Wednesday, December 21, 2005
08:30 a.m.

i failed

i failed the second part of my licensing exam.

and i have no idea how or why.

i knew i had screwed up one of the stations, although not in a away that would be dangerous to the patient. you're allowed to screw up a station if you don't kill anyone.
i felt i had done really well in the longer stations, the more family physician-oriented ones, and somewhat worse in the shorter physical exam ones. not because i couldn't do the exams, but because i tend not to state everything i'm doing as you're supposed to; "on inspection i see...on auscultation i find..."
it's hard to get into that kind of overt exam mode.

but i didn't believe i would fail.

the results today, on the website, are pass/fail only. i will of course receive a letter detailing my shortcomings, and then i will know why.

statistically i shouldn't have failed, and that makes it worse. i'm a resident who went through her whole medical training in this country, i'm fluent in the language, i'm in family medicine and this exam is basic mostly adult medicine so family docs and general internists should in theory do better than specialists such as peds or radiology.
so i shouldn't have failed. everyone i spoke to before the exam kept telling tme to relax, that i'd do fine. i'm in family medicine, this is a family medicine-friendy exam.

i'll retake it in early may, on the same weekend as my family college exam, which is supposedly much harder. at least i hope to do the college exam as well; i'm not 100% sure if i can, not having a pass on this one first.

i feel like shit.
and now i have to tell the army i failed.

Saturday, December 17, 2005
06:45 p.m.

the lion, the witch, and - WHOA!

i read the lion, the witch and the wardrobe as well as the horse and his boy when i was a kid, sometime before i was nine years old; i remember reading them in poland, even making some kind of diorama/book report with picture scenes for school.
i had only the vaguest recollection of the story itself, but i do remember that it touched me, and turned me onto fantasy novels for a long time. it did not turn me onto jesus, but hey, you can't expect everything from a book.

so today i went to see the movie.
it was good, and some scenes were very affecting without being tear-jerking. the special effects were amazing, and narnia was truly brought to life.
i read that lewis didn't want his books to be made into movies because he thought the animals, especially aslan, would end up looking stupid. well, aslan looked pretty damned good for a computer animation, but i can see lewis' point - aslan could not, did not, have anything close to the screen presence of the better human actors, including those playing fauns and centaurs.

but mostly, i mean the witch. tilda swinton was absolutely spectacular, and when she rode onto the battlefield in her polar bear-drawn carriage, i was rooting for her 100%. evil that good just should not lose.

riding
yup, still at it. braving the snowy roads of death to get there and all.
i've started jumping again, after a long break during which i worked on getting the basics down.
the basics are hard and make my legs hurt, but my control of the horse has improved to a great degree. it's not just that i can get her to go over a jump or the trotting poles without her trying to go around instead, it's also that i can now control the length of her trot, get her into the corners and against the wall, make her carry herself when she's working and, most importantly, make her listen to me, not the scary wind-blown noises outside that make her spook. when she's in work mode, when i'm paying attention and "riding every stride", she doesn't really spook on me any more. it's great.
but damn, it's hard work.

esca,
do family med for your elective! that's what i'm doing in april!
i was thinking about my electives, and what would be most useful, and whether it'd be too late to arrange dermatology or opthalmology or sports med or whatever, and you know what? i'm going back to the place where i was comfortable and happy, where i like the people, and where the horse is. fuck it, what's the point of stressing yourself? you'll be learning no matter where you are, and family med if what you'll be doing after all.
so what if you miss seeing that one rare special case of weirditis in residency? no guarantee you'll see it in any case, and anyways, that's what books and specialists are for.

Monday, December 12, 2005
11:22 p.m.

bloody D-cup

today a post-op mastectomy patient came in. one of her breasts was a perky D-cup.
only she didn't have a breast there anymore. it was filled with blood, almost a litre of it. like an implant.

no big deal, just a bleeder. off to the OR to drain it and tie off the vessel.
but man, that was impressive. and actually quite nicely shaped, too.

the lady i saw before her may be dead now; probably is, in fact. somewhat elderly, having undergone surgical and chemo treatment for bowel cancer the year before.
she didn't know her cancer had returned, in a much worse form: disseminated carcinomatosis, cancer seeded throughout the peritoneum, chunks of it in her liver. she had weeks to months to live.
only she didn't. she managed to perforate her colon. we didn't know why - could've been the anastamosis, or the cancer itself. or maybe just a random diverticula.
she was in refractory hypovolemic shock, third-spacing from the carcinomatosis, her abdomen filled with ascites that was now mixing with bowel contents and about to get infected. if she lived that long.
the treatment is surgical: open her up, drain the ascites, find and close the leak. colostomy. IV antibiotics. colloids.

in cases like hers, patients don't leave the hospital. provided they survive the surgery, provided they ever wake up again from the anesthetic, they may have days to weeks left. but usually the family will insist on at least trying, even if they know the cancer will very soon kill the patient. and surgeons operate because the days they buy do mean something, because a patient is entitled to treatment of a treatable condition, because a perforation is something they can fix. because they're surgeons.

her family was offered the operation. her granddaughter had some medical background, understood the situation. understood what wasn't being said: there is no hope. she will likely die on the operating table, or post-op in the ICU, intubated, ventilated. unaware.
they made the decision to withdraw treatment. a horribly difficult, horribly courageous decision. the right decision in my eyes, the one i would choose for my loved ones, for myself.
my staff tore up the orders he'd written to keep her alive, the pink admission sheet. i went to the locker room to compose myself.

Sunday, December 11, 2005
06:44 p.m.

of hot tubs and photo shoots

my riding instructor had a hot tub party on friday.
it was excellent, even though everyone present laughed at my whining when i realized that it was an outdoor hot tub. yes yes, i whined. there was a lot of ground to cover to get into the delicious water! cold, frozen ground.
ok, a lot of patio to cover.
but it was a large patio!
but the rummy eggnog more than made up for it. i've been such a fool, diluting my eggnog with soymilk to make it less cloyingly sweet, when rum is clearly the right and proper way. the righteous way.

today i had a photo shoot with this artist.
i had seen her work at a local arts fair, and loved it. especially the avocado picture you can see under "galleries - flower&fruit". she does these great B&W photos and hand-tints them.
so i decided that i needed some artistic photos of myself with a pomegranate. they'll be hand-tinted, basically just the fruit and my red earrings, possibly my lips just a little.
i should have the proofs within a week, to choose which i want tinted and enlarged. we took over 20 shots, and her studio floor resembled a pomegranate swamp by the end of the session. i'd randomly eat seeds that fell into my covered lap.

all in all a nice weekend. i just really really don't want to start another crazy-schedule week, even though i like both general surgery and the general surgeons themselves better than i liked ortho(s).
but one of them told me she'd remove that annoying mole adjacent to my earlobe. so at least i'm getting something out of it.
you know, besides the learning ^__^

Saturday, December 3, 2005
04:13 p.m.

my little tire drama

tomorrow, i shall have winter tires. i hope.

canadian tire, at least the location i was dealing with, seems to be staffed by idiots. hopefully they're idiots who can install tires.
the CT in the city where i live was out of stock on the tires i needed, as was the one where i work. but yay, there's another location inbetween, and it had a bounty of five tires!
so of course i call immediately, asking for the tires and when i can come in to have them installed. first guy who takes my call says they have the tires, but they may be on hold for someone - go goes off to check.
15 min later i hang up, having become bored with the muzak. i call in again. some other guy answers, says they have the tires, and i should come in right away. i tell him it'll be at least 40min to drive in. he tells me to hold, he'll check if that's ok.

