Res Ipsa

2010-02-01T16:34:00.000-08:00

OK, this is probably funny to no one but us residents, but in our hospital's relentless push to perfection, they have focused attention (ahem...wonder why) on the rate of falls in the hospital. If you're familiar with "The House of God" story, you know all about hospital falls, and even how they can occasionally serve a purpose. However, in general, they're bad. In our hospital, they're a pretty good benchmark of the care you get on each floor, and each floor is different.

For example, there is one floor ruled by an ancient doyenne of a charge nurse, who, I imagine, counts General Patton among her idols. Things run with the precision of a Swiss timepiece on that floor, and as we speak, they are currently on day 19 of no falls. I'd be willing to bet that the fall 19 days ago was likely with a nurse floating from another floor.

By comparison, there is another, not-to-be-named floor, in our hospital, where our team proposed that it would be safer if the patients were all simply placed on the floor on arrival. I have noticed in the last week that this floor has not even bothered to put up the "X days since fall" sign.

The picture of the floor posted above, was a floor where our team had a large number of patients over the last month, so we spent a lot of time there. Our med students religously kept watch over the board, and one day were swearing that the nurses had skipped a day, and had gone from 1 day to 3, and were in fact cheating.

Vacation Day

2008-06-27T07:29:00.001-07:00

So last Saturday, Karen, Dan, Payal and I decided to take a "Vacation Day." Granted, it was a weekend, and we were all off anyway, but whenever one of us said something like, "I need to get back to do "X," Dan would say, "We don't have to go back yet, it's Vacation Day," so that's where that term came from. We drove out to Geneva-on-the-Lake (the lake in question being Lake Eerie), which is this cute little touristy town on the edge of the lake, about 45 minutes from where we all live. It's a nice quiet drive on small roads out there, and you curve around for a while, and then you're suddenly on this strip with all sorts of cheesy t-shirt shops, arcades and ice cream shops. There are a couple wineries there, and they were sort of our destination.

Me, Dan & Payal at the lake shore

Dan & Payal on a bench by the lake. It totally looks like they're dating, from the pictures I took, but they're really not. They just happened to be in all the good photo ops.

Me, Karen and Payal at the lake

This is the Firehouse Winery. It's really more of just a bar, but that's OK. They do make some OK wine there.

Karen & Dan, wine-tasting

Payal and I, with our wine-tasting trays

We were happily enjoying our wine and our Vacation Day when this huge storm blew in. The picture doesn't do it justice. The sky was dark gray and the lake suddenly became this weird green/gray color, and there were some water spouts.

We retreated inside with everybody else, and then made out way down the street to hang out at a townie bar for a while, which was fun for everyone but Dan, because we told some guys (when they asked how he got to hang out with 3 such pretty girls) that we were all nurses and he was gay. He wasn't amused.

After we hung out at that bar for a while, we wandered over to the only really nice hotel in town, which has this huge lawn facing the lake. We stayed inside until the sun came out, and then we went out on the lawn with (seemingly) everyone in the hotel to watch the sunset. It was so beautiful, that when it was done everyone clapped.

All of us about to go watch the sunset

After the sunset, we all went inside the hotel and warmed up at this neat fireplace. It was the perfect way to wind up the perfect Vacation Day.

2007-12-10T16:18:00.000-08:00

So last week I got to join two great friends from Texas, Mitra & Brooke in NYC. We were all supposed to get in on Thursday afternoon, and then head to the hotel. Of course, NYC decides to have thunderstorms all afternoon, so everyone's flights got cancelled/delayed, and we were all late getting in. Eventually we all got there & were able to meet up in time for a late dinner at this cute Italian restaurant that was right down the street from our hotel. Our hotel was in a great area - it was only a few blocks away from Central Park in one direction, and then just far enough away from the 5th Avenue shopping area to help you work off that bagel you ate for breakfast on the way down there.

I'm sure it's been said before, but NYC is seriously about the prettiest city I've ever seen. Maybe pretty isn't exactly the word, but that's about all I can come up with. It's just unique and awesome in a difficult-to-describe way.

The skyline is absolutely beautiful, and thankfully I was sitting next to this really nice guy on the flight in who pointed out all the major sites, like the Brooklyn Bridge and the Statue of Liberty, from the air. It was a great intro to Manhattan. The Chrysler building is still my favorite building....here it is below:

Me, Mitra & Brooke out at the Italian place where everyone spoke Spanish:

On Friday morning, Brooke had to get up early to go a conference, and Mitra and I slept in and then walked down to the shopping area around 34th St. & 5th Ave. Apparently our hotel was on the border of Hell's Kitchen, which sounds scary but wasn't. It was a very varied area - all different kinds of ethnic restaurants, flower stands, and the occasional soup kitchen/homeless shelter. We started out at Macy's, partly just to say we'd been there, and partly to check out their entire floor of women's shoes!

Below is just a random view of 34th St.:

We struck out shopping-wise, but had fun looking. We went through their Christmas department which had all these 1950's toys like Jacks and Pick-up-Stix. It felt very A-Christmas-Story-ish. Then we spent the rest of the morning wandering around the shops down that way, and waiting to meet up with Brooke when she was done at the conference. We eventually all met up, shopped a bit more, and then went home to get dressed to go out with my friend (and fellow AZCOM alum) Luke, who is an intern at St. Luke's Roosevelt in Manhattan.

View of Macy's from the outside:

They had these neat wooden escalators you could ride that were seriously made of wood and looked like they were original to the store:

Us out on the town our first day:

I got thirsty and so we stopped for Starbucks. Here we got to see God's way of saying you should always stop and talk to cute boys: Mitra left her purse in Starbucks, and if we hadn't stopped to talk to this guy (he's the doorman at the Russian Tea Room but that's just to pay the bills - he's really an actor...seriously!) it wouldn't have given the nice lady from Starbucks time to catch up to us and give Mitra back her purse! Take home lesson: always stop to make time for the cute guys.

The next morning Mitra and I got some coffee and bagels at a stand in Central Park and then walked around for a while. This bridge has been in a bunch of movies, none of which I can remember right now, but everyone stopped for pictures there because it was so pretty. There was this neat saxophone player you can see in the background, playing Christmas carols. I don't know how he did it - seriously it must've been in the 20s and it was windy! I gave him $2 for his fortitude.

Central Park was beautiful - the trees still had pretty yellow/orange leaves on them, and there were lots of people just milling about. Very relaxing.

Here's what it would've looked like if we'd been able to go back on our last day in NYC (it only snowed on the way out, of course!):

Here is a picture of the Trump ice skating rink in the park. You can't see the Trump Zamboni grooming the ice in this one, but it's there. Trump seriously has his name plastered on everything around there - even the Zamboni.

Heeding the lesson from the night before, we stopped to take a picture with these guys. Too bad you can't see the one taking the picture - he was by far the cutest but we couldn't figure out how to gracefully tell the older guy to get out of the picture and grab the camera from Cute Guy.

My camera wasn't good for much, but the one good thing about having a ridiculously slow shutter speed (yes, even on a digital camera!) is that my camera is so slow it can now take time-lapse pictures!!

Here's a better one of a random side of Times Square, which isn't actually a square:

Mitra & Brooke, getting ready to go out I think:

Luke, Me & Mitra just goofing around:

Me & Mitra attending a communist rally. Seriously - there was a pro-Chavez/anti-Bush rally going on outside - of all places - a VERY upscale mall and a Whole Foods. That cop was totally laughing at us:

Saturday night Mitra & I went to see the NYC Ballet perform "The Nutcracker" at Lincoln Center. It was so neat to be there - I've seen it on all kinds of PBS music specials, but it was really something else to be there in person. It really didn't feel as big as it looks in this picture, and even our view from the cheap seats was GREAT.

The ballet was beautiful, and it was so neat to see it again - I remember going quite a bit when I was little and I loved it. We had champagne and gummy bears at intermission. Very sophisticated. It was funny though - I remember people dressing up very formally for the ballet before, and here they were in everything from furs to un-tucked flannels and grubby jeans. Things have apparently changed quite a bit since I was little....

However, the Snowflake dance was beautiful, and made me forget the tacky people:

The Sugar Plum Fairy and her Prince were pretty great too:

Mitra & I found this great, very "New-York-ish" cafe on the way that we liked so much we went back for dessert after the ballet. It was a fun night, and once again, I really didn't want to go back home. I can't wait to go back to NYC (and Boston too!) at the first opportunity!

Boston, Day 2

2007-10-21T11:07:00.000-07:00

On Thursday, we went to the conference for a bit and then took the T (their name for the subway) out to the Sam Adams Brewery. The tour was….wait for it…..awesome. Our tour guide was hilarious, and we got to taste all different kinds of barley and smell the hops (you don't taste those). The barley is great - it tastes like a cross between Nutri-Grain cereal and actual beer. You chew it and then it feels like you have solid beer stuck in your teeth, were it possible. Then we got our free tasting mugs (only 7 oz., unfortunately) and went to taste beer. The state of Massachusetts only lets them serve 21 oz. of beer to 1 person on a tour (so we only got to taste 3 kinds), but they did make sure to point out that you are welcome to take as many tours in a day as you want.

These people really really really do love their beer. The commercials really don't even do them justice. And apparently the cute older bald guy with the long beard in the commercials not only works there, but was working there that day, but we didn't manage to catch a glimpse of him. We really wanted a picture with him, but I guess we'll have to save that for next trip. So apparently all the employees there taste beer every day at 10:30 am and 2pm. The tour guide was like, "Yep, we start drinking every day at 10:30am, for YOU guys." And even the lowliest employee has to go through this course where they learn all about beer and beer making and beer tasting, and have to be able to tell not just good from bad, but what's wrong with it if it does go bad. Pretty darn impressive.

If they find any beer on store shelves that is past its sell-by date, they buy it back at retail price because their owner, Jim Koch (the founder and the guy in the commercials) would rather do that than have people drink stale beer. And every year the employees save samples of bad batches of beer and put it into a dunk tank, into which Mr. Koch gets dunked, as he says he'd rather put people into stale beer, than stale beer into people.

Our guide about to hand out the barley and hops for us to try:

Our tour guide teaching us more about how beer is made:

Beer being "finished"

Finally, getting to taste the finished product:

Below, our guide is explaining about "Utopias." It's this non-carbonated, almost liqueur-type beer that's something like 26% alcohol that they only make every few years. They only produce 9,000 bottles (or something like that), and it's illegal in most states because of the alcohol content. So you have to pre-order it in another state and then go pick it up. You drink it in a tumbler, not a regular beer glass. It comes in this golden mini-beer-finisher-model bottle, which you can't really see in this picture. Most of us had never heard of it, until some beer aficionado raised his hand and asked when the next batch was coming out. Luckily for him, it's this November.

Below is a picture of "The Perfect Pint" glass.

So what is The Perfect Pint? one might ask...It's the final result of Jim Koch's obsessive (I told you he loves his beer!) quest to create the perfect glass in which to drink Sam Adams Boston Lager. It's perfectly designed for just that beer, and when in Boston, you're supposed to send SABL back if it's not served in the Perfect Pint glass now. Funny. I suppose all other types of beer turn to dust in it, right? It's really almost ridiculous how much thinking/work went into this glass: the bottom is laser etched to send a continuous stream of bubbles to the top; the lip is created to deliver the beer to the back part of your tongue, which is where the bitter sensors are; it's made so that your hand won't warm to beer past it's optimal temperature (yes, they actually have an optimal temperature at which SABL should be drunk), etc., etc., etc.

Here is a link to an article about how Jim Koch designed "The Perfect Pint" glass: http://money.cnn.com/magazines/fortune/fortune_archive/2007/03/05/8401280/index.htm. It's actually really interesting, everything that goes into it. Who knew beer drinking could have advanced so far, technologically-speaking???

On Thursday night, we decided to go to this place called Dicks Last Resort. The waiters there are known for their rudeness, and the ruder you are back to them, the better your service. At first our waiter didn't seem all that mean, but then when Natalie tried to helpfully point out where her birthdate was on her driver's license when he was carding us, he was like, "I know how to do my job!" And they make silly hats for the diners out of white butcher paper, with various and sundry insults on them. Brian got one that said "I vacation on Brokeback Mountain." The girls get either hats or helium balloons that they attach to some of your hair so they float above your head.

Us at Dicks:

They give everyone bibs, for no particular reason....

Brian's lovely hat:

Natalie and i with our balloons..Very funny....

After that, we went back to - you guessed it - Pub Row.

Boston, Day 1

2007-10-21T10:16:00.000-07:00

So I just got back from a trip to Boston. Our program makes us go to the ACOI ("something-something-Osteopathic-Internists") conference each year, and this year it was in Boston. I went with Natalie and Brian, my fellow "IM" interns (the quotes are because only one of the three of us is planning on having anything whatsoever to do with internal medicine, but I digress….). So basically for agreeing to be labeled "IM" interns, we all got a free trip to Boston and a week off of work without having to use any precious vacation time. Not too shabby.

We left on Tuesday (the 9th) afternoon, and despite being delayed at LaGuardia (which is an every-day occurrence, our pilot kindly informed us), we got in in time to go out for dinner. Our concierge sent us to this awesome neighborhood restaurant called The Fireplace, and I think it's my favorite restaurant of all time. It was a bistro-type restaurant, but had (surprisingly enough) a cozy fireplace, a great menu, and the only other people there were clearly locals who knew all the staff, so we kind of felt like we were at a sort of bistro-version of "Cheers."

So the next day was the first day of the conference, and after snoozing my way through a couple lectures (seriously, some were almost comically bad - how can they hand out educational credits for some of this garbage???), I was so excited to see some of the residents from Botsford there (this was the hospital where I spent 5 months in Michigan as a 3rd year). I really loved working with those residents, and I didn't learn how good they were until I left and had to work with less-stellar residents, so it was great to see them again. I'm glad I got to see them then, because like all good, soon-to-graduate residents, they promptly split and we didn't see them for the rest of the conference.

Here we are in our hotel lobby, all happy and optimistic, before we discovered how lousy the lectures were going to be:

We left as soon as we figured out there was no merit becoming martyrs to that dribble (OK, so pretty much I decided, and thankfully Natalie & Brian were in agreement), and headed for the North End (Boston's Little Italy) to eat lunch. At this risk of overusing the a-word, this place was awesome. It was this cute street that is one of the oldest parts of Boston, and it's lined with family-owned Italian restaurants. We picked one and had the best Italian meal I've ever had. While we were eating, a guy outside wearing a track suit and comically-large sunglasses did business with a giant wad of cash with another guy who seemed to be in the window business. Natalie and I decided they were negotiating what exactly was going to fall off of a truck that night. The North End is really something else - the only people speaking English are the tourists - everyone else is speaking Italian. The street is like nothing else I've seen, and I'd say it's the first place you need to go to after getting into Boston (if you're hungry, that is). The place we went was Antico Forno, if anyone's taking notes.

That was the first night we went out looking for a good Irish pub. This being Boston, we found an abundance of them. Where we ended up that night was a string of pubs right next to the Union Oyster House (the oldest restaurant in continuous operation in the U.S., open since something like 1826). They sit on the oldest block in Boston, which must be pretty old. Between some of the pubs a very crooked and uneven cobblestone street runs, which adds to the aged feeling. Our favorite pub was this really old-looking one called The Bell in Hand. That's the fun thing about Boston - there are some pubs with boring names like The Tap, but then there's Rosin Dubh (the Black Rose), The Purple Shamrock, The Bell in Hand, and things like that. So we drank some Guinness and then went home.

The barely-visible sign over The Bell in Hand, my favorite pub:

The three of us at The Purple Shamrock (I think...it may actually have been The Tap...hard to tell as I think this was the night we went to 5 different pubs....)

Picture disclaimer: If you haven't heard, I accidentally laundered my nice digital camera a few months ago, and most unwisely bought a cheapo substitute at Target before leaving on this trip. I have since learned that digital cameras are not something one should scrimp on, as this one took terrible pictures. That is why they're all dark and fuzzy. I am still figuring out some horrible way to kill this camera in retaliation for making my Boston pictures come out so lousy, but in the meantime, please accept my apologies for their terrible quality. When Brian emails me his better pics, maybe I'll replace these.

