Confessions of a PA student

That's Not What I Said

2011-01-28T20:52:00.004-05:00

i noticed recently that when my family members and friends are having health crises and are retelling the stories or asking my opinion, they will tell me VERBATIM what their doctor said. like, "he says it's not an exact science" or "he said we'll have to wait and see." and then they'll reflect on what the doctor meant when he said that, what he might be missing or withholding, and what might be hidden in the message.

so the words we practitioners use matter. a lot.

this is why, when we were trained to do the female gyn exam, we were told to use only the words "healthy and normal." stick with those adjectives, less you worry them ("uh, huh, hmmm") or creep them out ("your labia looks nice" is not a good thing to say).

and know that they are hanging on every word you say. so be cautious. be wise. and be equally aware of non-verbals. a simple glance toward the door or out the window might tell a patient you are impatient to leave them and don't care about their plight. or, it might tell them that you're hiding something or nervous to share bad news with them. when in fact it might actually mean that you thought you heard the tow truck leaving with your double-parked car. on the flip side, when giving bad news, you have to be direct and sympathetic without giving false hope or no hope. it's a very tricky thing to do.

and i'm the same way with my MD's, by the way. when i'm pregnant and my ob/gyn says things are "perfect" (his favorite word), my heart beats a little more evenly.

words matter. which is why accents or unmatching dialects are challenging for both practitioner and patient. and why you have to try to unload your own personal stressors before encountering your patients. they might just pick up on them and think your mood has something to do with them. not easy. but important.

Should We Have to Pay for Our Decisions?

2011-01-20T16:43:00.002-05:00

some companies give health insurance credits/premium reductions to those who make healthy choices. not smoking, not drinking in excess, exercising enough, normal BMI and healthy food choices, wearing seat belts, etc.

but what if our government, once they are the even more dominant insurance carrier in the country, does the same? are we ok with them knowing how fat we are? if we smoke? choices we make for ourselves and our children? hmmmm....

and, how far will we go in encouraging preventative measures? an interesting op ed piece on cnn.com today questioned just that, in reference to vaccinating from diseases. they use the example of an unvaccinated child traveling to europe and bringing back the measles in 2008, causing an outbreak of measles in san diego. you should read it, but the gist is, vaccines are cheap, illnesses are expensive. and you have to consider the cost not only of the unvaccinated patient with the illness but also all those who catch the illness from said child and need to be treated themselves, or those in quarantine away from said child. all this medical care and time off work for the parents could have been prevented with a simple, cheap vaccine.

so should those parents not be charged more for health insurance if they're deliberately electing to go against medical advice and to put their family (and others) at greater risk of health issues/cost? this is assuming that we're looking at a future where you get perks for being healthy, conscientious families and get penalties for being families who smoke or are obese, or are otherwise at increased risk by their own choice.

food for thought.

More Sad Outcomes

2011-01-13T21:06:00.003-05:00

busy hospitals, understaffed, undercaring...who knows. but this article today on how a serious bacterial infection grew across a child's face as her parents watched in horror while sitting in an ER waiting room...sickening.

is it imperfect? hell yes. is it an outrage? absolutely. is the system broken? obviously. but does it mean you should stop seeking medical help when you/your family is sick? no. she needed iv antibiotics and aggressive management in a hospital. she just needed it sooner.

so...if you're blocked or dismissed by a medical practitioner when you are certain something is wrong- what should you do? my advice- (and i know full well what i'm saying here, since i might be on the other end of this) go nuts on them. give them a comprehensive and emotionally neutral description of the severity of the situation first and then if you are continually pushed aside, have a shit fit. be a squeakier wheel. sometimes that's what it takes to get things done in this world. sometimes rattling the cage one more time makes us give a quicker or more complete review that might show something crucial.

and your instincts are important. and i know parents are always worried that they're over/under reacting, but if it just feels off and your kid is not acting like your kid, make your voice heard.

also, i would recommend choosing your facilities carefully. this article says you should go online and find which ER has the shortest wait time, but i would say, if it's something that doesn't appear to be life or death, go to an urgent care first. they will a) see you sooner and b) if it's really something bad, will call ahead to the ER and have an MD lined up to see you when you arrive and meanstwhile they can be giving you some treatment.

it is extremely awful that this little girl ended up with so much debility when the parents did the right thing by bringing her in and it could have been stopped sooner. i know that after this story got released today, all triage units in ER's and urgent cares across the country are evaluating their process. let's hope that makes a difference and saves another family this tragedy.

Did Y'all See This in the News Today??

2011-01-06T19:33:00.002-05:00

once AGAIN. vaccines do not cause autism. amen.

and, make the right decision! and even if you have, there's a chance your kids are being exposed to kids who have not been vaccinated and are carrying around scary, archaic diseases and you don't even know it. find out (daycares are a little different than schools, ask yours if they allow for personal/religious exemptions).

Happy Almost Christmas

2010-12-19T21:47:00.000-05:00

Times is Tough

2010-12-05T19:44:00.002-05:00

there is a lot of worry lately as hospitals in our area are cutting more staff and slashing department budgets. often time PA's (and NP's, CRNA's, midwives) are the first ones cut, since we work directly for the hospital and cost a lot, but don't actually bring in our own clients like the MD's do.

most of the local hospitals that i know who have cut their PA depts end up hiring them all back because the MD's and other staff find that life is difficult without them. but the short-sightedness and new administration constantly coming in and reinventing the wheel and the frightening amount of red on the budget sheet is making all of us a bit nervous these days.

my plan is to ride it out. keep my head down and hope for the best. i think we're vital to the integrity of the surgical dept and that they'll figure it out, i just don't know how many casualties there will be between now and then. (gulp).

i have felt a little insulated from this economic crisis the country has been suffering for years. now i'm starting to look around my house and wonder what i can sell or burn or put into a soup. :)

What is On the BHE's Mind? Cow Farts.

2010-10-25T21:49:00.002-04:00

sorry, sports fans. i've been super busy lately. so in light of my hectic schedule, the BHE has agreed to write a post about what he's been into lately.

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so i've been thinking a lot lately about what we eat and how it gets to our table. frankly, the research i've done shows some very significant issues in our food supply. and since 2/3 of all americans are overweight or obese, i think it's a good discussion for us to have.

the topic is wide-ranging, so while we can make good arguments about the safety and sanitation in the meat supply or the damage that pesticides can cause in our bodies, i'll narrow it down to cow farts. i don't know if you know this, but global warming is kind of a big deal. and we spend a lot of time discussing the impact of carbon dioxide and different ways we can reduce our carbon footprint. and that's all well and good. however, if you really want to have an impact in reducing carbon footprint, you don't have to become a smug hippie who drives a prius 10mph below the speed limit. you have to worry about cow farts.

why?

because cow farts are made of methane, and methane is made of carbon. and what's worse, methane traps twenty times more heat than carbon dioxide. the average cow emits as much greenhouse gas as the average car, and worldwide production of beef and dairy are expected to double in the next 30 years. you can see the numbers problem.

so what does this have to do with our food supply? the vast majority of meat sold in the american marketplace is grain fed. even if you reject the resources consumed in producing the grain as food for our food, consider that it gives our cows indigestion. and that makes them burp and fart all over the place. if we fed our food grass rather than grain, or even just a grain diet that mimics natural grass, we can reduce their methane production by nearly 20%. there are health reasons why grass fed beef is much better for you, too. you can read up if you get off on omega-3 to omega-6 ratios.

food for thought.

Chemo is Awful, But Gravel in The Vagine? Whoa Now.

