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18th June 2009

health care reform meta

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

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

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

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

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

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

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

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

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

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

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

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

posted in On doctoring | 2 Comments

15th April 2009

the slow path

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

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

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

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

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

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

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

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

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

posted in All About Me, Resident Life | 1 Comment

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

28th March 2009

-blows off dust-

Mom has a lists of blogs from family members that she follows on a regular basis. I don’t think she’s quite ready to tackle blogging herself (I can set you up if you are, Mom!) but she enjoys staying involved in the lives of family who live far away. Of course, that doesn’t work very well when the blogs don’t get updated. My sister updated her blog Feb 18 (even though she had plenty exciting news to tell), my cousins the early part of March, and me, well, I haven’t updated this since March 1. So much for my goals of writing about Tolkien.

Thanks to Mom’s persistent pestering, you now all get to hear about my very busy life.

The first part of March, I actually went on vacation. As a resident, I get 4 weeks of vacation a year (which I have to plan out a year in advance. I also have to plan out my 4-days-off-a-month 3 months in advance, which makes spontaneous outings nigh unto impossible) and I haven’t had any vacation since October. I was pretty ready for some time off, believe me.
cut to be nice to your bandwidth! Click to read and see more!

posted in All About Me, Family, Photography, Social Life, Those Rare Days Off | 3 Comments

5th February 2009

reasons #500,435,562 why I’m still in residency

I wonder if there will ever be a time when I feel confident in my abilities to take care of clinic patients. Hospital patients, even though they are sicker and more complex, don’t bother me (too much. Don’t worry, there’s no an ounce of cockiness in me. Except that I know more neurology here at the private hospital. But that’s not hard). I have the labs, the xrays, the ancillary support and the time to figure out what’s going on. When a patient is admitted to me, I can concentrate on that problem and the one or two other medical problems to go along with it and everything else, I can, if not ignore, document and not worry about it. I have pharmacists to consult, time to look up articles, time when I can go back and ask the questions I didn’t get to the first time. I’m very efficient at it; I can see a new patient and have a good idea of what’s going on within 20 minutes.

It seems like an entirely different world in clinic, where I have a limited amount of time to get the patient’s entire history and yet pressure to produce answers right away. Symptoms that have been going on for years, I have to address and I’m expected to have a solution right then. I have no labs, no supporting procedures that I can order and have done by the next day. I feel like a fool because I haven’t done pelvic and breast exams, prostate and rectal exams, except for very specific cases, since I was a medical student. I don’t know the subtlities in how to treat erectile dysfunction or allergic rhinitis, because those patients don’t get admitted to the hospital.

My classmates don’t seem to struggle with this. I’ve never “belonged” in the clinic world and I feel it more and more acutely every week. I’m enjoying the medicine clinics much more than the neurology clinic, but I think that’s just because I’m new. Every week, I’m so drained and discouraged afterwards.

I keep waiting for that someday when it’s supposed to get easier.

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

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

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.

posted in Uncategorized | 2 Comments

19th November 2008

S.A.R.

(As one of my program directors called it today. I think it makes it sounds like I’m part of this secret society or something.)

I had my semi-annual review today. I don’t know why I get so nervous every time for these. I walked in today with the biggest pit of dread taking up residence in my belly. Of course, all of my fears were drastically way out of proportion. They did not threaten to fire me or tell me that I make their program look terrible. I’m doing fine, they said. My students and interns like me, my attendings rave about working with me, and I perform at the level where I ought to be. And if they truly had problems with me, they would be bringing them up when they occurred, not springing them on me. Probably true, but I don’t think I’ll ever get over the fear entirely–it’s definitely been ingrained from years of needing external validation.

I did share some of my concerns, that I feel that I’m too fragmented switching from medicine to neurology and back every three months and that I’m missing out on lectures that I need to prepare for boards and to take better care of my patients. They both agreed, so I’ve just added a couple hours of lectures to my already full week. I also stated that I feel like I’m being compared to my straight medicine or neurology colleagues of my year, which is unfair because I really am behind since I do six months less than they do every year. I’ve only had 10 months of neurology, when my neuro colleagues have done 14-15 months. My medicine friends will be finishing this year, going on to fellowships and jobs, and I’m not even half way done with my residency. So my in-training exam results are going to be compared to the PGY2s instead, which is definitely better.

I expressed my eternal frustrations with the neurology continuity clinic, of how I’m always behind, always stressed and never feel like I’m learning anything because of it. It’s too late for me (5 more clinics!), but I really hope that they change it so we have 40-45 minutes to see a follow-up patient and staff it. Ten minutes more would make everybody’s lives so much better.

