Like a speeding bullet

Hello readers!

Winding down to the end of residency now. Hard to believe, no? If I keep to my once monthly posts this may be my second to last blog entry of residency. *Gasp!

Part of me (the biggest part) is unbelievably thrilled!
And part of me (that little noodley part) thinks: "ohmygodihavetotakeboards
andrecertifymyACLS
andpackandmoveand
beforeilosehealthinsureance
seeadoctoranddentist
andpreparemyhumongouspowerpoint
andpublishmypaperandholycraphowmanydays?"

But, like I said, most of me is just tickled pink!

So, panic attacks aside, shall we review the month of May?
It began at breakneck speed, starting with a post-call party at Swing Fever, the band charity auction where I stayed up way too late and bought way too many auction items. My wins included interesting items such as an off-peak week-day stay at some resort somewhere on the Washington Coast (exciting, yes?). I also won a gift basket from the Jet City Roller Girls and a few other small items. The coolest item was a drumhead from my own inauguration parade experience. The winning of this was somewhat incestuous as I donated the item with a few of my bandmates. But I wanted it, and wanted it something fierce! Fierce enough to outbid, so there!

Immediately after the event, or more specifically, after 4 hours of sleep, we head off to Minnesota so spend some QT with Karin's family (as I described at the end of April). We flew into Fargo, endured a nearly 4 hour delay, drove about 3 hours to that little place called Middle River and, after I was awake nearly 3 full days, I ate and slept the whole week away. One highlights of the trip was a D.A.R.E. graduation at the local middle school. The end of the ceremony was punctuated by a rousing version of Johnny Cash's "Ring of Fire" but with the lyrics altered to reflect the middle schoolers promise to not drink or do drugs. Then we had cake and fruit punch in the cafeteria. Another highlight was on a literally freezing cold rainy (and in some places, snowy) May day we planted 50 lilac bushes. We stayed in Fargo the last weekend an played in the swimming pool and perused the mall. Mostly, we ate. By the end of the week, we were butter soaked, lard-laden little roly poly's barely able to waddle on the the plane thanks to the Land of Lakes predilection for all things dairy. (Note lovely MN rainbow above!)

I was welcomed back by total TFM chaos. We were still two residents down, and with pores still oozing Minnesota sugar and butter, I took an extra black weekend call, spending my first Saturday night back again on the wards being paged all night with admissions I was admittedly uncharacteristically remiss in admitting. (say that 10 times fast!) It was as if I had never left.



See, my "last call," ending May 1st, was evidently not truly my last. In fact, this coming last weekend in May, the "holiday weekend," will hopefully mark my last weekend at the hospital (note the quotation marks to emphasize annoyance). I already know I will be working both Saturday and Sunday as back up. Regardless, back in the pre-vacation blissful ignorance of May 1st, I treated my (supposed) last call as such and celebrated its end by roller skating around the wards (See above). I'd been fantasizing about this since they installed laminate floors and since I noticed a gently sloping hill from the 5J patient wing to the resident call rooms that just screamed "roller skate on me!" Filming is not allowed in patient care areas so I got some footage of me testing out the skates on this part of the wards, the nice slopey part! Most of my bloggy fans are on Facebook (and may even be reading this blog on FB, even though it is far superior and actually formatted on its original host, Blogger). So, they've probably already seen the video. But... for the three of you who haven't, there you go.

[Insert seamless transition from evils of residency to joys of band camp here. Or not.]

Band Camp! Last experienced in the summers of 1991, 1992, 1993 and 1994 as a high school student, I remembered band camp as a time of sore arms, worn out chops (chops: trumpet-speak for lips) and sun burn. Grown up gay band camp has much the same, but is waaaay more fun! I got to hang out with my 60 closest friends and partake in a talent show, play games, and play my instrument, dance and get some vitamin D and be near the ocean! It was really spectacular. And exhausting. And, did I mention fun?

Coming down off of a weekend like that was hard. Getting back in the swing of things, I took a look at my to do lists and, BAM!, was hit by reality. Not only is residency over and done with in just about 30 days, but I also will be moving, and lose my health insurance and no longer have a salary. But, hey, freedom does come at a price, n'est pas? I have so much to do, I thought about making lists of my lists. Instead, I thought it would be more fun (and debatably less productive) to make a list of reasons I am grateful about moving and finishing residency. E.g.: #8: I won't have to mouth-breathe between exits 134 and 137 anymore on I-5 (the aroma part of Tacoma). #11: less left lane driver rage, etc. I do love Seattle dearly and am excited to officially be a resident. Karin and I, as an homage to our favorite city, wrote a little song we performed last weekend. Left lane drivers are featured in the middle of the song. See below:

So, this brings me to the end of this here blog entry... So much to blog about all of a sudden but so little time. Perhaps June will bring multiple blog entries? That's probably an empty threat however. I would like to tell everyone about the video I'm working on for graduation with my classmates. I would love to vent about all the job offers I'm getting in "random small town only 40 miles from a great golf course in somewhere USA. Call now to sell us your soul and we'll call you every five minutes to harass you until you explode." But for now I must take care of patients, do this pesky big TFM Day presentation and publication thingy (worthy of its own blog entry but annoying enough to avoid the topic altogether), and try to maintain as much of a normal life as possible in the next 30 days while accomplishing the great feats of my endless to do lists. Next on the list: world peace. ...wait... wrong list.... right! Correction: forward my mail.

