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4th May 2017

dig the grave


It passed.

The amoral, atrocious, vindictive, abomination of a bill passed the house today. The more I read about it, the more I am horrified. Truly horrified. The media has been focusing on the pre-existing conditions clause, but what has made my soul ache is the complete destruction of Medicaid and the loss of $880 billion in funding. $880 billion. The fact that every single medical society, every single healthcare advocacy group decried it should have meant that they considered the ramifications and had a thoughtful, careful approach to it. But I overestimated their moral conscience.

I’m enflamed and outraged. I am also terribly depressed and worried. I’m not comforted by knowing that it has to go through the Senate, as everybody keeps saying. All this revealed is how much our voices are ignored. I hope that this really does bring change at the midterm elections – but it didn’t when the republicans shut down the government for weeks so I don’t know why this would be different.

A few years ago, I was really into politics – I read about how the Supreme Court worked, I followed different bills and lawsuits, etc. A colleague of mine suggested getting involved in the AAN (American Academy of Neurology), as they have some political leadership courses and I could get involved in advocacy. And 4 months into this presidency and all of those kinds of thoughts have vanished. I’m tired and the thought of getting involved more… I hear that this has encouraged many people of the democratic party to seek office, and boy do I wish them well, and sort of wish it was me, mixed with gratitude that it’s not.

posted in On doctoring, Politics | 0 Comments

17th November 2010

we used to wait

we used to wait

Both my dad and sister reminded me that I had been there when Laura was burnt by the tar. Apparently, my mom, sisters and I had gone on a bike ride and Laura had ridden her bike directly into the hot tar pit. So my memory was correct!

Speaking of nostalgia and memories, have you all seen the latest Arcade Fire video? I shared it on my Facebook a couple of weeks (maybe even months now!) and I still love it. Go here to their website, type in your address (nostalgia is one of the ingredients to making it powerful and mindblowing – it’s best if its the address of a place you grew up) and wait for it to load. It only works on Google Chrome or Safari and it also uses a lot of memory and processing ability, so it is best if you only have that one program open. And then after you see it, read/listen to the interview on NPR about how they made the video. It’s amazingly magical.

The video of where I grew up: http://www.thewildernessdowntown.com/#1339+E+Allen+Rd,+Tucson,+AZ+85719,+USA. The first time I saw it, it made me cry.

All About Me Day 07- A picture of where you live
I’ve inundated you all with pictures of my house over the last month. Does anybody not know what my house looks like?

Instead, pictures of my other “home”: Read the rest of this entry »

posted in All About Me, On doctoring, Resident Life | 0 Comments

29th June 2010

Match made in heaven

Match made in heaven

For better or worse, I matched!

Chris called me at 5:50 this am (!!!) asking me where I had matched. As I had stayed up late and then tossed and turned for hours, I was pretty blurry eyed and groggy. But I logged on the computer and there were the results. No fanfare, no congratulatory email from the department (it was 4 in the morning pacific time, so I guess that’s not too surprising), just results that had probably been released at midnight. I was rather stunned to just see them there – the past few days, I had had the habit of clicking on the “match results” link to test if they were accidentally released, so I was used to the curse “please check again” webpage. I had promised Chris that he’d be the first to know–I think it dawned on him faster than me what the results were!

As always, my emotions are in turmoil. I’m super excited and ecstatic and happy, and then the other side of me is shell-shocked and grieving at the thought of moving and leaving behind this life that I’ve created here. I’m happy here, even with the crazy snow storms and muggy heat. I love my house, I love my friends, and the thought of leaving that terrifies me.

