Monday, September 3, 2007
10:56 a.m.

Woe Is Me

Another week, another change in plans.

Now we're once again back to the tents; fine, I expected that anyways. I have bought a folding chair!
But we're not located together, oh no. The army, in its infinite wisdom, has decided to split up into three separate medical facilities scattered over the training area, with a doc in each. So it's looking like 2 months of sheer boredom, without the relief of Risk and Diplomacy.

There appears to be no particular reason for this, unless they're trying to make us shoot ourselves. Although with what? I suppose I'll find out tomorrow if those of us not in play are drawing weapons.

At least I'll have my worth of macadamias to console me.

Civvie clinic is going pretty well. Being the only doc there on the weekend gives me all the walk-ins, who are typically quick and easy and drive up the numbers. I saw 47 patients on Saturday.

Pregnancy tests have been coming in clumps. On Sat I had 3 positives, with all the women happy about it. Then yesterday again 3 positives, with one couple unsure what to do - they were given the prenatal screening test requisites which are necessary for both proper pregnancy management and terminations - and the other 2 women completely unhappy. One because of health concerns, the other...
The other was a mess. She came in obviously beaten up, but refused to say anything about it. Since she's a mentally competent adult she gets to live with her choices, and those include not reporting whatever the hell happened to her. I did ask if she was safe right now and she said yes, but of course she could've been lying. So I look over her injuries, nothing too serious medically, and get ready to leave when she suddenly blurts out that she hasn't had a period in 2 months.
Oh boy. Of course, the test is positive, and she starts crying. I make sure it's because she doesn't want to be pregnant - sometimes they cry in happiness and it's considered somewhat uncouth to recommend the abortion clinic at that point - and start going through the termination paperwork with her. The clinic needs information for the procedure, such as ultrasound confirmation of fetal age and some bloodwork. I explain all the forms, give her the numbers to call for appointments, etc.

I hope she wasn't lying about her dates. I hope she'll go and have the tests done in time for the procedure.
Because I hope to hell she'll terminate that fetus, this alcoholic and drug user who's clearly not in a stable place in her life.

Wednesday, August 29, 2007
05:31 p.m.

Shenanigans!

Working at civvie clinic this week for money, tra-la-la.

Patient comes in, young woman, moves stiffly and wih dread. We've never seen her in this clinic before. She presents me with long-term disability papers and asks me to sign off. She was in a low-speed car accident a bit earlier this month.

First thought, of course, is "What are you trying to pull?" She's not in a cast or neck brace or wheelchair or anything, so it's mighty early be ge talking long-term anything.
Well, her chiropracter already filled one out, but the insurance company wasn't satisfied thank heavens.

Apparently XR was ordered by the chiro, so I send her out while I track down the imaging. As luck would have it, our pain specialist was in today too - if you google his name craploads of whiplash papers come up, so that one was right up his alley. I refer her for instant specialist assessment and keep waiting for the damned XR results.

Specialist assesses, tells me it's all soft tissue, muscle spasm basically, that he referred to his trusted physiotherapist, and of course told the poor girl to quit her chiro immediately. Don't worry, you'll learn why soon.

XR report comes in, and they've done all the good stuff, flexion/extension views, the whole appropriate shebang. It's all totally normal except for suggestion of muscle spasm because of the loss of cervical lordosis; you basically lose your cervical lordosis every time you nod your head, so she was just holding herself stiffly because of pain and spasm, no big deal.

I go in to talk to her, and she looks...better. The disability papers have disappeared. I chat with her, show her the report, draw little vertebrae for her to explain what's happening and what's not happening, and find out the whole story. The chiropractor, imagine that, told her that her neck was dislocated in 3 places! And that she would be disabled for life! Now remember, he already had the report that clearly stated there was nothing wrong with her bones or their relation to one another.
He was cracking her neck on a daily basis, forbidding her to have hot showers because that would somehow make her dislocated neck worse, and filling out long-term disability for her. She was almost crying with relief when we told her that she would be fine, that nothing was broken or dislocated, that she could indeed have a hot shower and might in fact find a bit of heat helpful for the spasm.

The poor girl was afraid to move her neck because she thought it might kill her!

Fuck that made me angry. I've come across weird chiro terminology before, like the patients who are under the impression that random joints just dislocate randomly and have to be "popped into place" by their chiro - clearly "dislocated" in chiro-speak means something completely different than in the dictionary, and it amuses me that people are out there walking on what they think are dislocated hips.
But I've never come across such outright and damaging quackery. That girl was terrified, she thought her life was over. She was taking cold showers and living in fear of sudden death from the wrong head movement!

Wednesday, August 22, 2007
01:37 p.m.

Dental Failure

I am experiencing catastrophic dental failure. I believe my body is rejecting my teeth.

Apart from the whole root canal thing, I'm having a thousand cavities filled. In fact, they're booking me so they can do my fillings in quadrants. Its not just a cavity here or there, my mouth is now divided into cavity-containing quadrants!

Damn it, I brush twice a day, I floss before going to bed, I don't drink pop, I don't suck on hard candy. What the fuck, teeth? What. The. Fuck!

I'll have full dentures by the time I'm 40, I just know it.

Other than the inability of my teeth to stay intact, all is relatively well. I'm mentally preparing for two months of boredom in the field, but at least I'll be stuck there with a couple of similarly bored colleagues. One of them has Risk or Diplomacy or something like that. I'm considering buying Catan.

I almost went to Jamaica this week on a recce. On Sunday I got a mysterious call about an "interesting tasking", but by Monday we were stood down. Either DART isn't going, or they're staffing everything from the central area.
Of course the field never gets cancelled, but Jamaica does. Bastards.

Friday, August 17, 2007
02:24 p.m.

Raaaaah Car Accident

So, freshly back from field.
Field, apart from a sucky day when it rained the whole time, was fine. Nice, relaxing, lots and lots of downtime. Mostly minor patients, a few more interesting ones.

I got back early, being on the civvie-bus party and not on the "can't exceed 80km/h with these crappy army vehicles" convoy, and happened to run into a fresh new colleague who wanted to know where something on base was. So we hopped in her car and I directed her there.

We were behind an SUV type (SUV A), on a road that ends in a T-intersection and stop sign. He stopped, then started turning - while another SUV type (SUV B) was turning into our road. SUV B didn't have a stop sign.
SUV A T-bones SUV B, both at really low speeds since SUV A had barely started accelerating after the stop sign and SUV B had slowed to turn. It's a gentle collision, we were right behind SUV A and we didn't even hear a noise.
Both drivers pull their SUVs off the road and get out. Colleague and I look at each other and decide we'd better see if anyone needs help, although the mechanism of injury didn't exactly concern us greatly. Both vehicles have nice dents in them, but nothing is squashed.

SUV A's driver seems totally fine, although also pretty deflated since he's clearly at fault.
SUV B's driver looks pretty upset, but I ask if she's hurt anywhere and she kind of laughs/snorts shortly and complains abot her family's recent MVA record. She's walking around, trying to reach someone on her cell, not in any apparent distress.
Colleague and I don't identify ourselves as doctors.

We hang out for about 5 min before the first cop shows up, which prompts SUV B's driver to retreat into her vehicle. Paramedics duly show up and we let them deal with the driver, but speak to the supervisor about our post-accident observations.
By that time she's in her vehicle having her neck stabilized before being put onto the spineboard, and I'm having a hard time keeping my eyes from rolling.

We both give our written witness statements, concerning the approximate speed of the vehicles and the driver's lack of physical complaints or observable physical distress before EMS arrival.

Something tells me she may just develop severe whiplash, oh my.


Interesting Field Patients
There were two, really. The third was a deep gash on the underside of the chin, notable only for its cool-factor location and for the fact that I let two of my baby medics who'd never sutured on a human being close much of it. They were so cute and excited.

One was a migraine. Not a big deal, except he'd never had a migraine before. Positive family history and sounded like a common migraine though, so I treated it as such.
Except it wouldn't go away.
And it still wouldn't go away.
I started getting worried and having visions of missing some kind of bleed or tumor. I kept subjecting the poor, severely photophobic patient to repeat fundoscopies. But damn it, everything was normal.
I even gave him opiates, something I don't like for migraines. Didn't even touch the pain.

Finally, finally the second dose of injectable Imitrex worked. You're not really supposed to give a second dose if the first had no effect, but I wasn't exceeding the dosage, he was skating towards status migrainosus and my next step was to transfer for a head CT, so I was getting desperate.
Thankfully, after over 36 hrs of pain, the damned thing went away and didn't recur for the rest of the exercise.

The other was abdo pain that presented like an acute appy. Now, every doc who does ER is familiar with presentations that are just like acute appies, but turn out to be nothing and get you a grouching-at by the radiologist you woke up to read the imaging.
So buddy presents with vague, non-localized mild abdo pain and a bit of nausea. No big deal, gastro is common in the field, we give some Gravol and send him on his way with the usual "if x, y or z happens, come back".
He comes back the next night, around 0400. My duty medic wakes me up and reports that the pain, while still mild, is now localized to the right lower quadrant and it might be an appy, woo!
I, knowing that it's never a damned appy, shrug and tell him to keep the guy until I come in the morning. I nap til 0600, go for a run, have a shower and stroll into my medical station to examine my patient. Lo and behold, sure, he's got the textbook signs - Rovsing, psoas, McBurney; no rebound though, and not febrile.

I sigh internally and try to find some kind of imaging out in the boonies on a weekend. Ultrasound is out of course so it'll have to be CT. I call the closest hospital with one, clear it with their on-call radiologist, arrange for the CT tech to be notified when my medics are close to arriving, etc. I do all this because he has the proper signs and thus deserves the investigations, but I don't believe it's an appy.

Of course by now you've guessed that yes, it's a real, honest-to-God appy. It has to come out. The CT hospital has a general surgeon, but he's been on call for three weeks straight (ah, boonies) and has put his foot down on responding for longer. I direct my medics to take the patient to the big city and call ahead to the hospital I picked, only to be told I need to do the transfer through the Critical Care Line which will decide where he goes.
So starts a fun round of phonecalls between myself, my medics, CCL and the accepting surgeon, the two former parties on crappy cellphones located in crappy-reception boonies.

In the end he made it safely and had his surgery the next day without complications, and I spent the entire remainder of the exercise telling my medics not to bother waking me up at night because "If I refuse to get out of bed for a surgical emegency, I refuse to get out of bed for anything".

Sunday, August 5, 2007
09:14 p.m.

Not Wasting My Weekend

Ugh. So full.

Edmonton inconveniently schedules its food festivals just before I leave for the exercises, making me feel that I have to attend so as not to "waste" the precious pre-field weekend by vegging around at home.

This weekend is the Heritage Festival. 63 pavilions from different countries/regions set up both a cultural and a food tent, and visitors stroll around, getting obscenely full and entertained by many performances.

Since it was hot, I didn't actually eat much. A bit of sticky rice, a Korean hoduk for old times' sake, some cold tofu, crepe Suzette, and a Bosnian dish called Burek, seasoned beef wrapped in this dough and wound in a aspiral. Like a pretzel, except spiral-shaped instead of pretzel-shaped, and using thinner dough. It was yummy.
Wandering around I found that most cultures, no matter where they're from, will put their meat in dough, on top of dough, on a stick or in a stew. The drawback to living in a multi-cultural place is the realization that there really isn't that much variety in this world. I suppose that's why shows like Top Chef and Iron Chef interest me, because of the beautifully weird presentations they tend to display.