I saved my rants on my neurology program director’s selection criteria for the potential residents interviews (I’ll explain later), but believe me, I think that’s going to come up next time.

The SAR does provide me a chance to reflect on what I need to do to improve my performance and knowledge base. Even though I’ve been told that I’m doing fine, I know I need to do better. It’ll just be 2.5 years before I’m done and expected to know this stuff and I can’t afford to put it off or rely on the lectures to learn it.

Goals until my next SAR:

  • Read the review articles and case reports in the NEJM once a week. (Should I get subscription to NEJM, even though I hate getting journals and end up recycling without reading most of them?)
  • Read a chapter from Principles of Neurology a week
  • Read a chapter from the MKSAP board review book each night
  • Catch up on clinic notes (I’m 18 behind)
  • Complete evaluations (I’m 5 behind)
  • Improve on teaching with students. I always feel like I’m lacking time to teach. I need to have dedicated time with the students each morning.

Obviously, I have some work to do!

posted in Uncategorized | 0 Comments

14th November 2008

Happyness, the pursuit of

I am in a really happy mood right now.

All of the patients for clinic this afternoon showed up early and since I was gone to the neurology business meeting for lunch, by the time I came back they had all been seen (or not shown up) and my attending basically waved me away. A whole afternoon off. I love this rotation!

I finally got the bookcase and water bottles out of my car. Yeah for better gas mileage! Tomorrow I’m vacuuming the entire thing out and washing the windshield. Baby’s gonna sparkle.

I got more leaves swept (gutters are still full).

Chris just called, he’s got the weekend off and I’m going to Madison on Sunday to see him! I need to find someone to teach my sunday school class (anybody itching to discuss the law of chastity to a bunch of single adults? Yeah, didn’t think so), but that should be the only glitch. I haven’t seen him for more than a few, brief hours in months, so I’m really excited about the prospect of an entire day. I’ll get to see his new apartment, eat some kind of exotic food and just catch up.

I am relishing the thought of sleeping in tomorrow.

I had pumpkin frozen custard last night, which was phenomenal. THis really is the best time of year, ever.

In just a week, Susan and her family are coming for a weekend visit. Suz and I are going to the opera! And then we’re having an early Thanksgiving/birthday celebration with lots of mashed potations and pumpkin pie.

I’m doing great with my NaBloPoMo goals, haven’t missed a day yet. How are you guys; I hope I’m not boring you all too much! (I have noticed that as my posting has increased, the blogging of many of my friends has decreased… Hmm. A scientific correlation, perhaps?). NaNoWriMo has, as expected, fallen drastically short of the mark, but I’ve really come a long way in brainstorming ideas and plots and characters so it might be something that I can continue to pursue.

And to top it all off, there’s this:


I love Doctor Who and can’t wait for Christmas. 😀

posted in Uncategorized | 0 Comments

10th November 2008

maybe i can

Today was one of the few times I have really enjoyed clinic. As I mentioned, I’m rotating on the spinal cord unit during the morning and in the afternoon, I work in the neurology “specialty clinics.” Multiple sclerosis on Monday, general on Tuesday, dementia on Wednesday, movement on Thursday and seizure (if I’m not post-call) on Friday. The nice thing about these clinics is that there’s only one or two attendings and I can take my time on seeing the patients, because they are also seeing their patients. This afternoon, I saw one patient, a new diagnosis, and got to spend my time going over all of their symptoms, exploring the impact that the diagnosis is having on their lives, treatment, side effect, shown them the images of their brain, etc.

For once I didn’t feel pressured to rush through the history and physical, knowing as I interviewed one patient that the next two patients had arrived already and I was 20 minutes behind and I still had to staff the patient and the attending see the patient and then put in orders, explain again what the plan is, go through the side effects/how to take the new medications, remind again what the plan is, and point them to the front door. Is it any wonder that I sometimes overlook something on the physical exam or don’t ask if their great-aunt twice removed had seizures as a kid? Today, I got to focus on the subtleties and for once, really understood the pathophysiology of what the patient was presenting with.

I’ve been frustrated whenever I’m on the neurology side because I feel so far behind every one else; that I can’t seem to grasp the knowledge base that I need so badly so I can adequately take care of my patients. I’m mortified on a weekly basis when my attending asks me for my differential diagnosis and I can’t come up with it; and I realize that it’s because that above is how I learn, and I don’t get the chance to do that.

