Heterosexism and daffodils

I have been feeling a little bogged down by residency as most people have noticed. Tacoma, while not without its charms, hasn't proven to be a liberal city charged with excitement over advocacy and change. Last week I was treated differently by a clinic office where I was a patient. The receptionist was pleasant as pie to me until I brought up that they didn't have domestic partnership under "status" on their intake. This means same sex or common-law couples would be obligated to leave it blank or check "single" - a very big pet peeve of mine. After that she was cold and, while not completely rude, had obviously decided I wasn't worth her time anymore. In addition to the icky taste that left me, I also heard a rumor (from a reliable source, but a rumor nonetheless) that my employer is prioritizing profits over patients by trying to monopolize the market on drug-store clinic offices. I am not impressed. (Photo is a sign between my clinic entrance and the hospital entrance. First time I saw it I thought it was Russian).

So I am trying to reach out and find things that make me feel useful, happy, hopeful. Something other than work because, I have said it before, the work of a resident is pretty thankless most the time. Seriously, how many of you when you are sick and miserable feel thankful for anything? It also doesn't help that in our program the second year of residency is just as grueling, if not more so, than the first. So the light at the end of my tunnel is very far away.

Countdown clock:
Days left of residency: 816
Vacation days left of those: 49 (one coming up in a few weeks)

Next week I will be heading to a local elementary school to present to kids a pre-packaged presentation called Tar Wars. Click on the link to read more about it. It essentially is aimed to target kids before they start smoking or see peers smoking and involves some interactive activities.

The following week I will be traveling to UW medical school to participate in a workshop to teach first year medical students about the musckuloskeletal exam - joint exams, range of motion, that kind of stuff.

This weekend I have a black weekend. But after that I have my first weekend off in two weeks (oh the joys of a supposedly out-patient rotation)! That weekend promises to be nice with an event Tacoma has been hosting for 75 years.... drum roll.... the daffodil festival! And while it's still more than a week away, it's something to look forward to.

So long sterile field

Surgery
It's my last week of surgery. I'm certainly not broken up about it. I still find the OR unpleasant but I've learned a bit in the last month. I've found if I wear my glasses instead of a face shield I can battle my claustrophobia. I have learned to assist the surgeon much more efficiently. I have also learned to sew a bit better. The latter may be the only skill translated to my future career. However, assisting in the OR will come in handy as a resident - especially on our two month long R2 OB rotation where we are the first assist available for C-sections. However, I still strongly dislike the sterile field. I still find the OR demeaning to patients who are laid out naked, asleep, like broken toys with various parts taped, exposed, twisted, lifted, whatever suits the surgeon's needs. It was especially bothersome on this rotation as all my patients were children. I'll spare my readers the details.

On a positive note, I have learned more about surgical diagnoses. And I have felt many a hernia and feel more comfortable knowing when a referral to surgery is warranted. I also realize how glad I am that I didn't pursue a career in surgery. If I wish, I can use my newly honed surgical prowess to play this game - and that's enough for me.

This Friday, after my last morning in the OR, repairing hernia after hernia after hernia after hernia I take call for TFM overnight. Post-call on Saturday I hit up the Tacoma Ballet. Then I start orthopedic surgery on Monday. Most of my days will be spent at a nearby army base. The rotation has not had the most favorable reviews but I'll surely make my own opinion. I wonder how well my rainbow, anti-W, stickered car will go over on the base parking lot.

Oh, and bonus material: I bitched about my flight back from Houston but never got around to posting it. I got a bit caught up in my carrot soup adventure (am still, days later, finding orange-yellow splotches to clean in the kitchen!)

Bush Airport (figures.)

My flight home from Houston was a disaster. I spent 4.5 hours at the airport being jostled, stepped on, pushed around by crowds. Everything was so busy it reminded me of Boston airport at Thanksgiving (talk about chaos!). The best part? I had a joy of being notified every half hour the status of my flight, which, each time, was deferred until the next half hour. This occurred until I was no longer to make any connecting flights and looked like I would be spending the night in Houston or Portland, maybe even on my own dime.

I ultimately found, on my own, a flight leaving for Seattle within an hour or so. I lugged my crap to the gate to see if there were flight attendants there yet. No such luck. So I was forced to head back to the customer service center and wait with other frustrated customers. Thankfully, my last trip there (there had been three altogether) I was helped by a woman who was actually nice and helpful! Go figure! I was booked on a direct flight to Seattle and just had to wait and make sure it boarded, taxied and left Houston. But, by this point, I was much more optimistic.