In any case, most of my tickets were spent pursuing various drinks and other icy things. I had the Taiwanese version of Patbingsu (shaved ice is the best form of ice!), a vaguely interesting type of Israeli fruit punch, a great Sangria, a honeydew drink from Bali with the fruit shavings in it, sweet Thai iced coffee, and Russian Kvas. I got so far into the pursuit of drinks, I forgot that I'm not overly fond of young coconut juice unless it's liberally mixed with rum, and so had to dump it and content myself with scraping off the tender flesh, which I am fond of.
But my favorite turned out to be a drink from the Arab site, called Jallab. It was a date and rosewater concoction poured over crushed ice - it would've been too sweet without the ice, but perfect with it.

And unlike Taste of Edmonton, the Heritage Festival offers almost non-stop entertainment in the form of random cultural exhibitions. Nice place to waste 5 hours of so.

I should have eaten more fat. My fasting lipid panel confirmed my freakishly high levels of heart-protective HDL. I think I can safely subsist on cholesterol now.

Monday, July 30, 2007
07:59 p.m.

Ve Vant Your Bloooood

Freaking bloodwork.
Freaking fasting bloodwork, interfering with my morning coffee.

But at least my fellow doc told me to get it done so if I somehow manage to get on the Basic Dive Med course this fall, I'll actually, yanno, be able to go. My boss, who took my memo and said he'd try to get me on that or the Flight Surgeon course, neglected to inform me that I needed special physicals for both of them. Physicals that allow me to go into decompression chambers and centrifuges and fly on jet planes.

So, it appears that our plot to take at least October in 1-2 week shifts in the field will come to naught. All three of us will therefore spend both months in the field outside the actual training area, not seeing any patients because Task Force 1-08 will be doing their own medical coverage. We'll be there mostly to, ummm, hemorrhage our medical skills and watch DVD's.
I do have 5 seasons of Scrubs on DVD, go me!

I do have someone to ride Wavelet a couple of times a week while I'm gone, and one of the civilian nurse practitioners will move into my condo to look after Chibiko and be closer to work, because she lives way south of here. She's the one they gave my precious office to, so it's kind of appropriate she take my home too.

Now I go to cook my remaining scallops. Yesterday they came out very nice, but splattered my entire stovetop. I have forgotten the Lesson of the Fondue: scallops fight back.
I must find a lid for my pan.

Sunday, July 22, 2007
07:11 p.m.

Seafood Wrapped in pig

Went off briefly to the Taste of Edmonton festival downtown, making sure that my arrival would coincide more or less with the daily Taste of Wine event.

Ah, memories. The Taste of Edmonton was one of the first things I did last summer in my new home city, after the tiny crappy zoo and the giant mall.

A lot of the offerings were the same too, like the Butternut Squash and Maple Cream soup that I loved last year, but this time around I checked out the menu choices first and made a proper plan of attack. Last year I overstuffed myself with ginger beef and wasn't able to taste all the things I wanted, boo.

This year the biggest hits were seafood wrapped in pig. There were butterflied shrimp wrapped in ham before being fried, and bacon-wrapped scallops. The scallop stand pretty much had a constant line in front of it.
Clearly I am the kind of customer these places are trying to attract. I don't look at bacon-wrapped scallops and go, "Hey, this is delicious and so simple, I can have it all the time." Oh no, I look at them and go, "Wow, this is so wonderful and complex. Damn, it probably involves pans and spatter and that thing...ummm...that...oven! Yeah! Man, where is this restaurant located again?"

Ah, I fail at kitchen.

The desserts were nice too, I mostly stayed with the various alcohol-soaked fruit concoctions.

Speaking of alcohol, I'm very proud to have correctly identified the high-end red wine presented as having oxidized. I don't have a wine palate to speak of, but I did get a crash course from one of my wine-loving, vinyard-owning ER attendings back east, and that included being able to tell when a wine has gone off. Previously I'd just have assumed that it's not my kind of wine, or that my palate isn't up to the task of identifying the subtle flavours that are supposed to be there.
The presenter tasted the wine after I complained, grimaced, and opened a new bottle.

*sigh*
Ok, so my palate really isn't up to the task of identifying the subtle flavours that are supposed to be there. But at least it didn't taste nasty and bitter like the previous batch.

Thursday, July 19, 2007
04:20 p.m.

Ripping Out My Hair

Yesterday I waxed my legs.

Not had them waxed, as I usually do. Waxed them myself. A few years ago my mom gave me a DIY waxing kit called Parissa, not the pre-done waxing strips but the whole kaboodle - little jar of wax, spatulas, cloth strips.

The wax was interesting. I was able to use it without warming it up, although it was a bit hard to apply. I probably should've microwaved it a bit. It was also pleasantly sweet when I licked it.

The pain was pretty much as with salon removal; a bit easier because I had time to brace myself, a bit harder because DIY too far longer than having it done. I started to get worried about having enough wax for both legs, but thankfully it held out.

Sitting on the rim of the bathtub in shacks, reaching for cloth strips placed conveniently on the adjoining toiled, is not exactly a situation that puts one in the salon mindset. But! The kit includes a little vial of azulene oil, which is pretty and blue (hence the name), and therefore clearly very salon-y. Also, it does not stain white bedsheets blue once applied to the legs, which is a definite plus.

Still, next time I'm getting them professionally done, provided I'm not exiled to crappy towns with no spas as I am now.

I'm both bored and frustrated here. Bored because on the whole there's not that much to do, or not much to do medically; there is admittedly a lot of useless paperwork. Frustrated because I have young recruits coming in with fainting spells or chest pains and I read their intake physicals and learn that they've had street drug-induced cardiac problems in the past and I wonder why in hell they were allowed to join in the first place. Are we that hard up for bodies? Do you really just need a pulse to pass the standards these days? And not even a good pulse, apparently?

Not helping my frustration is getting a letter from one of our orthos today regarding a patient I referred to him. In the letter he basically informed me he put the patient, who's not an urgent case, on his long non-urgent wait list. Fine.
That was one paragraph. The other 5 of his full-page letter consisted of passive-aggressive insults about my competence, complete with his reasoning about why I shouldn'tr have ordered the MRI (I didn't, the doc who's now gone did before I came here), med-school mnemonics about red flags in back pain (when my referral clearly stated that there were none), and condescending suggestions about which websites to read for my "further education".
I can't believe he went so far out of his way to be a complete asswipe. I mean, he actually put effort into this letter.

He's the worst stereotype of an orthopod out there. None of the ones we have are particularly pleasant, but every GP I've worked with on base finds this guy especially assholish and arrogant. He's also a living example of the Short Man stereotype, and I wish so very, very much that one of us was a civilian, because then I could reply to his letter as I saw fit. But alas, he is military and outranks me.
I fucking hate the bastard. Hopefully he'll keel over and die in a speedy manner from something particularly unpleasant.

Back home tomorrow, back out here in less than 3 weeks. Le sigh.

Saturday, July 14, 2007
06:59 p.m.

Vacation's Over

My friends from Ontario have come and gone, and tomorrow I'm leaving for that hellhole again. I'm also confirmed for at least 10 days in Aug and all of Sept and Oct, and that's under canvas - that's a lot of time to spend camping in hellholes.

During their visit we went for a few days to catch the Calgary Stampede, and got hooked on rodeos. Well, I and esca's husband did, she just mildly enjoyed it; an enjoyment somewhat ruined by eating too much greasy midway food and consequently puking in the fancy hotel bathroom. Some people just can't hold their funnel cake...

Our hotel room was right next to the elevator, so we opted to move to one further away that had a king-size bed. One king-size bed. The registration lady loked at us a bit askance, and I got called Mrs. Esca'sHusband when I called reception.
Funnily enough, esca isn't even Mrs. Esca'sHusband. She kept her own name.

Sometime around midnight we ventured to the top-floor pool/hot tub, abandoned at that hour. I did call ahead to make sure it would be open ("What can I do for you, Mrs. Esca'sHusband?"), to be told that it was indeed open, and there woud be security patrolling. Yes, security. They would be patrolling. You know, the way security does...on patrol.
The repetition didn't help me catch on, so he had to spell it out for me. No drinking in the pool. Oh-kaaayyy.

Upon returning from Calgary we visited Wave some more and my friends hopped on her and she meandered around the arena. She is such a good horse. Husband even trotted/cantered on a lungeline.

It's hot. Summer tends to be fairly bearable here because the humidity isn't very high, but the temperature's been in the 30's for several days running. My ceiling fans are getting a workout, and for all I know my neighbors are getting a free show.

Thursday, July 5, 2007
10:40 a.m.

A Man And a Mosquito Walk Into a Toilet...

This town may suck in its lack of amenities, but the base clinic's nice and has a great civilian doc. She's originally from South Africa where she did her training, then she lived in Italy, and then for some reason came here...to this town...no, I don't get it either. Perhaps she's really a fugitive from justice.

In any case, she tells great stories of wacky medical hijinks. In SA in the '70s penicillin was too expensive, and syphilis was raging. When her medical group ran out of penicillin and couldn't buy any more, their solution was to catch some mosquitoes in a jar, send the syphilitic patient into an outdoor toilet with the jar and tell him to open it.
Whereupon he'd get sweet sweet malaria, his temperature would spike to 40 C neatly killing the Treponema spirochetes, and then he'd get some readily available quinine to cure his malaria. Not 100% effective, but the risk was acceptable given the consequences of untreated syphilis.
I vaguely remember hearing about this method sometime in medical school, in some "history of medicine" lecture, but I've never met anyone who actually practiced this way.

Testing diabetics for blood sugar also presented problems when there were no test strips available. The patient would simply pee on his doorstep, and in the morning the number of ants in that spot would be counted. Many ants = sugars too high.

In the later 80s, when statins became available but were astronomically expensive, they prescribed at 1/4 effective dose and advised the patients to eat a grapefruit with the medication. Grapefruit is processed through the same pathway as some lipid and cardiac drugs, and can cause build-up of the drugs to toxic levels. By prescribing a lower dose and counting on the grapefruit's effect to bring the drug up to therapeutic levels more patients were able to afford the medication.

You can't practice medicine like that anymore. It doesn't matter how remote and underserviced the area, you wouldn't get away with it. It's wacky problem-solving frontier medicine from the past, and it lives on in medical history lectures, and I'm so happy to be able to work with someone who actually practiced it.

Oh, and there are persistent rumors that Prince Harry is now in our training area, but no official confirmation of course. Certainly we get a lot of Brits training at this base for Afghanistan.

Thursday, June 28, 2007
03:35 p.m.

Hatshepsut Found?

The mummy of 18th dynasty pharaoh Hatshepsut may have been identified, based on a preliminary DNA match with her grandmother Ahmose-Nefertari and a tooth inscribed with her name that fits into the jaw of a mummy found in the tomb belonging to Hatshepsut's nurse. Apparently speculation has been ongoing for a few years about the identity of the two mummies found in that tomb.

If the identification pans out, Hatshepsut died obese and possibly suffering from diabetes and liver cancer. Since my obsession with her began several years ago with Pauline Gedge's Child of the Morning, the find will shatter my rather idealized image of Egypt's most powerful female ruler. Woe.

Visiting her mortuary temple complex at Deir el-Bahri is still one of my dreams.

Dr Zahi Hawass is giving most of the official media statements. He's the guy who's always narrating the Discovery programs on Egyptian antiquities. For some reason he bugs me and I have no idea why, he just does. Maybe because he seems to be in every single TV program on ancient Egypt?

In other news, I have no tooth or jaw pain today except for brief flashes of unpleasant sensations when I hit my temporary filling with my upper tooth, but I've almost always had that with new fillings and it goes away after a few days. Still, that's no reason to change my planned post-root canal all-icecream diet.