I’m off to bed. I’ve been so exhausted recently and it’s my own Tuesday morning clinic tomorrow, which means back to the nightmare. Only 7 more clinics.

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3rd November 2008

exhaustion

I’ve been falling asleep all day long today. Just can not keep my eyes open. I’m not sure why. I did get about 7 hours of sleep last night… and 11 the night before (I LOVE sleeping in). My eyes have been itching all day long, and I think this new prescription for contacts is off, as everything out of my left eye is blurry, so that might be contributing. Oh, yeah, and that daylight savings thing too.

I’m working in the spinal cord unit at the VA right now. Six patients. Rounds consist of walking around and looking at pressure sore wounds, which have definitely surpassed the definition of “sore”. They are usually large, open and somewhat smelly. I’ve never ever liked wounds/skin infections. But as it is something that I will see over and over as a doctor, especially now that Medicare in its infinite wisdom decided that pressure sore were “never events” and won’t pay for the hospitalization if one develops during the stay, I guess I’d better get used to checking, probing, and wrapping these buggers.

In any case, in the afternoons, I have neurology clinic. Today was MS (multiple sclerosis). 2 of the patients cancelled so my attending told me to go do something and he’d call me when the last patient showed up. So I took myself out into the gorgeous 74 degree sunshine and had a nap on the grass. 🙂 Just a lovely break to the day. Likely won’t ever happen again.

And I’m still tired. I’m about to go and put myself to bed. But I really need to go to the gym (another November goal. I swear, I’m treating November like it was January 1st).

Nano word count: 355. Yep. This is going so well.

Lastly, because I love it:

One day more!

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1st October 2008

teeth and brains

I made an appointment back in August to get my teeth cleaned tomorrow. This was the earliest date they had available. Neuropath is an easy rotation, was my thoughts. And if anything happens, my good buddy Prem will cover for me.

Alas for my poor-not-be-professionally-cleaned-and-detarred-for-two-years teeth, while neuropathology is an extremely easy rotation (I was done by noon today), Thursday’s is the busy day, with going to the VA in the morning and then to the medical examiner’s office in the afternoon and Prem, my back up plan, is not doing neuropath with me this month so he can’t back me up either. I will probably be done by 3, but not in time for my 2:15 appointment.

*sigh* My poor teeth. At this rate, they’re going to be rotted off by the time I can see a dentist.

In good news, I’m spending the month cutting up brains. Wow, have I forgotten a ton of anatomy. I’m going to have to study quite a bit. I rather enjoyed it; it reminded me of when I loved neurology so much that I would spend hours studying the material, drawing out the tracts and nuclei That seems like such a long time ago now. Brain tissue or at least fixed in formalin brain tissue, has a texture that is quite similar to mushrooms. The pathology resident and I were joking about how we felt we were in a cooking class.

Now, excuse me. I’m off to sleep so I can wake up in the morning and not embarrass myself by misidentifying the subthalamic nucleus 5 different times. Tomorrow is always fresh, with no mistakes in it… yet.

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14th September 2008

i love weekends

I have had a fabulous weekend. It’s been so refreshing and relaxing that it almost feels like I had the entire weekend off, instead of just Saturday.

Friday, I came home post call and packed for the “girls only” camping trip. It was one of my friend’s 30th birthday, so to celebrate, we decided to go camping. Yay! I’ve been wanting to go camping all summer long but have been thwarted over and over again by forgetting tents, threatening rain and long work hours. The weather didn’t look promising, but I was naive enough to believe the forecast of “20% chance” of rain. It started raining before we were even on our way. There went those plans. Instead, we went to my friend’s mother’s house, and sat under her car port, grilling our tin-foil dinners (seriously, tin foil asparagus is the most incredible food ever), and basking in the glow of the fire pit (I’m more determined than ever to get one). Afterwards, we all came back to my house and had a sleep over; my upstairs room almost looks like an oversized tent and everybody fit perfectly. We stayed up late talking (well, they did. I crashed early. 2 hours of sleep in 40 hours does not a coherent Julia make) and in the morning consumed pancakes (cooking tip: the addition of vanilla, cinnamon and cardamon makes a fantastic pancake). I haven’t had so much fun in a really long time.

After they all left, I decided to take advantage of my one day off and went over to Home Depot to research more about garage doors. The contractor was busy with another customer, and I got impatient waiting, so just as I was about to decide to leave and just order the darn thing online, one of the other sales associates stopped me. He listened to my rambling complaints of what was wrong with my door and felt that the door and opener were not the problem, that likely I needed some lubrication and new wheels as they get worn out.