2010-10-15T09:28:00.002-04:00

http://pagingdrgupta.blogs.cnn.com/2010/10/14/how-the-ancient-world-dealt-with-cancer/?hpt=C2

really interesting article on how ancient societies faced/treated cancer.

i assume that one day we'll look back at chemo and radiation with the same horror that we look at blood letting, leaches, and, in this article, injecting gravel into hoo-ha's for uterine cancer. eck!

interesting anyway. :)

Veterinary Medicine Might Have Been the Way to Go

2010-10-03T09:19:00.005-04:00

my dog won't stop getting injured. she is a retired greyhound and came to us off the track 4 yrs ago in good shape. but she has a tendency to get wounded just by passing by another dog or by running around our yard, or by stepping foot into the dog park. it's ridiculous. i know for a fact we've spent more on her out of pocket this last couple of years than we have on either me or the BHE.

and this week she had to get a claw amputated! the ligament and claw on one of her front feet. she's limping around all pitiful-like. this was clearly a bigger surgery than i would attempt, but i gotta tell you, for the minor lacerations, i am so tempted to sew her up myself. it's just that i don't want her thinking of me as the bad guy and i don't have a ready supply of lidocaine and stuff. i don't think we could train her to bite down on a strap of leather to get through the pain.

so for now, we're putting our vet's kids through college. you're welcome, susie and george.

Back in MY Day....

2010-09-19T20:49:00.005-04:00

we recently launched an electronic (computerized) medical record system at my hospital. i know, i know, we are a bit behind the times. basically, instead of scribbling some illegible order that the unit secretary has to interpret and input into the computer system for the nurse to see and follow those instructions, now we just put our orders directly into the computer ourselves, and they go directly to the nurse's inbox. eventually, progress notes and everything will be on the computer. already, lab and radiology reports, vital signs, lots of stuff has been available exclusively on the computer, so this is just one more step to being paper-free.

there are a lot of positives to this. medication errors should be fewer, and any of us practitioners can access our patients' charts from any computer, which is convenient.

but, the system isn't very intuitive and a lot of people are grumbling. especially our, well, more seasoned physicians. one of my favorite surgeons is brilliant in the OR, but i doubt that he's ever sent an email. watching him attempt to input a simple order for tylenol is like watching a monkey try to do complex math.

things just change so quickly. in the 30 years this favorite MD of mine has been practicing, he went from a simple gall bladder resection taking 5 hours through a blurry, dark camera, cigarette smoke billowing through the halls of the hospital, and all the physicians being treated like gods, to a gall bladders taking 20 minutes, smoking not even being allowed on the hospital campus, and the docs being made to put their own damned orders in a complex computer system. ouch.

the other day i saw a nissan comercial for a remote car starter that uses your cell phone to start the car. for my generation, this makes some sense and doesn't seem all that frightening or sci-fi. but for older generations, this is straight out of the jetsons. it's just too bad that when you text your car to tell it to start, it doesn't fly to greet you at your front door. maybe that's next. :)

A Funny Thing Happened On My Way Into Work...

2010-09-07T18:30:00.002-04:00

so, i see weird stuff every day at the hospital. it's just the nature of working with people, i think. people are weird.

yesterday, i saw flesh eating bacteria taking over some poor sap's entire backside before they bothered to come in to get it checked out.

today, i saw an RV parked outside the hospital in the employee parking lot and could totally see inside to some lady blow drying her hair!

what the what?

like i said. people are weird.

Mayhem, Murder, and Medicine

2010-08-26T10:10:00.003-04:00

as we near the 5 year anniversary of the devastation of hurricane katrina, news stories and remembrances are popping up. above is a very tragic tale of desperate measures taken during the throws of hurricane katrina and the subsequent legal battle over suspicious deaths of patients. at one of the new orleans hospitals, apparently some 9 patients were not going to be able to be moved/evacuated, presumably because of their degree of dependence (i'm guessing ventilator patients? it never says), and so were given toxic doses of narcotics to facilitate death by the remaining staff physician and pharmacist.

i am dismayed, but not shocked for several reasons. i'm also not entirely sure it was the wrong choice by the caregivers...

during katrina in 2005, i lived in a small town in mississippi, about 3 hrs north of the coast. the hospital where i worked at the time took in patients who were evacuated from our sister hospital in louisiana. from these patients and their families, as well as in local news reports, we heard all sorts of awful stories about hospital wide power failure, then generator failure, and then death for those patients dependent on machines. i heard a lot about MD's having to make tough choices about who could use the remaining resources and who was most likely going to die anyway. there were wings of hospitals quarantined to house the dead and dying with no electricity, no air conditioning, 90 degrees and wet....it was a war zone. and only a scant few of the staff stayed behind to help and didn't evacuate with their families like they were told to do by the state.

things couldn't have been any more bleak and the situation couldn't have been farther from the norm under which these practitioners usually and comfortably practiced (presumably) ethical medicine.

i know i always tend to side with doctors, and i don't know the exact details of these cases. AND the families heart break is compelling. but STILL, if it was as i imagine, put yourself in their shoes... your hospital is drowning, your few staff members have been awake and working for days on end, many of your patients are dying, and you have a choice to either let these few patients who can't get out in time die slow, suffocating, miserable deaths, or you administer meds that will take them quickly.

if that was the situation, wasn't it humane and in fact 'doing less harm' to facilitate death?

you tell me. what would you do?

and then, here's a more happy story about a midwife delivering bebes during the storm.

Post Op Day 2, From the BHE

2010-08-12T16:40:00.001-04:00

the OR is really bright and really cold. it took me two days to remember this, because anesthesia is retroactive.

i woke up from surgery on tuesday afternoon, and i'm glad to say the results are considerably better than the surgeon expected. he was able to remove 8 pounds of skin and fat that i wouldn't be able to exercise away or otherwise remove by my own effort. and my amazing wife tells me i look entirely different from every angle. so that starts to make the discomfort i've been in since then generally worth it.

i was told by the doc that i'd be "pretty sore" for about a week. and that's generally true, except that pain meds work. i have a pain pump delivering lidocaine directly into my abdominal muscles and i also have been taking a regular dose of vicodin. so my whole core feels very tight and my range of motion is severely restricted, but my actual pain level is really less than that of a sprained ankle. and that's a pretty crazy thought.

but i have to take a moment to commend the doc, the nurses, the techs, and even the transport personnel at MBH for taking amazing care of me. every single person i encountered at MBH had a big smile and a deep well of concern for my well-being. i felt like a VIP (i kinda was), but i also think my level of care wasn't that much greater than what anyone else receives at MBH. and that is pretty impressive.

most of all, though, i owe a tremendous amount of love and gratitude to the regular author of this blog. she has been incredibly supportive of me from the time i started to losing weight, through keeping it off, through running a marathon, and now through the decision for surgery and my aftercare. she is a model of love and sacrifice, and i'm incredibly blessed to have her.

Post Op Day 1

2010-08-11T14:14:00.001-04:00

surgery is done and he's home and feeling pretty good and looking AMAZING.

more details from the BHE to follow.

Guest Blogger: Transmissions from the BHE

2010-08-09T13:06:00.001-04:00

hello from the BHE! my former-PA-student-and-current-practically-a-doctor wife has asked me to share about my experiences leading up to what is a very exciting day tomorrow.

i am having abdominoplasty surgery to remove excess skin from my midsection (which she mentioned in her previous blog, "to cut or not to cut"). in fact, i just received a call that i was rescheduled from 9:30am to 7:30am. i have to be to MBH at 6am.

for as much as i've been really excited about results, i'm also a little nervous. i have no relevant experience upon which to base my expectations.

i grew up fat. i was a fat little kid, i was a fat high-schooler, i was fat in college, and i was fat as a young man living his own life. for brief moments, a couple times, i had lost enough weight that people noticed. but i could never sustain the weight loss, and i've always been fat. at my peak i weighed 285 pounds. and then i got married fat. with her help and encouragement i was able to work all that weight off and reach a minimum of 199 pounds. and since then i've put on 20 pounds of muscle. i'm at the peak of my health. i've run a marathon, two half marathons, two 25k races, three sprint triathlons, and an olympic triathlon. i've kept the weight off for four years. i'm ready for the operation. but i've always been fat, so i don't know what it will look like not to be.

the process of elective surgery has been very interesting. there are a lot of procedures and precautions that have to be taken beforehand, and there are a lot of preconditions that need to be met in order to undergo what is very major surgery. surprisingly, because i'm spending a night in the hospital, i'm eligible for FMLA leave, and short term disability insurance, which means i'll be getting paid for about half the time i'm out. it seems a little wrong, but after paying for the surgery in cash, we really could use the money.

i think it will be most fruitful to compare the information i've received and the process i've gone through to this point after the procedure. but i can't help but be impressed with the amount of information that both my doctor and the hospital have been able to convey to me in a very approachable way. but we shall see if the two align tomorrow.

