Pre-call

I am up too early for my first call. I have a bad cough and after my cold medicine wore off sleep was impossible. Plus, I'm out of the stuff that doesn't make you drowsy so got up extra early to hit up the 24-hour Walgreen's down the road.

First day in clinic wasn't too bad. The computer system is still a bit of a mystery to me (despite the 8 hours of training). It seems like a great system and I'm sure I'll grow to love it but for now it's a bit intimidating and a real barrier to me giving good patient care. We are supposed to be smoothly documenting out patient visits in the room with the patient, maintaining eye contact, nodding sympathetically, asking the probing questions, observing their signs and symptoms, typing away unobtrusively. However, in the rooms of the clinic where I was working, the monitor of the computer - a desktop of gargantuan proportions - was facing the patient. So, in order for me to type and talk simultaneously I would have needed two pairs of eyes, the second pair strategically placed on the back of my head. And I'm guessing that scenario would not have improved patient rapport but only freaked out the poor pregnant lady as she saw blinking from behind my hair.

My rapport was also compromised considerably by the fact I was coughing up a storm. After alienating the patient with my ineptitude at working the computers, I would then start coughing as they were prone on the examination table, gel on their bellies, prepped for ultrasound. I would then excuse myself for the room and they would hear me hacking for a good 5-10 minutes until I came back to apologize in a raspy voice. Okay... this only happened once - the prone on the belly part. But I did have to make a dramatic exit several times. This all fortunately, only happened in the later afternoon. The patients in the morning got to see me a bit healthier.

At the end of the day I walked home in the pouring rain in my white shirt, with a borrowed umbrella, and realized that the day had been perfect. We all fear that first day, when you do everything wrong, embarrass yourself and bumble around like an idiot. I got that out of the way now. And to boot, I was sick, so I can pretend that I have an excuse for it :)

As an aside, I got to examine some pregnant cervices for dilation and perform some prenatal GBS and STD screening and such. A good refresher for today, the big day.

Today: Call. I'll get there between 7 and 8 and we round late, 8:30 AM, since it's Saturday. Then it's 24 hours of Labor and Delivery, likely quite a bit of triage (clinic is closed on weekends and women with all sorts of issues big and small will be coming to us and not to their regular docs), and I'll probably be in some c-sections (but I'm a bit ambivalent about surgery right now as I really just want to get my deliveries in the bag). I'll report on the first day of call at some point (of course without violating HIPPA because I'm that good).

Now to see who frequents the 6th Ave Walgreen's at 6 AM on a Saturday...

Resident Life and Urban Art

I've been meaning to update everyone on orientation for a bit. Friday night we had a BBQ with faculty, staff, residents and everyone' families, sig O's. Of the class graduating (the leaving R3's) there are 8 residents and 11 children. The trend continues through the ranks - our class only having 5 kids for 8 residents. I was fashionably late, and apparently missed the part of the BBQ where everyone stands up and introduces their siginificant other, kids, etc. The photo is of my attempt at eating the world's largest hot dog.

I think it's required, but late last week we had a lecture on sleep deprivation. I thought it was very interesting. More interesting, surely, than the discussion on hospital protocols. Personally, I think the presentation should be for the rest of the world. We know we are sleep deprived, and hungry, and gaining weight, and grumpy and falling asleep at the wheel. But the nurse who gets mad at us because we weren't cheerful after a 30-hour shift, or the guy in the Mercedes behind us, who's honking because we didn't immediately gun it at the green light? They need to learn how tired we really are.

Yeah sure, we learned some tips and tricks. But the real message is that nothing helps sleep deprivation like sleep.