I attempted to install the wheels yesterday and I think I’ve figured out the whole problem. It’s doesn’t even seem to be worn out wheels. The tracks were entirely caked in about 6 layers of grease and grim and the bottom part has rusted and the wheels were in a similar state (I don’t think those wheels have made actually contact with the tract in years, hence, there is barely a sign of wear on them, once you remove some of the grime).

I spent all day yesterday getting as much off as I could with a combination of paper towels, knife, fingernails (they could angle the best. I chopped them all off afterwards), and finally, dish soap (didn’t work so well). There’s still at least one multiple layers, but it’s already running just a little bit smoother. I just need to find a really good grease solvent to cut through the rest of it (any ideas???), and then lub it up good with some WD-40, and I think I’m set! YAY! You have no idea how much of a relief this is, this possibility that I might not have to replace my garage door. Of course, I still might have to actually replace the tracks if the rust at the bottom is worse than my original glance-over, but my bishop’s wife has recommended an independent contractor who is reasonable, so I might be able to get that done for a quarter of what I originally predicted. SWEET.

Afterwards, I cleaned up and went over to my neurology program director’s home for dinner which was nice. Everybody brought their kids, there was more food than imaginable (we have a rather large mix of vegetarians, meat consumers, Muslims observing Ramadan, etc). And then after that, I went to my friend Laura’s birthday party. She decided that she wanted to do a sing-a-long party, so we all got together and sang “The Music Man.” Yep, you read that right. We are such nerds. I haven’t seen it since high school at least; I remember most of the lyrics.

This morning, I rounded on all of our patients. We’ve cut the number patients down a lot, which made for easy rounds so I actually was able to make it to church for the first time in three weeks. And then I came home, ready to make potato soup for our on-call pot luck tomorrow, but I’m missing several ingredients, so instead I’m heading to the grocery store bright and early, chopping the vegetables and bringing it all to work so that it can cook in the crockpot all afternoon. Yummy.

And, I’ve figured out most of the problems with my from-scratch blog. It should be up and running in a couple more days. I’m so excited for its unveiling.

This week will be busy. I’m on call tomorrow and Friday. Saturday, I’ve invited my entire church over for a party. *boggles* Not sure exactly what possessed me to agree to host a party when I’m post call and sleep-deprived but there it is. It’s going to be fun, with a firepit in the backyard with camping chairs around and white Christmas lights on the fence, music in the front room, games and instruments downstairs, more games upstairs and tons of food. Luckily, I have the day off on Thursday to clean and all of my friends are coming over Friday when I’m at work to set up, so I don’t have to do that; hopefully, all I’ll have to do on Saturday is nap, take a shower and put on clean clothes and greet the guests.

Okay, I’m off to bed. Gotta get those veggies in the morning. 🙂

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24th August 2008

saturday night ramblings

Apparently, my ladder was also among the casualties of the recent heist of my garage, as I discovered this morning when I tried to find it to examine my garage door that has now started making grinding noises and loud squeaks when it closes.

The ladder was heavy, folks. 50 pounds or so. I could barely lift it. It changes this break in from a neighborhood kid going around, testing doors and lifting a camera. This appears more orchestrated than I had thought.

I’m so tired of feeling vulnerable. Now I get to add nightmares of nefarious thugs using the ladder to break in my upstairs. I already freak out every time I open my garage access door. I peer out my screens before leaving the house to make sure that the back gate isn’t open. I’m jumpy, and just two weeks ago, I felt safe.

The door’s gotta be replaced… there’s no way that it’s going to last this winter and I can’t leave things open and leave like I did before. So I’m researching doors and deciding between Lowe’s and Home Depot and will be getting it professionally installed so it’ll last a little longer.

***
There are two trees near work that have red leaves on them. It’s still August, trees! The weather last week felt like autumn had arrived. A friend and I were going to go camping today… and then it turned into summer again. Hot and humid. And supposedly rainy. It hasn’t rained a drop. So we ended up not going. I haven’t been camping yet this summer and I start inpatient wards again next week so I think I’ve missed my chance.

***
I went to a baseball game last night with the rest of the neurology department. It was so much fun. I love baseball, have since the fall of 1992 when the Toronto Blue Jays won the world series and since moving to Milwaukee have made it to a least a couple of games every year. The Brewers stadium (Miller Park) is awesome…we always get the nosebleed seats that are a hundred feet above the field, which always freak me out until I get settled. Last night’s game was the first where the roof was open. I saw with my friend Rehan and his 4 year old son who was shyer than anything… which was easily cured by the spun-suger cotton candy. We made faces at each other with our blue tongues through most of the game and were good friends by the end. Lots of pseudo-nephews and nieces has taught me well.

