There are definite benefits to traveling with real adults. When Chris and I were first planning our trip, he was convinced that he wanted to do a touring group, where we’d basically stayed in hostels the entire visit. I tried to convince him to rent a car and staying at B&Bs would be less expensive and more flexible, but he preferred the other option. So be it, I’m a camping girl by nature, so “roughing it” a little by staying in crowded hostels and sharing tepid water didn’t bother me too much. Besides, it’d be an adventure.

Once his parents were invited along, however, the plans changed. Definitely in a good way.

Chris’s mom email me today with the websites/pictures of our lodging in Ireland. Take a look:
http://www.vrbo.com/64925
http://www.vrbo.com/42661
http://www.wildflower-cottage.com/

If I thought I was excited before…

*squee!!*

Only 3 more weeks!!!

It’s been a long, long, time since I put pen to paper and pulled anything creative out of my brain.

After last night’s Dr. Who, Ali (watcher_junior) demanded “Gah. Someone rec or write some Rose/Ten fluff. Now. Please?!”

Well. I’m a slow writer, so I couldn’t comply with the “now”. And I wasn’t doing so well with the fluff part either; trying to rewrite certain scenes at the end of Gridlock turned into a big angsty blowup between the Doctor and the TARDIS… And of course, in the process of trying to do a bit of research on it, I discovered that already, somebody had written out the little idea that I had and did a much better job, well, that completely killed my little story. It was a crappy anyway, painfully stilted with too much “telling.” Nearly a thousand words, though, miscarried. That hurts.

Instead, I’m posting a drabble, that would have served for the introduction (albeit in a lengthier form). I hope you like it, Ali!

Astronomy Lessons

I realize that recently this journal has been rather short on details of my personal life. For that, I apologize.

One of my favorite blogs, Barbados Butterfly was recently taken down. She’s a surgical registrar in Australia, and apparently her administration found out about her blog and suspended her for a week. Gossip thinks that it’s because she violated patient privacy, my thought is that it’s more because she was criticizing the management and the training environment for surgeons. In any case, she’s now gone.

It certainly has made me wary about what I’ve said here in my journal. I’ve never identified my patients by name or even by disease, but I haven’t changed much of the other details, because part of the reason that I keep a journal is to react to those who influence my daily live, for good or bad. I don’t think I’ve crossed any HIPAA rules, but it certainly starts to make one a little more wary. I realize that I’m writing in a public forum; even though it seems so intimate and small, where I feel like I’m writing to my friends, but since most of my posts are public these days, I really know better. And that has curbed my tongue on what I might otherwise express. I’d post it as friends-only, but I know that there are some faithful readers who have yet to join LJ (it’s really easy, folks). So instead, I’ve blabbered on about more frivolous stuff, which I’ve really enjoyed doing. It’s nice escaping a little while into fandom and poetry, avoiding responsibility.

Things in RL haven’t been that exciting recently anyhow. RL ramblings

On a scale of 1-10, how nerdy would it be for me to drive down to Chicago and fangirl Atul Gawande?

Yeah, that’s what I thought.

I think I might just do it anyway. 🙂

From weather.com:

8 TO 10 INCHES OF HEAVY WET SNOW IS EXPECTED BY EARLY WEDNESDAY EVENING….EAST TO NORTHEAST WINDS OF 20 TO 30 MPH WITH GUSTS TO 40 MPH MAY CREATE BLOWING AND DRIFTING SNOW AS WELL.

If I get snowed in again, I’m not going to be very happy.

It is bitter cold outside, with gusting gales and , and it seemed
appropriate. I tend to relate to the nature poems; I suppose the small-town
girl who spent weeks in the mountains still lurks beneath the surface.

Poem: “Tracks” by Marge Piercy, from The Crooked Inheritance. (c)
Alfred A. Knopf.

Tracks

The small birds leave cuneiform
messages on the snow: I have
been here, I am hungry, I
must eat. Where I dropped
seeds they scrape down
to pine needles and frozen sand.

Sometimes when snow flickers
past the windows, muffles trees
and bushes, buries the path,
the jays come knocking with their beaks
on my bedroom window:
to them I am made of seeds.