I have also finally had my winter tires changed to my summer ones, mostly because one of them was going flat. Stupid tires. Stupid car maintenance. The nice people at Canadian Tire put little stickers in the corner of my windshield, reminding me when my next oil change should be. I ignore them, to my car's detriment.

Wednesday, June 27, 2007
01:54 p.m.

Root Canal!

I am post...well, first part of the root canal. Apparently my tooth is stupidly complicated with windy, twisty roots, and the dentist ran out of time. Which doesn't overly impress me, but at least I'm not the one paying for this.

So the roots are now dead and the canals cleaned, and I have a temporary filling. The next appointment will be to fill the canals with this rubbery toothpick-like material called gutta percha, and to slap another filling on it, also temporary. My regular dentist will then do a permanent filling and crown.

The freezing was hell of course, but going through the initial pain to get it done properly was worth it. I was frozen from the middle of my lower lip to about the middle of the ear, resulting in a false sensation of swelling when I stuck my finger in my ear.
An interesting effect of the freezing was confusion of temperature sensation, resulting in the lower half of my face on the right side feeling burned. Not unpleasantly burned, more like I had an intense heat lamp focused on just that part of my face.

So certainly my pain/temperature senses were knocked out and the procedure wasn't too bad. A few times I felt something besides pressure, something not exactly like pain; perhaps the interpretation as pain of a cold stimulus or something, I'm not sure. It was unpleasant and it made me wince, but it only happened a few times. Mostly I was just irritated by the dental dam, so I consider that a pretty good experience overall.

What annoys me is waiting for the second part now, because I have to be reasonably careful not to chew crunchy/hard stuff with that temp filling. I like crunchy stuff, damn it.

Oh, and I'm annoyed at my teeth being complex and twisty. Can I somehow blame the Commies for that?

Sunday, June 24, 2007
09:19 p.m.

Die by Strychnine, You Tiny Bastards!

Spent 6 hours today exterminating prairie dogs/gophers/badgers from one of the summer pastures. One group would go ahead to mark the various holes with orange flags, then the killing crew would move in to put the poisonously delicious bait down the holes and pack them down with heavy clay.

We got over 200 holes, hopefully accomplishing pasture-wide genocide.

Three more pastures to go, 20 acres each. I despise burrowing animals.

Chibiko's a burrowing animal. Hmmm...wonder if she likes suspiciously sweet grains?

Tried to move Wave into a better paddock, a somewhat bigger one than the medical/quarantine ones. With some nice grass and trees, and a couple of calm friendly horses in an adjoining paddock.
However, she freaked out and wouldn't quit running around and snorting. Trotting should be ok for her by now, but she also broke into canter with skidding stops, so I threw her ass back into the tiny, bare, muddy medical paddock. Idiot animal.

The horses in general are morons. They live on an army base across the street from the armored training area. They have small-arms fire going on next to them at all times of the day, they have tanks and artie sims going off, there's the firefighter training tower behind the winter pasture that periodically sends giant plumes of fire and smoke into the air. Every now and then a chopper lands behind the barn. And they're used to that.
But lead them down a quiet path, and a shivering branch will send them into conniptions.

Also, root canal in 3 days.

Monday, June 18, 2007
06:23 p.m.

So Its Come to This...

Root canal.

Yes, root canal.

Root canal.

I have a temporary filling in, but the nerve was exposed and I'll need a fucking root canal before it starts inflaming on me. Once again the same story, old filling cracked and cavity started under it. In fact the dentist found a couple of small cavities under other old fillings, and these will just require a new filling.

But...root canal!

I could blame myself for giving in to my dentist-phobia and avoiding them under my teeth literally start falling apart, or I could blame the political regime in my country of birth for not fluoridating the water.
Myself, or political regime.
Myself, or political regime.

...

Fucking Commies.

Sunday, June 17, 2007
08:23 p.m.

Chippity-Chip

Good thing the army has full dental coverage, I keep chipping off my damned teeth. The first was shortly after I arrived here, just randomly chipped off, no cavity or anything. The second time was in the fall, while I was back east for a course, basically a cavity formed under an old filling and made it chip off.
Yesterday's is also on a tooth that had been previously filled, sometime in my teens. Pretty much all my back teeth are filled, the legacy of growing up with no fluoridation, so this chipping isn't a bad thing - the new fillings are white and look prettier than my old silver ones.

Other than the continual failure of my teeth to stay intact, there's not much new to report. Wave is back home in a medical paddock, just hanging out and on a diet because she looks pregnant. 6 weeks of not moving takes a toll.

Since I've been given the go-ahead to start riding her for few minutes at a walk, I took her out to the outdoor arena for a handwalk to see how she'd react. The first time...did not go well. The arena is behind the barn so she couldn't see any other horses, acted nervous and kept calling loudly to her paddock neighbor. She was not paying attention to me and I was thankful for that chain around her nose. I kept asking her to stop and back up, basically just obedience exercises, and I really had to haul on the lead and whack her knees with the crop to get her to obey. A couple of times I swear she was thinking about rearing, but didn't.
The second time went much better, she was still calling out but otherwise was minding me. I didn't have to use the crop, and most of the time she stopped when I did, on a slack lead. I think she just has to get her mind back into work mode.

In any case, I was frustrated by the first arena walk, so I went to the tack store and got a fly mask, blanket and new girth. What coping problems?
Ah, I also got her a glucosamine supplement. Oddly enough the studies of its benefits are more convincing in livestock than in humans, and I take the same view of it as I would for my human patients: it won't hurt, it may help, so if you can afford it then why not?
It smelled quite pleasant, vaguely reminiscent of something familiar and edible, so today I licked some off the little scoop as I was preparing her feed.
The familiar edible thing? Instant mocha coffee mix, that's what it tasted like.
Well, not quite. More like a teaspoon of instant mocha coffee mix stirred into a tablespoon of salt. Not table salt, some kind of freaky mineral salt with its own objectionable flavor.

In other words, I won't be making drinks out of Wave's supplements anytime soon. And that is a good thing, because they're goddamn expensive.

Friday, June 8, 2007
06:19 p.m.

I Have a Mac

I have bought the mid-range MacBook.
This is because I can't handle any more time without the internet. My desktop has sputtered its last and been duly pronounced by the nice tech people. The library just isn't cutting it, and I've been net-less for the duration of BOTC and that's more than enough.

That, and all my Mac-owning/experienced friends have been pressuring me to buy one for years. Obviously I had to get a laptop, I'm fairly certain I was the last doctor in this country without one (I'm still holding onto my cell-free record), and the non-Mac options are many and terrifying. Terrifying because they're so many, I guess, and there doesn't seem to be one everyone can agree on in terms of quality. Mac makes it easy.
It also makes set-up easy. Take out of box. Plug in power. Plug in Ethernet. Turn on. Surf. Literally that simple. I don't know what any of the big shiny icons on the bottom of the screen even mean, but I can access the internet and that'll keep me happy for now.

Next step is a new digital camera. Mine has been looked over by techies, and they can't do anything quick and cheap. Sending it into the repair centre would probably end up costing me more than my 3-year old Canon is worth. They weren't against spraying it with deinoized water, and I will try that, but from the way they said it I understand that they wouldn't be against running my car over it either.
So, there's the newer digital Elphs from Canon, apparently the new Sonys are also good, and freaking Olympus makes the only waterproof ones but I gather their picture quality isn't as good.

Thursday, June 7, 2007
05:47 p.m.

I'm Home

Back home, not yet unpacked, only to learn that the army wanted to send me to some wasteland for 2 weeks. Managed to avoid wasteland by pointing out that it has 2 resident MOs, both of who would be fully capable of running the damn TCCC course.
Will still have to run our own TCCC course starting next week, and that means not seeing patients. I don't see patients any more, I run courses, go on courses, attend conferences, and do paperwork in between.

I'm also on 24-hour standby for the B.C. floods, so I won't even bother unpacking for now. Normally I'd home to be send there, but Stampede week is coming up fast and that tasking could last a month or more.
So keep dealing with your shit in-house as you've been doing, B.C. I believe in you!

I'm back home, Chibiko's back home, and Wave's coming home on Monday. The follow-up ultrasound showed the tear has healed well, and there's still inflammation in the tendon. She can go off stall rest (after 6 weeks, the poor thing) and into a small medical paddock, and begin the slow process of rehab. She should be rideable again, but I won't be jumping her. I just don't want to risk it.
My trainer claims to have found a "perfect" horse for me to progress on. She's listed at k. Do I need another, far more expensive horse right now?
No harm in seeing it, I suppose.


Electronics Hate Me
If not a new horse, I'll at least need a new digital camera and computer. The camera met its end suddenly by way of a bracing salty spray, but the computer's been dying a slow and painful death for a few months. By now it turns on for half an hour or so before abruptly shutting off, and that's only if I'm lucky. Most of the time it doesn't even turn on long enough to load Windows.

I'm thinking laptop. Laptop for web surfing, some playing with photos, maybe watching DVDs. What should I get?

Tuesday, June 5, 2007
10:40 p.m.

...A Three-Hour Tour

Today I saw orcas in the wild.

Victoria has a resident killer whale group, J pod, and I skipped the last few hours of today's conference offerings to go see them. It was all pediatrics and geriatrics in the afternoon anyways.

I didn't see the newest month-old baby, which is apparently still pinkish in the places that orcas are white, but I did see the year-old baby swimming with its mom. I think I managed to snap the mom's dorsal fin, those suckers are fast and surface unpredictably; I had the same problem with the pink dolphins in Hong Kong.

One of the teenage males put on a show for us from only about 50-75m away, jumping straight up as if he were performing at SeaWorld. Of course he jumped once when the boat was still moving, the second time when I was fumbling for my camera.
Then, as our eyes and cameras were glued to the spot he breached from, the little bastard swam about a thousand kilometres in a random direction and jumped again on the horizon, which goes to show that juvenile males are pretty much jerks across species.

The waters were growing too choppy to continue chasing the whales and we made our way back, the Zodiac occasionally ramming our spines like it was dropping several feet onto concrete. The fun part was trying to guess which drop would be gentle and which to take on our feet.
When we got back, we found that the flotation suits provided weren't waterproof everywhere. Specifically, they were highly permeable in the crotchal area, and our little group of 12 walked out onto the downtown streets looking like we had ourselves a pissing contest on that boat.

I did succumb to temptation and booked the wonderfully relaxing in-room hot stone massage following the excursion, and that proved fortuitous as it distracted me from the sudden death of my camera.

Ok, so my PowerShot obviously got sprayed with saltwater. It wasn't doused, the battery and memory card compartments were dry when opened, but it did get sprayed. It won't turn on at all, not in the picture-viewing or in the picture-taking mode, and I did switch to new batteries with no success.
Now what do I do? Wash it with plain water, hit it repeatedly, junk it, sell it on eBay?

Saturday, June 2, 2007
05:32 p.m.

Post-Basic Destressing

After 4 weeks of living in hard stands (big semi-permanent modular tents with concrete floors) and in hootchies in the field, I departed the hated basic training encampment at 0630 today, and by early afternoon Western time found myself in the Chateau Victoria, in a suite with two TVs and in-room spa services.

After 4 weeks of living on hard rations, box lunches made of "processed cheese food" and absolutely no vegetables, hay boxes filled with slop of various degrees of disgustment, and the very rare relief of a meal at the Officer's Mess, I pigged out on seafood phyllo pastries, mini-samosas, really fancy canapes and the chocolate fondue fountain, and the wine&cheese is still to follow.