I was a little concerned about a bit of a double standard. The program here adheres very strictly to the resident work hour rules. These rules, for those who aren't aware of them, have been imposed upon programs in the US. Not as punishment, but because if they weren't imposed upon them, the wouldn't adhere to them. However, even here, I have heard little bits and pieces of things that concern me. "I'll definitely respect you if you want to stay past your hours... but you can't." Or "Dedication is admirable, but we have to assure you aren't exceeding hours." There's also "One resident was mad at me because I was sending her home after 30 hours. She said I was impeding her educational experience." Hm. If that's not sleep deprivation talking I don't know what is. Yes, I'm sure there will be times, as my 30 hours ends, that I will want to stay and finish this one last thing. But I know that after 30 hours awake, you'll have to show me something ten times before I learn it. Alert, I might pick it up the first time. (photo from my window at night.)

I also told some folks I'd put the following on my blog. Here are some of the resident work hour rules. And, for those in need of even more education, click here or here for more information on the resident work hour regulations (the first link is AMA, the second is AMSA's ...photo explained in last paragraph).
Some of the Standards (right off my handout)
1. Call scheduled no more than every third night
2. One full 24-hour day in 7 free of patient care [averaged - not enforced per week]
3. Limit of 80 duty hours per week averaged over four weeks
4. 24-hour limit on continuous duty with up to 6 additional hours for transfer, debriefing or didactic activities [that pretty much covers anything in residency].
5. a 10 hour minimum rest between duty periods
There's more but that's the gist of the regulations.

Interesting point our residency director made: in "his day" they worked longer hours. However, according to him, they had more hours that were less productive. Since we are cramming the same education in to 80 hours (instead of 100 or 120) a week we have virtually no downtime. So our 80 hours are intense and spent running around, admitting patients, going to didactics, getting our work done, with very little down time. Hmm... makes me wonder if the Gray's Anatomy folks are adhering to the work hour regulations since they do seem to have a lot of downtime. (photo from art festival)

Also interesting. There was discussion of brain-washing. How do you brain-wash someone? You sleep deprive them, give them bad food, and expose them to repetitive messages. Again I say: hmm...

Regardless. I'm not working much at all this past week and had lots of time to go to the Urban Art Festival here in Tacoma. It was a great time! I didn't go until rather late in the evening as it was pretty nasty all day. It rained and even hailed! Definitely not good street fair weather. However, a rainbow emerged (literally) and the sun came out for a few hours and I moseyed on down to the Art Festival to see what was happening.

By the time I got there many booths were packing up. I talked to two artists who said the winds and rain were so bad they were literally hanging from the support beams of their tents to keep them from blowing away. The exhibitors did look spent, but those like me who had the luxury of coming when the weather was nicer were enjoying ourselves. The music was great - it was "I can't believe this is free" kind of great. There was a main stage with live performers and a DJ in a covered parking lot (not sure if that was his original location, given the rain). The DJ was playing techno music - making me a little homesick for Detroit and, again, bummed I missed the electronic music festival there. I listened to both for a while but preferred the live music ultimately as the crowd gathered there was much more diverse.

The exciting thing is that there were a lot of left-wingers there. I saw a guy in a tie-dyed lab coat (see above), people wearing PFLAG stickers, dancing old hippies (both near the music venues and far from them). It was pretty great and made me like Tacoma even more. I hope the weather is more favorable for the Festival next year since it seems like something I may want to spend more than an hour at if possible.

Hump Day?

Orientation is going well. No running around in the woods and bonding by trust falling or anything like Suhani's program, but we're starting to get to know each other. My group is pretty diverse. Here are our stats:
There are 8 of us. 2 men, 6 women. 3 married with kids (multiple kids for 2). 2 of us are single (me and one of the guys) - the single guy is from here and currently living with his parents until he can find a better place. One girl is born to a Mexican immigrant family, another to a Pacific Islander immigrant family. One guy is 50 years old. I'm the token gay. People are from everywhere: Gig Harbor (here), Oregon, Seattle, California, Minnesota, Arizona, Vermont... most people went to school in a different location than their home towns. There are two DO's and the other 6 of us are MDs.