To the cats I am mother and lover,
lap and toy, cook and cleaner.
To the coyotes I am chaser and shouter.
To the crows, watcher, protector.
To the possums, the foxes, the skunks,
a shadow passing, a moment’s wind.

I was bad watchful mommy to one man.
To another I was forgiving sister
whose hand poured out honey and aloe;
to that woman I was a gale whose lashing
waves threatened her foundation; to this
one, an oak to her flowering vine.

I have worn the faces, the masks
of hieroglyphs, gods and demons
bat-faced ghosts, sibyls and thieves,
lover, loser, red rose and ragweed,
these are the tracks I have left
on the white crust of time.

A little bit of background. This poem is from an anthology entitled “Body Language” which is a collection of poetry written by those in the medical profession: medical students, residents, physicians. From the Amazon review, “By presenting physicians who are also skilled poets addressing a diverse range of medical situations, Body Language offers fascinating insights into the inner world of people who regularly face life-and-death decisions.” This poemespecially struck me, the fledgling neurologist in training, and offers you, I hope, a glimpse into the world of teasing out diagnoses and sometimes being right and sometimes being wrong.

Cases

Man in his late seventies comes in with his wife,
weak, lost twenty-five pounds, can’t eat, hard to talk,
seeing double off and on past eighteen months,
been to a family doctor and two specialists.

They don’t know, I’ve got some ideas. It’s
beyond my scope, here in the rural north country.
I get him tucked away in the medical center
by the following morning. He’s out in five days

with a diagnosis, I was right for once. He’s
eighty percent better on treatment, says
he’s two hundred percent. Gives me the credit
for once. The gray hair helps. Man comes in

to emergency with loss of vision in one eye.
works full-time, in his sixties. It goes away
and he wants to go home. Internist and eye doctor
find nothing. I find something and say, No.

Family says I’m overreacting but they all agree,
reluctantly. Urgent angiogram-surgery on the
neck arteries is booked for the following morning.
That night his opposite side becomes paralyzed.

Emergency surgery cleans out a nearly
blocked vessel. They don’t appreciate the
postoperative pain. They don’t appreciate my
style or anything about me. He walks out

saved from an almost certain permanent
disability. Woman comes in with a headache,
high blood pressure, in her fifties. I do a spinal,
few red cells, radiologist gets me on the phone.

He says the CAT scan’s negative, I’m not
so sure and send her down country for an
angiogram. Radiologist was right and I was
wrong — no aneurysm in her brain. Young

mother of two comes in with seizures hard to
control all her life, and paralyzed on the right side
from birth. I consider a CAT scan a waste of money:
the gray hair stands for experience, remember?

She gets slowly worse over the years. Her family
doctor does a CAT scan, finds a malformation
of the brain. We just ain’t so smart, my old
teacher used to say when I was an intern. A man

comes in, in his sixties, can’t work, losing weight,
muscles are twitching, hard to swallow, hard
to talk. Do some tests, tell his wife and him
he’s got Lou Gehrig’s Disease, it will affect

his breathing, he’s going to die, it will be
tough, we’ll try some things. We do, he gets
worse, can’t walk, can’t feed himself.
I visit the house: a small cape with a screened

Porch behind a variety store in a small town in
New Hampshire. He gets worse, I
visit some more, talk some to him,
to his wife and son, the man dies.

~~Parker Towle, from Body Language. (c) The Library of America

I’m sitting here in neurology clinic, trying out the “post by email” feature. I can’t access LJ from the VA hospital (they have more security firewalls than any other place and so far, I haven’t been able to bypass
it). So this might be the next best thing.

April is National Poetry Month. In years past, fileg has posted a poem a day for the entire month, and I was introduced to so many lovely poets and works of art that stirred something deep inside that I thought long dead. I had forgotten, that once upon a time, I found time to paint, to write, to engage that creative side of me.

She hasn’t posted any this year (nudge, nudge), but I thought I might continue the tradition. I won’t be able to do every day (I’ve already missed 2 days), but I’ll do as many as I can. In addition, if you have any favorite poetry to share, send them on!