Neat shot of this cool building, Fauneuil Hall

(most unfortunately pronounced by all Bostonians as "fan-well")

Back to my old haunts....

2007-09-23T09:44:00.000-07:00

So on Thursday night I drove up to Detroit as I had an "audition day" at one of the derm programs there. This is the one with the attending who picked on of last year's residents based on the sole fact that he had the best shoes of any of the applicants….So I wore my favorite BCBGs….

I got to stay with my friend Rana, who was in my class at AZCOM. It was so good to get to see her again, and we stayed up wayyy too late Thursday night, talking. Then I went to my audition day on Friday, which was surprisingly fun. I say surprisingly, as it's one of the typical (that is to say, non-academic) D.O. derm programs that I wasn't at all interested in until I visited. The residents and the attending (who was quite the character) were all so nice, and made me feel so welcome. So now it's definitely on my program-radar, but it would mean never getting a serious academic appointment anywhere, and it's not really a very academic program (and thus would mean being asked for the rest of my career "You trained where???")….

Friday night we went with a group of interns from Rana's hospital to an Oktoberfest (yes, in September) in the unmistakably German town of Frankenmuhl, MI. I remember hearing of my Swiss grandparents going to all kinds of polka festivals, and that's pretty much what this was. Well, that, and a lot of beer drinking by little men wearing lederhosen. Seriously, it was so fun. I wasn't brave enough to get up and try polka-ing, but it was fun to watch the cute little old couples all dressed up in their traditional German costumes.

This wasn't one of them, but you get the idea:

There were several different polka bands, and for the most part the music all sounded the same to me, except when one innovative band managed to turn the "Boot Scootin' Boogie" into a polka, and all the people in their lederhosen were out there dancing to it. There simply aren't words…..

I can't speak for our entire group, but for me the absolute highlight of the night was when the band started playing "The Chicken Dance" (and who says this song is just for white-trash weddings???) and all the aforementioned cute little old couples plopped these giant chicken hats on and went out to join the dance. Seriously - they were giant stuffed chickens, that just looked like they'd landed on their heads. And it showed some PREPARATION for said Chicken Dance. It was AWE-SOME !!!

So that was our awesome Friday night. On Saturday Rana was on call, so just slept in and then drove out to the cute little town of Farmington Hills, which is where I spent 5 months during my 3rd year of med school. They have this adorable little farmers market in a pavilion on the town square there every Saturday, and it was my favorite thing to do there. Thankfully it was exactly the same. It feels very big-city and small-town at the same time for whatever that's worth (I have this idea that only people in Greenwich Village have farmer's markets, for some unexplainable reason). The same flower vendors were there, selling ridiculously giant-sized bouquets of flowers for $5, and the Farmington Hills Bakery ("We Knead To Please") was there, selling their yummy turnovers and parmesan bread. I got my coffee (they didn't have the hot apple cider like they used to) and wandered around for a while with my flowers, listening to a guy playing the guitar, who was actually very good. Kind of like a small town Eddie Vedder playing a farmer's market.

So after I got as much as I could physically carry, I loaded up my goodies into the car and drove around Farmington Hills for a bit. It was so nice to be back there. I would be so happy to be there for the next 3 years. As long as it's within an easy drive of the farmer's market. I should have that in my contract somewhere.

Minor League Baseball Fun

2007-07-08T16:26:00.000-07:00

(This is yet another old draft I never got around to posting...I wrote this the first week of internship)

So on Saturday night the new interns, our chiefs (who are funnily enough, the only 2 medicine residents prior to our arrival) and our program chief (and attending for the week) went out to the Lake County Captain's game. They're the Cleveland Indians farm team, and the University Hospital Health System (The"UHHS" in "UHHS Richmond Heights") has a box there and they let us have it for the night. It was so much fun!! I remember really not liking baseball games when I was younger, but they're, say, at least 10% less boring when you're watching them in person. And when you're surrounded by all kinds of new friends as well as free drinks, well, it just becomes a fun-a-palooza.

Our team lost when the other team hit a 3-run home run in the bottom of the ninth, but other than that, a good time was had by all. They cater the box, and then toward the end of the game, they come around with a - wait for it - DESSERT CART (!!!!) and coffee!! And it was serious dessert - pineapple and raspberry cheesecakes, all manner of snacks covered in chocolate, and the like. I could get used to this.

Here are all the medicine interns/residents with the Captains' mascot:

From left to right: Bryan (intern), Christine (resident), me, Natalie (intern), Ben (resident) and Kellie (the third-year transfer resident)

Ben is explaining to Natalie how to convincingly explain "I promise, I never got that page," to the nurses to get out of dumb calls. Just kidding, of course we'd never do that!

A pretty picture of the scoreboard at sunset:

The view from our box:

Getting Settled In Cleveland...

2007-06-27T15:03:00.000-07:00

(Note: I started writing this my first week here, and am only finishing it today. I put newer comments in parentheses)

This is a very delayed post, but I was going to wait to write my first Cleveland blog until I moved into my new housing and got all settled, but it's become apparent that that might not happen for another week or two, so I'm just going to write anyway. So this is going to be pretty long, but hopefully not too tedious. (This is old: I'm already partially moved in, and will finish moving the last of my stuff this weekend)

So for right now I'm staying in the UHHS Richmond Heights (my hospital) student housing. Our apartment is nice, but the whole building is typical of all the apartments in Cleveland, which is to say, old and smelly. The lobby has the exact same set of furniture (minus the plastic covers) that they had in the nursing home where I worked as an EMT, which is really funny. However this furniture is bolted to the floor, which I assume is to prevent its walking off and being exchanged for some sort of street currency (i.e. crack). And on either side of the lobby is this creepy pseudo-fireplace contraption that consists of a light and a rotor thing that casts fake flames inside the fake fireplace. The wheel that spins it makes this eerie creaking sound, and when you come in the lobby at night, it's dark other than the fake fireplace. I always start hearing Edgar Allan Poe in my head when I walk in at night. To get to our apartment, you have to walk down this long hallway that either smells like old cat food, cigarette smoke, or the combination of both, which is truly heinous.

The fake fireplace thing is much less creepy in the daylight:

So here's an update on the housing situation. I think I've found this cute little house to rent that's not too far from the hospital, and in a cute little neighborhood of postwar starter houses where I can jog outside for a change. However, the owner (who's renting it as she had to move out-of-state for a job but doesn't want to sell it) forgot to leave the key with someone here, so I haven't been able to see the inside of it. So the key should be getting here on Thursday or so, and as long as it's decent on the inside, that's where I'll be staying. I'll basically have the house to myself, which is great. (Addendum: I've seen the house, and it's pretty cool, though a bit dusty…I spent a few days cleaning/dusting and now it's a bit better..it just needed some airing out)

My window is the one that's mostly covered by the tree branches. Crazy neighbor's house is to the left:

Not that I want to stay up here one more minute than I have to, but I am really liking Cleveland so far. The people here are every bit as nice as they are in the South, which I didn't expect at all.

Example A: I've been going to this one coffee shop near the hospital every day to listen to talk radio on the computer and pretend to study. Almost every day the lady that works here (Lori) brings me hot cookies right out of the oven, coffee refills, sandwiches (which led to what will be hereafter referred to as The Turkey Sandwich Incident), and today it was cinnnamon toast. She's so nice!

Example B: Yesterday, I was checking out at Trader Joes (my delight at finding TJ's here goes beyond all description), and the lady was talking to me and asking me where I was from, etc., and then she said, "Hold on just a sec." And before I knew it she was coming back with a bouquet of flowers, and she said "Welcome to Cleveland, these are for you," and then she insisted on giving me her phone number in case I needed anything. She said "Everyone can use an extra Jewish mom, and my kids are all grown up, so…" So now I have an extra Jewish mom, just in case.

So tonight I was planning on going to an Indians game with my roommate, her boyfriend and another friend who's an intern at the Cleveland Clinic, but right now it's pouring rain and thundering, so that might not happen. I always think of the Indians as a terrible team but I think that's because of the movie "Major League" because apparently they're in first place right now. (Kept raining, didn't end up going….)

My first week here I went on a "Lolly The Trolley" tour of downtown Cleveland, which was really fun. The guide was great, but it was a whirlwind tour, with a lot of area to cover in 2 hours, so I would need to take 2 or 3 of them to really absorb everything. The city is a lot prettier and greener than I would've imagined. What was sad is that they haven't preserved their history very well. All of the historic homes/places (of which there aren't many for a city this size) were only added to the National Register in the mid-to-late 80s, and I think it's amazing that no one noticed their importance before then. There is one long street called Euclid Ave. that stretches from the west of the city all the way out to the eastern suburbs (where I am), and used to be called "Millionaire's Row." There used to be hundreds of mansions there, owned by the likes of John D. Rockefeller, etc. Now there are literally only 3 left, and only one of them is open for tours.

One neat thing the city is doing is renovating a huge warehouse district into neat lofts, and when they're finished, and more restaurants/businesses come back to downtown, that is going to be one fun place to live. They have a daily farmers market downtown called the "West Side Market" that I'm going to go to some Saturday or other, and they also have a neat area of different ethnic grocery stores that I'd like to try if I can ever find it again.

This is a picture of the greenhouse at the Rockefeller Gardens. We stopped there for a few minutes and were able to walk through the greenhouses. It was very pretty, peaceful, and quiet in there.

This is the outside garden part:

This was one of the stranger types of flowers I've ever seen. It had a puddle of water in the center, with the center part floating in it...Kind of cool.

So this week (6/25-6/29) I've been doing orientation. They gave us our long white coats with our names embroidered on them on the first day. What an awesome moment! Mine is wayyyyy too big, and can't be altered without basically reconstructing the entire coat (which would cost more than a coat does), but I still love it….I would probably sleep in it if I knew that I wouldn't have the terrible luck I always do which inevitably involves getting caught doing something silly/embarrassing. I think my intern class is going to be great - everybody's nice and outgoing, and we've already got some fun outings and road trips planned.

I start on the internal medicine hospitalist service on Monday, and I also have my first night of call that night. Thankfully I'm on with a senior resident, so hopefully it won't be too bad! I am seriously out of "work" shape after a month of vacation and a month of anesthesia (okay, so maybe I only went to ten or so days of that but who's counting?....) before that. So if you don't hear from me for a while, it's because I'm going to sleep at 7:30pm….

Last weekend I had a "Temple moment" (the irresistable urge to leave the town where you are asap) and wanted to get out of Cleveland for a bit. So I drove to this cute town called "Geneva-on-the-Lake." Surprisingly enough, t's right between the town of Geneva, and the lake (Eerie). It's a cute little kitschy town that is basically Myrtle Beach but not in the South. It had one main street that was lined with arcades, ice-cream and pizza restaurants, and putt-putt courses (including one that was "Mom and Pop's Rainbow Putt-Putt" which I would venture to guess was named before the rainbow symbol took on the meaning it has today).

There were lots of pretty white sailboats out on the Lake:

My med school graduation!

2007-06-07T08:09:00.000-07:00

So last Friday I finally graduated from med school. I thought that going through the ceremony would finally make me feel like a real doctor, but I have to admit, I don't really feel any differently than I did from the day before. But it was fun! Graduation "weekend" actually started on Wednesday, when my friend Allison rented out a nail salon so all us girls could get pedicures together. it was so much fun! And our other friend Azadeh took time out of studying for Step 1 to come hang out with us too!

******

Us getting pretty toes:

Azadeh, Allison and I:

Then a lot of my family came in from California and Georgia, and we went out to eat at PF Chang's on Thursday night after (almost) everyone got there. We got to sit at this huge private table that was sort of hidden behind the bar but in front of the kitchen, so we could watch them making everything. It's not the best place for people with otosclerosis to sit, but the rest of us didn't mind! My little cousin Matthew provided the entertainment by repeatedly sticking his chopsticks up his nose.

Me with my grandparents at PF Chang's. You can tell how Grandpa loves to be in pictures:

My Aunt Shay supervising Matthew and his chopsticks-cum-weapons:

The next morning we had to get up early to get out to the Maricopa Events Center, located in what felt like Los Angeles, by 8:30am. When I have my own med school, graduation will start no earlier than 2pm…especially if it's over an hour's drive from the school!

This is me hanging out with Megan before the ceremony. In retrospect, I probably should have put on the silly hat, because in all the photos where I'm not wearing it, I look like I just randomly decided to put on a black gown that day:

Joking around (posed) with Jennie & Tori before the ceremony, in front of the concession stand. Yes, there actually was one. At a med school graduation. Only at my school.....

Tori, Jennie & I before the ceremony (again):

With my friends Chuck and Eric before sitting down:

With my friend Abby before the ceremony:

With my friend Ruqayya after the ceremony:

Despite the early hour, my school managed to put on a somewhat decent ceremony, the one exception being our esteemed President, who was clearly winging her speech. One would think she would have taken, say, 15 minutes or so on her private jet flight from Chicago to pen something appropriate for a medical school graduation, but no. But I should thank her, as she provided a sort of impromptu psych review in that she was repeatedly inserting neologisms (something schizophrenic patients do) in her speech, with such memorable words as "strucken." Seriously….where did they find this lady? She was also blinged-out with a huge gold medallion, the origin/meaning of which no one could decipher.

Dr. G winging her cheesy speech.....Unfortunately you can't see the bling in these pictures:

Matthew enjoying popcorn during the ceremony:

Me modeling my hood after the ceremony:

With my mom & my brothers after the ceremony:

Me with my mom:

Tori, me & Jennie:

Me picking up my diploma. It would've been nice to take a picture in my cap, gown & hood with the diploma, but our cheap school makes us turn in the cap & gown to get our diploma. Nice.

So after the ceremony we took approximately a million pictures and then proceeded to lunch at Abuelos, which was really good! Then we went back to the Plaza and had a champagne toast and opened presents. The next day we just lounged around by the pool, and then went out to dinner for my grandma's 46th anniversary of her 39th birthday at Macayos. Of course they insisted on singing one of those cheesy Mexican-restaurant-birthday-songs to her, which she really enjoyed. Plethora and bulging jugular veins are usually a sign of enjoyment, right?

The young folk decided to go out to dinner on Friday night after the ceremony, and we ended up at Buco di Beppo, and we had such a good time.

Here are all the cousins together:

Jennie, Tori, Me & Megan:

James, Jackson & I with the nuns:

On Sunday everyone took off, and after dropping Jackson off at the airport at about 1, I took off for Cleveland. I didn't get very far. I only made it to Albequerque the first night. But at least it was a start.

Good Times in Sedona, AZ

2007-05-23T21:23:00.000-07:00

So I'm at this awesome hotel in Sedona that happens to have, along with daily 8am duck feedings, a wine and cheese reception in the lodge every day from 6-7pm. I was so proud of myself because I went out without knowing anyone, and sat down and joined a large group of people (this is my Mt. Everest, folks) and conversed.

All I wanted was some good wine, polite company for a short time, and to get back to my Sherlock Holmes book, and my punishment for my efforts was that I go to spend two hours in the company of New-Age nutcases (In case you're not familiar with Sedona, it is supposed to have multiple "spiritual vortexes" in the rocks…I'm not sure what a spiritual vortex is, but I do know that they attract a LOT of hippies and New-Age enthusiasts).

The scene unfolds: Three couples and one empty chair. They looked normal enough. They were all sitting in the prime seats by the fireplace, which is where I wanted to be, so that's who I joined. One nice normal couple that was there at first shortly left….left me to the wolves…er….New-Agers.

Here is a sample of the conversation for the next two hours (if you're asking why I didn't leave earlier, I literally couldn't get a word in edgewise, and being in the middle, was somewhat wedged in - I could've escaped, but it would've looked awkward):

· The nice lady to my right was working on adjusting her fourth chakra, which in case you were wondering (and for the folks in Rio Linda) is located four finger-widths below your belly-button. I didn't even ask how one goes about working on this. The reason she's working on it is that it is very "bound up" due to some recent litigation at work. (????)

