Friday, February 22, 2008

Health care is a right, and don't call me kiddo

Pet peeve #19: I hate being called kiddo. It really pisses me off (see left). I assume it is supposed to be a term of endearment. To me it means I'm a kid, less than, and I hate it with a passion. I stood there internally boiling when the nurse called me kiddo the other afternoon. I was boiling, I tell you. The conversation? It was about the clinic schedule. Which had been triple booked. 11 patients to see and staff in 3.5 hours. Complicated patients -- ones who often have never seen a doctor before and are coming in for, say, diagnoses of diabetes with renal failure. Not to mention my medical interviews had to be conducted in three different languages (who said my French would be useless here?). So to couple "hey - by the way, you're it today, but we scheduled for twice the docs" with a "kiddo" evoked a reaction in me I didn't expect. I didn't do anything about it -- it would have been unprofessional. Kind of like, say, calling me kiddo.

Last week in general was full of hard work. I finally finished my research project and managed to return to the farmers market again on Wednesday where I got my picture taken with the OB Robot and froze my butt off watching the lunar eclipse. The weekend was uneventful mostly thanks to the rainy, cold weather we've been having.

My project, basically, looked at the population seen by Father Joe's clinics and what kind of unique issues might be addressed. I had hoped to talk about LGBT homeless and runaways, however the LGBT Youth Center and housing coalition never returned my calls. I also briefly addressed the issue of illegal immigrants and their non-existent access to health care. Excerpt from my report:

Poignant example, an elderly woman brought in illegally by her daughter (whose status was unclear but who was fluent in English and well-established in the San Diego area). This woman had a stroke with left sided weakness and swallowing difficulty. However, speech and swallow evaluation, therapy and additional rehabilitation resources were an impossibility. Even if she returned to Mexico it appeared unlikely she would get the help she needed.

I don't care how you feel about immigration, you cannot deny that this woman deserves care here, now. Who would care for her in Mexico? Her family is here. How would she get around with her hemiparesis alone while her legal alien or even resident children risked losing the jobs if they went to help care for her? How would you feel if you had a stroke in a foreign country where you don't speak the language and no one could help you?

I barely touched on LGBT and immigration issues and ended up primarily addressing the issue of nutrition. A majority of the patients seen at The Village (the source of most the data I used) are homeless. Many of their top diagnoses could easily be linked to nutritional concerns. So I talked to the San Diego Food Bank, some other shelters and sites and read a few articles and came up with some theoretical suggestions for the population.

And now the project - hooray - is done. I have two more days of clinic (Mon, Tues) and then it's back to Tacoma for my favorite* of all rotations: surgery.

* "favorite" actually meaning "most loathed". Sarcasm can be hard on blogger.
photos shamelessly pasted from google image

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Tuesday, February 19, 2008

Week(end) in (short) review

So, I had this great idea to summarize my weekend in Haiku. However, after much thought (minutes, at least) I decided against it. Maybe I'll defile an ancient Japanese art form later.

This weekend wasn't bad at all. The work week was hard. There was one day where I seemed to be the only doc who showed up on time for clinics and ended up having the responsibility of chipping away at the long queue of indigent patients alone, without knowing when, and if, my co-residents or attending will show. What made this particularly intimidating is that I am in the unique position here in CA where I need complete back-up from a UCSD attending - I can't even sign my own Rx's or sign the clinic's discharge orders letting the patients leave after being seen! So, as a result, each patient I saw remained in the mobile unit or clinic office, waiting in a little line to be re-seen or staffed before they were able to get their cough syrup, asthma inhaler, or clean bill of health (whichever the case may be). Thankfully everyone who was supposed to show up eventually did. And, though patients were needlessly waiting, at least they had somewhere warm and dry to wait because that day was a particularly rainy and cold one.

After all that, my Dad and step mom, Julie (above), who were delightfully in town for a couple days, spirited me up to Laguna beach to visit with Julie's brother, Daniel (with me, playing imaginary chess at left - I'm so winning). We walked, window-shopped, ate. It was very relaxing and nice to see my family for the first time since early fall.