This was The Writer’s Almanac poem for today, which I adored (and he’s a Utah writer! Even better!):

“Unwise Purchases” by George Bilgere from Haywire

Unwise Purchases

They sit around the house
not doing much of anything: the boxed set
of the complete works of Verdi, unopened.
The complete Proust, unread:

The French-cut silk shirts
which hang like expensive ghosts in the closet
and make me look exactly
like the kind of middle-aged man
who would wear a French-cut silk shirt:

The reflector telescope I thought would unlock
the mysteries of the heavens
but which I only used once or twice
to try to find something heavenly
in the windows of the high-rise down the road,
and which now stares disconsolately at the ceiling
when it could be examining the Crab Nebula:

The 30-day course in Spanish
whose text I never opened,
whose dozen cassette tapes remain unplayed,

save for Tape One, where I never learned
whether the suave American
conversing with a sultry-sounding desk clerk
at a Madrid hotel about the possibility
of obtaining a room
actually managed to check in.

I like to think
that one thing led to another between them
and that by Tape Six or so
they’re happily married
and raising a bilingual child in Seville or Terra Haute.

But I’ll never know.
Suddenly I realize
I have constructed the perfect home
for a sexy, Spanish-speaking astronomer
who reads Proust while listening to Italian arias,

and I wonder if somewhere in this teeming city
there lives a woman with, say,
a fencing foil gathering dust in the corner
near her unused easel, a rainbow of oil paints
drying in their tubes

on the table where the violin
she bought on a whim
lies entombed in the permanent darkness
of its locked case
next to the abandoned chess set,

a woman who has always dreamed of becoming
the kind of woman the man I’ve always dreamed of becoming
has always dreamed of meeting.

And while the two of them discuss star clusters
and Cézanne, while they fence delicately
in Castilian Spanish to the strains of Rigoletto,

she and I will stand in the steamy kitchen,
fixing up a little risotto,
enjoying a modest cabernet,
while talking over a day so ordinary
as to seem miraculous.
—

GUESS WHAT??

I am done with call, done with working weekends until June!!! That’s right, baby! Two whole months of no every-fourth-night (or third, really) call, normal sleep (if I’d ever go to bed), no discharge summaries (behind by 10 now. Did about 6 of them today), no “only four days off a month.” SWEET.

My last call was on the 31st, and it was brutal. 5 patients, essential after midnight. Because it’s the end of the month, I should have been done and gone by 7, but I was three patients behind by 4 in the morning, and falling asleep in my chair. I was there until 10, and by the time I crawled home, absolutely collasped into bed. I didn’t wake up until 9 that night. I know that there are amazing people, who come home post call, take an hour nap and spend the rest of the frollicking. I really wanna know their secret.

I almost posted that night that I was quitting residency and going to go work as a pharmaceutical consultant, as an April’s Fool joke…. but at the time, it was too close to the truth. There are times when I hate what I do. Hate the long hours, the lack of sleep, the inability to have a normal life. And then when I get pages that state roughly that I’m a horrible person for leaving rounds early (!!! I shouldn’t have been at rounds at all! I was nice to stay and actually present a patient, because I knew him best!) and *cry* not updating the patient list, this desire to run away is amplified (I wish I could caulk those to April Fool’s jokes, sadly, I think that these particular persons do not possess that kind of humor. My comrades from last month, oh yes (I’d have done the same to them, the little rascals), but not these ones.

Enough with that. I’m happy now. Today, I spent working on discharge summaries and reading articles in between critiquing the new Dr. Who season, as we have no patients on the hematology/oncology service right now. Not that I mind being bored for once! Oh, and I also bought rose bushes and blueberry, raspberry (I don’t think all of my raspberry bushes made it through the winter. 🙁 ), bosenberry, and grapes bushes, and strawberry and asparagus bulbs, so I’m so excited to be planting a garden! Ah, my friends, spring is here!

Besides YouTube, how is everybody (ie… the four of you on my flist) watching Dr. Who? Waiting until it shows in your neck of the woods? I did try to do torrents, but my connection is way too slow. It was going to take something like 6 hours to download one hour, I decided it wasn’t worth it. You Tube’s fast and it was there, right after it aired, so that’s a plus. I can deal with the fuzzy screen.

In any case, yay! New season!!