· (Side note: much like your face can hurt from smiling too much, my face now seriously hurts from two hours spent trying to retain a perfectly straight, credulous face)

· The lady on the right had an "experience" at one of the spiritual "vortices" that are supposedly in the rocks here. She told me that her spirit tour guide had them lay down and meditate, and while doing so, she decided (I didn't ask why….) to leave her body. When she tried, she found that she couldn't (I was loath to tell her that I have this same experience every time I try to put on my "college-size" jeans)

· The lady to my left discussed all her various "readings" with different astrologers and the various crystal shops she was planning on visiting in the morning. She also taught me the importance of having copper near/on the crystals as it helps keep the good energy in (or something like that, honestly I wasn't taking notes)

· I also got to hear about the lady-on-the-left's various past lives, her monk who is her guardian angel, though she cannot discover to which order he belong(ed) (assuming he is no longer with us), and how she and her husband knew each other so well when they met because in a past life they were orphans who were raised together…Hmmmm…..

So all in all it was an entertaining experience all round. I don't think my companions meant it to be so, but it was indeed. Unfortunately two of them are leaving tomorrow, but I am confident their equally-loony replacements will prove no less entertaining.

Hiking in Sedona, etc.

2007-05-23T17:47:00.000-07:00

So today was my first full day in Sedona. I got up and had the coffee and scones they have in the lobby every day. They were yummy! I read the paper (with the funniest article by far reporting on how 25% of American Muslims are pretty much A-Okay with homicide bombings, and was inexplicably titled "Muslims reject extremism." (???)) and of course, spent some time watching Fox News and playing on the net.

I wanted to get started hiking, so after driving around for awhile, I purchased my Red Rocks Pass (without which you literally cannot park anywhere in Sedona, especially anywhere scenic), and off I went. The New-Agers from last night had told me about Schnelby Road (where you can drive up on a 5-mile dirt/rock road if you have an SUV) which has a great view from the top. For about a mile, my car was probably so happy that for once it was being used for the purpose for which it was designed. However, it was really bumpy and had some sharp rocks, and after about a mile I decided a good view of (what else?) the red rocks was not worth 4 new tires, new alignment, new suspension, and new shocks. So I turned around and went back to a turnout and parked where some trails started. I took one that ended up following next to the road for 4 miles, and then split into two others, with no indication of their lengths/destinations. I was bored by then anyway, so I turned around and followed the road back. I was the only person on the trail almost the whole way, and aside from the numerous Pink Jeep tours that kept driving by, it was really quiet and peaceful. Here are some views of the red rocks from the trail and road. They all have different names like "Snoopy Rock," "The Nuns," and "Cathedral Rock," but as far as I can tell, none of them resemble those things anyway, and I have no idea which is which.

So now I'm back at the hotel, and having scrubbed off my red rock-dust "tan" from my legs, I'm back to my Sherlock Holmes book and eagerly awaiting the New-Age enthusiasts I'm sure to be inundated with at the wine and cheese reception tonight.

Here are a few pictures from yesterday and today:

This is my patio that I really haven't spent much time in yet but it's beautiful.

I have to say - this hotel is the best. I am having so much fun with all the random little things they do. As if the nightly wine & cheese reception and the daily coffee and scones weren't enough! So each night when they do the turn-down, they even lay out the bath mat in the bathroom for you, and they leave these really neat chocolates on the table - tonight it was orange and crispy chocolate, and last night it was cinnamon chocolate. I'm not a chocolate person but I felt like I had to try them and they were actually really good! Then they turn the clock towards the bed so you can see what time it is when you wake up. And I'm not sure what happened to the dirty clothes I left on the floor this morning, but I am really hoping they are at the complimentary laundry service....I don't remember reading anything about that, but I am hoping they are not going to charge me to clean every clothing item I leave on the floor....because if so, I'm going to have to find somewhere to hide my laundry. :-)

This is the area with a bunch of chairs and fireplace that's right outside my room.

Here's the other side of the same room. 4 steps to the right is my room.

This is this really neat jasmine-covered arch between the hotel and the cottages by the river - it's smells so much even I can smell it, and it's soooo good!

This is a view of the red rocks from the hotel:

Here is a sign right when you drive in the gate:

And here are the ducks on the river (but they're really hard to see in this pic, sorry!)

Here is a view of the red rocks from the trail I was on:

More red rocks.....

Even more red rocks.....

More pictures of red rocks to come tomorrow!

"Today Is a Sunny Day In Savannah"

2007-03-12T17:16:00.000-07:00

So this post actually starts on Saturday night, but who's counting...I went on a Savannah Ghost Walk - not quite as good as the one I went on with my mom in Charleston last year, but entertaining in its way. I have to say it was so fun to just be walking around Savannah in the dark with hundreds of other like-minded tourists that the guide could've been giving a lecture on the Henderson-Hasselback equation and I wouldn't have minded a bit. So we walked around a few squares, and as we stopped in front of a bed-and-breakfast, two women who seemed to have been waiting on its porch (literally) ran down to meet our group. They said "Can we listen in while you talk about this house because we're staying here, and we've been watching the tour groups come by, and we want to know some of the history because some strange things have been going on." It turns out that this house is supposedly very haunted (but not with mean ghosts), and it once was used as a mortuary for a time. There is even a break in the granite paving stones for where they used to slide the coffins in and out of the basement! So anyways, these women were the leaders of a group of Girl Scouts who'd rented the entire B&B out for the weekend. When they'd first gotten there, a group of girls went up to play on the 4th (attic) floor. Before they opened the door, they realized that the room was already being used by other kids (or so it seemed!) as they could hear the sounds of their playing outside the door. They were wondering how some of their fellow Girl Scouts had beaten them up there, as there was only one way in/out, and when they opened the door, no one was in there! And then one of the women told us that on the first night, she'd been awakened at about 1:30am by the sounds of the girls playing in the hallway. She opened her door, ready to yell at them to get back to bed, and realized the hall was empty. She assumed they'd just heard her getting up and had beaten her back into their rooms. The next morning, she was chastizing several of the parents for letting their girls stay up so late, and they were all like, "What are you talking about? We were all asleep at 10!" (!!!) It turns out that that house is haunted by sounds of children all the time, though no one knows who the particular children are/were. Pretty spooky!!

*****

The picture below is of the 1790 House, which houses a poltergeist ("messy spirit") in room 204. Apparently when you book this room they make it abundantly clear that you will be spending the night with Anna, the resident poltergeist, and that as you have clearly been warned in advance, there will be no refunds. Apparently she likes to turn the faucets and shower on and off, flush the toilet all night, and steal women's lingerie (to what purpose, I cannot imagine). When we were walking by (this isn't of room 204), our guide shouted "Look there!" to scare us. The funny thing is that whomever propped up this sad mannequin "ghost" neglected to notice her missing hand. She looked more like a defective prop from "The Ring" than a real ghost, but it was campy and funny nonetheless.

So to explain the title of this post: If you didn't know, I'm on a neurology rotation right now. Every day, when my attending checks various patients for dysarthria (slurred speech, often as a result of a stroke or a TIA), he asks them to recite "Today is a sunny day in Savannah." So I kept thinking of that as I was meandering about (what felt like) the entirety of Savannah. I started out at Panera, per usual, and then I took my copy of "Midnight In The Garden Of Good & Evil" which I'm re-reading for the umpteenth time to the prettiest square I could find with an adjacent coffee shop (Chippewa Square, as it turned out). I got myself a sandwich and drink and settled down on a park bench and read for a while, until the very-attentive gnats got the better of me. I could try to explain how peaceful and beautiful it was there, with all the azaleas in full bloom, surrounded by statues of famous Savannahans, but I think you just had to be there. So after reading for a while, I figured I'd best get down to being a serious tourist for a while. So I walked until I found the Owens-Thomas House, which is one of the best-preserved houses in Savannah, and also the house from which le Marquis de Lafayette made his famous address, although few understood it as it was in French. It was such an incredible preservation - they have done a remarkable job. They have it painted the same colors the original owners would have, and gave so many details and historical tidbits throughout the tour that I was very impressed. The balcony on the right of the house (right over the pickup truck's bed) is the balcony from which Lafayette spoke.

Next I wandered over to the Colonial Park Cemetery, which was one of the two main cemeteries in the town during its heyday. The reason I took the picture below is to illustrate how bare it is. Even though it's smack dab in the middle of the town, there are hardly any graves. Why? might one ask. It's because of the 10,000 or so Union soldiers that were encamped there for 10 weeks in the War of Northern Aggression. They moved the tombstones around willy-nilly, and the only ones that are left either couldn't be moved, or were conveniently not in the way of a tent. The soldiers didn't stop there however. They defaced many of the tomstones, changing birth/death dates so that some people are now 400 years old, changed male names into female names and vice versa, and generally defaced what should have been hallowed ground. Kind of hard to believe they did so much damage with apparently no remorse (or discipline).

So when the city came back into the hands of the Georgians, they were left with all these tomstones, with no idea where to put them. They decided that the best, and most respectful way to diplay them was to mount them on the brick wall that surrounds the cemetery.

After that I drove out to Bonaventure Cemetery (the "Garden" part of "Midnight In The Garden Of Good & Evil") but it was closed, so I drove on to Tybee Island, which wasn't. They have a very cute lighthouse (which was, of course, closed, otherwise I would have climbed it), and a very nice beach - just like I pictured a southeast-coast beach...salt grass, and lots of shells.
The day was getting to be partly cloudy and you could see plenty of the "fingers of God" (the Renaissance term for when light breaks through clouds in rays) coming down from the sky. I really can't believe this picture came from MY camera, but I promise it did:

Another view down the beach on Tybee Island:

Even though I had errands to run later I just had to get in the water so I can say I've set foot in the Atlantic ocean, so I did, but not much more than that.

I just went to Kroger with sandy feet. I'm sure they'll get over it someday.

Savannah Ghost Walk

2007-03-11T09:30:00.000-07:00

Yesterday was my big touring day in Savannah. First I went on the Old Town Trolley Tour, where they drive you all over town in this eye-catching orange and green trolley. I just wanted to get an overview of the town and figure out where I wanted to go spend more time later. It was so great - our tour guide was Denise, and she was hilarious. Lots of town gossip and speculation, and who cares if it was true - it was entertainment! Then last night I went on a Savannah Ghost Walk. It was OK - not nearly as good as the one I went on in Charleston, but a good way to kill an hour or two and possibly learn a bit more about the town. The best part was when we were stopped in front of a particular bed & breakfast, and two women excitedly ran down the steps and said, "We've been watching the tour groups stop here and talk, and we want to know what's going on with this house, because some weird things have been happening!" It turns out that they were leaders of a group of Girl Scouts who had rented the house out for the weekend. When they first arrived, a group of girls were headed up to the attic floor to play, and before they opened the door, they heard a group of other kids already playing in the room. They were wondering how some of their group had already beaten them up there, as there was only one way in and one way out, and when they opened the door, no one was there! And then one of the leaders said she'd been woken up at about 1am by what she thought were the girls playing in the hallway. When she opened her door to yell at them to get back to bed, there was no one there. She thought they'd just been faster than her and gotten back into their rooms before she could see them, and when she asked several parents the next morning if they'd let their kids out during the night, they all said no! Here's a picture of that house (I know, it's kind of dark, but this is actually my only picture that turned out!):

(The people in the doorway were some of the little Girl Scouts whose moms wouldn't let them come down and hear what our tour guide was saying, because they didn't want them to be even more scared!)

Excuse me, I believe you have my crack pipe...

2007-01-29T11:15:00.000-08:00

I think the fine citizens of inner-city Atlanta are conspiring to make me miss it even more than I thought I would….Last night was a banner night in the ER. What was funniest was that for once, all the weird patients didn't come to me…they ALL went to one hideously unlucky internal medicine intern rotating in the ER this month. Poor thing, all she wants to do is take care of hypertension and diabetes, and she gets multiple patients who are seriously crazy even by Grady standards. For starters, her first patient was having psychosis with delusions of grandeur (just what it sounds like), and would not respond to you unless you addressed her as "Goddess Johnson (name slightly changed for privacy, but not much - she seriously insisted on being called "Goddess.")." Patient #2 was (at least he said he was, though he WAS schizophrenic, so you kind of have to take everything with a grain of salt) a head of the KKK, and stated that everyone in the ER was of such low intelligence that it was not even worthwhile to speak to us. What made this even funnier is that that the intern is Jewish, so she was like, "Great, wait till he gets around to reading my name tag!" Thankfully, she has an awesome sense of humor, so we had many a good laugh at the nurse's station about all of her patients last night. I don't remember another ER shift where I've laughed so much. Another of her cadre of patients was a person with hepatic encephalopathy (one can get quite loopy with excess amounts of ammonia in the brain!) who kept coming out of his room and entertaining the nurse's station with various antics. Lastly, a discharged patient inadvertently left their crack pipe on their bed….Apparently this a not-uncommon finding at Grady, and most of them have the audacity (unless they're too strung out on crack at the time, of course) to come back and claim their property….I'm going to miss this place….

*******

Tijuana Police Have Guns Confiscated, Issued Slingshots

2007-01-23T16:49:00.000-08:00

TIJUANA, Mexico — The police department has issued about 60 slingshots to officers in the violent border city of Tijuana, where soldiers confiscated police weapons two weeks ago on allegations of collusion with drug traffickers.
Municipal police spokesman Fernando Bojorquez said Monday that the slingshots, along with bags of ballbearings, were given to officers patrolling areas of the city visited by tourists.
Tijuana's police force of 2,000 officers has been without guns since Jan. 5, but some patrol alongside armed state police.
President Felipe Calderon sent 3,300 soldiers and federal police to Tijuana at the beginning of January to hunt down drug gangs. The soldiers swept police stations and took officers' guns for inspection amid allegations by federal investigators that a corrupt network of officers supports smugglers who traffic drugs into the U.S. The weapons are still being checked.
About 100 police demonstrated outside Tijuana town hall on Monday demanding the return of their guns. "The arms are our tools for work," said officer Juan Manuel Nieves. "Do they want more police to be killed?"

More than 300 people were slain in Tijuana last year including 13 police officers.

A little trip down memory lane.....

2007-01-18T18:19:00.000-08:00

Today started out late in med-school terms - we didn't have lecture until 9am, so I had time to run to my favorite Midtown breakfast spot, Einstein's Bagels. I noticed something I'm sure they've had forever, but I'd never seen there before - the Martinelli's apple juice that comes in the little round bottle shaped like an apple! I remember this being SUCH a favorite thing when I was little.... I also remember them being a lot bigger than they seem now, but I digress.....

I remember we used to go to this not-quite-mom-and-pop-but-not-exactly-a-chain grocery store in Sacramento called Corti Brothers (sort of a precursor to the trendy places like Whole Foods we have today I think), and for whatever reason I associate that store with the Martinelli's apple juice apple bottles. It's not there anymore - I think it's a chain drugstore or something equally lacking in character, but I can't really even remember when it closed. I also remember they had excellent bread stick samples, that we could get while we waited at the deli. I know this post will be of absolutely no interest to anyone but me, but it was a neat little side-trip to memory lane this morning, finding something I didn't even know I missed.

Best Chief Complaint Ever!

2007-01-12T13:43:00.000-08:00

On my last ER shift (better known as the "projectile pus day"), I had my favorite chief complaint EVER. It was: "abdominal pain s/p (status post = after) eating a large amount of butter beans and pig tails."

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For those of you not from the South, butter beans are lima beans. And down here, apparently they are occasionally consumed in such large quantities that they cause abdominal pain (read: gas) severe enough to drive patients to the ER. In this ER, we round at every shift change, and so the offgoing resident was presenting this lady, in all her housecoat-and-hair-curlers glory, and when he said "butter beans and pigtails," we were all kind of looking at each other with puzzled expressions. Only a few of the group were from the South, and so when they realized that we all thought "pig tails" were some kind of breakfast pastry or the like, they said, "NO, they're actually the tails of the pig. She was eating actual pig tails!!" Then there was a collective, "Ohhhhh...." Apparently this is a combination not unknown to the Grady ER, so all when we had given her some fluids and proved that she could tolerate PO liquids (liquids by mouth), we let her go. She was the cutest thing - she had her walker with her, and she called it "Old Bessie."