I’ve joked before that The Match is very much like a marriage ceremony, albeit a rather sadistic one (even in arranged marriages, you at least know the name of the person to whom you are vowing). By submitting the list, I tell whoever selects me, that for better or worse, I’m committed and that I’ll pick up my life and become theirs. I knew when I submitted the list that I would be leaving Milwaukee. As much as I’ve loved being here, this isn’t the place that I wanted for training. The program director belittles and torments when he’s not a in good mood, which is not something that I want to endure for two years. I wanted a place where I would have women mentors and colleagues, which I couldn’t get here. So I chose to go elsewhere, just like I chose to come here for residency, leaving my comfy life behind. I grieved then, and I’m grieving now, between the smiles of elation.

posted in All About Me, On doctoring, Resident Life | 2 Comments

31st May 2010

previously, on This Resident Life

previously, on This Resident Life

I had not intended to take such a prolonged absence from my blog. Three months! I think it’s the longest break that I’ve had since starting my blog in 2003. The longer I was away, the harder it was to come back. I’ve missed writing, scribbling down my thoughts, but the longer I was away, the harder it was to actually write. Granted, it’s been a really busy three months – lots and lots of time in the hospital, my four precious days off a month being used to interview, too many 30 hour days – but every time I sat down to blog, I couldn’t get the words out. The first entry back had to be deep, ladled with meaning and symbolism that would make you all read and weep for my prolonged absence, because your life just had not been complete without my pithy remarks. This won’t be that kind of entry. I’m on vacation right now, visiting my parents and my mother was so excited when I opened up my computer, thinking that I might update. And who can deny their mom anything? So, Mom, this is for you.

When last we spoke, I had just started the whole interview process, I think, for neurocritical care fellowship. Yes, it’s still ongoing. You all were here for the drama of applying and then thinking that I had missed the deadline. Oh ho, foolish Julia! It took until April to even get an interview from a majority of the programs (and I just had another email this past week from a program who hadn’t said a thing until now), so it’s been a rather prolonged, drawn out process. I did take a couple of notes throughout my interviews, but as they dragged on (and on. And on. And on). I stopped doing that as much, which left most of the programs as a big fuzzy memory. Oops. It’s okay, all of the programs have wonderful relationships with neurosurgery, there’s plenty of teaching, all of the fellows are happy and there’s no more call and the water fountains stream golden honey. Or something like that.

I’ve completed all 11 (!!) of my interviews; I have a top choice (and a close second) and now am contacting programs declaring my everlasting love and asking if they will be mine. On June 22nd, my rank list is due and on June 29th, the arranged marriage match will be confirmed. In one month, I’ll know where I’ll be planting roots for two years.

And since I’ve been telling everybody, my first choice is San Francisco. So if in June, I mention that I’m headed to Atlanta, then you’ll know that things turned out really, really wrong (I didn’t even interview there!). I’ll be really, really happy when the whole thing is over.

I’ll let you know. 🙂

posted in On doctoring, Resident Life | 2 Comments

14th November 2009

saturday is a special day, it’s the day the crazies come out to play!

Remember that parable about how if you carry a calf every day, pretty soon, you’d find that you could lift a full grown cow?

Residency is like that, I think. Because I’ve been doing this for so long, I can do things now without thinking about them. I just stuck a needle in my patient’s back (a spinal tap or lumbar puncture). At first I hit bone, but then, because I’ve done so many of these, I knew where to reposition and guide it through the ligaments into the subdural space. Champagne tap.

I got criticized last night by the fellow for giving tPA to the patient I mentioned, because patient had complications right afterwards, which didn’t show up on imaging and obviously, I had missed the diagnosis. My attending this morning criticized me for not arguing more, because, in his opinion, I was right. I didn’t have enough confidence (always a problem) in my thinking and honestly, you can’t convince this particular fellow of anything.

The cow named Residency and I need to do some more bench presses together. That’s okay. We’ve got another year and a half together.

(Obviously this was composed way too late at night and my metaphors and similes are rather poor).

I told Dr. L today that I’m doing critical care. I’ve worshiped him since I was an intern (some of the starry-eye devotion has faded as he became more human, but I still adore), so his opinion has been very important to me. He’s excited for me. I think if I want to stay here, I should have a position, which is a comfortable sort of feeling. Now if I could just get up the courage to ask for letters of recommendation.

My research project has stalled, because, as always, when I did the literature search, I found that all of my ideas have already been researched to death and I can’t come up with any cool spin on it. Lovely. Have I mentioned that I hate research?