Thoughts about Season 3, dar be spoilers

8 second spoiler for Dr. Who:

http://www.youtube.com/watch?v=frGVZdl4q2Q

Waiting until I can see it in context before I jump to conclusions, but really, what I want to know is why nothing like that happened to me as a medical student. *pout*

Btw, yahoo has more pictures of that adorable polar bear. Apparently, animal rights activists are all upset that when the cub’s mother abandoned the baby, instead of letting him die the zoo keepers’ feed him and played with him.

They’re really just a bunch of meanies.

I mean, who could resist such a cutie?

For the whole story: http://news.yahoo.com/s/nm/20070320/od_nm/germany_polarbear1_dc

(never did get my cute baby animal icons….:( )

Did I tell you all about the latest development in my life? No, well guess what? I had a very sweet man propose marriage to me.

He’s 91. Do you think the age difference might be too troublesome?

This is why I love being at the VA. There’s the perks of he slower pace of life, and men constantly telling you that you’re pretty. Flattery, my friends, is a heady thing. (Don’t worry, it was very quickly tempered by being called nurse after introducing myself as Dr. D****** every single morning. Bah).

My patients, for the most part, are sweet and genuinely thankful for the care that they receive. It’s like watching Miss Manners in action, why she preaches on minding your manners and saying please and thank you. Because they are more appreciative, I have more satisfaction about my job, and while I might not provide any different care in the way that I work them up or think about their issues or provide medicines, because I’m happier, they perceive that they are getting better care, so they in turn are happier, which makes me happier…

And it’s nice sleeping a little on call. Last night, I was in bed a little after midnight. My pager went off once at 6 am and I woke up at 7. That’s 7 hours of sleep. Granted, I was waking myself up every hour to make sure that I hadn’t overslept a page, but it was still rest and sleep, more than I get at the Big Hospital down the road.

And can I just say how much I love my cointerns?? I work with some fantastic, humorous, smart, fabulous people and I can’t imagine how more difficult this would be without them in my life. Someday, I’ll share the stories, someday. See, sleep makes me a big softie. 🙂

*****
I really can’t figure out the fascination with MySpace. Ads sprinkle every page, which have clashing, difficult to read color schemes. Loud, annoying music blares whenever you, poor sap, make the mistake of clicking on someone’s profile. And I have yet to figure out the allure of adding “comments” to each other profile, which basically turn into instant messaging tag teams, and if you happen to be a stalker a curious bystander, you have to click on all of those profiles to get the whole story.

But I have run into some old friends of mine. A classmate from high school who’s now a nurse, a fellow Access girl who just completed medical school, Sam and her husband and her sister and her mom (*g* Sam, we should just give it up and become blood sisters. We practically are.), a college roommate of my sister’s, etc. And today, one of my medical school classmates… who actually moved out here with his wife to do residency. Besides the month that I worked with Ann in the ER, I’ve barely seen her or Aaron. We live approximately 10 miles apart and it takes a webpage to reconnect us. Yep, that’s the technological world we live in.

OTOH, it is because of technology and the wonderful invention of cell phones that I had a fantastic call last night from Kenya. 🙂 That’s one way to brighten up a call night.

The iTunes Single of the Week is a MUST HAVE.

I first heard Brandi Carlile’s “The Story” on Milwaukee Public Radio’s “Cafe Tonight” (still the best music on the radio in Milwaukee *sigh*) and I almost swerved my car off the road, I was so intent on finding out who sang this song (it was a dangerous drive that night. First time I heard “Chasing Cars” by Snow Patrol as well). Strong, raw vocals and powerful, yet slightly whimsical lyrics. I bought it on iTunes that night.

Lyrics for The Story

I spent my day off… updating my journal design.

Well not entirely. I did apply for my temporary license where I had to vow with my soul and with blood (okay, with just a notary public) that I was telling the truth and the whole truth that I spent 5 weeks after graduation last year lazing around and moving, instead of doing medical stuff (because heaven forbid I should ever take some personal time and not let TPTB know).

I’ve been wanting to revamp the journal for a long, long time. My beloved Anne layout had been used for over a year, and I just kept looking at it, longing for something better. It’s nowhere near what I want (I gotta figure out how to customize Flexible Squares), but it’s a new pretty background that makes me happy. I had really thought about doing a non-fandom layout, but I couldn’t resist. It was so bright and cheery.