Never Again

2007-01-11T09:35:00.000-08:00

I think the title of this post was said by somebody famous (I'm going to get irate emails from various people for not knowing who said this, I know!) about what the Nazis did to the Jews after WWII....I am using it in reference to an event that happened yesterday in the ER.

******

Background: When you go to I&D (incision & drainage) an abscess, it is important to remember that the contents are under pressure (that's why they're so painful!), and that's why you're supposed to be very careful when doing this....When you stick in the needle that shoots in the numbing medicine, you leave a hole that pus sometimes uses to escape. So that is Hazard #1. Hazard #2 is the fact that an abscess is basically a lump of necrotic tissue and pus, and it smells like nothing else. It's comparable to GI bleed smell, for those of you with medical backgrounds...It is truly awful, and everyone in the vicinity will know you are doing an I&D as soon as you make the incision. Hazard #3 is simply that, should you NOT have released some of the pressure with the needle sticks while numbing the patient up, be ready for Vesuvius when you make the incision across the dome of the abscess. So because of the aforementioned hazards, one should probably always put a gown, a hat, and most definitely a face mask with a splashguard on it on when doing an I&D. But we in the medical field are fairly lazy, and after doing a few of these with no Vesuvius-like eruptions, I was getting lazy as well about gowning up. Thank God I DID have a face mask on though....

******

So to move on to the events of yesterday...I was I&Ding a large abscess on a patient's jaw, and as I take out my syringe with the numbing medicine in it, I see a stream of pus, flying straight toward my face as if in slow motion. Yes, pus can move in slo-mo. That is why I am SO thankful I was wearing a mask and splash shield!!!!! I would have loved to see my expression, though as I couldn't, I have to imagine it looked something like JD and Turk, below:

For those of you who know how OCD I am, you can only imagine how disgusted I was. I just turned to the nurses and said, "Exactly how much pus am I wearing right now?" because I couldn't see below my face shield and I really didn't want to look. I had it ALL over my shirt....And of course I still had to pack the wound, so I couldn't just run & change. And in true Grady fashion, no one would go get me clean scrubs. (In a community hospital, the nurses would've actually sympathized with me and would've had scrubs waiting before I had even finished the procedure - ahhhh sometimes I miss community hospitals!) Of course I got misdirected to where I could get scrubs, so for the next 20 minutes I was wandering around the hospital, smelling like an abscess, trying to find where I could get clean scrubs.

******

So here is what I will be wearing the next time I suit up to I&D an abscess:

And as to doing an I&D again in just a mask and gloves, I say, Never again!

Okay, Okay, so I spoke too soon!

2007-01-06T09:30:00.000-08:00

I've done 3 shifts in the ER now, and while I'm exhausted, I'm having a good time (still would never do ER though!). Except for a few select ER nurses with the perpetual panties-in-a-bunch, most of them are really great, although slow....It's not unusual for your lab orders to sit on the chart, for no particular reason, for 3 hours or so....I don't know why - they have more nurses here than I've seen anywhere else...It's just that most of them don't seem to do a heck of a lot. I've taken to starting all my own IVs and drawing my labs, which is a great skill to have at Grady. I also made the happy discovery that even if your patient is 10th on the radiology list, if you just wheel them over and dump them in the radiology prep area, they tend to take them, without seeming to realize that they're out of order....It's great!

******

So far, I've had a new diagnosis of a brain tumor, I've gotten to see a patient with a recurrent pituitary adenoma (with all the classical symptoms/signs except she didn't have bitemporal hemianopsia, which I was kind of disappointed about), and I've gotten to see a bunch of cool things all related to crack use. Who would've thought crack could be so fun? And educational! What has suprised me is how sick 99% of the patients are here - and even on the "slow" side. (The ER is divided into two zones - the Blue Zone, which is the medical, i.e. "slow" side, and the Red Zone, which is the trauma/surgery side and tends to have much sicker patients). I've only had 1 social visit, which was a homeless guy who just wanted to get out of the rain for a bit. So we got him some dry clothes and a sandwich, and he hung out in the asthma treatment room for the night. I almost like it more than a community hospital - there you see a lot more psych-induced problems...I thought there'd be more of that in a county hospital, but apparently not.
******
On another note, they gave us yet ANOTHER assignment - a tedious bore of a group project of which I will spare you the details. I was sorely tempted to raise my hand and ask when our TIPS reports were going to be due (If you haven't heard of TIPS reports, you need to watch "Office Space.").

The Most Ridiculous ER Rotation....Ever!!!

2007-01-02T09:38:00.000-08:00

I never thought anything could take away my joy of being in the ghetto of all ghettos, but something has. I had orientation for my ER rotation this am, and it was ridiculous. We have to take 3 - count em - 3 tests, just for EMORY! That doesn't count the other one I have to take for my school, all in the same week, and coincidentally, the same week I just signed up to take my Boards!!!! Aaaauuugghh! And one of the tests is an OSCE!! (For the non med students, an OSCE is an "Objective Structured Clinical Exam" which is where you have the fake patient and someone is in another room marking you off for things you forget to ask/do. They're the single most tedious/stressful thing in med school, and what's more, they're basically just practice to ensure we don't fail the clinical skills part of our boards, which ALL of the students rotating in ER this month have already taken!!!) So we're being graded on something that is a practice test for a test we've already taken....Go figure...Then there is literally no end to the paperwork they want us to fill out for each shift...In addition to all the paperwork we have to do to take care of patients!!

***

I am about to have an aneurysm. Seriously.

Apologies...

2006-12-23T14:27:00.000-08:00

Due to the losers who have such time on their hands to be able to spam my blog, I had to change the comments so that only registered people can comment. Since pretty much only my mom seems to comment, I don't think that'll affect too many people, but I felt compelled to let yall know! Also, apparently they can change my pictures on the blog to porn, and I don't know if eBlogger has fixed whatever lets them do that, so if you ever notice any inappropriate material on here, you can safely assume that that was not my doing, and please let me know ASAP so I can fix it....thanks!!!

Residency Interviews

2006-12-16T20:58:00.000-08:00

So I've been on a few residency interviews in the past couple weeks, and let me just say....residency interviews RULE!!! Med school interviews are terrible - at best, the questions you get are variations on the general theme of "why in the world should we let you come here?" On residency interviews (4 now), I have only been asked one relatively serious question, and none at all pertaining to medical knowledge. The gist of residency interviews is, "What can we say/do to make you sign a contract here?" So here is what makes residency interviews so great: First, they pay for you to stay at nice hotels. And not just for the interview itself. If you want to come back for a "second look" (which is where you schedule a second trip out to look at a program after they've already interviewed you) they will pay for that stay too.

So when you get to the hotel, some nice residents from the program meet you in the lobby and take you out to a fancy restaurant and tell you all about why you should come to that program. You kind of have to take their information with approximately the same grain that you would a drug rep dinner, but it's still great!

The next day you go on your interviews, and a tour of the hospital, and then some other residents take you out to a nice lunch too! It's fun getting to meet all these new people, and see the different programs, but I have to say, after only 4 interviews, all the hospitals and residents are starting to run together, and if I hear "So do you have any more questions?" one more time I'm going to have a stroke. Some people I know are going on like 15 interviews, and I don't know how they're going to survive. Seriously.

My First Chest Tube!

2006-12-09T11:12:00.000-08:00

Yesterday I got to put in my first chest tube!!!! This is a really cool procedure (and much coveted by med students the world over) - partly because it gives you the ability to really help someone in just a few seconds, and partly because they're pretty dangerous if you miss. If you're a little overzealous you can stick it in the liver, through the lung and into the mediastinum (where the heart and the aorta are), and even into the lung on the other side, all of which don't help the situation. You put in a chest tube when a person either has blood or air in their chest. In either case, the water or air is taking up room that the lung needs to expand, and the tube helps suck both of them out. If the patient has air in their lung (a pneumothorax), you'll get a rush of air when you stick the tube into the pleural cavity (where the lung sits, which usually has a negative pressure - if air rushes out, you know that there was a problem there). If they have blood in their chest, you'll get a gush of blood into the tube. In my patient's case, he may not have had any blood in his chest at all, as we didn't get any blood (or air, for that matter) back after inserting the tube. We think radiology may have overcalled it.

But at any rate, now I can say I know how to put in a chest tube!!!!

It's kind of a brutal procedure, and it's always nice when the patient is unconscious (or sedated well) when you're putting a tube in. You make an incision in the mid-axillary line (kind of under the armpit), after numbing the skin in that area. You can't really numb the skin and the muscle between the ribs completely, but you just do the best job you can. Then you stick in forceps, and open them and use them to make a hole in the muscle & cartilage between the ribs. It's very important to go right on the top of the rib, as a triad of nerves, arteries and veins runs right under every rib, and if you lacerate those, you give the patient a hemothorax, instead of fixing one. Then you grasp the tube with a bigger pair of forceps and stick those through the ribcage and into the pleural cavity. This is where you listen/feel for a rush of air, or get a lot of blood coming out of the tube. Then you stick the tube in until you feel resistance (the lung), and then sew it in place, and tape it VERY carefully to the patient's chest. Below is a Google image I found of dummies they have that teach you how to put chest tubes in.

We don't have any of those at Grady.

Here is a picture I found of what the tubes look like after you put them in. I didn't put in a pigtail chest tube, but that's more or less what the tube I put in looked like.

It was an exciting day!!!

On Call

2006-12-02T17:52:00.000-08:00

On Tuesday night I got to take call, and I think it was my most fun day/night so far in med school. I got to see a bunch of operations I'd never seen before, and we had some good trauma. The general surgery residents cover call for the trauma service, so I got to see some normal general surgeries, that I should've seen last year on general surgery, like a below-the-knee amputation (BKA), which was SOOOOO cool....The residents here are so nice, and not at all like this guy:

They love to teach and let you help, so a great time was had by all. They were halfway through an APR (abdominal-perineal resection - when the patient has a necrotizing infection in their nether regions, and the flesh down there has basically rotted away, you have to go in and clean it all out, and try to find enough skin to stretch over what's left - a very complicated operation) when I got there, so I watched the end of that, and then after that we did the BKA, which I got to scrub in for, and help file down the end of the bones with what was basically a giant metal nail file. So much fun!

*****

The most serious case of the night was a patient who had a motorcycle accident, and basically not a scratch on him. He basically only had a bit of abdominal/LUQ (left upper quadrant) pain, and was joking with us....When we were cutting off all his clothes and putting a Foley (tube that goes in your urethra to your bladder - not very fun) in, he was like "This isn't at all like the Discovery Channel!!" He was a really nice guy. Unfortunately he turned out to have a Grade 4 (Grade 5 is the worst) splenic laceration. On CT, his spleen looked like hamburger, basically. Here is where your spleen is:

And this is what it looks like when it's on the scrub nurse's table:

The spleen above has a pretty minor laceration. So your spleen is what holds a lot of the cells that help pick the bad stuff (like viruses and bacteria and dead cells) out of your blood. So it has a VERY good blood supply, and holds a lot at any given time. It's also pretty important to have - people that don't have one are very susceptible to overwhelming infections later in life. And what's funny is that most people don't know whether they have one or not. When you ask a patient who has a scar over their spleen area if they had a splenectomy, many of them don't know what you're talking about. Kind of strange that so many people let surgeons dig around in their bellies without much concern over what they have left in there....So the spleen has a lot of blood running into/through it, and the blood carries hemiglobin, which carries oxygen, without which your cells can't live. This is hemiglobin:

In this case, our patient's hemiglobin level before we took him to the OR was 6 (normal for a guy his age/size would be 14-15 or so, and from 5-below, the patient could die very soon - usually from a cardiac arrhythmia, because the heart is starved of oxygen). Intraoperatively, it went down to 4. He was not doing very well. The reason we didn't give him any more blood was that he was a Jehovah's Witness, and they won't accept any blood products. Before we went to the OR we told him how dangerous this was and that there was a good chance he could die, and he was just like, "Can't you use those blood expanders?" No, real life is not like TV. So after we came out of the OR we talked to the family, but they said no. That was what he wanted. So there was basically nothing we could do. The next morning, his hemiglobin was 3. I imagine his blood was probably almost clear, having so few red blood cells left....His vasculature was basically full of normal saline instead of blood. He died that night.

******

Take home lesson: Jehovah's Witnesses probably shouldn't ride Harleys.

Word of the Day:

2006-11-22T06:22:00.000-08:00

Today's word is crackacardia (pron. "crak-uh-car-dee-yah").

Definition: condition often seen in a patient protesting, "I ain't no crack ho...I don't do no crack........I'm doing a lot betta....just one little rock today."

*****

I'm totally kidding. No such word. This is just something one of the Grady trauma fellows coined that I thought was great. In reality, cocaine (in our area, most often taken in the form of crack, which is just cocaine cut with baking powder) stimulates your sympathetic nervous system, which makes your heart beat fast, which is called tachycardia. For those of you who always wanted to know all about crack, here is some info I found on (where else?) Google:

"Crack" is the street name given to cocaine that has been processed from cocaine hydrochloride to a ready-to-use free base for smoking. Rather than requiring the more volatile method of processing cocaine using ether, crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water and heated to remove the hydrochloride, thus producing a form of cocaine that can be smoked. The term "crack" refers to the crackling sound heard when the mixture is heated, presumably from the sodium bicarbonate.
On the illicit market, crack, or "rock," is sold in small, inexpensive dosage units. Smoking this form of the drug delivers large quantities of cocaine to the lungs, producing effects comparable to intravenous injection. These effects are felt almost immediately after smoking, are very intense, and do not last long.

Trauma @ Emory

2006-11-21T17:04:00.000-08:00

I just started Trauma service at Emory (Atlanta) on Monday. I'm actually not at Emory Hospital, which I assume is nice and middle class. I'm at Grady Hospital in the heart of the ghetto, and it could not be any better!!! It is soooooooo ghetto. Patients/homeless people (in this part of town, the terms are more or less interchangeable) hit you up in the hallways for money - it's great! I learned that the McDonalds next to the hospital is NOT the place to go for coffee after pre-rounding at 6:30am, as that is when all the homelss guys wake up and congregate, hoping for you to give them 50 cents for "food." Hmmmm....I'll have to find somewhere else to get coffee for the next 2 months...

*****

I knew that this would be a great place to come for trauma, since it's so giant and inner-city, and it has been everything I hoped it would be. On our first morning, traumas started rolling in at 9am (for some reason, everyone decided that Monday morning was a good time to get shot) and didn't stop. I didn't leave till 7:30pm, and they were still rolling in. I got to see a head GSW (GSW=gunshot wound, for future reference) that had brain matter all over, and got to review a bunch of neuro stuff. I got to sew up the bullet hole (just to make it look better for his family, I think, as there was no medical reason to do it....See the "P.S." below) Then I got to see a chest GSW that actually didn't look too bad, till we saw the x-ray with the bullet right in the vicinity of the spine, and realized that the patient couldn't move or feel his legs. At first I seriously thought he wasn't cooperating with me, but then I realized he wasn't faking it. Very sad....Then we got to the OR and I now can say I've seen a heart with the bottom chunk of it sheared off sort of like a heart-divot.

*****

P.S. My resident said if anyone asks I can now say I've done brain surgery.

Great article..for guys and gals...

2006-10-30T16:34:00.000-08:00

I hope Ginger (not to mention the author) won't mind my lifting their article for my blog. Despite the title, I thought it was a great read for both guys and girls. Here it is:

Stop Test-Driving Your Girlfriend

by Michael Lawrence

"How do I know if she's the one?" I can't think of a question I encounter more often among single Christian men. The point of the question is clear enough. But a rich irony dwells beneath the question. In a culture that allows us to choose the person we're going to marry, no one wants to make the wrong choice. Especially if, as Christians, we understand that the choice we make is a choice for life. The question is not merely ironic. If what you're after is a marriage that will glorify God and produce real joy for you and your bride, it's also the wrong question. That's because the unstated goal of the question is "How do I know if she's the one ... for me."