I was going to share about my little flirtations with the cafeteria cook (we’re on first name basis now!) and how one of my favorite nurses just informed me that he could walk through paper and then proceeded to perform the lame magic trick. But I am tired and want to sleep. So I’ll just leave you with the little tidbits. 🙂

posted in On doctoring, Resident Life | 0 Comments

12th November 2009

nablopomo is the only reason that this post exists

I didn’t leave the hospital today until almost three o’clock, trying to figure everybody out and make sure that everything was ordered, discharging patients (inherited 18 patients today, discharged 8. Not too bad!). I then slept and slept and slept and if my stomach hadn’t awoken me unhappy about its prolonged fast, I might have slept until morning.

I have realized, again, how much I truly despise the attending on the team. I haven’t worked with him since I was a junior resident, but at that time, he told me (in front of a patient and his family) that I was an incompetent, lazy physician, who didn’t know how to take a history and couldn’t do a physical exam. Haven’t felt the love since then. He hasn’t changed. He chewed my interns and I out for admitting 2 patients, for not getting all of the details of the history on another (even after reviewing the chart 5 times, I still don’t know why such-and-such was done, so getting more details is impossible!) and so forth. He’s a big time researcher, and brings a lot of grants and money to the department, but I wish that he would stop doing inpatient rounds. He obviously hates it, and the rest of us don’t benefit either.

My social workers and case manager are bringing me pumpkin bread tomorrow, because I’m being such a good sport about covering all of the teams. So there are bright spots. 🙂

And now back to bed.

posted in Resident Life | 0 Comments

21st October 2009

all but the promise ring

all but the promise ring

I met with Dr. W, my neurology program director, for my semi-annual review today. As Dr. F, the internal med director didn’t show up, and I’ve been in near constant contact with Dr. W over this “remediating” situation, it wasn’t quite as nerve-racking as usual. They’re still not planning on kicking me out, so I’ve got another 6 months to breath easily.

He did ask me, point blank, what my “end of residency plans were” and I admitted that I’ve been struggling with that very decision, trying to make up my mind. I feel like I’ve been wrestling with it since starting residency. Unfortunately, as applications for fellowships are due in just a few short months, I can’t afford to be indecisive for much longer.

Was I interested in multiple sclerosis? He probed.
Movement disorders?
Neuromuscular diseases and doing EMG and muscle/nerve biopsies?
Epilepsy and electroencephalograms?
No. No. No. So much no.
Having a continuity clinic and seeing general neurology or medical patients?
And critical care?

Critical care? I love critical care. I love the patients. I love the systematic approach to complex medical decisions. I love the procedures. I love/hate that moment when the patient arrives sicksicksick and I’m terrified of how I’m going to mess this up…and then take the deep breath in and just listen to the lungs and heart while I figure out what to do. I love having the family meetings and helping people figure out what their loved ones would want, arriving at “good deaths” if necessary.

But. But. I can see myself as happy as a hospitalist or maybe working as a stroke attending. I can. And I could do that without any extra training.

My attending laughed at me by this point. Dude, he said (and yes he did say dude), You have to go into critical care and you know it. He basically parroted back everything that I had said… and he was completely right. I’ve been trying to convince myself to do critical care, (honestly since third year of medical school), but truly, I’ve been looking for excuses not to do it… and really haven’t come up with any. Except that I don’t want to go through the application process again (which, since I have to eventually apply for a job, is logically ridiculous) and that fact that I’m not nearly competitive enough. My CV (curriculum vitae or resumé) right now reads that I’m doing residency and not much else.

Dr. W. gave me some fabulous ideas of how to enrich my CV, including talking to some of my favorite attendings for letters of recommendation, and research ideas that I’m much more interested in, such as quality of life measurements and how we communicate with families. Exactly the type of stuff that I’m interested in.

So I have a plan. I’m emailing Dr. J and Dr. BFF for assistance and ideas on the research projects. I’m talking to Dr. N, Dr. L and Dr. H about letters of recommendation. I’m getting a list of good programs which to apply from my classmates.