10 min later third guy picks up the phone and asks what i want. i tell him i'm waiting for the guy to tell me if i can get my tires installed today. he puts down the phone, and i overhear a conversation between him and (presumably) the guy who went to check about the time. the conversation makes it clear that he didn't check anything and was confused about why i was still on the phone. so third guy tells me to come in "right away". once again, i repeat that i'm calling from another city and it'll take me 40min to get there.
he tells me to call again later when they're less busy. i say no, just tell me if you can do it today. if you're so busy, you probably can't; tell me that and i'll make an appointment for tomorrow.
he tells me to wait, and goes off to find someone else because he "can't make that call". WTF?

someone else turns out to be a manager of some kind. he apparently can make that call, and tells me there's no time today. that's fine, i have tomorrow off and can come in then. i ask him to hold the tires for me, he says fine, gives me their service hours and asks what time i want to come in.
i say 1100, because that way i can sleep in.
he says no, he'll only hold the tires until opening hours, 0900.
then why ask me what time i wanted to come in? my god, you're the only CT in the bloody area that still has the tires i need, of course i'll come in when you need me to. but don't go giving me fake options here.

now i'm kind of scared that one of them will forget about me and will sell off my tires before i get there tomorrow.
the whole thing gave me an impression of disorganization, although it's probably just a normal, busy service center. probably the worst was when they put the phone down and i was able to hear them talk and see that they were kind of out to lunch regarding my request. putting a customer on hold would probably be better, but then again they apparently forgot about me when they did put me on hold that first time.
still, i need those tires. or else you'll all bound to read about me totalling another car on the highway, and i wouldn't like that at all. nor would my insurance company.

general surgery
that's my december rotation. the first two days were fun, lumps&bumps and clinic, with some scoping and ER consults.
the clinic staff buys lunch; free food is always a bonus.

alas, same problem: that 0800-2200 mon-thurs schedule. fri is a normal day, ending at 1700. the resident on before me told me she had never been so depressed during any time in med school/residency as she was during the gen sx rotation in nov, and that's because of the hours. a call schedule would be better, because even that allows for some time to...well, live. exercise, go out to eat, something apart from hospital/sleep/hospital.
i was doing the ortho rotation in nov, under that schedule. but i was taking a day off a week, and i can't do that now because of the xmas holidays. there's only so much time you're allowed off per rotation.
i checked the PAIRO contract and talked to my program director, and the schedule is 5 hours over allowed time so i told my staff that i'll be taking off an hour early every day. they seemed surprised, but were fine with it.

what i don't understand is why my fellow resident isn't willing to confront her staff. hell, "confront" is too harsh a word; just tell them that she'll be starting late or ending early. she's guaranteed those rights under contract, but she apparently prefers to put a smile on her face in front of the staff and complain bitterly behind their backs to anyone who'll listen. and for all i know get depressed on top of that.
yes, that one hour doesn't make that huge a difference. but with a schedule like that, every little bit helps: that one hour earlier on fridays is the difference between leaving while the sun is still up and when it's already dusk. yesterday it made me smile.

residents like her don't only make themselves miserable, they make it harder for others. the staff only gets confused when one resident is willing to accept anything thrown at her, and another speaks up for her rights. they see the latter as the problem, not the former.
i often stay later if there is anything interesting going on, and i'd never blame her for doing the same. but she isn't doing it for interest's sake, and she's told me and many others how unhappy she is, and still she won't open her mouth and complain. making it that much harder for whoever comes after her.

Thursday, December 1, 2005
09:28 p.m.

TRUCKmageddon

today, i called my mom to see if there had been any offers on the house.
and she told me a story i had trouble believing.

yesterday she was returning home from work. it was rush hour, and she was stuck behind an 18-wheeler. the truck stopped at a red light, she stopped, the cars behind her stopped.
then she realized the truck was backing up. there was a little space between them, so she backed up a little as well to make more room; she figured maybe he'd gone over the stop line and needed to back up a smidge.
SLAM!
the truck backed up right into her.
SLAM!
it did it again.
SLAM!
and again.
SLAM!
and again.
she was terrified, thinking that the driver had road rage or had lost his mind, that he was trying to kill her.
she was honking, as was the woman behind her, into whose car my mom's car was pushed. as were the people around them, who witnessed this.
he didn't stop hitting her until a man ran out of his car and started banging on the truck's cabin.

someone had apparently activated an onstar alarm in their vehicle, and two police cars arrived. they interviewed her, the woman behind her, and the other witnesses.
and of course the driver. what was his reason for destroying my mother's car?
he had gotten halfway into the intersection when the light changed. he was trying to back up.
he claimed not to know he was hitting her.

that, as anyone with a quarter of a brain sees, is bullshit. if you're not hitting something, you'd back up easily. there would be no need to keep backing up in the same spot; he obviously knew he was being stopped by something behind him.
and this was rush hour. there were cars all around him. what the FUCK was he doing?

my mother is unhurt. she is shaken up, of course. she thought she would die. she saw her doctor and got some time off work, she's still going to go on vacation with dad like they planned, albeit a few days later because some things with the insurance company need to be worked out. she doesn't know yet if her car will be written off, or if it's fixable; all she knows is that she can see her engine without opening the hood.

i can't believe this happened.
i can picture it. i can picture it perfectly because it's such a TV moment. it plays in my mind like a scene from CSI or L&O.
i just can't believe it happened in real life.
i can't believe it happened to my mom.

Wednesday, November 16, 2005
11:25 p.m.

holy fuck!

my parents just bought a bungalow. they just bought a new house, and i learn about it from an email send by my brother.

all right, so they bought it late yesterday.
all right, so their phone went out.
all right, so i'm on rotation and they don't have my phone number there.

but still! this kind of news, over email, from my bro. holy fuck.

i really want to see the house, but it won't happen until the move-in date sometime in march. i'll see the outside of it, sure, while i'm on holidays at home. holidays which have now morphed into "you need to pack up your stuff"-days.
how much stuff do i still have at my parents'? with the exception of my impressive miniature alcohol bottle collection, it's obviously all things i don't need; haven't needed in the past four-plus years.
and yet, it seems there's a lot of stuff there. and so, a lot of work packing it up, or perhaps disposing of it.

my mom got her large separate dining room. those L-shaped living/dining rooms were the bane of her existence while she was house-hunting.
and they got a hot tub, which makes me jealous.
and a small fish pond, which...well, i'm not jealous of that because i don't even want a yard, but it's neat.

moving, though. i detest moving, even when the army packs up all my stuff for me. seriously, they pack it all up; i don't have to lift a finger.
my parents, of course, do. but the hot tub and dining room must be worth it.

*** EDIT ***
well, the house inspection revealed aluminum wiring. the sale is on hold; my parents want them to knock down the price enough so they can replace it all with copper. apparently there are insurance issues with aluminum.
so it may go ahead, or it may fall through. mom developed a migraine. poor mom.