I haven't formed an insta-bond with anyone yet but everyone seems really nice. I came out on the first day at the very end and everyone is still talking to me which is a good sign. The faculty seem really, really nice and I can tell they have A LOT to teach me. I hear one faculty routinely makes people cry but "that's normal" and that, really, "he's very approachable". Apparently he is just very intense. Everyone here seems really happy with the program. The hardest rotation is FP (family practice). Mostly because of long hours. The OB and Peds rotations look amazing in caliber. All the other rotations look great, but Tacoma stands out in that it trains amazingly well in ALL disciplines and has a famously thorough peds and ob program. It's also great that we are a tertiary care center (people refer here from around the state) but don't have to share the patients with other residency programs. So we get to learn A LOT.

In the next few months I also have to start thinking about where I want to do my underserved rural or urban rotation. The rotation falls in February. I'm a bit conflicted. I can pretty much do it anywhere I want as long as I can arrange a real rotation with a valid experience. That means I can do urban underserved in Detroit or rural medicine in Zuni if I want. However, Detroit in February doesn't sound uplifting and I'm pretty sure Zuni in February isn't much better. One of the things I've picked up from the residents is that the "easier" months like your rural/underserved month and orthopedics tend to be the ones that bolster you - pick you up from the depths of despair. So I'm brainstorming. Next year I will also be able to pick another similar rotation, urban or rural, pretty much wherever I want, just as long as its underserved. Some kids have even gone international but it's much harder to do and may limit your freedom to do more international work your R3 year so it's not ideal. Any suggestions are welcome of course. Where can I go in February that will make me forget about my crappy November-January?

So, yesterday I was feeling a little run down - from both orientation and being down about being on call on the holidays this winter (and being on FP over the winter - kind of a double whammy). So I went for a run. Initially I was tired and down and couldn't muster the energy to run around. However, the motivation hit me suddenly (around 8:30 PM) and I drove to Ruston Parkway (a waterfront drive) and parked beside a long boardwalk. I grabbed my iPod and hit the pavement. It was truly uplifting. I started running into the mountains, the sun setting behind them. There was sea air, thick and salty. People were riding bikes, rollerblading, skateboarding, making out on the beachy areas, walking the length of the piers, going out to dinner at the waterfront restaurants. It was really nice. Then, when it was time to turn around I turned to face the other direction, peeling myself away from the mountains, the water and islands now on my right. In front of me was Mt. Rainier. Huge, looming and all its snow was pink from the sunset. It was unreal! This picture at left gives a great idea of what I saw (but without the Tacoma dome below it - I saw it above water. Ultimately the view was replaced by more mountains, trees lining my path obscuring the mountain. I cooled down on a pier, watching the last of the sun sink behind the mountains, the sky flame red, and stretched while barges and large boats floated by from the docks to the bay.

First Day

Well - here it is. The first day of internship. Granted, I have orientation for a week or so before I interact with real live patients. Nonetheless, I'm excited.

Yesterday was very relaxing. I skipped out on Pride as it was cold and rainy and I didn't feel up to dodging raindrops at a street fair. Nothing is more depressing than soggy drag queens anyway. Sive and I curled on the couch and cat napped (ha!). In the early afternoon I received a call from the Vet that Sive's labs came back looking good! So the two of us celebrated by then snuggling on the couch some more and watching TV (she wanted to watch Lifetime, I wanted to watch Spike, we compromised and watched USA).

Ultimately I cleaned more, organized more, bought tons of groceries, made a turkey Manwich (a craving I've never had before but was shopping hungry - my obvious fault. Manwiches are kinda gross). I also made the famous "Gerry's Meatloaf" That my mother and I learned about from Torontoite, Gerry, on our Turtle Trip to Saint Croix. It freezes well and I figure will be appreciated post call and after long days on OB. I feel better now that all the raw meat has been cooked in my house.