This is just a quick entry to say I'm back, if not at home. Hell, it's better than home. This is one of the really nice medical conferences, and if I was paying for it out of my annual allotment of Continuing Medical Education money I sure as hell wouldn't be staying at the Chateau. However, for the low low price of wearing the uniform during the conference, my CME funds remain untouched and I get to live it up in style.
Hell, seeing how I just finished the pilot basic training, I'm not even sure they'll want me to work the recruiting booth at all. I might scare away the prospects.

There'll be more later, with pictures and no bitterness. Bitterness fades very quickly when the thing making you bitter is over for good, and the organization that was responsible puts you up in the best hotel you've ever stayed in.

Oh, and I didn't make Top Candidate. I was first runner-up, which means I got kudos on my course report but no pretty flag. Ah well, I even voted for the guy who did get it, he was a solid leader without resorting to the overly authoritative stance like I tend to do. I'm a powermonger - give me power, and I'll be in your face, mongering.

Sunday, May 20, 2007
10:04 a.m.

Fucking God, It's Real

It's real basic training, compressed into 2 weeks of all the classroom lectures done via distance learning, and all the remaining hands-on material done over 4 weeks.
In the past 2 weeks, we spent 8 days/nights in the filed, living in hootchies, being eaten alive by blackflies, sleeping an average of 3-4 hours a night, usually not all in one chunk. My skin may never recover from the constant application of DEET - which doesn't work, I'd bathe in it if it worked - cam paint, dirt, cold , sun and that rifle-greasing oil.

Ah, the cold. Of course one expects cold in the field, but our barracks are also not heated. We're not at the actual base, we're camped out in the cadet's summer training camp, which isn't open yet because...it's not summer! It's getting down to 0 Celsius, and we have no heating. At all.

Pilot courses. This will change; we've already lost some people, may lost more over this weekend because at least one of our members is talking to his lawyer about getting out of the contract. We're all GP's and nurses - this course is meant for all Health Services staff, and I'd really like to be a fly on the wall when the first surgeon goes through and sees what's happening to his hands.

I'm not trying to be whiny. I went through recruit training and did fine, and I'm in line to be Top Candidate on this one. I qualified as Marksman on the C7, I got 100% on my Small Party Task, I know how to do and call drill properly. I don't like the cold, but I can suck it up.
But the candidates were lied to. This course was supposed to be designed specifically for already-trained professionals, with an understanding that we all went through stuff like sleep deprivation and know how to function under adverse conditions. Basic Training is meant for still-untrained members who, after completion, may go on to be Medics or Infanteers or Supply or whatever it will be, but who at the point of the Basic are still untrained and should therefore be given a broad basis in soldiering to prepare them for many different jobs.

There's no point in trying to get a bunch of doctors to do section attacks and sentry duty - it's not only outside the scope of our real-life army duties, it also nullifies our Geneva protection. We're not allowed to actually do this crap, and that's what rankles - it's one thing to have to suck it up and learn something that may be useful, quite another to do the same knowing the material being taught is completely useless to your job.

2 more weeks. We got from 1400 yesterday to 1800 today off for passing inspection (and because they'd be facing a mutiny if we weren't given a chance to destress), and it's time for me to go back. At least I got to see my parents and sleep in a bed.

Friday, May 4, 2007
07:53 p.m.

Well, I'm Off

This is it.

I've packed my uniforms, my field kit, my cool tac vest, my boots and shiny, shiny parade shoes, my socks, my many pairs of cute army-issue boxers.

I've dropped Chibiko off at her boarding place, saw Wave one last time and walked her a bit in the downpour, then brushed the water off of her.

I've eaten all the fruit in my fridge.

And in the wee hours of tomorrow I start my journey back east for my leadership course. Or basic training/leadership combined course, the first-ever Health Services serial attempted. I wonder how different it will be from the basic training I did back in 1999, when I was an insignificant no-hook Private.

At least I already know how to march, that'll put me ahead of at least 2/3 of our group.

I will be offline until early June. Goodbye, civilization!
I will mail! Mail me back!

Thursday, May 3, 2007
09:44 p.m.

I Is Drunk

I is drunk on free pharmaceutical alcohol and filled with top-notch pharmaceutical steak and cheesecake.

Seriously, the only time I go to super-expensive restaurants is when a pharma-corp sponsors it. This one was about antibiotic resistance; very important steak topic.

Ah yes, last great dinner before I hit BOTC and am forced to live off of IMP's and box lunches for a month.
Although I will be flying to Victoria, B.C. directly from my course, for a magically sponsored medical conference. Magically sponsored means it's not coming out of the money allocated to us for medical conferences, but from a separate, above-and-beyond fund. I like that fund a lot, last year it took me to the Family Medicine Forum in Quebec.

I should sleep.
But I'm too drunk.

Wednesday, May 2, 2007
08:23 p.m.

Quantum Leap

Today I ran for an hour.

A whole hour, steady pace, through pissing rain.
I've never done that before. Oh, I've run for exercise, up to 30 min at a time. Then I'd abandon it because I hate running, and after a time start up again and work up to 30 min or so. I never tried training myself up for any kind of distance runs.

I don't love running. I don't get a runner's high, although maybe I'm just not doing the distances required for that yet.
But I love the sense of accomplishment, the feeling of my breath coming slow and steady instead of burning my lungs like in the beginning, the way I'm not really aware of my legs any longer because they just move easily on their own. I love that my muscles don't ache any more, either during or after a run.
I also noticed that after starting to run, after the first few days of painful hell and fatigue, I do feel more energetic during the day. I've stopped sleeping in on weekends, my appetite for random snacking has disappeared, I feel weird and jumpy if I don't run. Today was supposed to be a rest day, but my legs just started twitching as I was sitting in front of the computer.

I just wish I loved the act of running itself. Perhaps in time I will, if I don't abandon it yet again.

Still, when I get that second wind, when my breathing slows and settles down and my legs go on automatic, running feels like it's what my body was designed to do.

Sunday, April 29, 2007
06:05 p.m.

State of Our Fitness

I'm up to running 30 min at a good pace with no leg pains, shortness of breath, or any other untoward side effects. By the end of this coming week I should be able to do an hour, which ought to be more than enough for my upcoming course. Push-ups are also progressing decently.
Blisters caused by the breaking in of my second pair of marching boots have not slowed me down. Yay me.

My horse, in full-time training for almost two months, has suffered a partial tendon tear and has abruptly been confined to her stall and a teensy medical paddock, allowed but one 15 min handwalk a day.
It has made her insane, as I discovered when I visited her this weekend. She was acting like a racehorse being led to the track, snorting, bug-eyed and desperately trying to run.
This increased-fitness thing clearly isn't working out for her.

The ferret is holding steady at her usual routine of flipping out completely for an hour and sleeping for the remaining 23, with eating scheduled somewhere in between. 1 hour of exercise a day is certainly above the minimum recommended for cardiovascular health and fitness, but I'm not sure how all that sleep factors in.

Le sigh.
Earlier this week my mom called and I gave her the news about the tendon injury. Mom doesn't quite get the horse thing and didn't really want me to buy her, but not much she can do about it. She also didn't get why I send her into training in the first place since she's a well-behaved lesson horse, and why the training and the board at that barn was so expensive.
So now that she's injured, mom started questioning why I'll still be paying to keep her at the expensive barn (because I'm going away for a month myself, and at the training barn my trainer will look after her), why I can't just dump her into the pasture at my cheap subsidized barn, do I think the training was pointless, do I think buying an older horse was a good idea, etc etc.

I was already irritable from a week of 14-hr days of instructing in the field and doing jump coverage, and from only recently learning about the injury myself, so I'm afraid I snapped and unloaded on my mom.

She hasn't called since. I think a little communications break may not be the worst idea.

Wednesday, April 25, 2007
02:25 p.m.

Birthday!

Today I turn not-quite-30.

I celebrate this occasion by working at the civvie clinic in the morning, and then going out into the field to watch infanteers practice their medical skills in the dark.
Through the wonder of night-vision goggles I will apparently be able to see the spurting arterial bleeds of our moulaged casualties.
Fun fun fun.
Pharmarep came by civvie clinic today, so I scored a nice lunch and a big piece of chocolate cheesecake for later. Pharmareps are birthday love.

I was also just informed that BOTC is almost definitely a go, so May will be spent on quasi-basic training in tent village with no internet access. But if I have to go, I consider May the best month to do it - it's not really cold any more, and it's yet hot.

Tuesday, April 24, 2007
06:48 p.m.

Waaahhh!

Wave has managed to tear the deep flexor tendon in her hind leg. The leg's been off sometimes, especially during lead changes and canter work, but she wasn't really lame and it wasn't constant. More recently she was tensing up and pinning her ears when asked to put more weight on that foot.

So we did XR last week and found nothing, and ultrasound was today. Tendon tear ahoy!
She's now on stall rest/handwalking for a month. She totally did this on purpose to get out of training.

My trainer suspects the initial injury may have occurred as far back as February, when she started four-beating more during the canter, but otherwise was happy and showing no symptoms. It then got worse with training because the work was more rigorous, and that's why she started looking unhappy and acting weird and spooky.
She also says Wave is a pretty tough mare to have kept going as well as she did without really showing lameness - I just had a lesson on her 2 weeks ago and she was fine. I was just doing walk/trot, but it probably still hurt her and she was putting up with it, and now I feel all guilty. Sigh.

She's staying at my trainer's barn for now since I'll probably be send on BOTC in May, and then we'll do a follow-up. The vet says it should heal fine with rest, so all she really accomplished was to get out of her last month of training and deep-six all the expensive muscle building of the past 2 months.
Damn horse, sabotaging all my efforts to make her the best she can be.

If she's ok by July, I'll make let esca ride her!

Good thing I started running again, since my horsey exercise is being interrupted. Though that was mostly in preparation for BOTC, out of fear of dragging down my platoon. Army peer pressure is good for you!
That, or maybe I should start looking into this tendon tear business. It clearly leads to the sweet life.

Monday, April 16, 2007
06:43 p.m.

Weighty Matters

So, our government - not sure if provincial or federal, I wasn't paying attention that closely - wants doctors to "take ownership of obesity management" and to treat it as aggressively as we treat diabetes.

That would be fine, if it wasn't for the politically correct pressure in the opposite direction. It's evil and judgmental to call people fat, don't you know. Even if you couch it in proper medical terminology instead of the schoolyard bully's "fatty-fat-fat".
Oddly, we can keep reminding smokers that smoking is bad. It's standard practice to do that, since studies have shown it makes quitting more likely; not pushing and harassing, just mentioning it at routine visits.
Smokers know they smoke and that smoking is bad, but we still talk about it. We're supposed to.
Fat people similarly know they're fat and that it's a health risk, and now it looks like we'll have to address that fairly frequently, and yet I personally know doctors who've had official complaints because they discussed someone's BMI and hurt their feelings (complaints were naturally dismissed, but what a bother).

The main problem is that obesity, like smoking, is a lifestyle issue*. You can certainly medicalize it to an extent and that can be helpful, but you can't exactly equate it with diseases like cancer, as an obese patient on the news program did. Cancer and its ilk are cured (or not) primarily with medical intervention that doesn't rely on individual effort.
Lifestyle "illnesses" like smoking and obesity must be cured almost entirely by the patient's own effort, with only some peripheral medical aid. The onus must remain on the patient.

For obesity treatment we have the lovely Orlistat, which works by blocking fat absorption. It can cause the much-mocked side effect of oily anal leakage, but it's the only medication that works no matter what the patient does.
The others, like the serotonin/norepinephrine reuptake inhibitor sibutramine and the new cannabinoid-1 receptor blocker rimonabant, are basically what I call self-control enhancers. They work in various ways to suppress appetite or mimic satiety, and tend to be fairly effective in official studies - but in those studies, subjects tend to be highly motivated and keep to a diet and exercise regimen as well.