Vacations make me happy

Ah Boston. My old haunt. What a great welcome you gave me! First you make me feel all at home with your Seattle-like weather, gradually warming up and showing me, step-wise, what the sun looks like so I don't run like a little groundhog back in my hole. It's bright! Then you awe me with your fabulous queer culture and I rediscover the sore muscles that come after playing kick ball in the park.

Since I last saw you you seem to have grown a little. I remember you smaller. Your gay band is really awesome, The Freedom Trail Band, and they were exceedingly welcoming and kind - even finding an old trumpet for me to borrow so I could join in on their practice!

Boston, thanks for always being there for me. JP, Somerville and even Cambridge still feeling a little like a homecoming!

Now if we can just do something about that East Coast Hospitality...

Coffee at Diesel: check
JP Licks ice cream: check
Queer kick ball: check
Chinatown: check
Naps: check
Lay in the sun: check (photo above)
Read my book: check
Frolicking in a garden: check (photo below)
Picnic in the sun: check
Meeting up with awesome old friends: check

Tomorrow: more sun-bathing (weather permitting), maybe another run in the park. Some Queereoke in JP and more naps.

The rest of Vegas: reflections from 30,000 feet

Saturday was a good day. We both woke around 3:30 in the morning and both managed (A with a little more difficulty, being on that pesky EST) to go back to sleep until a reasonable time.

Our day:

• Breakfast again at the hotel. Smoked salmon two days in a row! I feel so spoiled!
• Lay bundled in our layers by the pool, getting some cloud-filtered sunlight, talking, people watching (a favorite game of ours was pointing out cute lesbian couples to each other)
• Walk the strip again. This time we made it almost to the end of the strip – the Stratosphere looming just a block or two away.
• On the way we found our caramel apples (they were at The Venetian, not the Bellagio), got a massage at Brookstone from these massive chairs that, after the ministrations of the sales people, held us captive, reclined and listening to the in-store Motown medley. A highlight from this part was pulling the leg of one of out chair jailers – we claimed dryly that Motown music history and basic mechanical car knowledge is part of the State of Michigan education exams, a requirement for all Michigan students.
• I drooled over the cutest over-priced hoodie in Paul Frank, spend a little bit at David and Goliath, and put blinders up as we walked by the numerous designer show stores.
• Then we booked back up the strip, returning to Todai to make it just 30 minutes before their lunch buffet closed, gorging ourselves on sushi stuffs, their little mini-desserts rounding off the meal quite nicely.
• Then I forked over the money and bought one of the amazing dresses we tried on at the Betty Page store the day before.
  
• We found ourselves being followed by a group of cheerleaders who insisted on one-handed death-defying lifts all over the city.
  
• By then we were spent, rested in the room, I even got a good nap in.
• After the sun went down, we went out again. We dolled up in dresses, me in my new one and A in a hot little black number and we caught some free shows. Treasure Island (TI) Sirens – the cheesiest of cheesy show girls lip syncing to really bad music and pretending to have a little pirate fun. The tall gentleman and his wife watching from behind us were almost just as entertaining as he shouted his Arrr’s and his wife drank a big yellow margarita out of a plastic skull larger than some human heads. (Avast me mateys! See "sinking" ship at right).
  
• On this trek I did catch an Elvis – carrying a studded leather cape and whisking conspicuously through the crowd.
• We caught the Volcano erupting at the Mirage on the way back from TI and then meandered back to the Flamingo, still dolled, A nursing her cold and me a bit dismayed that there really aren’t any slot machines with actual slots for coins (I had put aside a coin of every face to try for Luck but it turns out they were better suited for tip jars).
• We each had a slice of pizza, watched a movie while we packed, and hit the proverbial hay, A missing her boys immensely and me missing A already.
• A left early in the AM while I fell back asleep and woke two hours later.
• The airport was crowded. The driver of my shuttle was from Sierra Leone and we talked about the war while navigating the way there. The Texan with the Mohawk and the reluctant New Yorker (“Where am I from? For now, New York”) joined in the conversation as well.
• Beside me on the plane was a Marine reading about Java programming and, as I type this, we land in just under an hour. I finished Fahrenheit 451 (finally) and realize that it makes me want to read and write like I used to – every day.
  

Funny how a trip to Vegas ended up with inspiration to read more. And maybe grow some kick ass sideburns. That would be Elvis-y-cool for sure.

Viva Vegas Vacation

I started this blog entry in my PJ's before heading of to Vegas. I think it was the chill of my apartment and the need to keep my fingers moving to prevent them from becoming little fingersicles. I wrote about a nightmare I had. Family Practice was suddenly no longer a viable specialty. They were going to shuttle us all to either Obstetrics or Medicine-Pediatrics. It was part of Obama's restructuring of health care. I thought it was a horrible idea. Some thought it was genius. Suddenly, here I was, more than half way through my second year, closer to graduation than the start of it all and I didn't have a job! All those years of medical school, the "fun" of the last 20 months, for nothing. I don't know what brought it on. All things considered, it wasn't all that terrifying. It certainly was less so than the nightmares I'd been having about my building falling over.