***
I did go by Best Buy and look at cameras today. I’m going to have to postpone my purchase of the SLR for a couple of months because of the expense of the garage door (natch). But I have decided that the D40 is the camera for me and I will be getting it to celebrate my birthday in a few months (gotta have some reason to look forward to that milestone). It’s small and featherlight, which because of my multiple shoulder surgeries is a necessity. And I think it’ll be just as portable as my last camera. It never fit well in my pocket anyhow, so the one camera will probably do me just fine.

Although I hadn’t realized that the camera doesn’t have live preview on the LCD. I’ve been so used to taking pictures using the LCD only for years that it might take a bit to get used to that again. I loved being able to angle it and getting those shots that were impossible before because I’m short.

Thanks for all of your input! It was sooo helpful and I was so excited to see that many of you had similar cameras and were taking gorgeous photos with them. It makes me feel more and more that I would not just be throwing my money away on a frivolous purchase. 🙂

I did walk out of Best Buy with a copy of Summer Magic on DVD. I couldn’t help it; it was on sale and I need a little more “femininity” in my life. It’s not available on YouTube folks, and sometimes the urge for Old Time Disney can be a little strong.

***
I’m not entirely sure what to make of Joe Biden as Barack Obama’s running mate. I hadn’t even realized that he had been in the primaries and haven’t heard of him before. It looks as if it is going to get ugly, though, and I had been impressed that both candidates had refused to get really ugly. The jabs about Obama being a celebrity candidate and McCain’s 7 houses (seriously??) were pretty mild compared to elections in years past. I guess that’s all going to change now.

At least it’s not John Edwards. I guess I can be thankful that he turned out to be a cheating louse just prior to the decision for running mate (sorry to those who like him. I could never support a guy for president who’s entire career was based on cerebral palsy malpractice lawsuits. But that’s the doctor in me).

My favorite personal speculation was Senator Harry Reid as running mate. I like him a lot and his acerbic tongue and I giggled at the thought of both Harry Reid and Mitt Romney as VP candidates and the chaos that would cause. The Mormons would be all up in arms, questioning if they could really continue to be a card-carrying member and vote Democrat. And the rest of the world would freak out that the Mormons were taking over and soon there would be “National Green Jello with Carrots Day” in March and no alcohol in the country. Good times. Such a missed opportunity. 🙂

***
Strictly Ballroom is still one of my favoritest movies ever. If you haven’t seen it, you should. I watched it again for the hundredth time with my friend Erika who had never seen it again. It’s one of those movies that I can watch over and over and it still cracks me up and turns me into a sappy romantic. I miss dancing…

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7th June 2008

affirmation

The sun peaks through the heavy clouds, shining through the large bay window of the neurology physicians work room. The room, as always, is bursting with people. Dr. Peltier is rounding with her team; they have just admitted a new patient who has been a diagnostic mystery–an illness that not only is causing neurologic deficits, but GI complaints as well. The team is discussing what tests should be ordered: labs for vitamin deficiencies for sure, but should they repeat the MRI and spinal tap or get an EMG? Would a biopsy serve any purpose?

Around the computers, the neuro ICU team clusters. A patient had been transferred from an outside hospital because of a head bleed. The patient is surprisingly stable with no deficits (alert, oriented, pleasantly conversant and able to move all extremities), a different picture than the transferring team had painted. The images show the real truth: a tiny little speck of intracranial blood from where the patient had hit their head–something that would resolve on its own, requiring no intervention and needed nothing more than closer observation for a few hours. The team is disappointed, not only because of the lost opportunities for procedures and action (for real head bleeds are usually the sickest patients we admit), but because now they had to write orders to transfer the patient out of the ICU–when they had just written the orders to admit.

I sit on the window seat, conversing with Dr. Lynch, the neuro ICU attending who had quickly lost interest in the CT images. He’s my favorite attending and I’ve got a bit of a hero-worship crush on him. He’s three-fourths of the reason that I’m considering a career in critical care–I admire his calm demeanor in stressful situations, the relaxed yet structured rounds, the evidence based approach the patient care, and his endless supply of random bits of knowledge. Today, the conversation diverges from discussion of a patient who had had another stroke to the origin and extraction of heparin and its antagonist protamine. It’s a fascinating history lesson on 2 drugs that I’ve used commonly and had no idea how exactly they worked. I wonder if I’ll ever have half the knowledge that he does. He teases me to remember this conversation so that in years to come, I’ll be able to pimp my residents about it.

