So long Tacoma, smell ya later!

The month of June was rather eventful.

It has totally exhausted me and have as much brain power as a cardboard box right now so bear with the less flowery language herein (the literary part of my brain is resting and waiting for its big binge after my board exams!)

So... June: Let's start from the beginning and try to break it into bite size pieces...

TFM Day
June rushed in with the dreaded "TFM Day" - a full 8 hours of residents (and other notable speakers, but mostly residents) giving dry presentations on evidence-based topics that are on their way to publication via the FPIN Network. I won't bore you with too much detail about the event. Just know that the whole process involves at least a year's worth of work, research and stress. My topic? Anal pap smears. I had hoped to perform a evidence review on transgender primary care but that wasn't approved. So even though I didn't quite get my topic of choice, in the last few years at TFM I have had the opportunity to present transgender medicine topics on my own accord. My TFM Day butt-talk (as I fondly call it) went very well and was actually a pleasure to give. The paper for publication is another story for another time.

Cle Elum
To celebrate the end of TFM Day, and the nearing end of residency, my class head off to Cle Elum, a quaint little rural Washington town, home of yummy Pioneer Coffee, and spectacular views! We recovered a little, bonded a little more, ate a TON (including an awesome Indian dinner made by our Indian classmate). We were there two nights and one full day and at the crack of dawn on Sunday Karin and I head back for our first uniformed marching band gig, a picnic in the park just blocks from her house. Afterward, we waiting in line, in uniform, for nearly 2 hours to get our $1 BBQ fixings (veggie burger included).

The Last Rotation
My last rotation of residency was an elective. I chose to rotate at Bastyr Center for Natural Health, a comprehensive naturopathic, acupuncture and homeopathic clinic in Seattle. In order to do this, however, I had to battle my nemesis, I-5. During the rotation I drove 300-500 miles a week, commuting from clinic to clinic. My previous efforts to coordinate my TFM clinics into full days (freeing me to learn at Bastyr for more than a few hours at a time) was massively unsuccessful - so back and forth and back and forth I went. But the elective was fruitful and I even felt, with my own index fingers on the pulse of a 90 year old woman, the actual palpable changes acupuncture creates in a person. Pretty amazing.

Chaos
Then, the proverbial you-know-what hit the fan and I started hurtling toward graduation at breakneck speed. Moving, packing, vet appointments, address changes, insurance coverage changes, forms to complete, etc etc... And, for extra fun my Mom and step-dad flew into town. We celebrated her birthday at Ray's Cafe, and over the weekend enjoyed in the festivities of the Fremont Solstice Fair and Parade! (us at right - Karin is on the end with the bass drum and I am playing trumpet behind her.) They stayed at my place, on the pullout couch, while I was packing and working, and then, for extra fun, my Dad and step-mom came into town and we had graduation.

Graduation
Graduation was a nice event - good food, good company, ample beverages to soothe savage beasts. However, it was four and a half hours long. For just eight residents. I was the very last to be graduated and by the time it came around for me to say my piece everyone was exhausted and surely sick of being there so I just said a few words of thanks and that was that. Kind of anticlimactic, I think. It didn't help that after all those hours of graduation hoopla I had clinic the following Monday. The best part of graduation for me was giving gifts to my advisor and getting to share with everyone the movie I had been working on for the better part of 4 months! I would love to post it here but am not sure people would appreciate their images up here for the world to see, dancing around and such. I rewrote all the words to Hotel California to reflect life as a resident at TFM and TG and filmed various folks singing and dancing along to the words. It was such a kick to make and I spent way more time on it than I did my FPIN!

Pride
Then came pride, or, "the gay Christmas", as Karin and I call it. With both sets of parents in town, my move a matter of days away, residency finishing, and all my duties with the band I was spread pretty thin. But I managed to enjoy marching in the parade, partaking in some of the street fairs and the festivities at the Seattle Center after the parade was over. One of the highlights of Pride this year was the huge rainbow flag the Seattle Center put on the Space Needle! A historic day! Now if only we can get equal rights like marriage, or at least equal taxation for domestic partners!

Then back to work for me after Pride. It wasn't easy but I managed to work a hellish, soul-sucking clinic on Monday, finish packing, and move my whole life to Seattle on Tuesday. Tuesday night Karin came back to Tacoma with me to finish cleaning the apartment. Wednesday I went to work and closed my charts, tied up loose ends, returned my parking pass, all the usual last day stuff. Hilariously, I got in trouble my last day for not having my badge. Figures some safety big shot would be touring the clinic on June 30th. He was understanding after I told him it was my last day and I had just returned it!

