Monday, November 13, 2006
02:54 p.m.

Winter Wonderland my Ass!

I don't want to die.

Seriously, winter here might kill me. This city doesn't salt its freaking roads, and we've had constant snow and ice for a couple weeks now. They pour sand for traction, or so they claim.
I'm driving on ice. Not "ice patches" or "black ice" or things along those lines. No, I'm driving on what is essentially a bumpy icerink, and when the temperature gets a touch warmer parallel grooves of no-ice are worn into the roads by the traffic. I'm actually happy to see snow, because snow allows for traction for my winter tires. I was totally willing to get ice chains, but apparently that's not allowed.

I've gotten used to the strange bumpiness of my anti-lock brakes engaging, and to the mild fishtailing my car does on left turns. As well as to the sight of other cars fishtailing, or stuck in ditches along the roads. 40km/h has become my standard speed.
Thankfully Alberta drivers aren't crazy and seem to understand winter driving. Cars making left turns are allowed plenty of time, with other traffic waiting for them to complete their turns. People wanting to drive faster don't honk and gesture angrily at terrified out-of-province transplants like myself. Drivers having right-of-way at stop signs wait to see if the other car can actually make a stop before crossing the intersection.

But the bloody pedestrians need to die.
We have these unmarked (well, marked but without those flashy lights I'm used to) pedestrian crossings everywhere. People just running willy-nilly onto the road initially took me by surprise, but it wasn't really an issue before the road turned to sheer ice.
People! I'm practically skating here! I may not be able to stop no matter how much I want to, so at least stand at the crossing and watch for a successful slowing-down before you venture into the frozen death zone.

Oh, and in honor of Remembrance Day I watched Grave of the Fireflies and got incredibly depressed. Damn you, Studio Ghibli!

Sunday, October 29, 2006
03:53 p.m.

Pigs Must Die!

So that we can learn.

I successfully finished my ATLS (Advanced Trauma Life Support) course yesterday.
Mostly it was PowerPoint, discussions and practical stations, but the highlight was the animal lab.

As part of trauma care we need to be able to put in chest tubes, do venous cut-downs and put in surgical airways, and we should know how to do a pericardiocentesis (although a trauma patient needing that is pretty much dead). And unless you're at a trauma center or in general surgery residency doesn't teach these skills too well - I've put in a chest tube before, but haven't done any of the others.

So we did it on pigs. Living, very heavily anesthetized pigs.
Ours stopped breathing somewhere around chest tube 4, which probably means that putting in 4-5 adult-sized chest tubes into something the size of a 4 yr old kid may be deleterious to their health. We did do a thoracotomy on it later and it neither had a hemothorax nor a punctured heart, so who knows what exactly killed it.

The only disturbing thing for me was when a still-living pig from one of the other groups started into agonal breathing. Agonal does not mean "agony" and the pig wasn't in pain, but it was a pretty hellish sight, its snout opening and its head coming right off the table. They had done their thoracotomy too and we could see the exposed heart pumping in an irregular rhythm, occasionally fibrillating. The instructor finally arrived with a huge syringe a KCl and stuck it right into the heart, stopping it dead.
RIP, piggie.

Winter Wonderland
Heavy snowfall yesterday and today, reminding me to put on my fucking winter tires already.
And Wave got turned out today in a blanket, because I'm a huge suck. Most of the other horses are out with no blankies, but it is -8C and I...I am a suck.

Ah yes, and in but a few days I shall see esca once more, and beat her senseless for never updating hug her.

Wednesday, October 25, 2006
04:12 p.m.

Life Begins to Take Shape

Up at 0600, get dressed, go to barn to kick out Wave. Arrive at work. Twiddle thumbs for hours See patients. Change clothes, back to barn to muck out stall, possibly ride, bring in Wave for the night.
On weekends sleep in later, screw with Wave's head. Horses are creatures of habit and get used to their usual timings, but no way in hell am I getting up at 0600 when I don't have to.

Army will screw liberally with my head as well. There will be taskings like the jumps I'm covering this week, or courses like the ATLS I'm doing later this week. Or I'll be going away like I'm doing next week, yay Quebec City!
It'll be harder when I'll have to go away for weeks for longer courses. And possibly easier when I deploy, because I may just dump Wave at a full-service barn for that duration and have a trainer work with her.

But in a nutshell, that is my basic schedule. Add an evening shift or two at a normal clinic so I don't forget medicine.

Luxuries
Today I spend $50 on groceries that were total luxuries. By that I mean, none of the stuff will be for an actual meal.
A couple of fancy spreads for fancy cheeses (peppered black mission fig and spiced quince), some fancy cheeses to go with that, fancy drizzlers for icecream (mango/guava/rum and raspberry/lemon/vodka), fancy icecream and sherbet to go with those. Some fancy fruit. Spiced squid to chew on.
My life is good.

Monday, October 23, 2006
10:23 p.m.

Everything I Know is Wrong

In riding, I mean.

Not in medicine...I hope. Although if I'll continue at the rate of 2 patients a day, it will be soon enough. Starting in Dec I'm picking up shifts at a regular non-army family practice clinic.

Back to riding - I have been taught incorrect basics, apparently. Now, I know that every time you get a new instructor they change things, but these are very fundamental things. Starting with the saddle not really fitting Wave, driving into her back when I lean back for the canter and making her go faster and faster to escape the pressure, which frightens me and makes me lean even further back. Ah, vicious circles.
I'm perfectly willing to buy a new saddle, but my instructor likes the fit of this one around the withers and thinks it'll be ok with a riser pad.

The saddle doesn't fit me perfectly either, throwing my legs forward into a sitting-in-chair position, but it's not too bad. The bigger problem is that this position has never been corrected, so today we spent an hour at the walk working on that and on my contact with her mouth, which also sucks ass. She actually bends very nicely at the poll like a hunter should, but I never asked her to do that before because I had no idea how. And my instructor didn't teach me, so I rode her with her head high in the air. Augh.
I finally got like 2 good strides out of her, but she felt so light in my hands for those, errr, seconds. Instructor got many more, and she looked so pretty!

Also, my inner thigh muscles were actually spasming. Spasming!

Wednesday, October 18, 2006
07:53 p.m.

Horse Manure is my Life

Or will be as of tomorrow morning.

Wave is now on her winter schedule of being kept indoors overnight, so I get to muck out her stall every day. Oh, why can't I live in a nice temperate climate where she can be on pasture board throughout the year?
She's also started on a rice bran oil supplement. It's a liquid fat basically, that I add to her grain. The last two days she carefully ate the grain around the oily spot, leaving a near-perfect circle in her grain pan. Picky. Think of the starving zebras in Africa!
Today she finally ate a bit of the oily grain, yay. I just don't want her to lose weight over the winter.

Army matters
My angsting over my CO proved unfounded, as I suspected it would. Although that didn't stop me from angsting, of course.
It's just that in trying to accept a spot the career manager offered me, I inadvertently went over my superior's head. The army, it really frowns on that.
Silly games really, but at least they have rules one can learn to operate in. And I get to go on my fully funded conference.

I also learned that we may have too many docs who "want" to go to Afghanistan when our turn rolls around again. Which...yeah.
I suspect that it's not so much a matter of "wanting" to go as a need to, if you have career progression in mind. You seriously lose any credibility with the troops if it's wartime and for some reason you've managed not to deploy.

But I also know that at least two among us will most likely not continue past their obligatory service. Eh.
I do want the career. I can't let someone who's only going to leave anyways take my potential deployment. That I don't want.

*headdesk*

Wednesday, October 11, 2006
07:52 p.m.

The "Globe and Mail Test"

There's an excellent drug out there, called Etomidate.
It's an anesthetic/hypnotic and it's approved just about everywhere but Canada. Europe uses it, the US uses it. Random paramedic organizations and ER's in Canada use it, although I'm not sure just how, since it's not approved.

It's not a new drug, therefore it's no longer proprietory to its company. As such, it's cheap and the company won't spend the scads and scads of money to get it through the morass of licensing paperwork in Canada. Understandable.
It's remarkably stable with regard to circulation, and can be used instead of the cocktail of 3-4 different drugs that most anesthetists use.
Canada does use it - in Kandahar. That's a multinational hospital over there, and the nations represented expect to be able to use the medication. Our docs like it too.

So apparently there's now a plan to get the army to fund the licensing process to get it approved. Not because we can't use it over there; we do. But because using a drug that's not in fact approved in Canada on our troops overseas won't pass the "Globe and Mail test".
Politics is stupid. So is the whole licensing process - can't the US and the EU and Canada just agree to cross-license? I'd trust a drug approved by any one of them as much as I'd trust one approved by Canada - no process is perfect, the occasional MI-inducing Vioxx can slip through any of them, but for crying out loud. How much money are we wasting on these licensing organizations?


No money in saltwater
We got two wildly different trauma presentations in this course.
One, from an anesthesiologist involved in trauma training, was the status quo - two large-bore IV's, start with crystalloids, then consider switching to colloids or blood transfusion. Fine, just what we've heard all our lives throughout our medical training.

But the lecture by the trauma surgeon was far more fascinating. True, it was more battlefield-focused, and in the battlefield your transport time to the hospital may run into hours.
But he basically said not to bother with pre-hospital IV's. I'm over-simplifying, yes, but he may as well have said that for all the status quo-breaking he was doing.
He advised to withold IV fluids entirely if rapid transport is available, because the time wasted getting the IV in is worse for the patient than the benefit of getting that fluid would be. There's actually an urban-centre study with time to ER of average 15min, that showed patients with IV's doing the same as or worse than patients who didn't receive IV's on the way to the hospital. Which actually makes sense, since how much fluid can you get into a patient in such a short time anyways, especially since with crystalloids only 1/3 of the fluid remains intravascular.

IV fluid dilutes the clotting factors, plus it can cause hypothermia when cold (as it would be in the field). Blood pressure over 80 systolic can pop off clots that have formed, so he advised us to titrate it to level of consciousness, not BP - if the patient's conscious at 70 systolic, don't push more fluids to drive the BP higher.

When transport is delayed, as it often is in the field, we're now going with colloids. I think it's actually some hypertonic saline/dextran combo, but there's other stuff in the pipeline. The days of hauling bags of saline or Ringer's around will soon be a memory.

As the surgeon said, "Industry will never fund studies of IV fluids. There's no money to be made in saltwater."
True, but the US military is, currently to the tune of $65 million. War tends to revolutionize trauma medicine because governments will fund studies into materials and techniques that aren't lucrative like new lipid meds are.
The trauma center in Houston is running a trial on thawed plasma as primary resuscitation fluid, foregoing crystalloids and colloids entirely. I don't know if that trial is army/war-related or not, but thawed plasma is being used that way in Iraq as well.

Fascinating stuff. Not really applicable to the civilian setting, not quite yet - but at least it's enough to breathe a sigh of relief if you can't get in your two large-bores into them. It won't matter.

Tuesday, October 10, 2006
02:09 p.m.

Superior Worries

I fear that I'm not getting along with my CO.

I may be over-worrying. I've only ran across him a few times; we're both new to the base. I've barely had a conversation with him.
Still, I don't feel a connection. The other docs seem to be getting along with him, but they've also been on base longer. I get along fine with the Base Sx, but he's not in my chain of command unless I'm in the clinic.

Example: I want to attend a specific conference. The other docs either can't attend it because of competing courses, or aren't interested. I fill out the paperwork, and nothing happens.
So I call, because there's a deadline. I talk to the man, who has me check with the others and confirm their non-going. Fine, I do that.
Then he gives me the 3rd degree on whether I asked them if they're "intending to go", or if I phrased it as "interested in going." WTF? They're not going either way, the thing's in three weeks and they'd indicated no interest in it whatsoever.
Then he asks me if I asked everyone else about going. Not just from my area, but across Canada. That isn't my job, and the funding spots are regional anyways! It doesn't matter!

So, apparently, he'll talk to his superior and get back to me. Maybe. I don't know what to think; the conference is a minor matter, but he's pretty much in charge of my career for the next four years. Feeling that he doesn't like/trust me isn't going to make it easy, and I don't even know if it's true. It probably isn't and I'm just being a paranoid idiot.
Still. There should be no problem with the conference. Why is he making it a problem? Why is he acting like I'm trying to lie to him about the wishes of the other docs? They have seniority, I wouldn't have even asked for it if I knew that any of them were interested in going.

Technically I can talk to my career manager, but that would be going over the CO's head, which is heavily frowned upon. I would do it in a heartbeat if I was just going to finish my oblig service and get the hell out, but I don't want anything to jeopardize my long-term career.
I hate politics.

*curls into ball of angst*

Wednesday, October 4, 2006
08:05 p.m.

Doctors in the Field

Just back from the 2-day field exercise that was supposed to be a 3-day ex, but was condensed once the fun parts got cancelled. Ah well. Really, don't helicopters still fly in mild drizzles? I'm sure they do, but not in Borden.

Anyhow, we got rained out. Actually for most of today we got drizzled out, but there was a bona fide storm during the night and our stupid tent leaked, and thus my sleeping gear is somewhat wet and disgusting.
At least the rain didn't start until the end of my fire picket shift.

My love/hate relationship with IMP's (individual meal somethings) was renewed. I love that bread approximation they contain, one one that can apparently look pristine after 6 weeks of being left to the elements (according to a guy on a recce course). It comes with its own packet of that stuff they put into new shoeboxes, that desiccant shit.
That's good bread-like stuff, I tell you. It might even be lembas, who knows.
The actual meals range from quite edible, like the lamb stew, to projectile-vomity, like the bleeding lung omelet with salsa.

In any case, we did better than our instructors anticipated. We had to set up a 5-section HQ and a 4-section medical facility, and the two 10-person tents for us. Setting up the medical facility was a pain, and we were led through it, most people didn't know what they were doing (my fieldcraft was returning to me in bits and pieces from years back), the load master didn't know what a load master even was, and I'm sure we looked pretty hopeless.
But the HQ tent went well since it was basically the same thing.

And today we had to tear down the med facility, scout a new site, put it back up, tear it down again, go back to the original site, tear everything else down and put it all up again inside the school's hall to dry. Tomorrow morning we'll be tearing it down for good.
It went really well, faster than I remember doing it as a MedA after much more practice. I'm not sure why that is, except that in practice back then we did what we were ordered when we were ordered, while here, once we knew what basically had to be done, we made our own decisions as to how we'd proceed. Decisions that made packing up so effective that we were done far before our estimated end-time and had to hang around drinking Timmie's until the drying-out hall was free.

Probably, we worked a little more like troops really out in the field and less like a course there for study, following precise instructions. It was nice.

We also did night vehicle nav, and nobody got lost. Yay us!

Still, I'm glad we're home.

Shit, and yes, we're calling Borden "home" now. That's what the field does to you.