Sunday Jeanne and I went downtown for the Chinese New Year festival. Last weekend (was that just last weekend?) we went to the Vietnamese Tet Festival. This event was less a carnival (like Tet) and more a street fair with vendors and Chinese food and, of course, a cultural show (see dancers below) that went on all day with everything from dancing tots to Kung Fu. Reminded me of the Chinese dances I had the pleasure of learning and performing back in the Biorhythms days. It was very festive and a beautiful day.

Then, to top it all off, today, thanks to our forefathers, I had the day off. Bad news: it was cold, overcast and dreary. Good news: I wasn't working. I sat around and read (am very disappointed with my Pulitzer-prize winning book - 1985 must've been a slow year for fiction), wrote ramblings in my journal and stared blankly into space while I tried desperately to keep warm. I think my lazy day was partly due to the awful night sleep I had. In fact, "sleep" is a bit generous for what I did last night. I had terrible nightmares and really vivid dreams. I would blame it on something I ate, however, I seriously doubt sliced cheese and vegetables were the cause of such torment. I think part of it was a movie I had seen, Paris je t'aime. It was an interesting movie, with really only a couple violent or disturbing scenes. My theory: I haven't watched much TV or movies lately so the visual images must've lit some sort of subconscious fuse and BLAM! my cortex went haywire.


Hopefully tonight will be restful, for this promises to be a hard week as well. Hopefully by the end I'll have completed my research project for this rotation. God I hope so, since the data collection alone for this thing has been absolute torture and drudgery. Who knew it would take three days and five times as many phone calls to get M&M data for San Diego County?

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Thursday, February 14, 2008

VD, not just an STD

I'm not going to go on and on about VD. How it's a construct of consumerism, yadda-yadda. Actually, to be completely honest, I don't mind constructed corporate holidays. They are holidays after all. Sometimes they are a day off of work, sometimes they are just an excuse for consumerism. Either way, I am not anti-VD because it's "made up" or "a vehicle to make money" because, if you really sit down and think about it, all holidays are "made up" and every single one of them, yes, even Flag Day, invites the greedy little mouths of capitalism to bite in.

I don't like VD because it's very anti single. Sure we can recognize our friends, send love to family. But really, don't we all know deep down inside that valentines day hype is all about romantic love? Hell yeah. So those romantically-starved folks out there are looking at the little hearts and flowers everywhere thinking, "Jeez, why can't it just be Groundhogs day again? That was more fun. And they are much cuter than fat babies with weapons." I know I am.

Bah humbug VD.

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Tuesday, February 12, 2008

Dude, the waves were *epic*

The best part about this rotation is my four weekends off. The first was the first weekend I arrived, a rainy book-reading, movie-watching kind of weekend (read Kafka on the Shore and watched Juno - highly recommend both). This past weekend was absolutely beautiful. On Friday, later in the day, I walked to Dog Beach and watched the dogs play.

There is something about watching dogs play with each other and their owners that is meditative and peaceful. It's such unconditional love and joy it's hard not to have it touch you. I never seem to tire of watching the dogs. One dug a hole and was standing in it barking at his owner and digging some more. Another pair, dog and human, were rolling around in the sand together. One time I saw a man and a dog on the towel, stretched out on their sides, facing each other. The man was stroking the dog, lovingly. The man's wife or girlfriend was standing to the side smiling, not at all perturbed the dog had taken her place. I think I realized the most special part about dogs is that, instead of belonging to you, they belong with you. They are part of your pack and I honestly feel it means something to them to be with their owner.

There was a festival on Saturday call the Tet festival (follow the link for more info). It was a Vietnamese festival for the lunar new year and spring. The sun was pounding hot and we explored the festival (which was really a carnival with a stage and some sponsors) and watched the opening ceremonies. The lion dance was by far the best event of the day, in my opinion. (photo above from Tet Festival -- courtesy of Jeanne, all others on this post are courtesy of Jeanne as well).