*** EDIT2 ***
well, house has been bought. i'm back to pack-up-your-room for the holidays.

Sunday, November 13, 2005
06:24 p.m.

making ends meet

"making ends meet".

what does this phrase suggest to you?

making enough money to put food in your mouth?
a roof over your head?
transportation for work, so you can continue getting paid?
perhaps some entertainment, like going to the movies or a restaurant every now and then?
putting in a fully-enclosed saltwater swimming pool with retractable stadium roof in your backyard?
all of the above?

the hospital where i'm doing my ortho and surgery rotations is a sick hospital. by this i mean there's open infighting, sniping and back-stabbing, no communication between departments, low morale overall, all of that. i did my obs/gyn there too, and i didn't really notice it back then because i was in a self-enclosed bubble up on obstetrics, where the staff is generally happy and has very little need to coordinate anything with any other department.
but now that i'm down in the ER and OR, it's pretty noticeable. people are unhappy, both docs and nurses. they collect in their respective lounges and bitch about each other, the hospital administration/corporation, the government, whatever.

in this particular case a bunch of surgeons were discussing how low their pay is compared to the other provinces. they probably meant compared to alberta, where pay is indeed higher; i doubt they were comparing it to the maritimes.
they talked somewhat idly about various ways to force more pay, such as working to rule or submitting a resignation of their hospital privileges en-masse.
and then one of them said it. actually said "when it gets so bad that you can't make ends meet".
that you can't make ends meet.
a surgeon said that.
a surgeon who, 15 minutes prior, was discussing the logistics of installing the above-mentioned retractable roof enclosure around his pool.

the disconnect with reality is staggering.
and it's happening to me too. my take-home pay now is just over $3K a month, and i have no dependants. i've a pretty comfortable life; it'll get a hell of a lot more comfortable in july when i graduate and start making real-doctor pay.
and i remember what it was like when i had to save like crazy for xmas gifts, or when a restaurant dinner was a real luxury, i do. but still, when i'm browsing a community like alchemylab and someone mentions that they can't afford to buy a few imps, something that would cost maybe $20 or so, it brings me up short.
i wonder if, in a few short years, i'll be like that surgeon. if "making ends meet" will start to mean "i'll have to decide between that tennis court or a stadium roof for my pool".

Friday, November 4, 2005
05:51 p.m.

all of a sudden, it hits you

Q: what do you call two orthopods looking at an EKG?
A: a double-blind study.

it's amazing that i didn't realize this until now, but better late than never.
i was happy in the family practice rotation i just left. i was happy, consistently, for the last four months (exam stress excluded). i liked getting into the office, i actually liked my work; i could have stayed there for the rest of my career.
i wish i could've.

alas, that's not how residency works. so now i'm in another town, doing ortho. the schedule is stupid, the patients aren't mine, the orthopods change every day, and...i don't want to get into work in the morning.
rotations can be good or bad. this one is really pretty good clinically, no scut, decent teaching. the problem is certain preceptors and the schedule which breaks PAIRO rules, but it's not a bad rotation, especially for ortho.

still, i'm not happy there. that's what i realized, that while i've had both good and bad rotations i've never had one where i wished i could have stayed for good.
and now that i have experienced it, i know i'll miss it and that subsequent rotations, even decent ones, will seem worse for it.

ah, also the army took away my slim hope for a posting in the general area of that last family rotation.
funny; i didn't expect to get that posting as it's considered a plum one, but i had hope. now the hope's gone, and i definitely feel the difference.

Saturday, October 29, 2005
11:52 p.m.

it is finished (i hope)

well, "it" isn't really finished until mid-december, when i get the results.

but until that time i have done all that is required of me: i have completed the second part of the medical licensing exam, and barring failure (don't let me down, path residents!) only the brutal fellowship exam looms large in my future.

there were 8 10-minute stations, and 6 couplets comprised of 5-min exam or history and 5-min supplementary written question stations.
i really screwed up only one of them that i'm aware of (curse you, obstetrics!), but of course i probably made mistakes in others. hopefully non-fatal ones.
nevertheless, i feel better about this one than i did about the first part of this licensing exam odyssey, which just left me shaky and convinced that i failed because i didn't know the stages of the female orgasm, plus it seemed that i took way too many people off life support against the wishes of their loved ones.
but apparently that was the correct course of action. screw the wishes of the loved ones, says the medical council of canada.

i feel like i should be drinking. i got falling-down drunk after the MCAT, and i'm pretty sure i drank after part one of this exam. heh, i drink so little that i can't even remember the last time. camping, maybe?
still, post-major-exam drinking feels like a tradition. i should continue it.

Wednesday, October 28, 2005
11:30 p.m.

AAAARRRRRRGGGGGHHHHHH!!!

AAAAAARRRRRRRRRGGGGGGGGHHHHHHHHHH!!!

AAAAAAAAAAAAAAAAAAAAHHHHHHHHHHHHHHHHHHHH!!!

*sobs*

AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA!!!

Monday, October 26, 2005
06:30 p.m.

urge to kill...rising

wheee!

today my horse spooked and i only nearly fell off!

she spooked at a trot, and my foot came out of the stirrup, but i stayed in the saddle. go me.

the army is making noises about horseback riding being an "extreme sport" and possibly not covered under their disability insurance. so i've requested clarification while contacting some insurance firms for supplemental disability insurance.
but ah, the catch-22: they won't insure me because i'm in the army, which is considered too dangerous anyways. and the stupid army may not insure me for riding. it's ridiculous, as is the corporal i'm stuck talking to about insurance - incompetent woman, when i ask for details of specific disability insurance coverage, you do not forward my query to the physical education team! what the hell are you thinking?

gah. i'm tense and unsettled because of the MCCQE2 this saturday - the medical licensing exam. i'm studying in bits and pieces, can't really keep my concentration. everyone who ever wrote this thing says that family residents tend to do very well on this thing because it's such a general medical exam, anything can be asked - peds, psych, trauma, internal, surgery, cardiology. we see all of that. but telling me this doesn't really help because i tend to get tense before tests anyways, the bigger the test the worse i get.
this test is big.

the riding helps with the tension somewhat. damn it, i want to keep riding. damned annoying army.

Sunday, October 23, 2005
04:35 p.m.

things to do in the fall

horse threw me again.

well, "threw" isn't the right word; it conjures up images of her rearing up or otherwise trying to actively get me off. she just spooked, abruptly made a very tight circle, and i landed on my ass.

she tends to spook with high winds or strange noises. none of that was apparent today - there was a constant, slight rain drumming on the barn roof, and the pigeons were making their usual clatter. she wasn't acting spooky at all while i was riding.
the other girl in the arena, setting up jumps for her own horse, had no idea what happened to set her off. maybe a random raindrop.

i landed on the upper part of my butt, just where the sacrum starts. not as bad as the last fall, and i got in the saddle again for some walking and slight trotting.

but this time i'm angry - a bit angry at her, because WTF? stupid animal, are you afraid of rain now? but that's not really fair, and i know horses are prey animals and spooky by nature, and it will pass.
mostly, i'm angry at myself. that previous fall was during my first serious attempt at canter, my seat was all discombobulated, and it was no surprise at all that i fell. but this time she was at a nice trot, and i felt stable. i've been trotting regularly without stirrups to strenghten my seat, i've been concentrating on keeping my lower legs glued to her side, and then this happens. it wasn't even a huge thing really, i could see what she was doing as i was falling. she stopped and stood there rather calmly after her little circle was done.
i should've been able to stay on.

