I am the proud owner of The Book.

Which is currently in the front seat of my car, locked, so that I’m not tempted to stay up all night and read. I have to be at the hospital in the morning, and even though I have no patients, I have to be alert enough that if one came in, I wouldn’t kill them.

Went to the local bookstore with some of the other neuro residents and one of my attendings, met up with his family. So much fun oohing over the kids and their costumes and how excited they were. Of course, the first thing they all did when they got the book was open it up and read the last word. I succeeded in not listening to carefully, so I’m still not spoiled. 🙂

Kinda sad that it’s all over now.

I think this is the first time since third year that I’ve had an attending dislike me. I’ve had ones who were difficult to read and who I disagreed with, but we had a pretty cordial relationship in the end. But I can’t seem to impress this one at all. I’m still struggling on how to be a resident–how to give my medical students autonomy and yet make sure that nothing major is missed; and things have been overlooked, pretty substantial things that luckily did not harm any patients. All of this has not been impressing me to my attending.

Can’t believe I’m actually looking forward to my rotation in the ICU to end.

Venting is a very good thing. Can’t say that it made the troubles go away, but I do feel like I may have a little bit of a game plan (yes, I’m being vague, perhaps more details in the future).

Have to give a presentation on a paper tomorrow. Haven’t found the paper yet. Plus I have clinic. Gosh, I love Tuesdays.

Still loving the ICU (for real, no sarcasm here), but it’s freaking me out. Starting to sink in that I’m the one “in charge.” Even though I have a fellow as backup, he’s not always there, and if something goes wrong, I’m expected to step up and direct and manage until he gets there. Plus I have 2 fourth year students that I’m responsible for… and they’re making decisions that I have to constantly evaluate to make sure they are appropriate. Plus, I have to know about every patient on the team, which even though it’s a small team right now (3 patients. 1 consult. 2 of the patients are palliative. All that equals no fun, no procedures for Julia), these patients have been here a long time and that’s a lot of reviewing that I have to do. I’ve already “messed” up once, where my student wrote an order that I should have questioned more closely and didn’t, leading to extra invansive procedures on an already sick guy.

And now, I really have to go track down an article to talk about.

The Dark Is Rising movie looks as awful as I feared. A LOTR ripoff and completely missing the point of the novels (I’ve been horrified ever since I heard that they were Americanizing it). I try really really hard not to be a literary snob, where I sniff at every change that they make from book to movie, but. But. *sigh*

Trailers can be found here

There’s a reason that they only give me three weeks of vacation a year and four days off a month…

Any more and the taste of freedom would be so alluring that there would be no way any of us would return.

(Moving over to the ICU for the rest of the month, which I love, but it’s so hard saying goodbye to the days of freedom).

My holiday was excellent. I now have new light fixtures downstairs, a spider free basement, vacuumed floors, a draining tub, sparkling clean gutters, a weed free garden, watered and trimmed raspberries and bridalveil bush and a (mostly) working garage door. And a year after moving in, I’ve officially, completely, totally unpacked! Plus I spent two days up in the Upper Peninsula (which, except for the license plates, the locals refused to admit was actually part of Michigan), where I wandered around lighthouses and drove through forests and saw the cliffs of Lake Superior. And I spent yesterday with Chris, getting sunburnt exploring an art festival, eating burritos and sushi, and watching Harry Potter. A very busy and somewhat exhausting vacation, I think I need another one, especially since I’m heading into a stretch of 13 days straight. 🙂

My parents and sister will be arriving either early this morning or sometime tomorrow. I have my entire house to clean and arrange and basically unpack (it takes some of us a while… like a year).

Am I?

Nope. Instead, I’m doing fun memes like this. I did this one two years ago, but my friendslist has changed enough that nobody is recognizable anymore. And I must say, even though I went on a friending spree and added a whole bunch of lovely Dr. Who enthusiasts *waves*, they didn’t overwhelm it quite as much as I thought they were going to.

Pictures of my LiveJournal Friends

Tonight, I realized that I am not 20 years old anymore and screaming at the top of my lungs, listening to loud music, being pushed and shoved by drunken slobs are not my ideas of fun anymore. (Not that they really ever were).

And that’s okay.

Because that was a fun part of my life, but growing is ok too

(Let’s see if I’m still saying this when I hit 30 in a year and a half)

But Dashboard Confessional is pretty awesome live and I still love “Vindicated” as much as I did when it represented the dark haired rebel boy who had a thing for paperback novels in his back pocket.