But I'm glad all the same. My skin feels weird and tight, and I'm on my period, and that was probably TMI but I don't care; you didn't have to go into the field with a pocket full of tampons.

Sunday, October 1, 2006
06:56 p.m.

Updates from Nowhere

I am bored.

I am bored a lot here. Borden is a hell of a boring army base when you don't have a car. Actually, it's boring when you do have a car, but you can at least escape the boredom. Like we did yesterday, convincing a couple of the lucky car-having guys to drive to Barrie for a movie.

Two weeks left, after three of Death by PowerPoint. I'm not kidding, three weeks of 0800-1700 of pure PowerPoint madness; one of the guys here, a reservist (and therefore somewhat insulated from threats of discipline) has outrightly told our main overseer that studies have shown this to be an improper way of teaching adults, and therefore he naps outrightly after lunch. I used to feel sorry for the earnest after-lunch guest instructors for having to witness this, but that was in the middle of the second week. Now I wish I could nap too.
It's not the poor instructors' fault. They each do one to a few hours at most, they don't know that their couple of hours or really interesting (to them) stuff comes hard at the heels of three weeks of the same shit. And in practice there is just no way of cramming all this allegedly necessary stuff into the course without making it longer, which would just mean more time in Borden.

This coming week we have two days of field, so at least we'll be free of the horrors of PowerPoint. There were supposed to be three days, with some time for shooting the 9mm pistol, but of course the fun part was cancelled.
The fun part is always cancelled. Borden has a way of sucking joy out of everything.

I've started running again. At least unremitting boredom is good for something; I tend to give it up when I have better things to do.

My current anger is focused on having to do Basic Training. For officers it's 9 weeks of IAP (Initial Assessment Phase), followed by five of BOTC (Basic Officer Training Course) which, I believe, is a whole lot of PowerPoint interspersed with screaming.
However, I already did 9 weeks of Basic with the Reserves that, except for one crummy week of small party tasks, doesn't really differ in any great way from the IAP. I don't understand the need to take me away from clinical work for almost four months because I missed one week of something I'll never need in the first place, when I could just do the BOTC part.
Stupid, stupid. I already feel myself forgetting my medical knowledge at an alarming rate, and I doubt cleaning showers and polishing boots will help me retain it.

Oh, tip of the day: radiation is no big deal. Dirty bombs usually disperse alpha radiation, which is the pussiest of all radiations. Paper can stop it, people. Paper! It can't hurt you unless you inhale or swallow it.
A good dose of gamma will just kill you so again, from a medical triage POV, no big deal. You'll die no matter what, and you're no danger to medical personnel or other patients. Even if you get less and don't die, you're not considered an immediate emergency; there's quite a few hours to play with. The bleeders get seen before your irradiated self.

Conventional chemical weapons and biological weapons, however, are a bad bad thing. And, of course, don't scare the population quite as much a radiation, because there's no mystique about them.

Tuesday, September 26, 2006
06:23 p.m.

Velcro as Predictor of Mental Illness

One of the docs on course is from Newfoundland.

Over the course of his life there, he noticed people in malls wearing Velcro sneakers. Regular adults, not kiddies or arthritic old men who can no longer tie their laces.
He noticed, or rather gradually realized, that said adults were...not quite right. Staring into corners, muttering to themselves, things like that.

The mystery continued until his psych rotation at the mental hospital. The mental hospital; Newfoundland has one.
A schizophrenic came in, showing typical symptoms of self-neglect. The nurse went to work getting his cleaned up and disposing of his stenchy clothes. As his socks hadn't been washed in months, she decided to give him new shoes as well.
She went into a room and opened this huge metal drawer, filled with - Velcro sneakers of all sizes.

And thus mystery was solved.

The kids at the Youth Detention center also got Velcro sneakers, red ones. I suppose it would make them easy to recognize as criminals in the event they bothered to keep the shoes.
Which they probably didn't, because what kind of cool criminal wants to wear Velcro?

In any case, today's lesson is: If you wear Velcro, you've been to a place where you can't be trusted with laces.

Actually, today's real lesson was all about parasites that burrow under your skin and crawl across your corneas turning you blind, or take up residence in your lumphatic system and make your balls grow to 30 times their normal size, or find a comfy home in your brain and give you seizures, but I'd rather not dwell on that. The Malaria Belt (which also happens to contain most of the other thrilling organisms we learned about) is a nasty, scary place. Parasitically speaking.

Monday, September 25, 2006
05:03 p.m.

Swallow me, Chump!

There are these worms.

A kind of hookworm.

They burrow into your foot if you happen to walk around shoeless, and then burrow upwards, until they reach the bloodstream.
Once there, they zip around until they finally reach the lung, go into the tissue and are horked up with your sputum.
Then, they (presumably) hope, you'll swallow the sputum and allow them to reach the place they were aiming for - the gut. Instead of spitting them the hell out onto the street, like a sane and disgustingly unhygienic person would.

Seriously, how does something that counterintuitive evolve? How does burrowing into the foot get you into the intestine? How many fits and starts did this life cycle have to go through before it settled into this idiotic system?
The creationists amaze me at moments like these. I can understand this tortured cycle evolving via hosts that were a bit simpler than us mammals, but to be thought of on purpose? Either God's totally on acid, or he doesn't exist. I mean, really. Fucking hookworms.

We've reached Tropical Med week, and it is good. Medical and gross, although not as gross as the effects of chemical warfare we'll hopefully get to see later this week. They have videos, we know that, and we hope that political correctness has been suppressed enough by events in the Middle East to allow their viewing.
When I was on my MedA course 6 yrs ago, they didn't allow the videos. The goat-rights activists got to them. I think we care less about the goats now, and besides, they've been dead a long time.

Also, take-home lesson of the day from the ID guy: don't eat stoolcicles. Sounds common-sense, I know, but it's amazing where delicious stool can be found in the developing world.

Wednesday, September 20, 2006
08:41 p.m.

Half a Doctor

I'm currently in week 2 of my 5-week BMOC (Basic Medical Officer Course), and only now did we get internet access. It's sad, in this day and age, but what can you do when your course staff is bordering on incompetent.

Last week in Ottawa was fine enough, not really military-like except for the wearing of the uniforms and coming to attention when something senior walked into the room. And at the end we met the Surgeon General (a woman, woot) and went to dinner with the higher-ups and, well, it really made us feel like a part of the organization. Which is a problem for many medical officers, whose entire training is essentially at civilian institutions.

As an aside, we learned about a funny calculation the army medical branch does, the so-called "medical horsepower". We have many civilian docs on contract doing in-garrison care, which is basically family medicine/walk-in clinic in slow-mo with weird army paperwork. The uniformed MO's do in-garrison care as well, but our main purpose is to be ready to deploy, and to provide medical support for in-country field exercises.
The medical branch has set the civilian contract doc as 1 horsepower.
The equation is 2 MO's = 1 civ MD.
I'm half a doctor.
From their point of view, it makes sense. We're to spend one day a week in a civvie ER, keeping up our emergency med skills, and one day a week doing army stuff with our units. So really we're only working 3 days a week, at best, doing in-garrison care. The civvie contractors work a normal week, and nobody gives a shit about their ER skills; they're not getting deployed anywhere.
But it's also appropriate in another way.
We're making half their salary, with the added danger of dying overseas for the win. Yes, it breeds...discontent, to say the least.

Oddly, the Ottawa week, death and low pay aside, was good for morale. Like they told us, if they needed docs for in-garrison care, they wouldn't need us in uniform. We're soldiers first of all, and the lectures on history and what the medical branch is currently doing were oddly uplifting. I haven't felt like a soldier, like a part of the Forces in any meaningful way, since I got into med school.

Among the recent history lessons was a talk on the restructuring of the medical branch into its current, clinical delivery unit-oriented model.
It was called the Primary Care Renewal Initiative, part of Rx2000, and included a nauseating number of committees and sub-committees and evaluations and the like. Well, we are talking about a huge government organization trying to make radical changes; it never goes well at first.
One of the evaluations in the early stages of the change was the Hollander eval, and its conclusions were as follows:
"...a marriage made in administrative hell and has so many practical pitfalls one cannot even begin to describe them."
This, we were told, was a "frank assessment of the leadership" of the CDU model.

My base actually has a very well-functioning CDU set-up, so I suppose those pitfalls were at least partly taken care of.

In any case, Ottawa week is over and we're on base. It's much more "army", checking arms and being forbidden to walk down convenient hallways because we're "students" and officers or no, doctors or no, we're inferior to instructors. Some people aren't taking this well, and it's pissing off those of us who are actualy thinking long-term career. When you're on course, if one person messes up, you've all messed up; that's just the army way. Some people, counting down the days to the end of their obligatory service, don't care that they're making the rest of us look bad.
The endlessly disappearing course staff who's failed to provide us with the things we need to finish certain tasks isn't helping.

There are good lectures, really. And there will be more good ones once we hit tropical med and the wonders of NBC warfare.
But this week, it's mostly, well.
It's stressful.
It's boring.
It's pointless.
It's death by powerpoint.
It's hurry-up-and-wait.
It's army.

Hey, I still have to do my basic training. That should be fun...

Thursday, September 7, 2006
09:14 p.m.

The Journey Home

The army, in its infinite wisdom, is sending me back to Ontario for 5 weeks. It's for a course I need and I'll get to see my parents and esca, so I'm not complaining...too much.

But damn, it's hard being new in the city and finding someone to look after your pets. I finally found a kennel that would take my ferret, they've had them in the past and one worker there seemed really knowledgable about ferrets.
None of the other places I called would, nor would the vets - one place usually does board ferrets but their exotics vet was away, so they wouldn't take her.

And then there's Wave, who at least is staying out 24/7 until the herd moves into winter pasture and I'll start bringing her in overnight. But I still give her grain and supplements daily.
Thankfully the barn environment is nice and friend-breeding, so I got two people for grain duty, and a third volunteered to ride her. I wasn't looking for anyone to do that because I thought it would be too much trouble; she overheard and offered. She does dressage with the instructor that I'll be working with when I return, and of course is far more advanced than I am. We gave it a trial run with her shiny and expensive dressage saddle, and Wave did well enough other than her usual stiffness. Which may even be improved by the time I get back, yay!
Horse people are love.

Real estate agent came over this evening, to see the house and drop off a fancy gift basket. Real estate agents are funny in their in-touch-keeping.
Her visit spurred me on to finally put most of my place in order, except for hanging up the pictures. But it distracted me from packing, woe. My plane leaves at 0800 tomorrow.

I don't want to pack.
Maybe I'll watch TV.

Monday, September 4, 2006
02:03 p.m.

Animals, the Deadly and the Merely Silly

Steve Irwin's death is keeping me from packing up my field kit.

Ok, not really. I don't need an excuse to procrastinate. But I have been reading various commentary on the Croc Hunter today instead of doing what I'm supposed to.

While I've seen some mean-spirited stuff, most of the actual jokes are quite funny. Well, why not? The people making them didn't know him personally, nor did the people laughing. The beautiful complexity of human emotion allows me to feel a bit sad and sorry for his family, while laughing my ass off. And then feeling somewhat guilty. And then laughing again.

Anyways, the very first thing that actually made me laugh was this, made by LJ user catsluvdmb:


Beautiful!
Swimming with rays is one of my dreams. I've snorkelled with small ones in the Mayan Riviera, but I really want to swim with the huge manta rays that'll glide majestically past you instead of scurrying along the sand.

Horsie
Took Wave riding outside the arena yesterday. Not actually a trail ride since I wouldn't go on one alone, just a walk along the paths on the Saddle Club's property and some trotting in circles on a patch of grass.
It's a route she's walked every day going from pasture to barn and back, but man, was she freaked under saddle. Snorting like mad.

Still, she did fine until I decided to take up back to the barn, and then she did the back-up, refuse-to-go thing that happened on my last (quickly aborted) trail ride back in Ontario.
But back then I was on pavement, on a sideroad, only heading towards the trail. I was afraid to force the issue because hitting concrete and possibly being run over by a car weren't on my list of happy experiences.

This time I was on grass, and shit, I've fallen before. Not something to look forward to, but something I could handle. My biggest fear, then and now, was that she'd rear when just backing up wasn't enough to make me give in; but Wave is much bigger than that Mexican beast and I do jump her, so I figured she'd be unlikely to fall over if she did.

I also have a stupid, stupid fear of letting go of the reins when she's being disobedient. Sometimes, when she refused a tiny cross-jump, my instructor made me walk her up to it and bring her over. She can easily walk over those (hell, I can too), but she'd try to back up and I just couldn't bring myself to release a rein, reach behind and slap her butt with my crop. I don't know why that is, since even if she'd jump from a standstill, it's certainly not holding onto the bloody reins that would keep me in the saddle. They have to be relaxed, and they are when I jump.

So, irrational fear. I think that's why I like skiing but am afraid of snow-boarding. There's nothing to hold in your hands! Skiing has poles, and yes, I don't actually do anything with them besides push off, but they're there! In my hands! Making me feel safe.

Ok, ending tangent.
I decided that I was ok with falling on grass, made myself let go of the stupid rein, and whipped her on the behind. And she gave me no trouble at all after that.
Kind of anti-climactic after all the discussion of falling and rearing and holding-stuff phobias, I know. But it made me feel so accomplished.

Thursday, August 31, 2006
09:50 p.m.

I Need Fucking Sleep

Ugh. I have been awake and alert for 19 hrs, having woken up at 0230 after 5 hrs of sleep. The only reason I'm going in to work tomorrow are the hints that I'm finally getting promoted.
Other doc: "Well, you've been told in no uncertain terms to be at parade, even though it's your leave. And strongly warned to know how to approach the CO and how to receive...things..."
We practiced that particular bit of drill yesterday. It better happen.

Anyways, still whining about my sleeplessness. But then I think about the guys and gals who did this idiotastic race thing, and how they must feel. 32 km run with 50lb rucksack on, then pick up 150lb sandbag (not leaving ruck behind) and march it 3.5km, drop it, get into canoe with ruck and canoe some 15km, get out, put ruck back on and run the last 5.5km to the finish line where ruck is weighed. If it's less than 50lbs, you're eliminated.

A full marathon is 42km, and they sure as hell don't wear a 50lb ruck while running, nor do they climb into canoes for kilometres while their legs, practically immobile, stiffen up, only to get out and painfully hobble run again.
The dude who won the NYC marathon did it in just over 2hrs last year; our top finisher today took 4hrs 41min. The last runner was still about 1/2hr out when we packed up the field hospital, leaving one ambulance behind to wait for her. She'd been at it nearly 10 hrs.
134 people started, and only 3 didn't finish.

And our only injuries were muscle strains, blisters, and skin rubbed raw from clothing. No-one collapsed, no IVs were started, no EKG's taken, certainly no transport to the nearby civvie hospital needed.
These people are in insane shape.
I hate them all.