And I’m applying for fellowship.

posted in All About Me, On doctoring, Resident Life | 0 Comments

7th July 2009

two things I had forgotten

1. How good a long workout can be. Did I tell you that when one of my friends moved this spring, she gave me her elliptical machine and weight bench? I can’t remember. In any case, I haven’t use them more than 1-2 times a month. Did I also tell you that my friend had a household of cats, and the elliptical machine had the unfortunate residence in the litter room? I like cats (although I’m slightly allergic which keeps me from giving in and buying a cute ball of fur), but I don’t like my hands smelling like cats after a workup. I’ve sprayed it with bleach, baking soda (no worries, I washed it with water in between), more baking soda, and two applications of Febreeze and with a towel, it’s tolerable.

In any case, I walked for 30 minutes today and burned 300 calories! Go me!

2. The perfection that is the show Everwood. Oh, my poor, neglected, canceled-in-its-prime show. TPTB at the WB finally, finally heard the numerous pleas and released the second season on DVD, and I had forgotten how much I love this show. The relationships, the characters, the acting is just perfect. Every single week. It makes me homesick (in the cathedrals of new york and rome, there is a feeling that you should just go home and spend a lifetime finding out just where that is) and heartsick and happy all at the same time. I miss good tv like that. (Season 2 can be purchased here from Amazon if my little missionary moment convinced you. 😉 )

In other news: I had a lovely 4th of July weekend. I had a blissful three days off, and caught up on sleep and read for fun for the first time in months (East by Edith Pattou, The Princess and the Hound by Mette Ivie Harrison and Princess of the Midnight Ball by Jessica Day George. Hmm, wanna play spot the theme? Actual book reviews are forthcoming, I hope), helped my friend paint her mother’s bathroom, went to another friend’s house and played with sparklers for the first time ever, and ate strawberries and ice cream cake, and just had a nice time. I really miss not having a summer vacation; this was a small but appreciate glimpse of freedom.

Picture evidence of the weekend and of the rest of my adventures in May and June can be found at my Picasa web site, including English Country Dancing, seeing Carbon Leaf in concert (one of the best concerts ever), and hanging out with my crazy yet beloved coworkers.

The VA emergency department has continued to be somewhat slow. I’ve seen a total of four patients in the 3 days that I’ve been there. I’m not complaining – I’ve gotten caught up on my clinic notes (it’s amazing how quickly I can get behind if I don’t do them immediately after clinic) and I have a big fat 1000 page book that I’m determined to have read by the time I switch to the medical ICU in August, so I appreciate the chance to study. I start night float on Friday. Meaning, I work 8 pm to 8 am (or 6 pm to 8 am on the weekends) for a week, admitting the sick patients who come in from the emergency department. Long ago, I lost any semblence of a circadian rhythm, but it’s never been tested like this before. I’m kinda excited to see how I handle it and I’m hoping to get a couple of things done in the day, such as getting a basement/foundation specialist to diagnosis why my house leaks and taking my car to the garage to figure out why it suddenly sounds like it’s been possessed by a family of crickets.

And that’s it with me. How are all of you?

posted in All About Me, Everwood, Friends, Frivolous Fandom, Rejuvenating the Soul, Resident Life, Social Life, Those Rare Days Off | 0 Comments

1st July 2009

july 1st

My morning was free today. I celebrated by taking a long nap, buried in blankets. I honestly think we could bring peace to the world by initiating global nap time.

It’s drizzling and cool today. The weather forecasts only mild rain throughout the day. No major thunderstorms for which I am thankful. Did I mention that I had a plumber out to my house last week, who pulled off the rusted cap to the sewer drains, peered down and stated that snaking the drains wouldn’t help the flooding situation at all? It’s a city system problem, that the water backs up in everybody’s drain when it becomes overwhelmed with the rain water – my neighbors fair slightly better because they have sump pumps installed. If I installed a flap in the drain to prevent the water from coming up, I risk building up pressure so that the water comes up through my sinks or toilet instead, causing even more problems. Installing a sump pump could cost thousands. Over $100 dollars to be told that there is nothing that I can do, except petition my city officials to expand their drainage systems.  I haven’t decided whether or not to seek a second opinion. And neither have I figured out how to address the leaky windows/floor either. All I can do is hope that we’re done with the thunderous rain storms for now and keep everything up off my floors (the cinder blocks are staying).

