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5th November 2014

polishing the old times

I had lunch with Chris yesterday. I think I mentioned in my sum-up post from January that he had gotten into the surgical critical care fellowship here. We don’t work together at all, although both of our ICUs are right next to each other due to ongoing hospital construction, so there is some hall passing on occasion. I was kinda looking forward to bossing him around. 😉

Things have changed in the 12 years since we’ve became friends. He got married (an event that still hurts to think about how much I was excluded). He has a 1 year old son. We went from seeing each other every single day for nearly 3 years to barely talking on the phone once a year (part of that was definitely me avoiding and licking wounds). So I was understandably nervous about having him in the same state again. Overall, it’s been nice.  I’ve been over to their house for dinner a couple of times and had lunch with Gretchen and Oliver once (a very brief meeting in the cafeteria, mostly spent in preventing a runaway). Chris and I meet for lunch a couple times a month, depending on our schedules. And there’s no denying that I have missed my friend. There are very few people who just understand me and unexpected hallway hugs after a tough family conference are just soul-saving and precious.

Anyway, he is currently interviewing for attending positions across the country. He interviewed at Utah and the interviews went well and they seemed to like each other. He’s got a potential interview here at OHSU. Both would really be a great start to his career with support for research.

His wife wants him to go back to Wisconsin and take a private practice job.

I wanted to laugh at him. Because I could have told him that he was going to get into this 5 years ago when they were in the middle of dating. She was saying then that she loved the idea of raising her family in Wisconsin, because that’s where her folks and her sisters lived, and that she was trying to convince him to not pursue public health because she didn’t want to raise her kids in a foreign country. She went to Boston because it was a short term gig. She came out here because it was only a year. He didn’t ask me then; I didn’t offer because  I like Gretchen quite a lot; she’s a heck of a lot more patient about some of his personality ticks than I am.

His marriage. He gets to have this fight. They’ll figure it out. I didn’t offer any advice, just listened. I don’t know what our friendship is going to look like in the future, but I’m glad for these few moments to connect again.

posted in All About Me, Chris | 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

12th May 2009

what a different some post-production editing can do

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.

posted in Chris, Friends, Photography, Social Life, Those Rare Days Off | 0 Comments

25th April 2009

4,600, but who’s counting?

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.

posted in Adventures in Home Ownership, All About Me | 2 Comments

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

4th February 2009

and I don’t look good in leggings

I haven’t quite known exactly what my mood has been recently. Having all of the free time has not exactly been conducive to actual productivity. I’m so worn out and tired and somewhat depressed (despondent, I think would be more apt) that I haven’t done much for the past couple of days, but laundry and watching YouTube movies (Groundhog’s Day on Feb 2, course, North & South yesterday, and Jane Eyre today). I did get my antenna and digital converter set up, but that’s hardly an achievement as I have a Christmas tree still up and scattered stuff everywhere and dishes in the sink. I’m frustrated, a deep soul restlessness type of feeling, which is hard to define and harder to shake.

Chris got his fellowship position. The ending to his personal statement must have been better than I thought (or else they overlooked that due to the rest of his impressive resume, which, since I also helped him put together looks pretty good) and he’ll be going to Boston in June. For 2 years. I’ll be done with residency by the time he gets back. So much for having my friend nearby. I’m an emotional schizophrenic, wavering between ecstatic happiness (Boston! I’ve never been to Boston (in the fall)! Atul Gawade! We did it!) and moroseness. Usually the happiness wins out; tonight…

There is sunshine ahead. A weekend with Susan and her babe in two days (really just one long call day). A week of vacation  to Utah and Arizone in a month (I’ll be looking for tickets tomorrow). Presents from India. Glorious rays of sunshine. I just need to shake of the chill and clinging fog.

posted in Uncategorized | 1 Comment

1st February 2009

perfect month

When I was a little girl, I was a weird little girl, who scoured calenders and discovered that the magical month of February, so abused and maligned for its cold, frigid days and single-awareness event, had the potential of being a perfect month, filling equally every spot in a 4 week calendar in a beautiful rectangle when the 1st fell on a Sunday. I remember using my computer and plotting out which years this would happen. It was a rather rare occurance, because leap year would happen and mess everything up (stupid leap year) and honestly, I thought I would never see it; I’d be old and withered like when Halley’s comet comes again.