*****

The question frames the entire decision-making process in fundamentally self-oriented - if not downright selfish - terms. And it puts the woman on an extended trial to determine whether or not she meets your needs, fits with your personality, and satisfies your desires. It places you at the center of the process, in the role of a window-shopper, or consumer at a buffet. In this scenario you remain unexamined, unquestioned, and unassailable - sovereign in your tastes and preferences and judgments.

*****

The problem of course is that as a single Christian man, not only are you going to marry a sinner, but you are a sinner as well. From a consumeristic perspective, no woman on this planet is ever going to perfectly meet your specifications. What's more, your unexamined requirements for a spouse are inevitably twisted by your own sinful nature.

*****

The Bible reminds us that though our marriages are to be pictures of the gospel relationship between Christ and the church, none of us get to marry Jesus. Instead, like Hosea, we all marry Gomer; that is to say, we all marry another sinner, whom God intends to use to refine and grow our faith in Jesus. So what's a guy to do? Ask the right questions.

*****

To begin with, start with a different question. Instead of asking if she's the one, you should ask yourself, "Am I the sort of man a godly woman would want to marry?" If you're not, then you'd be better off spending less time evaluating the women around you, and more time developing the character of a disciple. Start by considering the characteristics of an elder that Paul lays out in 1 Timothy 3 and Titus 1, and work toward those. Then you should ask another question: "What sort of qualities should I be looking for in a wife so that my marriage will be a picture of the relationship between Christ and the church?" If you're not sure what those characteristics are, then spend some time reading Proverbs 31, Titus 2:3-5, 1 Peter 3:1-7 and Ephesians 5:22-33.

*****

Once you've asked the right questions, and once you've found someone you suspect fits the biblical description of a godly wife, you now need to decide whether to get married. And men, though this is a big decision, it's not a decision that should take too long. How long is too long for a dating relationship? The Bible doesn't provide a timetable (after all, most marriages were arranged during Biblical times). But it does provide principles that point us in the direction of making a decision to marry or break up in the shortest appropriate time. Think like a servant, not a consumerIn 1 Thessalonians 4:6, Paul warns the Thessalonian Christians against "taking advantage" of their brothers or sisters. The larger context in the first eight verses makes clear that what Paul primarily has in view is sexual immorality, in which you take from one another a physical intimacy not rightfully yours. But the text also suggests that there are other ways you can take advantage of one another in a dating relationship. And one of the primary ways men do this is to elicit and enjoy all the benefits of unending companionship and emotional intimacy with their girlfriends without ever committing to the covenant relationship of marriage.

*****

Too often in dating relationships we think and act like consumers rather than servants. And not very good consumers at that. After all, no one would ever go down to his local car dealership, take a car out for an extended test drive, park it in his garage, drive it back and forth to work for several weeks, maybe take it on vacation, having put lots of miles on it, and then take it back to the dealer and say, "I'm just not ready to buy a new car."But so often, that's exactly the way men treat the women they're dating. Endlessly "test driving" the relationship, without any real regard for the spiritual and emotional wear and tear they're putting her through, all the while keeping their eyes out for a better model. The Scriptures are clear. We are not to take advantage of one another in this way. Instead, as Paul says in Romans 13:10, "Love does no harm to its neighbor. Therefore love is the fulfillment of the law."Remember that love is never easy.

*****

One of the myths out there is that if you just spend enough time searching, if you can just gather enough information, you'll find a woman with whom marriage will be "easy." The fact is, such a woman doesn't exist, and if she did, she likely wouldn't marry you. And that means that you don't need as much information as you think you do. No matter how long you've dated, everyone marries a stranger. That's because fundamentally dating is an artificial arrangement in which you're trying to be on your best behavior. Marriage on the other hand is real life. And it's only in the context of day-in, day-out reality, with the vulnerability and permanence that marriage provides, that we learn what another person is really like. Some of the things we learn about each other aren't easy. But who ever said that love and marriage were supposed to be easy?

*****

Men, the point of marriage is that we learn to love our wives as Christ loved the church. Yes, as Revelation 21 and Ephesians 5 tell us, one day, Christ's bride will be perfectly beautiful, without spot or blemish, altogether lovely and loveable. But the church is not there yet. First, Christ had to commit himself to us, even to death on a cross. This is the model we're called to follow. It's not an easy model, but it is worth it. So your goal should not be to date her long enough until you're confident marriage won't be hard, but to date her just long enough to discern if you're willing to love her sacrificially, and if she's willing to respond to that kind of love. Remember that to commit does not mean to settle.

*****

Does this mean you should just "settle" for the first Christian woman who comes along? No, not at all. You should be making this decision in light of the qualities held out in Scripture for a godly wife, and you should marry the godliest, most fruitful, most spiritually beautiful woman you can convince to have you. But you also need to be aware that you live in a culture that says the ultimate good in life is to always keep your options open, and that any commitment is inevitably "settling" for less than you could have tomorrow. You must reject that kind of thinking for the worldly garbage that it is. Did Jesus Christ settle for the church? No, he loved the church, and gave his life as a ransom for her (Mark 10:45). Marriage is fundamentally a means to glorify and serve God, not by finding someone who will meet our needs and desires, but by giving ourselves to another for their good. So if you find yourself hesitating about committing to a godly, biblically-qualified woman, then ask yourself, "Are my reasons biblical, or am I just afraid that if I commit, someone better will walk around the corner after it's too late?" Consumers are always on the lookout for something better. Christ calls us to trust Him that in finding a wife, we have found "what is good and receive favor from the Lord" (Prov. 18:22).Marry true beauty when you find it.

*****

Finally, the Scriptures call us to develop an attraction to true beauty. 1 Peter 3:3-6 describes the beautiful wife as a woman who has a gentle and quiet spirit, born out of her faith and hope in God, and displayed in her trusting submission to her husband. Men, is the presence of this kind of beauty the driving force for your sense of attraction to your girlfriend? Or have you made romantic attraction and "chemistry" the deciding issue? Now don't get me wrong. You should be physically attracted to the woman you marry. This is one of the ways marriage serves as a protection against sexual immorality (1 Cor. 7:3-5). But we get in trouble, both in dating and in marriage, when we make physical beauty and "chemistry" the threshold issue in the decision to commit (or remain committed) to marriage. Physical beauty in a fallen world is fading and transient. What's more, the world narrowly defines beauty as the body of a teenager, and scorns the beauty of motherhood and maturity. But in which "body" is your wife going to spend most of her years with you? Personalities also change and mature, and what seems like "chemistry" when you're 22 might feel like superficial immaturity 10 years later. Even over the course of a long courtship and engagement in the prime of your youth, physical attraction and chemistry are sure to go through ups and downs. We must resist the temptation to value the wrong kind of beauty.

*****

No one lives in a perpetual state of "being in love." But in marriage, our love is called to "always protect, always trust, always hope, always persevere" (1 Cor. 13:7). If mere worldly, physical beauty is the main thing attracting our love, then our love will prove as ephemeral as that beauty. But if we have developed an attraction to true beauty, then we have nothing to fear. Marry a vibrant growing Christian woman, and you have Christ's promise that he is committed to making her more and more beautiful, spiritually beautiful, with every passing day (Rom. 8:28; Phil. 1:6).

*****

More questions to ask: How then do you decide, in a reasonable amount of time, whether or not to marry the woman you're dating? Let me conclude with some more questions you should be asking:

Generally speaking, will you be able to serve God better together than apart?
Do you desire to fulfill the biblical role of a husband outlined in Ephesians 5:22-33 with this specific woman?
Do you want to love her sacrificially?
Does this relationship spur you on in your Christian discipleship, or does it dull and distract your interest in the Lord and his people?
Are you more or less eager to study God's word, and pray, and give yourself in service as a result of time spent together?
Do you think she will make a good discipler of your children?
What do other mature Christian friends and family members say about your relationship?
Do they see a relationship that is spiritually solid and God-glorifying?

If you can't answer the questions at all, then you may need to spend some more time getting to know each other. But if you can answer them (and others like them) either positively or negatively, then it's time to stop test-driving the relationship and either commit to marriage or let someone else have the opportunity.

Halloween in Philly

2006-10-30T15:26:00.000-08:00

Well it wasn't quite Halloween, but Hannah and Heidi (my two cousins in Philadelphia) and their roommates were having a costume party this weekend in Philadelphia, and Shelly (their sister) was flying in for it, so that's where I was this weekend. It was so much fun. Everyone that came really got into dressing up, and there were some great costumes (but I think ours were the prettiest). Here we are below. Hannah (far left) was Esmerelda, and her friend Farley dressed up as Quasimodo (Hunchback of Notre Dame) - they both looked great. Between Hannah and I is Shelly, who was a Moulin Rouge dancer. On the far right is Heidi, who was a colonial lady, and found the prettiest dress at this costume shop in Philly.

*****

The party was a lot of fun - their roommate Anne, who teaches ESL at Penn, invited a lot of her students, who all came, even though they had no idea what Halloween was about. Thankfully, Hannah once had to write a paper on its origins, so she explained to them what it was all about. Apparently the whole Jack-O-Lantern thing comes from a Celtic tradition where they'd carve gourds and put them in front of their houses to ward away evil spirits. Anne had two students, one from Japan and one from South Korea, who came with digital cameras in hand, and took pictures with literally everyone in costume at the party. Now I bet we're all on Japanese/South Korean blogs and/or MySpace sites....

The next day we went out to this cool little diner, and then went to the Edgar Allan Poe House. I'm glad I went, so I can add it to the list of things I've done and impress maybe, oh, one person at a party 30 years from now, but other than that it was a bit of a disappointment. The Poes only lived in Philadelphia for 6 years, and during that time, they moved 5 times. The only reason this house is known as "THE" E.A.P. house is that it's the only structure they lived in that's still standing. However, it's been extensively remodeled, and is completely empty. Apparently they had no records or receipts to tell them what was in the house, and decided not to guess. So you walk through a completely empty house. One room is furnished according to what one of his characters said he preferred in a pamphlet, but as many of his narrators are 180-degrees opposed to Poe's true sentiments, it's hard to tell whether he really liked this sort of decoration, or whether he thought it was the ultimate in tacky. Kind of funny....It would be like me writing a short story with a character preferring, say, Austin-Powers-esque decorations, and then 100 years from now, a tour guide leading guests through my old house, pointing out that I really loved plastic furniture and formica.

The one redeeming quality was that in the one furnished room, they had a CD player with recordings of Christopher Walken reading "The Raven," which were quite entertaining and more than made up for any lack of decor.

Pseudoseizures

2006-10-25T17:21:00.000-07:00

So in this George Orwell-1984-world, where we can't call a spade a spade, we have such a thing as pseudoseizures. Pseudoseizures are when the patient is faking seizures, for whatever reason, but of course there is no ICD-9 code for "fake seizures," and we therefore can't bill for it, so we call it "pseudoseizures" which DOES have an ICD-9 code, and makes everybody happy. In the medicine world, for whatever reason, when someone is faking something (be it consciously or subconsciously) it is a rule never to confront them about it, because the story goes that your confronting them just might push them over whatever edge they are teetering on at the moment.

I am not sure I buy that.

******

Last night I admitted a patient that was doing perhaps the worst impersonation of seizures ever. Here are some rules about seizures:

1. If it's a real seizure, the patient loses control of their bladder and/or bowels. Since people tend not to like to wet/soil themselves, the fact that a patient (and I'm sorry to say it, but it's almost invariably a female) stays continent throughout a "seizure" is one of your first clues that it's fake. My patient stayed continent.

***

2. A seizure is an area in the brain where neurons are firing like crazy, and one of the signs is that the patient's eyes deviate together toward the focus (area) of the seizure....My patient kept her eyes open, blinked them like a normal conscious person, and looked around the room.

***

3. One of the medications we use to stop a seizure, Valium, take at LEAST a few minutes to work. Upon being given 5ml normal saline (i.e. salt water), my patient promptly "woke up."

***

4. After a patient has a seizure, they are post-ictal (just means "post-seizure") for usually 30-60 minutes, if not more. Basically they are really groggy, and can't really talk or answer questions. My patient had no post-ictal period at all. She would stop rocking (also a good sign it's not a real seizure) and within 15-20 seconds be fully alert.

***

Unfortunately, most of the people who come in with things like this have some reason to want to stay in the hospital, as I suspect this patient has. It would be much simpler for all of us (not to mention it would get me to the gym and/or Panera that much faster) if they found some other way of letting their stress out....

So there is your 5-minute tutorial about seizures vs. pseudoseizures.

Test on Friday. Just kidding!

Interviews so far:

2006-10-18T17:06:00.000-07:00

I've heard about a couple more interviews in the past few days, so I thought I'd post a tentative schedule. Right now I'm only getting interviews for categorical medicine (3 year internal medicine programs) and medicine prelim years (the year of medicine you have to do before starting the 3 years of dermatology). I won't hear about derm interviews for at least another month (I think...) [Half the reason of posting this is in case something happens to my Palm in the next month or so and I lose my schedule!]

11/10 - Case Western in Cleveland, OH (prelim medicine) - this I'm particularly excited about because their derm program is the one that takes D.O.s into their derm program!

12/1 - Emory in Atlanta (categorical medicine)

12/4 - UT in Chattanooga (categorical medicine)

12/15 - Carolinas Medical Center in Charlotte, NC (categorical medicine)

That's it so far....

York RULES!!!!

2006-10-18T16:49:00.000-07:00

I just have to express my amazement at how awesome this rotation is. For one, I have finished - seriously - at noon, 11:30, and 10:30 for the last 3 days. That just doesn't happen!!! On my first day with my attending, he handed me the list of patients and took off for the office. This place is so great! He doesn't teach much, but he lets me run the service, so I'm assuming I must've not looked like too much of a moron on my first couple of days, and it's so great. In the past 3 days, I have had time to go to work, go to the gym, take a nap, go to Panera, and read a fun book, ALL IN THE SAME DAY! The cafeteria food is great and free, and as long as you don't mumble your order, Gladys the lunch lady won't give you too much hassle (as my roommate Becca found out the hard way yesterday). It really just doesn't get any better than this.....

York, PA

2006-10-16T14:42:00.001-07:00

Yesterday I drove from Durham, to York, PA, perhaps better known as "The Factory Tour Capital of the World." Hmmmm.......Anyhoo, the house is a teeny little postwar box-like thing that's actually pretty nice inside, after a bit of elbow grease. It's right next to the hospital, which is great. And guess what - we have memberships to this really nice health club right down the road. I already went today - I'm so proud of myself!

And who says God doesn't have a sense of humor? Below is the view from our front door - you got it, a Stouffers Cookie Factory! The little thing on the bottom right is the door to their factory store, which is right in front of our house! When I got there last night, it was dark and all I saw was the across the street was some kind of industrial complex. This morning, by 7, the air was already filled with this wonderful baking aroma....Yep, the same time I resolve to start working out and being healthy, God puts me right next to a cookie factory!

This is just a really pretty tree in our neighborhood. I love these - you never get these in California or Texas (or Arizona, for that matter!). This is one of the many things of the east coast/north that I never get tired of seeing......

I haven't met my attending yet, but I'm already inclined to think he's a great guy. When our student coordinator paged him about 12:30 to find out where to send me, he told her to tell me to go home & enjoy a day off - how cool is that! So I went to the gym, Panera (now), and then I'm going to meet the other students at a pub for MNF. What a great start - I am loving York already!

What I'll miss about NC:

2006-10-16T14:42:00.000-07:00

As fun as York is turning out to be, I'm still really missing NC, and I can't wait to go to my interview in Charlotte in December. Here are some of the things that I am thinking I'll really miss:

The vegetarian sushi in the Duke cafeteria.

Miryam at Panera that spoke to me only in Spanish, and always had my tea ready for me as soon as I came in the door, which was so cool.

Cheesy dining establishments with names such as "Biscuitville" and "Bojangles."

All the maple trees that were turning such a beautiful pink, right when I had to leave.