How Would You Design Your Brain?

2010-08-07T00:02:00.002-04:00

i would be able to ballroom dance really well and i would speak several languages fluently. i would have a WAY better memory for details and, specifically, things like geography and how to spell werds correctly. i would take out some laziness or complacency and replace it with gettin'-after-it-ness and the tendency to act now instead of sit around for a while instead. i would have already read and retained all the great literary works. i would take out the think/say mean things about other people part and put in more, be-kind-to-them-this-may-be-their-first-time-driving-on-the-street-with-other-cars part. i would greatly enhance the "likes to exercise"part. i might take out the "enjoys peanut butter directly off the spoon and has been known to dip it in chocolate chips and just go nuts for a while" part. i would lose some insecurity and gain some peace of mind.

The World Is a Dirty Place

2010-07-22T18:34:00.004-04:00

when you go into medicine, you know you're probably going to get some human waste on you at one time or another. i remember warning my little sister about this when she was considering going into nursing. i promised her that any number of colorful bodily fluids would end up finding their way to her clothes, skin, possibly and awfully, into her eyes/mouth. not at all pleasant to consider, but definitely does happen.

and that's not even counting that funky spunk that could be in said fluids.

yesterday, i was doing a PICC line (peripherally inserted central catheter), which is a fairly invasive, bloody procedure, on a patient with hepatitis. no accidental needle sticks or scary oopses occurred, but this happens not infrequently that we are at risk of exposure. we health care professionals do procedures like this and surgery on patients with hepatitis, HIV/AIDS, chicken pox/shingles, MRSA/VRE, tuburculosis, etc, etc quite often.

we use this safety protocol now called "universal precautions" which means we pretty much never should be touching a patient without wearing gloves. and if they have any known current infection (in lungs, on skin, in stool, etc), we might also wear a gown and mask. but it can get pretty lax. in the OR, we all wear sterile masks, gowns and usually 2 pairs of gloves and we're uber careful when passing/using knives and needles. but i must admit that if we know a patient has a blood borne infection, we proceed with extra EXTRA caution.

lately, everyone in my department has been trying to get pregnant. and though we get fairly cavalier about the whole exposure thing when we're only putting ourselves at risk, it's a whole other ball of wax when you're talking about a vulnerable fetus inside you. in addition to all these nasty pathogens, we work in a fairly hostile environment for growing bebes. cement and xray are both known teratogens and we do our best to stay out of cases that use them (total joint replacements, fracture repairs, etc), but it's a challenge.

some days it feels like to be totally risk-free i would have to leave medicine all together. which i'm not going to do. so i guess you do your best to protect yourself and don't take undue risks while also not living in total paranoia.

no problem, right?

Gross. And Sad. And Gross.

2010-07-16T21:34:00.005-04:00

it seems like lately at work, i've been surrounded by more death and dismemberment than i am comfortable with. every time i go down to the cafeteria for lunch, just minding my own business, trying to get a sandwich, there are undertakers in black suits in the morgue hallway, transferring a bagged body onto a gurney.

why you ask is the morgue near the cafeteria? i think it has something to do with refrigeration.

heh....bleh.

it puts me off my feed, but it also is a painful reminder of the gravity of the work that we do. even though all lives will ultimately end in death, and we know this...i can't help but feel a little bit like we failed that one who's being wheeled away, since one of our core tasks as health care providers is, you know, making people stay alive.

most of my days involve elective surgery for hernias or gall bladders...or even for more harrowing things like breast or colon cancer...still, typically, our patients are fairly well when we get to them, and most of them go home at the end of their hospital stay without major problems.

but this week, i had to help amputate a foot for gas gangrene. the patient will hopefully survive, since we got to him soon enough (barely), but part of him will be sent to the morgue.

if you have a clearly infected limb (discolored, bad smell, redness/blackness, hot/cold to touch, non-healing sore, fever) GO TO THE ER. DO NOT WAIT.

i don't want any part of you to be sent down to that cold hallway near where i make my salads.

right then. so we've agreed on that.

5 Babies Have Died From Whooping Cough in California...If Only We Could Have Prevented this Tragedy

2010-07-01T13:35:00.015-04:00

tetanus (vaccine= DTap) polio (vaccine= IPV) pertussis (vaccine= DTap)

this just pisses me off.

living in fear and making dumb decisions out of ignorance. how many times do we have to explain that vaccines have not been shown to be linked with autism? and yet people are still not vaccinating their kids. how many ways do the folks associated with the original publication have to rescind their opinion and demonstrate that further studies don't back up the link? how many kids have to be maimed or killed from these awful (SHOULD BE ERADICATED) illnesses? what is wrong with people??

my fear for the kids in our country is this: as long as only small pockets of people aren't inoculating their kids, those kids should be safe, since the rest of the country is covered and won't spread the diseases around...BUT, if this community of un-vaccinated kids gets bigger and, if in our well- traveled, global community, they are exposed to kids from other parts of the un-vaccinated world, these nasty bugs will be shared among friends and we will have epidemics and lots of childhood death here. that were preventable. big kids might just get sick or end up with disabilities. but babies die. and all that sucks. and is preventable.

please read this article from cnn last week. it covers the whole vaccine scare controversy and there's some interesting added juice about how the spear-head MD from the original article that started everything was working for a competing vaccine company and was in it for greed, etc, etc.

the doc i scrubbed with today spent some time doing medical missions in africa and saw the damage that things like polio and measles and tetanus can cause. he said the middle bottom tooth of all the adults is removed so that WHEN they get lockjaw from tetanus, they can still get food and water through the gap. that is how prevalent/expected/normal it is there. this MD has been practicing in the US for 20 yrs and has NEVER seen a case here. we do not expect it. because we have forced it out of our community with vaccines. this generation has no idea what these deadly and mangling illnesses look like. check them out above. not pretty. and those are only a few of them.

please get your kids caught up with their vaccines. for their sake and for that of their friends, family members, classmates, neighbors, and, most importantly, my future children. :)

at the very least keep reading and asking questions about it. check your sources when you're reading "compelling evidence" against vaccines. here is the current cdc recommended vaccine schedule. it's big and complicated. you can also just go see your pediatrician. and i am happy to help find any info you need or do any research to answer questions/discuss these issues.

Good Doctor? Bad Businessman?

2010-06-22T18:21:00.004-04:00

so i've twice gone to this dermatologist for various little skin shtuff. i happened upon him because he was on my plan and was extremely local to work.

nice guy. young. clearly a new grad. i know this in part because when i call, i get in within a matter of days (not months) and when i arrive, i wait a matter of minutes (not hours).

he's sort of goofy. i think i mentioned this way back when. when i was complaining about my dry skin patterns on my hands, he showed me how to "fake" scrubbing my hands for surgery, or recommended that i quit my job and find something that would be less traumatic for my hand skin. right.

so, he's a little different. and....either he's supremely ethical and is a trust fund kid with no med school loans, or he simply hasn't caught on yet that he might be inadvertently putting himself out of business.

exhibit a) steroid cream for my eczema/psoriasis itchy winter stuff. most derms i've seen in the past give you a script for wee little pocket size doses of the precious. it lasts about 2 days, covering about 1/8 of your skin problem, and you have to go back to them to get more. this guy gave me a shitton per order with multiple refills- putting himself out of an office visit to get new scripts.

exhibit b) today i went to deal with some plantar warts that have been on the bottom of my feet for an embarrassingly long amount of time. they don't bother me, and i forget they're there until the BHE has my feet in his lap as we do, and he starts making gaggy faces when looking at said warts. they're tiny and not in painful spots, but none the less, to avoid the gaggy faces, i went to again see this doc. he explained that unless i get padding for my shoes and can avoid rubbing those spots and building calluses, wart burning/freezing/excising won't do any good. he gave me instructions on a $10 fix from the drug store and said the warts will either go away on their own or an over the counter remedy will likely cure them. so i was sort of annoyed that he got my $20 copay for just advice and no magic treatment, but he gave me a good 15 mins of his time and a cure instead of a quick fix. but if i follow his instructions, there will be no need for me to come back to him.

maybe that's his trick. maybe he knows that people are non compliant and we will always be back as we will never practice real prevention as we're told. hmmm....

but i appreciate his honesty. he kept saying that he could burn/freeze/dig them out, but they'll just come back until i fix the root problem. and he seems genuinely interested in doing that.

so i like him for his integrity but i do worry for his longevity as a business owner.

thoughts on this?