Life as a free woman
Now, here I am, among piles and piles of boxes. Overwhelmed with how much stuff I have to fit into Karin's apartment. We are working hard to make it our place (not just me squeezed in to her place) and it's not going to be easy (33 years of accumulated stuff is a lot!) but we are doing it! The pets have been without incident, Sive lives in the loft with a gate separating the beasts for the time being. I am so happy to be done with residency and ready to start the rest of my life, with my fiance, my family. Karin, me, Sive, Lucy and a houseful of boxes. I couldn't have imagined a happier ending to this story.

Next step? Studying for boards, unpacking, nesting, and continuing my advocacy here in Seattle and through GLMA... now only if I can find where all my advocacy stuff is... and maybe, soon, the feeling of being done with my indentured servitude will hit me.

2009 in Review

Now for the traditional Year in Review Post!
2009 was really a year of changes for me.

Click here for last year's entry, if you are feeling extra nostalgic.

Most photos are from my recent trip to Detroit for Christmas.

January: Rotation was Night Float and Geriatrics, emphasis on the Night Float. Uppers: The fabulous inauguration of the new President Obama. Marching in his parade. The world-wide sigh of relief at the end the "W" years. Downer: The start of the Dental Saga of 2009. Inauguration and a wedding not included, I had all of 2 days actually off the entire month, yet somehow managed to cram in 4 dentist appointments and a two-part root canal.

February: Night float and geriatrics continue. Upper: Vegas, baby! Downer: That night float crap was getting really old, the dentist crap even older. My only weekend off was spent at an all-TFM retreat. I was so dizzy and sleep deprived I think I may have hallucinated once or twice.

March: My "Away" Rotation with Puyallup Tribal Health. Uppers: Shilo turned 20, Sive turned 10. I ran a 5K, started in on Honk Fest excitement and spent a ton of time on horseback. I got back in shape, I took care of myself, and finally wrapped up the Dental Insanity. I also completed my USMLE Board Exams. Downer: My friend's wife died. My community, Rainbow City Band filled an entire section of the funeral home. So, the silver lining: It made me realize how lucky I am to be a part of a community like RCB.

April: Ah April, the best and worst of times. Rotation: Inpatient Pediatrics. Downer: Peds just about killed me. The hours were insane, the patients sick as hell, and the attendings, ruthless. But the uppers! The Uppers! I played at HonkFest West which magically fell on my one weekend off that month! And, most amazingly (include all superlatives here), I fell in love. And while residency tried its damnedest to crush me with my peds rotation, I was like one of those trick candles and sparkled despite it all!

May: More blasted Peds and the start of clinical GYN. Upper: Swing Fever with RCB. Vacation in Boston (the only thing I managed to blog about). Downer: Yeah, peds was still killer, and just when I thought it was over I was back rounding on the service my first weekend after vacation, covering for another resident. But despite the peds interjections, GYN heralded my last rotation of R2 year. And any free time I had was spent with my girlfriend, Shilo, and my band. In that order.

June: GYN continued. Upper: Realized I was almost done with R2 year! Woo! Started my Countdown Calendar. I played some awesome gigs including ones for the Majestics, Solstice Parade and Pride. It was a very RCB-heavy month for me. Downer: Getting the swine flu sucked.

July: Internal Medicine. Uppers: Played for the Rat City Rollergirls, Mom came to visit, got to see my friends Suhani and Rachel even if it was just for a few hours. Downers (this wasn't my best month): q4 call, new interns, and most insane month for the hospital ever. My one weekend off that month spent over-caffeineated, sleep-deprived at a board meeting in Chicago. Missing playing in the Seafair parade. And did I mention getting totally and mercilessly spanked by Tacoma General Hospital. How much left on that countdown? I was so brutalized that month by work I didn't even have time for one little blog entry! I did highlight a bit of the month in my first of two August entries under the subtitle: Red, white, blue and burned out.

August: First two weeks the flogging continued as Night Float. But, at least this time I didn't have a dozen dentist appointments keeping me up during the day while I should have been sleeping. Instead I had elevator construction and a record-breaking heat wave! Uppers: Dad and Julie visit from Michigan. Mount Rainier! Downers: Said goodbye to Shilo, the horse that kept me sane and human. One of the hardest things I've ever done. Here it is almost 5 months later and I still feel heartbroken. And to add to it all, my dear, sweet dog, Kiki, passed on. It was indeed a month of loss.

September: Rotation? Keep reading. Summed some of the month here. Upper: LGBA in New Orleans - very, very awesome. GLMA in DC, also pretty fabulous. Lullaby Moon - surreal. A good month for recovery from the losses of the month prior. Downer: I spent so much time working in the hospital as back-up I completely have forgotten was rotation I was on. Had to look it up. It was ophthalmology, urology and ENT (OUE). Go figure.