Wild Ride
I ended up with the "last seat" on the plane. A woman was with two small children next to me. I had the middle seat and she offered me the aisle (either that or sit between her children). I served as a changing table, consoler, formula mixer, formula tester (inadvertently - ended up burned by hot water and with formula all over my clothes). But I was so happy to be on that plane I would have breast fed if she asked me to!

The flight was terribly turbulent. We were forced to stay in our seats a majority of the flight (thus my supporting role as a changing table). Even the flight attendants were asked to take their seats on occasions. Apparently a man a few rows ahead of us was "having a nervous breakdown" a flustered flight attendant informed my adult row-mate in response to her pressed call light. The real treat of the flight was when a young man a row behind and across the aisle sneezed a wad of phlegm onto the left side of my face. I've had worse (remember my first month on OB?) but that was just uncalled for. Cover your mouth you germ-spreader, you!

I ended up back in Tacoma very late and so completely exhausted I fell asleep with my clothes still on.

Domestic Goddess

So those who have known me longest know I never cooked. Even now, when I make something as simple as an omelet members of my family, and some of my oldest friends, will exclaim with shock, "you cooked?!"

Confession time: I've been a bit of a closet cooker since I really learned to eat healthy about a year and a half ago. I have to blame Troy and Tom, two old roomies from way back when who were great cooks and did a lot to dispel my fear of all things kitchen.

Today I have outdone myself. My revelation came from two thoughts:
1. I decided I wasn't going to let that pound of carrots in the fridge go bad
2. I love soup

I already make a killer black bean soup (if I say so myself) and have been known to buy large vats of homemade soup at the local grocery - plus, the month in San Diego with Cathy's homemade pots of heaven was an inspiration. I really like carrot and squash soups but there are a few spices I really don't like that are often used in the pre-made variations. So I thought I'd make my own version!

The result was rather good. Fresh grated ginger, garlic, onions, cumin, curry, turmeric... it was scrumptious. In a flash if inspiration I added cinnamon at the very end. After everything was simmered and the carrots were sufficiently mushy I pureed the soup. Most the recipes called for cayenne pepper, which I didn't have on hand. Next time I'll try some of that, maybe less turmeric, and certainly much more ginger (no such thing as too much ginger). The only kitchen disaster worth mentioning in this carrot soup adventure was when the top of the blender flew off during the pureeing process, hitting me, my kitchen and anything in range with numerous yellow-orange splats. But it wasn't a difficult clean up, and the only real casualty was my right sock which is now curry-colored.

The best part of it all? I stepped out to take out my trash, and when I returned the house smelled of all the above spices. And suddenly I was reminded of a number of things: college, friends, comfortable places with love and companionship, other people's homes where I feel safe and warm. And I was actually moved by the smell of my own house.

Now that's damn good soup.

NPA, AMSA, GLMA, oh my!

I am now* wrapping up my 4 days in Houston for National Physicians Alliance (NPA) conference. I would love to talk about explorations of Houston, TX and the fabulous meals I had at its famously awesome restaurants. However, essentially every day from 8 AM (6 AM Tacoma time) until 9 PM was committed to sessions, organizing, meetings. The weekend was exhausting, but productive and invigorating... and exactly what I needed!

It's great to spend time with other docs who think like me, who care about change, policy, patients, diversity, integrity, moral responsibility, wellness. Here at NPA there is no talk about how we can maximize our practices to make more money, it's all about how we can further social justice, try to stay pharm free (battle drug reps), fight data mining, advocate for the underserved, struggle for a health care system that is actually about health care, not sick care (to use Dr. M. Joycelyn Elders, the former Surgeon General's, words from her keynote address on Sunday).

These are my people.

Thankfully, NPA and AMSA had enough overlap that I could see my old chums from LGBTPM/HAC, Global Health and AMSA National. I also got to reconnect with GLMA as their Executive Director was also here this weekend. I missed the GLMA National Conference as it coincided with an inpatient rotation and was way off in Puerto Rico. Next year it is fabulously in Seattle so I will certainly make every human effort to attend as much of it as possible.

Hey - and look at all those links up there! I bet you are itching to just check them out... :)

*disclaimer: Melikagirl seems to post my blog sometime in the future. Proving that on the Internet, time is not a continuum. So "now" may not be an acurate description

Soggy in Seattle/Tacoma

Today I was so cold I had to take a hot shower when I got home from work just so I could feel my toes again. For some reason, the 2 degree weather in Michigan never quite felt this bone-chilling. Must be the dampness.