Drivers so polite that they actually really mess up traffic flow, while giving you the (incorrect) right-of-way.

Franklin Street in Chapel Hill, with the 20 different houses I want to own someday (along with the house in Charleston, of course!).

Being abruptly woken up in the middle of the night to the honking of Canadian geese right outside my window (we had a flock that roamed the neighborhood and seemed to be very awake at odd hours - are geese nocturnal???)

And many other little things that will come back to me at random times....

Mommicked....

2006-10-13T18:22:00.000-07:00

I was feeling kind of sad that I hadn't gotten to visit the Outer Banks (an island chain obviously on the eastern part of North Carolina) on my trip here, and this week, God sent me something soooo cool in place of it! (Maybe this is something only I could think is cool, but anyhoo....) So I had read in my North Carolina travel book about how some people from the Outer Banks speak a dialect and have an accent that is the closest thing to Old English. Fewer and fewer people are speaking it, but it says that if you go hang out on the docks, etc., you can still hear it.

Well, this week, while chatting with a patient and his daughter, I found out that they were from the Outer Banks, and I asked them if they knew where the people were that spoke Old English. They were like, "That's us!!" And when I remarked that neither of them seemed to have much of an accent, the daughter told me that as she worked in a bank, she'd basically had to lose the speech (it's really more a way of speaking, than an accent per se, I found out). She said that one of the things they say is "onliest" where we'd use "only." Even though she said she didn't use many of the words, I heard her say "onliest" several times throughout their visit when she wasn't thinking about it! Another thing she told me about was "mommick." It is usually used as a descriptor, as in "I'm all mommicked out." It sort of means to be overwhelmed/tuckered out. How neat is that!!!

******

My patients were from one of the northern islands, near the Cape Lookout light house (otherwise known as the one painted with black-and-white diamonds). All the North Carolina lighthouses are painted in black and white, but with different patterns. I think they're beautiful, and they're the main reason I wanted to go see the Outer Banks, so I posted some pictures here:

Below is the Cape Lookout lighthouse:

Another view of the Cape Lookout lighthouse:

Below is the Cape Hatteras light house, presumably before it was moved 1800 yards inland to keep it from being consumed by the Atlantic.

So I have to say that getting to meet a sort of piece of living history was a pretty good way to compensate for not getting to see the Outer Banks on this go-round.

First interview...I think....Maybe...!

2006-10-09T17:12:00.000-07:00

I finally finished my applications!!! I submitted the derm ones Saturday night, and the IM/Prelim ones Sunday night, and I already got a response from the Medical College of Georgia (for a prelim spot), that I needed to get all of my forms in ASAP, as I "look like a very strong candidate" and interview spots are filling fast." So I am guessing that means that when they get around to downloading all my documents from the ERAS post office, they'll give me an interview!?!?

******

This is so exciting/stressful! You can literally watch on ERAS (the national website through which we apply to residencies) to see which programs have downloaded your documents (letters of recommendation, USMLE scores, etc.), and then you know they have everything they need to decide whether to give you an interview or not! Right now it's mostly just IM/Prelim programs that are downloading info...Out of the 63 derm programs I've applied to, only a couple have started to download things.

******

I should explain: derm is a 3-year residency program, that you start after you do either a Preliminary Year in Internal Medicine (aka internship, the first year of residency), or a Transitional Year (which is just like a Prelim year except it isn't strictly dedicated to IM - you'd still do a month of Peds and a month of OB, and this is widely regarded as the easier way to go - less call, less ICU months....). So if you're applying for derm, you apply right now for a Prelim spot for next year, and a derm spot the year after that. And since I'm sort of an iffy derm candidate at best, I'm applying to IM programs (3 years) as a backup. You can also just go to your prelim program if you don't match in derm and hope that a second-year IM spot opens up in the meantime, which is fairly common. So now you all know just about as much as I do about the whole derm match process!

The Hand Song

2006-10-08T12:59:00.000-07:00

I just downloaded the original Nickel Creek CD (bluegrass) and they had the neatest song on it. Thought I'd post it...I'm going to try to attach the music but I haven't done that yet, so don't hold your breath!

The Hand Song

The boy only wanted to give mother something
And all of her roses had bloomed
Looking at him as he came rushing in with them
Knowing her roses were doomed
All she could see were some thorns buried deep
And the tears that he cried as she tended his wounds
And she knew it was love
It was one she could understand
He was showing his love
And that's how he hurt his hands

He still remembers that night as a child
On his mother's knee
She held him close and she opened her Bible
And quietly started to read
And seeing a picture of Jesus he cried out
"Mama He's got some scars just like me"
And he knew it was love
It was one he could understand
He was showing His love
And that's how He hurt His hands

Now the boy's grown and moved out on his own
When Uncle Sam comes along
A foreign affair but our young men were there
And luck had his number drawn
It wasn't that long till our hero was gone
He gave to a friend what he learned at the cross
But they knew it was love
It was one they could understand
He was showing his love
And that's how he hurt his hands

It was one they could understand
He was showing his love
And that's how he hurt his hands

The verdict is in.....Derm it is!!!

2006-10-05T15:44:00.000-07:00

So I finally decided, sometime last week, I think, to do derm! I feel very relieved to have finally decided on something, and this time I can't change my mind, because I'm literally out of time to - it's great! So right now I'm sitting at Panera, working (sort of...) on my personal statements - lots of fun....In my endless efforts to procrastinate I thought I'd show yall what I'll be working on in the future. If you ever wanted to know what your skin looked like close up, here it is:

So for the next few months I'll be checking my email/voicemail an absurd number of times because that's how they contact you to let you know you have an interview. At best, any given med student only has about a 60% chance of matching in dermatology, mostly because there are so few spots. They've kept the number of dermatology residency spots artificially low, because that increases demand, and therefore pay....So if you ever wondered why it takes 4 months to get into see the dermatologist, that's why! So since I'm a D.O. applying to only M.D. programs my chances are probably less than that 60%, but I'll try to keep positive over the next few months....Most types of programs interview from October through December, but derm, because they're so special, makes everyone wait and they don't interview people until December through February....nice....

So here is one of the things I'll be treating...Below is a something called a squamous cell cancer of the lip. For whatever reason if it's on the lips, it shows up on the lower lip 90% of the time...This one would be very tricky to remove, because it's huge, and if you mess up, the person may be drooling/not able to smile right for the rest of their life. They have a sort of new surgical technique that does a really good job with lesions on the face especially. It's called Mohs micrographic surgery, and when they remove a lesion, they literally graph out where it was, and look at it under a microscope. They can tell immediately if any malignant cells were left, and then they know exactly where they came from. It has a much better cure rate than conventional surgery, and the patients have a better cosmetic result.

The next picture is a basal cell cancer. The difference between the basal cell and the squamous cell cancers is basically the cell type, and the fact that squamous cell cancers are more invasive and metastasize (spread to other organs) more often (even though it's still pretty rare). The way you tell it's a basal cell cancer is that it's kind of pearly-looking, with a rolled border and it usually has teeny blood vessels running through it.

This is how a squamous cell cancer would look if you were looking at it under the microscope....Everybody remember the lovely keratin pearls we all had to memorize for histo? That nice pink ball in the middle/right of the field is called a keratin pearl, and they're found in any kind of squamous cell cancer, be it in the skin, the lung, or wherever....If you see one on a slide it's not a good thing...

Blue Ridge Parkway & Biltmore Gardens

2006-10-03T15:49:00.000-07:00

Here are the rest of the pictures from my Asheville trip. Below are two pictures I took from lookouts on the Blue Ridge Parkway. You can see why they're called the Blue Ridge Mountains - at any hour of the day the distant hills are blue, even though close up you can see they're green with some red maples. Not sure what makes that color, but who cares - it's beautiful!!! If you're ever in that area, you must take some time to drive a bit on the Parkway.

Here is one of the back porches of the Biltmore House that leads to the Conservatory and path to the Bass Pond. I wonder how old that wisteria is....parts of it were as thick as regular tree trunks...

This is a statue in the Italian Gardens (actually built in the French style, which I thought was kind of funny) that I liked.

This is a beautiful pathway down to the conservatory....On the right were water fountains in the stone wall and statues lining the walk.

This is another statue I liked.

Below is the conservatory with its hothouse. There were SO many rooms in it, but I guess it would take that many plants to provide flowers for the house. It was a very neat place to walk around in - very calming, and they had baroque music piped in, which was so fitting! To the right and left of this walkway, there were the most enormous rose gardens I've ever seen.

This is the bass pond. The water was so clear you could see the bass floating in the moss below...Wish I'd had a net....

All along the walk to the pond, and all around it, they have benches placed so you can take a break and appreciate the surroundings. It was so peaceful!

The Biltmore House & Winery

2006-10-01T14:55:00.000-07:00

On Saturday I drove to Asheville to see the Biltmore. If you go after 3pm, your ticket is good for the entire next day, so that's what I did. I drove around Asheville and drove for awhile on the Blue Ridge Parkway until then, and it was amazing. I would recommend having 2 people though - one to drive up and one to drive down, so one person can always have their eyes on the road!

On Saturday afternoon I decided to just see one thing, and since I knew I couldn't fit the house and gardens into 2 hours, I started with the winery. It is so neat - they have a free behind-the-scenes tour that I just happened to be in time for, and it was so interesting. More below...

I made sure to be at the Biltmore house right when it opened...The gates open at 8:30, and since the house is 3 miles from the front gate (yep, it's that big of an estate!) that's when I got there. It was so awesome - I literally had every room to myself when I toured the house, and the same with the gardens and bass pond. It was amazing. If you ever visit the Biltmore, I'd highly suggest doing that. I can't imagine that it'd be the same experience, having to walk through this amazing castle of a house with screaming kids and people with cell phones (as I saw going through later). They have an Inn on the estate, and I'd recommend staying there - it isn't very expensive, and the estate is just so beautiful and relaxing to be in...It's a couple miles between each building (the house, the winery, the deerpark, etc.), and I think it's about the most beautiful drive I've been on (next to the Blue Ridge Parkway, that is!). There is a small river running along much of the drive, and there are trail riders and carriages out & about too. Some other things they have at the Biltmore estate are private fly-fishing lessons (I'm totally doing that next time) and a Land Rover Driving School, where they teach you how to drive your Land Rover sideways on hills without toppling over.

Above is the view of the house as you walk in from the parking lot, and below is a view from the esplanade (raised walkway - but that definition doesn't quite do the Vanderbilt esplanade justice!), and behind me is this enormous, beautiful hill, with a statue of Diana at the top....After 4 hours of walking, I didn't quite feel like walking to the top for a picture from there, so you'll just have to imagine it....George Washington Vanderbilt took his inspiration for the estate from a French Chateau, and you definitely feel like you're in Europe, not America while you're there.

Below is the winery. It used to be the calving barn until they turned it into a winery in the '80s. The chutes where they used to chuck waste from the stalls are now just perfect for aging wine (seriously).

Below is Rosemary, our awesome wine tour guide, pouring us samples of an unfinished wine....I was expecting it to be weird-tasting, but honestly it was better than their lower-quality wine that they had during the sampling! She taught us all about what grapes they grow and use, and taught us all about the process of making red wine, vs. white wine, vs. champagne. Anyone ever wonder how they get that giant cork into the champagne bottle? They microwave it! Apparently cork becomes quite malleable after 45 seconds in the microwave, and then they cram it in and put the wire cap on. Rosemary spoke of the importance of covering the bottle top with a towel when you open champagne...We were all kind of laughing (as in, seriously, has anyone ever poked an eye out with a champagne cork???), but then she told us how her daughter was at a party last year and someone opened a champagne bottle with improper technique, and her daughter caught the cork right between the eyes! (She was OK, but now you'll remember to use the towel, right?!?)

Below are some of the white oak barrels they age the wine in.

I have more pictures of the garden & bass pond, but I knew Blogspot wouldn't let me put them all in one post, and now my computer is running out of battery, so I'm going to finish this tomorrow!

Seagrove, NC

2006-09-23T14:40:00.000-07:00

Today I finally made it to Seagrove, NC. This is a community of potters, some of which are descendants of families of potters that first came to this area in the 1700s and have been making pottery ever since! It's basically about 125 pottery shops, all along Hwy 220/705, and they're all in cute little houses, and you just go from one to the next, like a treasure hunt. I had so much fun! I learned about Seagrove from my North Carolina guidebook, and one of the pictures in it is of Buck Owens throwing a pot, and when I went to his studio, he was sitting out on the front porch welcoming people!

Below is the Ben Owens pottery studio/shop. There is some confusion over the Ben Owen III and the Owens studios...Apparently there was a common ancestor (Owens) and at some point the Owen branch dropped the "s." So they're related, but different studios, and very different styles. I don't know anything about pottery, but after visiting about 15 studios, you start to figure out who's an artist and who's not.

This is what the inside of most of the stores look like. Usually the kiln is right next door.

Face Jugs: I first heard about Face Jugs on Antiques Roadshow...They're something that southern slaves started making in the 1800s. According to Google, no one really knows what the point was. They're just normal pots thrown on the wheel, and then a horrible face is crafted on. They're really something to see, and apparently quite desirable as American folk art pieces...I tried to convince myself to get one a) as a pretty good conversation piece, or b) as a good investment, but they're pretty pricey, and pretty ugly! I tried to include a few pictures of them below, but BlogSpot is being weird and not letting me add any more pictures. So if you really really want to see one, Google "face jugs" and you'll get plenty of examples.

Add this to the list....

2006-09-14T15:17:00.000-07:00

One more thing that only I could've done happened this week. I had to find out for myself that cell phones and washing machines don't make a good combo....I came home from studying (i.e. playing on the internet at Panera), had my phone in my sweatshirt pocket, and decided I should start laundry right then, which included the sweatshirt I'd been wearing...I remembered the phone right about when the spin cycle was about to start. This event was discussed by my fellow students the next morning, and some reasoned that I might have been better off had I let it go all the way through the spin cycle...I will leave this experiment for the reader to conduct for themselves...

At any rate, I am now phone-less. There are unfortunately no T-Mobile stores in North Carolina or South Carolina. There is one in Columbus, GA, and so hopefully my mom is picking up a new one as we speak, and will bring it to Charleston, where we're going this weekend. So in summation, if you've called in the past week or so, and I haven't called you back, it's because my cell phone was drying itself out on the bathroom counter....Incidentally, the wonderful SIM card in it, upon which I so carefully saved all of your numbers, is now non-functional as well, so can everybody please email me with your phone numbers! Thanks!!

******

(P.S. To all my friends who are G.A. addicts, hope you like the video - I liked the song but I put this video in for yall - you're welcome! And the new season starts Thurs. night!)

Crisis

2006-09-04T13:44:00.000-07:00

So if you haven't talked to me in the past couple of weeks, I'm kind of having a crisis. For the last 4 or so years I've been sure I wanted to do ER, but then when I did it, I thought it was pretty boring. When I was a tech, you were constantly running around doing stuff, which was 95% of the reason I liked it. But as a med student, it's totally different. Most of your time is spent waiting around for stuff....waiting for the nurse to get labs/UA, waiting for your patient to go get their x-rays/CT/US, waiting for the official radiology report when you can see for yourself that there's no fracture, etc...So it's actually mostly standing around, and it's quite a different experience, which I wasn't exactly expecting, and now that's thrown me for a loop....

So what to do? The different fields are all so different, all with different personalities, different levels of patient exposure, different levels of lawsuits, etc. I think two can be summarized in an exchange from (what else) Scrubs. On their first day, JD (medicine intern) and Turk (surgery intern, but you can more or less include ER and other less-cerebral specialties here as well) are discussing what their respective interns are doing as soon as orientation is over:

Turk: "Hey the surgery interns are going out for a beer afterwards-want to go?"

JD: "The medicine interns are having a Pac-Man tournament...."

So any prayers over the next couple weeks would be appreciated. I should already have my applications in by now, but I haven't even started my Personal Statments yet, as I can't really write them until I know what I want to do. The things I'm thinking of right now are: Radiology (great lifestyle, but you get sued a LOT), Internal Medicine (see above exchange, and know that it's called Eternal Medicine for a reason), and Dermatology (great lifestyle, maybe a little more competitive than I'm qualified for...)