Wednesday, August 30, 2006
08:18 p.m.

I Have Drugs and You Don't, Nyah!

Yes, the army gave me drugs to keep at home.

Actually, to keep in my jump bag, which is like a huge backpack filled with free goodies. I have the equivalent of a whole anesthetic set-up (minus the breathing machine, of course) - the drugs to put you under, the drugs to get you back, the laryngoscope with many blades blades, the ET tubes, the trach kit, the CO2 detectors I never bothered to learn to use because I was always told no place would ever have them.
And the equivalent of a crash cart (again, minus the shocky machine) - the nitro, the injectable anti-arrythmics, beta-blockers, morphine. Adenosine, she of the "I make your heart stop and you love me for it" fame.

Injectable anti-psychotics just for the fun of it. Anaphylaxis drugs. Anti-emetics. Anti-spasmodics. Anti-asthmatics?
Syringes. Needles. Many needles. A bunch of IV kits.

Wacky foldable splint things. Otoscope/opthalmoscope set. Medical tape, blessed medical tape. New Littman stethoscope so I don't have to befoul mine with the filthy outside world.

I wonder how much all this is worth. I wonder how much some of it is worth on the street.

Ah, I also got issued my field kit: it filled two duffel bags, a rucksack (also issued) and two barrack boxes. And now I have to assemble it all. I want to join some kind of city-only army that doesn't have to lug all this shit around.

And I still have to get up at 0230 tomorrow. I may have to use one of those epinephrine kits on myself.

Monday, August 28, 2006
08:07 p.m.

Licensed to Heal

Yup, I am officially a shiny, fully licensed physician.

My days of writing utterly illegal prescriptions are finally over. No, seriously. The army didn't care. The rules on base a somewhat different, and the college didn't probe either - as long as I wasn't messing around with civilians, it was apparently ok for me to go rogue.
I have also learned that the servicepeople can't sue us. That, and not the existence of some "army equivalent", is the real reason we don't have to carry malpractice insurance.

MWA-HAHAHAHAHAHAHAHA!

Oh yes, and through a minor deadline oversight I was also illegally driving around the city without insurance for a few days. That has now been corrected, but I'm clearly well on the way to a life of crime.

Damned horse
Just before the nice and warm weekend, she managed to lose her shoe and make herself unrideable for the duration.
She did it on purpose, I know it. I could see it in her eyes.

She is truly a horse of evil. We are well matched.