And I think I have filled my lifetime quota of Summerfest.

And the most important news of my life?

One more day of work and then a week of vacation. 8 days completely off. I cannot wait to turn my pager off and chuck it far far away.

🙂 Life will be sweet, my friends.

Stupid YouTube.

I’ve never gotten tv this year (no bunny ears, no cable, no nothing), so i’m always a bit behind on what everybody else is watching. But after Becka starting posting clips, well then, that made me want to go out and watch all of the clips of SYTYCD as I could. I had forgotten how much I love this show.

And YouTube took them all down today. 🙁 So I haven’t even gotten properly caught up. I’m sure they’ll crop up again soon.

But I did get to see some of last year’s stuff and I had forgotten how much I loved Benji. It’s funny, Becka always goes for the lyrical, interpretation dances, and I’m always impressed with the formal. And I had forgotten how much I LOVE the West Coast Swing. It’s been so long since I danced; I’d look like a clumsy buffoon if I tried now. I miss it. There are so many of my college, early adult years that are tied in memories of dancing.

Work is incredibly dull right now. Incredibly. I’m completely bored. I have 1 patient that I’m covering. One. We get about 1 consult a day, usually someone with pneumonia and the primary team refuses to take our advice so it makes me feel extremely frustrated; I hate wasting my time, and if you had already decided on a treatment plan, then why did you ask for a second opinion??? Grrr. Also, I’m at the VA which blocks most of the sites that I want to visit (like LJ), so it leaves me with a lot of time to do nothing. I’m studying right now, for Step 3 which I’ll be taking sometime in the next six weeks, but that gets very dull as well (I don’t wantto learn any more about pediatric rashes! I’m done with that forever!). So right now, I know basically everything that’s going on in the world, as I have literally read just about every single article in the BBC.

Ewan and Charley, btw, were in Eldoret today. *sniff* I miss the place, well, not so much the stench and the mice, but everything else. The pineapple. I definitely miss the pineapple. They’re leaving Kenya, going into Uganda and I’ll probably lose track of their trip, but it was so awesome to hear and see pictures of the areas that I was at just a year and a half ago.

So Ewan McGregor and his friend Charley have been traveling the continent of Africa on their motor bikes. They did a similar sort of trip where they travelled across Europe, Asia, Alaska and Canada on their bikes 3 years ago (as documented in the DVD Long Way Round). I’ve been intrigued and somewhat following their trip this time because it’s Africa, and it’s really dangerous too, more so than the first time.

They’re now in Nakuru, Kenya, and I laughed when I read this on their blog:

‘We’re finding misery on the roads. Very difficult to ride.’ The Kenyan roads – and the police – prove unpredictable.

Ah, the roads. I had almost forgotten about the massive pits that would swallow Jeeps whole. And the roads at Nakuru were some of the worst. The government had finally decided that the roads in Nakuru were so bad that they were willing to put the money to getting them fixed – plowed, paved, the works. So in their infinite wisdom, they tore up all of the pavement and then stopped. Completely. That was at least five years ago when they started the project, and I’ve never experienced such pits and dust storms. The dust storms rivaled blizzards, because at least with those, people actually try to slow down. Those were the times. I should have taken pictures, there is just no way to believe the road conditions.

(I’m really just posting so I can use my pretty pretty icon. Carry on, carry on.)

There. I feel better.

ETA: I should clarify (option #2) that this isn’t about texting in general, more about texting while driving, no matter what conditions (highway speeds, stop and go traffic, construction, etc). I text (occasionally). I’m painfully slow at it and it probably causes great amusement to those around me, but it’s nice in the way that an email is nice–when you just want to say something nice and quick and not get caught in pleasantries.

This went through about three days ago. Yeah, I’m slow like that.

When you see this post a quote from Doctor Who on your LJ

“Doctor, they’ve got guns.”

“And I haven’t. Which makes me the better person, don’t ya think? They can shoot me dead, but the moral high ground is mine.”
~ Army of Ghosts

I rewatched Army of Ghosts, Doomsday and then Fear Her this evening. And it’s still such a sucker punch. I still cry. 🙁

Found one of the best ever reviews/exploration of season three and the finale, (which I liked, btw, flaws and all) here. I disagree with some of the premises, but it’s really well written and literature based and it almost, almost redeems everything that was weak about this season. Really. Go read (but only if you’ve seen this season, because I will not be responsible for spoiling you!)