I was hoping for a break in the weather but saw the below report instead. (From weather.com). Kind of a typical report for these here parts. At least in the last 4-5 months.

I'm leaving for Houston for the National Physician's Alliance Annual Meeting tomorrow morning. Woo-hoo! Here's hoping for warmer (and maybe less rainy) weather.

Stitch in Time

Okay, okay... I don't hate surgery as much as I thought. I most certainly would NOT chose orifice-bound red hot pokers over this.

I don't love it, either, but I'm definitely getting some more technical skills from this rotation already. A full week and nearly dozen surgeries later I can stitch a wound closed and actually have it look kinda decent. I even intubated a 7 year old without much difficulty - wasn't even nervous. Granted, I used an LMA, so intubation might be a generous term for it, but it still felt like I did something. (LMA = Laryngeal Mask Airway, so easy to place that the 7 year old probably could have intubated himself if he was awake).

And, surprisingly, that's all I have to say about surgery. I still haven't been yelled at, demeaned, or treated like dirt. There's still three weeks so I'm not holding my breath.

However, I have been scutted out on several occasions. I just keep reminding myself that I'm an intern, a lowly intern, and I'm supposed to scut. Scutting, sadly, is my expertise. And while it's a bit frustrating being ordered to do remedial, often secretarial-type things with no educational value on patients I have had no interaction with, just because it makes someone else's life easier, or lets them eat lunch a few minutes earlier, it is only during training. (Photo from Michelle Au's Scutmonkey comics.)

The real question is, when I'm no longer a resident and am out in the real world, will I look back and pretend it had educational value and convince myself it's okay to train my own scut-monkeys? I'm afraid that answer may be yes. Philosophically speaking, we get ourselves through some rougher times knowing it'll be over at some point. But in reality, it'll just be over because someone else will be doing it instead of us.

Enough philosophy. I'm on surgery. Grunt grunt. No deep thoughts allowed.

My new computer is sweet, by the way. Mac's rule and my Macbook Pro is no exception. When I got it I thought it was cool that while it's got a bigger screen, it's much thinner and lighter than my old 2004 iBook. I also thought it was neat to actually see letters on the keyboard since mine had long since worn off. And that was all before I even turned it on! The picture at left is a Macbook Pro in 24-carat gold with diamonds on the apple logo. Not exactly what I'm typing on at the moment, but it sure feels like it. Below is a video of my old computer and its Death Screen - the best imaging I can seem to get when my computer is at just the right angle. Sive also co-stars as herself.

No butts about it

My welcome home was rather uneventful. Beth was so kind to pick me up at the airport. Sive protested my absence with caterwauls for days (still more noisy than usual but more like her usual self). I joined my comrades for drinks at a pub a block away and took overnight call admitting patients to Tacoma General.

Then after a long post-call nap on Saturday I attempted my taxes.

Suffice it to say that it didn't go well. The sum result is many wasted hours and a totally dead computer. In fact, I type this from the call room at TG.

Sunday I caught up. Cleaned house, ran errands, repotted plants, shopped, shopped and shopped some more (and we all know how much I love shopping <-- sarcasm again in case you missed it).

Then Monday I started surgery. The morning began with me perusing anal anatomy in my text book while I ate my Kashi waffles. The first case involved making an anus in a child born without one (for those of you Google-happy folks, it's called an anorectoplasty). It was an interesting procedure. I was yelled at all of ZERO times (already an improvement from med school). And I even helped a little. At one moment in the surgery I was holding traction on the rectum, newly freed from its prison too high in the perineum, protruding like a little slug with black threads in my grasp like little whiskers, and I had a terrifying thought as the primary surgeon sewed sphincter muscle to the slug -- what if I hold too much traction? What if I pull the anus right out? And I flashed to terrifying future where Surgeons would shake their heads mournfully and remember the resident that pulled the rectum right out of the baby. But hold the traction too loose and perhaps the anus wouldn't be in the right position! Thankfully, the moment was short and the muscle was tacked on expertly. I let lose of the whiskers and after only a few hours at most, a little baby now could poop.

So hopefully surgery will be a more benign experience this time around. But I have to admit, I still hate scrubbing in, breathing my own breath in the mask, and living in perpetual fear that I may jeopardize the sacred sterile field.

Apologies for the poor metaphor above (I know slugs don't have whiskers) and thanks to Tacoma for being sunny and all spring-fresh and blossomy these last couple days. Making the transition much easier.