October: Away rotation on the East Coast, LGBT Medicine. Adventures aplenty. Uppers: I completed my GLMA conference. My talks were huge hits. I loved, loved Mazzoni Center. My RCB "TV Land" Concert was sold out and fantabulous. I only wish I had video of our awesomeness to share! Our pep band played at Macy's in a mall which was a really fun experience. I celebrated Karin's birthday for about 2 weeks straight! I dressed up as Daddy Warbucks this Halloween and had tons of fun with my friends in Seattle. Downers: The month had to end. And I missed the long-time coming, awesome, big, gay Connecticut wedding of my old friends Stevie and Jill.

November: Rotation was HIV Medicine. Uppers: A low key Thanksgiving on the Oregon Coast. The rotation rocked. Educating my program about transgender health and making TFM officially a trans-friendly place for patients! Downer: My 99 year old grandpa died. Half my program was struck down with the flu and, as above, I had to struggle for my balance.

December: And here we are. Rotation: Pediatric ER and sports medicine. Upper: my first week vacation since R2 year! Christmas with family and Karin and Lucy. Christmas caroling with Renegayde. Adventures in Detroit. Another sold out concert with RCB (left). Downer: Good-bye weekends, I'll see you in March.

Oh, the weather outside is frightful

Get this straight. I'm not complaining. I love it here. It's far preferable to being in the Midwest right now. Or the blustering, snow-covered Northeast. Really. But, for this week, it's bitterly, bitingly, abnormally cold. My friends are taking pictures of their temperature gauges because single digits awe them. I imagine them craning their heads, looking for the preceding "3" before the "8" sitting solo like a headless snowman on their digital dashboard reading.

But, like I said, I'm not complaining. See, we also are having blazingly beautiful, bright, sunny days with the mountains all snow-capped and glistening, and the usual slate blue of the Puget Sound looking brighter and more cerulean than it has a right to be this time of year.

It's the interview season for residencies. Which is interesting because it helps me look at TFM from a fresh angle. Last year I got to interview people I hoped to work with! None of who ended up here, as far as I can remember. Now, at the time I write this, I have 202 days left of residency. So, interviewing is more like interviewing my replacement. I'm hoping to get a queer-friendly, pro-choice extrovert to come here. Wish me luck!

This weekend I am caroling with my band in downtown Seattle. I did this last year and it was great fun! Next week we get to have a fun Holiday Concert. I say "holiday" instead of Christmas because interjected into all the X-mas classics is a little klezmer medley ending with a dizzying rendition of the hava nagila. Jews even got a little cookie parity at rehearsal last week (see left)! My favorite song we perform this year, however, is not the usual Sleigh Ride (because I'm a sucker for the horse whinny) but a kazoo rendition of Jingle Bells, to be performed concert night with local school children. See video below for a short preview from rehearsal!



Now, I hate to kill the mood, but I have to wrap up with a bit more somber news. Tacoma has been rife with tragedy and crime lately. The economy has hit everyone hard but for some reason gun-related crimes seem abnormally high. Most have already heard about the four police officers who were gunned down the day after Thanksgiving. Their memorial was this week. Also, my neighborhood bank was robbed and my favorite breakfast place was held up at gunpoint and the elderly owner assaulted by one of the robbers. My bank was robbed! Two blocks from my house. Seriously?

In hard times people are supposed to band together. It seems some haven't been getting the message. For Christmas this year I want a Kevlar vest and all the weapons in Tacoma and Seattle to turn into gumdrops.

August ends with a whimper

As you may remember from my last post, August started with night float. Running like a mad woman around the hospital. Some of those nights truly tested my reserve. Between attendings scutting me to the point of near breaking (so they can get more shut-eye) and technological mishaps such as pager blackouts and electronic medical record crashes I survived by the skin of my teeth!

Mid-month, after a well deserved first weekend truly off in over 7 weeks, I changed gears and started my next rotation: ophthalmology, urology and ENT. Whoever thought eyes, ears, nose, throat and prostates were well lumped may have been a little nuts. But I can't complain. For the most part, I have had just about the whole of the last two weekends free and it's been wonderful.

One highlight of late was a totally awesome Seattle Storm game (Karin's iPhone pic at right at overtime!).

Another more recent highlight was a weekend in Rainier National Park with family and my super awesome girlfriend who put up with two distractable, hyperactive Eamans in a place without telephone, TV or Internet!

This photo at left is just a sampling of what an amazing place that park is! Walking through the clouds, wild flowers, clean air, blue skies, was pure joy.