The ER is “mercifully benevolent” today, in the words of one of the attendings today, a change of pace that I am enjoying. Either everybody got the message that the hospitals are to be avoided on July 1st or they’re all at the baseball game down the road. It’s now 4 pm and there’s been nobody so far. I’ve been good and have used the time to catch up on some clinic notes. I’m sure as soon as I suggest an early end to the day, the patients will start pouring in.

posted in Adventures in Home Ownership, All About Me, Resident Life | 0 Comments

30th June 2009

an epoch of my life

an epoch of my life
  • Today marks the end of my third year of residency. Tomorrow, I start work at the VA emergency department (ugh. I like the VA. I hate the ER) as a fourth year. Two more years to go.
  • I told the director of the neurology critical care fellowship here that I’m planning on applying. I still vacillate about it, mostly because I dread putting together the application, asking for letters of recommendation, and somehow fitting a new, amazing, novel research project into my already busy-enough life. I hated the application process going in to medical school and into residency. The thought of doing it again makes me want to weep. But neuro critical care is really where I thrive the most. I still have tons to learn and I find it intimidating but… I think it’s where I should be.
  • I finally made up with the attending that I was arguing with last week. He felt pretty bad about things, told my program director that I was really great, etc. Except that I kept getting confronted with all of the drama and it was this continuous awkward situation. But I apologized for for the emotional breakdown today, he apologized for being harsh and misjudging, we hugged, and hopefully it’s all good. I’ve got three months before I’m back anyway, enough time for it to be completely forgotten when I ask him for a letter of recommendation.
  • Chris moved to Boston. I didn’t get to see him off. Three years ago, I cried for 2 days straight when he left for Asia, thinking that it was the end of our friendship. It wasn’t. This won’t be either. But I still miss him dreadfully.
  • I heart Milwaukee. Especially the baseball games and tailgate parties. And I really heart my camera. Look for pictures later this week.

posted in All About Me, Friends, Resident Life, Social Life | 0 Comments

18th June 2009

health care reform meta

Chris moves to Boston at the end of this month (I’m hoping for one more quick visit, but he’s booked solid with going away parties and moving companies). On July 1st, he’ll be working with my hero, who distills the health care reform arguments and gets down to the heart of the problem, and does so beautifully. Dr. Gawande’s latest article in the New Yorker is a must read. I’m sending a copy to my representatives, because nobody, nobody is addressing the real issues that affect medicine. I strongly disagree with Pres. Obama’s ideas of health care reform (and I’ve agreed or at least grudgingly understood why with all of his decisions so far–but I knew back in November that while I was supporting his election, it wasn’t on the platform of health care reform), but I loath every other politician’s idea as well. They aren’t in health care. They see health care from a business model, and the focus is on “saving money,” while insisting on continuing to provide care exactly how it is now.

“…We are witnessing a battle for the soul of American medicine. Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.

“There is no insurance system that will make the two aims match perfectly. But having a system that does so much to misalign them has proved disastrous. As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.

“Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of cordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the countrys best electrician on the job (he trained at Harvard, somebody tells you) isnt going to solve this problem. Nor will changing the person who writes him the check.

“This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Heres how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some skin in the game, and then theyll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes.”

From The Cost Conundrum, The New Yorker, June 1, 2009.

A few short months after I started residency, the neurology department switched from paying their physicians a salary that was based on experience and tenure to a “relative value unit” compensation system, meaning that patient visits or procedures were reimbursed based on a calculated fee. A basic office visit would be 2 RVU, doing injections for headaches would make it worth 10 or performing an EMG would give you 30. You had to make a certain number of RVUs in order to get a base salary, anything else you do is “gravy”. Things changed overnight. Attendings who used to lecture at noon time suddenly were squeezing in more clinic patients or doing another procedure. My program director is the only one who lectures any more. When on service (meaning they’re in charge of the patients who are admitted to the service and over the residents), attendings leave for a few hours to see clinic patients, cutting into the time that they spent teaching. My neurology clinic was a disaster. Instead of learning how to diagnose and treat migraines, seizures, Parkinson’s, etc, I had lectures on how to document my notes, so that they would generate the most income.