LEAVE ME ALONE...I'M STARVING!

2010-06-20T12:36:00.004-04:00

so i've gained a bunch of weight recently for various reasons (fried fish sandwiches mostly) and now i have to lose it. so i kicked it off with a fast last week. i started monday and intended to go through wed or thurs. the BHE and i have done many 3 day juice/veg broth fasts in the past and find them to be a great cleanse (and how!), and also a time to assess how/what/when we're eating and take some control over it. sort of like a reset button. we do it safely and carefully...like not if we're sick to start or have major runs or other intense physical requirements during that time. and we also use 100% fruit juice and veg broth, so at least our brains are getting carbs the whole time.

but tuesday i did 4 vascular cases back-to-back without much of a break, which is enough to sap your energy on any day, but without any solid food and just the minimal calories of juice, i was pretty tired by the end of it. and then that night i worked late and was on call tues night...so when i got a call at 9pm that i would have to come in at 11pm and would probably be there all night, i ate.

i was worried that in the middle of the night with minimal fuel in me i might be a risk to the patient. i didn't want shaky hands or sleepy reflexes while operating. i didn't end up having to go in to work after all, but i still think i made the right call by breaking fast early.

i've worked with docs who fast for ramadan (islamic month of fasting) and, although that is only a dawn to dusk fast, i've often wondered if any of them worry about losing mental sharpness with patients on those long days without energy. and theirs is an absolute fast (no juice or broth or even water i think?), so that's much harder. i know there are exceptions for people who are ill, elderly, pregnant and nursing women, but i don't know if anyone opts out (instead feeding the poor, saying certain prayers?) because of their job. i'm guessing for these doctors i know, they get used to it pretty quickly. and they're probably better disciplined and healthier than me in the first place and their bodies don't require a bagel an hour to maintain its happy glycemic load.

anyway...food for thought. get it? heh.

And Now I Want Some Corn

2010-06-08T18:37:00.005-04:00

so, in my pre-PA days as a social worker, i had to complete an internship for graduation. mine was in farm country with (mostly) mexican migrant farm workers, working with their children in a head start program. it was an amazing experience, and quite an education for me. witnessing the challenges of making a living in the field, with the health risks and dangers, getting a glimpse into the legal issues immigrants deal with while working seasonally, observing the family dynamics as the parents left their kids at our program as young as 2 wks old for 10 hrs a day so they could return to the farms. and there's was a very nomadic life as they followed the crop. most of them made enough money in the 6 month growing season of spring/summer, that they returned home and lived very comfortably, many not having to work at all in the winter. and there was the cultural intrigue for me, too. although some of the families were from columbia and cuba, most were mexican, either from mexico itself or from florida or texas.

we were a school, a daycare center, a resource center, and a health clinic, and i focused more on the financial and health aspects of it. (i also helped teach an adult ESL class which was a total head trip- do you KNOW how messed up the english language is? like "por que se usa 'i' antes de 'e'?" to which i would have to reply, "it's just how it's done. no idea. move on."

so, anyway. i learned of many fascinating cultural traditions, especially as they pertained to health and wellness. here are a few of the folk remedies that i recall. and bear in mind that a lot of these people were from tiny villages deep in mexico where they had only to rely on their own small community and had no access to big city resources. many didn't speak spanish, but rather native dialects.

- "Mal de ojo"... it was my understanding that if your child started acting sickly or strangely, you would suspect that they had had sort of a hex put on them...but it was not totally a malicious thing, it was more like an adult complimented the child or looked at them with envy or pride or something of the sort. to remove the "bad eye" when you put the child to bed at night, you would crack an egg into a glass of water and place it under the bed. then, in the morning, if the egg had cooked, you would know that the curse had left the child and gone into the egg. here is a little snippet on this to read further. apparently the "evil eye" is seen in other incarnations in other cultures, too.

- Fussy baby... if an infant child is being temperamental, you could asses their soft spot (fontanelle) and if it was sunken, you would either put your thumb into the roof (hard palate) of the child's mouth and push up or you'd hold the child upside down by the ankles and pop them on the bottoms of their feet. supposedly, if you correctly diagnosed the problem, you would hear a "pop" when the soft spot went back up. this one is addressed here. apparently it is called "mollera caida" and there are even more interesting remedies available. there is definitely something to this one as a sunken fontanelle can mean dehydration which would make for a fussy baby. you can see how a little education can go a long way.

so, i've always remembered those and found them very interesting. i loved so much the opportunity to learn about these cultures and experience their customs. the people i worked with were so warm and welcoming and eager to teach me new things. and they fed me! really well! to this day, i put mayonnaise, chili powder, and lime juice on my corn on the cob.

try it. ud. lo amará!!

I Saw Sex and the City II...All I Can Say is That Liza Minnelli Should Put Some Pants On

2010-06-05T09:33:00.002-04:00

oh my word, i know it's been 10 yrs since i've posted, and i dearly apologize to anyone who is still following me (hang in there!).

life has been crazy throwing medical issues my way directly and to my family. we're vollying them back pretty well, but it's been a chore.

and i've been working like a dog. well, not like my dog, mind you, who sleeps some 22 hrs a day and the other 2 hrs sort of lolls around. i want her life. just for a day or two. i don't want to eat her lamb and rice pellets (bleh!), but all the rest of it, i'll take.

anyway, so i've worked some 30 hrs of call this week and this is my 11th day in a row working. all of it is blurring together...especially considering i came into work at 1 am last night, after that case slept for a few hrs, and then was back at it at 7:30 this morning. but...money, honey!

so anyway, i will do my darndest to be more diligent and post something more than just apologies for not posting.

hope everyone had a delightful memorial day and is enjoying this gorgeous weather (that i keep hearing about). :)

To Cut or Not to Cut?

2010-05-12T21:17:00.002-04:00

aaaaahhhhh!!! life has been such a crazy busy emotional mess lately. some parts great, some parts scary.

several times recently i've had to help family and friends make decisions about whether or not to get surgery. just yesterday my dad underwent back surgery for a herniated disk that was causing him agonizing pain, not allowing him to sleep, and totally interfering with every aspect of his life. several months ago my grandfather debated the risks of taking out a tumor in his bowels at his tender young age of 86. the BHE and i have also been discussing the risk/reward of cosmetic surgery after major weight loss.

all these make for hard decisions. surgery can be dangerous. it can also save lives. every day at work i see proof of both. so where does that leave me in advising my loved ones on whether they should let someone cut them open? besides needing heavy sedation for several days leading up to any work i might need myself, i am still very much for it. despite the risks of infections, blood clots, wound ruptures, etc, etc....the list of complications is staggering and we see them all....despite all this, the huge majority of the time we don't see it. everything goes smoothly and patients are wildly improved because they were willing to take the risk.

taking tumors out saves a life. sometimes that's all it takes. taking off the bad joo joo that's pressing on a nerve on the spinal cord and instantly allowing you to be free from the pain that has controlled your life. taking out a diseased and dying organ that's dragging the rest of you down with it. releasing pressure on the brain to give you back normalcy. giving you the body that you've earned after years of hard work losing weight. or reconstructing breasts for you after battling cancer and winning except for the lady parts you're missing...those are such amazing things we can do for people.

and sometimes surgery is not the answer. most of the time every conservative measure is taken to manage the problem without having to cut. clearly. but when all other treatments have failed, or for those things that have to quickly be controlled/removed/assessed/attached/drained right NOW, surgery is the answer.

no one wants to have their abdominal muscles cut through. no one wants a scar. no one wants the pain and fear and risks. but most of the time from all the cases that i've experienced professionally, and now personally, when all is said and done, go ahead and cut.