But the same weekend I frolicked in the wild flowers something sad happened back in Michigan. My dog, Kiki, the sweetest beast on 4 legs, passed. She had battled cancer for years. My mother had treated her with this experimental "electric probe" device that supposedly cured her. I'm not sure that's true, but maybe it gave her a year or more of a decent good quality of life. Kiki was a red leopard Catahoula (or, so we think - she was a rescue dog). She probably weighed a good 50 lbs more than your average Catahoula and was a good two heads taller. She may have had more Dane or some other big breed in her but god knows she was the most devoted and lovable creature I've known. I'll miss her! The below video was before a leg surgery to repair her torn doggy-version ACL. She was particularly wobbly but so devoted she couldn't resist my mom's voice and had to get up for love at the sound of it!



Looking ahead
In a few days I head to New Orleans for the LGBA national conference. It coincides with an event I originally thought was a large LGBT event to help rejuvenate the city of New Orleans but on further research seems to be more of a gay-boy circuit party? Who knows - I'll know more once I get there. All I care about is that I get to play music with awesome people from around the US and Canada and explore New Orleans for the first time. The coincidence isn't lost on me that Catahoulas are the state dog of Louisiana. I'll be thinking of Kiki while I'm there, I'm sure.

See you in September!

The nightstalker

Nothing like showing up as the sun sets to a full bay of ambulances, their engines pumping diesel fumes, smokers sneaking puffs below the “This is a Smoke Free Campus!” sign, certifiably insane patients of mine yelling to their cell phones with central lines flopping around their necks. This is how my nights will start (although, admittedly, the insane patients of mine don't always greet me at the entrance). Then, about 12 hours later (plus or minus), I will drag myself back through the same ER doors, past that wet sound of people vomiting into blue condom-shaped emesis bags, past another line-up of rigs, not nearly as plentiful as the night before, sometimes EMS personnel joining the patients and families in creating that silver cloud of stank under those “no smoking” signs.

Such is the life of a night float resident.

I’m plodding through the night as I type most of this post. Admitting patients to Pediatrics, Internal Medicine and our own, beloved, family practice service which includes not only our bottomless barrel of sick TFM patients but additionally the Indian Health Service patients who happen choose Tacoma General over the multitude of neighboring hospitals and ER's. I cross-cover the same panels of patients and am the back up for the labor and delivery deck, in case things get a little crazy in their neck of the woods, too. It has the potential to be eerily quiet or insanely mad.

When not on the wards or in various ER's or delivery rooms I will camp out in our call room (me being insanely mad in the call room at left). This call room is located in the "M wing". The patients reside in L, K and J wings. The call room is flanked by volunteer services and the learning and development offices. Neither which are staffed after 5 PM. Thus, at night, the lights are off, the hallways are dark, and this part of the hospital feels completely abandoned, in a Stephen King kinda way.

One night in the winter, last time I was night float, I was walking back to the call room in the dead of night when out of the corner of my eye I spotted what I thought was a man down at the end of the dark hallway. The eyes play tricks on you that time of night so my first instinct was to ignore it. Then the man-shaped blob moved and I looked again. "Oh hi! You scared me!" Or some such generic statement miraculously came out instead of a yelp. He reported he was lost and looking for the elevator. How one would end up in the abandoned wing down a dead-end dark hallway looking for the elevators is beyond me. "They are over there," I pointed and discreetly entered the code to get into the room and closed the door behind me.

Not much later I get called to standby for a delivery on obstetrics. On my way down the yellowed stairwell of the M-wing I find the same man sleeping on a landing between stairs. I call security: "Does he have a red baseball hat on?" They ask. I recall that he did. "Thanks," they offer, "we have been looking all over for that guy!" I tell them his location and later find out they have evicted him from the building with the promise of arrest should he come back. I spend the rest of the night safely nestled in the bustle of a nurse's station.

But I digress. I wasn't talking about creepy night stalkers! I was talking about my current rotation: Night Float! Brought to you by the letter W! W: Withdrawal, the act or process of ceasing to use an addictive drug. Seems to be the flavor of the week for me and my adult admissions. And before I get called to admit another patient brought to TG by the letter W I will also present to you a superfast ubershort summary of July.

July 2009: Red, white, blue and burned out

Hold on tight, here we go.... July 1st I get the pleasure of starting on call. In the deep end from the start. On my first day a patient expires, my second day I get threatened with a lawsuit (by a crazy patient, go figure), and my third day we get 14 admissions. I get a day off on July 4th - march in a Parade, get this amazing photo taken (left) by the Adventure School photographers. Then back to work on the 5th for more insanity. Things persisted to be totally and inexplicably crazy until my "golden weekend" where I take a red eye flight and a train to Chicago and proceed to engage in a weekend long board meeting before coming back just in time to be on call the following day. By this time I am exhausted and worn out and amazed I'm still upright. Post call on the following Saturday I manage to stay awake well into the night, hell, into the next morning and finally crash after being awake for nearly 48 hours straight, a gig with my band at the Roller Derby and Bite of Seattle squeezed in for kicks. And did I mention my mom was visiting that weekend? Finally, I get a day off, it's spent perusing a farmer's market in the sun and before I know it I'm back at work and don't have a day off until August 1st - when I change rotations and now find myself immersed in the life nocturnal.