The conversations circle around me and I look around at all my colleagues, my friends, my teachers and a feeling of peace settles over me. I gripe so much about the endless paperwork and documentation, the senseless protocols and mandates, the increasingly demanding and ungrateful patients, the ridiculous phone calls in the middle of the night, the sometimes long and exhausting hours, and so forth, that it’s nice to have these moments of confirmation. There have been times, many, many times over the past two years that I have regretted my decision to go into medicine, times when I wish that I had a time machine and could go back and warn 20-year-old me to think more seriously about pursuing a career in creative writing or genetic engineering or becoming a bum. But now, looking around the room, I realize again that this, this is the place for me, the profession for me, the life for me and I wouldn’t change a moment of it.

***

It was the medicine department graduation last night. I almost didn’t go–because of my failed camping trip last weekend, I was determined to take off last night. The thunderstorms put an end to that plan, so I dusted off my google maps and went to the ceremony instead. It was a good decision.

Several of my friends graduated last night, friends who were my senior residents when I started as an intern and who guided me in patient care. Jenn graduated, done with her 5 years of residency. I met her when I interviewed for the program two and a half years ago and she’s the reason that I chose to do the crazy combination of two residencies in one, because she was doing it and was thriving. She rallied for me, told the program to pick me, and for that I’ll be forever grateful.

The program was great and I had a blast. I stayed out late and chatted and caught up with all of my friends (and some of the conversations weren’t even about medicine as well!). Now I’ve got to decide whether or not to go to the Neurology graduation this Friday. Normally, I’d just go, but my church is having a barbeque and a dance that night and there’s a good chance a certain fellow will be there…

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2nd June 2008

More decisions

Hypothetical question (really, truly):

If you were trying to impress a young lad with your homemade cooking, what would you use as a side dish to complement my signature salmon recipe? (I was going to make it into a real poll, but I got lazy.)

1. Roasted Garlic Mashed Potatoes. What better way to get a man’s affection than through the staple of life? Plus, the author promises that I can expect to be worshipped and kissed for at least 38 hours.

2. Crushed Hot Potatoes. It’s got the potato factor in its favor, but it’s simple, so it doesn’t make me look too desperate.

3. Lemon Flavored Saffron Rice. I brought the saffron in Africa and carried it all the way back with me and haven’t used it yet. I love lemony saffron rice and it would really complement the fish. Plus, Cleopatra reportedly had great success with her use of saffron um, probably not the kind of success that I’m really seeking at this time :D.

4. Other! I am obviously an inexperienced Kitchen Goddess and need to be taught immediately that the perfect side dish would be:______________

Your input would be invaluable. And needed before Wednesday so that I can go shopping. Hypothetically, of course.

(As an aside: I LOVE the Pioneer Woman blog. I discovered it a couple of days ago and have spent most of the day browsing through her site. The pictures are goregous and it makes me long for the small town life that I’ve left behind; I miss those times of absolute solitude. Another part of me is overwhelmingly grateful that Kris Hullinger and I never hit it off, because whoa, I am glad that ranching is not my life.)

***
This is my last month as a second year resident, can you believe that? It just incredible how time can fly and still seem so slow. I’m not halfway done with my residency yet… that endpoint still seems a long way away. I certainly down feel ready to be released on the unsuspecting world, but I find myself chomping to get done with this all.

I’m rotating on the epilepsy monitoring unit, which is a different experience. Basically we admit people and provoke them into having seizures and I’m learning how to read EEGs, which is really like learning how to read petroglyphs done in a 3-year-old’s squiggly scrawl. I have no idea what I’m doing. The worst is that it really comes down to physics and electricity and currents and vectors, and man, that was my weakest point in all of physics. I could never understand it. I read and read this afternoon and I’m still confuzzled. But I’m excited about a new challenge, and the hours will be a little easier than a regular wards month (still have to do call, bleh)

***
I got my DEA license! And promptly had to renew a prescription for a patient, so I’m already being tracked. We won’t talk about how much money this little “privilege” cost me, but all I can say is that the little bonus that they give me at the end of the year to cover licensing and exams(while supposedly leaving enough to fund a gym membership as well), didn’t even cover half of what I’ve paid this past year for the honor of becoming a Real Doctor (like Pinocchio, but still with strings). But it’s all done now.