Learned Some, Ate More

2010-04-29T16:55:00.005-04:00

in new orleans last week for a PA conference. and for food. lots and lots of food.

the conference was great- really good lectures from knowledgeable speakers on a variety of subjects. there's always reviews on hypertension and diabetes management, which is helpful. and this conference, though general medicine, was also very gyn-centric, which was great.

the BHE and i lived in a small town in the south for a while and i worked in a hospital there while we did. we quickly learned that the stereotypes of southerners as idiot rednecks is totally crazy. most of the people we knew were brilliant, creative, well-spoken and sophisticated. in the hospital where i worked, the standard of care was up to par with any other hospital i've seen and the staff was very well educated and trained. the only differences in care i could perceive is that people down south are just more polite/friendlier (they really are) and there's a lot more God infused into conversation- even patient/physician dialogue.

so all that being said, it was no surprise to me that the MD's who spoke at the conference (all louisiana physicians) were top notch speakers and i got a lot out of their talks. i do love the local colloquialisms, though. one urologist kept making me smile when he referred to urinary incontinence as "losing water."

and new orleans is one of my all time favorite cities on the planet. we went to a (very muddy) jazz fest on saturday and saw "simon and garfunkel" and "better than ezra" and a couple local bands. totally fun.

and we ate po boys (shrimp, crawfish) and boiled crawfish, fried green tomatoes, beignets, and chargrilled oysters, to name a few. num.

i have been SO BAD in not posting lately. stay tuned for a conversation on mexican folk medicine. i did an internship way back when with migrant farm workers (most of them mexican) and learned a lot about traditional treatments. so crazy cool...and i think you might find it interesting, too. so stay tuned.

Tired of McSurgery ready for a McBreak

2010-04-16T19:09:00.003-04:00

well, it's been a loooooong week. i've been working the afternoon shift (3-11:30) and i've been scrubbed pretty much the entire shift every day until today. long cases. tiring cases.

lots of discussion of health care reform. these heated debates around the OR table are welcome relief from the mind-numbing tedium of some of the cases. and then other cases have been harrowing emergencies where we all hold our breath the whole time.

when i get home i stay up late and never entirely catch up on sleep. i also never see the BHE on weeks like these, which is suck. and my brain hurts.

so instead of writing something informative or sophisticated as is my norm (ahem), i will simply share w/ you an article i found on McDonald's menu items from around the world. i was recently having this discussion w/ someone and i contended that some McD's serve beer and they said that was impossible, and we went around and around on the subject and we ended up digressing into Pulp Fiction quotes.

some of these are just fascinating- i would really like to try a McLaks but probably not a McSpaghetti.

This Really Does Play Out

2010-04-06T21:39:00.003-04:00

i have a PA student right now and so i'm busy giving her lots of good career advice. like h'eh.

http://scienceblogs.com/insolence/2006/05/how_to_choose_a_career_in_medi.php

Flavored Ice and Family Updates

2010-03-30T21:32:00.004-04:00

these are two things we need more of in surgery.

one of my wonderful grandfathers had major surgery this weekend and is doing quite well (praise God!). but again being on the other side of the mask made me realize that we have some room for improvement in the care we give our surgical patients and their families.

being starved sucks and we need to be more aware that checking a diet order on a form has a great impact on someone's mood and well being. and "ice chips" do moisten otherwise parched lips, tongue, and throat but are otherwise just annoying and awful. if only we could make them onion ring or cheesecake flavored- that might be more satisfying.

and when a family is waiting anxiously during a surgery on their loved one, frequent updates (calls from the OR to the waiting room) are SO helpful in curbing the terror that creeps up in your chest.

more soon. i've been slacking in my posts lately. it's been crazy what with my gpa being in the hospital and i'm on the floor this week (BOOH!) and i have a PA student (COOL!), and we're having weekend guests and yada, yada, yada.

more soon. for reals.

(but PS, real quick- SO GLAD I WENT INTO MEDICINE! feeling very fortunate that i was able to both assist with my care when i was the patient last august and also that i have been able to be a resource to my family during my grandpa's ordeal. this whole (surgical) PA thing has paid off. and good timing too, huh?)

Roosters Aren't Allowed in Hospitals, Apparently

2010-03-26T17:23:00.004-04:00

been taking lots of call lately. this means that outside of our regular shift (mine is 7a-3:30p mon-fri, we as a dept have to cover all the nights and weekends for all the scheduled and emergency cases. we split up the call, and you can usually take as much/little as you want. mama wants a new pair of shoes (living room furniture, vacations), so i'm taking more lately than usual.

i was on call all last weekend (friday night through monday morning) and worked into the wee hours of sunday night/monday morning, so i started the week kinda tired. and then was on call again last night. i got called in at 11:30, stayed until 1:15, drove the 20 mins to get home (cuz they won't call me back again for sure!)...got into bed about 1:35 and was just falling back to sleep...when i got paged again at 1:45. got back in my car, shivering in the now sub-30 degree weather and was back at the hospital scrubbed from 2:30-4:00....when finished, i dragged myself upstairs to the call room to get a little bit of sleep before my normal 7am day shift started.

the call room is in this very centrally located (so loud!) area and it's always too cold or too hot and there's rarely fresh sheets/towels and the bed is this flimsy little twin bed and...it's always the greatest sleep of my life. by the time i get to it, i'm so desperate for sleep and entirely drained, i'm looking more like a wandering mental patient than a useful PA.

so i slept hard from 4:30 and on through my alarm up until 7:40 when i was paged to come to the OR for my first case of the day. WHAT?! so i frantically tried to unscramble my brain and make sense of where i was and what part of the day it was and where i needed to be. fortunately, we had a little staff cushioning today so i was able to shower and eat and relax for a while before getting into my cases...but i ended up scrubbing 2 long cases and doing admissions and other stuff all day. i stayed pretty clear headed, if not a bit discombobulated.

on a side note, the emergency cases were genuinely urgent and we may have saved lives, or at least, vital organs. it's exciting and stimulating to be in on things like that. even if it is in the middle of the bloody night. (so to speak).

so now i'm home. i indulged in way too much of all my favorite foods (i deserve it! leave me alone!) and my plan is just to watch movies and lie around all night.

greatest feeling ever.

I Plan to Start Smoking, Eating Bacon Cheeseburgers and NOT Dealing with Those Funky Looking Moles

2010-03-21T19:41:00.003-04:00

everyone is talking about the health care reform. are we all panicking at the hospital? not so much. but is everyone a little disgruntled about it? well, sure.

here's a pretty good run down of the bullet items on the bill.

cheers.

Squeeeeeze.

2010-03-21T10:17:00.008-04:00

for a while now i've been running in these sexy compression socks. if i'm planning a long run, i'll wear them the day before and after, also.

now since everyone is all mad for marchness, i read on cnn.com today that the bball players are wearing a padded version to avoid contact injuries and to give them added support.

compression keeps swelling down and avoids varicose veins from developing. it's also the first thing you do when you have an injury, so having it already applied to the micro tears we endure while exercising can be beneficial.

athletes of all sport persuasions seem to be trending toward them. i dig it.

