This morning, the clock 04:05:06 (on 07/08/09). I slept right through that one.

I did take a brief moment in lecture this morning to reflect on 07/08/09 at 10:11:12. That’s a pretty one as well.

But even better is the upcoming 12:34:56 second. It makes my inner Count happy. 123456789! Ha Ha!

To celebrate, a few of my favorite Sesame Street memories (that I could find on youtube, anyway)

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?

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.

• 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.
• TWO YEARS MORE!

Here’s a snapshot of what I’ve been doing at 0500 on my call nights:

1. Trying to figure out why my patient suddenly dropped his oxygen saturations, increased his intracranial pressures and became non-responsive. The respiratory therapist did a great job of bagging him until the anesthesiology resident came up an hour and a half later (!!!) and exchanged out his mucus plugged endotrachial tube.

2. Declaring a patient dead.

3. Admitting a transfer patient that nobody told me about. They always come in sicker when they are surprises.

4. Fixing electrolyte abnormalities, following up on blood gases, worrying about why the hemoglobin had gone down.

5. Answering pages from the answering service and arguing with patients that no, I’m NOT going to make a refer to a private hospital in NYC, just because you feel you can’t possibly walk into an ER there (that was a few weeks ago, I’m still beyond angry about the insufferable selfishness and lack of personal responsibility that some people possess)

6. Discussing with the ER why I’m not going to come down and see a patient, when the radiology resident over-called a head scan for a patient who had no new symptoms.

7. Napping. (I hesitate to call it sleep when the pager is going off every 15-20 minutes)

At 0500, I am tired. I am exhausted. At that point, I have worked 22 hours with another 6-8 to go. I lose the ability to multitask and can only concentrate on the thing right in front of me. Things have a tendency to crumble at 0500 in the morning. I have coded more patients than I can count at 0500. It can be utter chaos and like most things in the ICU, completely unpredictable! Two nights ago, I was balancing why another patient had suddenly increased ICPs and was trying to manage that, in between putting in a subclavian line at midnight (another rant that I’ll spare you) and adjusting another patient’s ventilation settings. It was a relative light night. I only had 6 patients of whom I was taking care, but I still didn’t get any sleep until 2 and that was punctuated by frequent calls from nursing.

It is because of that, because of all of the above reasons, that when the patient rolled in at 10:30 at night, and when we all decided that the patient wasn’t quick sick enough to warrant a middle of the night procedure, and when the attending asked me to page everybody under the sun at 0500 exactly for a procedure at 0600, I decided that it would be best that I inform the fellow of the changed plans (it was supposed to be an urgent in-the-middle-of-the-night case, but the patient was stable enough to wait a few hours) and have him page everybody instead. It is, after all, HIS responsibility and it was at 10:45 at night (plenty of forewarning) and he had to be up and here anyway to get everything going for the case and who knew how my night was going to go.

So when the fellow doesn’t page anybody and shows up 3 hours late, guess who’s fault it is. Or when the tech comes in and can’t find the order for the procedure, guess who’s fault it is. And when anesthesiology doesn’t take the patient until 8 in the morning, because the fellow isn’t there to get consent, guess who’s fault it is. Never mind that when I called the nurse at 0530 in the morning to check up on the patient, and found out that nobody had been by to see the patient, I had everybody paged to remind them (it was the first page received because “the fellow didn’t get my page” from the night before. Bull crap. The pages are trackable, moron.) Never mind that I had let the operating room know before the patient was even admitted. Never mind that I had orders done, the patient seen, examined, story straightened out, blood pressure controlled, and the attending notified within a half hour of coming from the outside hospital.

I was yelled at, chewed apart by four different people that morning, for “slacking on my duties.” By the last one, when the attending was telling me that he’s not mad, but just disappointed in me, I was bawling, sobbing in the critical care unit. Control of my emotions is not one of my strong points post call.

The attending, one of my favorites which is why it hit me so hard, brought me up orange juice as an apology (although he really didn’t apologize – I think I just shocked him by the tears). And in the staff meeting today, apparently “things were clarified” and “it wasn’t [my] fault” and I am a “good resident.” So maybe a little vindication.

I’m still pissed off about it. (I moved beyond emotional once I got some sleep). I’m tired of being treated like a secretary. No, I’m tired of being treated like a lazy secretary, without any acknowledgment of the hard work that I’m doing.

I’m tired.