Tuesday, October 18, 2005
10:46 p.m.

faster pussycat, kill, kill!

today in ER i had a patient who was mauled.
by a jaguar.

by a JAGUAR.

let me remind my readers that i'm in southern ontario, canada. no big kitties up here, noooo.

he had lacerations and puncture wounds over both arms and lower legs, but according to my testing no tendon or significant neuro damage. he was numb over his hand, where a skin flap revealed muscles and tendons (they move!), but that's a common finding with swelling and didn't follow any specific dermatomes.

alas, it was a lot of lacerations, and some needed to be explored - there could've been partial damage to some structures which my exam wouldn't have picked up. my attending figured the sheer amount of both lidocaine and time we'd need to use on this guy to do the job properly, and called plastics at the tertiary center.
plastics is notorious about throwing up walls against patient transfer.

me: "play up the hand numbness."
attending: "good idea." *makes call while i listen* "hi, dr. plastics-attending, we have a patient here who had a run in with a jaguar...no...no, the cat. right, cat. he's got a lot of lacerations (blah blah description) and we'd like to transfer...well, good range of motion, some numbness over the hand...no, not bad. i think any single one we could do here, but there's so many...we're not really worried about nerve damage, we just think this needs to be done in an OR. ok, thanks."
me: *making WTF face* "why did you minimize the numbness? that was our ace in the hole."
attending: "bah, as soon as he heard "jaguar", he was all over the patient!"

i think it's partly bragging rights. you know, "you'll never guess what i did on my last shift". yeah, not many things will beat a jaguar mauling.

Sunday, October 9, 2005
10:31 a.m.

i'll just sneak into her room and put a pillow over her face

it's disgusting, the way we treat terminal patients.
last night a middle-aged lady was brought in by her husband, who was palliating her at home for terminal cancer. she was yellow like a simpsons character, had been non-responsive for days, hadn't eaten or had any fluids. she was on a hydromorphone pump for pain, and haldol and ativan for agitation.

and she was agitated. very agitated; moaning continuously, limbs jerking spasmodically. her pump rate had just recently been doubled, so i doubted it was the pain.
patients at the end of life often experience delirium, from the pain drugs (muscle spasms are also a side-effect of high-dose opioids), from dehydration, from the fact that all their organs are pretty much failing, sometimes from brain mets. occasionally a bolus of IV fluid will give a boost to their kidneys long enough to settle them and allow them to die of the disease itself, but it didn't work for her.

overwhelmed, having taken general internal med instead of the relatively easy, almost-no-call palliative care option, i went to the end-of-life manual and found a section called "terminal sedation".
i talked to her husband, assured him as best i could that his wife probably wasn't in pain, just completely metabolically deranged (no, of course i didn't use those words). apparently no one had talked to him about what to expect at the end of life, or if they did he didn't remember, not that i could blame him. he had enough to deal with.
i started the infusion for terminal sedation. this is a drug used in both anesthesia and in conscious sedation. it's a strong sedative, one to be used when you clearly expect the patient to die pretty damned soon.
it didn't settle her. i gave her a push dose, which would have dropped a healthy adult male and allowed me to dislocate and re-locate his shoulder without fuss, and still nothing. or maybe just a bit of an improvement in the volume of moaning.
the manual recommended adding phenobarb if not settled after 24 hours, so i increased the infusion rate and left her, still moaning. i suppose i could have given her more pushes, possibly until she died; in fact, "what's the worst that could happen?" was my answer when a nurse looked cross-eyed at my decision to give the first push.
but she wasn't my patient, and her husband was anxious for their own doctor to see them in the morning, so i left her.
her doc did come in, increased yet again the infusion rate, ordered a suppository in case her circulation was so affected that she wasn't moving the drugs effectively (something i didn't think of, unfortunately) and gave her scopolamine to dry up the death-rattle causing secretions in the back of her throat. so we're basically brow-beating this lady into sedation because that's the only thing we can do, and most of that is actually for the comfort of her family, not her.
she was still restless and moaning when i left in the morning.

and now i contrast her treatment with that of my ferret kurara, also diagnosed with terminal cancer. when she got to the point when i knew she was suffering, i was able to take her to the vet and hold her in my arms while she gently and very quickly died of a massive barbituate overdose.
her death was hundreds of times more dignified that this poor lady's prolonged struggle, and it makes me so angry that we aren't allowed to treat human beings as humanely as we treat our pets.

irony?
my other headache-inducing patient was an elderly lady admitted with CHF, who managed to develop flash pulmonary edema. yup, coughing up blood-tinged foam = not a good sign.
between massive lasix doses, non-rebreather masks, morphine and a nitro drip (which was quickly stopped when her dangerously high blood pressure tanked...dangerously) i managed to keep her alive and reasonably stable for her family doc to take over in the morning.
all in all i got 2 1/2 hrs of sleep tonight. and that precious sleep was interrupted by a call from the ER to go see a patient suffering from - what else? - insomnia.
bastard looked better than i did.

Friday, October 7, 2005
10:22 p.m.

...the harder they fall

well, i've had my first real fall from the horse.

i've "fallen" while dismounting after using a different saddle, having forgotten that it had a pommel-thing in the back (back pommel? whatever).
i've also had a flying dismount when she refused to jump for me, but managed to land on my feet.

no, today i landed on my side. and my arm, and my head. i actually saw stars (stars! not bright dots, stars!) and was too stunned to move for a second. i distinctly remember my helmeted head hitting the ground.

we were trying the canter again. i had quite successfully cantered on my own after jumping, because that's what this horse does: she gets worked up over a jump and breaks into canter on her own.
however, my canter position was basically a kind-of jumping position because i didn't know how to stay properly balanced on her back; remaining completely off it just seemed easier. this was fine as long as she was going more or less straight, but an erratic movement would have unseated me.
so my instructor, hair standing on end (probably) at my antics, decided she'd better teach me how to canter properly before i kill myself out of sheer stupidity.

i was doing ok. after a few tries i actually held my seat pretty well. i was going for one last transition when the stupid thing decided to spook at some random noise or droplet of water or whatnot, and moved abruptly to the inside. actually i thought she was falling, because she moved so suddenly that her whole shoulder dropped.
next thing i knew, stars. wheee!

one good thing about being a doctor, you can quite quickly examine yourself. i can do a gross neuro exam and clear my c-spine in a minute.
the damage is limited to my left flank. all muscular, too, which means that while it's fairly uncomfortable to twist or bend today it'll be hurting like a bitch tomorrow. and tomorrow i'm jumping.
i wanted to do one jump today, but my instructor limited me to a trot after the fall. she didn't want any more drama, and i can't blame her.

Wednesday, September 28, 2005
09:07 p.m.

go ahead and jump!

today, i jumped on my horse.

i've been doing ground poles, where the jumping beams are laid on the ground and the horse kind of high-steps over them but doesn't jump.
today i expected more of the same, but my instructor apparently thought we were going to jump. i don't recall her mentioning this; quite possibly the fear repressed my memory.

she set up a cross jump, where the poles cross in the middle. it has next to no height where they cross, but is higher on the sides. this encourages the horse to actually jump over the obstacle even though it's going over the middle where the height is minimal.

she shied off on my first three approaches, partly because she tends to test the rider, partly because i wasn't committed and she could feel that. the first two times she bend away early, and i knew she wasn't going to take it.
the third time i was on a good approach and was in jumping position when suddenly whoosh, she just went sideways. i swear, it was a pure sideways movement, and for a second i was still going forward without her. had this happened last week, i would've slid; this week i had the pants.
ah yes, i finally bought riding breeches, full seat. cotton on a leather saddle just has no sticking power at all. go suede, covering my ass!

on my next approach i was obviously committed enough and in better control of her, and she took the jump. jerkily according to my instructor, exhilaratingly as far as i was concerned.
we did it again, and it was better, felt much smoother. i was jumping, yay me! i even cantered for a few strides; not my doing so technically a bad thing because i didn't control her gait, but i didn't fall and was able to bring her back to trot.

can't wait for my next lesson. my half-lease starts tomorrow so i'll be riding without the instructor, but i won't be jumping without her. death and all...

chibiko
is mostly confused, i think, and full of playful energy when i let her out. she used to kind of ignore me and focus on kurara, and now i'm her only playmate.
it's early still. she may get lonely, depressed. but for now she seems to be doing ok.