February 1998 was a perfect month. I was 19. Feburary 2009 is a perfect month. I am (appropriately, some would say) 11 years older now. And I still get just a little bit of a thrill seeing the calendar on the side of my blog that is a perfect 7X4 rectangle. I am not determined to fill up every single one of those squares with a perfect link. 🙂 I told you I was a weird child.

***

I’m on call today, which so far hasn’t been bad. I even managed to slip in a nap; since I didn’t get to bed last night until 1 am (serious grousing over the single LDS male population here), it was needed. I’m back at the private hospital this month. I had forgotten its many quirks and frustrations, such as the complete incompetence to deal with neurological problems (it’s a sad state of affairs when I come here and feel like an expert) and the complete unwilliness to do anything without a bloody consult. There’s one episode that I’m still fuming about because it’s utter mismanagement of this patient and I am powerless to do anything. I hear bad-mouthing of academic centers all of the times because part of the care is given by relatively inexperienced interns and residents. True, but we have supervision by attendings who keep up on the research and for whom money is not the driving force. I’d rather receive care, any day, at a academic center.

*deep breath*

On the happy side of things, I get out most days by 1-2 pm and I usually sleep on call. Yay! Oh, cold, deceiving sun, how I have missed you! I have so many goals to achieve this month. Finally getting time to explore my camera a bit. Taking down my Christmas tree. Going to the gym (really don’t like my gym. It makes it difficult to get inspired to go there). Watercolor painting some of my photos. Sew my regency era dress. Clean my kitchen. Do my taxes. Study for the neurology in-training exam (that probably ought to be the number one priority, but somehow it’s not). There’s no way everything getting done, but it is awfully nice to have the extra time that I can dream about filling.

posted in Uncategorized | 0 Comments

16th January 2009

what a week.

I am so glad it’s Friday. I’m on call tonight, which means that I can avoid the freezing cold weather for 30 hours. By the time I’m released, the weather forecasts that it’s going to be a balmy 20 degrees. I may not even need the extra layer of sweats over my pants tomorrow!

I overslept this morning, arrived to the hospital an hour late. I tend to be chronically on the “a little late” side, but it’s been a long time since I actually slept through my alarm clock and awoke in a panic. It didn’t help that it now takes an additional ten minutes in the morning to get ready with having to blow dry my hair and put on the three extra layers of clothing.

It’s been absolutely insane around here. On Tuesday, I received 4 different pages from my program director; I was post call and blissfully slept through them and didn’t get them until the next morning, where I found out that unless my clinic notes were completed ASAP, I was going to be put on suspension. I didn’t think I had that many open (I had had 31 last week, I worked on a bunch, was down to 27 and of those 10 of them I had finished and was just waiting for the attending to finish their part). But it was apparently too many and I was in trouble. So, I spent most of Wednesday night, any free time on Thursday and all morning getting all of the notes done and sent on to the attendings. They’re all done, but it was a massive devotion of time, and now I’m behind in discharge summaries and other stuff. It never ends.

Project number two on top of this was helping Chris out by massively editing/revising a personal statement. He found this absolutely amazing research fellowship to apply to, run by no other than Dr. Atul Gawande, my hero. It’s always a time-consuming project editing his papers. He tends to think and write in fragments, forgetting all of those lovely linking thoughts and words to keep everything running smoothly. I tend to be a much more verbous writer, which he doesn’t like, so edits often go back and forth several times before we’re satisfied. Unfortunately because we now are residents and have no free time, we didn’t have a lot of time to work on it. He sent it off yesterday and I still wasn’t entirely satisfied with the conclusion and felt that there were other areas that could have used polishing, but oh well. He’s promised me a great gift from India (he’s going in two weeks) as payment and if he gets it, I’m definitely using my vacation time to try to stalk meet Dr. Gawande.

