2004
12:31 a.m.

alexander

i've read the reviews before seeing the movie, and they were not exactly encouraging.
but then again, i didn't expect the problems some of the critics had complained about - i know the story of alexander's life well enough not to be confused by a less than stellar narrative. my attention span can handle a three-hour movie. and i certainly have no problem with his bisexuality.
and i went into it already feeling a connection with the central character; i've read about alexander, studied him even, a bit. i like alexander, well enough to overlook some problems in the screen execution of his story.

i have to say i'm disappointed. disappointed and unfulfilled.
the horrible accents (yes, they're that bad) i can overlook. they're distracting, but only in the beginning; one gets used to them.
the two main battles are very well done. and i actually think the power struggles with his generals and advisors are one of the best parts of the movie.
but the scenes between fail to capture interest, and the dialogue is...well, parts of it seem to reach for the riveting phrasing employed in daytime soaps, but fall.
and the tortured interactions with hephaistion...by the gods, just either bring them together already or let it drop. i was actually expecting to see them portrayed as lovers, so this furtive teasing was just frustrating.

there are also moments of simple ridicule, like the conversation alexander holds with his new bride.
in babylon, when the persian princess stateira speaks to him, it is made clear she had been coached in what to say. of course; she didn't exactly know the greek language.
roxane, the bactrian "barbarian", seems to suffer no such difficulties. one wonders if she is related to disney's pocahontas, who similarly was able to converse with her lover-boy after staring him briefly in the eyes.
it was some time after that point that i saw a few people leave. i couldn't blame them; i was considering doing the same.

the problem is the scope of the movie. alexander accomplished so much in his short life, and stone valiantly tries to telescope it all into three hours - the battles, the politics and intrigues, whatever personal life can be squeezed in between all this.
but in trying to present the whole picture, he tells more than he shows, and he fails to make his mind up about his subject. that is all well and good for history books, and i've read about alexander and the mysteries surrounding his life and death with pleasure and interest.
but stone tells the story through alexander himself, and through one of his close advisors, not a historian looking back thousands of years and trying to guess the king's motivations. to present a compelling character, stone needed to make up his mind about which theory he would stick to, and he fails to do that.

the critics compare alexander to troy, which i suppose is natural but inaccurate. troy pretty much made mincemeat of its source material, while stone tries to be true to his.
i think a better comparison, one that would illustrate the problems with this movie, might be the lord of the rings trilogy. and that's exactly the main problem as i see it: this movie, to do justice to its subject, should have been longer. the brief, unengaging flashes we see in many choppy scenes should've been fleshed out, which would have made the movie compelling and complex rather than frustrating and occasionally sleep-inducing. make it longer, or else cut out the layering and make it into a decent action movie.

the best comparison i can come up with is kenneth branagh's four-hour version of hamlet. i watched it when it came out, and can honestly say that the time flew by. and that with a story i already knew, told in ye freaking olde english!
but then again kenneth had an excellent script-writer.
let's face it, stone's no shakespeare.

Friday, November 26, 2004
09:31 p.m.

all in a day's work: traumatizing teenies

yesterday was the first time i started a patient on the birth control pill.
she was 14, and clearly embarrassed about the whole thing. she wanted the pill to regulate her cycle; denied being sexually active, or thinking of becoming active.
hey, fair enough. that's why i went on the pill, after all.
i gave her the usual 3 months of samples, explained about starting the pack and about possible side effects, and bade her to return for a check-up and the actual prescription after the samples were finished - that's how we get them back into the office. give her a year's prescription, and you'll see her in a year. we like to know how she's tolerating the pills.

ah, but protestations or no, i still went through the safe sex spiel. HIV of course, but they all know about that. what they don't seem to hear about are the commoner, less deadly but still nasty infections, and i mentioned them informatively and cheerfully.
the poor girl looked about ready to die when i was done. so cute.
i don't think she was lying. i don't think she was thinking about sex when she asked for the pills. and i wasn't totally negative, that's not the point and it's not helpful.
all in all, she started out embarrassed about the mention of sex at all, and by the end of the visit i'm sure she was totally traumatized.

daddy's little girl
i finally had the oil changed in my car. a month after the little red oil light started glowing, and a week or so after i assured dad i'd done it.
i think my father enjoys worrying about me, car-wise. i honestly don't know anything about them; i can check that i have enough oil, and i can top off my washer fluid, but that's about it.
the thing is, my dad doesn't really have anything else to worry about where i'm concerned. my future is planned out for the next few years, with a rough plan for the next decade or so. i've never been in any serious trouble, and aside from mom's cooking i don't really ask my parents for any help.
now my having a car gives him something to focus on, something to keep advising me about. it may make him feel his little girl needs him, i don't know.