Tuesday, September 27, 2005
09:05 p.m.

in memoriam

when i woke up on sunday morning, i saw that kurara had bled during the night. from her nose; maybe from the mouth too, i didn't know. the bleeding had stopped.

the liver is an organ of amazing redundancy. you can easily do without half, allowing for transplants from living donors. you can do with more than half removed...or destroyed, infiltrated by cancer.
but at some point the scale tips. there is only so much redundancy before you lose the function.
the liver makes clotting factors.

she had stopped bleeding by morning, and seemed stable. as stable as she had been over the past week or so, growing increasingly short of breath when walking, or eating, or drinking. with sunken eyes, hesitant wobbling steps when she did walk (only to lie down somewhere soft and sleep again), a thin, cord-like neck when she raised her head to look at me. and, that morning, with her face covered in her own too-thin blood.
she no longer tried to beat me to the door. she no longer cared about the door, or what curiosities lay beyond it.

i had to go to work that sunday, and i did. there would be nothing to do for me had i stayed. i took her out, cleaned her, held her, fed her raisins - and how slowly, laboriously she ate them.
i went to work.
and i called the vet. it was time. it had been time for a while, but i hadn't wanted to face it.

today was a beautiful, mild, sunny day. there's a patch of grass with nice gravel at the back of my building. i stopped there and laid her on the grass, to pass time, to focus on anything but on what was going to happen. to give her a pleasant memory?
she was indifferent to her surroundings. the memory was for me.

the barbituate did its work quickly and gently. i held her in my arms, crying, and after a minute or two became aware that she was no longer breathing. she didn't flinch, didn't give one last gasp, didn't shudder.
she just fell asleep in my arms. her eyes were half-open; i was closing them when the vet came back into the room.

she will be buried at a pet cemetery not too far from here, with her own little headstone. i'll be able to visit, maybe even take chibiko.
she'll enjoy the outing, at least.

"The grieved are many, I am told;
The reason deeper lies,--
Death is but one and comes but once
And only nails the eyes."
- emily dickinson, "I measure every grief

Wednesday, September 21, 2005
05:55 p.m.

when physicians go camping...

they get creme brulee for dessert.

seriously. we had a four-day "wilderness emergency care" course in semi-northern ontario.
lectures on risk assessment and the dangers of exposure, workshops on how to properly start fires, make rubble shelters, find edible roots, set bones and immobilize c-spines, signal for evacuation. multi-casualty scenarios. all that good stuff.

in between that we got to go on hiking and canoeing trips in the beautiful wilderness (i learned to portage, yay me), swim, kayak, fire up the sauna whenever we felt like it, get drunk - hey, getting drunk is extremely easy after an hour plus of deliciously steamy dehydration!

but while we ate sandwiches or whatever snack bars we happened to have when off on trips, we always had breakfast and dinner (some days lunch too) in the main building.
and what delicacies there were! i remember camp food as being generally filling and bland. i sure as hell don't remember getting medium-rare roast beef, lambstew, stuffed peppers, ginger-roasted tofu, freshly made dark molasses bread...you get the idea.
and hell yeah, we did have creme brulee. dessert was always a highly anticipated affair.

actually, it was my first time doing an "adult" camp, and it was great. we could choose to sleep in cabins or tents. we could choose where to pitch the tents. we could choose to crawl out of bed at 3am and fire up the sauna. and drink! in the sauna! we could choose to sleep in if we were too hungover after a night of partying.
i actually had to stop myself from asking for permission to do...whatever.

note: nobody got hurt. but some pairs of pants went missing, and for a while we were mildly worried about a friend who wasn't sighted until noon the last day, after a night of heavy boozing.
well, not so worried that anybody actually went to check on him or anything...


kurara update
she's getting short of breath on exertion. basically not playing anymore, although she still clamors to be let out of the cage.
and then she'll slowly walk around the room and go to sleep in her fuzzy tunnel thing, which she is no longer destroying.

i don't know. she's deteriorating quite quickly. possibly...possibly next week i'll have to bring her to the vet.

Tuesday, September 13, 2005
09:20 p.m.

baby cows and ovaries

today i visited a friend who interviewed for residency at my school, but alas, chose to go somewhere else.
her father raises cows on the side, and a baby cow gummed me. it was endearing, and also kind of gross. i felt its bottom teeth, but they didn't really do anything. does it hurt when an adult gets your hand into its mouth?

and she has horses! damn it, i want a horse too. i drove over to my riding school to look over the boarding contract, but it wasn't ready.
i did speak to the owner. i won't be responsible for any costs beyong the half-board. if she gets sick, i'm not responsible for any medical bills. i don't even have to have my own equipment. it's a great deal.
and! once my instructor says i'm ready (ummm...in the...future), i'll be able to take her off the property and onto some local trails. i saw the other instructor leading some child students back from a short trail, and commented on it. the owner said that of course the kids aren't allowed to take the horses anywhere off the grounds; i said something to the effect that i imagined it wasn't only the kids.
but no, apparently i will be allowed to do it, instructor approval pending. for now i'm still struggling to keep her attention in the outdoor ring, surrounded as it is by so very many distractions. i don't expect approval soon, but it's nice to have it to look forward to.

ovarian drama
last night in was ovary night in the ER.
it sometimes goes like that, patients coming in with similar presentations. chest pain night. UTI night. ear pain day. broken bone day - on that day i was accused by the consulting orthopod of running a fracture clinic.
so last night was pelvic pain night.

pelvic pain, as abdominal pain, is a frustrating presentation. in many cases the physical exam, bloodwork and XR reveal nothing very specific. there were many times i was sure i got an appendicitis, picture-perfect exam, only to have it be an ovarian cyst or even some MSK problem.
in our hospital, i can call in the lab and XR from home. but i can't call in ultrasound, partly because the XR tech on call may not be trained to perform them, mostly because there'll be nobody around to read it. the radiologist rolls into hospital in the morning; it's good to be the radiologist.

my pelvic cases all had similar presentations, sharp, sudden-onset pain, non-radiating, some nausea associated but no other symptoms. presentations consistent with ovarian cysts, for example - not emergencies in the "load them into an ambulance and rush them to the nearest CT scanner", but still something we'd like to confirm on imaging.
the decision wasn't whether to scan or not to scan, it was whether to admit for overnight. it's a decision made on mostly subjective evidence, and people's pain tolerance varies so much after all. normal vitals and bloodwork all, no help there.

i admitted one. by morning, she had a temp. by noon when i had come to learn what happened, having previously transferred her to the next ER doc before going to the office, i learned she was already in the bigger hospital being checked out for possible torsion.
the rest, as far as i know, were fine. certainly no post-U/S admissions or transfers.

so i feel good. i made the right call, admitted the right patient. some instinct told me that she was the most likely to actually have something wrong with her.
and yet, the presentations were so similar. i was seriously considering sending her home too. probably nothing would have happened; she would've come back in for an U/S in the morning like the others, and been transferred based on the results anyways.

but it would have looked kind of...bad.