So there you have it. I won't even begin to go into the week-long heat wave with temperatures topping 104, the joy of having only one working elevator, the horror when that one decides to break, and how hot the stairwell can feel after 15 flights in 100 degree heat!

Ahead: another week of nights and then, holy crap, I have a full entire normal weekend off! The first real weekend off since the last weekend in June! Plans? I'm going camping and and plan to eat, nap, sleep and spend some QT with my cutie! (first photo is from my apartment window, of course)

Why I may need a tetanus booster

My last call, as usual, was long. Endless, you might say. My few chances to lie down resulted in the inevitable page. One aspect of taking call on OB is to do "courtesy checks" for the community docs. This can vary from everything from looking at a slide a nurse prepared to a full vaginal and cervical exam to a complete delivery. I am also the person on hand to assist with c-sections, of course. Between my bazillion speculum "courtesy checks" I assisted a handful o' sections and slept barely a wink. My own patients didn't deliver overnight. Which was particularly fine as two of them were preterm anyhow.

This afternoon, after a couple hours sleep after that endless call, I decided to walk to the post office to mail some letters. On the way I was brutally attacked by a crow. I was listening to my iPod, innocently walking on a well-traveled path, surrounded by kids, homeless people, campers, families, gangster wannabes. The park was pretty crowded for an early Wednesday afternoon. I get to a less populated part of the park (but equally as urban with a big construction project across the street and a bus stop) when my head gets slammed from behind so hard that my neck snaps forward. At first I thought maybe I got hit by a rock until in my peripheral vision I see big black wings and talons.

It got me good. Thankfully wasn't bleeding all over myself (last thing I wanted to do was go back to the hospital) but I do have a rather large lump, a very tender scalp and a few nice scabs where some hair used to be. After the attack, the bird followed and continued to scream at me. I pulled out my Nalgene bottle, turned to face the oily thing and dared it to come at me again, completely prepared to defend myself with deadly force if necessary. I didn't have to, but the way my adrenalin was pumping I was more than willing to fight back.

I love nature. I feel, in most cases, we have encroached on nature's little beasties. I'm starting to feel that crows, however, are less the victim and more the perpetrator. They are just plain mean. They drive out native birds and take over. I've seen a murder of crows (yes, a group of crows is called a murder) attack a lone eagle or barn owl before here. The are just big black feathered bullies.

I decided it was time to learn a little about crow attacks. My first source was Cornell:

My 10 year old son keeps having crows trying to attack him. He will be out in the yard and they come swooping down on his head. He has done nothing to them and he is terrified to go out side alone now. I have been out there and they have not bothered me. Please tell me what I can do.

Since you gave no indication of where you live, I have to guess on exactly what is happening. But, right now (late May) in most areas of the country crow babies are just fledgling (leaving the nest). In the first couple of weeks that the young are out of the nest they cannot fly well and are very vulnerable to predation. They hide in the trees and the parents are very protective of them. At this time the parents will mob (attack) any potential predator in the area. Usually this means cats and dogs, but it appears that your son elicits the same response. You are too big to risk getting too near. Just wait a few days and the fledglings will leave your yard and the parents will calm down. Try to keep in mind that these birds are not vicious fiends bent on your son's destruction, but merely dedicated parents trying to defend their own young in the best fashion they know.

Hm... so am I like a 10-year-old kid these crows? What aren't I "too big to risk getting near"?

Apparently, this is an issue in London as well. Check out THIS article. More than one Hitchcock parallel made surely.

And, now, a 60 second video about the true nature of crows as I see it:

Resident Evil Extinction-Crow Attack
Uploaded by systemofevil

The Old Gray Mare

Thank god for Shiloh (right). I can't remember if I mentioned, but my last couple weeks of pediatrics were hard on me. We had more than our fair share of tragedy. There were kids we diagnosed with cancer, babies we diagnosed with fatal and permanently debilitating diseases, a violent rape of a little girl, it was harsh to say the least. Earlier in the rotation we did have a handful of cute kids with lacerated organs from horse accidents.... bringing me back to my original topic. Some people have yoga, some people have meditation, some people have church. Me? Right now I have an old gray mare and endless fields of clover and wildflowers. I manage to get out there two or three times a week. most weeks. I don't ride every time. Sometimes I only have time to pet her a bit, let her graze at a clover patch (above). And the only fee for all this horse QT is the bridge toll ($4 per trip).