The horror...the horror
For some nefarious reason, I was reassigned from my cushy clinic job to cover an upcoming triathlon-like competition later this week.
My superior: "We'll all meet up at 0400."
Me: *oh God no* "Yes, sir."
~~~ la la la later ~~~
Superior: "I made a mistake about the meet-up time..."
Me: *oh thank Jeebus*
Superior: "...it's actually 0330".
Me: *weeps, gnashes teeth*

Thursday, August 24, 2006
10:02 p.m.

"...But a Whimper"

Well well well.

When I went to sleep last night, there were nine planets.

Now there are eight.

Astonishing, the power of science on a classification kick. Now if we could only direct its attention to Afghanistan, and why it's not a country.
Surely we can't be at war with it if it's not a country.

Wednesday, August 16, 2006
06:51 p.m.

And at Lunch, I Shovel Manure

My fellow doctor explains why patients at high-volume clinics still get good health care: "Sure, it seems like I only spent 2 minutes with you. But you have to take into account all my previous learning. In actuality I spent a good 30 min on your particular case, just...in the past."

I'm doing sick parade this month, because of the returning soldiers. They all need post-deployment physicals, so the other three health units were given that task and the fourth is running all-day sick parade.
Sick parade is like a walk-in clinic on serious benzos. It's ok in the morning, and then you're lucky to ge getting a patient an hour or so once lunch-time's over. We get bored. We chat.
Another doctor, bursting in suddenly: "Hey, you're not getting paid to talk!"
Nurse: "I want a raise."
Doctor: "Trust me, if you were being paid to talk, you'd be getting a raise."

All in the spirit of fun, of course.


Sleep apnea my ass
Yesterday a member came in for a follow-up about her appointment. She's been having trouble sleeping, and was referred for a sleep study. Which will happen, eventually; as in, maybe a year.
She was very slim and fit, immediately making me question the tentative diagnosis. Trouble sleeping for several months, menses also stopped. All bloodwork including hormone studies normal.
There were the standard mood screening questions with no red flags.
There was also a language barrier. She's French, not quite fluent in English, certainly not in medicalese.

I decided to delve in a bit deeper, asked more probing questions about her work, relationships, interests. Asked in simple language and making sure she understood.
She started crying partway through the interview, but by then I was already certain of my diagnosis. I was also concerned enough to get an immediate consult with mental health; the psych nurse just listened to the story and took over from us on the spot.

Yeah, so I feel good about catching that one. What good did those 4 or 5 TSH tests do, exactly? You got a normal result, move on. History, people! It's not like we're pressed for time here.

It had been six months since she first came in, complaining of sleep disturbance and fatigue.

Thursday, August 10, 2006
06:09 p.m.

I'm a Doctor Again!

I'm seeing patients!

Ok...one patient. But still, first patient since June 19th!

Basically, I arrived at work as scheduled at 0730. Twiddled my thumbs until 9ish, when I saw my patient (yay), who had...a cold.

Then I went to prison.
Or, actually, to tour the military prison on base. It is SCARY - not the place itself, which looks fine and very, very shiny, but the daily schedules and rules posted in it.
They're not allowed to talk to each other. They're not allowed to talk at all, unless staff addresses them. In fact, even on their daily phys ed break, if they're playing a ball game, all they're allowed to say is game-related stuff like "pass the ball"; no chit-chat allowed.
It's like those silent spiritual retreats yuppies take these days, except with marching and lots and lots of cleaning and polishing. After a shower, they have to clean and completely dry the shower stall, for example.

Gah, if I ever wind up in prison, I want it to be a civilian one.

Then I took a nice one-hour lunch break to see and feed/water Wave. After that, I was ready to see another patient, but was called away to an interview with one of my superior and informed I'll be going on a course, not a tasking, this Sept. Not that it makes much difference to me either way, but at least they're telling me stuff.
Then I went back to clinic, which was winding down. So I left to see Wave some more, got some sushi, and went home.

The sushi, it seems, will become a staple in my diet. A touch expensive, but what the hell. They're already recognizing me in the restaurant.


Sexy Hip Points
I've noticed my walk after I ride.
I've noticed it because my usual walk is very mundane. But after I ride, I feel sexy when I walk.
It's as if my hip points (or, if you're so inclined, anterior superior iliac spines) are leading the way, with my legs following and my upper body kind of staying behind. The whole impulsion for walking comes from the pelvis.

It happens naturally after riding, but when I try to replicate it on non-riding days it seems a bit ridiculous. I'm probably doing it all wrong.

Bah, I have not a naturally sexy walk.

Monday, August 7, 2006
10:29 p.m.

Wave is Here

She's actually been here since Friday night, adjusting and such.

It's so different actually owning a horse. She's in quarantine for 2 weeks, and during that time I'm 100% responsible for her - watering, feeding, hauling the manure out of her paddock. I've never done anything work-related beyond cleaning up the tack-up area after her.

In any case, on Saturday I lunged her, and yesterday I decided she was calm enough to try riding (they didn't break my saddle after all, yay).
She was forward as all hell, probably partly nervousness and partly energy from being cooped up in a small paddock. She'd break into canter every time I asked her to lenghten the trot, but generally behaved nicely, so I'll go again tonight. Yay Wave!
*** edit ***
Damn, she's forward. Her trot is too fast, it's hard to get her into a working frame, and I'm getting a complete upper-body workout just trying to keep her reasonably under control.
Now I wish I had that elevator bit.

As for my apartment, it's still a disaster area. I did manage to put up my new computer desk and drawer (I am IKEA's bitch), and tonight I shall actually sleep in my bed rather than on my living room floor in front of the computer, but that's about it.

Oh, and why is my place still such a mess?
For that you can thank the internet service providers and the stupid Axel obsession.

Thursday, August 3, 2006
06:18 p.m.

I Need Disaster Relief...

...because my apartment is a total disaster area.

Apparenty unpacking can be accomplished as quickly as packing, except instead of neat boxes you're left with shitloads of crap all over the place.

Why the hell do I have so much bathroom stuff anyways? And where did I keep it? I have a whole extra bathroom now, and I'm not sure it'll all fit.

I had to abandon my dream of a guest bedroom/office, and make it office only. That second bedroom, because of the balcony or whatever, isn't a square room. It's got funky corners, but while looking interesting this makes the room quite small.
There was one wall against which my futon could've fit nicely and been extendable into a bed, but alas, that wall was too short by something ridiculous like 5 cm.
So with the bookshelf, the drafting desk and the computer desk, the futon just didn't fit. And besides, color-wise it matches nicely in the living room, and this means I need to buy less couches. My guests can sleep in the living room, or a hotel if they dont like it. Bah, guests.
Speaking of computer desk, I need to buy one too, having left the giant L-shaped one behind. I was sick of it, but it admittedly held a lot of crap, crap which now covers my floor and infests all my chairs.

I don't know where to stick the ferret cage. It fits perfectly into the walk-in closet in the master, but do I want it in with all my clothes? There'd be nothing separating them.
I may put it into the office, since there's enough room. But the closet, I swear, it's like it was designed for that cage.

Everything made it here safely, with the possible exception of my saddle. I don't know if the sides got bent, or are broken; I wrote it in as damaged for now and will have it looked at, but I really hope it just needs more stuffing. I want to ride, not look for a new saddle!

The place shouldl be livable by tomorrow, but every surface will still be covered by decoratory knick-knacks. And I have no idea when I'll put the pictures on the wall.

The funny thing is, mine was a small apartment and I had it pretty stream-lined, no clutter really. How do people with clutter manage to move? esca?

Still, as if Canada Post were aware of my needs, today I received an IKEA catalogue in the mail.

Tuesday, August 1, 2006
03:15 p.m.

Wave is Coming!

She left her barn yesterday, and today is leaving Toronto for Edmonton, with one more overnight stay...somewhere.

Yay Wave! I miss her so much. And really, I'm not doing anything at all here. I could've been riding all last week.
I should buy a lunge line and whip. But she's going to be quarantined for 2 weeks anyways, and won't be allowed into the indoor arena. I'm not sure if she'll be allowed into the outdoor one, and I don't want to work with her outside of an arena yet. Must check this out.

My Camry has arrived, and today I picked it up. Ah, what a relief to have my own car again. I missed my CDs and my massage cushion. Plus, I kept hitting my head getting in and out of the tiny car Budget gave me.
Although I miss the way that little sucker could get into parking spaces.

My stuff is in Saskatchewan, en route to Cold Lake where it will arrive tomorrow. It will then journey on to Edmonton, to arrive on Fri. Thurs if I'm really lucky.
Well, the driver originally said it would be Thurs of Fri.
He got the days right, just not the week.

Yesterday I didn't bother going to the base at all, I just phoned my contact a few times. He didnt answer, so today I went in, worried about being AWOL or something.
My contact guy is on leave until tomorrow, so they send me right back home. Fine with me. I doubt I'll be doing anything in the way of work if my stuff's supposed to be here this week, but maybe they'll have me shadow one of their docs? Or maybe do sick parade, I could do that.

Today taxpayers paid for my sushi and some groceries. Thank you, taxpayers!

esca, you're unjinxed now. Please blog about the mind-numbing boredom that is prescription renewal!

Sunday, July 30, 2006
06:43 p.m.

Still Waiting

Tomorrow, perhaps, I'll start work.

Perhaps. Or perhaps my furniture will finally arrive - and where the hell is my car? - and I'll get 5 days off to "settle in".

I like living in hotels, particularly if someone else is paying. But this weird waiting and not knowing if I'm going to work or not is annoying me. Do I get to sleep in tomorrow, or should I get up in time for sick parade? I think I'm just supposed to "check in", so that means I can indeed sleep in. Maybe.
Other than the going away on taskings, it looks like my workday will be Mon-Fri 0730-1600, maybe 1500. This includes an hour lunch and paperwork time; for a doctor, it's a ridiculously easy schedule.
But since I'm with the field ambulance, I'll be going away on exercises. Which is fine, as long as I find someone reliable to watch the chibi.

Once I settle in at the base, I'll start doing a day per week in a local ER, working in a semi-independent capacity, kind of like an R3. Meaning I'll be able to treat and release, but I won't have to be the only one there (or even be in charge) if something major comes in. Again, nice, easy, comfortable.


Food, glorious food...
Yesterday I caught the Taste of Edmonton festival.
It was great. And the food portions were...decent, which surprised me. When I got my Butternut Squash and Maple Cream soup, I expected it in a ketchup cup-sized container, based on my experience with other foody festivals. What I got instead was a small bowl of the sort you'd get in a restaurant with a starter soup.
That and the rather large portion of ginger beef filled me up, and I had to go walking around for a while before eating more delicious stuff.

Mmm, and delicious it was. Bison kebabs, Polish potato pancake, strawberries in Grand Marnier with cream, Bailey's Mocha pie, scone with Saskatoon berry compote, fruit martini, kimchi...no wait, the kimchi was extremely painful. Why did I eat kimchi?
Why?

Thursday, July 27, 2006
05:58 p.m.

Absolutely Nothing Interesting is Happening

My stuff still hasn't arrived.

It may come tomorrow for all I know, but even if it does, the unload and unpack days are different so I'll be in this hotel until after the weekend. Army-contracted movers don't work on weekends, it seems.
Not that I'm complaining too much. The hotel's paid for, and I'm getting about $60 per day for food while staying here.

The apartment has been painted.
It looks pretty and pastelly. The living room is a nice pale yellow; from the swatch I thought it'd be more barely off-white, but it's still very nice.
My bedroom is a darker pink than I thought as well (curse you, color swatches!), but at least it's a colder edging-into-violet pink. I think it'll work well with what I'll be putting on the walls.
The orgage wall is...orange. And vibrant. I fucking love the orange wall.

Pictures to come when my stuff gets here...whenever that will be. They apparently have until Aug 8 to deliver, by which time my poor bonsai will probably be dead.
I hope they come sooner.

I got mail today, at my new address. It was briefly exciting, until I realized it was just my car insurance, confirming that I totalled my car while insured by them. Just so my next insurance is aware.
Why can't Canada Post lose those letters instead of my doctor qualifications?

Wow, such mundane matters I'm posting about. I went grocery shopping today because I was bored, and got a good deal on cheese. Not so good on grapes - I'm used to buying them for 99c/lb, and the cheapest I've found so far was double that.
I also finally found Haagen-Dazs Mayan Chocolate. Damn it, stores seem to have every flavor but that one. So now it's living in my fridge in my apartment, where i have no bowls or spoons. I licked some of it though.

I hope my stuff comes soon.
I hope my bonsai makes it. It's such a cute bonsai.

I think I'll go eat some calamari at taxpayer's expense.

Tuesday, July 25, 2006
06:56 p.m.

Dispatches from the West

I've arrived.

And I'm being orientated to the base and my eventual job, which I can't do because I'm still not licensed to practice medicine. I have the qualifications, just not the paperwork.
All original.
Including my pre-med Bachelor's degree.
The Alberta College of Physicians&Surgeons is insane.

In any case, I'm running around the base doing "personal admin" for a few days, leaving around 2pm, and then if my furniture doesn't arrive in the next couple of days I'll be taking some leave because they have nothing else for me to do. When it does arrive, I'll be getting some leave automatically anyways.
Oh, and the running around is in uniform, for the first time since I left the reserves to go to med school. Back then, I was a lowly Private (and, for a short time before I left, a Corporal), and like most of my rank I learned to avoid officers so I wouldn't have to interact with them or salute them.
Now I'm the officer, and even going to the Canex to buy some bootbands, little groups of NCO's saluted me and called me "ma'am". It freaked me out.

If I don't get licensed in the next couple of weeks I'll still start work like a resident would, "supervised", since in Aug we have 1500 troops returning from overseas and they all need full physicals. Apparently it's an assembly line of physicals.
I'm not sure if they intend to actually supervise me, or just "supervise" me. Doesn't really matter.

My condo's being painted, and the green room and bath look very nice. The living room had a coat of paint on it, but the horrid purple was still showing through. They said they'd be done tomorrow.

Chibiko likes the hotel room, which is oddly ferret-proofed. There's literally nowhere for her to disappear into, so I let her run free while I'm there. Otherwise it'd be the airline carrier for her, which I imagine must be like jail.

I need to go continue breaking in my beret.

Thursday, July 20, 2006
03:36 p.m.

Dude, Where's My Car?

On its way to Edmonton, I suppose.

Yesterday packers came to my house and packed...everything. It took them a mere two hours, including smoke break, to reduce my life to a bunch of large, sturdy boxes.
If that had been me packing, it'd have taken days. I remember packing up my one room at home when my parents moved, it was horrible and took forever. The scavenged liquor store boxes didn't help.

But my whole apartment was packed, labelled and itemized on endless sheets in two hours.

The movers came today, to move the boxes and furniture. It took them 2 1/2 hours, no break. They took apart everything and carted it away, wrapped in large cushiony blanket things. I didn't even know my coffee table came apart.
But the way everything was protected, down to every shelf taken off the bookcase, was amazing. That huge truck could probably ram into a wall and my stuff would survive.

Then the car people took my Camry. I have nothing now, save for my luggage and a bunch of garbabe that must be disposed of under cover of darkness into the bins of the bar/restaurant next to my place.
I'm trying to finish the food in the fridge, and consequently am living on a diet of vanilla soymilk, wild blueberries, and kutia (a traditional Polish Xmas dessert made of wheat, poppy seeds, various nuts, honey, dates and copious amounts of brandy-soaked raisins). It's a good life.

I've seen Wave for the last time before the move on Tues, and had one last lesson. My instructor tried her with a 3-ring elevator bit, a harsher bit than the French link I've been using. I picked the latter to encourage her to relax into the bit after years of having kids pull on her face and it's fine, but I can't stop her quickly enough after she gets to jumping; she can just ignore it. A part of the problem is my post-jump position recovery, but hey, there's no magic bit for fixing that.
She was great with the 3-ring and very sharp about stopping, even though I kept the reins looser than they should've been because I was afraid of yanking on her. We did a 3-jump gymnastic and she was under my control the whole time, which felt great.
My instructor suggested getting a bit like that and using it just occasionally, to sharpen her up. And when I start to trail ride as well, because she ignores the French link and just pulls for home.
I'll be seeing her again in early August, when she gets to Edmonton. She's on vacation for now, lucky beast.

Ah well, that's that. Nothing more left for me to do, just wait around until it's time to go to my bro's wedding. I'm flying out the day after that, as is he - although France does sound nicer than Edmonton right now. Particularly France with air-conditioned hotels.

Monday, July 10, 2006
06:24 p.m.

The Good Thing About Being a Doctor...

...is knowing other doctors.

Doctors with hugenormous houses where the guest bedrooms have ensuites bigger than my new living room.

Houses located on the grounds of their very own vinyards.

My 4-day stay in this house came about because of my whining. My horse is located over an hour's drive from where I live, and I have the key to the resident house in the town near the stables. But alas, resident house was sold, so my key is useless (or possibly still works, but...trespassing, you know).
So I dropped in to the local ER to kvetch with the nurses and bring them Timmie's, and one of my former staff was on and heard my whining. And in the spirit of collegiality (or insanity) invited me to stay over.

I was also given the opportunity to realize that my general aversion to dry wines was a result of drinking mainly crappy ones, and that there's nothing like a wine cellar filled with multiple hundreds of quality vintages to show me just how good they can be.
Sadly, I was dead drunk pretty much every evening, so I barely remember any of them. Curses.

I did go riding every day, and Wave took the opportunity to dump me again after I was lulled into a sense of safety and relaxed while she was standing still. The general sequence of events went like this:
Reins were loosened - my legs came off - I slumped relaxedly in saddle - Wave thought she saw a particularly vicious air molecule - my ass connected with the ground.

Thursday, July 6, 2006
07:35 p.m.

I. Want. This.