Radiology @ Duke

2006-08-21T15:54:00.000-07:00

I started Radiology at Duke this am. It was great - the only way it could've been a better first day is if I hadn't gotten sick over the weekend. The people here are really nice, and were really excited to have a visiting student (I'm the only visitor here - as opposed to at UNC, where at least half the students in the ED last month were visitors), which is kind of odd....I haven't seen any other visiting students wandering around either....hmm....Anyways, it was a good first day, and I already feel more competent reading x-rays.

I am on the Neuro service this week. They have such a big department here they don't divide it up like most normal hospitals, into CT, ultrasound, MRI, etc. They have Neuro, Chest, Abdomen, GI, etc.. So I will be learning about all things Neuro this week.

We spent almost all of today looking at chest x-rays which are about the hardest thing in radiology to learn how to do. One awesome thing about this rotation is that we get 3 hours of lectures each day, which is great, considering that as students, there really isn't any conceivable way we can contribute to patient care yet. So we might as well spend it getting great lectures (which they were). My favorite part was the lunchtime "hot seat" x-ray conference, where they said right up front that there would be NO calling on students. You can see why I enjoyed it so much! The cafeteria has decent coffee here (as opposed to UNC), and the hospital kind of looks like a castle - how much better can it get?

I had a bad day (...cue Daniel Powter song....)

2006-08-08T14:48:00.000-07:00

So I had kind of a rotten day in the ER today. I guess it's only fair to have one bad day to balance all the great days so far. It was the kind of day that really makes me want to do Internal Medicine....

I worked with the worst, most negative, unprofessional group of nurses I think I've ever met. One of them actually got mad that she (apparently) wasn't finding an open computer, so she wrote a note in crayon that said "Nrsg Only" and stuck in on the computer. Later on I needed to use it, and she promptly had a fit, started swearing to the nurse next to her about me (I'm serious), and then made a 15-minute personal phone call...So I guess she must've been really busy...I just sort of laughed and kept on working, which may or may not have been the right way to go about it. [Side note: this was discussed by the students at our lectures this am, and we've resolved to put a note on said computer stating "Med Stdnts Only" with the "S" backwards...]

Oh well, over and done with! So I was already kind of annoyed about that, and then as I went to see the next patient after that, two nurses each interrupted me twice while I was trying to talk to a patient (this is a relative no-no, especially if the questions are totally unimportant, as these were)...and I'm not meaning that they were interrupting the conversation to talk to me - I mean that they came and physically stood between me and the patient, interrupted me mid-sentence, and were asking the patient totally unimportant questions that should've waited till I was done...Such is the life of a med student....and intern....and resident, I guess!

Safe & Sound in NC (and busy!)

2006-08-02T16:47:00.000-07:00

So I made it to Durham, NC. I'm actually starting out with three weeks at UNC-Chapel Hill, and then after that I do a month of radiology and a month of CCU at Duke. So it's going to be a lot of driving for the first three weeks, but not too bad after that, as I live just a few miles from Duke's Medical Center.

I'm basically working every day for the next three weeks (I might get 1-2 off, but not sure yet), as I have to fit in 13 8-hour shifts as well as lectures and conference twice a week, and one shift with Orange County EMS, which I'm really excited about. In the meantime, I'm running back and forth between Raleigh (Wake Medical Center, which is where I'm doing most of my shifts for the first two weeks) and Chapel Hill, which is where our lectures/conferences are.

I've already met some other really nice medical students from around the country. We went out and had Mexican food as soon as orientation was over, as some of us are going into southwestern food-withdrawal. They are going to be a fun group to work with.

Monday was orientation (boring) and then last night I had my first shift at Wake Med. It was awesome - there we just work with one attending, and mine was totally excited to have a med student with her, and she constantly was asking me questions and teaching me different things. It was a great night. We got several traumas in, so I was happy, and I got to see a bunch of medical patients on my own. One of the traumas was a nice open tib-fib fracture (where you break both the bones in your lower leg, and open means that the bone fragments have gone through the skin), so that was neat to see. I found a similar x-ray on Google, so for you non-medical people, here is what a tib-fib fracture looks like:

These are pretty bad and definitely need surgery - you can't fix this with a cast. And it's especially an emergency because when the fracture happens, the bone fragments can cut the blood and nerves supplying that area, so it can actually end up being even a worse injury than it looks. Anyways, that is my teaching for the day, and I hope the x-ray wasn't too graphic for those with weak stomachs.

The COMLEX-Clinical Skills Exam

2006-07-29T19:09:00.000-07:00

So last weekend I went to Philadelphia to take the Clinical Skills part of my Step 2 Boards. Boards are divided up into four parts: you take Step 1 after your 2nd year of med school, and then after your 3rd year, you have to take Step 2, which has both a written component (no big deal) and a practical component (big deal). Then after your first year of residency you take Step 3.

The practical part of Step 2 is hugely stressful - you have to see 12 patients in a row, which wouldn't be a big deal, except you know going into it that there are going to be some "difficult" patients, so they can see how you handle a stressful situation, and then there are other patients who are instructed to not tell you VERY important information unless you ask using a particular buzzword...Like you'll have a middle age man there for what he says is a diabetes checkup, and the whole point of it is that he's there for erectile dysfunction, and unless you specifically ask about that, you won't get full points for that patient encounter. And then of course we had to do OMM (osteopathic musculoskeletal manipulation) on several patients, which most of us haven't done in at least a year and a half.

The redeeming part of the weekend was that I got to see Hannah & Heidi and their awesome house. It is SO neat, yet I forgot to get a picture of it! I got to their house late Saturday night, and then spent much of Sunday studying at this cute coffee shop, The Green Line. I will be ever grateful to them for their legal stimulants that helped me prepare for my test. Then we went out to brunch at the Continental, which was very cute and Austin-Powers-ey/Queer Eye for the Straight Guy-ey...

Here's the testing center:

Here's a very teeny picture of the testing room. There are 12 patient rooms, and you just rotate around in a circle till you're done.

Here is how I felt after walking out of the test:

I am reasonably sure that I passed. I made lots of mistakes (as usual) and as time goes by I remember more and more, but I think they'd have to be ridiculously strict to fail me for the things I forgot to do. So in a rapid 13 weeks or so, I'll get my results!

Afterwards I met up with Hannah & Heidi again and we went to the City Tavern, this really neat restaurant in the oldest part of town, where servers dress in 18th-century clothes and the menu is strictly authentic. Everything served is something they would've eaten in Ben Franklin's day. Apparently the Founding Fathers celebrated the end of the Constitutional Convention there, and the first Fourth of July celebration was held there. Pretty neat! My favorite thing was the pewter goblets in which water was served :

The sign outside the City Tavern:

Afterwards we went and engaged in a timeless Philadelphia tradition...walking by the Liberty Bell and taking a picture of it. It takes time to get a ticket to get inside the building, and then you have to wait in line to see it, so it's much better to just walk by the outside and see it, which is apparently what most Philadelphians do. So I call this picture, "View of the Liberty Bell from the Street."

Jennifer's Birthday @ The Cheesecake Factory

2006-07-29T18:28:00.000-07:00

Tuesday night was Jennifer's (my roommate from the Virginia D.O. school) birthday, so we met Azadeh (fellow AZCOMer) at The Cheesecake Factory in Chevy Chase. It was so much fun! We shared med school stories, lamented over our respective Clinical Education departments, and ate cheesecake.

Here is a cute picture of Jenn, Azadeh, and me:

Right when our waitress brought our cheesecake out, this cute little boy came over from another table and instantly befriended Jen, all the while eyeing her cheesecake. He was hilarious. They had about a 15-minute conversation until his dad finally dragged him back to their cheesecake-lacking table.

What I've learned this week:

2006-07-21T17:43:00.000-07:00

So it's been a long week, and I felt the need to vent on a couple of things. I hope it doesn't sound like I'm not liking ID, because I really am, and a bunch of funny things happen every day. They're often more entertaining in retrospect, when you're not so tired. Here are a few things I've learned this week:

When NOT to consult your local Infectious Diseases (ID) service:

1. When your patient has a fever caused by the medicine you just gave him. This is especially bad when they've had a fever, say, after every one of the last TEN times you've given him this same medicine, and when his vitals are perfectly stable, and he's sitting up in bed eating a cheeseburger.

2. DO NOT, I repeat, DO NOT, consult ID for a possible C.difficile infection when your patient has diarrhea immediately after you give him Senekot, Colace, and Mag….

(this happened this week…no, I am not kidding, they seriously did!)

3. Do not request an official consult at 6pm Friday night, on a patient that hasn't even had the faintest beginnings of a workup, and ask us what prophylactic antibiotics to give for the infection that they almost certainly do not have.

4. Do not ask us to clear your patient as "absolutely, positively not infected with a single germ" on Friday, for a surgery that is next Wednesday. How the patient looks right now has no bearing on what he'll look like next week. Especially if his grandkids with chicken pox come to visit over the weekend.

5. If you are going to put your non-infected patient on a whole regimen of non-indicated, inappropriate antibiotics no matter what we say, please don't consult us and make us go through the hassle of writing up a note on your patient with borderline personality disorder. Especially when you have already decided that Vancomycin is a spectacular first-line gram negative-coverage drug.

Other random thoughts:

1. Aplastic anemia and 16 beers a day are a GREAT combo! I am totally kidding - do NOT try that at home!

2. Be nice to your siblings. Someday you may need a stem cell transplant, and if you're a jerk, they might all be "too busy" to swing by and help you out.

3. If you have an immune deficiency, and someone in your naked yoga class has a bigger body piercing in a certain part, let it be. Keeping up with the Joneses only applies to houses and cars.

Visit to Mt. Vernon

2006-07-17T16:09:00.000-07:00

On Sunday I went out to Mt. Vernon. I would have to recommend either going on a weekday, or at the very least getting there right when it opens at 8am. I decided to sleep in which was not a good idea. It was completely overrun with tourists, and I bet if you were there during a less-crowded time, you'd have an entirely different experience from mine, which mostly consisted of waiting in lines. I would think the estate would be very quiet and peaceful, and more conducive to thinking about the previous owner's history as our first President than it was when I was there. I am glad I went, but I definitely want to go back at a less busy time for a second look.

Below is a view of the main house from the front. There are attached outbuildings on either side, connected by these neat covered walkways, but I couldn't get them all in the picture. That's actually why I didn't take very many pictures there - for almost every shot I wanted, I really needed a panoramic shot, and I couldn't find how to do that on my camera....thus, very few pictures.

The house is actually smaller than I had pictured it. It's easy to forget that their mansions were not the size of what we'd call mansions today. It was huge for their time though. The Mt. Vernon Ladies Association has managed to find many of the original belongings and have them returned to the house, so that about 40% of what you see is original to the house, which is pretty amazing for a house that old.

Below is George & Martha's back porch. They have a row of wooden chairs lining the porch, so you can sit there and enjoy the view just as they must have. Take special note of the authentic eighteenth-century traffic cone to the left of the porch:

This is the view of the Potomac from the backyard. The Mt. Vernon Ladie's Association has purchased about 4,000 acres across the river in Maryland, so that the view will always be unchanged, essentially what is was in the Washingtons' day.

I was on the path to the tomb, and I just had to take a picture of this sort of glade. I finally had a bit of the path to myself, and it was so peaceful and pretty.

George & Martha were actually buried in the "old tomb" initially, but the family crypt was falling apart, and before he died, George commissioned a new one. It wasn't ready until quite some time after they both died, but when it was, they were both re-interred in the new and improved tomb, pictured below:

Ghost Walk in Alexandria

2006-07-16T15:54:00.000-07:00

On Saturday night, Tori and I went to Old Town Alexandria and went on a Ghost Walk. You might've seen these guys on the Travel Channel, and I hate to say it, but I preferred seeing it on the Travel Channel! Maybe it's because they had better re-enactments, and on the tour you just have someone telling you the stories...It was fun though. We met at the Ramsay Visitor's center (the cute house below), and our guides were dressed in semi-authentic eighteenth-century outfits (probably would've been hard to speak to a large group and trot about town wearing corsets!), and carried lanterns with candles. It wasn't nearly as hot and humid as it has been lately, but Tori and I were wondering how in the world women lived here back then, having to wear about ten times the amount of clothing as we wear today, and not even having deodorant or makeup... All together now:Ewwwww....Once again, I pause to thank God for having me be born in this wonderful century with deodorant, Origins makeup, and antibacterial soap.

So moving right along...this was a sign right outside the visitor's center, explaining the origin of Alexandria. Hopefully you can read it:

We took of around town, led by Barb our very-enthusiastic tour guide. We learned some interesting stuff along the way, about the ghosts and hauntings of Alexandria, all of which this tour company researches from old newspapers and public records (with some rumor/speculation thrown in for fun, I'm sure!) - pretty neat!

Below is Barb explaining about how women could give men over 100 different signals by using their fans. This was the origin of the saying "don't get your signals crossed," because if a woman touched her right cheek with her fan, it meant she liked you, but if she touched her left cheek, it meant she didn't, and since basically any forward-ness on a guy's part in those days meant a woman could expect a proposal shortly, it was definitely a good idea to learn those fan signals very well!

Another funny thing she told us about was how the size/amount of hair in a man's wig was a very obvious clue to his wealth, thus the origin of the term "bigwigs." Thought that was funny...

She is standing on the steps of the house right next to George and Martha Washington's town house, and while she was teaching us about the fan signals and the meaning of bigwigs, the people in the house had ordered pizza, and we had to get out of the way of the pizza guy. We kept getting twenty-first century reminders of life all throughout the tour like that. It was kind of funny.

After the tour was over, we retired to Murphy's Pub, a neat place Tori & the gang used to go to more when they lived in Alexandria (they're mostly in Arlington now). This guy named Pat was singing these really funny Irish drinking songs all night, and everyone in the audience was apparently a regular (except for us), because they knew all the words and what to call out & when. When Pat says, "Lovely," you repeat "Lovely," and when he says "Brilliant," you repeat "Brilliant." There was one song where one line is "...and God bless the Queen," and as you're singing along with that, everybody in the place does the sort of lightbulb-turning wave the Queen does, all together. We felt positively British. Hopefully we'll get to go back before I leave - it was really fun!

Just another day in infectious diseases....

2006-07-13T19:45:00.000-07:00

So I was standing out at the front of my building today, waiting for my bus, and I was literally grinning from ear-to-ear, just so happy to be here, seeing what I'm seeing every day. The things they see on an every-day basis here, many doctors won't ever see, much less have the opportunity to get to treat. I got to see one really neat, rare thing today, and then I had another really cool thing that we had to rule out in a patient, so we had to do a bunch of investigating because no one knew for sure what to do. The neat thing here, is that everyone here is an expert on something or other. These are the best people in the world you can call with your questions, and they're right in our building!

I can't really tell you guys any specifics, but I thought I'd put some info about some of the oddball things that come through a place like the NIH. So the next time either of these conditions pop up on a "House" episode, you guys can tell your friends, "Oh yeah, methylmalonic acidemia, that's kid stuff!"

******

So the first "zebra" is something called methylmalonic acidemia (MMA). It's an autosomal recessive enzyme defect (meaning that both parents have to carry a recessive, or "hidden" gene that they carry but don't express themselves) that you're born with. It means you're missing the enzyme you need to process fats and proteins. The patients have vomiting, dehydration, hyperglycemia (high blood sugar), hypotonia (weak muscle tone), recurrent infections and lethargy. It's usually found in infancy, and its effects can range from mild to life-threatening. Babies can look fine early on, but when they start eating more protein, then the effects start showing. There are some pictures of children with it on the internet, but I don't think that's really a nice thing to post, because you don't know who posted those pictures, and if they got the patient's consent, etc., so instead I'm showing you this incredibly fascinating flow chart of where the enzyme defect is:

So basically whenever you have an enzyme defect, that means that the process that enzyme was meant to facilitate isn't getting done, and that the precursors for that reaction are piling up somewhere as they're not getting used, and this is never a good thing.