Contrast that to the internal medicine side, who pay their physicians a set salary. The attendings work their two weeks on service every three to six months. They staff the residents clinics and I never hear anything about how I need to see more patients or finish my notes in X amount of time so they can get all of the billing. The focus is instead on my learning: making sure that i understand thoroughly what the cholesterol panel on my diabetic should be for heart attack and stroke prevention. I just learned that that the internal medicine doctors will be getting a 15-30% pay cut next year because of the economy (and some piss poor economic decisions by higher management–but that’s a rant for another day). So far, I haven’t seen it affect the care that they are providing their patients or the education that they are providing me – a vastly different and much more preferable. I understand that unfortunately in this capitalistic* society, medicine is a business as much as anything and that I will have to face monetary decisions once I graduate, but I strongly disagree that it should be influencing my medical education or the care I provide my patients, to this degree.

Also check out his other article Getting There From Here that has a fascinating history lesson in how health care coverage and insurance evolved over the past century, as well as an examination of why idealism should not prevail in our quest for a better medical system. It’s a beauty as well.

Now if we could only get good tort reform as well…

*I support capitalism, but I don’t support endless greed (such as CEOs of private insurance companies or hospitals making billions of dollars a year), which is what our current system seems to be based on. We seem to be learning lessons very slowly.

(Sorry if I lost your comments. I was transferring all of my entries to my other blog, which for some reason copied everything 3 times, and then I clicked delete on the wrong entry. Argh)

posted in On doctoring | 2 Comments

15th April 2009

the slow path

(written this afternoon. The hospital’s firewall prevented me from posting)

I realized yesterday, as I was looking at my schedule for next year, that while I’ve been feeling like I’ve been doing residency forever, I still have 10 months of internal medicine left to go. 10 months. Since I’m doing a combined residency, I have 30 months of medicine and 30 months of neurology, compared to my colleagues who do 36 months of medicine or neurology. Not only am I missing out on six months of training, but as it is, I’ve still got a third of my training left. I’ve been comparing myself pretty harshly to my fellow residents, especially the medicine residents as they are graduating in 2 months and I certainly have not felt that I’m at that point and was quite discouraged. Yesterday, I was dispondant after getting lectured by one of my friends about a disease presentation that I didn’t know anything about, but he was rattling off all of the clinical symptoms and signs and I felt like an idiot. I feel a little better now, realizing that I still have time to learn it all.

I’m on neurology consults this month (I think I mentioned that) and it’s also been an opportunity for me to appreciate how much I have learned as well. I was on this same rotation two years ago as an intern and it was one of the hardest months of that year (the other 2 being the inpatient neurology wards). I didn’t know anything. I felt like I was struggling every day to ever come up with one idea of what exactly was causing the altered mental status/weakness/seizure/what have you, much less come up with a differential diagnosis or a diagnostic and treatment plan. Now, I at least know where to go and read about it, or know the common workup for common problems and can generate some reasonable ideas about where to go next. My attending actually commented on it. It was his last day, so he was giving me feedback, and he stated that he could see the growth and knowledge maturity. I feel more optimistic that by the time these next two years are over, there may be a middling fair neurologist in me. And that’s better than what I’ve been feeling in a long time.

On a related note, I’m still struggling on the decision for a career path after graduation. Unfortunately, the decision about fellowship needs to be made relatively soon, so that I can get research projects started to beef up my slim and rather non-impressive CV, as well as trying to go to conferences so I can start networking etc. I change my mind on an hourly basis. It’s a sad state of affairs. I’ve decided to give myself until June. Someday, I’ll do a big long post about the positives and negatives about the decision. Maybe it’ll help me think through things.

I am quite smitten with one of my attendings. I worked with him briefly last month and had butterflies during every patient presentation. Recently, I’ve gotten to interact with him more because our teams have been consulted on the same patients. When he greets me with a half smirk and razzes me about my treatment ideas, I get swoony. You think music is the language of love? For me, it’s vestibular neuritis due to colistimethate (don’t worry, I hadn’t even heard of the drug before, either!). I’m almost seeking out consults, just so I can have those few minutes of conversation.