The problem is, of course, that obesity isn't caused by hunger. There's a nice study where subjects were asked to drink at least 8 glasses of water a day and to report their satiety scores - drinking more water created feelings of satiety, but made no change in food consumption.
Overeating is a habit, and a feeling of satiety won't stop it. I tend to eat when I'm in front of the TV, whether I'm hungry or not. I know this and I know that it doesn't really matter to me what I eat, so I keep my fridge stocked with carrots and sweet peppers and avoid buying junk foods; I'll still eat as is my habit, but I'll have no ready access to high-calorie crap.

In the end, no matter the drugs, newfangled diets, the "new science of glycemic index" and anything else, it comes down to simple math.
Calories in - calories spent = calories stored.
Slow metabolism, genetics, hormonal problems, none of those affect the basic equation. They do count in that those whose metabolism is slower have to eat less, or exercise more, or both, than the people blessed with a fast metabolism. Life's not fair that way. But metabolism, genetics and hormones can't create calories out of thin air - those come from our diet, and the fat we accumulate is a direct result of not burning them up through activity. It's that simple, it was always that simple and it will always be that simple.

Yes, habits are hard to break. Changing a habit takes a long, long time, and there are usually setbacks, and that's fine. It may have taken a lifetime to set this habit, it won't change in a few weeks. The medical system can help, can guide and even prescribe those medications we have available - but the hard work will still need to be done by the patient. Medicalizing obesity completely, equating it with cancer, does nobody any favors.

This mandate, however, does imbue me with another kind of initiative. If it becomes the standard of practice, prescriptions of anti-obesity medications will surely skyrocket.
Time to look into some new investments.


*Nobody had better mention those people who are disabled in some way that makes them unable to exercise. They're not the reason obesity rates are rising like yeast on 'roids.

Saturday, April 14, 2007
04:19 p.m.

Happy Birthday, Wave!

Slightly belated, it was actually on Wednesday.

Wave is 17!

She's getting too spoiled. Everyone loves her and feeds her treats, I think she's getting confused when people come up to pet her and don't give her anything.
Of course I brought a huge bag of treats, but I totally had an excuse. It was her birthday visit!

I miss having her at my home barn. I miss having the whole barn routine as part of my day.
Her being away allowed me to go on a bunch of taskings and even vacation without worrying, but when I'm here my days are kind of...bleh. The saddle club really is my major non-work social scene, so. I miss it, and I miss having Wave there. By gum, I even miss mucking out her stall.

In good news, I'm apparently a priority to go to the Basic Dive Medicine course in the fall. I was feeling overlooked for not being loaded on the Flight Surgeon one, even though I fear the centrifuge, so Dive Medicine would be nice.

Wednesday, April 11, 2007
06:32 p.m.

The Taxman Always Hurts Twice

Ouch. Just did my taxes.
Due to the large accumulation of unused RRSPs from last year and most of this year, I won't have to pay anything. This should extend into next year as well because I still have a large chunk of untouched RRSP goodness stored up.
But after that, I'm toast. The army is good about taking off taxes, and as much as it angers me to see how much of my income disappears, it does leave me reasonably safe at tax-time.

The problem is the civilian clinic, which doesn't take off anything. Except its 40% cut off the billings, of course.
But my 60% cut remains untaxed until April, the evillest month, month of my birth. I only started there in Dec of last year, and already I'd have owed the taxman a grand if it wasn't for my precious RRSPs.
Hm. By my calculations, with the clinic's cut and taxes, I make for every 0 I bill. Booo, taxes!

The second problem is my military pension, which severely, severely curtails my ability to pay into RRSPs. In fact it's only April and I may already have exceeded my allotment for 2007. It's insane. Now I'll have to switch over to non-RRSP investments that don't give me any tax breaks.

Damn this government work. It doesn't let me hide my income, and it pays for everything that would normally count for a deduction.

Tuesday, April 10, 2007
07:55 p.m.

Miscarriage A-Flow-Flow

Ok, patients. If you're actively miscarrying and choose to see a doctor, please hie your ass to the nearest ER. Not because they can do anything for you, especially in the first trimester, but because they can at least do bloodwork and ultrasound on-site and tell you if that's what's happening.
And just in case you're not actually miscarrying but bleeding from something fun like placenta previa, they'll be able to tell that too. And with much more safety for your possibly-saveable fetus than I could, because the only thing I can do at our family clinic is stick things up there. Things that shouldn't be poking your placenta.

Two highly likely first-trimester miscarriages in a 3-hour period, at a normal family practice clinic. What the hell?

Thursday, April 5, 2007
05:39 p.m.

Airport Lounges Rock

Particularly since the military seems to enjoy putting me on non-direct flights with a few hours' layover.

In lounges you can relax, put up your feet, eat as much delicious chicken cury as you want, surf the net...drink. Drink some more. Surf the net drunkenly. Eat muffins. Drink lattes. Resign yourself to self-inflicted overactive bladder syndrome. Drink to forget about OAB.
And so on.

I'm not actually drunk, it's too early in the day. Besides, we had a party at the base last night, I was drunk then.

But I am drinking half-decent lattes and vaguely pitying the harassed masses outside the oasis that is the lounge, attempting to rest in those hard upright short-backed chairs, having to pay for each latte, browsing overpriced stores just to kill the time. I used to be one of them.
I'm still not one with the middle-aged gentlemen in business suits who will be flying at the front of the plane where legroom exists, but at least I've made it as far as their lounge.

The exercise went very well.
I was the senior medical authority of the FOB (forward operating base), set up to receive casualties of a major air disaster up in the arctic. The day before our main exercise, the Search&Rescue techs from Canada and the US were dropped off with their kit, stabilized the casualties and cared for them overnight. We were receiving them, retriaging, managing and moving out to definitive care.
There were 43 casualties, but 8 arrived already dead. I further deadened two of the major head injuries by not ventilating them because we couldn't spare the manpower.
One of them was deadened on-camera, so this may show up one of these days on the Outdoor Life Network. That'd be neat.

The Americans were both playing and observing, and there were military observers from Russia and Japan as well.
Sadly I didn't get to fly on any aircraft, being stuck in the FOB. Next time...

Monday, April 2, 2007
09:49 a.m.

Real Estate

My brother just bought a house, pending inspection.

Huh. I didn't expect it quite so soon. Four bed, three bath, hardwood floors, finished basement, fireplace, huge backyard.
I guess he'll have to breed soon too, gotta fill up those rooms.

I need hardwood floors. Having a ferret is murder on the carpets.

Leaving for B.C. today, the island. Looking forward to it, because the weather there is nice and it's snowing here. Again.

Monday, March 26, 2007
09:17 p.m.

Oh, Army...

Today, still on leave, I decided to drop by the base to check my messages and find out about that tasking I have next week.

Well, the tasking itself sounds great, to the east coast of beautiful Vancouver Island "with its stunning views and vibrant combination of outdoor adventures and cultural activities...one of BC's top year-round destinations!"
But it sounded great over a week ago when I first heard of it, and send emails asking for more details. Such as, will we be under canvas, in barracks, in hotels, what? How will I bring my medical jump bag, filled with many liquidy narcotics, on board the airplane? When and where do I report for duty? What, exactly, am I supposed to be doing there anyways?

Today I learned that I have to be there for next Monday, or possibly Sunday. Hey, could even be Saturday.
No word on accommodations. No idea when I'm flying out; it's in less than a week, shouldn't a ticket have been booked or something?
As for my jump bag, it's like I'm the first military doctor ever to fly with meds. Nobody seems to know anything.

It doesn't help that all out leadership, all of it, is either on leave or on a course/tasking. The CSM's position is being filled by a Master Corporal, the OC's by a Second Lieutenant. The CO is gone too. The BC contact person for the tasking itself is also away on course.

*headdesk*

This week I'm still on leave, and then off to a medical conference in another city. I shouldn't even have to come into the base, but clearly I'll be spending my free time there, trying to somehow find my way through this clusterfuck.

Sunday, March 25, 2007
07:59 p.m.

Home Sweet Home

Home feels warm.
My parents keep theirs relatively cold, because mom can't sleep when it's warm. She finds it funny that I want to walk around my place in briefs in the winter. It's winter, I should toss on a sweater and quit heating like a madwoman.
Well, it's my heat, damn it. If I want to prance around like I'm on the beach, I'll do it.

Except today it really does feel too warm. Oh well, opening the window will fix that soon enough.

Also, while I'm relieved to be back on my own turf, the lack of delicious home-cooked food in my fridge is a letdown.

Arrived back today, flight was uneventful except for the hour-long delay due to fog, and the drunken bunch a couple of rows behind me. Loud, but not obnoxious, and better by far then the three squalling toddlers on the way east. That was painful, it's like they seated all the kids in Angelina Jolie's menagerie the world directly behind me. My earplugs kept me marginally sane.

But I got a cool pic of the CN Tower's antenna poking through the clouds as we took off.

Vacation-wise the past week was great. I was able to meet with many of my friends - esca and hubby of course, and even meta proved to be alive - and this had the added benefit of taking me out of the house. I love my parents to death, but if I had to spend the whole week entirely with them, someone would've died. Listen, I'm an adult and I'm on vacation, if I want to read until 2am I will read until 2am, damn it.
When I was a kid and all-nighters didn't affect my days, I would read in bed and listen for my parents. If they seemed to stir too much, I'd flick off the lamp and wait a bit, then go back and read until the night outside turned greyish. Night-time reading is a habit that's stuck with me, although I don't stay up until dawn anymore.

Monday, March 19, 2007
12:31 p.m.

Time to Unclutter

I'm on vacation, back at my parents' home. Sorting through my junk.

This isn't my childhood home, they only moved here a few years ago. But they faithfully moved my stuff with them, throwing it into big clear boxes as it was, straight from the shelves and drawers. All the crap I never bothered to take with me when I myself moved, first for med school, the for residency, finally to my first army posting across the country.

Four large boxes of school binders and books, plastic jewelry, old musical instruments I never learned to play properly, glue-on nail kits from Halloween, assorted anime posters and pretty calenders, bits of various sci-fi memorabilia, ancient dried-out make-up, cassette tapes, kitsch I picked up at garage sales.
I whittled it down to maybe a quarter of a box of yearbooks, official-looking papers, a stack of correspondence I may never read again but which has too much nostalgic value to just throw away, my barely-started and long forgotten foreign coin collection, and a handful of matchbooks. I collect matchbooks from my trips; I never throw any away, but they have no emotional value to me - I use them up when I run out of normal matches or misplace my lighter. There are always matchbooks to be found among my junk.

My parents will probably hold a garage sale come warmer weather, but I believe those possessions of mine that could make a buck, or even a few pennies, have already been sold. These are just the kind of things people hold onto because of the memories attached to them, or because they may be of some use down the road, or even because they've been stuffed into a drawer for years and sorting through them seems boring and unnecessary.

I pride myself on keeping my home neat and uncluttered. My clutter had always stayed behind with my parents.

As did my brother's, apparently - he appears to have owned a photocopy of something called the Terrorist's Handbook. Sometime in early high school, judging by the binder in which I found it.
It looked fairly untouched to me. As did the girlie magazine stuck in the same binder.

Wednesday, March 14, 2007
10:25 p.m.

Telling the Future

Today I had a nasty fall off Wave.
We were in the training barn's arena, and there were a bunch of riders having a jumping lesson. We were just trotting around when one of them spooked into us, not close enough to touch but close enough to freak out my horse. I held on through her initial spook in one direction, but was off balance and fell when she decided to spin in the other.