Sunday, September 11, 2005
08:37 p.m.

my own horse!

ok, my half-horse. half my horse? rights to horse!

i think i'm going to half-board the horse i've been riding. meaning i'll pay half her boarding fees and have the right to come riding four times a week. if i can actually make it that often, or even three times, it's a steal.
naturally there will be rotations when i won't be able to make it in that often, but i'm already plotting to do my electives in the vicinity to take advantage of "my" horse. actually, except for the ortho rotation, which has some kind of wacky daily-call-until-midnight system on weekdays, i should be able to come in quite often.

as a part-boarder i'll also get first dibs on her. she'll be taken off some of her teaching schedule so she'll be available for me, and to make sure she won't be worked too hard.
this part appeals to me because i'm a jealous wench. and i'm jealous of a horse that's not mine. i know, it's very sad.

kurara update
she's doing fine. still no signs of discomfort, just fatigue.
she has, however, developed a biting habit. now both of my chibis bite in play, but kurara always quit when i said "no". in fact, chibiko was the more vicious one.
now kurara has started to bite, hard. hard enough to draw blood. both in play and when taking treats - before, i was able to hold raisins between my teeth, and she'd gently take them. now, after the way she went for a raisin i was holding in my hand, i'm not about to attempt it any more.
she also destroyed the fuzzy tunnel i got for them. completely shredded it with her teeth.
i'm not sure what to make of it. watch and wait, as with everything else, i suppose. and avoid holding raisins in my mouth.

Wednesday, September 7, 2005
10:44 a.m.

kurara is dying

it appears that i was wrong, after all. but not in the way i'd hoped.

she doesn't have adrenal disease. what she has, with 95% likelihood according to my vet, is lymphosarcoma. the mass i felt in her belly wasn't the right adrenal, it was her spleen.
her spleen, which sits on the left side of her abdomen. unless, of course, it happens to have a huge tumor in it.

she has lost almost 1/4 of her body weight, and i blame myself for not seeing it earlier. it was gradual, i see her pretty much every day, she has a decently long, healthy coat of hair. she wasn't really acting sick. and so i missed it until it got too obvious to miss, and even then i just thought she didn't like her food. i changed the kibble, bought more ferretone to pour on it to encourage her to eat.

it was last week that i really became concerned, when i realized that she was neglecting her hind legs. she could still stand upright for a treat, but when i gave her a bath she was sinking; she wasn't using her hind legs at all. she started looking my way when she wanted back into the cage, rather than jumping up herself.
and i realized that it had been some time since she climbed up on my bed.

the vet didn't feel any other nodes. she agrees that kurara looks remarkably well, except for the weight loss. her eyes are bright, her coat is shiny, her mucus membranes are pink, her breathing is clear. she doesn't appear to be in any sort of distress. really, she's only tired, very tired.
and she's dying.

right now she's at the vet's for a metastatic work-up and pre-surgery blood work.
if anything comes back positive, that'll be the end. if she has mets or organ failure, we won't proceed to surgery; i don't know about chemo. my vet didn't mention it, although there seem to be some ferret protocols.

i thought i had taken the news well. i could tell the prognosis, even with successful surgery, wouldn't be very good. it's easy to pick up even if they don't come out and say it, it's in the very way doctors give the news. it's almost easier if there is no hope, because it's final; obviously much easier if the prognosis is good.
but there is a specific way they talk when the prognosis is bad, and yet there is a chance. no telling how small a chance, of course. not even the work-up will really tell that, it'll only tell us if we can proceed to surgery. if we can "buy her time".

i thought i'd taken it well, until i found myself pulling over on the way home. i couldn't see the road through my tears.
kurara is dying.

***edit***
metastatic to lungs and liver.
there will be no treatment. she's enjoying her life now, is curious about each new thing, can still beat me to the door in an attempt to escape. occasionally plays with me or chibiko when she's not too tired.
she'll get more and more tired as time goes on.

i hope for a peaceful end, but with lung effusions it's more likely she'll eventually develop breathing difficulties, and i'll have to have her euthanized.

i'm having intermittent crying spells. i'll stop, and fool around on the internet, just trying not to think about it. then i'll start crying again.
she came and licked my face. she was just after the salt, of course. but it made me cry harder.

Tuesday, September 6, 2005
09:42 a.m.

sadness

i think kurara may have adrenal disease.

she is the right age and has most of the signs. i hope i can get her to a vet this week, because next week my schedule is crazy.

so, silver lining: if i'm right, my l33t diagnosing skills have crossed the species boundary.
the cloud: if i'm right, it's a fucking expensive operation. if i'm even more right and it's right-sided, it's also a fairly dangerous one.

i would gladly sacrifice my newfound l33tness for a clear blue sky.

Monday, September 5, 2005
09:20 p.m.

"Make the most of fleeting leisure.."

"..Hail it as a true ally,
Though it perish by-and-by."

it's kind of odd that, having lived in ontario for 15 years now and having gone camping once or twice almost every summer, i've never actually been to algonquin.
before this weekend, i mean. as camping trips go, this one was very easy on me: the friends i went with provided the tents and the food; all i needed was my sleeping gear and some liquor and snacks.

as camping trips go, this one was also very easy-going. we went on one short and pretty hiking trail, and spend pretty much the rest of our time at our site, traumatizing one member of our party by discussing various rectal diseases and initiating a heated debate on just how visually similar to diarrhea was her coffee (but that's what she gets for going camping with three doctors).

i spend the weekend horribly congested. i had office on thursday, followed by a night shift in the ER. on saturday morning i started feeling the first symptoms of the virus and, since i've had no contact with sick people for quite a few days before thursday, cursing the whole miserable lot of patients from that day.
i had my trusty neocitran and some OTC cold/flu pill samples, but that only goes so far. a virus must run its course. what i didn't have, what i actually held consideringly in my hand before deciding to put it back when packing on friday, was my decongestant nasal spray. and damn, i have the hardest time falling asleep when i can't breathe through my nose.

but my inability to breathe aside, it was a great weekend. i usually like to do more when camping, but since i was feeling lousy the extremely relaxed pace was lovely. we spend hours around the fire, catching up, just generally chatting, and cursing esca's hubbub for his pyromaniac tendencies.
and cooking, but i wasn't involved there. i don't cook anything beyond marshmallows when i camp.

and now, it's back to the grind. at least i only have one call this week, and the next weekend is free.

Monday, August 29, 2005
03:43 p.m.

damage report

well, my car insurance company has finally condescended to inform me what my new premium will be.
they've raised it - 42%.

that is actually a huge relief. it's not a company that gives you one "free" accident, i've only been with them for 7 months before i totalled my car, my full driver's licence was still practically sparkly-new, and the cop's report stated i was driving "too fast for conditions" although what conditions i can't tell. i wasn't speeding obviously, and both my and the road's condition were listed as "good" in the same report, but that wouldn't have helped me with the insurance company.
so after talking with an ex-insurance adjuster married to one of my fellow residents, i expected my premiums to at least double.

of course, i'm being careful now. i've just spend $600 on fixing a bad dent someone put in my rear passenger-side door while i was parked at a mall, and not a peep about it to the insurance people. they won't hear from me unless i need my car replaced again, dammit.

wasting time
this is my second week off. actually, i have to work thursday, in the office and then in the ER overnight, but have friday off because it's with the doc who takes a full day off after night shifts. the other one's still on his vacation.
i waste my time off unless i have something planned. last week was good, i visited my parents, visited shell for a belated b-day outing, went to a local festival, had my three horseback-riding lessons (have established trot; canter soon to follow), relaxed.
now i'm supposed to be putting my papers in order, faxing things to various offices, going on base to file claims...boring stuff. and worse, stuff that can "wait another day", until there are no more days left. because i have no firm deadline, it's easy to let it slide and just hang around the house reading, playing with the chibis, finding imaginative ways to put rhubarb in all my smoothies.

hmmm, i've actually ran out of yogurt. that may be the necessary catalyst for getting me out of the house.

in mildly concerning news, kurara is getting very thin. she was always much thinner than chibiko, but i don't think she was quite this thin.
she's eating, and playing and behaving normally, and her hair's not falling out. but i'm worried. i'll buy them some different kibble, and keep an eye on her. she may have to be seen by a vet if she doesn't start gaining weight.

ah, and if esca doesn't show some sign of continuing existence, i'm declaring her just as dead as o-ren meta.