I’ve missed having a work crush. It’s been a long time since CuteIntern disappeared into the dark coves of the hospital and I have not had a good flirtation since then. I think, however, that all of the period dramas that I’ve been watching these past weeks have affected my mind and I’m ready to see romance from every random corner. It’ll pass, I’m sure.

The hospital has a repeating playlist of songs that are piped over the hospital. It includes a piano version of the theme to Titantic and it plays Every. Single. Day. Usually around 10 or 11 in the morning. I went the entire day today without hearing it… until I returned a phone call just now and got placed on hold to that song. Grrr.

Vienna Teng is performing in Chicago this Friday and I’m so excited. She’ll never come to Milwaukee again; poor attendance for two concerts would convince anybody not to come again, but I’m grateful that I live so close to Chicago so I still can see her.

I realize that everybody has probably seen this video, but I couldn’t resist sharing. I love Britains Got Talent; it has a way of tugging at your heart strings. Paul Potts the first year, Andrew Johnston the second and then this year, Susan Boyle. Just lovely, I was seriously in tears.

posted in All About Me, Resident Life | 1 Comment

10th April 2009

pretty stick

Today was one of the most exhausting days I’ve had in a long time (boy, I’ve been spoiled). It was endless pages and endless consults (I had 5 before 1 pm and another after that), haggling with radiology to get an MRI done (if I hear one more time that’s its protocol… I understand that you don’t want a patient with metallic things getting an MRI done as those metallic things can come ripping out. However, when I tell you that this patient had a MRI done 1 week ago and survived it just fine, I think we can forgo all of the drama, okay?), managing a patient in status (poor intern had no idea what to do), answering questions about the dozen patients that I thought I could finally sign off (and got pulled back into their disease) and somehow still seeing all of the patients that we are still actively following as well. I didn’t leave until after 7:30 (and still came home to a glimmer of daylight! I love spring!). Good thing I didn’t have plans tonight (this is the reason that while I’m going down to Chicago next Friday to see Vienna Teng in concert, I’m buying tickets for the 10:00 show, rather than the 7:00 show. I may be driving home at 3 in the morning, but at least I’m mostly guaranteed to make it).

I came home to a lovely little package on my front porch though, which made the whole day better:

It’s wrinkled (muslin wrinkles like nothing else) and I didn’t wear any makeup at all today, so the big pimples that I’ve been fighting for the last week are quite prominent, (and we’ll entirely ignore the weight issue, shall we?) but I love the dress! I’m still fighting with the neckline (you can make out my divotted and scar-ridden right shoulder on the second picture), but I think if I pin it to the underslip (and maybe the bra), it should look better. Chris brought me home this gorgeous lilac silk shawl from India, which matches my dress perfectly, giving it just the perfect elegant touch.

Next is figuring out how to do my drab hair (the new haircut lost its luster pretty quickly). And finding my fancy jewelry. And then actually sending in the registration for the weekend of dance.

posted in Friends, Rejuvenating the Soul, Resident Life, Social Life | 5 Comments

8th April 2009

budding neurologist

Today, I woke up and thought to myself that for the first time in almost three years, I like neurology again. I’ve taken care of some really interesting patients with diverse diseases; I’ve come up with diagnostics and differentials that my attending agreed with; and I had a chance to read so I was starting to feel like I understood the difference between polyradiculopathy and polyradiculoneuropathy (don’t ask). It didn’t hurt that we had maybe 1 consult a day, so I could really sit and think about my patients care.

Of course, right after I thought that, my pager went off nonstop all morning with new consults and complicated questions (as well as stupid questions), making me feel like a freshly chopped chicken and the love faded. It’s still there, dimly trying to stay alive. Who knows, if I manage to survive tomorrow and clinic, it might take up permanent lodging; that would be nice.