Nightmares aside, here I am in Las Vegas! The sun has been out each day, the weather in the 60s. No poolside lounging for me, but I have explored the strip. There is so much going on all the time here. Even for someone who doesn't really drink and doesn't enjoy gambling there is a lot of fun to be had! My poor companion is battling a nasty head cold so we turned in early tonight but today was pretty busy.

Our Day:

• Big breakfast bright and early. I had eggs Benedict with salmon instead of ham and fruit instead of hashbrowns!
• Then nearly four hours exploring - our own Flamingo, Bellagio, Venetian, a few other places, some interesting people watching.
• Back to the hotel for a break - supposedly for a nap but we wound up messing around on my computer instead.
• Then another exploring trek. We checked out Planet Hollywood and Paris.
• Late lunch/early dinner in the old Aladdin desert walkway (or whatever it's called now): Mussels and ahi tuna salad (we tried Todai but it was closed between lunch and dinner so we ate at another place)
• At the restaurant we met a nice local lady who surprised us by paying for our lunch! Then helped us shop at the Betty Page store where I tried on 5 dresses and loved them all!
• Next we caught a few shows at the Bellagio fountain
• Then we went on a wild goose chase trying to find these caramel apples we swore we saw at the Bellagio but couldn't find again, gave up and came home for the night.

Tomorrow maybe we'll make it to Todai for lunch and find those caramel apples. Maybe we'll take a ride on a gondola and maybe we'll see a Vegas show, preferably one with impersonators - Elvis impersonators. And maybe we'll hang out in the sun, by the pool, in sweaters, seeing if our exposed skin can help us get enough vitamin D to bring back to our cloudy homesteads. (Our bathroom, by the way, above!)

You want an update? I got your update right here.

UPDATE: Reunion
Quickie update on being able to go to my 10 year college reunion. Remember my 23 steps to get a vacation? Well it failed at step 10. I got a phone call from the pediatric rotation liaison where she called and said, "We all discussed this switch at length and after much deliberation we decided: pppffffttt!" (okay, not a direct quote, but that's what I heard).

So I tried another tactic. Instead of swapping the week I proposed swapping out the entire rotation. It was accepted! So now I'm at the point where I need to request the week off. Here's the updated to do list for just this step (step 15 is where we are if you remember the old list).

1. Find coverage for my colposcopy clinic - DONE
   
2. Find coverage for my AM and PM gynecology clinics - IN PROCESS
   
3. Find coverage for my obstetrical patients.- DONE
   
4. Find coverage for my patients that may be admitted to the hospital while I am gone.
   
5. Find coverage for my in-basket and mailbox and any patient calls or concerns while I am gone.
6. Get signatures on the request from each person covering all the above
7. Submit this signed request to the chief resident.
8. Then on to the scheduler for approval.
9. Then to the clinic director for approval.

So much more manageable than the last list, don't you think? (Photo is actually of New Haven, but close enough...)

UPDATE: Band
This swap will also give me the opportunity to play with my band during the marching season. Which I'm totally excited to do! I'm really really geeked about the band. In fact, I think everyone (including the homeless lady outside of Starbucks) is really tired of hearing about it. We have two Christmas shows. I am on call for one of them but am trying to swap the call. I get to play the horse whinny solo in Sleigh Ride so it's definitely worth extra effort to go!

The fall concert went swimmingly. I hear there's a CD of the performance, maybe a DVD - not entirely sure. I am still singing the songs we played. If something shows up on YouTube and isn't entirely embarrassing I will definitely post it here. The turnout was great - a few hundred from what I hear? I played horrifically out of tune for the very first portion of Thriller and was inspired to improve in my tuning and pitch. It will be really helpful for the ballad-y holiday pieces we are playing like Imagine. So I bought a KORG tuner. An awesome invention and totally fun and I will probably talk about it more another time.

UPDATE: Sive's health
For those who don't know, Sive has been having a bit of a peeing issue. She had this issue a little after I first moved out here. Now it's back and it started looking a little more serious. She had gross hematuria at the vets office and even passed some clot (that's medical talk for peeing blood and blood clots). We had an X-Ray done which was a little ambiguous and some lab studies. So about $500 later and after a specialist read of the X-Ray we still aren't sure. It doesn't look like frank stones, no evidence of obstruction, no massive tumors. Her bladder had some sludge in it and her urine culture is still cooking. So we'll see what bugs grow as it is likely she may have an infection as well. (Sive watching TV)

UPDATE: What am I doing right now?
Right now I am at the GLMA national conference. I serve on the Board of Directors and presented again this year on LGBTI curricular change and integration. What's amazing that this is still a very hot topic. It's great to think how far UofM came in just my four years there. So many schools are trying to go through the same changes and its an honor to serve as a resource for all these medical, nursing, naturopathic, social work, PA and other students, residents and faculty. Blah blah blah education blah blah advocacy and all this stuff that is really awesome and I've been talking about this whole weekend...