***
I’ve had “There are no cats in America/and the streets are filled with cheese” running through my head all day today. I have no idea where that came from, as I probably haven’t seen the movie (An American Tail, for those who are less Disney informed (and yes, yes, I know it’s not a Disney movie, work with me here)) since I was 10. Weird, especially since I did give in and buy myself a copy of Mulan since I’ve had an inexplicable urge to watch that movie for the last month, so I should be having “I’ll make a man out of you” there in my noggin instead. I did resist on buying the copy of Escape to Witch Mountain which is another one of my childhood favorites; luckily the store didn’t have The Three Lives of Thomasina or Toby Tyler –those I could not have said no to.

***
I think I’m going for the hammock in the back yard, it would fit the space better. One of these days, I’ll redo the front and make a real porch where I can install the swing. I’ve just gotta make sure that the side of my garage could handle the weight if I hook it there. I wasn’t able to find a fire pit yet either, so my backyard beautification project is on-going.

***
And I think that’s it. It’s all I can think to talk about, unless you want to hear that I have dishes to wash and clothes to fold and my hair to cut and CuteIntern friended me on Facebook (mostly shaved now. Definitely cuter) and I’ve got a date on Thursday that might almost be called a second date and there’s still about 5 clinic notes that I haven’t finished. Yeah, you definitely don’t want to hear about those tedious details about my life. 😀

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10th April 2008

sundry

Another night on call. It’s been a blue-soul kind of day. I’ve pretty much been cranky since I walked in this morning. We changed attendings today, to one that I’ve worked with in the past. Nice guy, but he’s getting older (at least 5 years past the age of retirement, if not 10) and is becoming forgetful and very, very slow to round. I’ve got one patient that I’m convinced that has been misdiagnosed, and I’d love to have an attending that I could brainstorm with, so that we could provide the right diagnosis, but that’s not going to happen with this attending. Instead we’ll wait for the acute illness to pass and send [the patient] home without no additional answers. It’s just frustrating. Neurology, I’ve discovered is 50% crazy people with all types of somatization and conversion disorders, and of the 50% who have real disease, the majority of those, we still can’t do much more than just throw up our hands and say “dunno what you’ve got, but sucks for you.” Even those we think we give diagnoses to explain things, someone follows in the footsteps and doubt even those.

I almost got to give IV tPA for the first time my last call night for an apparent acute stroke. So close. I was so excited, because I was going to do it. I called the attending, he approved it and told me to do it. Unfortunately (or luckily for the patient’s sake), the patient woke up from the self-induced chemical high just prior to me pushing the medication into the waiting veins. Ah, well, I really wasn’t wanting to deal with all of the complications that would have arisen if I had done so.

I got my schedule for neurology next year (the medicine portion is still pending). Two months of NICU (woohoo!), a couple of consult months and a couple of electives. No general ward months. SWEET! At least I’ll have another year to perfect some of my differential diagnoses before I have to be in charge of interns and junior residents. Next year, I’ll have to solidify my plans for my Real Career and actually decide what I want to do with my life and then start making steps to get there by doing research or whatever.

I think I’m running into problems with my licensure application. I submitted it weeks ago, and in typical Wisconsin fashion, I haven’t heard one word from them. There’s a website where you can check the status of your application…. it hasn’t even been listed there. And of course, attempting to email gets silence and calling gets on a merry go round of automated messages and nobody real to talk to. I know that they received it; they deposited the application fee almost immediately, so at least I don’t have to worry about it getting lost in the mail, but it’s starting to get ridiculous. I’m giving them until Monday, before I start calling every day and harassing them. Since I submitted things in pieces, I want to know what they have and what I might need to go back and recollect (my med school verification for example). I have to have the entire process completed by June. I honestly thought that 4 months would be more than enough time, but I’m starting to get nervous now. I think I’ll be saving my tax refund just in case the unthinkable happens and the paperwork doesn’t get processed by June and I’m suspended for a month. I don’t like thinking that, and I’ll be fighting with claws to prevent it, but I’d rather not find myself with no savings and no employment.

My semiannual review is tomorrow, I swear I just went through that. I haven’t seen any of the reviews I’ve gotten from the interns and medical students from when I was the senior resident back in February/March. I’m a little bit nervous about that.

My med students should be done seeing our ER consult, so I’d better get back to work. Ta for now!

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8th November 2007

seriously

Life has been super busy and super boring. I think it’s all because super cute intern has moved on to greener pastures and I’m mourning. 🙁 While it may not have been true love, it was definitely TrueLust and made the entire month survivable and entertaining. The intern who replaced him is a girl and therefore not interesting.