Other thing going on in my life:

  • I have just about caught up with all of the little requirements that residency piles on me. I completed the last of my dictations (it was nine months old, but, as I discovered when I dictated it, I had never even taken care of the patient and it really wasn’t my responsibility. So I suppose that evens out). I finished all of my evaluations. I’ve stayed caught up on my clinic notes (that will probably change tomorrow). So I’ve finally been able to concentrate on something else: my house. It’s been a disaster since January when I got sick for a month and was working close to the 80 hours/week limit. But this week, I went through all of the papers that I’ve collected and recycled three entire boxes of junk mail and have collected another 3 boxes of patient information that I need to bring back to the hospital for shredding. No wonder I felt like I was drowning. I’m focusing on the progress and ignoring for now the pile of dishes, the laundry that needs to be washed and all of the sweeping. All in due time.
  • My beloved mommy finished my Regency dress this weekend and mailed it on Monday. I hope to get it tomorrow. There will be pictures. 🙂
  • I had a fabulous weekend, visiting Chris and his friends. We went to the symphony (incredible pianist!) and out to eat and then made crepes the next morning as we watched Sicko. Three years ago, as a fresh idealistic medical student, the documentary might have inflamed me to action. Now, after experiencing the multiple complexities of the medical system, I am become more cynical about the likelihood of success with medical reform. Doesn’t mean that I don’t support efforts to do so, but I see much more of the pros and cons of all of the proposals. Surprisingly, Chris was as conservative about the movie’s premises as I; residency has changed him as well.
  • In any case, there is some pictorial documentation of the weekend at my Picasa site. It already hurts thinking how much I’m going to miss this.
  • I’m getting an elliptical machine and a bench press from my friend who is also moving away (*sniff*). I’m so excited to have my own little gym. Now, the bitter cold of Milwaukee won’t be an excuse to keep me from exercising AND I won’t have to endure endless ball games. As soon as my house is in order (I’m hoping this weekend) I’ll get to retrieve it.
  • It’s actually been really hard recently, thinking about all of the friends that are leaving this year. My medicine resident buddies are graduating and going on to fellowships and careers, leaving me behind for another two years.
  • I am trying to get the courage to buy tickets to visit Sam and her little one in New York over Memorial weekend. In New York. I start hyperventilating at the thought (serious phobia issues here!) but I think my love for baby Meghan’s poofy hair might win out over my fears. I may not see anything more than central park and in the inside of her apartment, and I may just be one quivering jellyfish the entire trip, but it’d be worth it. Right?

And that’s all folks. Tune in next time for another addition of Glimpses of Julia’s Oh So Boring Life.

posted in All About Me, Chris, Friends, Healthy Living, Resident Life, Social Life, Those Rare Days Off | 1 Comment

14th February 2009

code four

I should be trying to go back to sleep. But my mind is reeling, preventing my tired eyes from staying closed.

I just lost a patient. The term is “pronounced dead”, which always seems so ironic. There’s no death until I say so. If I didn’t, is that non-beating heart still alive?

I’m a different person than I was as a naive medical student, where I had not seen or experienced death and cried for hours over the death of my fist patient. It’s a rare week when I don’t have a “code 4” proclaimed on somebody, and usually, we’re not too successful in bringing them back. Or if we do bring them back, they persist in vegetative states, their brains deprived of the oxygen, and I wish that we would not even tried, but that, that is not living.

Today was different. I can’t offer many details, because of HIPAA rules, but this patient was young. It’s the old people, the ones that we break fragile bones doing compressions, those with long histories of coronary artery disease, those are the ones who die from codes, not patients who had come in for completely unrelated reasons. We had had such hope for this patient, things seemed to go well and we had these moments of success before it quickly turned bad again.

My intern is devastated as he spent a sleepless vigil at the patient’s bedside, and it’s his patient, not some random person on a sign-out sheet, but the patient he’s been managing for the past week. My med student is numb and already back asleep.

I used to cry over my patients. I don’t do that any more. I told the family “I’m sorry, we couldn’t bring {patient} back” and watched the tears and sobs start, and I only got a prick in the back of my eyes. I don’t think I’ve grown hardened over the years. I’m a huge advocate of a “good death,” a death that minimizes suffering and prolongation of the process. I call the patient by name when I pronounce them, and I tell them goodbye as I leave the room; I know they can’t hear me, but I hope that their spirit knows that I tried, that God knows that I tried.

There’s going to be an autopsy. Maybe then, I’ll get some answers and some peace that there really wasn’t anything more that I could have done.

posted in On doctoring, Patient Stories | 7 Comments

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