So now for a snippet of the pure fun that was Friday night out at Seattle Trannyshack (filmed by the iPhone of the guy standing next to me). Strung out Judy Garland and some stage diving below:

I wish I had a video of Ben de la Creme - the BEST performer - a robot strip dance with light-up body parts... excellent performance art. And she's a local drag queen so maybe I'll get another chance to see her!

Weekend on Whidby

The weekend I spent on Whidbey Island with my father was fabulous. I was thankfully able to swap out my weekend of back-up to have the freedom to roam off of TFM boundaries. I even turned my pager off. Our ferry landed in Clinton, we stayed both nights in Langley and also visited Useless Bay and Coupeville.

As my Dad put it, we "ate our way though Whibey Island". The highlights of the weekend were:
1. The Food - Penn Cove Mussels in Penn Cove, the most incredible chocolate mousse in a a chocolate tulip (pictured), the most amazing caramelized kettle corn from the farmers market and a tasty salmon omelet breakfast are just a few highlights.

2. The Digs - A gorgeous two story beachside residence with a to-die-for panoramic view of the water. Warm, cozy, with a gas fireplace and flat screen TV. Luxurious down comforters and a pile of pillows I could get lost in.

3. The sunrises. See picture, taken from our window.

4. The beaches. Each with their own smooth volcanic skipping stones, bleached driftwood, washed up jelly fish, views of cliffs, mountains.

And there was so much more... It was peaceful and restful. The weather was cooperative all day Saturday (though certainly brisk - great hot chocolate weather). The place we stayed in Langley was called the Boatyard Inn. Check it out.

We rounded off the weekend with a nice dinner with the Seattle cousins and then it was back to work on Monday for me. Amazingly I was able to have some breakfast with Dad before he head off on Tuesday morning and we had the BEST Tacoma breakfast ever at Southern Kitchen. Definitely a place I'll have to return to. The fried catfish breakfast looked incredible but I had to have the cornmeal pancakes. I won't even get started on their famous beverages. Click on the link above for a great review.

As when family usually visits I had a bit of a low afterwards. Thankfully I had band practice and Shilo planned Tuesday and Wednesday respectively. A difficult call on Thursday (thanks to our new live in-patient electronic medical records) and a busy workday today rounded up the week and here I am back in action. I have my concert tomorrow with the Rainbow City Band. I'm a little nervous. The woman sitting next to me in the trumpet section said that she thinks we sound the worst we have ever sounded at a dress rehearsal... but you know what they say about bad dress rehearsals, right? Of course I have invited everyone and their mother. A couple of my resident friends, Shilo's mom and my faculty advisor plan to be there if they can make it. Hopefully we won't suck too badly.

On a side note, today a clinic patient about 10 years older than me exclaimed as I was introduced: "A doctor! But she's a kid!" I'm flattered that to some people I look half my age, but it gets tiresome. Maybe I should spend more time in the sun and get more wrinkles, of course skin cancer isn't fun either. I actually had one patient say to me "You don't look old enough to be qualified to be a doctor!" Qualified? Even Doogie was qualified. Hm. I should start thinking of ways this may work to my advantage... maybe people will sue me less than other doctors because they think I'm so young?

So I'll leave this lengthy post with that last reflection and this hilarious pictures of cat "costumes" Pet Smart tried to market to me.

7 Days in Colorado

My trip started eventfully with a two hour delay due to a leaking oxygen line in the cockpit. We found this out, of course, after we had all boarded, returned our seats to the upright position and fastened our seat belts. They were kind and let us deplane if we'd like. I had lost my boarding pass in the boarding shuffle so did not deplane, instead, stuck in flight delay limbo hell, paced the pictured skyway over and over and over again.

Nonetheless, it all worked out amazing well and I landed in Denver the exact same time as my friend, Suhani, who landed two gates over. The thrill of being in Not-Tacoma was overwhelming. I was brought back to earth when using a public bathroom that was obviously transplanted from some preschool to the rental car agency. I managed to give myself a closed head injury in the tiny stall and wound up with a goose egg and a headache. More than 10 days later my scalp is still sore.

The first night I saw my way pregnant cousin and her family on Pearl Street. We ate yummy deep dish pizza and settled in to our awesome cabin right at Eben G. Fine park (the name which I kept thinking sounded like a jive remark: eben g'fine, jive turkey!). We were a stones throw from multiple trails, paths leading to the funky, liberal city of Boulder and vigorous mountain hikes.

On the third day, when we were not quite acclimated to the altitude but certainly motivated, we took a 4 hour hike, about 2.5 hours which were straight up. Thankfully, we motivated each other and made it to the top where we were literally greeted with applause. While the trip up was hard, the trip down had its own challenges. At times we were almost crab-walking between cracks in boulders and at times slipping a bit. In fact, there was a terrific wipe-out from my climbing partner. One that had us in stitches all day and her practically in crutches the rest of the week.