That evening we went for an art walk on Ray Street. Local artists, student artists, gallery after gallery until we collapsed. One artist in particular seemed blog-worthy, Adan Chinchilla. He does modern/abstract interpretations of pet photos. Instead of the usual immortalized-on-canvas realistic, dusty, old, oil paintings he paints bright interpretations. I mention it mostly because I know many of my readers (hi!) are pet-lovers and may actually consider one day immortalizing their pet on canvas. Much better than stuffing, that's for sure.

Sunday was restful. We went for a long walk late in the morning and watched huge waves crash along the bottom of the OB Pier. It was remarkable. They must have been at least 20 feet high. Surfers were little dots on the waves and surfboards were flying in the air as the riders were pounded into the water. I had visions of tsunami the waves were so impressive. Then, just like that, the ocean calmed.

I definitely had a great weekend. I was sorry to have to go back to work but the pace at work isn't too overwhelming and while the patients are complicated they are mostly very nice people. The faculty is also very kind and do a lot of teaching. It's not a stretch to see myself working in this city... small house, big dog, sunny weekends... but we'll see what the future has in store. I have another couple-few years in gloomy Tacoma to figure it out.

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Wednesday, February 06, 2008

RIP Cell Phone

Unexpectedly my phone decided to quit on me. I always thought it would go in a bang, crashing down a flight of stairs and shattering into a million pieces. Or gently into the abyss when the contract was up and it was just time for a new one. I never expected it to die so suddenly. One minute I am chatting with Andrea about babies and breast milk and the next minute my phone decides to get all wacky one me. I won't go into the gory details of its death. Just rest assured that it was gruesome. There was blood, guts, screaming and begging. Actually, there was white screen, black screen and red screen. The electronic equivalent of blood, guts and screaming.

So, my friends, while my contacts remained intact (thanks to a free online service Verizon offers) my photos are all gone. No more closely cuddled newborn babies to show off. No more Sive and her criminally cute faces to make people ooh and aah and say, "wow, she is big!" No longer are the photos from my last year in Ann Arbor with the trees changing color and friends' faces in pubs. But, you know what? Those pics kinda sucked. Face it, some phones take really crappy pictures. Mine was one of them. So, while there are a few I'll miss. it's much preferable to have a means to communicate with loved ones then sob over some mediocre pictures of them.

So there you have it. Death of a cell phone. Now I have the identical phone and, thanks to some futzing around, the identical ring tone (thank god because I detest the free ones - they all sound like your phone is going to explode! Seriously, do I really need a virtual red hot poker jabbed in every orifice when someone calls?)

Good news however... we had really yummy food tonight at Jeanne and Cathy's. Cathy is a whiz with homemade soups and Jeanne whips up a mean salad. The pic at left shows me enjoying such soup (note the steam rising!) and Cathy offering me some wine. My aunts, if I've failed to mention this before, are vegetarians and we have been eating fresh fruits and veggies every single day. I swear I've eaten more fiber in the last five days than I have had in the last five months. Well, maybe not quite, but the healthy eating is doing me hella good.

Another aside: the California primary was today. Can't vote here so I can't get excited about it. Nonetheless, I have to say, from what I have seen in the debates, I genuinely like both democratic candidates. Much to the chagrin of some of my other progressive pals who think Hil is a devil moderate in liberal clothing. Alas, enough blogging for the day. I must get some rest to help replenish my energy for more adventures in homeless health care tomorrow. Stay tuned for more fun filled adventures.

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Saturday, February 02, 2008

The big, the sad and the promising

First - some ruminations from the airport (1/31/08):
7:30 AM – check bags and go through security
Ever since they hired a special group to do security I have found the security personnel have been so much nicer. TSA employees, in my experience, have been generally very sweet people. Except today. Today they seem grouchy.

8:00 AM – buy WIRED magazine
I love this magazine. If I didn’t already get NEJM, JAMA, AAFP, EW, The Week, Environmental mags and ten million email listserv messages I would totally subscribe.