Treatment consists of giving other enzymes, and limiting protein intake. So for example, a patient with this disorder may look overweight and have high blood sugar, and look a lot like a regular type II diabetic, but if you check their protein level, it's almost zero, and they're so protein deficient that they are losing their hair and have skin breakdown. And the sad thing about the really rare diseases like this is that it's usually not diagnosed for a long time, leading to a lot of stress for parents. That's why we spend so much time memorizing "zebras" like this for boards - you might never see something like, this, but if you're ready for it, you can save a family a lot of heartache, not to mention the patient's life.

******

The next cool "zebra" isa bug called called Echinococcus, and I guarantee you, if it hasn't made a "House" or "Gray's Anatomy" episode yet, just give it some time - this bug is pretty darn cool (once again, as long as it isn't in your liver!)!

This is the echinococcus life cycle - it's basically a tapeworm, which can go from a definitive host (often a dog or fox) to an intermediate host (usually a goat, a sheep, or the occasional unfortunate human) and then back out into the environment, eventually to be picked up by another host.

OK, so this is a chest x-ray even I can read. And that's really saying something. In x-rays, air is black, and solid structures are white. So your lungs should be clear (or almost clear) black, and then you can kind of see the sternum and other bones showing up as white. What you shouldn't have is that giant ball in the right lower lobe of the lung (picture the patient facing you)....this is not good. There are three different kinds of echinococcus, and at least one of them really likes people's lungs.

The bug eventually settles wherever it wants to be, and makes a giant cyst that usually isn't found until the patient finds a mass in their abdomen, or starts coughing up blood. Another type of echinococcus really likes livers:

This is a CT: think of this picture as if the patient is lying on a table on their back, with their feet right in front of you. You're looking up through the abdomen. The liver is the big white thing on the right, and what shouldn't be there are all those circles. Big circles in livers are bad. These are giant cysts that echinococcus makes wherever it settles, be it the liver, lungs, or brain (plus some other really random places).

And here's the cool part: you can't just go in and take out the cyst. Why not? one might ask...Because when the cyst fluid with millions of tiny particles of the echinococcus leaks out of the cyst, your body can have an overwhelming allergic reaction and you can die. Not good. So what they do on some of them these days is stick a big needle into the middle of the cyst, aspirate (suck out) the fluid, and then shoot in a drug that kills the echinococcus. Pretty cool stuff. Or you can just give them albendazole and hope it goes away, but that's not very exciting. Who wants that?

Rotation #1: Infectious Disease Consult Service at the NIH

2006-07-12T16:36:00.000-07:00

Hey everybody! Well after quite the road trip, I'm finally at my first rotation of the year: Infectious Diseases (ID) at the NIH. I just finished my first week, and it was AWESOME. Put it this way....the first patient we rounded on had about as many problems as all the patients on my Michigan service combined!! The patients have things I've either a) never heard of or b) never, ever thought I'd see and c) things the attendings and fellows have never heard of prior to that particular patient presenting themselves either - it's amazing! On the down side of that, I now have a LOT more than I thought to read up on tonight!

One example of the cool things I'm getting to see is the cute little blue guy below: an amoeba. They seem kind of funny when they're in Far Side cartoons, but not so much when they show up in your liver after a trip to Mexico!

These are not your run-of-the-mill infectious diseases patients...they all have cancer...and not just that. They have the weirdest infections that you don't see in normal patients/hospitals. In fact, the ID fellows here have to go out to regular community hospitals for rotations so they can learn how to treat simple cellulitis, because they'd never learn about normal things here! Also, most of the patients on our service have had stem cell transplants (took me a minute to realize that it was "stem" they were saying, and not "bone"!)...something I didn't even realize was that common yet! Apparently there are only two centers in the country that do them on a somewhat regular basis - here, and somewhere in Washington state. So that is yet another thing that I need to learn about, ASAP!

So the building below is the clinical part of the NIH, where I work. Its actually just the front of a giant complex of buildings, most of which were part of the "old hospital." So where I work is called the "new hospital." It only opened 1 year ago, and it's the most beautiful hospital I've ever seen or will see. Not only is everything perfectly clean and new, the patients are very happy campers as they each have their own flatscreen TV that is also a computer. So I have to say that this is probably the only time I'll ever go see one of my patients in the ICU and find them surfing the web!

When you walk inside the doors, this is what you see...There's this incredible atrium that is probably 7-8 stories tall. There is a giant garden at the center of the building, and lots of light everywhere. It must be an incredible place to be a patient. I would've tried to take a picture of the atrium area, but it's just too big. You really have to see it for yourself.

This is what is on the wall to the left of the security desk in the above picture. I thought it was neat so I took a picture of it.

My roommate here is from the West Virginia Osteopathic school, so that's pretty neat! Our apartment building is right next to the NIH, so I won't have to drive in the traffic here!! Yay!! But the NIH is so big we have to walk to the edge of it, and then take a shuttle over to our building, which is on the opposite side of campus (reminds me a lot of A&M in that respect!)

We found out right away why the rent is so reasonable in our particular building (as opposed to the rest of Bethesda & DC where rent is outrageous)…it's right across from the Bethesda Fire Dept.! We were still moving our stuff in when the first call went out. Funny. But actually I think I've already learned to sleep through the alarms, because I don't remember being woken up by any this week! When I get time (after I go to the Spy Museum!) I'm going to walk around in Bethesda/Chevy Chase and take pictures of some of the houses here. I think it's about the prettiest area I've ever seen (not quite Charleston, but pretty close!).

This weekend I'm going to try to do some board studying, and we're also going to take a tour of Haunted Alexandria - I can't wait! I might try to make it to Monticello and Mt. Vernon this weekend too, but it depends on how much studying I get done between now and then!

Charleston Pictures 2

2006-07-11T18:26:00.000-07:00

The next two houses are mansions along the Battery. The Battery is the area along the seaside where they had all the cannons facing out to sea during/before the civil war. Now there is a park in front of the houses, next to the sea, and the whole area in general is called The Battery. There are some incredible houses there. The one pictured below (I think) is the one that still has a piece of a cannon (before the Confederates deserted the city, they blew up all the cannon so the Union wouldn't be able to use them) sitting in the attic. With all the poverty during Reconstruction, the family didn't have the money to remove it and fix the attic. By the time anyone had enough money to fix things, they decided that it was important enough, historially-speaking, to preserve. So it's still there in the attic today!

This is just a pretty mansion along The Battery. I'm sure it belonged to someone important at some time, but it's been awhile since I took the tour now, and I can't remember who!

This is a house I'd like to own someday, which was in the regular residential area of the Historic District. "Regular" in the Historical District meaning "at least 1 million."

This is another house I wouldn't mind living in. I noticed quite a few houses with this neat, unfinished-cement-looking exterior. I bet there's a name for it, but I have no idea what it is.

This is a sign outside this incredibly neat, quiet graveyard at St. Michael's church. It's this tiny, walled garden cemetery, and it has Charles Pinckney and John Rutledge buried there. If you can't remember who they are, check Wikipedia. The neat thing about this cemetery was that it was so old, it had people buried in it who died in say, 1707, and it also had people who died in the late '90s...I wonder who you had to be to have a space reserved there....

I found John Rutledge's grave, which is so old that you can't read the lettering, so they had these helpful signs beneath it. I ran out of time before I could find Charles Pinckney's grave

(I had to go get started on the tour).

Below is the house where George Washington stayed when he made his one visit south of Virginia. Everyone tried to do everything for him, and treated him as a sort of king, because as the first President, no one really knew what to make of that position. They knew how to treat kings & queens, and so they tried to treat him that way too. He would have none of that - he insisted on paying rent everywhere he went. Also, at almost every evening event, they would have a sort of throne-like chair reserved for him, but he would never sit in it, and always insisted that the ladies of the party sit there instead.

Below is an epitaph on a local doctor's tomb in St. Michael's cemetery that really impressed me. I don't know if it'll enlarge if you double-click on it, but I included what it said just in case. It reads:

"Sacred to the memory of Benjamin B. Simons, MD. 1776-1844. As a Physician, he was eminent. As a Surgeon, he had no superior in the United States. As a man he was scrupulously just, with stern integrity and uncompromising honor. He was eminently distinguished in his day and generation."

I thought this was a good reminder of our predecessors, and what enormous shoes we have to fill.

Charleston Pictures 1

2006-07-09T16:31:00.000-07:00

So after I left Texas, I went to Columbus, GA for a few days to hang out until Jackson could get leave and we could go on to part C of my road trip: Charleston, South Carolina. What was really neat was that my friends Tori and Ginger (from D.C.) were going to be in Charleston that same weekend, so we got to meet up for dinner before I had to leave early for D.C. and my rotation.

[Incidentally, Blogspot won't let me post more than a couple pictures at a time, so this one's going to be a multi-post to get all my pictures in!]

The pineapples were a sign of hospitality in the South, and apparently when sea captains came back from Barbados, they'd put fresh pineapples they brought back with them on spikes on their gateposts to announce their arrival home, and that they were open for trading.

This pink house was the very first house to be restored & preserved in Charleston. It dates from the 1690s!!

This stained-glass Tiffany window is in St. Michael's church, where George Washington worshiped when he made his one visit to the South, and you can still see where he sat, in the visitor's pew. It still has a very active congregation, and these cute ladies were watering the flowers and dusting while we were touring their church.

This is St. Michael's Church, which was once Anglican, and then switched to Episcopalian after the Revolution. It's where George Washington visited, and also one of the Four Corners of the Law (representing the Spiritual/Holy law) of the main intersection in Charleston. So the main intersection in Charleston has four important buildings, one on each corner. They call it the Four Corners of the Law, because each corner represents a different aspect of the Law: Spiritual, Federal, State, and Local.

This is the South Carolina State House, representing the State part of the Four Corners of the Law.

This is the Federal Post Office, representing the Federal part of the Law.

Below is the Charleston City Hall (under reconstruction), representing the Local part of the Law.

Texas Road Trip

2006-07-08T07:34:00.000-07:00

So after we took our 4th-year test, I hung around Phoenix and ran errands etc. for a few days, and then I made that ever-so-fun 16 hour drive to College Station, Texas. I got to stay with the Sterlings (Texas family) for a few days, and then Liz and I drove over to the great metropolis of Temple, Texas to visit Mitra and Brooke at their new apartment. We tried on some really cool glasses at Marshalls (see below!) and then had ice cream at Maggie Moos. What else could you ask for in a day? J After I got a check-up for my car, it was on the road to Georgia to see Jackson for a few days!

Shopping in Temple (Liz, Mitra, Me)

At Maggie Moos Ice Cream in Temple

(Liz, Mitra, Brooke, Me)

Dr. Sterling & Betty (aka the Texas family!)

Playing Rummikub, possibly the most fun game ever!

Trying to take a picture of the really pretty sunset in the Sterling's backyard - this didn't really do it justice!

Sorry it's taken me such a long time to update the blog! Their site was having some technical problems for a few days, and then I found out the hard way that you really can't save partial posts and then add pictures, etc., later, and since it takes quite awhile to add all the pictures, I have to wait till I have a decent chunk of time (and a good wireless connection!) to do a post. Hopefully I'll get caught up in the next week or two!

UNC here I come!!!

2006-06-26T14:50:00.000-07:00

OK so I'm just a bit excited. I just found out today that I got an audition rotation at UNC-Chapel Hill, aka the Mecca of Emergency Medicine. !!!!!! Not only do they seem to be willing to let me on the property, which is awesome enough in and of itself, they are letting me do only 3 weeks instead of the normal 4, which is incredibly nice of them! So now I am not going to be visiting Gettysburg (at least this August), but I think I can handle that. I also have to reschedule my board exam (written) because I can't take a day off when I only have 3 weeks there. And now I have about, oh, three months less to finish my ER book - whoops! :-) Maybe they'll cut me some slack as it's my first ER rotation......riiiigghht..... :-)

So for my updated schedule for this year: (though this can and will change all the time!)

July: Infectious Diseases at the NIH in Bethesda, MD

July 24th - Noah goes to Philly to take the national physical exam test (fun!!)

August: 3 weeks of ER at UNC-Chapel Hill (Mecca)

August 21-Sept 16th: Radiology at Duke

Sept 19th-sometime in October: Possibly CCU at Duke (not confirmed)

Sometime in Oct-Sometime in Nov: ER at Maricopa (if my school didn't accidentally cancel it
along with my burn rotation, which is quite possible)

Mid-Nov to Mid-Dec: TBA (i.e. I have no idea)

Christmas "break": Noah will either be working somewhere or in Scotland, hopefully the latter

January: TBA

February: Cardiology at Eastern Carolinas in Greenville, NC (i.e. the place with the combined IM/ER residency)

March: TBA

April:TBA

May: Something easy as I just won't care anymore

More fun with Nissan...

2006-06-19T21:41:00.000-07:00

So after all the fun I've had in the past 3 years with Nissan, I happened to Google my car's model to see if there were any recall notices on it....Hmmm...I thought that if they had those, then the company was obligated to inform you, right? Nope...Turns out there are two on my car. Problem #1 is that water can get into the rear axle housing, causing corrosion and this might cause the axle assembly to SEPARATE FROM THE CAR while driving (!!!!???!!!)...Isn't it comforting to know Nissan is on top of safety issues like this! :-) Problem #2 is that (again) water can get into the pump terminal on the fuel-sending unit, causing an abrupt stop in fuel delivery to the engine, causing the engine to FAIL WHILE DRIVING, possibly causing an accident (this is straight off the NHTSA website!!!)....Hmmm..Anyone thinking about buying a Nissan (particularly Xterra) out there?? I'd recommend going with the Volvo instead! :-)

So we're done…for a bit anyway!

2006-06-17T17:26:00.000-07:00

So yesterday we took our 4th-year test, after 3 weeks of lectures, and it was great…OK, not really. It really stunk - they took most of the questions from the lectures themselves, not from the notes, so we will find out in a few weeks if Noah will be re-taking it! Just kidding (hopefully!). We have to wait a few weeks because someone in our class just had a baby Wednesday, and they won't release our scores until she takes it, which apparently will happen whenever she feels like it…How knowing our scores will help her on the test, I'm not sure, but for whatever reason, it's a big security concern with our ever-vigilant Clinical Ed department…

Along with the test, we were given a survey about OCM III/IV from the aforesaid Clinical Ed. dept….Below are some pictures of us giving them our constructive criticism… I suggested that topics such as "Advanced Head and Neck Dissection" perhaps are relevant to say….the ONE student who is going into ENT in our class, but that our time might be better spent discussing things that are a) going to be on Boards or b) that more than one of us are ever going to need to know. I am sure they will take my comments to heart, and make a sincere effort to improve the courses for next year….Okay, of course they won't, but it felt good to vent!

After the test I spent some quality time at the pool and reading a non-medical book, and then we went out to dinner with Chuck & Melissa (and baby Lucas!) because they're moving back to Vegas today. I took a bunch of pictures which are below:

Today (sad to say), I started studying for Boards, even though I don't know when I can take them now. Most people are smart enough to schedule one easy month so they can study for Boards a bit, but I didn't think to do that. So I have a totally hard schedule until about February, and sometime in the middle of the mess of applications, interviews, normal rotation work, etc., I now have to study for Boards!!! Oh well….what can you do…

More later…..

Katie and Allison filling out their sure-to-be-discarded surveys

Eric gleefully filling out his survey

A bunch of us standing around, debating answers after the test

(the normal routine!)

Chuck & Melissa and baby Lucas

Golda holding Lucas, who doesn't seem to mind being passed around like free candy!

Me holding Lucas, who as I found out has a great Moro reflex! (that's the quite-entertaining startle reflex, for non-medical people)

Learning how to blog!

2006-06-15T16:34:00.000-07:00

Okay yall, I am just getting started, so give me a bit to get this going...I started this so I could post pictures of where I am and what I'm doing this year...Wish I'd started this last year but oh well! I'll be at more interesting places this year anyway! So as soon as a) I figure out how to work my digital camera and post pictures and b) actually have something cool to take a picture of, I'll get started! :-)