This painting, I mean. This huge, 36x72 inches, probably over $4k painting.
Because! Horse!

esca's evil and enabling hubbund showed me some of Jennifer Mack's work at the Ottawa gallery, but the one I really really want is located in Edmonton.

This page has the links, the painting is called "Desert Sunrise II".
Isn't it beautiful? They're actually not that...glary?...in person. They've been photographed badly and look like the colors would hurt your eyes, but they don't in reality.
They're absolutely beautiful and I must have it!

Other than ogling huge paintings that cost as much as my actual, living horse, I'm slowly preparing for the move.
Just made arrangements for Chibiko to fly with me; she can't go in the cabin, which is probably better because the cabin carrier would have to be small and squishy to fit under the seat. In cargo she can have a nice big carrier where I can hang her hammock.

One of the docs I worked with in the ER in the town where my horse is invited me to stay at her place, since I was whinging that I have to drive over an hour to ride. I used to crash in the resident house since I had a (not so legally) obtained key, but they're selling the house.
ER doc owns a vinyard. I believe I shall go live with her this weekend.

Professor esca is working, I think. Seeing patients. Or not seeing them, as the case may be.
Hee. Professor.

Tuesday, July 4, 2006
03:03 p.m.

Vacation!

Today I went up to the army to put in my final paperwork and make sure they won't ship me off somewhere on some kind of training before I move to Edmonton. It's not really enough time for a course, but you never know with the army.
And indeed, the nice lady in charge of me tried to think of something, but was finally forced to give in and approve what is essentially a vacation until the 19th, when the packers come to pack up my stuff. I have to be present for that, but I don't actually have to lift a finger - they pack, move and unpack everything. I "supervise" and stay in a hotel. Ah, moving...

I'm flying out on the 23rd, a day after my brother's wedding. I was wise to make the closing date after the wedding, as there's no way they'd have let me delay or come back for that.

Spend 2 hrs with my free financial advisor from MD Management, going over all the options to repay my mortgage faster and deny the bank as much interest as possible, and shifted my RRSP's around into riskier but potentially more high-interest stocks. It was fun playing with money.

Party Time!
Party at esca's was fun and alcohol-filled. They always seem to have good parties where people just click well (some click lawyer-lickingly well) and there's none of that awkward dead air.
I certainly know that getting some residents together anytime, anyplace leads to easy chatter, but that's because we're bonded by eternal hatred of our staff and/or patients so we always have something to talk about. But it wasn't just us medical scut-monkeys, so I guess they must know a good selection of people to invite.
Also, lots and lots of alcohol helps.

When it came time for the Canada Day fireworks, we went out in little groups and promptly got separated. esca's and I found a spot on a hill right on the highway, where a large tree almost perfectly blocked the fireworks from view. We were too tired/drunk/lazy/uncaring to move.

But I got a nice picture of the tree looking like it was on fire, so there.

Wednesday, June 28, 2006
12:54 p.m.

Post-Edmonton

Well, I missed my flight yesterday. Totally my fault, I thought it was at 11:40, and it was actually 11:20. I knew it would be very close timing, but that lousy 20 min was enough to get me from "You can just make it if you run" to "No way in hell are you getting on that plane, girlie".

So I cooled my heels for nearly 4 hours, angry that Air Canada doesn't sell day passes to its business-class lounge like some other airlines do.
And I bought The Devil Wears Prada, which may in fact be the perfect airport/inflight book.

My connecting flight was also delayed, so I made it home about midnight, feeling tired and sorry for myself - until I realized that it was in fact only 10pm in Edmonton, and that I therefore shouldn't feel so bloody tired.
So then I just felt silly. Also still very tired.

Friday, June 23, 2006
04:09 p.m.

And the Condo Goes to...

Edmonton's real estate market is batshit crazy.

My realtor told me that in years past, she'd clear her schedule for the army people who come on house-hunting trips, show them homes all day for maybe three days, then they'd narrow down their choices, and on the fifth or sixth day tender their offer.

When I arrived, she had four condos to show me, with no guarantee that there would be anything new on the market in the naxt few days. Although she kept checking, constantly. And even drove us around condo complexes to see if there were any by-owner sales that weren't listed.
Four!
I was admittedly picky about the area I wanted to live in, and the type and size of condo (2 bedroom, apartment-style, not on the first floor). Especially the area.

I looked at the places, two in an area I wasn't crazy about, one in a nice area but in a building plagued with management and structural problems.

And the first one I saw, in a great area with a very easy and short drive to the base, exactly what I wanted. Of course with one offer already written, but not yet presented - that would happen later that day.
The condo had almost sold before, but the buyer's financing fell through. Hallelujah!

I tendered my offer, a few thousand over asking price and hoping it would be enough. My offer would be conditional upon financing, which was made harder by the army's idiotically bureaucratic refusal to write a letter confirming the new salary I'll be making starting July 1st. With one offer already having fallen through, an unconditional offer could be accepted over mine even if I offered more.
And it's not like I had scads of time to look for more places, either.

I stayed in the car while my agent went up to present, as did the other potential buyer. We were in adjoining parking stalls, studiously ignoring each other as she fiddled with her cell phone and i drew kitty pictures on my Clie. I didn't know how desperate she was, but damn it, I needed that condo!
And it was my agent who received the call, asking us to come up to sign the offer.

She had chatted with the owners about me while presenting, about what I did and how much I liked the place. They said it had some effect on choosing my offer; they may have been lying, mine may simply have been higher or I was a better risk after they'd been burned once, but it doesn't matter.

I bought my condo!

Hey, I'm not too demanding a client. The last time I bought a condo, when I moved to go to med school, it was the first and only one I viewed. Easy commission ^__~

Tuesday, June 20, 2006
11:34 p.m.

PASSSSSSSS!!!

I PASSED!

I PASSED EVERYTHING!

Goodbye, panic attack-like symptoms whenever I checked the results website.

Goodbye, increasingly frequent dreams of having failed the thing again. Of telling my parents, of informing my employers, of having my posting rescinded and...doing who knows what.

Goodbye, constant feeling of stress, of fucking DOOM descending on me and screwing up my plans, my move, my standing in the eyes of my employers.

esca was the first to check; I'd already checked much earlier today and there was nothing, so I figured that I was right and they wouldn't be out until the 22nd.
She says it took her a few moments until the "Pass" registered. It didn't take me that long - I was suddenly convinced that I'd failed after all, as soon as I saw her result. I don't know why, except maybe that she was so positive after her exam while I felt that I did horribly.

I checked right after, fighting to keep my eyes from closing as the screen changed.
My "Pass" prompted a quick reaction of hugging and jumping around, a round of emails and phone calls.
But unlike the board exam results, it didn't produce this adrenaline-filled joy that pushed us out of the house for a walk, just because we couldn't sit still. It was, rather, this huge weight finally lifted, happiness and relief without any burst of energy.

I suppose it was like finally reaching the finish line in a marathon. A two-year marathon.
It was, in an odd way, exhausting.

But it's over.

I'm done.

I'M FUCKING DONE!

Tuesday, June 20, 2006
02:08 a.m.

Code Orange in ER, Code Orange in ER!

My residency is officially over, and it ended with a bang.

Mondays in ER are always horrible, because people are idiots. They sit on their (or their kids') minor symptoms and enjoy the weekend, and once Monday rolls around and it's time for daycare/school, they figure it's time to get whatever it is looked at.
Of course, they can't get into their doctor's office that day, so they all head to the ER with their few days' history of cough, or rash, or fever.

So it's always pretty bad.
But today was really, really bad.
First, we happened to get a few truly sick, deserving-of-ER patients, and those kids naturally suck up a lot of staff and nursing time.
And second, we were short-staffed. A resident, a fellow and a staff were out ill.

A resident is really no big deal, the number on the schedule tends to vary anyways. We had enough.
A fellow is serious, as they can see the kiddies and discharge them without waiting to review with staff. Some will even review the residents' cases, although not all.
A staff is disastrous, because they not only quickly see the fast-track cases, but review with us residents. If a staff is missing, the wait time to review, and thus to discharge or to start any orders, can lenghten hugely. As it did today.

When I started my shift at 4pm, the wait-time for "urgent" cases was 5-6 hours, not at all unusual on a Monday afternoon. Over the day, that wait time goes down as we catch up, which is essential because by 1am there's typically only one staff and one resident on.
By midnight, the wait time was 6-7 hours.

They called the code. Code ED means the ER is in serious overrun-by-patients trouble, the wait time has become unacceptable and is rapidly on its way to becoming dangerous, and all available staff from floor nurses to the PICU resident have to come to the ER and help if they're not currently busy.

Only there was some confusion with the announcers, and a Code Orange was initially called instead. Code Orange is "external disaster", as in "a plane crashed and dead bodies are piling up outside our doors".
A Code Orange makes everyone come to the ER.
It was fun.

Sure, they cleared that up in a couple of minutes. But hey, my first (faux) Code Orange!

And my last shift of residency, lenghtened by a couple of hours because of the code. I'm done, people.

Except for my dreams of failing the exam, of course. Which I still have. Those dreams suck hard, and seriously interfere with my happiness at finishing residency.

Wednesday, June 14, 2006
06:33 a.m.

Countdown to the End

I've come to the point where I can actually count down the hours to the end of my residency.

Let's see, 2 more ER shifts and 2 hrs left in this one makes 18 hrs. Yes, in 18 hrs this hellish glorious journey of learning and sleepless nights and frustration at humanity's stupidity and endless scut work and evil attendings and patients changing their stories and making me look dumb will be over for good.

There was a good deal of beauty in residency, but I'm currently working the midnight-to-8am shift which does not lend itself to bringing out the warm&fuzzy memories.
Maybe after I've had a rest...and a passing licensing exam result.

Speaking of humanity's stupidity: lady, if your kid is walking around with chattering teeth, she is not in fact having a febrile seizure. And for the love of all that's holy, don't tell the triage nurse she was "unresponsive" for an HOUR because her teeth were chattering so badly that she couldn't really talk.


SARS is Hilarious!
This Friday my friend's taking me to see SARSical. Apparently it's a real hoot.
All deadly diseases should have musicals. It would greatly improve their public image.


Edmonton
I have a real estate agent already lined up, my mortgage pre-approval should come through today or tomorrow, and the hotel's booked.
I feel like I should already be there, looking at condos. Instead of here, spinning my wheels and counting down the hours.
That's 17 1/2 more to go.

Back to the grind, I guess.

Sunday, June 11, 2006
09:20 p.m.

Fucked-up Dream

Ok, so last night, possibly brought on by my Bailey's nightcaps (what? I was cold, dammit!), I had a truly fucked-up dream.

I was a nun apprentice. Furthermore, I was with a group of nun apprenti who had to get to the 10th floor of this industrial-type building to...sing? Or something.
Somehow I got separated from my group and had to make my way up alone. This building was a weird maze, in that each elevator would only go up one floor and then I had to get off and search for the next elevator. There were stairs, but they were on the outside of the building and rickety and also it was fucking hot in my black nun apprentice robes.
There were other people in the building, but for some reason they were hostile and wouldn't tell me where the elevators were. I think there was a reason for the hostility, but I don't remember it. Maybe they were filthy heathens, who knows.

Anyways, I finally made it to the 10th floor and rejoined my group, who were all sitting around, presumably getting ready for the singing or whatever it was we supposed to be doing up there. I'm a bit sketchy on the details.

At that point, I suddenly took a handful of birth control pills.
And realized I had no water with me, and neither did anyone else. I woke up with the sensation of trying to get the bitter, chalky pills down my throat.

I have no clue why I had the pills, or why I took them.
Perhaps we were up there to choose the mother of the next Messiah, and I objected? It was a pretty weird dream.

Wednesday, June 7, 2006
10:47 a.m.

The Day of the Beast...

...has passed, bringing with it nothing but joy.


I PASSED MY FAMILY MEDICINE BOARD EXAMS!

Later, walking along the canal, some of the gross water weeds drifted into the shape of a heart. The world is beautiful ^__^


Now only that damned licensing exam stands between me and total happiness.

Tuesday, June 6, 2006
05:40 p.m.

Emergency! My baby coughed!

Doing peds ER in the big peds hospital, seeing about one patient an hour.
Mostly uncomplicated patients, mostly because of the horrible bottle-neck created by endlessly waiting for staff to review the patient before they can be released.

I amuse myself by reassessing my patients and going over their old charts. It's not much amusement, but hey, beggars can't be choosers.

Actually, I'm being overly whiny. It's a fine rotation, not taxing at all, nice 8 hour shifts with time to get a bite to eat midshift. There are some very interesting cases too, weird metabolic disorders I've never heard of, and some kidlets just really sick from the run-of-the-mill stuff.
And of course I get to hang out with esca and torture her with my relatively cushy schedule; she just started her Internal medicine rotation.

What escapes me is the mentality of some of the parents I see. On Sunday we had a 5-6 hour wait for non-emergency cases, and people waited. Listen, if this ER is perfectly comfortable letting your baby wait for 6 hours before so much as getting in the same room with a doctor? Your baby is NOT sick.
Since when have people started coming to ER with a one-day history of low-grade fever easily relieved with some Tylenol? A mild cough for a couple of days? Some loose stool? In whose demented mind does that constitute an "emergency"?
I thought the reason they came into the ER where I did my community rotation was because they'd usually get seen within half an hour. But no, people will actually wait 6 hours to be told "Your child has a common cold, now go away". Huh.


Edmonton preparations
The army has already booked me airline tickets and a rental car. I didn't really want a car as the only places I intend on going are the various condos for sale, and it's my realtor's job to drive me there, but whatever. If they booked it, I'll take it.

Also found beautiful hotel to stay in. A pet-friendly hotel, where "pet"="cat/dog". "Ferret", apparently, does not constitute a pet. Not that she's coming with me on the home-hunt, I just found that amusing.

And I've been looking at condo listings. Yesterday I found one for half a mil, with a fireplace, jacuzzi, and one of those two-storey living rooms with a winding staircase in it. A two-bedroom condo, for half a mil; the mind boggles.

So that's it. I'm getting mentally ready for the move while letting my mind rest during work. It's a nice way to end residency.

Monday, May 29, 2006
07:43 p.m.

Money money money money mooooneyyyyy...

Had my meeting with the army's relocation people, who let me know how many thousands of taxpayer dollars are available to fund my house-hunting trip, move me, put me up in hotels and my ferret in boarding, feed me in style, cover my phone calls, car rentals and parking, pay all my home-acquiring fees, buy down my mortgage rate, and just plain hand over to me to do with as I please.

It's a lot. Thanks, taxpayers!

The only thing they won't do is move Wave, because she is "livestock". Poor Wave. Still, the "to do with as I please" part of the taxpayers' generosity should cover her move.

Only one month or residency left. One month, and I'm done, pending exam results.
Less than, actually, because I'll be going to Edmonton the last week of June to find a place to live, hopefully a condo I can buy. And a place for Wave.

Gymnastics
On my last lesson for...a longish while, I did the gymnastic again. Last time it was inside the barn, immediately following my wacky Mexican Falling Horse adventure, and I fell off because a tight turn at the canter spooked me.
This time around I was way more comfortable with the canter, not to mention happier to be outside (more room! no walls to smack into!).

The good thing about gymnastic is that once the horse starts the sequence, it'll pretty much pick its own way through it, allowing the rider to concentrate on her own position rather than on guiding the horse.
Wave was being very good, not trying to run around the first jump. We build the course to three cross-jumps with no flat strides between them, then a trotpole, then another cross-jump. Neither she nor I had any problem with the initial jumps in a row, but she tends to charge full out after she's over them and I have trouble regaining my seat firmly enough to bring her back to me, so the last jump was quite a bit less comfortable. She didn't shorten her stride appropriately, and fumbled a bit to get into position for the jump; and I of course have to work on making her shorten it.

Still, it was great. I didn't fall off, I was able to control her pace and direction once she was out of the gymnastic, and it did wonders for my self-esteem jumping-wise.

Of course I almost fell off when she was at a stop and I was paying attention to my instructor. She saw a cat on the fencepost OMG! And wheeled and took off at a canter like it was a hellhound pursuing her.
I swear that cat was asleep.

She spooks for fun when she's bored. And apparently the gymnastic, to me the most exhilarating thing I've done to date, is boring.

Esca
appears to be dead. I should investigate this posting silence.
Perhaps in a couple of days, I will. A couple! Of days!

Thursday, May 25, 2006
08:26 p.m.

Happiness!

Jumped verticals today, for the first time.

And Wave didn't need to be schooled over them, which made it so much better. Well, I had to school the first crossjump, but that's...just how things are for us right now.
Actually, they're probably like this:
Wave: She wants me to jump. I'm totally trying to go left...or right.
Me: OMG, jumping. She'll totally try to go right...or left. Maybe she'll just stop dead!
Instructor: Stay committed! Leg on! Look past the jump!
Wave: Ok, I'm going to wiggle left.
Me: OMG, she's going to run around! We'll never make it!
Instructor: No, look past the jump, not at it!
Wave: *wiggles more*
Me: *stares right at jump, commitment to jump vanishes*
Instructor: Stay committed! Leg on! LEG ON!
Leg: *totally comes off*
Wave: *runs past jump*
Instructor: *headdeskpole*

I am getting better. Just a little while ago I had to school every jump, even the same jump after we changed direction. Now she's just being difficult about the first one, and I was so surprised and happy that she didn't make a fuss when the crossjump changed to a vertical.