Tonight I will debate making either black bean soup or Suhani's Lasagna. Both of those should freeze well also. However, I hear rumor of a potluck at some point next weekend and both of those would also be great potluck dishes.

So have I resorted to boring domesticity? Cat, couch and meatloaf? I don't think so. This time next week (or, rather, time time next week probably after a few days of various certifications in life support for various populations) I will be delivering babies.

I got the hang of delivering placentas as an M3. I held a bladder blade during c-sections like a champ. Now I will be catching monitoring fetal heart tomes, stitching up tears and opening uteri like butternut squash. The actual catching of the baby is the "easy" part. I have so much to learn in the field of OB.

For now, however, my biggest concern is what to wear for picture day.

Summary: Cat healthy, Pride skipped, fridge full of meatloaf, starting with obstetrics next week. More later on my new co-interns.

Tacoma Aroma

So there was this rumor I heard about the "Tacoma Aroma". This less-than-affectionate terminology apparently came about in the 1930s when Tacoma's Sulfur-emitting paper mills began to stink up the city. By the 1990's sulfur emissions had been reduced by more than 90%. The aroma is still famous but rarely smelled. The wind has to be just right, you have to be in just the right place, in the right part of town. South of the Tacoma Dome, at La Quinta, my father and I got a whiff (I thought he farted, he thought I farted, it was all very amusing).

Since I've moved, I've smelled nothing but good stuff! Cut grass, pine needles, and best of all, today, I got a wonderful whiff of lilies. I went for a jog in Wright Park (old pic of a bandstand at right). The park is behind my house, about a 27 acres I think. It has statues, a lion and two "Greek maidens," Fannie and Annie. It has a cannon, a large pond, bridge, an Ibsen bust, basketball court, and enough homeless people to qualify as an urban green area. There's also a conservatory (left), built in 1890, opened in 1908, I haven't been in it yet (I was a bit sweaty) but running by its open doors I peered into to rows and rows of lilies, trees, other flowers. It smelled amazing! Each lap of the park (about a mile around) I was given a second and third wind by the smell!

Earlier in the park, as I was unpacking my LAST BOX (!) there was drumming. I could hear it from my open windows. It sounded like a marching band percussion line. I peer out my window and there was a procession of highschoolers graduating. Friday I caught a bride and groom posing for pictures. The water view is amazing but the park has yielded some great people watching, exercising, and flower smelling.

Unpacking has been going well. I finished all my boxes (see above) and have been organizing and reorganizing my closet space. The only storage I have for my bathroom is a small medicine cabinet so I had to arrange all my toiletries and such in milk crates in the hall closet. That was fun (note sarcasm).

Tomorrow, if I can get off my duff in time, I'll be heading to Olympia for Capital City Pride. I'm going to try and make the parade and some of the park activities and come back in time for dinner. Of course, there is a chance that I may sit on the couch and watch the endless run of Law and Order: SVU reruns and try to get my wireless security working. However, I will try and get out and go to pride. I even put out my rainbow belt and socks and wristband for the occasion.

The last of it

Okay - quick rundown on the rest of the road trip... mostly because it involves cool pictures.

We spent some memorable nights at hotels like the Wyo and Ruby's (in Missoula). Ruby's was on a river and pretty sweet. I also found I loved Missoula. It's a real college town, like Cambridge or Ann Arbor, but smaller, and in Montana of course. It was hip with a very visible gay scene and we ate yummy vegetarian at Tipu's Tiger.

We visited the sight of Custer's last stand (left). It was sobering. The battlefield remains untouched and basically identical to what it was like back then. We also drove through the mountains of Montana and Idaho, passing through tiny mountain villages like Wallace. Some of these places were famous for their whorehouses (a miner's gotta do what a miner's gotta do).

We made a stop in Spokane to visit dad's cousin Henry and his wife Renee and spent our last two nights at a hotel in downtown Tacoma. The view was nice (but not as nice as my place) and Sive enjoyed herself immensely (see left).