I Totally Beat Mickey in the Race, but Captain Jack Sparrow Kicked My Arse

2010-03-13T18:19:00.003-05:00

well, we're back from Disney and i have to say that Disney is way better than anywhere that is not Disney.

it is seriously, truly a magical, wonderful place. i am an adult. i am without a child as an excuse to be there, and i have no shame in saying that i am smitten.

everything is shiny and perfect and not tarnished, worn, chipped or un-cheerful. they have put so much effort into making every ride, every tour, every show, even every restaurant and shop a perfectly designed theme...it's easy to get swept up in it.

it helped that we were there in a pretty quiet time of year (longest wait for a ride- 30 mins), but even the lines on the rides are fun and engaging.

and the race was great. i ran 10 mins faster than my last half marathon and it was totally fun- characters were out to get pics with and we ran down main st in magic kingdom and since it was a princess themed race, everyone wore tiaras and tutu's and stuff. so totally fun.

and then we broke off our crazy diet after the race (tra-la!). we at french and italian food at EPCOT on sunday, and just kept eating our way through delicious things all week long. num. and no GI rot like i was afraid of- we actually showed some restraint in re-acclimating to dairy and such.

restraint until we got back home and went to town on the 4 boxes of girl scout cookies we'd been saving until after the diet. so good. but so bad. but so good!

and, as the race was a fundraiser for the Leukemia and Lymphoma Society, i was thrilled to raise over $6,000 for the cause! if you haven't heard about Team in Training before, it's the Leukemia and Lymphoma Society's fund raising program where you raise money and, with help and support from your local team, train for a run/bike/triathlon/walkathon. then you go compete in your event and a small part of what you raise goes to your travel/entrance expenses. so you get to travel to a cool location, compete in a challenging event, and raise money for an awesome cause. i had a great experience with it. if you have any inkling at all, do check it out.

so, race and Disney were awesome and fun but now we're back home and back to work.

i'm taking on a PA student for the first time in a few weeks. it's great, because if they ask you something you don't know, you just get a superior look on your face and say, "why don't you look it up and report back to me on it tomorrow." :)

Breast Pumping in the Bathroom in a Business Suit?

2010-03-04T19:20:00.005-05:00

well, the Oscars are this sunday and i've seen 7 of the 10 films on the best picture nominee list. i'm going to disney world this weekend (hoooooorrrrraaaaahhhh!!!), so i won't be able to continue on my quest. all my reactions are in a previous post (see below).

the movie that probably stuck with me the most was "up in the air." one of the themes they explored that i've been contemplating is females as successful career women vs family women. are the two mutually exclusive? can we ladies really have both? be both ambitious, successful women and available, successful mothers? can you have a complete and happy home and family if you're also an important and busy big shot at work? and if you try to juggle both, are you guaranteed to be plagued by guilt or be somehow lacking in one role or both?

recently in American society we've seen that there are more and more women who are the primary bread winners in their families. i'm curious about what this has done/will this do to the family unit, if anything. i know some of the concern is how gender roles might be rattled with these changes and that this can add strain to marriages.

any thoughts on this out there in the interweb? anyone have any personal experience on the subject you care to share?

"I'm Mr. Krabs. I like money!"

2010-02-27T14:06:00.002-05:00

so having now been a surgical PA for a full year and change, the BHE and i are reaping all the benefits of our inflated combined salary. it's been mostly magically delicious since we've been able to aggressively pay off my loans, go on some great vacations, work on the house, and donate to charities.

but we did our taxes this morning and i think we put all of uncle sam's kids through college last year with what we paid in. oh, well. at least we'll get some help with retirement when that time comes....right? right? guys? hello? anyone?

anyway...we found that we are officially evil white rich people. there was even a stamp that came on my W2 that said "EWRP."

so for every additional dollar we earn, we get to keep an increasingly small part of it. good times.

i guess i don't really mind being an EWRP. but i'm gathering that also being a DINK (dual income, no kids) isn't a good plan. i guess i've come up with another reason to start squirting out some kids. they're not just good for mowing the lawn and mixing drinks. they can also be adorable little tax breaks. hmmm...

What Do the Cure for Autism and Fake Boobs Have in Common?

2010-02-26T21:06:00.002-05:00

jenny mccarthy, of course!

she's long been the celebrity spokesperson claiming that vaccines are to blame for autism. she has a son with autism and has started her own resource center which, incidentally, sounds pretty awesome.

what isn't awesome is the scare tactics and rumors employed by her campaign. the autism-vaccine connection has been debunked, but forget what research has found, forget the recommendations by medical governing bodies, you should trust this mom instead. because she just knows. and she's famous...so you ought to listen.

i already talked about the vaccination debate a while ago, but this article on her claims and efforts and how they don't jive at all with scientific findings popped up this week and i decided to reopen the subject.

Since They Don't Pay Me to Watch Movies....

2010-02-19T16:29:00.002-05:00

great day at work. i've been really enjoying it lately. i'm attempting to be more useful by learning some new stuff.

i'm now doing feeding tube placements where, for patients who are unable to eat, we place a long thin tube down the nose, through the esophagus and the stomach and with a GPS-like tracking device, we aim to get the tip into the small intestine. although we are using numbing lubricant, this is about as unpleasant as it sounds and often results in bloody noses and patients gagging and cursing us the whole while. it's hard to do (i didn't go into this to torture people, i swear!) but by the time they order this tube, these patients are often wasting away and desperately need the nutrition. that's what we try to remember...although i was helping with one a while ago and the patient (in a thick eastern block accent) kept asking us "what deed i ahver do toh yoh?" good question, buddy.

..also i'm learning (finally, again) to do peripherally inserted central catheters which is an IV line placed in an upper arm vein that tracks to larger and larger veins up the arm and finally lands in one of the veins that feeds into the heart. we use PICC's for long-term antibiotics or for patients who will require IV access for a long time- things like TPN (total parenteral nutrition), etc. we use an ultrasound to find the veins and to watch our placement and then snake in a guide wire before placing the catheter in. it's pretty neat. we do it at bed side and we're able to get a lot done without much disruption to the patients. in interventional radiology when they do one they use sort of moving xray picture so they can see exactly where the tip of the wire is, if it coils, if it goes up the neck instead of down toward the heart, etc. we have to trust the fuzzy ultrasound and our "feel" that it's in the right place (obviously, must be able to draw blood from it and flush saline through it to show it's at least functional) and then we confirm which vein it's in by xray afterwards.

so even though it's february and OR case load is down, i've been staying busy and enjoying the new challenges.

and so far nobody at work in this weight loss competition has started a riot or anything, but i've been hearing a lot of grumbling. paczki day came and went and most people refrained with difficulty. my own weight loss efforts with this crazy diet are sort of meh. energy level still good, but i'm tired of all the food prep and some of the food still tastes like dirty cardboard. just a few more weeks until the half marathon, then we'll ease off a bit.

cheers!

ACADEMY AWARD MANIA!!!

2010-02-09T19:20:00.007-05:00

alright, sports fans. here is the list of the 2010 Academy Award Best Picture Nominees. this year i swear. I SWEAR! i am going to see them all and make my predictions before Oscar Night (march 7). the only one i might intentionally bow out on is "push" because it just sounds too hard to watch and i try to avoid movies that wreck me inside and haunt me for days afterward. i've read a lot about it, though, and i think i get a feel for its strengths.

anyway...as always, read my review of the films on the column to your right (unless you're looking at your monitor from behind the computer? then it would be to your left). i will also keep this list up to date with my predictions and thoughts. (in case you care). (you totally know you do).