I really liked the Foot of the Mountain Motel where we stayed. Aside from the funny smell in the apartment. However, this mystery sewage, metallic smell (that Suhani only was able to sense on one occasion but which seemed to invade my nostrils every time I started to relax) inadvertently led to meeting the hippie, Indian flute-playing, fly-whispering, hotel attendant who reminded me a little of my brother and totally brought a smile to my face).

Tanya arrived and we continued to explore Boulder, shopped, strolled, had a meal or two at the lovely Tea House and just enjoyed the relaxation.

The last two nights I spent at a fancy hotel. I made good use of the hot tub, pool, free apples and Tanya and I halfheartedly explored the nearby shopping areas.

Mostly I just relaxed, caught up with a couple friends, read my book, and ate during the week. Exactly what I wanted to do.

Sleep, Loss, 5 Days Until Vacation

Well, I tried to crank out a quickie blog entry before my last call. Didn't work so well. Here I am post-post-call about to go back to work to round on all the c-sections I did on my last call (yep - every delivery was by c-section, half of them emergent under general anesthetic - just a typical call for this black cloud). I am very drowsy so I apologize in advance for the typos. Pre-call I didn't get much sleep as I kept hallucinating my pager going off all night and had to answer all the non-pages. Last night I think I did sleep most the night, but now the days are shorter and I wake up in the dark again, groggy and disoriented.

I am so excited that my last week of the massive marathon twelve-week Q4 call is upon me. One more day as rover (i.e. secretary, ultrasonographer, referral nurse and slave to the OB clinic), one more crammed packed high-risk OB clinic, two more of my own nutsy clinics and ONE more call. That's it. Then I start vacation. Thank GOD!

Speaking of vacation... On the way back from riding the other day I saw a car drive by with a Yale sticker and felt a longing for Connecticut. I still haven't heard about my May rotation swap. For all I know it's circling around some committee somewhere. I'm anxious to submit it back to my own people so I hope I get approval soon so I can move on to step 11 of 23.

In my initial attempt on this blog entry I was reflecting on last Friday. It was a particularly hard day for me at work. Sure, I had to get up extra early round on the bazillion patients I delivered (plus pre-termers trying to keep their buns in the oven a little longer). But then I find out one of my favorite panel patients is losing her one-day old baby to child protective services for some vague unspecified reason. The patient, me, her nurse, and even the social worker were all shocked. How come they don't take babies away from totally unfit mothers but then take them away from rehabilitated mom's? I don't get it.

Then, I had my "One on One" in clinic. That means that a faculty doc shadows me all clinic, sits in the room while I interview and examine my patients that day and gives me instantaneous feedback. Sounds fun, eh? It's kinda like being a medical student all over again. Then, after she didn't show for her appointment, I find out one of my patients died. She was one of the hardest (I've blogged about her before) and one of the crotchety-est patients on my panel. But she really liked me, trusted me, and we had a great time together. I looked forward to seeing her each clinic even if I knew she would whip out some health-threatening surprise each time. I easily spent more time with her than any other patient. I rounded on her in the hospital, in the ICU, saw her each month in my clinic, talked to her while she was ventilated, even watched the snow fall at 5 am on Christmas morning post-call and she gave me root beer as a gift (and because it didn't jive with her diabetic diet). Funny, I always talked to her about her end of life plans but she was so resilient I think everyone thought she would never die, even though we all knew better. I also imagined myself being able to say goodbye at her funeral instead of finding out days later from a "why did you miss your appointment" phone call from my nurse. SG, I hope your passing was peaceful and you are breathing easier wherever you are...

Thankfully I had a Saturday off to try and process all of this and catch up on a little sleep before hitting up another week of everything and my Sunday call was too busy to think about anything other than work.

Twenty-Three Steps to Get a Vacation

They say time flies when you are having fun, so is the opposite true? Is it like that last scene in that X-Files episode where the former speed-addicted teenager watches the second hand creep, creep, creep and then skip back a beat and creep another second forward? The agonizing passage of time...

I bought my ticket for vacation in Colorado. I hope to be there for the birth of my new little cousin and I hope its warm and pleasant. Not surprisingly, given my incredibly regimented schedule, I have most of my vacations planned through the next 12 months. All except the last. My last vacation of the year has been exceedingly hard to manage. See, the residency gives us our schedule for the next full year at one time. Then it's on us to try and find a time during one of the few rotations where its allowed to vacation to find coverage for our work and maybe get it approved to go.

I want to go to my 10-year college reunion very badly. I miss my college friends and they think they might be able to make it. This could potentially be a very fun reunion and I could get some QT with Boston and my friends that live there. (Picture of Obama speaking at this year's May Commencement and Reunion - will be hard to top next year).




So here are the hoops I have to jump through to make it happen:

1. I have to swap my rotation week. I need to find a person to be willing to take on a week of in-patient pediatrics that week in exchange for their out-patient rotation. DONE
2. I have to make that week as equivalent as possible in call days, call points and days off. DONE.
3. I have to make sure that our swapped out-patient weeks are also as equal so we don't end up taking unequal back-up or hospital call. DONE
4. I have to get a signature from said person. DONE
5. I have to submit it to the Chief Resident for approval. DONE
6. It has to then be submitted to the scheduler for approval. FAILED - now onto #7
7. It has to be documented that the during said swap we are actually covering for each other - me covering for her out-patient duties and her for me (The whole idea of a "swap" apparently not obvious enough to get authorization). DONE.
   