On the 8th the movers finally came with all my stuff. Minus my bedframe which was still tucked away in a warehouse in Michigan. It has since been sent via UPS. The move appears to have resulted in a broken 15-year-old hand-me-down CD player (not a big loss), a few scrapes, warps and paint chips as well as some serious drama regarding my couch.

My beautiful, comfy, warm, cozy, awesome, anyone-can-lay-on-it-all-the-way leather couch would not fit in the elevator. My gung-ho movers were not to be beaten and decided to start carrying the couch up the 15 flights of stairs. As they arrived on floor 6 one mover came up to check out the clearance from the hall into my apartment. It wasn't going to fit!

Now what? Big leather couch on stairwell. We deliberated about what to do, I consulted the landladies about where to put it, cried a little bit (hey - moving is stressful stuff!) and ultimately we came to a solution: I could store it for free in the apartment oversize-storage space as long as I got rid of it in a few days. Now... would it fit into the storage space? With much maneuvering, rolling, lifting, standing on end, and four brains figuring things out it was finally laid upright in a storage unit. I listed it on Craigslist for all of $100 (9-foot leather couch - probably worth $800 in its used condition). I got a ton of interested people within hours. The lucky recipient of a brand new, used, leather couch, a dude named Colin who bought it as a b-day present for himself, and his buddy were able to maneuver the couch out so much easier than it went in! I mourned but I'm dealing.

Then there was the Ikea drama. Long story short: Ikea dresser bought, dresser assembled (over two-day period), by father for most part (love ya!), Ikea dresser drawers don't work, Ikea dresser weighs 200 lbs, Ikea customer service finally agrees to replace dresser and remove old one, also agrees to assemble dresser for me. Horray! It was a long ordeal and I was known to say "I hate Ikea" or "I'll never shop at Ikea again, the bastards!" but in the end Ikea was great and helped me work it all out. With the help of Mom (love ya!) who knew how to finagle customer service like a hardcore pro. Another dresser bought was much easier to assemble, restoring some faith in the Ikea system. See the massive amounts of screw and pegs for the dresser that caused all the problems at left!

So that's pretty much the excitement of the first few days in Tacoma - then, after the 'rents were all gone, there was the kitty situation (mentioned in the last post).

Sive was exhibiting all the signs of a kitty UTI and had to stay for about 24 hours at the vets to get a urine sample. Results on Monday. They took other labs but I'm pretty convinced she's overall healthy, just may need to clear a bit of a urinary tract infection. Poor baby. I missed her so much and last night without her was actually harder than I thought!

When I returned to the vets this afternoon the receptionist and I started talking and there was meowing from "the back". Sive heard me talking and started yelling for me! They brought her to the front and she immediately started reaming me out for leaving her there. They loved her and were sad to see her go. I got lots of compliments on what a good kitty she is. :) But I got a stern talking ot about her weight. They recommended a prescription diet cat food. Expensive, but something I'll think about for later. For now we'll just play more and eat a little less :)

And check out the view from my living room sofa the other day :)

Runs with Cat

Traveling with my cat was much easier than I anticipated. For those of you curious as to how Sive managed the five days in the car here's an update:

The first day I had Andrea's help. She gave me great advice, grab the scruff of the neck (triggers endorphins and chills the cat out) and then pop the pill. Worked great. Every day I gave her a mild anti-nausea med with sedative properties. She wasn't conked out but was really chill in the car all the way there. Each day got easier in regards to pill popping and crate stuffing. One day she was so quiet in the crate we got worried and had to make sure she was still okay in there! She was fine, just hanging out.

After a couple days on the road she figured out the routine and began to hide in the mornings after her pill. Thankfully, all the hotels we stayed in didn't have space under the bed for her to hide so she ended up getting a bit creative. In Madison she found a way to wedge herself between the box spring overhang and the floor where the head of the bed hit the wall. Another couple places had lazy-boy recliners she could hide under. The other times she chose to burrow under the covers (see cat-shaped lump below).