Two days ago, I had come to the decision that I was going to throw in the towel, and admit to myself what I’ve known for the last three years (but didn’t really want to admit because it’s going to be more hard work, and research projects and more CVs and applications and The Match all over again and did I really want that drama). I want to do critical care. I want to do neuro critical care (still trying to figure out the general part, but that’s even more complicated). And I kinda wanted to stay here, mostly because I’m not super competitive, I don’t believe in the nonsense that you have to go to the big name hospitals to get good training, and I rather like every body that I work with. I have a great rapport with most of the nurses, the nurse practitioners are fabulous, the attendings are good teachers, etc.

And now. This.

Hahahahahahahahaha. Ha.

The good news: the leak in my basement when it rains extremely hard does not seem to be coming from the toilet. Horray!

The bad news: I have no idea where it is coming from. Well, I fear that it is dripping down the inside of the bathroom walls, but I can’t seem to locate a source. It just seems to appear, like zombies rising from the ground. Or something like that.

For now, it’s trickling down the basement drain. I only flooded a year ago because the downpour was too much volume and speed for the drainage system to accommodate. I am sure tired of dealing with this issue.

I should have spent tonight finishing up clinic notes. Instead I spent it looking at neurological equipment that I’m not sure I’ll ever use and updating my WP blog to 2.8, importing LJ entries with their new import system. Somehow it messed it up, transferring everything in triplicate and when I attempted to delete it, it deleted the entry on the LJ side. Of course, Livejournal, in their infinite wisdom has decided that you can’t import blog entries to their database, so I had to repost, losing the comments (on LJ. It’s still there on the WP side). It’s going to take me forever to delete (correctly!) and merge everything.

The rain is really coming down now. Come on, little drains, keep up. I’m going to try to sleep.

ETA: Scratch that. It’s coming down the majority of my windows now. The drain that my church installed for me is not keeping up and I’ve got a large puddle puddle at my back door. My rug has already been taken up. It’s supposed to last for the next two hours before letting up. CRAP.

ETA #2: And the drains stopped working and I flooded my basement again. This time I had the sump pump, which I pumped into a sink and managed to keep from flooding every where. Sure am glad that I kept it all up on cinder blocks too. I’m going to be utterly useless at work tomorrow. What I really need to do is take the day off, get everything bleached and call a plumber to come look at my drains. And figure out how to waterproof windows

again

.

Of course, it’s starting to rain again.

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)

New York = fabulous.

I conquered NYC. And managed to do it without meds, thank you very much. It helped that I saw and experienced most of it from a double-decker bus and ferry, but I still did it.

I did not get to see any Broadway musicals (it didn’t fit in to plans very well, was horridly expensive, and I hated Times Square so much that the thought of lingering there to try to grub for cheap tickets made me want to cry. Perhaps once it’s closed to automotive traffic, it’ll be more manageable (ha!)), nor any of the museums, so that will have to wait until next time.

I took 569 pictures. The majority of them are crap. Taking pictures from a bus means that I have lovely pictures of stoplights, and people’s heads as we were jolted around. The rest are exposed badly as I moved from shade to bright sunshine and didn’t always remember to correct.

Sam’s baby is delicious. Seriously contemplated sticking her someplace in my luggage, but then realized that since it was all carry-on, I’d be discovered before I made it very far.

All in all, a fantastic weekend. Too short as always.

Select photos can be found here and here

**
This weekend, I am visiting Susan and her own delicious child, Alice, and we are finally, finally going to go country dancing. Susan has also arranged a date for me (!!) with a guy who is excited about the prospect of english dancing(!?!!!), which sounds too good to be true, but I am optimistic nonetheless. And on Sunday night/Monday morning, my parents arrive in town for a week’s vacation. Which means I should have spent tonight cleaning rather than fussing with my pictures, eh?

http://xkcd.com/587/

My favorite episode:

In twenty-four hours, I will be in Hoboken, New Jersey, settling in the “spare room” of Sam’s new apartment and cooing over Miss Megs. Her hair, I’ve been assured, is still delightfully long and poofy and she still adores her toes.

In twenty-four hours, we’ll finalize plans of what we will see over my seventy-two hour visit. We’re attempting to fit in a Broadway musical, a 2 hour boat tour around the island, a stroll through central park, a visit to Gray Papaya (I’ve been spoiled by the Milwaukee brats, I’m not sure that New York’s dogs can live up to it), a museum or two, seeing another friend (who’s husband is visiting for the weekend, so they may not be around), and lots and lots of baby time.