My new, pretty, stiff saddle also has stiff billets, making it difficult to properly tighten the girth. I adjusted it twice under saddle, but apparently it wasn't enough - it slid off when I fell, ending up halfway under Wave and making her panic.
Thankfully she decided to take off away from me.

There were lots of other people in the arena and someone caught and unsaddled her, and I walked her around once I sorted myself out. She continued acting very spooky, trying to rear whenever someone rode by us, so I chose not to get back on. Normally I do after a fall, it lets her know that dumping me doesn't mean a rewarding end to worktime, but normally she's also totally calm after the spook. I'll have to talk to my trainer about this; I know she doesn't like other horses passing her, but she's never freaked like this before.

Where does the future come in?
Last week my trainer unsuccessfully tried to find the liability release form I need to sign before riding in the barn. So we dispensed with it for the time being, but I did tell her that my imminent plans involved falling off the horse and suing the barn into the ground.

Fuck you and your sense of humor, Universe. Next time I threaten to do something, it will involve me winning the damned lottery.

Sunday, March 11, 2007
06:51 p.m.

How Do We Measure Up?

Since I have so much free time at work that I'm thinking of finally learning to type properly during clinic, I've taken to actually reading those medical newspapers that keep arriving with my name on them.
One such paper is the Medical Post, and one article caught my eye. In it the author compared Canada with countries that, while still guaranteeing access to health care regardless of ability to pay, make significant use of the private sector. The services are publicly funded, but in part delivered by private, for-profit companies that understand the concepts of competition and efficiency.

Out of the 28 developed countries that guarantee access to health care, Canada ranks 24th for access to physicians, 13th for access to MRI machines and 17th for access to CT scanners.
Our health care system is the second most expensive one among those 28 countries.

The countries being compared with us aren't paragons of capitalism. Sweden, for example, is generally acknowledged as being pretty socialistic. And yet its government, recognizing the inefficiency and money-wasting of a publically run system, allows private for-profit hospitals to compete for public dollars. Somehow, those hospitals make a profit and deliver better health care than do ours.

Some countries, like Germany and the Netherlands, have moved to increase patient responsibility in the system. Part of the cost of health care is paid out of pocket.
Now, since these countries do have universal access health-care programs, I assume the poor are given a break under this system. But I'd love something like that to be instituted over here, even in a very limited capacity to cut down on patients who run from one doc to another for second and third and sixth opinions, usually not bothereing to bring copies of their tests and therefore necessitating repeating those tests. All of that costs the system money, and the system is hurting.

As the author of the article wrote, "It is well time that Canadians sat down and took an honest look at what works elsewhere in the developed world. Using proven policies from other developed nations with universal access health-care programs would dramatically improve the state of medicare for all Canadians."

I couldn't agree more. We love to compare ourselves to the US, to crow that although we don't have an MRI on every block, at least we provide health care to everyone who needs it.
But the US isn't the be-all and end-all. There are nations out there which manage to do the same, and to do it better. Is is against those nations that we should compare ourselves.

And on a lighter note - movies!
Today I saw 300 and Breach.
300 was fun. It was a comic book movie, obviously so, and a damned good one. It was fast-paced, entertaining and gory in that comic book type of goryness that's very detailed and very unrealistic. I highly recommend it.

Breach was the heavyweight. Ryan Phillipe's character, the young idealist who's supposed to spy on Hanssen, was fairly well done.
His wife bugged the hell out of me, in that typical "OMG I know you can't just go around sharing FBI secrets with me but don't you trust meeeeee" whiny-woman way, but thankfully she wasn't onscreen that much.
But Chris Cooper as Hansson made the movie. He played an incredibly complex character, not likable but not a one-dimensional villain either. You could follow his reasoning, believe that he didn't do this purely for profit - but also not just because he wanted to show cracks in the US defences. His pride and his bitterness are beautifully portrayed.
Good movie, great acting.

Saturday, February 24, 2007
12:39 p.m.

Horsie's Gone

She was moved to the show barn last night, while I was sitting in an ambulance, reading mindless magazines and waiting for crazy people to drop out of the sky. For such is my life.

I eventually made my way to the barn to find her all settled in. Evidently she likes the automatic waterer, and everyone thought she was very cute, and someone asked my instructor S if she's sure that she doesn't want to sell her right away.
We're pretending she's a flip horse belonging to S, so I don't have to pay an even higher premium.
S says that she's obviously been around, being moved to a completely different barn didn't bother her at all. She acted her normal self when I saw her, not hyper or worried or anything. New home, ho hum, bring on the hay.

Today I'm packing for another journey to Wainwright, training area of hell and frozen piss on blue rocket urinals. This time, however, I'll be staying in "suites" - read shacks - and working in the clinic.
And the training area when required. And being on perma-call, since I'll be the only doc they'll have.

I was strongly warned to stay out of the bars "even if you're a bar person". They must be pretty awful, as must living there be - what's there to do in winter but go to bars? Heck, even the town's official site, which is designed to make it seem like a wonderful place, mentiones the "luxurious accommodation of a modern motel."
Luxurious? Motel? Something does not compute.
It seems a pretty bleak place and one I hope never to be posted to.

Sunday, February 18, 2007
02:33 p.m.

Slightly Less Pain

Today hip was well enough to ride, much to Wave's displeasure; she had an unexpected day off due to my limpage, and was hoping for more of the same today.
I didn't ride for very long because it still hurt whenever I tried to close my left leg properly, plus she's a bitch on lesson day if I have a long ride the day before.
Pssshhh. This will end soon enough, this Friday she's off to her immensely expensive but work-heavy training.

Poor thing's going on 17. I should be retiring her to the pasture, not sending her for training.

She responds so much better when I'm mean firm with her. Last lesson she finally spooked properly - she hasn't done that since she arrived here - spun around, cantered off into the opposite direction. I lost a stirrup but managed to stay on, meaning I still haven't fallen off since moving out west. I used to fall off all the time in Ontario.
I then proceeded to kick and crop her ass past whatever imaginary thing spooked her, and she in turn proceeded to be fine for the rest of the lesson, didn't even fuss about the jumps and didn't try to pull me over them either.
And she was weirdly affectionate after the lesson, kept sticking her head out of her stall. Usually she turns her butt to the door as soon as she's in and only turns around when I bribe her with treats.

Perhaps my horse is a masochist.

I offered to bribe esca with treats too, coffee and crabs and pho and stuffs. Will it be enough for her to come, or does she get treats at home?
Should I be mean instead? Perhaps she too is a masochist...

Friday, February 16, 2007
12:48 p.m.

Paaaiiinnn...

Just finished BFT.
13km march in 2h 26min (I finished in 2h 10min, yay me), with 20kg of webbing/tack vest and ruck, 2kg of helmet on your head, and 3.3kg rifle. On crappy footing which, while actually better than the last two Fridays because of the cover of wet sticky snow that provided some decent traction, was still crappy enough to cause some wipe-outs and one serious injury (patellar dislocation).

The rifle can be slung using a patrol sling, but that just results in extra weight hanging from a neck that's already protesting the helmet and the damned ruck.
Equipment made by the military sucks, there has to be a way to make those things more comfortable. My shoulders are patterned in red and blue from the stupid thing, and mine's actually not a bad fit as army rucks go.

In any case, I didn't find it taxing on my legs since they're nice and long and thus allow me to keep pace without having to shuffle/run. But during the last 2km my heels started complaining and threatening to blister, my neck has started divorce proceedings due to inhumane treatment, and I did something unpleasant to my right shoulder during the post-march fireman's carry. Blah.
At least they stood us down right after the BFT, and we have a long weekend to recover. I stopped by the pharmacy to stock up on delicious free Ibuprofen. Mmmmm, drugs.

Oh, patellar dislocation guy? Popped the thing back in place and marched on for another 6km before his knee mutinied by swelling to twice its normal size.
Some people, I swear. And then they get all light-headed when you try to stick a little needle in them.

Friday, February 9, 2007
07:43 p.m.

Footwear of Death

This morning we did a forced march, in preparation for the BFT (battle fitness test) next week. Basically a march in uniform, ruckrack and webbing/tack vest, with a timed pace. The BFT will add the helmet and weapon, and be for 13 km - I think we did 6-7 km today.
I booked myself off work for that day, so I won't have to come back and hear people whinge about their minor aches and pains.

However, this is February in Alberta, plus Canada as a whole is in some kind of freeze anyways. It was -21C this morning when we marched, -25C with dewpoint.
All surfaces have turned to ice. We had 7 falls during the march, 5 of them bad enough to fill out paperwork and send the members to sick parade, because the Canadian army is incapable of designing footwear that functions in Canadian weather.
The soles of our everyday boots turn to tractionless frozen rubber in this weather - the common wisdom holds that they're made of the same material as hockey pucks. We have "wet-weather" boots that are even worse and memos have gone out ordering people not to wear them below -10C because they'll kill you. I believe they were meant for winter but we're being told that they're supposed to be for wet but warm weather, which is bullshit because they're Gortex lined with some heavy-duty crap that keeps your feet toasty in the coldest temps. No way in hell are they spring/summer boots.
The mukluks have decent enough traction but about as much ankle support as your average sock.

So yeah, no wonder members keep bugging their docs and physio for boot chits. They want permission to buy their own, civvie footwear, because it is the sane thing to do.

Holy hell, the army was going to design a bra to hand out to its female population! Given their stunning success in designing other wearable items I'm thankful that they decided to just give us a yearly bra allowance.

However, I did learn that I can pay Wave's entire monthly training/board bill with 7 hrs of relatively easy work, so today wasn't all frustration. It's good to be a doctor.

Monday, February 5, 2007
06:18 p.m.

It's Like a Second Mortgage, Without the Equity

Since my work is hell-bent on sending me away while the herd is still in winter pasture, requiring me to constantly find people who'll put Wave in and muck out her stall, and because work also send away the girl who usually does that for me, I have decided to send Wave away.
Send her here, that is.
Amberlea is an A-circuit show barn, home of my instructor, and charges a whopping 0/month in full-service boarding fees. Quite a change from my friendly gummint-subsidized /month co-op barn.

She'll be in full training with my instructor, which will run me an additional 0/month. All this for 3 months, after which she'd better come back perfect and fit. Hell, this is the kind of money you spend on a horse you're trying to tune up for sale, or one you're training for showing, not a 16 year old mare with a few slightly annoying lesson-horse habits and less-than-perfect muscling.
Gah, I swear she'd better learn to clean her own stall or something.

My saddle store finally called me back, and alas, my saddle will be some time coming. They did offer to lend me the saddle I tried on, which is the same fit to the horse and just 1/2 inch smaller in seat for me.
I'll take them up on the offer, of course. Given how much I'm spending on that saddle, I deserve to be riding in style on their equipment.
Yay entitlement-me!

Work is rather boring, if discovering new and exciting paperwork SNAFUs on a daily basis can be called boring.
And it appears that it can, so it is.

Esca chooses to be on call when I'll be visiting out east.
Ditched for coffee, ditched for food...still, I never imagined I'd be ditched for work!

Sunday, January 28, 2007
08:01 p.m.

Shoving Tubes up Noses

Finished instructing on my first Tactical Combat Casualty Course.
It's an infantry course, actually originated with the US special forces, and went off great when my colleague instructed on one last year for the infantry.
Mine was run for armored and, well, the tanks are all in Texas right now for training. The one we had wouldn't turn left. It was sad, really.
Lots of constructive criticism on pulling it off, most of it directed at the armored unit that was supposed to supply its troops with...armored...stuff. They're the ones running the course, medical only supervises the medical part of it, and that went pretty well.