CuteIntern’s facebook profile reads this: “Custom has made dancing sometimes necessary for a young man; therefore mind it while you learn it, that you may learn to do it well, and not be ridiculous, though in a ridiculous act.” Soulmates. Srsly. (Or not).

In more news, I have not talked to DateBoy since said date. I’m thinking about calling DateBoy and inviting him to my house for Thanksgiving dinner, which may be the most forward thing I’ve ever done. Or not, because I keep changing my mind.

I’ve put on weight this month because of all of the stress. And the easily available candy at the nurses station. I haven’t worked out in a month. So much for the plan to be down ten pounds for Christmas, so I could finally, finally have a vacation without my mother mentioning how unhealthy I look.

I’ve had some very difficult patients that I’ve had to deal with that have sucked compassion out of me. I’ve realized that I hate treating migraines. But to make up for it, I’ve had 3 of the loveliest patients, including two who have made a romantic out of me again, because they (and their spouses) have proved that true love really exists.

My next day off is Thanksgiving, which happens to be my birthday. I haven’t had a day off since the 28th of last month. I get four days off in a row to make up for it. I’m not sure I’m going to be able to come back.

I’ve been on call every Tuesday except one since the last week in September. Tuesday is clinic day, which means I have to see all of my patients before 8. Since I really shouldn’t be in before 7 (therefore, having enough time to go to noon conference the next day and not break the ACGME 30 hour rules), it makes the morning incredibly hectic. What makes them even more fun: all of those Tuesdays, except for one, my team has been post call. So I have to hurry through clinic (where I always get behind), race through lunch, so that I can go upstairs and admit the 3 ER patients, learn about the NICU transfers, follow up on the stuff that the other intern wasn’t able to complete, write my own patient notes that I didn’t get to do in the morning, discharge the half dozen patients of the intern’s (because my patients are all rocks which I collect) and then start getting pages every 30 seconds on 3 different pagers. Yeah, I loathe Tuesdays. Only a year left of clinic!

The best part: I’m still on call every Tuesday until the middle of December. And every weekend except Thanksgiving.

I’m still trying to remember why I loved neurology. I think I need to see David Renner when I go home so that I can be reminded. It’s probably pathetic that when prospective interns come and interview here, I end up gushing about Utah more than the program here.

Susan and Bobby and Allison are coming for Thanksgiving. I’ll be cooking something delicious, I hope. Should I ask DateBoy or is that really weird? I think I need more furniture if I do.

I spent the evening reading old Gilmore Girls fanfiction. Mostly general stuff, featuring townies, and it made me realize once again what a brilliant, wonderful show it once was.

I’m going to the opera next week with two of my girlfriends, Kristen and Erika. The Merry Widow. I was very excited when I first heard about it, because from the radio ads, it sounded like it was the translation that I fell in love with in high school. Alas, my sleuthing has proven that it is not so (although I think it’ll be better than the San Francisco version), but I’m still ecstatic about it. I’m dressing up. I can’t wait.

I’m also having a painting party involving my living room next week as well right before the opera. Need to clean the place before before then, I think. And I need to buy paint. And moth balls.

I’m totally addicted to this blog and have wasted away more of my evening reading her archives and laughing so hard I almost started vomiting.

I’m going to be 29 in 2 weeks. And I think that’s enough to stop any more random musings.

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25th October 2007

just gotta

Gotta love the 13 hour days. When we don’t round until almost 6 pm, and I’m still so far behind that I’m just finishing the admission note for the 8 o’clock (am) stroke. When Cointern takes the day off. And senior resident is post call. And there are four strokes within a hour of each other, with just me to see them.

Things did get better, two of the neurology residents stepped in and admitted two of the patients (*loves*) and I did manage to see all of my patients by the time we rounded, so I guess I should be proud of that *snort*. But I never got lunch (and I only had orange juice and Saltine crackers for breakfast) and I missed the “interview” dinner where we take out the potential residents…free food, love it. That’s probably a good thing, because I am so tired and so frustrated and so ready to be done that I might have painted an overly negative view of the program and then nobody would want to come here which would create more work for me.

And now I’m scrounging up a frozen dinner and climbing into bed, because if I don’t get more sleep tonight, I will start crying tomorrow.

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    • the common denominator November 3, 2021
      When I was cleaning up the cross-post yesterday, because the wordpress plug-in I use always leaves all of these spaces between each paragraph, I accidentally clicked on one of the tag links on the side bar. Liz. My old college friend and roommate. Two posts down, I noticed that I had said something about how […]