“Avatar” - seen it and think it should win for cinematography and art direction, visual effects and maybe even director...but the story and characters and PURPOSE of it were lacking too much for it to win as best pic. But count me not surprised if it does end up winning.
“The Blind Side”- missed (but looks like a made-for-tv movie. just sayin')
“District 9”- missed (have it here from netflix but never got to watch- sigh)
“An Education”- missed (like "the reader" but w/o the nazi's?)
“The Hurt Locker”- scripted but filmed like a documentary. very anxiety-inducing and believable as you follow an American IED squad as they risk life and limb trying to disarm explosives in Iraq. not preachy or melodramatic like a lot of war movies. great characters, cinematography and feel...but not grandiose like the others. kind of simple and to the point, which might not be enough zsa zsa zsu for the oscars.
“Inglourious Basterds”- seen it and think it should win for costumes (though can't since not nominated), maybe original screenplay, maybe cinematography, but def not best pic. it couldn't land on the style it wanted to be and was just sort of long and sloppy. And didn't really feel like Tarantino to me, except for a few random moments.
“Precious: Based on the Novel ‘Push’ by Sapphire”
“A Serious Man”- Coen brothers and their dark world where people suck and luck is bad. The "luck" in this movie is in the form of a curse on the generations of a Jewish family, and how it effects the life of one especially sad sack man. Beautifully shot movie with some moments that would make insanely awesome photographs. Plus the editing, the acting and the script were all really well done. (Except the wife- wasn't crazy about her performance. Just have to put that out there). It doesn't quite have the twisted shock and depravity of "Fargo" or the vastness and viciousness of "NCFOM" but it's a very well put together, satisfying movie. But I don't think it will win.
“Up” -seen it and think it should def win for animated feature film and maybe music. this movie had it all. it was brilliant animation, fully developed characters and story and just a lot of fun and heart. i don't think this could possibly actually win since it's a cartoon and has talking dogs in it, but that it's nominated gives me some hope in american cinema.
“Up in the Air”- cool movie. I think this one should win (of the ones I've seen so far). Very cleverly constructed and executed. Thought-provoking and not overly sentimental. Didn't dwell on the heart break scenes, but didn't make nice either. I loved it.

..oh, and by all means, PLEASE SHARE YOUR THOUGHTS IF YOU'VE SEEN ANY OF THE FILMS.

So What's Your Beef with the Beef?

2010-02-07T16:34:00.006-05:00

as a vegetarian of 13 years, i have had to field a lot of questions on why i don't eat meat and how i get the precious meat vitamins without it. people have even pointed to my incisors and say, "you see, we're meant to be carnivores." and now on this new wacky vegan diet, people are even more curious about how we're not wasting away as little anemic waifs.

through my years of vegetarianism i have found ample health and social reasons why it's better that i don't eat meat. below, i'll do a quick down and dirty synopsis of the health and social reasons why i don't eat beef. (i'm focusing more on beef, since poultry and fish don't have a lot of the same dramatic consequences...and i do recognize that eating in moderation does improve things, but you'll see what a small quantity "moderate" is). and i'm really not going to preach at you or anything- by all means, enjoy your burger... but here's some food for thought. :)

Health:
-Pro's of eating beef: great source of iron, B12, and protein.
-Con's of eating beef: -increased risk for colon cancer, increased risk of heart disease and early death (note that vegetarians apparently live 7 yrs longer and vegans 15 yrs longer than meat-eating counterparts)

Social:
-animal cruelty (this is unpleasant. you've been warned), 22 million animals are slaughtered daily for people to eat them
-we could feed the world if we stopped putting the majority of our grain/soy into feeding the animals we eat
-lots of ground water pollution and grossness from the waste products of said animals

so that's a very brief and in-comprehensive summary of why i choose to be a vegetarian. i kind of got bored there toward the end. the internet is rife with good info and also a lot of crazy propaganda on the subject, so as you do your own research, be careful.

if you're curious about where i get the meaty vitamins as a veg, i'll tell you... Iron= beans, green leafy vegetables (note: iron is best absorbed if combined w/ foods containing Vitamin C), B12= if not vegan- dairy and eggs, if vegan- nutritional yeast and fortified products, Protein= beans, tofu, and nuts. and unlike meat, these all contain all kinds of other nutrients as well.

but...after all that, if it's the flavor of the juicy red meat you just can't live without...i can't really help you there.

:) toodles for now.

The Skinny on the Skinny

2010-01-27T21:17:00.003-05:00

the BHE just asked me, "are you gonna blog about our awesome new diet?"

well...i am going to discuss the diet, yes. would i call it awesome? let's decide.

pros: tons of energy, in a good mood, usually full after eating and satiety lasts a good while, down a few lbs.

cons: green poop, cooking/grocery shopping/cleaning kitchen roughly 2-3 hrs a night, all the recipes are unique from each other in many ways but all still retain a general flavor of 'health.' (if 'health' were a color, it would be brown death).

so it's kind of a wash right now. will stick it out. only 6 wks left. sigh.

not much to report from work. been taking a lot of call lately. also am heading up a 60+ person department-wide "biggest loser" contest. first weigh-in is tomorrow. lots of people are really excited about it and it's something unified we can all do together.

so on all fronts the focus is getting skinny and fit. i will start to share diet and exericse fallacies soon. let's start with this hilarious new hand-held battery operated weight. i can't watch this without rolling on the floor laughing.

You Have Some Dirt On Your Shoe, Were You Going to Eat That?

2010-01-16T11:31:00.004-05:00

the half marathon is exactly 7 weeks from today. the BHE and a friend and i ran 10.4 mls this morning. i'm doing about 3-5 mls twice during the week and then a large mile number run on the weekends. and my fund raising for the leukemia and lymphoma society (as part of this race) is already all done. people have been insanely generous and supportive.

$286.74 spent so far on the new diet. this includes all the staples that we'll use in many dishes (hemp seeds, lemons, quinoa, etc) plus a fancy grater and a new blender. when we were looking for some of the wackier ingredients, we out hippie-fied even whole foods store, so i'm feeling pretty smarmy about that. :) they only had ground amaranth and we needed whole seeds, herumph herumph, herumph.

so...we'll see how it goes. so far all we've tried from the recipes in the book are "direct fuel bites" which we ate before and during running. blended dates, lemon juice, and coconut oil all chilled and cut into squares. actually quite good. and we didn't fatigue during the run, so they did their job. but the rest of the day we ate normal food (left over cheese pizza, hummus on pita, thai soup, salad) as sort of our 'last meals' before we officially jump on this vegan crazy wagon.

i'm excited, but i really cannot believe how granola we are being. on second thought, i don't even know if we can eat granola on this diet...

Oh, the Hippy in Me Seems to be Winning

2010-01-11T11:18:00.002-05:00

so, i am running a half marathon in 8 weeks as part of a fund raiser for the leukemia and lymphoma society. 13.1 mls is a long way and involves a lot of training. the race is in florida, so will likely be in the 50's-60's when i run it, but here and now where i'm doing my training, it's in the balmy teens and twenties. running in the snow is like running in the sand- there's a whole lot of resistance dragging you down. plus, the slushy snow then freezes and becomes hazardous, foot-catching, ankle-rolling pot holes along the way. but over all, it's actually really enjoyable! the obstacles kind of make it more fun and as far as the cold, you bundle up so nothing freezes and falls off, but once you're moving, it's rather comfortable. and i guess if i have to survive winter in the midwest, i'd rather get through it at high(ish) speeds.

and with all the running we've been doing, you'd think the Christmas season lbs would just be melting off, right? wrong. i've been half-assing weight watchers for a few weeks with no results, and now i'm ready for change. the BHE has been reading a book on eating right while training for long distance races called "Thrive: The Vegan Nutrition Guide" by Brendan Brazier, a vegan professional iron man athlete. he talks a lot about whole, simple foods. like fatty acids instead of complex fats, amino acids instead of complex proteins, simple sugars, etc. lots of sprouts and whole grains and greens and fruit and stuff. the idea is that you're giving your body only valuable energy that it can use and not store. i know this will be a challenge, but recall that we're already vegetarians, so the stretch is maybe less than it would be if we had to come off meat, too. and i'm not sure if it requires this, but i will be giving up caffeine and alcohol, too. i don't want to pollute my body while simultaneously giving it the good stuff. the book includes menus and recipes for 12 wks, so starting this coming weekend, we're going to follow it up until the race. i'm excited and nervous. excited to feel awesome and clean, nervous to feel hungry. excited to lose the weight, nervous to not eat cheese and coffee and booze for 2 months!! excited to be back in control of what goes in my body, nervous about how much is going to come out of my wallet at the health food store.

so i'll keep you posted on how it's going. should be an adventure!