Reason number three it’s been insane: I started my medicine clinics this week. It’s going to be a good change. I really like the attending that I’m working with; we’ve worked together on the wards last year and while he’s intense and sometimes difficult to read, he’s also a great teacher. He loves to do procedures and he believes in taking full ownership of the patients–no referrals out unless it’s absolutely important, which I love. He spent 15 years doing medicine in Nepal which probably explains some of his attitudes. Yesterday was a little bit frustrating; new department, new way of doing things, feeling a little bit like a medical student again, but I’m sure it’ll get better.

I’ve still got a lingering sore throat and my fellow has now developed a cold as well and I’m sure, infected me again. Sometimes I hate evidenced based medicine: I know very well that antibiotics are not going to help, but I’m just so tired of the dwindles.

I’m giving a talk in church on Sunday, on self-reliance. When he asked me, Bishop said that I was an “ideal” person to give it, that was before the above trouble, I guess. I’ve lived here two and half years and they finally managed to catch me with a Sunday that I was free and not post-call; actually I haven’t spoken in church since 2001, right after the terriorists attacks, eight years is a pretty good record! The VA blocks access to the LDS website, but I’ve managed to circumvent that; I just can’t print anything off which is great for the environment but not so good for my preparation. I’m more than a little nervous…

So to sum up: I’m hectically busy (I’ve just admitted another two patients so I have to rush away to finish their orders). Mom, I got your email, will look for the package, a few oranges sound nice but would probably freeze before I could eat them. Becks, here’s the update on my life. Barbara: I did get your Christmas card! Thanks! Still haven’t made it to the post office, but hopefully will next week, maybe a Christmas card for Easter. Ellie: I’m so glad you wrote! Please tell me more on how you’re doing. And to everybody else: hi! I’ll hopefully get to talk to you later.

posted in Uncategorized | 3 Comments

8th January 2009

Shhh

I figured out how to access LJ here at work! Yay!

Wow, has it been a busy two weeks. I’m back over at the VA on the cardiology service and there hasn’t been a quiet day yet. We’re just slammed with patients, the entire hospital is, really, all of these people who decided that they’d just stick it out for the holidays and now are coming in with raging pneumonias and cellulitis, and more pertinent for me with chest pain or florrid congestive heart failure. I admit virtually every day, on call (the 30 hour stretch) every 4th night and for the vast majority of the last two weeks, I’ve carried most of the team as well as most of the ICU patients because none of my patients could be discharged home and just kept adding up.. The call nights have been long so far. I’m not quite to the “neurology call night” busy level, which is the definition of a busy night.

Worse, I’ve still been sick. Had a sore throat every day for over a week. Make that two weeks. This morning, I woke up without a sore throat and was so excited… only to have it return this afternoon. If it’s still here by the time I go home tomorrow, I’ll have one of my coworkers write me a prescription. Nice knowing those in power. 🙂

My fellow just left for the evening. As he was walking out the door, he spouted off last minute reminders of tests that needed to be ordered or checked up on and then, he bolted back to ask me if I was “single, married, children?” Bizarre.

I have the whole weekend off. It’s going to be bliss.

I never made it to the post office to get stamps and mail off Christmas cards. Would you all still want them now? Every year, I swear I’m going to get them off and every year, I forget that I work beyond the hours that the post office is open. *sigh*

I know that there have been several emails, voicemails, telegraphs that I have missed and am behind in responding to and for that I beg your forgiveness and patience. I’m also behind on 8 discharge summaries, 2 dictations, 6 evaluations (from October) and 31 one clinic charts. I’m failing everybody right now and just trying to stay above water.

Anyway, I’m off to order dinner (frozen custard, snickers flavored. And something else), but just wanted to check in and let every one I’m alive. 🙂

posted in Uncategorized | 5 Comments

21st December 2008

*sob*

Winter and I are not friends this year. Not only did I spend hours on Friday shoveling my car out and snowblowing my paths, it then snows another five inches and has blown for the past 24 hours to the point I can’t see any of the sidewalks anymore. I have to be up at 6 tomorrow to give myself time to shovel again before work.