I’m still packing. Have another load or two of laundry to do. Just finished eating (I love corn). Trying to decide if I should bring my laptop (long trip without it, but want to be light on the luggage). Decisions, procrastinated decisions.

I’m on psychiatry consults this month. My coworkers have called this “great immersion therapy” for my phobia. We’ll see. Immersion or not, I decided I couldn’t do it without meds. I’m hoping that it’ll be better through a camera lens, but I’m not sure. Hence the back up, so I don’t have a melt down in the middle of the street. I’m still worried and on the verge of hyperventilation if I think about it too much.

New York, New York. Here we go!

I went to see Chris this weekend. He moves in just a little over a month. I have so little time off between now and then, that I’m not sure if I will get to see him before he leaves. So I’ve been grabbing whatever chances I have, even if its just a short Sunday afternoon visit. We had lunch with his surgery colleagues, watched a movie (Kramer vs Kramer, which I had never seen. I think the movie’s overall story means less now than it did 25 years ago), looked at pictures from their trip to India, went for a walk, ate decent Mexican food, and just had a quiet visit. My favorite visits with my friends are exactly like this, being immersed in the mundane, everyday moments. Gretchen asked questions about life in medical school, and once I stopped teasing Chris about his “player” reputation, I struggled to answer them. The junior high-like sagas seem so surreal and so long ago, that it’s difficult to find the right words to convey why those events meant so much, changed so much. Without the fallout from Candice, without the literal shunning from that group so that Chris was the only one who talked to me for months, we wouldn’t have been as good of friends and in all likelihood, he’d be decorating my Facebook friend hall of fame, and not much else. Strange how little, stupid things like that can alter an entire life…

Anyway, I attempted to take pictures of Chris and Gretchen, capture them in tender moments. Yeah, I don’t think I’ll be advertising my services any time soon as a professional photographer, as I completely forgot until after I had shot 5-6 pictures that I had adjusted the shutter speed to take pictures in the bright spring sunshine, which didn’t translate very well to florescent lighting. All of the pictures were crap. With the magic tools of photoshop, I did manage to salvage this:

and turn it into this:

Still grainy, but so much improved, I’m rather impressed with myself. 🙂 The others are completely worthless though.

A few other (entirely unedited) pictures from this weekend can be found here.

And now that my headache has finally dissipated, I am returning to bed. I do love the (very, very rare) rotations where coming in just before nine is perfectly reasonable.

A visit to Chicago and meeting my favorite musician, Vienna Teng.

From Vienna Teng

Back to the Grand Geneva resort, this time with my internal medicine peeps. I’m going to miss these people.

From Medicine retreat – 2009

A murder mystery party. There is a serious lack of pencil-thin mustaches these days.

From Great Uncle Seymour’s Birthday Party

I’ve taken over 2000 pictures with my camera since I got in December. To say that I love it is an understatement. If I die, I may end up bequeathing all of my earthly belongings to it. My friend, Vaishali’s husband brought his D300 to the medicine retreat, which is such a massive camera compared to mine (it weighed a ton. I’d never be able to keep it steady) and, it took beautiful pictures, but I think mine does a good job too and will be even better once I get more practice and become a better photographer. He lent me his 50mm f1/8 lens for the evening though, and oh, that is heavenly. It is going to be my next (and likely last as I can’t really see needing anything else) lens, I’m just saving my pennies. My next project is learning how to create high dynamic range landscapes; I took some photos during that rainstorm a couple of weeks ago, when my basement was flooding again and if I had known that HDR existed then, the pictures would have been phenomenal, instead of just pretty.

From Wisconsin spring

This totally made my day:

My basement is leaking again. Thankfully, the drain was able to keep up with the amount of water (it really pounded for a while; I thought for sure that they’d back up again). This time, however, the window sills were caulked, the outside drain took most of the water away from my back door, and the walls were dry. It was just that there was a puddle of water that continually drizzled towards the drain–coming from the bathroom. I think it’s seeping up from under the toilet (it’s water, it’s not sewage as far as I can tell). I’m worried that I’m going to need to get a plumber in here. I don’t know how; I have no days off during the week and I don’t get done until after 5 or 6 most nights. It’s times like this that I wish I had a husband or roommate so that I could let them deal with this.

Grrr.

On the bright side, it did not flood and all of my belongings are still safe.