The last few weeks of OB call have been predictably busy. I have delivered a bunch of babies the old fashioned way, and and am getting the hang of c-sections. Still not a big fan of the OR but according to the attending on the last c-section I apparently "have excellent surgical skills" with an added-on, "and I don't usually tell people that". Are you all laughing at the irony with me? What this really means is that I'm going to have a terribly hard time just assisting at this point and am getting some serious pressure to be the primary surgeon. Need I comment again on the irony? On my last day of pediatric surgery I sewed up a small hernia incision terribly - poor kid. But sewing together big things like a uterus or the tough stuff that hold the guts in (fascia) is a bit easier - and the needles are much bigger and easier to see squinty-eyed at two in the morning.

As an aside, I never went to the Tall Ships festival. But I had a pretty good view of the actual ships from various other spots in Tacoma, sometimes even my windows were enough. It looked a little campy, certainly touristy. I did, however, find some good pics of the event. In the last picture (below), click on it and you can see my apartment (and even my window) behind Stadium High School (the white high-rise on the left)!

Today is my last day off for two weeks. I've stocked up on groceries, did laundry last week, went for a short run, a long hike, and sorted through the last two weeks of mail. I also finally vacuumed (yay me!). I don't know how I did it but the day is over now. Back to the grind tomorrow. My next day off, while far away as July 26th, also heralds the release of the new X-Files movie!

Rah Rah Happy Birthday America

So my first call on the OB deck as a solo resident went surprisingly well. There was a three or four hour period where things were a little crazy. I had to call in help from the resident on call for internal medicine. However, by actually running between deliveries (literally) I was able to catch all the kiddos. The nurses, I cannot emphasize enough, are really amazing. In OB it's standard to have one nurse for one patient. Sometimes a nurse will go to lunch break (ah, unionization) but overall it's really consistent for the patient and, I have to admit, great help for me. The nurses really know their stuff. Sometimes there are conflicts as they have their idea how to manage the labor and you have yours, but overall the coordination of care goes pretty smoothly and we have a baby at the end. My nurses saved me last night. When I had five laboring patients, a cesarean section and triage was full with concerned moms-to-be, they help manage things to the point where I could pretty much just run from vagina to vagina to OR to vagina and catch babies. Heck, I even got about an hour or two of sleep in the 30 hours I was there...

...which is good since here I am, post-call, and there are fighter jets and B52s flying around outside my window in celebration of the USA. Sometimes, when the fighter jet flies spiraling up into the sky, flips around upside down and back toward the waterfront, it emits a sonic boom and all the car alarms go off. It's all very exciting but definitely not conducive for sleep. However, just to show how tired I was, I did sleep through it for about an hour or two. (photo, by the way, is patriotism, the Sisters of Perpetual Indulgence way).

I was on call last 4th so I'm not sure what is Tacoma typical, but especially exciting now is that the Tall Ships are here. Those who don't know what that means (like me until I looked it up) it translates as really cool ships with big sails (a rigged sailing vessel according to Wikipedia. - source of the photo). It's a yearly festival and at a different location each year. Tacoma is the lucky waterfront this year. For pictures of some of the ships and info about the various "villages" as part of the festival you can check out the Tall Ships Tacoma Website. Traffic yesterday when the ships were sailing in was apparently atrocious (2 hours to go two exits on the freeway per one report).

So this weekend is a Golden one for me. Which is particularly nice since I'm still recovering from pediatrics. Case in point: there's a stack of unsorted mail and random papers surrounding my couch like a moat. I haven't vacuumed since who knows when and I think the dust bunnies are so plentiful they are starting to organize a guerrilla attack.

The most ambitious plan for my sleepless post-call Fourth will be to ride my bike down to the waterfront to see the Tall Ships... if I can muster the energy (and if this iced coffee I'm drinking now does its trick). The rest of the plan includes laundry, sorting mail and watching fireworks from the windows. In all, not a bad post call day. If I'm lucky I'll get decent breaks between loud things to sleep! Tomorrow I head up to Seattle for my little cousins' joint b-day party. I bought them hula hoops. And couldn't resist so I also bought one for myself. (One of my cousins at left hula hooping - and, look, another Utilikilt behind her!)

25 months to go, but who's counting

I have 25 months left of residency. That is, 761 days. Approximately. I would make little hash marks on my wall but I might lose my deposit.