8. I have to get my faculty advisor to sign the swap request. DONE.
9. I have to get the other resident's advisor to sign it. KINDA - he signed conditionally, adding step #10 to the mix.
   
10. I need approval from the in-patient hospital service involved in the switch. This is now going to be discussed in the meeting for the service faculty, if it is appropriate for the switch to occur. PENDING.
    
11. I have to resubmit to the chief resident.
12. Then back to the scheduler.
13. Then to the clinic director. - if this is approved then the swap is for sure and I will have an out-patient week the week of reunion.
14. Then I have to request the week off.
15. Find coverage for my colposcopy clinic
16. Find coverage for my procedure clinic.
17. Find coverage for my obstetrical patients.
18. Find coverage for my patients that may be admitted to the hospital while I am gone.
19. Find coverage for my in-basket and mailbox and any patient calls or concerns while I am gone.
20. Get signatures on the request from each person covering 15-19.
21. Submit this signed request to the chief resident.
22. Then on to the scheduler for approval.
23. Then to the clinic director for approval...

And then, after step 23, the vacation might be approved and I can attend my 10-year college reunion.

All this for 7 days off in May 2009. I wasn't kidding when I told my college friends that I may have to move mountains to go to attend.

On a positive note, only three weeks left of OB. That means only three weeks left of this endless 16 weeks of inpatient life - on call every 4 days, only 4 days off a month, living by my pager, sleeping little, eating crap and falling out of touch with everyone that matters. Then I get one week vacation, one week of a more relaxing rotation and then right back to in-patient life.

689 days left of residency...

Nose, meet grindstone

Back from vacation and now it's on to four consecutive months of 80-hour work weeks with the usual four days off a month.

Please allow me to heave a huge sigh of self-pity.

*sigh*

On the bright side, I'm getting one the of most dreaded, dangerous rotations of second year out of the way right out of the gate. By dangerous I don't mean the rotation is performing prostate exams on sky-divers. I mean the well-being of pregnant women and unborn children at Tacoma General will depend primarily on little old me every fourth night all of July and August. Translation: every single delivery, tragedy, ER case, c-section, pre-eclamptic seizure, preterm labor rule-out, everything, anything, that could possibly happen to anyone pregnant at Tacoma General is my responsibility. There are exceptions for private doctor's patients but, really, until that private doc comes in from, say, Gig Harbor, to see his or her patient I'm the back-up. Also, it is true that there will be at least two attendings available to help me. At least one of them in-house. And there is another resident in the hospital doing night float that I can call for help in dire situations. Despite all that, I can't help but feel that this is a risky way to go about bringing life into this world. However, it's not my call and it's been done like this for a long time without any truly adverse events (that I know about). I'll be sure to let you all know what it's really like when I'm in the thick of it.

As for the two months before that. These remaining 7-ish weeks of internship I will be rotating on in-patient pediatrics. I think the last time I did that was October of 2005. So wish me luck on that.

The bad thing about this stretch is that I will not be able to take advantage of the NW's supposedly gorgeous summer - the reward we get for enduring the abysmal weather of the last 6-7 months. The silver lining is that at least in my 80 hour weeks I will get to still see some daylight. Even if it's just during my trip from hospital to bed. The other silverer lining (wordsmith = Liz) is that the dreaded two consecutive months of R2 OB will be o.v.e.r. and I will begin to have a better idea if I want to pursue OB as part of my future practice. (photo I took of tree in Wright's Park).

I feel like I should include a brief summary of my vacation. It was rather nice. I got to see lots of friends, spend some QT with family and even got to finish reading a book. I went for a few runs in a park, walked around Detroit (took photo at left of Spirit of Detroit), saw a ball game, and spent part of a day in Grand Rapids and ate awesome Indian food at a friend of a friend's Hindu celebration/ceremony. I relaxed, I rested, I ate a TON of ice cream. It was good and I actually feel pretty refreshed (despite the nasty cold I caught somewhere along the way).

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!

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.

From rainbows to Elk, with yummy food in between

Before I start a new adventure I thought I'd wrap up the last two.

My last full day in Kauai was very nice. It managed to rain all morning conveniently enough for me to mess around on my uke and then finish my book, a Japanese crime thriller called Out. The double rainbow ending in the ocean behind Sue and Irv's condo was fabulous (as evidenced here). Then the skies cleared and we first lounged by the pool and then by the beach, and I may have actually gotten a tad of a tan-line (but only if you're in the right lighting).