My instructor keeps telling me that jumping is really no big deal for the horse, at least not the baby heights I'm jumping. But it's a big deal to me, and she senses that and therefore it becomes big to her too. Today I was able to stay relaxed and not freak at the sight of the vertical, and that helped her jump without fussing.

Tuesday, May 23, 2006
09:06 p.m.

I am an Angry Coward

I feel that I should update, but...about what?

Everything's still the same - still in peds, still kind of liking it because of the generally slack schedule.
Still awaiting exam results, which is kind of keeping me in a paralyzed state, as if the exams really weren't over until I get the results.
Still going to buy my horse that I only recently found out is a full Thoroughbred, not a TB mix, and has something called a "passport" for competition; I gather it's something official to prove she's a full TB.
Still moving to Edmonton, and back to being annoyed with the army over the length of time it took me to find this out, as making the house-hunting trip will be rather difficult time-wise.

Ah. New annoyance: new people moved into my little 5-apartment building, and are leaving their garbage in the hallway. There used to be a big garbage can with a sealable lid that I originally requested for the hall, for the purpose of keeping used ferret litter there until garbage day (I didn't want it inside my apartment for obvious reasons). But new people started piling up massive amounts of normal household garbage, clothes and recyclables in and around the can without bothering to seal it, so I complained and landlord took the can away.
Now they're just piling it up where the can used to be.

Today I made a little note and taped it above the area, calling the people filthy skanks. I'm actually prety sure they're guys, but they're still filthy skanks. I'm also pretty sure the note won't make a difference.
If the trash situation persists into the summer, I'll just have to go through their garbage to ascertain for sure who it belongs to, and then get them to open their door and fling it into their apartment, hoping for maximum scatter.
Yes, in the summer of course. When I'm ready to move. Cause I may be angry, but I'm also fearful of retribution.

*** Edit ***
Apparently people really dislike being called filthy skanks.
Garbage gone from hallway, removed to outside. Not properly packaged so I don't know if garbage people will remove it, but at least it's no longer stinking up the building.
The group removing it (and my little note) consisted of one skanky and heavily tattooed guy and three skanky chicks in skanky clothes.

Tuesday, May 16, 2006
03:00 p.m.

Go Weeeeeeeeeeeeeest...

Edmonton.

Yup, the army finally got my posting through. Edmonton, city of giant mall and block heaters and endless winter. But, a city at least. I was so afraid they'd plop me in the middle of nowhere.

And lots and lots of horse activities. Let's see how much it'd cost to trailer Wave westward.

Edmonton.

I'm going to live in Edmonton.


Miscellaneous

I'm hooked on Haagen-Dazs Mayan Chocolate ice cream.

I've been pretty fond of their Chunky Monkey since pigging out on it in undergrad during exams, but wasn't impressed by other flavours. Then I finally tried the Bailey's and - total disappointment. The ice cream version of one of my favorite liquors is just bland, bland crap. Hell, adding actual Bailey's didn't really help, it just wasted the precious Bailey's.

But Mayan Chocolate, my gods! It's so incredibly delicious and complex, with its dark, slightly bitter cocoa flavour and the underlying spice of the cinnamon.

You must immediately go out and buy it.


Also: Edmonton.

Monday, May 15, 2006
06:03 p.m.

I Like Pediatrics!

Ok, what I actually like is being treated like a clerk (senior med student to you non-medical types) whose judgment can't be trusted and whose opinion is unwanted.

Why? Because I can go through my days on peds with my brain in neutral and take it as slow as I like, that's why.
If this was anything but the end of my residency and I wasn't distracted by fears of exam failure and where the hell the army will place me, I'd feel insulted. 90% of the cases in minor ER is the type of thing I dealt with alone on my rural rotation, and never even thought to consult the staff about. It's bread-and-butter family med stuff.

But here, every case has to be reviewed with the staff. Not only that, but most of the time they don't care to ask me for the diagnosis and management, just tell me what to write in the chart. They do ask for my findings on the physical exam, but all but one of them double-check it anyways - seriously, if I didn't know what an ear infection looks like by now, I'd deserve to be shot. And I can tell a wheeze from a crackle, really I can.
I used to volunteer my diagnosis and management, but now I don't bother any more. They fill out little sheets with my daily evaluation, and it's all "Meets/Exceeds Expectations" - I wonder just how low their expectations are given the amount of work they seem to want from me.

Once, I had a lady come in for a prescription of her kid's puffer. The kid was well - I did a cursory exam just so I could chart about it. She just ran out of the puffer, her family doc was out of town, and she wanted a script.
I wrote her one and turned her loose, without reviewing with the staff. I mean, there was no patient!
But of no, you should've seen the frowning and worrying and prominently-written "Did not examine patient" on the chart. That's when I decided to give up, and I've been content with my decision.

I do quite enjoy the booked specialty clinics. They're fairly slow-paced and there are interesting problems I've never heard of, meaning that therefore there is teaching. I especially like the neurology clinic, because quite frankly seizure disorders used to scare me and I had no idea how to do a good neuro exam on a kid. It's actually amazing how much info you can get out of them.

The one place that treats me like a resident is the inpatient ward where I do call. But the workload is tiny (4-6 inpatients), and there are hardly any ER consults - I had one (!!!) each on my last 3 on-calls. And on the last call the hospital's internet service went down, and I nearly lost my mind from boredom. I tell you, things are seriously fucked when you start praying for consults.

I'm told the big children's ER where I'm going in June is similar - you do one patient at a time, you wait forever for a senior to review the case, then you take another, wait again...I don't care.
I'll be halfway to vacation in my head.

Wednesday, May 10, 2006
07:25 p.m.

How to Make Babies Behave

Dehydrate them!
Really, moderately to severely dehydrated infants will just lie there quietly while I poke at them and stick things into their ears. In fact, the severely dehydrated ones won't even fuss at IV insertion.

Of course the major drawback to this method is babydeath, but then again nothing is perfect.

Last night was my first pediatric floor call, and actually my first actual call in something like a year; ER night shifts don't count. Peds floor call includes looking after the ward but not the PICU, and taking ER consults.
I had some minor calls about medication to the ward, nothing I couldn't handle - and trust me, there's a whole lot I can't handle when it comes to hospitalized children. Then there was the run-in with the father of a severely retarded adolescent who was admitted basically because he was getting too violent to handle, and the parents wanted to know why (the answer of course is puberty, but they won't accept that without all the bells and whistles of a full work-up...which naturally is checking out fine thus far, or as "fine" as this kid is capable of being).
I had to call in my senior for support on that one, because seriously. You want me to read your kid's brain imaging and tell you what "the team's" plan for him involves? At 11pm at night? Dear crazy family member, I'm here to try to make sure none of those patients I know absolutely nothing about expire during the night. You want to talk to the "team", you can damn well bother to be here during the day when the team infests the ward.

Really, people - leave us poor night-call residents alone. Our job is to keep your loved ones alive during the night, but quit bothering us with management questions and progress reports. We don't know.
And some of us don't care. There, I said it.

Later, I admitted a tiny pedie with pneumonia and dehydration. She was a sweet baby, and had a supremely sane mother. I actually enjoyed the consult and woke up earlier than I had to so I had the time to check on her in the morning before running off to the Kiddie ER/clinic where I spend my days.
She was doing marginally better but hadn't rounded the corner yet, as evidenced by her calm tolerance of the various tubes and monitors attached to her. She'll probably be home by Friday, my next call day.


Random Updates
Still don't know where I'll be posted. Hatred of army has burned out, replaced by apathy. Perhaps that was the intention all along?

Went riding today, first time in over a week. And for the first time, she stopped dead before a jump instead of trying to go around, causing me to nearly fall off. I saved myself by pushing off her neck back into the saddle, and then worked on making her take the damned jump - my instructor would be furious to know I let her off after refusing a jump.
Almost as furious as she'd be if she knew I was jumping without her supervision, I suppose.
Anyways, she took the jump after a second refusal that wasn't quite so harrowing (mostly because I expected it). Stupid mare.

Another tip of the day: best way to avoid being bitten my mosquitoes? Stand near a horse! The buzzing annoyances won't even notice you.

Monday, May 8, 2006
06:21 p.m.

Possibly Over For Life

My exams, that is.

If I passed this time, that is.

This past weekend I wrote the 2-day Family College exam, and rewrote the damned licensing exam I barely failed last fall. By one measly station.
The Family College exam I feel ok about. The written was in two parts, morning and afternoon, and I was flying after the morning part. The afternoon brought me crashing back to earth, but apparently mine wasn't the only such experience and after reviewing what I wrote I realized that yes, I'd guessed on a few questions, but I also could answer many quite confidently.
Confidently enough, I hope.
One annoying thing - esca and I spend a lot of time studying specific drug names, dosages and durations, and none of that was needed. In fact, we focused so much on specific regimens that I at least had trouble answering questions when asked for drug class rather than specific generic name. So hey, I put down the names. May be worth part marks at least.

The simulated office orals went all right (I had sekrit help yay), three of them very well, one ok, and the last I wasn't sure because the simulated patient/examiner was giving off unhappy body language vibes no matter what I did. I think I did ok in that station, and others reported the same response from the "patient", so maybe it was just him.

The licensing exam was another matter.
Last fall I felt very confident after I finished. But last fall I didn't practice my physical exams, and those were the stations I did badly on. The physical exams for the test are very different from the exams any normal doctor does in real life, so it was actually necessary to practice the exam format specifically.
So we did, esca and I. And as I went through the exam, I was aware of small things I missed, which made me anxious. By the second-last of the 14 stations I developed a knot of nausea that wouldn't go away, and in the last and for me most difficult station I fervently hoped that I wouldn't puke all over the examiner (it'd probably have cost me marks).
The thing I can't tell is - did I actually do worse, or did I do better because I practiced, and because I practiced I was simply more aware of some extra things I missed? Did I do worse, or was I just blithely ignorant the last time?

Time will tell, of course. Too much time for my liking - they won't let us know the results until later in June.

One funny thing - esca felt good after the licensing exam. Last fall she had a premonition of doom, and she failed. Last fall I felt great, and I failed too.
This time our feelings are reversed - and our results as well, I hope.

Wednesday, April 26, 2006
01:40 p.m.

Happy Birthday To Me

Ok, that was actually yesterday.
Two of my preceptors took me out to dinner (on different days). It was free dinner week!
Incidentally both of these preceptors, both female, also happen to be childfree. They're married, they have smashing houses and boats, they take weeks and months(!) off to travel the world, and they're very happy with their decision.

But what I'm really happy about is this: it's official. I have first refusal on Wave, who'll go for about $4k.
That's within the range that I was told by various disinterested parties would be fair for her age, training and medical history, so the owners aren't trying to take advantage of me. There is another interested party who runs a riding school, but they'd prefer she go with one rider.

So if all goes well and I'm not posted somewhere completely ridiculous and uncivilized, I'll be buying a horse.

Monday, April 24, 2006
11:09 p.m.

"I Shoot People"

Today I went to the penitentiary with my staff, for the methadone clinic.

On my psych rotation we went to the methadone street clinic to provide psych care, and it always freaked me out. It just seemed so unsafe, being locked in a tiny room with some sex offender barely out on parole, with nothing but an alarm button to help me. I'm told some residents, particularly other females, refused to go. I can't blame them.
The pen was the total opposite. This wasn't for psych care, it was the actual methadone clinic. There was a nurse in the room, the door stayed open and the guard station with two guards was right across the hall. One guard frisked every inmate who went in, and generally stayed in the hall. And yes, we had panic buttons, but I can't see them being necessary when the guards apparently jump in and drag out any inmate who so much raises his voice.

No raised voices today. Everybody was really pleasant, because they know that they'll be dropped from the program and/or my staff will leave for good if they become threatening. She is the only doc with a methadone license willing to work there at the moment, so if she decides to quit they'll be shit outta luck.

But she did tell me stories about when she was still the prison doc, not just the methadone doc. As methadone doc she doesn't prescribe anything else, the prison doc who has no methadone license takes care of all other meds.
A lot of inmates are on various pain-killers like long-acting opiates, Percocets, etc. Very often things they're addicted to or that have monetary value.
One time some gang member was going out on parole and wanted her to write him a script for morphine, which she refused. To which he replied, "I shoot people".
It was meant to be intimidating; there is a reason many docs won't even consider working for corrections. She, however, only shrugged and told him in that case she'll see him back pretty soon. I'm told he looked quite startled at the reply.

She says prisoners, and addicts in general, will often try things like that. Not necessarily threats against others, but threatening to go back to drinking if they can't get their opiates, or to go out and shoot up. Expecting the physician to take on the responsibility for their behavior, to write the script just to prevent what was threatened.
She doesn't take any of that shit. I like her a lot.

Wednesday, April 19, 2006
07:40 p.m.

'Scuse Me While I Stop Your Heart

Last night I got to push Adenosine.

Adenosine is an anti-arrhythmic, used to convert a patient's heartbeat back to normal. The gentleman in question had known SVT that usually converted on its own, but this time it had been going on for over an hour and he was getting worried.
On EKG his heart rate was about 160, and he was pale and sweaty.

Adenosine is given by IV push - the drug is injected through IV and "chased" with some saline to push it through faster. It's supposed to work within two minutes; usually within seconds actually, but after two minutes you can decide it didn't work and double the dose.

Adenosine stops the heart.

Well, it causes a brief asystole for maybe 5 seconds, the famous flat-line on EKG. The patient remains conscious and you can observe the "Adenosine stare" when the heart's stopped, when the patient classically experiences the "feeling of impending doom". You're supposed to warn them about it.
This guy's been through it before so he didn't get too doomy, but it was still very exciting. The first dose didn't work, either because it just didn't or because the funky Y-tubing didn't deliver it fast enough. I changed the tubing and doubled the dose, pushed it, watched the monitor. Saw it flatline. Saw the beat return, normal sinus, nice and steady.

It's usually a safe procedure, but obviously the patient can still crash. I felt excited, and scared, and prepared. I felt like a doctor.
I didn't wake up my staff.

Riding Update
Working on canter in a 20 meter circle.
I did that before, but every time I went to canter the horse did this...orbital escape trajectory thing. She'd break into canter and zoom straight out of the circle, and I could bring her back and keep her in it but I couldn't start her on it.
Now I can, yay. Little steps; every time I think I'm doing well, my instructor introduces new material or becomes more exacting about something I thought I was doing correctly. This is all good, but it's hard.

I've been asking around about the range a horse like her could be sold for. If I do buy her, I don't want the owners to take advantage because they know I'm emotionally attached to the silly thing.

Sunday, April 9, 2006
05:08 p.m.

I Wanna Make Her Mine

I want to buy my horse, the one I'm part-boarding.

I would do it now, but alas, my life is not my own. I have no idea where the army wants to put me. It could be Petawawa, in which case trailering her up there wouldn't be too problematic. It could be Alberta, which is halfway across this rather huge country. Or it could be Nova Scotia - same problem, opposite direction.

However, she'll be going for sale. The riding school is closing as the owners want to concentrate on breeding and their dog training business. She's not a breeding prospect because she has some faults; she's a bit cow-hocked in her hind legs, her front legs are slightly too far under her body (camped-under, I think the term is).
She also sustained a hock injury way back when she was being shown, and consequently her jumping is limited. But that doesn't matter too much, because at this point I'm nowhere near her limit.

She's 13 now, stiff as a board especially on the left side from going around and around in big circles for lessons. But she's very very kind, will put up with a lot of shit from a novice rider without throwing a tantrum, has excellent stable manners, is safe for trail riding, and even with her limits she's still capable of a lot more than I am right now. I'm nowhere near ready for a non-schooling horse that would still need training.

*sigh*

And I love her.

And I can afford her.

But all that may not matter if they throw me across the country.

Sunday, April 2, 2006
08:11 p.m.

Jesus Christ, Superdoc

My preceptor acts. He acts with the local theatre group, takes voice lessons, and yesterday I saw him in a great performance of 'Jesus Christ, Superstar'.
He was but a lowly background apostle, but he put in a quick turn as one of King Herod's dancing-girls. He lamented to me that he's being cross-dressingly type-cast, as he also played the Sultana of Morocco in 'Dick Whittington and his Cat'.
Another family doc played Caiaphas, with a truly stunning crown-hat-thingy. I kind of want that crown-hat-thingy; I'd totally wear it and make patients bow down in my wake. I don't think he's acted much before and his gestures seemed a bit tentative but I swear, his voice as Caiaphas was very much like the vocal on my cast recording. He got that deep, deep, gravelly thing dead-on.

The performance was very good. Not even "very good for a small county group", it was very good period. One of their speakers acted up near the end of the first act and had to be cut off, but otherwise it went off without a hitch.
Heh, and now that I checked, the plot synopsis in the program is from Wiki's entry on the musical. Or from wherever Wiki's entry came from as it's not credited, but the thing's word for word.


Horses gone crazy