Susan posted about the ball and all of the fun that she had on her blog. Isn’t she beautiful? I’m still very wistful at the lost opportunity.

My weekend wasn’t that bad. Erica came over yesterday, we did some last minute shopping at Target, got some yummy noodles and then sat down to watch the 5 hour version of Pride and Prejudice (swoon). I wrote out some of my Christmas cards (they’ll probably be mailed on Tuesday, so won’t be arriving until after Christmas) and then tried to piece together the pattern I had bought for the dress. Since it was a last minute decision, I had bought the pattern online as an instant downloaded pdf, which I then printed out to tape together. It was a nightmare getting everything straight and aligned and in the end, not only did I discover that the last row had gotten off alignment, I had only printed off the pattern for skirt– I still had the entire bodice pattern to tape together. At this point, we finished the movie and ran to Walmart to buy the commercialized version. Much easier to deal with.

I’ve since washed the fabric and poured over the instructions. Tomorrow (after work) I hope to start on the bodice toile: cut out the pieces for the bodice lining and fit it to the right size. It’s going to be hard doing it without an assistant to pin but I haven’t found anybody here who had a mother who insisted that they learn to sew as I had (I appreciate it, Mom).

I’m glad that I switched patterns, by the way. The original pattern sized up by 2 sizes from what I normally wear; it was quite distressing. The new pattern is more accurate.

I’ve been really getting into sewing and quilting blogs recently. Two of my favorites are actually surgeons: Suture for a Living and The Stitching Surgeon. Both of theirs tend to showcase their creations rather than providing tips or patterns, but it certainly has hit that little creative bug that has been dormant since high school.

And now I’m off to bed. 6 is going to be coming very very early.

posted in Uncategorized | 2 Comments

16th December 2008

Oh, I love a ball!

I’m in such a tizzy. If you’ll remember, in my last entry, I mentioned that I am going to a Christmas ball. With English country dancing like this:

I’ve been very excited since I heard about the possiblity of a ball, but I had mostly reined it in. Until Susan posted on her blog about how excited she was and how she was thinking about trying to shop for a new dress for the occasion, which of course set me off looking for regency gown patterns all afternoon while I waited for ABGs and EKGs for my sort-of-sick-but-not-really patient. And I found a darling pattern that doesn’t seem like too much trouble if we keep things simple. Short sleeves. No overdress or stays or chemise this time.

Susan’s going to try to recruit some of her friends to help her out down there. If they can, then hopefully she’ll work on her dress this week. I’ll buy material tomorrow for mine, cut it out here and we’ll sew it when I arrive on Friday/Saturday (I’m unfortunately on call Thursday night, so won’t be able to work on it. Unless I drag along my sewing machine, which will just taunt the powers that be to send me every crashing patient in the state. No thanks). We’ve had to sacrifice the opera to make it work, but if I have a ball gown to make up for it? Totally worth it.

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14th December 2008

Reason for the season

I’m spending Christmas here in Milwaukee this year. I’ve got Christmas day off, but have to work Christmas Eve and am on call the next day, so travel was out of the question and having family come out here is ridiculous. So I’m having my own celebrations. This weekend, I’m driving down to Illinois to see Susan and her family; Suz and I are not only going to see the Metropolitan Opera, we’re going to a English Country Christmas Ball, where we’re going to learn how to dance like a Jane Austen character. Susan states that there were a few cute, single gentleman at the previous dance, so I am very eagerly awaiting the festivities. *SQUEE* So much fun. I may have to break out the satin gloves.