As promised, I'm posting here a pic of the awesome Shave Ice I had in Hanalei. Really, really fine shaved ice (but no D, officially), almost like snow. then its totally drenched in tropical flavored syrup (of your choice) with (get this!) rich, creamy ice cream (also of your choice) on the bottom. That's right, folks, this is waaaay better than your usual beach-side crushed ice SnoCone. In fact, SnoCones everywhere should be ashamed, because obviously there is an opportunity to explode your tastebuds and make you writhe in ice-cream headache joy if only the SnoCone it would instead be Shave Ice. *sigh*

On the flight home I read nearly the entire book Life of Pi, which I thought was excellent. My layover at the Honolulu airport was spent reading and playing my ukulele in the sun. A good last horrah before back to birthing babies. (Me, floating in ocean at left)

The last adventure was this past weekend. The "R1 Retreat". We have two retreats in the year.Each class of residents gets their own and then we have a mandatory whole class retreat. the mandatory one has more structured activity. The class retreat is unscheduled, mostly because we're too tired to plan anything and we have no budget. But we can get the days off if we are scheduled to work that weekend (which I was). Basically it's two days where we eat, sleep, and eat some more (note copious amounts of food in cabin's fridge, below). Very relaxing.

We went to a cabin in a place called Packwood. It's near a ski slope called White Pass and in the mountains. We had Elk running around our yard daily and on Saturday most of the folks went out sledding, snow-shoeing, skiing or snowboarding. Me, I spent most the weekend lounging in the outdoor hottub, reading and, of course, eating.



On the trip, however, one of the interns (shrouded in darkness at left, with the retreat's fab view behind him... and Liza) made an announcement that he was leaving to pursue internal medicine. He obviously initially thought FP was the career path for him but realized at some point he was meant to be an internist and is actually starting over (Egads! I can't even imagine being an intern again!) in Portland next year. He will finish out most of his year here and, actually, we only have to find coverage for one of his calls in his last month here. We will miss him as he adds not only another Y chromosome to the residency (we are very XX-heavy), but he also is a pretty cool guy. Additionally, the concern is raised about how we replace him because, being a rather small program where each class of 8 essentially runs Tacoma General, we can't really function a resident short for very long. The Program Director will put out the word and we will interview applicants. I'm crossing my fingers for a cute, single, hard working lesbian derby-girl-turned-doctor but you know what they say about beggars and choosers...

Now, better get out of my jammies and into my flight suit (er, jeans and sweatshirt) because I'm off to San Diego!

Island adventures

The last three days have been pretty adventurous. On Wednesday we started with some whale sightings out the window. I got out the binoculars and watched them flip, flop, dive and smack various flippery parts on the water. We spent an appropriate amount of time sitting around doing nothing, reading, Then Sue and I hit up the lighthouse in Kilauea (view from lighthouse walk at left) as well as checked out the little shops in the area.

For lunch we returned to our favorite Fish Taco place and enjoyed ourselves (Irv as well) another yummy beachside meal (see right).

After that we vegged at home (I may have skipped out for a run, taken a nap, or both) and then made sure to head to the beach to see the sunset where Sue reports having seen the famous green flash once. The rotation of the earth meant the sun was a bit off center and given the cloudy weather we have been having it was hopeful to even see the sun but its rays were cooperative and lit the sky pinks, oranges and purples before it melted away into the pacific.

Thursday was our Big Adventure. We got up early and piled in the car to see the rest of Kauai. Kauai is inhabited mostly on the shorelines as mountains make up most the interior of the island. There is really only one main road and it makes a horseshoe shape around most the island (map at left, click on it to see detail). Sue and Irv live in Princeville, one almost the end of the eastern part of the U, our trip was to go all the way to the other side, where you can wind your way into the mountains enough to see the untouched wilderness. On the way out, near Hanapepe, we stopped at the tiniest little shack with the door ajar. Sue was excited to get her potato chips, I was a bit nervous she had the wrong place, but we slipped in the kitchen and there was a grumpy middle aged guy cooking up all sorts of yummy snacks, bagging them, and watching the soap operas. For myself, I got sweet potato chips, sliced as thin as paper, spiced with garlic.

On our journey we drove past two lovely waterfalls, each spectacular in their own way and many hours later we found ourselves at the end of the road where we turned off to admire Waimea Canyon. The drive was a bit treacherous and wound up and around the mountains. We explored the various nooks, crannies and outlooks there much to Irv’s dismay (“Once you’ve seen one waterfall you’ve seen them all. What’s the big deal?” Irv laughed). But he was good-natured and humored both me and Sue who agreed (since we did spend the numerous hours driving out there, and up the mountain) we’d make the most of it. There were a number of tourists at each stop and people found the wild chickens and roosters cute. Sue, however, likened them to rats. They used to be on farms until hurricane Iniki wiped out the entire island and freed them to procreate, cluck and crow to their heart’s content. Now they are everywhere. Literally. Even, we noted, at the local Costco.

On the way back from the canyon we stopped at a lovely music store where I bought a soprano ukulele. I had gotten a baritone uke for my mom way back in the day and taught myself to play it. I thought, since I do fancy musical instruments from around the world, a uke from Hawaii would be appropriate to add to my collection. We also stopped at a coffee plantation and on Poipu beach, a busier and more tourist friendly beach – probably because of its location on the sunnier side of the island and it’s protected shallow waters where toddlers are safe to wade. (pic at right taken while driving around the island).