My brother-in-law suffered a spontaneous pneumothorax (collapsed lung) this week. He’s fine, just has a nice chest tube sticking out. The funny part? My sister didn’t tell me (okay, this is my sister, who didn’t tell me she was dating someone. To be fair, I was the first to hear about the engagment, but I guess I shouldn’t be too surprised). Apparently, I won’t have to worry about needing to give too much medical advice to family members. 🙂

My family (sans Laura and Josh) will be coming out and visiting me in about a week. I’m so excited. Not only do I get to show off my place and my home (and boy do I have a ton to do before they get here!!), but I get a week of vacation. We’re going to go up north, around Minnesota and Michigan and maybe catch some of Canada in those few days and I’m so excited to get away from the city. In my heart of hearts, I belong in the rural, backwoods country, where there isn’t more than a dozen people around me. The influence of living in a town of 250 in the formative years. 🙂

And I am now officially a Resident, a PGY2. Snap. Just like that. Things aren’t really that different. I have an intern, who’s much like a medical student at this point, and there’s a fellow (a freshly graduated resident who I worked with on call a few times last year). As always, freak out was a little overwrought. But that’s nothing new. It still has the potential of being very scary in the future, when I won’t have a fellow backing me up, but it’ll be a little bit of time before I have to face that.

Snagged from ravenmoon:

Go to the Simpsons’ Movie site to make your own!

The hair shade isn’t quite right and I’m a few pounds heavier and the hair is not that cute right now, but not a bad representation. 🙂

Kinda wanting to go and make the Doctor and Rose. Or better yet, Simpsons!Mulder. He was my favorite.

I did not end up getting a permanent account. I was really having a hard time justifying the expense of it and kept putting it off. I did convince myself yesterday that maybe it wasn’t that much money, but I was on call and that didn’t leave any opportunities to slip away.

I think I probably would have regretted it. I had been counting on the end of the year bonus from work so that I could indulge a bit and discovered that Uncle Sam had taken 40% of it, leaving me with less than what it’s going to cost to take get my medicine license, so I can’t even afford that, which is much more important in the long run. I’m so tired of money issues, so wearied. I was really hoping that with the very small cost of living raise that some of the money pressures that I’ve been drowning in for the last six months would ease, but taxes and insurance are going to suck that all away as well.

*sigh*

On a good note, I’ve completed my last call ever as an intern! Whee! Of course, things really aren’t going to be that much different next year. When I’m in the neurology department, I’ll be a “junior resident” which is really the exact same thing as an intern (still the low man on the totem pole) and when I’m on my medicine rotations, I’ll still have to take call as a senior resident (just not as frequent and I won’t have to write daily notes! Yay!).

And I just realized how confusing my life must be to those of you who actually read this thing. And that I’ve never explained what I’m doing. I have a tendency to assume that people can read my mind, and are really living my life with me (I should have probably outgrown that belief when I was, I don’t know 15 months old. I’m a little behind) So allow for a brief detour.

explainin’ stuff here

This was today’s “The Writer’s Almanac: Literary and Historical Notes” World War I

Sorry I’ve been MIA for the past few days (and I was doing so good with the “post every day” thing too). One of my patients died on me, unexpectedly, and it’s been chewing me up inside, wondering what I missed, what I didn’t do that lead to the situation. I was responsible for her overnight… why didn’t I realize earlier that something was wrong.

Also, all of those fears about becoming a senior resident are overwhelming me. I’m not prepared, as this weekend taught me. I was the first one to the code, and all I could do was stare at her. All of the ACLS training (from a year ago), vanished and I could barely even remember to check to see if she was breathing or if there was a heart beat. Luckily, there were others who responded quickly and were adept at setting up the machine and directing others–exactly what I should have been doing. We got a heart rate back, but she was without oxygen too long and the family decided to withdraw care today.

A year later and I’m still not ready for this.

I spent most of the afternoon browsing around a map store. And oh, it was heaven. I love maps. Maps of places that I’ve visited. Maps of places I want to go. Ethnic maps. Topographic maps. I’ve collected a few – I’ve got a lovely map of the city streets of Antigua that needs to be mounded and a historic map of Ireland that needs a frame. I hope to one day decorate my upstairs (and most likely my bedrooms) with maps and frames pictures of all of the places that I’ve been to. In Kenya, I almost struck out. The only maps available there were road maps (and as good quality as the roads themselves). So instead, I had a map made for me, on a large plate. It’s gorgeous (I shall definitely have to take a picture) and is hanging on my wall.