On Christmas, another friend, who is also geographically family-less, is planning to come over for a mini Christmas celebration with present opening and a yummy breakfast. I haven’t decided what yet, but pumpkin pie is somehow going to be involved. The afternoon will either be spent at one of the nursing homes with people who haven’t family (I see so many of them in the hospital; they break my heart) or serving somewhere; I feel somewhat anxious in the need to be there for someone who is also lonely this Christmas. There is so much need in the world but I’m trying to do the pitifully little that I can. I’m listening to the Christmas devotional and have been so touched by Pres. Monson’s talk:

The message from Jesus has been the same. As we follow in His steps today, as we emulate his example, we will have opportunities to bless the lives of others. Jesus invites us to give of ourselves. “Behold the Lord requireth the heart and an open mind.” Our opportunities are indeed limitless, but they are perishable. There are hearts to gladden, there are kind words to say, there are gifts to be given, there are deeds to be done, there are souls to be saved. Is there someone for whom you should provide service this Christmas? Is there one who awaits your visit? … During this season, hearts that are confined reach out and long for a Christmas visit…

There is yet time this year to extend a helping hand, a loving heart, and a willing spirit. In other words, to follow the example set by our Savior and to serve as he would have us serve.

I think the anticipation of the coming weeks is going to be my saving grace. I’m beyond burnt out. I worked 11 hours today; I went to work early so that I could get done in time for church, because it was the Christmas program and ending up not leaving until after five p.m. I feel like I’m living the subtitle of Doctor Strangelove: “How I learned to stop worrying and love the bomb.” Hysteria is shortly to follow, I’m certain.

My holiday cards have been delayed until later this week, so if you’d like to get on the bandwagon, there’s still time. Email me with your address. 🙂

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13th December 2008

holiday cheer

I took over 150 pictures of the ward Christmas part tonight. Probably 120 of them are crap, but it was fun playing around with the flash and ISO and driving other people nuts. I just love it so much.

It’s raining right now. Earlier today, I had to wear an extra sweater because it was so cold. Supposedly it’s suppose to get warm up to 50 tomorrow and then down below freezing the next day. Makw up your mind, Wisconsin weather!

I have to be to work at 6ish tomorrow morning so I can be done and be to church on time as it’s the Christmas program. My microwave heat bag has just finished getting warm and I’m ready for bed. 🙂 I do love these cozy winter nights.

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10th December 2008

exhausted

I’m so tired, physically, emotionally, that as soon as I finish typing this, I’m going to bed.

I’m hoping that the extra sleep will make tomorrow go by a little easier. I got extremely emotional about a patient and the unreasonable stubbornness and stupid surgical pride of his attending today and just about lost it. I’m just frustrated because the family members have expressed their wishes and the patient’s wishes, but because the attending differs, well, then. The attending’s ego will be bruised for a days, but it’s the family who will have to live with the consequences and it infuriates me.

I’m not sure if critical care is for me. And for entirely different reasons than when I first started this month.

***

My christmas cards are going out this weekend, so if you want one, send me your address at jcd1013@gmail.com or reply to this post.

***

Also, I think I left my half-eaten burrito on the back of my car. Poor little burrito…

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7th December 2008

O tannebaum!

I bought a Christmas tree!! It’s fake and cheap and sparse on the full, fluffy branches, but hey, Charlie Brown loved his little tree and I’m rather fond of mine. I gave in to my inner desires and bought all purple and silver ornaments. With the ornaments up, it doesn’t look too bare. My friend Erika came over tonight; we assembled the tree and arranged ornaments and topped the evening off with hot apple cider.

It also gave me a chance to play around a bit with my camera. Still learning (Erika performed in her church today and I brought my camera and took fuzzy photo after fuzzy photo. It was only afterward that I discovered that the lens was in manual focus mode), but I’m so overwhelmingly in love with the pictures that I’m getting already.

From Christmas

(Click for the other pictures of my tree)

Rounding at seven tomorrow morning, which means I have to have my patients seen by then. So I guess it’s goodnight!

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6th December 2008

clueless socialite

After moping today for being left out of activities and gatherings, I realized this evening that not only had I forgotten about the formal masquerade ball tonight (some of my friends were really excited about it; I’ve already attempted to get all of the guys involved to dance before and was much more realistic), I completely and totally spaced my friend’s Christmas party on Tuesday. I did nothing that night, just went to bed early. I feel absolutely horrible.