The last couple weeks were eventful. In addition to working I managed to sacrifice a lot of sleep to go and have some fun. I saw Ani Difranco in concert at The Moore in Seattle (great venue!). My friend knew her bassist so we got backstage passes and hung out with him after the show. He was a Wesleyan-o-phile so we had lots to talk about! I've scanned our cool backstage passes that had Ani's label logo on it (Righteous Babe records).

I also participated in Dining Out for Life - a fundraising effort where restaurants donate proceeds to HIV/AIDS foundations (nearly 70 restaurants in Tacoma participated and donated 25% of the check). I went out for sit-down Greek (a differentiation they make here since most Greek seems to be take out). I have to say I was actually disappointed. The saganaki wasn't really cooked, just kinda warm around the edges, the grape leaves looked sad, and my veggie Moussaka was kinda tasteless. But the pastry at the end was fabulous. Hard to mess up filo dough and custard, but I could be wrong. It made me miss good, real, Greek food from Greek Town in Detroit!

I also traveled to Seattle for a two-day course for life support certification in obstetrics required for my practice. It was over the weekend which was admittedly lame, but in Seattle which was great. I really loved my time in Seattle. It was so nice seeing cars with liberal bumper stickers, the occasional Jewish star here or there, young alternative rocker couples, gay and straight, with their babies, people commuting on bikes, rollerblades and kayaks (yes, commuting by kayak!). I am ashamed to admit I was depressed coming back to Tacoma. People here are very quiet about their political beliefs, education, Judiasm and sexual orientation. Which is great for them, and I totally respect, but it means that we can't identify each other and things feel very homogeneous in a way that certainly doesn't include any religious, sexual or political minority (or political majority as the case may be). I felt like I fit in in Seattle. It was really a nice feeling and one I kind of forgot about. Now that I remember that feeling, not having it is making me feel restless and irritable.

Next week I return to Motown for my last vacation of intern year. The first half will be in Walled Lake (more or less), the second in Detroit (more or less) and my plans involve a Tiger's game (vs. Red Socks if I'm not mistaken), a rock concert (the Kills !!) at the ever-awesome Magic Stick, catching up with friends and family, and hopefully sleeping a lot and relieving stress as opposed to creating it!

Paradorama

Daffodil festival was lovely. The parade lasted 2 sunny hours. And it didn't disappoint. As with every Tacoma event there were Pirates. Hoards of them. With big booming cannons, to boot.

There were dozens of marching bands, flag corps, dance squads, clowns and, crucial to every parade, Shriners.

I found myself at a little Detroit-like corner (complete with abandoned buildings) that was sunny and a bit less overwhelmed with people. I took pictures of lots of princesses, queens, clowns, acrobats, bikers, floats advertising various other festivals, fairs, events and much ,much more.


I started to feel a little giddy when I realized we are launching again into fair season, with the Puyallup fair next week and the Strawberry festival around the corner.

I'm glad I was able to make this event. It appears to me to be the biggest event Tacoma has held so far (at least in the 10 months I've lived here - although I was on call and thus missed the 4th of July festival). I'm sure their 75 years of experience in holding this parade helps. It was great seeing so many people out on the town. The snow on the mountains was glowing today and the water looked extra blue. A few pals of mine hit the slopes for some snowboarding and one said she's never seen it so busy. Amazing what a little sunshine does to transform this part of the country. From bleak to bustling in just one day.

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.

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.

SoCal Bound

It's official. I'm headed to San Diego for my urban underserved rotation. Woo-hoo! [ insert Happy Dance here]. I leave the 31st and come back the 28th of Feb (on call here at TG on the 29th -- boo).

I haven't yet had the chance to upload pics from my last day(s) in Hawaii. Heck, my suitcase is still fully packed in the hallway. The joys of the 80 hour work week, eh?

And on a completely unrelated note, here is a hilarious video about Tacoma:

And if you liked it... there's a sequel on YouTube called South 5: True Grit. Very funny. Maybe even funnier? Oh... what the heck. I'll put it on here. Don't say I never gave you nothin':

Some serenity

I wanted to make a more peaceful blog entry as the last couple were certainly more cold pricklies than warm fuzzies (anyone remember that book?). So here is a video from the Point Defiance Zoo and Aquarium. It's one of the two Beluga whales. Amazing beasts. (Dont' mind the shakiness at the end... I forgot how to stop it once I started recording.)


And an as an addendum, a little birdie was on my window sill appearing to try and get in! Sive put an end to that by leaping and thrusting herself at the window. No harm came to the cat or bird. But it was interesting to see the bird exploring my windows. I wonder if the people who lived here before left seed on the sill or something. I think I'd have to avoid that as there are way too many crows in Tacoma to go bird whispering. They call a group of crows "a murder" for a reason... ;) Okay, go back and watch my peaceful video again :)

Cowboy

I have learned that my program is considered a "Cowboy" FP program. For some this makes sense. For others there are visions of pretty horses and 10-gallon hats. To clear up the confusion I posted the following on my Facebook page. I'll put it down again here on my Blog for everyone else. Excuse the nerdy X-Files reference but two points for everyone who recognized it!