8:20 – read some of WIRED
Totally sweet. Way more fun than JAMA. Pictures are cooler too. A columnist vocalized something I have been trying to figure out for ages: “If you want to read books that tackle profound philosophical questions, then the best – and perhaps only – place to turn these days is sci-fi. Science fiction is the last great literature of ideas.” This comment was made in context of a novella about the ramifications of duplicating physical property like we can MP3’s. This would include (I presume from the tone of the column) medications, electronics, and vehicles. The result in the novella is the demanding of royalties from developers to the point of warfare and invasion. Hmm… much less passive aggressive than letting HIV+ third world citizens go untreated and transmit and die from AIDS. Interesting theory. I may have to find this novella and read it myself. It’s called After the Siege.

8:45-9:00 – walk around airport
Random thoughts in the airport: That man totally looks pregnant. He’s not fat anywhere else. In fact, I wonder, maybe it’s not a man. Maybe that is a pregnant woman. No. No… that’s a man. Amazing - he's totally skinny everywhere except his belly. I bet its ascites.

After wandering around and trying every hand lotion I come across I probably smell nasty. Like a cocoa butter-tangerine-lavender-coconut-cherry-olive oil smorgasbord. And you know what? My hands don’t even feel the slightest bit moist! Imagine that. Maybe I should go back and try the hemp hand lotion.

9:15 AM – finally find an outlet. Plug in and type.
Wow, I have an hour before we are even going to think about boarding. It’s nice not having anything for the overhead compartment. Then I don’t have to worry about gunning for the space. Maybe I’ll board late. DVT’s suck anyway.

Debating signing up for some wifi. When will they just make it free? Like drinking fountains? Seriously folks, wireless is becoming a bit of a racket. It’s everywhere, there are probably more than a million (surely) possible connections in just one city. Each person shelling out, say, $40/month on average? That doesn’t even include the cost of a router. Yeah, mine is $33/month for now, but after my deal is up the price will soar. I understand they have lots of cost in managing the main routers, connecty thingies, etc, but when all is said and done, in this high tech world, how much will it ultimately save everyone if we just install routers on every street corner? And get businesses to buy in with a one-time yearly fee? Sure, I don’t know everything about wireless web connections – obviously, since I used the term “connecty thingie” – but don’t you think there is a better future than $10/hour service in an airport and $50/month at home?

My tummy hurts from my skim hot cocoa. Drank it way too fast.

9:40 AM
Why, for the love of god, does time have to pass so slowly? Off for more hand lotion.

* * * 2/1/08 * * *
Flight was uneventful. I read a little, watched a little movie on my computer, dozed a little...
Arrival was smooth. Aunt Jeanne picked me up and I ate a MOUNTAIN of steamers on the bay before heading back to the house and settling in. It was a good thing, too, because I needed the fuel to figure out that I was charged my deductible twice by my insurance company. This is not the insurance company's fault but still incredibly aggravating (long boring story).

I slept ok but realized sometime in the night, that I now, officially, have a URI. Gr.

Today in clinic was overall pretty nice. I would say excellent but the first part of the day was spent learning the system which is never fun. As I told Liza and Suhani my morning went like this: 2 hours orientation and paperwork. Get my first patient, see him, staff him (time for that, 30 minutes). Then spend another 2 hours writing his prescriptions, entering his orders, his referrals, documenting his visit, sending the proper messages through the proper channels and then realizing I did some of it on the wrong patient and having to undo and do it again.

The afternoon was much smoother and I saw a decent flow of patients. Most with mundane complaints. However, some of these folks have heartbreaking stories of how they ended up homeless - today it seemed to be mostly due to alcohol problems. The clinic I worked at today is situated in the middle of a place called Father Joe's Village. Click on this to find out more about it in general, and click here to read about where I am working. Pretty neat. Most, if not all, of my patients are sheltered there or living on the street.

Monday I am working with a traveling clinic. The Mobile Medical Unit. Click here for more info on that. It looks really awesome and I can't wait to see what they have in there.

I have a feeling this rotation is going to be very rewarding. I'll keep everyone posted. And don't forget to check out those links!

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