Tell me how it looks for y’all. Not too fuzzy? Doesn’t take too long to load? No white areas? Color okay?

In other news, my patient survived and is doing better. So I’m sleeping better and not being haunted by dreams.

I’ve lately discovered that iTunes is now carrying Pod casts of several of my favorite NPR radio shows, namely “Wait Wait, Don’t Tell Me” and “News from Lake Wobegon” (wish it was the entire show of A Prairie Home Companion) and StarDate that have been satisfying my inner nerd. Today, I discovered that they are also carrying another Garrison Keillor program, “The Writer’s Almanac.” I remember listening to this every morning as my parents got ready for school. Plus, I discovered that they have the transcripts online, so I’m very excited at the prospect of introducing some poetry into my daily life again. I’ve missed that.

And lastly, for at least my amusement: Conversation at work yesterday….

MED STUDENT: Yeah, so {patient} thought that Julia and I were twin sisters. I guess we could be fraternal twins.

ME: That would have been one long gestation period!

MS: I’m 24, how old are you?

ME: *pause* *pause some more* Um. I don’t know. Either 27 or 28. I think I’m 27. Wait. No, I’m 27. I think. I had my birthday in November and I’m pretty sure I turned 27. Or maybe it was 28.

MS: You don’t know how old you are??

Yes, it’s true folks, until yesterday, I didn’t know how old I am. Let it be known, that I am officially (according to the computer because I had to look it up on google before I would believe it) 28 years old. In just over a year and a half, I will be 30. Hmmm. I wonder when I’ll ever start acting my age.

Dear Sore Throat

Go Away. Seriously. You have long outworn your welcome. I want to be able to swallow without feeling fire in my tonsils. I want to be able to breath without coughing hard enough that I actually vomit. I want to be able to sleep and wake up feeling human. And I want to be able to talk. That one’s kinda important; see my job requires that I ask people a lot of nosy questions and I can’t do that now with my little elderly and usually deaf patients.

And really, if you must crash here, you should have brought along your little friends, Fever, Lymphadenopathy, and Exudate, because then, I’d have the chance to take antibiotics and kill you dead. Instead you just leave me with a viral illness, sick enough to be completely miserable, but not sick enough to actually call in sick.

I hate you.

Julia

how blessed the day when the lamb and the lion can lie down together without any ire….

First it was the baby white Bengal tiger triplets

Click for cuteness overload

Call:
— Wake up at 6:45
— Shower, brush teeth. Head to work with wet hair.
— Arrive at work at 8:00 am
— Discharge 1 of 2 patients by 9:00 am.
— Cointern is post-call; spend most of morning and afternoon trying to finish up on his work.
— 14 patients to dictate
— 4 completed dictations by 5 pm.
— Eat lunch at 3:45
— First admission at 5:15.
— Second at 5:25
— By 8 pm, am already behind by 2 patients
— Capped with 5 admissions by 10:12
— Supervising resident is busy. We don’t finish seeing my patients until 3 am
— I eat dinner (chili cheese hot dog. I’m sure it’s great for my diet) at 12 am
— In bed at 3:15. Am awoken every 15 minutes by pages. Really, really silly pages
— Wake up at 5:30 to finish admission notes from night before
— Wait impatiently for new intern to arrive so I can sign over the patients and leave
— New intern doesn’t arrive until 7:10.
— I don’t leave the hospital until 7:30.
— Drive through a blizzard to the VA hospital. I have 5 patients to see before 9 am.
— Arrive at 8:15 am.
— Am told by resident that we have orientation to attend
— Am feeling extremely post call and nauseated by the adrenaline rush of the blizzard drive (you try keeping control of your car on 2 hours of sleep!)
— Meeting finishes at 9 am.
— I haven’t seen any patients.
— Excused from first part of rounds to see patients.
— First man is very sick. Was told by last month’s intern that patient was very sick. Thought this was patient’s baseline “very sick but stable” self.
— Fly by other patients and they’re all doing good.
— Meet up with team and start rounding on my patients together
— Patient #1 is very sick. Much sicker than baseline.
— Within a half hour, he’s intubated.
— Finally finishing rounding at 12.
— Finish notes at 1:15.
— Leave hospital at 1:30.
— Blizzard is at least finished
— Get home by 2:00
— In bed by 2:30.
— Wake up briefly at 11:30, fall back to sleep
— Wake up again at 8:25 this morning.