Thursday, August 25, 2005
11:19 p.m.

feeding frenzy

"Eating the living germs of grasses
Eating the ova of large birds
the fleshy sweetness packed
around the sperm of swaying trees
The muscles of the flanks and thighs of soft-voiced cows
The bounce in the lamb's leap
The swish in the ox's tail...
Eating roots grown swoll
inside the soil
Drawing on life of living
clustered points of light spun
out of space
hidden in the grape.
Eating each other's seed
Eating
ah, each other.
Kissing the lover in the mouth of bread:
lip to lip."
- Gary Snyder

currently consuming mass quantities of dried cuttlefish and rhubarb smoothies. not at the same time, because that would be kind of gross.
or would it? cuttlefish and lemon soju isn't gross, and rhubarb is so very refreshing...maybe i should add alcohol and try it.
the cuttlefish i bought at the oriental mart have MSG. did the ones in korea? i have no idea; i'm pretty sure we ate "fresh" ones, but we also bought them packaged, like any other snack.

ah, today i was back on the mare again. and this time, she trotted for me.
i don't think i got magically better at it just through one lesson. but i do think i'm more confident in what i expect from her, and i'm no longer hesitant in asking. she responds to that, she'll do what i want as long as i'm clear that i actually want it.

since i have the week off, i went to visit my parents and shelly. she and i went to the EX, and happened to catch the trick-riding show.
two tiny, tiny gymnast girls hanging upside-down or standing right up while galloping. man, were they tiny. young teenies, both. pretty good show, but far too short.

Saturday, August 20, 2005
02:23 p.m.

sweet success

my new horse is big. bigger than the one i'm used to, and i swear, his hooves are twice as big *shudder*

he is also headstrong and prone to yanking on the reins to put his head down. and to wandering off in his own little direction unless i really pull hard on the rein to tell him where to go. and man, is he strong.
he's also got some kind of an allergy, so periodically he'd do this cough/sneeze thing and it'd feel like his sides were exploding. the first time it nearly startled me off the saddle.

but - he'll trot for me! he'll trot and he'll stay trotting, circle after circle, until i find the rhythm and post. and then it's just so very right and easy and wonderful, and he won't slow to a walk after a few strides. i fucking love this horse.
his stride is much bigger than that of the mare i rode before, so it took a bit to find the rhythm; i'm not used to finding it right away, at least not yet. i kind of went up and down out of synch a few times, wondering what the hell was wrong, and then i found it. ah, such a great day.

i stole a little crabapple to give to him after the lesson.

Friday, August 19, 2005
07:56 p.m.

my loins are aflame

shit, i didn't even know i had those really really inner thigh muscles. they were perfectly happy sitting way up there out of anyone's way, just relaxing and hanging out, and now they suddenly have to work. hard.
consequently they punish me when i attempt to walk after dismount. these are some angry, bitter muscles.

today i got the horse to trot all the way around the circle, with vocal encouragement from my instructor (to the lazy horse, not to me).
i'm starting to get brief flashes of just what i should be doing in the saddle. suddenly everything feels right, i'm able to balance well and keep my heels down and my feet in the stirrups and exert pressure without feeling like my legs are popping off, and then she'll shift or slow or speed up (hah, i wish) or i just lose it on my own...*sigh*

yesterday we tried the posting trot because i felt weird just sitting in the saddle, being bounced up and down. i had these two, three magical strides where i caught the rhythm, went up on my feet when she pushed me up - i felt what i imagined the instructor felt when she demonstrated the trot, the smooth, right motion.
i must've been so stunned by success that i relaxed my legs. and, of course, the hellbeast slowed to a walk. arrrgh!

today was stormy and she was a bit freaked out, so we concentrated more on walk and position, and then just before the end did a bit of a sitting trot. but i didn't fall off in the corners, so yay!

tomorrow (wooo, three times/week. i'm burning $$$ here) she'll try me on a different horse, one apparently more responsive. also less careful of new riders; my horse, lazy though she is, has a good idea of her rider's ability and will, for example, stop when one is falling off. the other one not so much, but he will trot when asked, and not try to stop at every corner.
we'll see. if you never hear from me again, blame the trot. always blame the trot, for it is evil.

right, and i'm here for more than riding lessons
for example, i'm here to learn more medicine!
this week was tough, because the doc wanted to squeeze in more patients before his vacation. the other doc's already gone - their 2-week vacations overlap, granting me one precious week off - so we were squeezing in some of his patients too.
but today, he gave me the greatest compliment ever given to a resident: he said that i actually halve his work (instead of doubling it), and that he trusts me to stay in the office alone seeing patients when he has to leave. which he promptly did for a few hours, although i warned him that i'd double his staff's salaries and redecorate with fluffy throwrugs if he leaves me in charge for too long.
but i feel good. really, really good. i feel i can actually do family medicine, unlike a vast majority (according to a recent questionnaire) of my fellow residents, i do in fact feel that i will be well-prepared for the practice of family medicine.

and that that i'll be able to ride a horse. so yeah!

Sunday, August 14, 2005
03:48 p.m.

falling off the horse

ok, nearly.
my horse is lazy. or rather, i guess she's smart. she'll try to get away with as much lazyness as possible, and needs to be pushed on constantly.
not an issue when i'm walking, but getting her to trot is hard. getting her to keep trotting is harder, especially around corners when i have to keep the leg pressure on while adding extra pressure with the inside leg. i'm not used to this, so my outside leg pressure comes off - she feels this, and immediately slows to a walk.
finally, i got her to round the corner at a trot.
and felt myself slipping off the saddle. damn.
i managed to hang on, rounded the corner and stopped her to readjust myself.

seriously, the trot is a stupid gait. ok, it's probably stupid now because i just started learning it and can't quite get used to the feeling. it's a sense of being completely out of control, although my instructor assures me that my seat is very good (except when i'm falling off, i suppose).
ah, and i need to relax my lower back more. except every time i do that, my leg pressure relaxes and she slows again. argh.

losing my virginity
my BPAL virginity, that is.
i've ordered 12 imps. there are some scents i'd definitely order a full bottle of, but reading the reviews i've decided to see how they work with my skin chemistry first.

i think kumiho is the only "milder" scent i've ordered. the rest are all pretty heavy (the red queen, kali, lady macbeth, dragon's heart), which i prefer. i don't wear perfume to work because any medical setting discourages the use of scents, so when i do wear it it's to go out and i want to be able to revel in it, dammit.
my current favorite commercial scent is opium, with green tea for day. i can't wait to get the BPAL imps and experiment.