But pretty amazing to see non-medics go from "Can you also needle decompress on the right side?" to actually understanding the difference between an open and a tension pneumothorax and responding appropriately.

Also, we made them shove nasopharyngeal airways up each other's noses, so that was fun.

A propos nothing at all, today I went to the Pet Expo and saw Bonkers, the black bear that was in Brokeback Mountain.
And a cute wallaby that I got to pet.

Sunday, January 21, 2007
07:59 p.m.

Mushing Through The Snow/ In a Seven-Dog Skitt'ry Sled

Spent a beautiful weekend in Banff, Alberta.

Didn't have time to go skiing, for although I skipped boring lectures this morning to escape early, Saturday was actually filled with useful hands-on tutorials. Yay, bleeding mannequins!
I did go to the Banff Upper Hot Springs, which were about as nice as an outside hot tub in the winter, but didn't evoke any of the expected hot-spring awe. Since, yanno, they build them to look exactly like a freaking hotel pool.
It seriously detracts from the experience of "taking the waters". Well, maybe it doesn't if you believe in the healing properties of said waters, but if you just want to sit in a real "hot spring" for the fun of it, this one isn't for you.

But today I went dog-sledding! And that was definitely worth escaping the conference early; in fact, I should've left even earlier and taken the longer tour.
Hell, I want to go back tomorrow and mush some more. Return customer, ahoy!

For the first part of the trip I was sitting in the sled feeling nice and cosy while a guide drove, and then I was able to drive myself. Since there was no-one in the passenger compartment when I drove, the sled was light and skittery on the turns.
The views were spectacular.
The dogs were cute.
The cider was hot.

The journey back was sad, for tomorrow I must work again.

Sunday, January 14, 2007
02:56 p.m.

Rate MDs

There's this website where users can anonymously rate their doctors. Today I checked it out.
I'm not on it, which doesn't surprise me since I haven't been in practice for long. None of the docs I went to school with are on it, at least none of the names I looked up.

But some of my former preceptors are. The family doc who wrote me a nice letter when I was applying for family residency is there, with a smiley fact next to her name. The ob/gyn that I did a few shifts with is there as well, ditto the happy face. The neurologist who taught us in med school is there too, with a neutral face because he's "arrogant" - yes, I can see him coming across like that, but the man's brilliant and an excellent teacher.
Not too many docs I know, but I don't think that site's been open to Canadian docs for long.

But. There's this family doc on it, with a frowny face. Someone I personally haven't worked with, but know in passing because I've worked in the same practice. His frowny face comes courtesy of a patient who describes him as not having "any expertise in women's health issues".
Why? Oh, it's a good reason, let me assure you: he performed "an endometrial biopsy on me with no freezing whatsoever." Oh noes! What a bad, bad doctor.
Oh no, waitaminnit, endometrial biopsies are normally performed without freezing! I'd tell a patient to pop an Advil a couple of hours before the procedure, if she was stupendously nervous I could be convinced to prescribe her an Ativan for it, but that's not a painkiller and it's certainly not freezing.

Ah yes, she also felt dismissed after seeing him as follow-up after fainting and going to ER. Now, I understand how easy it is for a patient to feel dismissed, how important is it for physicians to choose words carefully, to be able to reassure without seeming to talk down to the patient. So perhaps he came across as dismissive and that's fair enough, but seriously, a single episode of fainting in a young person with no cardiac issues is usually pretty dismissible. Yes you do an exam, yes you do tests if indicated (if the ER hasn't done them already, which they usually did), but mostly you tell them that there are tons of possible benign causes, none of which can be conclusively linked to the particular episode.
So now this doctor has a bad rating because this woman thinks he fucked up a procedure which he in fact did correctly, and because her fainting spell seems more significant to her than it actually was medically. When in reality, if he's guilty of anything, it's probably a less-than-perfect bedside manner.
That doesn't seem right to me.

Then again, I could log on there and anonymously boost his rating, as, indeed, could he himself. Goes to show how much a site like that is worth.

Wednesday, January 10, 2007
06:38 p.m.

Winter's Back!

Hit -30C today with windchill.
Which, if you're out in the wind, is just plain old -30. And I was in fact out in the wind. Not for long, just long enough to be fervently grateful that I could go home instead of to a tent.
It's supposed to stay cold like this past the weekend, and warm up again mid-week. I hope it does warm up, because in 12 days I'll be out in the field again. Days only, maybe an overnight or two, but outside all the time supervising a medical course.
Still, if it remains that cold I imagine it'd be changed to indoors, since our pretend-casualties would rapidly become real ones in such weather.

I've gotten myself onto a soup kick somehow.
I've gone through many of the Gardennay soups, with Butternut Squash and Golden Autumn Carrot coming out as favorites. I didn't mind the Garden Broccoli with Real Parmesan except it was far too bland, but Summer Asparagus with Sweet Basil was...I don't know, I like asparagus but that soup wasn't very good. And it made my piss stink to high heaven for two days, so I'm staying the hell away from that one.
The Knorr brand Carrot & Coriander Soup and Autumn Vegetable Soup with Real Cream are also winners, and hey, I'm sensing a trend here. I'm into the autumny, yellow-to-orange colored soups!
Then there are Safeway's obscenely expensive but delicious Signature soups, like the Lobster Bisque, Cravin' Crab & Sweet Corn Chowder, and Tuscan Tomato & Basil Bisque.
I am a soup whore.

Wave was a bitch all week, refusing to move off the leg, not wanting to turn, hell, not coming when she's called from the field. She usually doesn't come all the way to the gate unless it's really cold (today, you bet your ass she came), but she'll start walking towards me when I get close enough to her.
This week, she'd lift her head, look at me, and turn away. Bitch bitch bitch.
So today I didn't really feel like riding her. My feet and fingers had developed that deep, intense ache that comes with frostnip, it was windy and icky and rattly in the arena, and I was tired. But I didn't ride yesterday, so I made myself do it.
And I'm glad I did. I lunged her first with my snazzy new sidereins, and then got on and she was really good. Didn't canter because of the rattling although it wasn't really spooking her, but she was moving off the leg and making little 10m circles and all. Nice horsie ^__^

Now I go eat yellowy-orange soup.

Wednesday, January 3, 2007
08:04 p.m.

Patient Frustrations

Most of my patients are run of the mill - kids with colds, adults with colds, plenty of well-women exams since I'm the only female physician in the clinic, UTI's, well-baby checks, mood or anxiety disorders, rashes. Mostly easy stuff, occasionally interesting.

Today I had a walk-in with cough and "chest tightness", a life-long smoker who usually goes to a certain walk-in and sees a specific doctor there. It sounded like a bad cold, until I asked how long it's been happening and he said well over 2 yrs.
So, not a cold. Fine. Tests should be done, but just in case I ask him if he'd had any tests. He's vague and evasive. I go through them by name, and he's had them all - EKG's, bloodwork, chest XR, pulmonary function tests. He's on some kind of puffer, doesn't know what it's called.
Why is he here?
Well, buddy is frustrated with his doctor. He thinks his doc's attitude to him is too dismissive, his symptoms aren't getting any better and he wants them fixed, dammit!
Yes, he's been told he needs to quit smoking. It's haaaaaaard!

Best guess is COPD, of course. The puffer is probably for that, he's on no heart meds, all the right tests were ordered and he would have been told that the one and only thing that will help him is quitting smoking. So instead of taking this good advice he goes to another clinic, doesn't bother to bring his test results or so much as remember what meds he's on, and he wants me to fix his chronic, years-long symptoms.
Shit, I almost wasted the system's money on this loser by re-ordering all the tests.

Another frustration, this one ongoing, is the apparent antibiotic culture of a certain segment of our immigrant population.
This applies to those born overseas only, I've found. Those born here, or who grew up here, have no problem accepting that the symptoms they or their kid is showing are due to a virus and therefore no antibiotics are needed.
But I have daily encounters with mothers who simply will. not. accept. the fact that I won't prescribe antibiotics for their kid's common cold. I've tried to compensate by taking unnecessary throat swabs, which is a better alternative to unnecessary antibiotics, but this doesn't appease them.
I have the very strong feeling that they just go to another clinic after they leave my office, perhaps a busy walk-in, and get their antibiotics anyways. Either way, they all leave my office looking very unsatisfied, like the doctor didn't listen to them, didn't take their concerns seriously, dismissed them as unimportant.
This both hurts and annoys me. I try so hard to educate my patients, I spent much longer seeing a patient than any of the other docs here, but nothing I can say to these women works!

And speaking of antibiotics, I've also had a couple of patients originally from Europe come in with infection and claim they were allergic to every antibiotic under the sun except antibiotic X.
Antibiotic X is some European brand name. No, I don't have internet access at work and no, telling me brand names from another continent won't help. You've been in Canada for years and years, you've taken antibiotics prescribed here with no problem, it's not my bloody fault you keep going to different doctors all the time so we don't have your previous files. If it's such a huge issue for you, make the effort to fucking learn the name of the "safe" drug you keep taking here, or go to the same clinic every time.

Next week it's back to army work.

Sunday, December 31, 2006
03:04 p.m.

Happy New Year, Everyone!

I'll be going to a fondue party later this evening. Mmm, fondue. I fucking love fondue.

Xmas parties were many and varied, the best one being at my OC's house. Weird, since I dreaded going to that one. But one of the NCMs who also attended is some kind of amateur bartender and kept making drinks to order, so I got drunk on mojitos, both the usual and a blended version. Fresh mint and all that; man, do I love me some mojitos.
Civvie clinic has a party on the 6th at a dinner theatre. I've never been to one, so I'm pretty excited. And that'll be that for the parties.

I like civvie clinic. I'll make enough over the break working part-time to buy a new Amerigo saddle, and those are fucking expensive. In fact, it'll cost more than the horse did.
Plus they feed me, both the pharma-corps and when staff brings food. They always bring too much and then nobody eats the leftovers, so I take them home.
The clinic has replaced my mother.
Yeah, I still don't cook.

Wave escaped again, I need to watch her in the mornings. She never leaves her stall on her own, or at least I thought she didn't. I was getting ready to saddle her and turned away to grab something from my tackbox, and she calmly strolled off through the open door and down the hallway and out. She wasn't running, just walking with purpose.
Once she got out of the barn I managed to grab her mane and tried to turn her around, at which point she broke into a trot towards the pasture, dragging me along. Sliding me along more like, since it's still icy as hell. It must've been a pretty funny sight.
I finally managed to stop her by turning her to the fence, and cursed my idiocy for not grabbing her halter. Thankfully by then I had a bit of an amused audience, and someone grabbed it for me; once haltered, she returned meekly to her stall for saddling and generally behaved herself in the arena.

This whole post is full of short choppy sentences. I sound like I'm drunk already ^__^

Wednesday, December 20, 2006
07:14 p.m.

Pharma Reps are Love

One of the disadvantages of being an army physician is the lack of visits from pharma-reps.

They do, however, visit the civilian clinic I'm working at. And the reason they're love is that they bring food. Food, glorious food...

Today we had a rep from Abbott, to talk about the weight-loss pill Meridia and the ACE inhibitor Mavic. She brought their trial info and talked seriously about how Mavic is really great and powerful and Meridia is to be used in conjunction with lifestyle changes and blah blah - food!
She brought a huge selection of meals, meal-sized salads like Asian chicken salad and salmon salad, rib or steak dinners, a couple different chicken dinners, a bunch of different hot sandwiches, appetizers galore and desserts.

I think I'm gonna have to steal the Meridia samples she left, because I'm totally unwilling to change my pharma-food-loving lifestyle.