Yesterday I went into the pasture to catch my horse as per usual.
But! Instead of chewing on hay like she usually does, she and the other three mares were galloping across the field, snapping at each other, and bucking while at a gallop.
I stood there with lead-rope in hand, watching my horse apparently attempt to hit her shoulderblades with her back hooves, thinking "Am I really stupid enough to want to get on top of that thing?"

I've never seen her like that before. Usually she's pretty calm and eating, or in her stall if I come in the morning or evening. But spring is here, and they're feeling frisky.
I stood out there for about 15 minutes, carefully inching closer until she was cut off from the other horses - when one started running, they'd all start - and finally paid me enough attention to realize I had a treat for her. That allowed me to snap the lead-rope on her.
Once the lead was on, she was totally calm. But the boss mare came close and of course the others followed her, so I had to stand there some more and swish the end of my rope at her until she went away. I didn't want her crowding my horse when I led her out of the pasture.

The ride itself went great. I'm finally getting the feeling of a proper canter. Slowly but surely.

But seeing them go crazy in the field got me to thinking. Who was the first prehistoric human who, upon seeing prehistoric horses go through conniptions on the wide open plains, thought to himself "It would surely be a great idea to get on top of that there thing"?
How have we managed to not Darwin ourselves out of existence?

Sunday, March 26, 2006
07:22 p.m.

Eeeeeeee! Hack! Haaaaaaack!

Yay, I went for a hack on my horse today. My very first hack ever.
I was lucky to go, since the owner said I could take her out but not alone. Which makes sense general-safety wise, plus I've never been out and wouldn't even know where to go.
So today I got to the barn a couple hours later than I'd planned, and lo, two younger but more experienced girls were willing to go with me as a warm-up for their rides.

For me, it would be a cool-down since I didn't want her too frisky. So I took her through her paces in the outdoor arena, which both I and she love - she's much more forward outdoors, and she doesn't spook at all. Tractors, birds, wind, she doesn't care when she's outdoors.
I cantered a lot on a 20-meter circle; my position is much better now, I don't bang against her back like I used to, but I'm still having trouble keeping my heels down during canter. They creep up when I'm trying to keep leg pressure on her. Meh.

And then, off for the hack. We went for a tiny one, just 20 minutes down the road and across a clearing between two fields. She kept stopping and backing up initially and I kept having to kick her forward, but she didn't have any problem with cars and wasn't so much spooky as distracted.
I trotted her on the clearing and one of the girls cantered her horse a bit; she was having trouble keeping him under control, he kept side-stepping the whole time, but she's a good rider with a lot of experience so it didn't freak her out (as it would me).
On the way back I couldn't get my horse to stop. She would walk, she didn't try to run away on me, but she just absolutely refused to stop. The best I could do was one-second almost-stops, which was weird to me because in the arenas she's always sooo happy to stop. Must work on that.

It was fun ^____^

Not fun are the presentation I have to do for Tuesday, and studying. Sadness...

Tuesday, March 21, 2006
07:51 p.m.

Air bubble in IV hysteria!

Do you people know how much air we'd need to pump into you to seriously affect you in a negative way?
About 10cc's.
10cc's.
Per kilo.

So do me a favour and stop freaking the fuck out because there is a teensy, almost invisible air bubble in your IV line. I'm not going to bruise my fingertips flicking it away. It's not going to hurt you.
Usually when people get like that, we start pumping them full of some kind of benzo. Or just jump straight to knocking them out.
Patient on OR table: "OMG! An air bubble! Get it out get it out get it out get it out get..."
Anaesthesiologist: *injects milky liquid of peace*
Patient on OR table: "...out get it out get it...*snore*"

Knocking out patients who annoy you is so great. I want to be an anaesthesiologist now too.
Last week, a patient with horrible veins was brought over from pre-op without an IV. The nurses had tried and failed. I tried three times, getting flashback each time, but the vein blew on me when I advanced the catheter.
The anaesthesiologist tried two or three times, same result.
Another anaesthesiologist wandered by to ask my anaesthesiologist something. She said she'd help him if he put in the IV and, miracle of miracles, he got it on the first try with his special non-OR needle.
The patient to him, impressed and/or relieved that she wouldn't be tortured by us any longer: "So, are you a read medical doctor? Not like an anaesthesiologist?"

Yup, she got knocked out. She was going to have a spinal before that comment, but nobody was interested in hearing what she had to say next.

Wednesday, March 1, 2006
05:34 p.m.

This mini-vacation brought to you courtesy of the Armed Forces

I was all set to start my Anesthesia elective this morning, but hurray woe, the army forgot to process all my out-of-town paperwork and so forbade me from...well, leaving town. And going to my elective.
The sheer disappointment at not being able to wake up at 0600, jump into my freezing cold car and drive for an hour nearly killed me.

They sorted it all out by about 1000, but it was enough to give me the day off, as my new preceptor was post-call anyways.

Of course, I wasted the day on the internet. But such is life.

The Errant Cheque
Last week, I received a cheque from the WSIB (Workplace Safety & Insurance Board), for filling in some ER injury report. Alas, I have no WSIB claims number - there was one written, and I assume it belonged to whatever staff doctor I was working under at the time, and who therefore should have received said cheque.
But I wanted to keep it. I did the work! I deserved that money!

So I polled my friends and one staff. My fellow residents were singularly unhelpful, their responses ranging from "Isn't that illegal?", through "I'm pretty sure that's illegal", to "You really shouldn't defraud the health care system".
The staff was even less helpful: "What? How did you get that? I have to hunt them down for these and they just send it to you?"

Thusly dispirited, I returned the cheque.
But really, that $33 was so mine by rights. Those forms are, like, 3 pages long! Maybe even 4, I really don't remember.

Tuesday, February 21, 2006
07:12 p.m.

"We should take lessons from the sociopaths"

So said my psych preceptor, while discussing how turning family practices into Family Health Teams and/or Networks doesn't really give anyone more vacation time.
The idea was to band together and so have someone to take over for one's patients when one goes away. But the funding schemes for these practice models require the doctors to also work evening urgent-care clinics and weekend clinics, so in reality they're seeing more patients than before.
And somehow, it doesn't make getting vacation any easier, because now you have to find another over-worked colleague to cover your shifts.

The docs were saying how their feeling of guilt for shifting this work onto their colleagues wasn't really all that different from the guilt feelings of abandoning their patients to the tender mercies of the ER for a week or two.

So my preceptor figured we all need to take a page from the anti-social book and quit feeling this pointless guilt. Sociopathic physicians, unite!

I just think they have a sucky set-up. It works quite well in that town where I ride, and where I'd really, really like to practice if it wasn't for the army.

Speaking of anti-socials, one of my patients today had many of the traits of that disorder, although not enough to make a diagnosis. Just more traits thereof than your average person.
She was actually fascinating to listen to. People with no or very little apparent conscience are very interesting to me; I'm addicted to Anne Rule true-crime books because she writes so well about sociopaths.
I suppose part of the fascination is something like envy - not that I'd want to actually lose my conscience, but it gets so annoying at times. For example, when I want to do something purely selfish and I know someone's feelings would be hurt, or I have a fight with, say, my mom. Even when I think I'm totally in the right, the thought of having hurt her feelings is painful.
Being conscience-less would be so freeing. Oh sure, you'd be a monster. But a free one!

Sunday, February 19, 2006
10:14 p.m.

Lovin' the Teenies

(Not that way)

I love the teeny girl psych patients. Their problems are so...cute.
"So-and-so talked about me behind my back!"
"My cliquish friends are breaking into two cliques and I have to choose!"
"My mom won't let me so this, that or the other!"

By saying the problems are cute, I'm not trying to imply that they're irrelevant. Not at all.
But they're so familiar, and so many of them can be helped by teaching the kid coping skills. There's nothing else involved but interpersonal relationships - no HR department throwing policy at them, no government bureaucrats denying disability applications or telling them thay in order to get these benefits they'll have to move out of their homes, no having to deal with agencies that you really can't deal with.
And best of all, these kiddies are still so flexible. By the time I get them, many adults are set in their patterns, their life skills (or lack thereof). Their inability to cope with even normal disappointments and life stresses has become chronic, part of their core beliefs, and changing that is a long, painful and setback-strewn road even for the motivated patient. With the teenies on the other hand I'm already seeing very positive results, and my rotation is a mere 2 months. It's great ^__^

Of course, I don't have any of the really hard cases. Sexual abuse, for example. But patients like that wouldn't be given to a resident whether they were teenie or adult because it's a difficult enough thing to talk about with one therapist, much less with residents who change every 2 months.

My teenies have social anxiety, conflicts with parents, depression, alcohol problems, even one with sometime-symptomatic bulimia; the usual things. My favorite one has nyctophobia.

Another thing about teenie girls is that they'll talk. They'll confide quite easily. My preceptor says that it's probably because I'm a young woman, someone who's more of a sister figure, not so authoritative; they talk to me more easily than to him, a middle-aged man.
Teenie boys probably suck as psych patients though. I've only had one, and he was there because mom made him come. Getting even the most basic, non-personal information was like pulling rivets, but to be fair, he didn't really want to be there in the first place. I've had young male patients, low-20's, who were perfectly fine.

But nobody's as great as those teenie girls. I will genuinely miss them. If I were setting up my own practice right now I'd try to steal them.

Weather
We've had schizo weather here too, dear. On Thursday it was all nice so I went riding, and when I came out my car was covered in a carapace of ice!
And as I was cleaning it off, I hit my windshield wiper and it broke into 3 pieces. It was pitch black out, icy rain, my gloves were too thick to manipulate the pieces, so for literally 15min I stood there in the sucky light from my headlights, trying to figure out how to get the bastard together again while my hands froze.
I finally managed to snap it together - thankfully, because there was no way I could've driven anywhere in that weather without wipers. I'd have been sleeping with the horses if I hadn't fixed it, and they're not that cuddly.

Saturday, February 11, 2006
11:48 a.m.

Setbacks

Last night, I had a nightmare about riding.

The Mexico thing - I'm guessing that's what it was - affected me more than I realized. After I came back last week I was still too sore to even trot for any length of time, so we did flatwork at a walk. I felt good.
Yesterday, we went over an exercise called gymnastics. Three trotting poles, a cross-jump, another trotting pole, then another jump. Initially it started with all obstacles as poles, then the first cross-jump was added, then the second.

I didn't do too well. I was ok over the trotting poles, and even over the first jump once I made the horse obey me. But when the second jump was added, I fell apart.
The course is quite long, and therefore the last jump ends somewhat close to the wall, forcing a turn. A turn the horse can make easily - but I couldn't. My horse gathers speed as she goes over jumps, and was in a strong canter after the last one; all I saw was the wall rushing up to meet me at what seemed like insane speed.
I did the turn, but in two-point, not cutting her speed. And when we went around again, my whole posture fell apart. I was hanging over her withers, my elbows were locked solid, my knees were pinching, and she was able to weasel out around the course completely. Several times. We eventually went back to trotting poles only.

And that night, I had the nightmare. About going over that last jump, not making the turn, and smacking straight into the wall. I jerked awake at the sensation of falling.
I've never had a riding-related nightmare before. Not after any of the times I've fallen off during lessons.

Today we worked at the same thing, starting off with the poles and then both crossjumps.
Same thing happened. I couldn't get myself under control after the last jump, couldn't get her to slow, and hung in two-point when doing the turn. My instructor removed the second jump, and I went over again - and again, even with just one jump, I couldn't recover.
And fell off at the turn.

Stupid little fall that didn't even hurt me. We went back to the course, trotting poles only.
My instructor tells me I've gone into panic mode at speed, that the things that have been solid for weeks now have fallen apart because of this. Instead of sitting back with my weight in my heels, I continue leaning forward, on my toes, in an unstable "save my organs" crouch.

So we'll go back over that course with trotting poles, going into two-point and recovering, until I once again have the posture down. And we'll work more in canter so I lose my fear of speed, and can transition properly into a trot.

But I'm angry because I didn't think the Mexico fall affected me that much. I didn't feel that it did; I didn't feel any fear going over the gymnastics, I was excited. I like jumping.
How can I work this out if I don't even feel the fear that I obviously have? I felt out of control going at the wall, yes. I couldn't make myself sit back properly. But I didn't feel afraid, more frustrated. I wanted to keep doing it until I got it right.
Only...it's me who's not right.

Monday, February 6, 2006
09:26 p.m.

The Life Scamtastic

Ah, the Mexican tour operators. How they tried to scam us.

The resort had a deal with one car-rental agency and one tour agency to operate on its premises. Nominally these were completely separate entities, but given how they were able to offer money off each other's services and had access to each other's keys, it was clear that they were at least in some ways connected.

In any case, the car rental guy was Carlos. He kept horrid "office hours" and could never be found when he was supposed to be there, so we had to push our car trip from Friday to Saturday after efforts to locate him when he said he'd be around failed utterly.
That worked out fine in the end, as we took a trip to the Cuzama cenotes on Friday with the tour agency. It was a gorgeous trip, we got to the cenotes on a horse-drawn rickety cart that travelled on rail tracks and shook alarmingly with every turn. I spent the travel time to the first cenote calculating the best way to jump out of the thing in the event of its (obviously imminent) derailment, but was able to relax about it as we went on.
The cenotes themselves (Chelentun, Chansinic'che and Bolonchoojol) were beautiful and crystal-clear, although we only went into the first two; the last was having its ladder repaired, and the temporary one was flimsy and rickety and scary. Fresh from one injury, ass pain still making me limp, I wasn't about to chance it.

We hooked up with Carlos after the cenote excursion, filled out the rental paperwork, showed him the horse-crushing 50% off coupon, and ran into the first scam - oh no, the coupon wasn't valid because he was already giving us a "special" rate. Which he didn't mention until he saw the coupon.
Not in the mood, we called over the tour guy who gave the coupon, Manuel. Short discussion in Spanish followed (I only understood the word "horse") and the coupon was validated.
We impressed on him the importance of starting out at 6am, and he told us to pick up the car keys in the evening from the front desk. 10pm, no keys. Front desk guy tells us that sometimes the car gets returned at night, so to check back in the morning.
6am, no keys. No Carlos.
8:15 am, Carlos arrives. We're furious, having gotten up at 5am. On vacation, no less! He makes a call and tells us that the tourist who had the keys failed to return them as she was supposed to, so we redirect rage at tourist - until she strolls over to return the keys and it comes out that
1. her contract ended at 9am so she had every right to keep those keys that long, and
2. she didn't want to return them before speaking to Carlos because the lights didn't work and she had to drive in the dark on her hazards.

We're given an upgrade (with working lights), told to return the car with a half-tank of gas as we got it, and start our trip to the cenote Dzinup, Chichen Itza, cenote Ik-Kil, and the city of Izamal. Other than completely getting lost in Izamal in the dark after the light&sound show, and finally having to latch onto a city bus to take us out onto some kind of main road, the trip went swimmingly.

On our trip to Merida, we heard from our guide Noel (?sp) about a snorkelling tour being planned for the next day. Since it was impossible to snorkel in the waters off our resort because of constantly stirred-up sand, we were very interested.
We'd heard about another snorkelling trip, one where you're taken out on a boat ad dropped by a reef, for $45. We asked Noel if that's what this trip was, but he seemed not to know about that one at all - strange, as it was his company that offered both.
His trip was to the Mayan Riviera, to a place called Xel-Ha, for $60, box lunch included. If you click on that link, you'll see that Xel-Ha is the reef equivalent of an amusement park, with a set entrance fee. Noel didn't mention any of this to us, just told us there's good snorkelling there; we thought it would be a boat trip like the other one, only to the Caribbean.

On the morning of the trip, we learn that three other people cancelled, and there would be only myself, my friend, and another woman. Knowing they make their profit on volume, I asked if the trip was therefore cancelled, but Noel said no, he didn't want to disappoint us. So I asked if it would cost more in view of the cancellation, and he said, "Maybe you'll have to pay $10 when you get there". For the boat, I assumed. An extra $10 was fine with me.

About 4 hours of speeding later, we arrive to be faced with the gate to an amusement park, and entrance fees of $33 with no food and $59 all-inclusive. We also learn that oops, no promised box lunch for us.
We assume that our entrance fee, at least the basic, is paid.
We assume wrong.
The woman with us, who we termed cheapo-woman for mostly unrelated reasons, throws a fit. The driver is summoned to call Noel on the phone to explain this; it's not like the entrance fees are new or even recently changed. He didn't tell us any of this.
The upshot is, the driver/tour company end up paying the basic entrance fee for us, and we have a marvellous 3+ hours in the park, snorkelling with giant parrot fish, seeing a big sting ray, and an initially scary encounter with fish that looked like piranha, only much, much bigger. And, ummm, non-dangerous.
We also paid for the dolphin interactive experience which made us 30-40 min late for our trip back but was sooo worth it. The dolphins even foot-pushed each of us across the enclosure!
The photo people tried scamtastically to scam us on the pictures, so we ended up not getting any, especially since they wouldn't put less that 50 pics on CD (at $15 a pic!) and their print quality was atrocious.