We also stopped at a shopping center in the area that served Puka Dogs (click on picture at left to see the menu). These are hotdogs made in a special Kauai way (though it appears they now have a store on Waikiki beach in Honolulu). The buns are roasted on spires – the spires make holes for the dugs. The dogs are dressed in various spicy “secret sauces” and then dressed with exotic relishes like coconut, mango, and papaya. It was delicious and I ate mine while watching a staged Tahitian/Polynesian cultural show.

On the way home we saw one last sight – spouting horn. Where the waves crash under a lava shore and then growl like an animal before they spout up to tens of feet in the air.

Friday was much less structured. My goal was to populate my freckle colony with some sun exposure. Unfortunately a rain cloud seemed to be following me around the island. I did get up before dawn and go with sue to find some seashells - found some spectacular ones that I’ll be bringing back with me. Aside from that, my productivity was resigned to pool sitting, beach bumming (albeit mostly in my sweatshirt) and exploring a bit of Hanalei’s shops after a yummy dinner out (goat cheese and fried eggplant salad – yum!). Oh! And I can't forget Shave Ice! The best place (according to Sue) is in Hanalei. I, of course, got a picture of that treat but you'll have to wait until the next entry to see that delight.

Today is my last day. As I look out the window it is again rather cloudy with a low ceiling and some scattered rain. I can’t remember, but I feel like low ceilings are the ones that burn off easier. I can only hope. Either way, it is still nice to be on vacation and away from the rigors of internship. And it’s been great traveling to a new place. All I can do is think about when I can do it again and where on earth will I head to next? (photo at left of late evening sun at Spouting Horn lookout).


Stayed tuned for a last entry on Kauai in the next few days.... now I'm off to see if I can spot a rainbow and drink my toasted coconut Kona coffee!

Kauai

It’s hard to believe it’s been more than 7 months since my last traveling adventure. No wonder I was starting to get antsy.

Here I am now, in Hawaii for seven nights. I’m on the rainier of the islands, Kauai, just a hop skip and a jump from the supposedly wettest place on earth. It’s been overcast mostly, with a few sun breaks, definitely not shorts and tank top weather and certainly not sunbathing weather. But it’s been nice to relax, read my book and watch waves crash. The best part of the wintery weather is that it makes the sea very volatile and actually fun watch. It also makes it harder to spot whales coming up for air since they make a whitecap and the choppy water masks them. But I still sit on the balcony and watch, read and watch some more (view from my bedroom above - on a rare partly clear evening... no whales).

The first day I arrived was uneventful. I arrived late in the day, ate too much, and was asleep by 8:30 (two hour time difference from WA). I slept well to the sound of crashing waves (at right) and was rarely awake enough to appreciate the ripping sound of the 30 mph winds assaulting the house. I was up by 6:30 the next morning and went to a nearby grocery to pick up some toasted coconut Kona Coffee. Yum. I’ve never been a fan of flavored coffee but something about coconut makes me a little crazy. That day it was rainy and bleak so Irv, Sue and I were homebodies. I did manage to get a run in, heading to the Princeville hotel (a huge behemoth on the shore with fountains and excess everywhere).

After the run it was too rainy for much else so we pretty much sat around and read. I took a humongous power nap and read some more. I also played with the dogs from the condo next door, Champ and Peanut (at left).

The next day (yesterday) involved a bit more adventure since the clouds were less threatening and we even had some sunny breaks. First Sue and I went to see Anini, one of many beaches close by (with Champ in tow). There we had marvelous fish tacos, spicy carrots and mediocre beans. We then drove the length of the beach (and pointed out what is rumored to be Cameron Diaz’s new cliff-side house). Sue also showed me some of the more rural properties (one large lot owned by the neighbors – Champ’s parents). Reminded me a lot of the mountains north of Chiang Mai.

Later that day Irv and I hit up two beaches, Hanalei (where Puff the Magic Dragon frolicked in the autumn mist and rock stars make their homes) and Lumahai (where rip tides claim swimmers and unsuspecting tourists). Hanalei had a few surfers and a gorgeous view with very nice walk-able sand (many barefoot runners passed us by). Lumahai, on the other hand, had ginormous violent waves and the sand was deep and foot-sucking! I took a couple videos of the waves (if only my videos had sound) and we ogled at the area where Detroiter, Mitzi Gaynor washed that man right out of her hair in South Pacific. We also stumbled upon a local farmer’s market (left) and picked up some yummy coconut and Rambutan (lychee-like) fruit at my request and bought apple bananas, Irv’s favorite. On the way home we stopped by to admire the Taro fields (below).

After all that trudging through the sand I thought I’d be beat, but I ran again, this time in the opposite direction and toward the taro fields. After that we all had a delicious meal of avocado veggie salad (pictured) and steak and mushrooms. I crashed early once again.
Today I anticipate numerous adventures. Perhaps a return to Hanalei to shop, or to the lighthouse in Kilauea. Hard to believe it’s half over already! I'm hoping for at least one sunny day to add to my freckle collection, but the R&R alone is pretty damn nice.