She enjoyed the evenings most, checking out the hotels, sniffing around, drinking from the sink, jumping on things. She ate like a champ and used the litter box every night without issue (yay!).

Now we're settled and she's happy but I worry she might have a UTI since she is using the litter box about 5 times more than usual. She may be just marking her new space or being neurotic but there is a vet’s office close by so we may just pop in if it doesn't get better soon.

Now I just have to figure out where to put the litter box in this small space! The bathroom is waaay too small for both it and me so I'll have to be creative. Next post will finalize the travels and after that a bit of a dramatic summary of moving/unpacking hell. I bet you all can't wait for that.

Day three - still driving

All this driving is wearing me out. But it's been pretty smooth sailing. One casualty on the way out here - I think it was either late Wisconsin or early Minnesota when Pat Benatar came on my iPod. Just as she was singing "hit me with your best shot" a starling dive-bombed right into my front fender. Or, at least, so it appeared. After impact, in my rear view mirror, all I could see was a tuft of feathers floating. We inspected the car at a DQ in a small farming town (Chatfield, MN) and saw no evidence of bird parts. I'm optimistic that the bird miraculously flew under my car and survived to tell the tale... maybe via its own little birdie blog.

At the aforementioned DQ I got the chance to eat some fried cheese curds. Kinda yummy, kinda gross (see cheesy goodness at left). We also, in Blue Earth, Minnesota, got to hang out with the Jolly Green Giant! HO HO HO! (check out his giant booty!)


Aside from the JG Giant and the kamikaze bird WI and MN were without much incident. South Dakota, on the other hand, was pretty fun. A long, long state, there was plenty of opportunity for adventure.

The second night we stayed in Chamberlain, SD, population 880, right on the gorgeous Missouri River. It was an adorable town and I got to explore it when I went for a little jog in the morning.

There's a store in Wall, SD. Some of you may have heard of it. Those of you who have ever driven down I-90 in SD surely couldn't have missed it. It's called Wall Drugs. Every mile or so along the entire length of I-90 is a sign for this store! "Coffee 5 cents" "Free Ice Water" "See our backyard, bring your camera!" etc etc etc. So much of the state was spent in anticipation of Wall Drugs. Not sure if Wall drug lived up to our expectations. I think it may have. I did get to ride a jackalope (see left!)... and see an animated t-rex, and western art, and ice water, and homemade ice cream,stuffed game of all types, old photos of Calamity Jane...

SD has kitsch. I thought the trip to the UP was kitschy. I thought rural PA could be kitschy, or Platt, Nebraska. I was so wrong. Giant prairie dogs, giant steer heads, steel reenactments of "Cowboy and Indian" fights. The thunderstorms we drove through were also spectacular!

Today we finally traversed SD and are in Wyoming. We saw Mount Rushmore, the badlands, the black hills... it was a lot of tourism and less mileage but still more than 11 hours in the car. I'm exhausted, so 4 states and yet another time zone later I must sign off and hit the hay!

Road tripping

Just finished day one of the 4-5 day drive to Tacoma. Yay for free hotel wireless. :)

So sad leaving my awesome condo. :( and my friends :( especially my pregnant friends who may be moms by the time I see them again.

Sive and I are chilling in our $46 hotel room. At least it has AC to beat this Wisconsin heat. Tomorrow hopefully will make it through most of South Dakota.

Today's tally:
1 time zone change, 4 states (Michigan, Indiana, Illinois, Wisconsin), and about 400 miles (shorter driving day as we stopped to see a cousin in Chicago on the way out).

Probably around 2000 miles or so to go. Hopefully will have free wireless again to update tomorrow. Must now get my beauty rest. Tomorrow is going to be a long driving day. Thinking 10 hours on the road.