The map store was amazing. The owner, a grandfather type who followed me around, answering all of my questions, stated that they had over 6000 maps, and after seeing the place, I believe them. They didn’t have a map of Kenya, however, their map of Ireland blew mine out of the water (alas, it costed close to $500!). And the globes! Oh, how I want a globe! In the end, grandfather-owner did manage to talk me into a shiny antique map based on some explorer from the 18th century’s drawings. It’s soo gorgeous and I can’t wait to see it on my walls!

When I was in South Africa, I bought this map

It’s lovely and exactly what I wanted. Problem is, it’s huge (705mm X 670mm, which roughly translates into 27 X 26 inches). And rather square. And I can’t find a frame to fit it. I tried to get it priced this afternoon. $160 dollars. For a frame. Of wood. Does this make sense to anybody else?? I’ve come across this problem before, because I’ve actually framed some puzzles that now serve as artwork, which were odd sizes (All the World’s A Stage and Fairy Tales. Next I want to do The Oath) and I made the frames myself… went to Home Depot, bought the wood, sweet talked the salesboy into cutting it for me and glued, stained, everything. The first time, I used glass and my upstairs neighbors (I think they were the drug dealers) were having some kind of ruckus and it fell and shattered and I redid it in plexiglass. It was time consuming and it took me months (mostly because I’d lose interest). And Liz made me pinky swear that I would never do it again (I think she was really really tired of puzzles by the time she moved out). So I’m stuck.

Any ideas of where I can get a cheap (but decent) frame made?

I am 9 days from completing my internship, the first year of my residency. After this, it will be me in charge of the interns, directing the team, and helping the fresh-faced, confused recently-made-doctors in taking care of our patients, making sure that nothing is overlooked, that we consider everything that could be potentially causing our patients symptoms and that it gets worked up properly. A whole new level of responsibility. Instead of 5-10 patients, I’ll be responsible for knowing about 15-20. It’s the next step to becoming a Real Boy independent physician. I know that I have areas of weakness (still hate EKGs, still hate drugs), but overall, I think I’m doing pretty good. I’ve even gotten praise from my attendings and residents in reviews, stating that I’m performing above the level that I should be. Maybe I let some of that go to my head…

I missed the diagnosis of an aortic dissection yesterday. Completely and totally missed it. Granted, my patient didn’t come in complaining of the classic symptoms and we thought we had the reason for the other chief complaints–once we got the blood pressure controlled, the headache disappeared and the abdominal pain was gone as well. I was ready to discharge, had all of the paper work ready and was rather upset at my attending for wanting to get an echo, and then a CT scan on a patient who already had a reason for a murmur and was doing fine. Eating, breathing, walking, with no complaints. But there’s a reason for the hierarchy, and I got the scan without too much arguing (just a lot of internal grumbling).

Even then, I missed it. I looked at the scan yesterday morning, saw a little fluid at the lung bases and that was it. I completely missed the large bulge in the aorta, as the blood leaked out. I didn’t get it, until the radiologist called and informed me what the pictures really showed.

Aortic dissections are deadly. They can rupture, causing instantaneous, massive blood loss. In medical school, it is one of the “red sign” diseases that are always top on the differential, as they are the worst case scenario.

And I missed it.

It was my four year LJ anniversary last week. Wow, time goes by fast. Just yesterday, I was primping for my first “date“, choosing my words ever so carefully, wondering if LJ and I would forge a lasting relationship. We drifted apart those first few months, time creating a wedge, but slowly, I was drawn back to LJ’s charisma and listening ear and we’ve been steady every since. *smooches LJ*

Linen, btw, is the traditional gift for the 4 year anniversary. Or flowers. I would accept both from my adoring readers.

On a related note, permanent accounts go on sale tomorrow. Each time, I’m tempted and then talk myself out of it. I calculated it out. Between my paid account and my user pics, I’ve easily spent more than $150 dollars in my 4 years here. I could, you know, go back to the basic account, with a basic layout and 3 user pics, but uh, I’m kinda addicted. It’s my place. My friends are here. My life is preserved here. But then there’s that “forever commitment” that putting down the money entails. And what if one day, LJ and I part our separate ways, that we no longer have anything in common and all we do is bicker? And what if I decide that 138 userpics isn’t nearly enough to express myself and I go looking for greener pasture.

Or maybe I’m just a commitment phobe. 🙂 Maybe LJ and I should just run off together into the sunset, and I should just stop worrying what the next day or year or lifetime will bring?

Decisions. So many decisions. My mind would be eased with flowers….