In any case, we get back without incident, tip our driver $20 each on account of willfully being late (we knew perfectly well that the dolphin thing would make us late), and run into Noel who immediately tries to tell us that he informed us of the fee, that the $60 was for transportation only. We call him out on his blatant lies (and his lack of food provision; we were hungry), and he - well, instead of defending his position, he immediately backtracks and offeres us a free tour the next day. Which we declined given that it was our last day for purely relaxing.
I imagine some people fold and pay. Hell, we probably would've paid at the entrance, having already made such a long trip to get there, had cheapo-woman not been with us (she, of course, didn't give the driver so much as a buck after having him halt at several outdoor market things to look for a souvenir bowl).

On our relaxing day, we tracked down Carlos the car rental guy. The deal was that we'd pay full price on the rental and that Manuel the tour operator would reimburse us the 50%, which was fine. We went over the final paperwork, and OMG, the guy actually tried to scam us for a 1/2 tank of gas, saying that we only brought it back half-full! Yes, exactly as we received it, and we took a pic of the dash at the beginning of our trip to prove it (by then we weren't about to trust them on anything). My friend was provoked into incredulous laughter.
Carlos backed down, scammed us a couple of bucks on the exchange rate, and left it at that.

Manuel, of course, tried to scam us one last time. He owed us $35 from that 50% off car rental, and told us he'd get it to us Tues afternoon. We kept looking for him all day, but he did a runner on us. Wed by 7am we're set to leave for the airport, so I finally got our Sunquest rep guy to phone him at home in the late evening, and he had the nerve to ask if it was important that he come in. He promised to come in before we left on Wed, but I knew that once we were on that airport bus it would be game over.
So I informed Sunquest dude that we were taking all of Manuel's rental-scooter keys (Manuel usually took them home with him, but possibly because he'd been avoiding the resort all day they were still on his desk) as insurance. If we didn't get our $35, the keys were taking a free trip to Canada. As I put them in my pocket, Sunquest dude was once again dialling his phone.
Manuel showed up before our bus left. He did not look happy, which was highly uncharacteristic of him.

Friday, February 3, 2006
11:47 a.m.

Loss of sex drive will DOOM our civilization!

Does anyone ever read The Situation with Tucker Carlson? It comes up on my MSN page regularly, so I do. It tackles relevant issues of the day in interview format and Tucker, bless his heart, always has an agenda so the interview is more of an editorial.
I disagree with his agenda most of the time, but the interviews are generally entertaining.

"The Libido Killer" is from a January interview with a doctor who also hosts some kind of sexual health show, and revolves around the recent publicity of the birth control pill's negative effects on sexual drive.

I kind of boggled when I read it. As I said, I read him quite often so I'm pretty used to his viewpoint, but this was just...ludicrous and incredibly amusing in a terribly sad way.
First, with almost every exchange, he presses home how much of a "big deal" it is. Women may experience decreased libido when taking control of their fertility! They won't want to fuck men! This is a big deal, people men! Big, big deal!

Then his guest, a Dr. Pinsky, relates an experiment where female chimps were put on birth control, lost their interest in sex, and how that affected the pod males' behaviour: "And what it caused was all kinds of aggressive acting out in the male chimpanzees. So we may be affecting our culture in ways that we haven‘t really come to terms with yet, in ways that we haven‘t seen and really aren‘t blaming on the birth control pill that may have something to do with it."
Oh noes, men may get all aggressive when they don't get sex! Let's blame the pill instead of, ummm, let's see, who could we blame for men becoming aggressive? Obviously not the men, that would be wrong. After all, the poor bastards aren't getting enough sex!

The topic moves on the pregnancy which, after all, is one of the reasons women take the pill in the first place. Dr. Pinsky, to his credit, does say that pregnancy carries more risks than the pill, although he then promptly calls pregnancy a "diseased state". Ummm, ok, I give you risky. It is a risky state. But "diseased"? That just shows me how you view women, buddy, and makes me glad you run a talk show instead of actually seeing patients.

The best part is when Pinsky tells Carlson that "most women throughout human history could expect to die in pregnancy." Totally true, although the risk of death is minimal in the developed world right now. Minimal, but present.
Still, they were discussing the possible death of the mother-to-be. And what does Carlson say? "But at least you get something in the end. I mean, nothing results from a low sex drive. That‘s just depressing."
Yes, nothing. A living woman, but of course that's nothing when set against the loss of sex for those men-chimps.

Like I said, at least the man's entertaining.

Thursday, February 2, 2006
07:12 p.m.

Falling Off Horses - the Mexican Edition

Oh yeah.

I was crushed by a horse in Mexico.

My title is somewhat misleading, to tell the truth. After all, I wasn't the one who fell.

Last Thursday, our first full day in Mexico, I decided to drag my friend on a horseback-riding tour. There was a storm the day we arrived and the weather was still relatively cool, and the forecast promised soaring temperatures later in the week so I thought it would be a good time.
The horses - mine brown, shorter than the one I ride here but not at all wasted-looking like the ones I rode in Cuba, hers white and pregnant - were duly saddled up, and I mounted. My horse acted alert, and when one of the guides rode him a short distance to check the saddle he broke into a quickish trot.
When I went up, the reins were far too short so I held onto the mane with one hand and onto the pommel with the other. I was going to ask the guide to fix the reins, but the horse started backing up - and then reared.

To my startled gratification, I remained firmly in the saddle, holding onto the pommel and leaning forward slightly. I had a brief moment of triumph - Hah, animal, I take lessons! You won't knock me off so easily! - before everything shifted.
The horse had lost his balance. He was falling straight backwards, with me still in the saddle. I felt the exact moment he overbalanced, and the sheer incredulity is still etched in my mind.

He fell back, then to the left, onto my hip and leg. My feet must have come out of the stirrups at some point because when he immediately got up again, I remained on the ground.
With intense, intense ass pain.

I waved off the guides who were trying to get me up - my ass wasn't about to let me do any such thing - and as I lay there flat on my back, still not quite believing that the idiot horse actually fell over on me, I heard someone approach and start the C-spine protocol on me.
A nurse and a paramedic, who happened to be staying at the resort. I waved them off as well, having already gone through it in my head. After all, it wasn't the first time I had a horse-related fall. I knew the drill.

Eventually I got up and hobbled into the lobby, further alarming everyone by shaking my head and blinking rapidly; I was only checking my contacts, but there was no need to tell them that. My head had never actually touched the ground during the fall.

The end result of the incident turned out to be a free massage at the resort, half off our car rental, possibly less of a willingness to press us on tour scams (I shall relate the scams in another entry), and still-lingering ass pain.
And one hell of a story.

Ah, and you don't need to believe that the horse was branded with a "13". But he was. And it's always been my favourite number.

Tuesday, January 24, 2006
06:03 p.m.

Mexico!

Off to Mexico.

Tomorrow morning - early morning, so I won't post for about a week unless I find cheap and plentiful internet over there. And I don't intend to be loooking too hard.

Of course, now that I have a 3 hour drive ahead of me, it started snowing heavily. Weather hates me, and I return her favor.

Sunday, January 22, 2006
05:04 p.m.

Happiness is being drunk in a hot tub

Ah, my weekend was so great.
First my staff was sick and cancelled work on Friday, so I went and got a haircut and highlights for my vacation.
Then, my riding lesson on Sat went really well, me having broken my mental barrier against cantering on the "bad" side of the barn - the side where she usually spooks, because that's where all the noises are. Even when it's quiet and I canter, I still stiffen up on that side, pressing my knees in and relaxing my lower legs, and she drops to a trot. I finally got over that, with much "Leg, leg, leg!" from my instructor.

And in the evening, my instructor had a sweet tropics-themed party. I was staying over so I could drink as much as I wanted, and I really don't know how much that was. I lost track between the Jell-O shooters and the Tequila shots, but there are some interesting pictures that show me giving a good account of myself with the Tequila.
I was already changed into my cute pajamas when other guests decided to jump into the hot tub, and I just had to join in. Really, there's nothing as relaxing as a hot tub when you're completely smashed.
I need a hot tub, only how will that work when I don't want a house but a condo? Ah! Friends!
That's it, I need hot tub-enabled friends. I'll keep the ones I have now, but any new ones had better come with hot tubs.

Had I been at home, I wouldn't have moved anywhere today. No hangover, just a happy lassitude. But I had to move my ass out of my host's home, so I went riding on my way back to my place, and the horse was sweet and non-spooky and we did more canter work. Then I cleaned my riding boots and made them shiny. I feel so very accomplished.

I think now I'm going to release my ferret into the wild apartment and go crash. Or maybe I should eat something first.

Mexico in 3 days! I can't wait ^__^

Monday, January 16, 2006
07:08 p.m.

The softer they fall

Yay. I fell off again, but this time it was an ok fall. Not one where I suddenly found myself on the ground, looking bewildered.
One where instead I found myself teetering in the saddle, fighting for balance, and then giving up and falling in a semi-controlled, non-injurious manner.
And more importantly, I knew why I had fallen. I allowed the horse to run too quickly, not really fully under my control, and I had lost a bit of my balance in the saddle. I was aware of that, but instead of correcting myself I turned into a serpentine, and a bangy sound made her spook just a little and my lack of proper balance caused me to fall.

This is progress. First, it teaches me the valuable lesson to always, always remain properly seated - I was taught this lesson, of course, but I'm sure a fall will actually make it penetrate my thick skull. It also teaches me to never allow her out of my control, even for a little bit - ditto on the teaching of that and my lack of absorption.

But what's best is that I not only got back on (I did that the other two times too), but that I wasn't at all nervous when I did. The past post-fall times I only did some gentle trotting, tense and anxious about falling again.
This time, I did lenghtening/shortening trotting exercises, getting her to run pretty damned fast, and at the end even some canter work. Given that previously I wouldn't canter if she even acted mildly spooky, never mind actually making me fall, I felt really happy with myself.

The difference is that the other two times I didn't really know why I had fallen. Sure, it was probably because my seat wasn't good, but I didn't know. I couldn't tell.
This time around I knew exactly what mistake I'd made, and knew that if I corrected it she wouldn't be able to get me off her back. I actually felt confident (although somewhat sheepish) getting back into that saddle.

Psych
It continues.
There are some really interesting, hopeful patients. I'm doing a lot of CBT with them, thought records and the like, and it's fascinating stuff. My supervisor tries to get me to see the patients who, well, still have a hope as he likes to say.
However, the hopeless ones hang over every workday like a dark cloud. The personality disorders who couldn't cope their way out of a paper bag, the somewhat scary drug-addled parolees after a benzo script, the chronics of every flavour who have seen their way through every psychiatrist in the general (and not-so-general) vicinity...
The schedule is among the lightest of all my rotations, and yet I still come home drained on the days those patients do show up.
Thankfully, as is the nature of office psych, more often than not they don't and then I twiddle my thumbs and daydream, wishing there was a cubby-hole where I could hide and read TIME magazines psychiatric texts.

esca dearest, I emailed you about your letter. But you should know that, wounded by your cruel mention of kimchi, I considered just letting you twist in the wind.
Twist!
In the wind!
Snakes!
On a plane!

Thursday, January 5, 2006
09:15 p.m.

Oh, for the love of sweet sanity

It is the first week of my 2-month psychiatry rotation, and already I'm feeling like smacking people.

Not all people, mind you. There are genuinely ill people of my supervisor's practice. In fact, most are genuinely ill, are frustrated by being ill (or worse, defeated by it), and want to get better. Even if they don't seem to want to get better, it's usually because they're too depressed to see any chance of success and have lost all motivation. There are people who have been dealing with serious, treatment-resistant depression for decades, and at some point they just lose the hope for cure. They learn to "manage", and passively hope for death, and it's wrenching to know that there's really nothing I can do to help them.

But by gum, I seriously want to bash with thick, multi-volume charts the heads of those who talk themselves into being seriously mentally ill. Those people almost universally have poor life-coping skills, most of the time have personality disorders or traits thereof, borderline being the most common, and without fail, one and all, want to be put on long-term disability.
Gaaahhh!

This is by no means limited to psychiatric patients. Family patients do it too, usually with vague MSK pains, the origin of which can't be found by any diagnostic known to man and the pattern of which makes no physiologic sense whatsoever; probably most specialties have patients that do it. Well, maybe not oncology. Or neonatology, but who knows - those infants can be wily.
But with psychiatric patients, it's just...I don't know. Worse somehow, probably because their appointments are not only significantly longer, they involve nothing but talking. At least with the other specialties you can kill some time examining the patient. Yet again. With the knowledge that you'll find nothing.

Tuesday, January 3, 2006
05:00 p.m.

Analyse this

In honor of the new year I will use proper capitalization from now on. Yay, capitals!

New Year's Eve was spent in a drunken haze at esca's house, which was filled with hubby's friends, who were filled with alcohol from their drinking game. Which I joined, because it...had alcohol? Alcohol is a good thing.
Hubby was the only one negatively impacted by all the alcoholly goodness, but even he had the presence of mind to puke in the toilet. He didn't have enough mind left to make it to bed, but that's what friends are for.
I was meant to sleep in their bed, but opted for the downstairs couch in fear of being puked on. Apparently this fear was unfounded and I ended up with a sore neck from the couch. Eh. Hubby actually got up earlier than either one of us, and made us breakfast. Bastard recovers quickly, but I maintain that I was unfairly hobbled by a cold and by esca's sabotage of the treatment thereof (she had thrown out her supply of Neocitran).

Well, back to work it is.
It's strange to be at home. For the past 6 months I've been on out-of-town rotations, so coming home every day feels odd. I feel that I should be quickly cleaning up and leaving, and then I remember that I'll be coming back here after work.
So, of course, I don't bother cleaning up *shrug*

I've started psychiatry. It is the best rotation available, with a family doc-turned-psychiatrist who travels to small surrounding towns twice a week. While trapped in his car, you get teaching.
Tuesdays are half-days, and he stays put in the city. I saw five patients, one of whom nearly got committed. If I had been on my own, she would've been; but he knows her better and can judge just how serious her suicidal ideation is. At least, I hope he can.

So we got to talking about my educational goals for the rotation and the like, and then - whooosh! - he slides right into the Territory of the Less Than Appropriate. Basically he offers to counsel/psychoanalyze-lite/whatever me if I have anything I want to "bounce off him", and says that many of his residents have taken advantage of that.
Which...it's...just no. He's my supervisor for the duration, and he's supposed to evaluate my role as physician, not mental patient. Sure, I was happy to get my surgical supervisor to take that mole off my ear, but that's rather different from talking to this guy about any psychological problems I may harbor.
The guy seems very nice, and he appears to genuinely like teaching. I'm sure that it'll be a great rotation, or as great as it's possible for a psych rotation to be. But man, that was weird.

Friday, December 30, 2005
11:24 a.m.

looking forward to 2006

i should probably update, so the "i'm pissed" post isn't the first one to catch my eye and remind me that i should be angry.
of course i hope to be pissed tomorrow, but in a somewhat different manner. a happy manner ^__^

xmas was great, with mom making the usual goodies and me freezing them and transporting as many as i can back to my place. one of these xmases i'll have to follow her around and make a "family recipes" booklet.

esca and hubbie didn't make it this year because they had to entertain in-laws! HA! so bro asked if he could invite an old friend from germany, and mom was like, "WTF? no, he's not family!"
you're family, esca.

in any case, it was the family and the she, who will officially be family in july. lots of presents, although thankfully no-one went overboard like last year. i got a great riding system (ariat paddock boots and half-chaps) and a whippy crop! and lots of other stuff like clothes and beauty products and delicious things. ah, a sake set from bro - i have one already, but this one's very pretty too. and second season of scrubs from shell! i hadn't even known it was out, because the first season took so goddamned long. we watched the first disc at her place and nearly died from funny ^__^
esca totally gave me porn. ah well, what can one expect from the likes of her?

all in all a very happy time, and it shall get even happier in about 26 days when shelly and i go there for a glorious, skorkelly, booze-filled week. damn, i can't wait.

happy early new year's, everyone!

Friday, December 23, 2005
02:07 p.m.

i am PISSED!

i got my official results from the MCCQE 2, the licensing exam.

required to pass: 400
my score: 460

why did i fail?
"data acquisition", my friends. apart from the score, there's how many stations you have to pass. i missed by one. one!

but it's what i missed that makes me furious. i had higher-than-average scores in problem solving (yes, that means my diagnoses were correct), patient/physician interaction and CLEO (legal/ethical/organizational).
where i was short was data acquisition which, when i read the explanation, basically means i didn't keep up enough of a running commentary for the evaluator as i was doing my physical exams.

i didn't fail because i misdiagnosed my patients, or because i mismanaged their care, or because i have a crappy bedside manner. i didn't fail because my medical knowledge is lacking.
i failed because i'm not good at the test-taking itself. this specific type of test-taking.

and that's not fair.

Thursday, December 22, 2005
05:10 p.m.

i have archived, so i will not have to stare at my failure in the new year.
yay, not staring at failure.

but mostly because esca told me to. once again.
see you on new year's, my dear!