The only thing better than food brought to the office by the pharma-reps are educational seminars sponsored by the pharma-corps, because in addition to food they tend to have booze.
Today's rep left us an invite to one such event. Score!

Money money money mooooney...money!
The main doc at the family clinic sees over 90 patients in the time it takes me to see about 25. I'm currently working at an average of 5/hr, so 10 min per patient with a couple minutes for charting. I'd like to take it up to 6/hr because I have some slow periods in my day.
He's seeing something like 13-14 pts/hr, giving him 4-5 min per patient including charting.

Holy crap. I think the man bills over k daily, and he works every day too. Some days he works 10 hours.
I want to make snide comments about giving good patient care and stuff, but really I'm just jealous.

Tuesday, December 19, 2006
08:30 p.m.

Curse You, Family!

I am now the proud owner of a Keurig Gourmet Single Cup Home Brewing System.
It brews coffees and teas and apparently lemonades out of those little Timothy's cups. Esca's hubby had one of those machines at his workplace and I found it pretty neat...for a workplace.
Now I have the freaking thing in my kitchen. WTF, family? Am I the only one who understands the concept of no gifts?

Over the past few years my family members have been trying to one-up each other in terms of gift-giving, which is a nice concept but had gone to ridiculous lenghts, like laptops and trips to tropical places. So when I moved here and wasn't coming home for Xmas, I suggested we give it a rest. I assumed there would be small presents for those who'd be there, of course, because a tree without presents is a sad thing.
But now I have a freaking home brewery in my kitchen.

My bro send me a gift card, which frustrated me for the same reason. I considered sending him one in return, but you may as well be exchanging cash at that point.
So I went to a local artisanal tea shop because my bro fancies himself a tea gourmet, and got him a bunch of unique teas plus some flowering tea. And something nice for my SIL. Then I thanked him nicely for his gift to me, send his off, and bitched to my parents about the whole thing. And now they do this to me.

I feel like such a scrooge. The coffee thingy is beautiful, it makes good coffee and I like it and I'm grateful, but damn it, we had a policy this year. Why can no one in my family follow it?

I'm standing my ground and not sending any gifts. But I will make it up, of course, on Mother's Day or on their birthdays or some other time. Because. Because it seems that my family can't exist without gift-giving.

Sunday, December 17, 2006
03:10 p.m.

Runaway Horse and Frozen Ferret

On weekends I like to ride in the morning.
Wave tends to be a bit more forward because of being in the stall all night, and that's good too; at least she doesn't drag her back feet around.

So today I saddle her in the stall and she's nice and cooperative as usual. Then, instead of heading straight to the arena, I take her down a path looking for a nice spot to take pictures. It's a gorgeous sunny day with snow sparkling everywhere, and dammit, she has a new saddle pad.

I position her.
She stands quietly.
I back off to take the shot - WHOOSH! She wheels and canters off down the path.

Didn't get far of course, she doesn't take off into unfamiliar places. In her previous home she was sometimes allowed to wander outside her pasture and never left the property.
She just went to the far gate of the pasture and hung around, looking sad that she couldn't get in and mingle with the free, unsaddled horses. She ran back and forth a few times, then gave up and came to me. Silly mare.

She stood fine for the pictures after getting that out of her system.

Taking pics of her reminded me that I haven't taken any of Chibiko in a while, so I took her out in the snow later. Only for a few minutes because the poor thing was cold, but I got a couple of really nice shots and she got to tear around the hallways like a...ummm, ferret on crack. More crack than usual.



Hey esca, are you guys hitting the Xmas parties? There are too many parties here! I want time to my asocial self!

Sunday, December 10, 2006
06:11 p.m.

The Sock Odyssey

Yesterday I spent 4 hours in a Walmart.

I went there for a car issue, because my trusty Canadian Tire was clogged up with people wanting winter tires put on. Of course it was the same at Walmart, but the wait was shorter, plus they had the photolab that would make my Xmas cards.

Still, it was 4 hours of drifting mostly aimlessly between aisles, tasting crappy chocolates that were being given out, smelling various beauty products. I eventually went to the McD's and ate a sundae veeeery slowly, reading a paper and hoping nobody would kick me out.

In the fullness of time I ended up in the sock section, contemplating my sock drawer. You see, I always bought the cheapest socks I could find in bulk. I do have a few pairs of fancier colored socks, but those are just for outfit coordination purposes; most of my everyday socks are utter crap.
Plus they're usually smallish. Sock sizes suck: no matter what the manufacturers of those "fit shoe size 4-11" claim, if the thing fits someone with a teeny size 4, it ain't gonna fit my 11 wide properly. No sock has that much give.

It's like the fucking pantyhose - the taller you are, the more freakishly stick-insect thin you have to be to fit into the size chart. Some of the size/weight ratios in the C group, where my height would put me if I even bothered with regular pantyhose sizes, are actually in the medically underweight zone.

Back to socks.
So, I was contemplating my habit of buying crap socks, while petting the nice super-soft marled ones from Pathfinder. With moisture-wicking properties!
And I decided to pretty much toss everything in my sock drawer and buy new ones. Yeah, I spent a fortune on socks yesterday. Fuzzy, soft, size-appropriate, premium quality socks. In pretty colors!


Combat Casualty Care
I got the watch the final exercise of the 3C course this Friday. The scenario was some bombs going off in a house, creating a bunch of casualties. To simulate this, smoke grenades were tossed into the FIBUA house.
I was in that house, observing.
Breathing smoke grenades sucks ass.

The scene was actually quite chaotic and realistic, at least to someone like myself, who hasn't witnessed the real thing. The gory make-up on the casualties was excellent.


esca continues her sojourn in the world of the living blogging, yay!
"Is that all you can tell me?", indeed. Lady's an idiot.
And although you plague me with math, it's impressive to see how one inconsiderate patient's lateness adds up.
But adding is evil, for it is math.

Tuesday, December 5, 2006
07:49 p.m.

Personalized Script Pad!

Breaking news: esca still alive (or possibly undead)! Pass it on!

This evening I did my first shift at the family med office. I'll be working there one evening a week, and then four days a week during my winter break, which is three weeks long (yay army).
It's pay-per-service, so I have to learn the diagnostics codes and some procedure billing codes. I don't bill directly, the clinic gets paid for my services and I get paid by them in a 60/40 split. I could've gotten 65% somewhere else, even 70% isn't out of the question in this environment of physician shortage, but this clinic is very very close and they're familiar with the vagaries of military physicians - here one day, gone 3 months. Plus they're a real family office, not a walk-in, so there's continuity of care and I'll have my "own" patients.

I asked them to book me every 15 min, but they also booked easy patients for my first time so I ended up with quite a bit of time on my hands. Colds are seen in under 5 min, and I had a couple that were strictly script refills.
Probably I'll end up booking every 10 min and taking the odd walk-in once I learn where all the paperwork is. Right now it's finding the stupid diagnostic codes in the Great Book of Utter Confusion that's slowing me down. Once I get into it properly even a single 3-hr shift a week will add about a grand a month, and I could pick up the odd weekend too. If I feel like it.

Oh, and they had personalized script pads for me! I've never had my own script pads; you don't get them as a resident, and the army doesn't use them either.


Wave Update
My instructor (S) got on her yesterday and did a 5-jump course, 2 feet being the highest.
At first Wave tried to slink out beside the jump, but S stopped her dead and kicked her - wow. I don't kick her, and I really should what she does things like that. It doesn't harm her, and the change was amazing; it was like she went, "Oh, it's you" and immediately dropped into a proper frame and went onto the bit. Like she knew she couldn't get away with shit.
And she jumped it all, when before with my previous instructor she had to be schooled over every individual jump. Even the same jump in the opposite direction had to be schooled. Yesterday she did the whole course, both directions, automatic changes, no problem - and I have no idea when the last time she even jumped 2 feet was. It's not high, but I only ever did crossrails and I don't think anyone else jumped her while I was riding.

S says that when she knows she can't run out beside the jump, she tries scaring the rider by going really fast instead. Which works with me, but not with S, and yesterday she worked on getting Wave to jump the course under control. And she did!
I'm not firm enough with Wave, I've been told that before. She knows I'm not a good rider and she takes advantage, and I hesitate to punish her. Hell, I still don't really like hitting her with the crop, and I hit myself even harder and know it doesn't hurt.
Must. Learn. To. Kick. Horse.

Thursday, November 30, 2006
06:47 p.m.

Fun in the Snow at Forty Below

Oh, yeah, bitches.

It went down to -40 C with the windchill, -30.8 C purely temperature-wise. That was Tuesday, the coldest motherfucking day we were stuck in that frozen wasteland of a training area, but we were sitting below -20 C consistently since we got there.
Oh yes, and that's a noon temp. I'm not even bothering with night-time here, because wild horses couldn't have dragged me out of my arctic sleeping bag at night.

But wild horses have nothing on blown generators, and ours blew one icy night shortly after 0100, forcing me and a hapless corporal to drag ourselves outside and fiddle with it until we gave up and called for help. The maintainers, those unlucky souls who I'm certain didn't get any sleep at all because shit was blowing all over the place in those unholy temperatures, fiddled with it for a couple of hours until admitting defeat and hooking us up to the floodlight generator instead.

See, the army uses crappy, crappy fuel; lowest bidders and all that. It's got a high water content, and the shit just freezes, which is exactly what it did.
We had to spare one of our precious heater hoses to run back to the generator trailer to heat it, so it could in turn heat our clinic tent.

Hindsight being 20/20, I never should've gotten up that night. Had our meds and equipment frozen, we'd have been recalled and this ridiculous exercise would've been cancelled.

And I, in turn, would never have had to live through one of the most unjoyous experiences in my life: diarrhea, at below -20, with nothing but blue rockets for a bathroom. Blue rockets with those urinals on the sides, urinals that all had about a half-inch of frozen piss around their rims.
The guys claim it's from inevitable spray, but who the fuck believes them.

I never ate so much Imodium so fast in my life.

There were fun parts too, but I'm not in the mood. Maybe later, once the bitterness dies down and I regain feeling in my toes.

Monday, November 20, 2006
07:00 p.m.

Got any X, any smack, any horse, any Jugie Boogie Boy, any blow?

Tylenol #3 - 500 tabs
Oxycocet - 100 tabs
Morphine sulfate 10mg/ml - 10 1ml vials
Fentanyl 100ug/2ml - 4 2ml vials
Midazolam 1mg/ml - 4 5ml vials
Ativan 0.5ml - only 12 tabs, sadly
Ketamine 50mg/ml - 2 10ml bottles
Succinylcholine, a paralytic agent - 2 bottles just for kicks

I can't help but wonder how much would my stash of goodies be worth on the, uhhh, free market?

Nature hates me, take #78
Oh yeah, and I'm leaving for 10 days (with my stash, don't even think about it). To go live in the frakking field in a frakking tent.
And nature, bitch that she is, has decided that she will celebrate by dropping the temperature south of -20C.

I'm quitting recycling and thinking of buying an SUV. Why should I care about nature if she clearly doesn't give a shit about me?

Yes, I personalize weather. What of it?

Thursday, November 16, 2006
10:41 a.m.

Naked

Last night I had a dream.

I was in some kind of large military complex where I apparently belonged, although I've never seen one quite like that. Perhaps it was my dream-vision of the hell that is St Jean, which I hope never to see.

I was wearing my army boots, and army shirt, and beret.
And a pair of jeans.
Somehow, nobody important spotted this life-shattering infraction. Clearly, I had to get out, get home and change. I went outside.

And promptly ran into a huge parade led by my Commanding Officer, that had somehow formed between me and the parking lot.

I swear, this is absolutely the military equivalent of the "Shit, I'm naked in high school" dream.