*sigh*

After the symphony, we met up for dinner and drinks. The conversation turned away from surgery and medicine and into the impact that the failing economy was having on us. Chris joked about how when I started residency, he had pushed me to buy a house for the financial investment (it was encouraged to most of us freshly graduated medical students) and a year later, when he was in the same position, he had decided against it and how glad he was that he hadn’t bought a house.

“How much has your house lost in value?” One of the group asked me.

“I don’t know,” I demurred, “I’m not selling it for another two years at least and I figured I’d save my heart the stress test.” Besides, I reasoned, the housing market had never been as profitable in Milwaukee. Milwaukee is very much a blue-collared city and the home values and resell reflect that. Surely, it could weather the storm a little better.

The City of Milwaukee decided, however, that they would have none of this blissful ignorance, thank you very much. Since I am the one paying taxes on the property, they felt it was their duty to inform me of their recent appraisal of my property and sent me a nice official letter (in purple ink. I applaud the creative and aesthetic touch). Net Change: -4,600. Ouch.

My first thought: “Hey, that means my taxes will go down!”

The COM may have thought that they were bringing doom and gloom, but they hadn’t ever encountered the little orphan annie who resides prominently in my frontal lobe. For my raspberry bushes have sprung the first leaves of green this week and I have tiny rhubarb shoots popping through the ground and a garage door that now locks. You just can’t get better than that, even if the CoM has decided that it’s worth less this year.

I’m not doing the English dancing weekend after all. I piddled around, delayed sending in the registration, debated eternally where or not I should go until it was too late. It would have been easier if there was somebody that I was going with… or if the price had been half as much; then I’d have done it without a second thought. In the end, I decided that I could not splurge on it, and I’ll have to find another place to wear my pretty dress. I’m planning on going down to Illinois in May for a English dance so it will be displayed then.

So instead of men in cravats, I’m going to New York to visit Sam and baby Meghan. This is such a huge deal for me and evidence of how much I want to see that wild baby hair. I’m already trembling and have a pit of fear in my stomach. I don’t do tall buildings. That’s the understatement of the year. I become paralyzed under their shadow, frightened to near death that they are going to fall on me (yeah, September 11th was virtually my worst nightmare come to life). And that’s just the comparatively scrawny buildings in SLC. Needless to say, a visit to the Empire State Building/Chrysler Building/Times Square/Ground zero and even the Statue of Liberty are not on the list. Right now, I’m liking the idea of a boat tour of the city: a chance to see the important sights and bridges, but from a distance, where I can practice taking pictures of reflections in the Hudson River. I’m also looking forward to central park and seeing the skyline there.

And if all else fails, I’ll get myself a prescription for some propanolol and/or alprazolam and medicate my way through. The benefit of being a doctor.

So, question to my wise friends out there who have been to NYC: Which are the must see sights, mostly in Manhattan and that won’t frighten me to death? And from those who live there, any hidden nooks that shouldn’t be missed but are often overlooked by the tourists?

I had this awesome dream last night where I was working for President Obama. I was supposed to deliver something for him, but got caught up in this conspiracy and we were talking over this telephone that had a garden hose as the cord as it was supposed to be safer than our cell phones. As we were talking, he suddenly realized that it had been wiretapped and I was in trouble, so he stole a car from the secret service to come pick me up. We then escaped with other members of the team, who included a few people from my residency, on a ferry from Milwaukee down to Chicago. It was a pretty fancy ferry with a big chandelier and a garden with a pool. Barack (as I called him) and I discussed security policies (aka, who was after me) and how I could stay safe. As is the case with most of my dreams, the rest is rather vague. I think he left to confront of the men who was chasing me, as he had also ended on the ferry, and I was sleuthing and flirting with the pool boy (alas, Dream!Barack was as married as in real life).

I woke up this more in a rather good mood. 😉

I wish it had lasted longer, that I could have pressed the snooze button just a few more times. Hard day. Fifteen patients that I had to see before noon. By far, the best part of the day involved taking a mid day break with one of my friends and getting hot chocolate and swooning over Franz Ferndinand, who is apparently coming to concert in a week. As a resident, there’s no such thing about having a lunch hour; if you manage to finish your work in time, you can look forward to a noon lecture. But today we played hooky, even though it put me behind and I was rushing to finishing seeing everybody.

And now off to bed again. I wonder who/what I’ll dream about tonight?

(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.

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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.

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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.

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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.

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.

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.