I did get to see a few hours of sun this afternoon, finishing work a couple hours earlier (it’s hard not to get cranky when you woke up at 6 with the thought of getting done early and your fellow announces at noon as you’re putting the finishing touches on the sign out sheet that your patient needs a central line (he didn’t) and he expected you to do it) and took the opportunity to play around with my camera a little bit. The problem with getting a new camera in December is that there isn’t a lot of varied scenery to shoot. Snow. And more snow. I still haven’t done much more beyond the automatic settings, but that will come. Some pictures will be forth coming. 🙂

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29th November 2008

christmas greed

It’s probably a sad reflection on my priorities when I tell you that the only Christmas shopping that I’ve done has been for me.

But that’s only because I’ve been saving up to buy this for months now, and researched every price available and when I saw the bargain price, I couldn’t resist.

Yes, I bought my camera.

Isn’t it pretty? I found it at a reputable dealer online for over $250 dollars off the suggested retail price with the two lens that I wanted. I haven’t found a better price in the months that I have been saving my pennies. I’m still sort of hyperventilating from the purchase; even though it was a steal, I never make frivolous purchases, but I know once my hands are on it, that will pass. I can’t wait to try it out!

(Psst, for those who might be interested, I bought mine at Adorama. They have other kits there of the Nikon cameras that are a steal as well.)

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28th November 2008

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28th November 2008

Gray Friday

*grumble grumble*

My chief resident sent out the holiday schedule earlier this week, so we would know who was covering each service and could plan our time better. I noticed that I wasn’t listed to work at all until Sunday, which I knew wasn’t right. We have 4 days off a month, and my four days are later. Because I know from personal experience how overwhelming the neuro ICU can be on the weekend (splitting 12-16 patients between 2 people is hard enough; when they’re sick enough to be in the NICU, it can take you a half hour to just gather information on each one, much less actually see them) and since that’s the service that I now belong to, I decided to do the morally right thing. Instead of sleeping in and going out to shop* for Christmas presents and a Christmas tree, I went to work. We were promised that even though it wasn’t an official holiday per the hospital, the neurology department was still treating it as such and therefore only needed to be there until approximately 12-1pm. Half days are so deliciously refreshing (sun! air! couch!) that they almost feel like a full day off.

I was done with everything by 1:30. I had admitted a new patient, talked the plan over with the fellow, written orders, confirmed results from the consult services, rechecked labs, finished notes and updated the signout sheet. And my fellow wouldn’t let me go. First, it was making sure the radiology would do the study we needed. Then it was signing out to the resident who was on call that day. Then it was waiting for the fellow who was going to start on the service starting that day; he was supposed to show up at 3, he didn’t arrive until almost 4. Then it was the back and forth decision of whether or not to place a central line in our new patient (patient left for the above study, removing that decision). Finally, both of the fellows left, leaving me to go around and write all of the orders that they had decided were suddenly needed.

I finished at 5:30 pm. Happy holiday to me.

(Did anybody understand the above paragraphs? I swear I really wasn’t trying to be cryptic.)

This is an important month for me. I love neuro critical care. I love the complexities of patients broken down into easily managed systems. I like the procedures (even though it’s been over a year since I did a central line or an art line. At one time I liked them). I like that it’s evidenced based. I just don’t know if I like it enough to do another 2 years of fellowship. More years of training, with long hours and which would require starting to do research now so I have a resume that looks impressive. And I don’t like research. All for a career that will always be demanding and time-consuming and I don’t know if I have the physical or emotional endurance for a lifetime of being an intensivist. I’ve been trying to make up my mind about this for months, mulling over both sides and never quite getting to a decision that felt right. So I’ve given myself this month to figure it out.

*Actually, after the news of the worker getting trampled to death at the Wal-Mart in Long Island, I’ve decided to continue my tradition of avoiding shopping on Black Friday, permanently. Because, that’s insane.

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