Thursday, August 11, 2005
09:14 p.m.

what? DEATH?

today was my second riding lesson. i got to sign the waiver - you know, the one with "dangerous sport" and "possibility of injury, even death" on it.
damn it, i knew picking up their hooves and sticking sharp metallic objects into them was a bad idea! these people are obviously bend on eliminating me from existence, as i do this twice every lesson. that's eight hooves altogether. heavy, skull-crushing hooves!

"my" horse gets distracted relatively easily, and is hard to drag out of the pasture. she kind of crowded and head-butted me aside when i tried to make her leave the grass and come into the stable to be saddled.
apparently having predominantly kids as learners is bad because they don't teach the horse to listen, and so she feels she can get away with doing what she wants. my instructor is happy to have an adult learner who won't let her follow her own horseish fancies.
but unlike kids, i am aware of my own mortality. the horse is bigger than i am! and she's bossy! bossy with hooves!

in happier news, i have a good riding position and my instructor can draw some imaginary line from my earlobes to my heels through my shoulders, or something like that.
oh, and my ischial spines hurt. this would also fall under "good".

tomorrow i face the hooves some more.

***edit***

penguins in love are so fucking cute.
and i absolutely must have a life-sized baby emperor penguin, around the first-steps period where it's all grey and fluffy with itsy bitsy fluffy wings and that adorable black and white face. stuffed, of course. someone out there must make those; we have eleventy billion types of teddy bears, i figure someone must make baby penguins.
no teddy can hold a candle to one of those.

so yeah...go see march of the penguins. you'll laugh, you'll cry, you'll "awww" a lot. and then you'll want a stuffed baby penguin of your very own.

and, esca? all will be well!

Friday, July 29, 2005
01:23 p.m.

more schadenfreude

so a few days ago a patient came in for a check-up and to request some bloodwork.
this particular patient's family follows some wacky raw-food diet and completely eschews any supplementation. we have another patient from the same family, who is persistently and symptomatically iron deficient, and refuses to take any iron. this patient has been to dieticians and has tried adding iron-rich veggies to no avail. i find her rather stupid - it's not just a lab value we're getting hung up on here. she feels fatigued and crappy, and it's not like we're even asking her to change her diet. just take a supplement for a while, for crying out loud.

but nevermind that. my patient, who self-importantly gave me a lecture on the wonders of raw-fooding and the evils of meat and how my life could greatly improved if i turned my back on the normal omnivorous nature of human beings, is not iron deficient.
she is, however, diabetic. and her LDL cholesterol is sky-high.

i guess the powers that be like sticking it to pompous pricks.

Wednesday, July 27, 2005
08:57 p.m.

mmmmmm... ^__^

chocolate soymilk-bailey's smoothie. a blender is a wonderful thing.

starting riding lessons on friday. i can ride as far as trail-riding is concerned; i can even gallop without falling off. but i don't fool myself into thinking that i'm any good at it, or that i'd be able to control a horse that hasn't been taught to keep nicely to a set trail.
these lessons are english style; as far as i'm able to determine every saddle i've ever occupied had been western.
i can't wait. i'll aim for twice a week, it's not like i'm doing anything else with the money.

except paying car insurance, possibly. i still don't know what the damage there is, but i'm leery of harassing them too much. maybe they'll jack it up even higher for the annoyance factor. after all, as far as i know insurance companies can do pretty much whatever they want.

darling, i'm trying to call but your line is always busy! don't give your fucking landlord a red cent!

Saturday, July 23, 2005
08:51 p.m.

i love my job

seriously, i love my work right now. i love the office(s) i'm at, i love the people i work with, i love the alternative funding schemes that allow my preceptor (and, by extension, me) to spend actual time with patients instead of watching the clock. i love not being supervised to death, being able to deal with issues and send the patient on their way without even bothering to discuss the case. i love being able to stop medication or prescribe medication or whatnot, without my preceptors' say-so.
i love that on thursday, he actually thanked me for being so efficient, because that allowed him extra time to work on...whatever new funding scheme they're organizing now.
i love that he said that patients seem to trust me and like talking with me, and that i can go ahead and see the ones whose reason for visiting is the notation "personal".
i love that i'm actually enjoying dealing with the psychosocial issues.
i love that i love family medicine.

it may be that i have good preceptors. but really, they're such polar opposites - one is just thrilled to leave me in the ER as early as he can so he can flee home, likes getting out early, champions personal life. the other preaches the importance of joy through burial in work, stays in the ER past midnight, doesn't care if we fall behind a bit so he can discuss something interesting with me, tells me that my current state of "no life" is ideal for medicine.
i'm somewhere between those two, just exactly where depends entirely on the day i'm having, on the patients i'm seeing. but the point is, i'm seeing the patients. neither of them interferes with my style, expects me to be like them. i'm allowed to feel like we're colleagues, sharing an office. i'm a junior colleague, and i sometimes ask for advice, but no-one hovers watchfully over my shoulder or *shudder* videotapes me.

and?
and i'm learning that i can do this, that i did in fact manage to learn a great deal of medicine (even though, of course, i have even more to learn).
and i'm learning that i enjoy it.
and that is so good.

i'm still scared shitless when they leave me in the ER though. and last time the ward called me, and we have this little quasi-intensive unit there. it wasn't the unit, but they could call too.
i don't want calls from the unit ;__;

and now for the ranting part of my job love
my fellow resident isn't having a good time. i'm not sure why. preceptors most likely, because a preceptor can make or break a rotation.
yet she's also stuck in the compliance-mode of most med students and residents: she doesn't complain if she's asked to do something she shouldn't be doing. she's carrying the inpatients for her entire call group, instead of just those of her two preceptors. that isn't right; the preceptors who teach get the benefit of having residents do some of their busywork, those who don't take on learners should do their own damned jobs. quid pro quo.
i was like that as a med student, i stayed way past noon on post-call days when told to until i got physically ill once, i carried more patients that the rules said a med student should carry (bad for student, certainly bad for patients). i was afraid of bad evaluations.

but now i see it's just a headtrip. "paying your dues" when coming from the specialist residents means "shut up and retract for the next six hours even though you're not learning anything and even if you were it'd be totally irrelevant to your future career, while i do something interesting". fuck that, i've never once seen a specialty resident "paying dues" to family medicine. "being a team player" means "forget your post-call day off so the third-year resident can take off early and not be bothered with your patients". i'm past that. i'm a good team player, and if i've had a decent amount of sleep (say, 3 hours), i'm more than happy to stay longer. if the team is short because some people are sick or off, i'll usually stay. i'm working five consecutive weekends right now, against PAIRO rules, but i'm choosing to do so because the work is interesting and not particularly onerous and i have nothing better to do. if i did, i'll simply tell them to stuff it (well, i wouldn't have to. they're nice, reasonable people who expressed surprise at the schedule, and i actually had to give assurance that yes, i'm ok with it for the time being).
the thing is, abuses happen largely because people think the world and their careers will shatter if they complain officially. and really, there's nothing more psychologically freeing than calling a supervisor "beneath contempt" in one's official, going-to-the-dean evaluation.
i heard that one orthopedic surgeon at the hospital where i'll be in december likes to make residents cry by yelling at them in front of patients.
i can't wait.

Tuesday, July 19, 2005
10:39 p.m.
squee, new layout, again courtesy of esca. why did i even bother buying that html book...way, way back when?

my cast of layout characters is expanding.

oh, and the butterfly? fucking amazing!