"Cowboy = hard core.
"In other words, after these three years you supposedly can put me in the middle of nowhere with a scalpel and stethoscope, tell me the truth is out there, and I can fix anything. ;) Cut out an appendix, deliver a baby (any which way it needs to be delivered) and resurrect the dead - you name it. True go-get-em cowboy style. Of course, I have to hand my soul over to my program for safekeeping while they prepare me. Horsies are much more fun."

And speaking of souls - I have to admit that I am feeling mighty drained, and my first vacation of the year gets closer and closer I start to think I may see light at the end of the tunnel.

Overall, Derm/Family/Gyn is going well. Life is quasi normal-ish I suppose. I get to see Mt. Rainier on the way to work Mondays, Tuesdays and Fridays which is swell. Assuming the fog isn't crazy and it isn't raining - um, which is kinda most the time. But that last couple days have been special.

Oh, and I got my car registered. It has a fancy license plate in the front! That's right, here in WA they ear their plates in the front and the back. So West Coast.

If ya'll are lucky I may come back and post about my fabulous adventures this weekend in Seattle and at the Zoo. Here's a sweet floating Walrus and Helene being touristy and blurry. (first pic is another one of my awesome sunsets. The silver lining to a rainy day.)

The Golden Weekend

Ah... the golden weekend. Two glorious days in a row with no responsibility to the wards. Where I can nap, clean, shop, read, rest, renew and rejuvenate.

Last night Beth and I hit up a show at the gorgeous Pantages theater here in Tacoma (old photo of the Pantages looking a lot like it does now). It was the opening night for the season and there was some hoopla with speeches before the start of the show. They recognized the president of a great Tacoma magazine: City Arts. A great resource for all things artsy in the South Sound. But most interesting was the announcement that this part of Puget Sound is notable for being so culturally rich, it is second only to Manhattan Island! I kid you not. Ben is probably guffawing, or rolling his eyes at this (my townie co-intern) but it is apparently true.

I had a conversation with Beth last night. We hit up Tully's for some post-show hot cocoa and while moseying back up the slope of St. Helen's we passed a gay bar, (well, at least a bar with lots of neon rainbows, one reading "PRIDE"), colorful closed storefronts with whimsical antiques and funky clothing selections, and were looking out over the docks. I revealed that sometimes I feel like Tacoma is is great secret I'm dying to tell everyone. Last night I really felt I was in a cultured city with a multitude of resources - art, music, theater, nature...

The show itself was fun. For all ages. It was called Cirqueworks Birdhouse Factory. There were acrobats and contortionists, dancers and jugglers. It was really amazing to watch. Reminded me of the days when I would catch Cirque du Soleil on TV and just sit there, mesmerized as people were dangling from hoops with one toe or twisting in pretzels and sitting on their own head. I found particular delight from a sequence involving a trampoline and three men bouncing around like hot popcorn (at least, that's what I thought it looked like).

Medicine is winding to a close. I have two more calls and 6 more days (Mon-Saturday). Then I begin a much less grueling rotation (or so I hear). I discharged a patient last week that I had been seeing pretty much every day for nearly four weeks. We weren't able to help her much. We gave her electrolytes when they were low, blood when she was too anemic, fluid when she was dry, diuretics when she was too overloaded, but all in all, she is terribly sick and there's not much we can do. The catch was, she was rather young, and this illness was new and we kept hoping she would turn a corner. She never did and eventually we sent her home, stable, and on 12 new medications that keep her that way. From her room I could see my apartment windows. From my apartment I could see her room. It took me a few weeks to realize this but, once I did, I started having dreams about her. Mostly about her getting better. Talk about no escaping work, eh?

I promised I'd mention in my blog a little walk I took with KP (who still insists that Tacoma Pride is lame) and her poodle, Blue. Along the way there was a young emo guy taking pics of rocks he made into heart shapes. KP, knowing a good opportunity for poodle-fame when she sees one, offered Blue to make the pictures more.. poodley? Now, somewhere out there in the ether (or perhaps the internet?) is a picture of a scruffy black poodle in a heart of rocks. We may have to dub Blue the Rocky Love Poodle from now on.

Quote of the week: Liza, animated, describing why she so loves colonoscopies: "It's so exciting when you get to the cecum!! You're like, 'Yay! I made it!'"

Photo of the day: Candy man. Don't know where, don't know why, but I love it. I just hope he's wearing sun screen.