Sum up. Slept : 18 hours (+ 2 fragmented hours). Last ate: 30 hours ago. Last brushed teeth: 49 hours ago. Last showered 49.5 hours ago. # of pages: Filled up pager 3 times (can get 19 pages). And received 3 yesterday when I was comatose.

Had some interested dreams. I dreamed about Dr. Who, tenth doctor and Rose starring and with a small crossover from Everwood (Edna and Harper were in it). I never remember details of dreams very well, (something about a horrible obstacle course, where the contestants were trying to get back home and had to pick the right shoe hanging from a string) but it was very, very dark, and Harper died and Rose was crying. And me…. I was fixated on the fact that my laptop got flattened during the escape.

So, now I’m off to brush my teeth and seek out an IHOP, because man, I’m hungry.

I dreamed about Africa the other night, that I was back in the hospital. It’s been just over a year since I came back. I was talking to Chris last night, who’s on his journey across the world again (I think he should have arrived in New Zealand now), and will be going to Kenya for a month in March, and I was trying to tell him about all of the people and the cultures…. and realized that I had forgotten. Names, mostly, of the people that I had met. They’ve come back to me now, after sitting here and scrouging around for the faces. Lenai. Shawn. Raj. Liz. Leigh Anne and Karla. Time moves so quickly, and before you know it even the brightest, most cherished memories begin to fade.

I’m almost 2/3rd of the way through intern year, and I am so tired. Bone weary. This is my fourth month of Q4 call, of admissions and discharges, of early mornings and long rounds, and I’m just tired. Not to mention, I got three emails, questioning my professionalism yesterday (they were directed at a group, not just me), that pissed me off. I had one of my clinic patient’s mom call and yell at me (I managed to remain logical, she calmed down and listened to me). I argued with a patient today. I’m usually very good with my patients, I try to be compassionate, but he started yelling at me the moment I stepped into the door, so I was much more blunt and hard than I usually am… and predictably, it did not go well. I left in the middle of another one of his tirades, just turned around and walked out. Didn’t apologize or nothing. 🙁 Not good.

I miss traveling. One of the med neuro residents here just got back from a rotation in Zambia, where he worked in a neurology clinic, but really ended up doing everything that they asked for (the stories he tells of taking care of trauma patients after a bus accident!), and all I can think is “I wanna do that!” Make a difference, rather than just feeling like I’m the drug dealer for the patients with pain “crises” and serious drug addictions.

Chris left yesterday for another 3 month stent across the globe, this time to New Zealand and Australia, then to Kenya for the same rotation that I did, down to South Africa for an overland trip that sounds amazing, and finally to Ireland, where we’ll met up (with his parents. Did I tell you that development? I like his parents, they’re very nice people, but it’s already hard enough explaining to people that you’re going on vacation with your very platonic friend, without getting parents mixed in). Three whole months of traveling. Bet you couldn’t tell I was jealous. 🙂

Speaking of Africa, this story is amazing: http://news.yahoo.com/s/ap/20070220/ap_on_re_af/running_the_sahara. I’ve been reading their blog at National Geographic (why did it not dawn on me that it would be a website as well), and it’s quite fascinating

And still speaking of Africa, would my dear African friends like to meet/host Chris for a few days while he’s down there visiting your country? He’ll be traveling in and out of Jo’berg Aprilish and in need of a good time and friendly faces. Obviously, I understand not rushing out to welcome people you don’t know and haven’t even “met”, and that you have jobs and real lives, but I figure I’d dangle a little carrot and remind melancthe that he’s pretty cute and see if she’d bite. 😉

It is amusing me, however, when I picture explaining to him how I know you… and how you are aware of his existence. Yep, still haven’t “come out of the closet” with the blog to him. 🙂 I guess this will really be my chance.

Okay, to bed. One of my precious days off tomorrow, and I will not squander it!