I'm at 36 New Years Resolutions and Counting...Think They'll Take?

2010-01-07T18:07:00.003-05:00

well, Christmas has come and gone. it was a sort of stressful season this year. and it's been crazy nuts busy at work. with extremely sick patients. i've been distracted by life for the last 6 months or so, but now i'm buckling down and focusing on work. i'm learning new things and trying to get really good at the things i already do. and i'm taking more call. i figured that there's a reason they pay me so much and that is that i'm willing to work some less-than-desirable hours. plus, i have big plans for loan repayment this year and a few little vacations, so the extra overtime cash will be groovy.

so...one of my resolutions is that i will post more often (i know. i'm sorry. i've been la-zy lately with my blogging) and that i'll include some interesting medical discussions. new studies, controversies and concepts. i haven't yet tackled the whole health care reform thing, but i'm working up my chi to do that one, so look for it eventually.

hope everyone had a healthy and happy new year! (and PS- if you have something you think might be interesting to discuss, let me know and i'll get right on it).

for now, so as to convince you that i'm not attempting to make this a boring, all educational and no fun reading experince, i'll leave you with this article posted on cnn today regarding the significant health benefits of having frequent sex. haza!

And to Think We Let Our Children Carol to These Abominations!

2009-12-17T17:53:00.006-05:00

and so here we are again in the yule season (what's a yule? is that like a hybrid of a yak and a mule? why would we celebrate its log then?). anyway...it's a stressful time of year, as we all know. shopping pressure and cost, memories of lost loved ones and fighting with, perhaps planning the imminent death of, the loved ones you still have...almost everyone i know is grouchy and anxious and stressed and broke. fa-ra-ra-ra-ra....

so it's important to remember the whole point of Christmas. and for me, that's Jesus and the love and hope and redemption he brings. and family all piled on top of each other. and food. and giving presents is fun, too. especially if it's something totally personal and unique and surprising. that, i like.

and Christmas carols are alright. especially the pervy ones. i laid out my favorite Christmas date rape song last year.

this year, i'd like to note (with alarm!) some of the lyrics of my favorite holiday infidelity song...

Winter Wonderland (1934 by Felix Bernard and Richard B. Smith)

He'll say: Are you married?
We'll say: No man,
But you can do the job
When you're in town.

so all my life i've thought "WHAT JOB?" geez! what is this "parson" fella getting away with while he's in town?! and are we really expected to believe that this conspiring little vixen who likes to lie by the fire is unmarried? we KNOW she's a stone cold freak who likes to play in "the eskimo way." i don't even want to know.

but, in reviewing the available information....i have to admit that i didn't entirely know what the words were leading up to and following this phrase, and now that i see that "Parson Brown" is a snowman (and, furthermore, that "parson" means "minister"....), perhaps i jumped to conclusions.

nah. i stand by my position that this song is sketchy and must be stopped.

To Cut or Not to Cut: A Discussion on Baby Woo-woo Trimming

2009-12-01T18:57:00.005-05:00

so i was recently talking to a coworker about her soon-to-be-on-this-planet male child (or, you know, out of amniotic fluid and into fresh air? is that better?) and whether or not she plans to circumcise him upon his arrival. people seem to be considering this more often, instead of just doing it routinely. anecdotally, i've observed a trend away from circumcision over the past few years, when it's been widely considered the norm in most cultures in the US for many years.

it is definitely a cultural thing. in the US, reports i found showed that between 55-90% of the population is circumcised. it varies by race and age and country of origin within the US population, also. but in the UK, it's more like 15%. it seems that if it's not a religious custom, than we generally do for our boys whatever the males of our community have had done to them. (or you know, theirs).

but just because dad and grandpa were or weren't (eck), does that make it right? is there any true need to have it done? is there a right answer here?

here are the reasons i find AGAINST circumcising (mostly given by hippies, so if you smell a faint aroma of patchouli while you read this- that's why):

1. he will lose all the best parts of his wang-doodle and all that sensitivity!
2. it is archaic. initiated back when Jews lived nomadic lives and wore sandals in dirt floor abodes and bathed rarely...we don't have those hygiene issues anymore and it's easier to keep the 'bits and pieces' clean.
3. it is unnecessary pain inflicted on a poor bebe
4. there is risk of things going amiss and leaving the child malformed for life or in danger with a major complication (on this note- there is a large amount of material out there and it isn't very conclusive, but known complications are rare, according to most studies i found (cdc says 0.2- 2.0%), and mostly include infection, bleeding, and not removing enough foreskin).

and now the reasons FOR circumcising (and these are usually argued by the kill-joys, so if you smell the faint odor of fluoride and low fat butter substitute, that's why):

1. don't worry about losing a little sensitivity- some would argue this is a good thing!
2. even in our much cleaner society, a lot of grime can still develop under the foreskin. this is known as smegma (SO TOTALLY NOT MAKING THIS UP!)
3. if done in the baby's first day of life, they have zero memory of the pain, and they rebound very quickly (anesthesia usually involved a sugar sucker and nothing more)
4. and most importantly in my book- there is increased risk of HIV and other STD's with the warm and moist little winkie umbrella still in place for infections to brew in. (interestingly, today in the news there was an article about Africa pushing circumcision as an AIDS prevention method). there is also a significant increase in UTI's and a small increased risk for penile cancer and, subsequently, cervical cancer (in female partners of the uncircumcised) from HPV transmission. and then, there's always phimosis and paraphimosis where the foreskin either can't retract back behind the glans or is stuck retracted and swells and can't get back around...and then penis tissue dies painfully. not good.

so that is my small analysis of the foreskin situation. take from it what you will and pipe up w/ comments or questions if you have them.

toodles!

Happy Thanksgiving!!

2009-11-27T22:50:00.002-05:00

News Flash: Life is Big Suck

2009-11-10T19:18:00.005-05:00

i heard a proclamation today from one of the nurses that "the world is ending. people can't go on. we're too evil." she was referring to a series of murders and other violent crimes we'd just heard summarized on the news in the break room. is she right?

i'm usually quite the optimist, but lately i've also been feeling pretty defeated. tell me how to get through this one. i've been sick to my stomach since hearing about the recent heinous gang rape and attempted murder of a 15 y/o girl in richmond, california at a homecoming dance where, apparently, some 10 people were involved in the attack and another 12 witnessed it and did NOTHING except maybe take some photos and videos on their cell phones. i mean- seriously? wtf? can that really be explained at all with saying it was "alcohol induced" as the cnn article described it? can we blame this on booze? or on group mentality where an individual's boundaries and rules change when fueled by the force and enthusiasm of the group? or did this some 20 guys all have terrible upbringings and are subsequently void of empathy? does this school recruit all the area sociopaths? what could possibly explain this??

there must be something in the news that will re-store my faith in humanity. some girl scout saved a dolphin from a burning building? anything?? let's see....we've got the snipers re-visted, the fort hood massacre, the teenagers in florida who deliberately set their friend on fire....hmmmm...what else? oh! here's a fun looking article entitled "how to defend yourself against pirates"....oh, but wait. it's for real. drag.

and kareem abdul-jabbar has leukemia. of course he does.

but at least 'hurricane ida' has been downgraded to a tropical depression.

that's appropriate.

i mean...for reals...is there any doubt why i prefer to read celebrity gossip than real news? like i'm only pretend worried about the state of fergie and josh's marriage. no real angst required. ya know?

sigh. well, i guess 'sesame street' turns 40 this week, so that's good. and on that note, this makes me laugh out loud.

i guess that's the only answer i've come up with so far. keep laughing. take joy in little things like little kids do. i saw a bundled-up dad scurrying into a gas station tonight holding his toddler son. the dad looked stressed and hurried. the son looked ecstatic. SHINY BUILDING! AND MAYBE CANDY IN MY FUTURE!

that's how i'm gonna try to get through the day.

maybe there will be candy.

Halloween and Yes, I Love Technology

2009-10-31T18:47:00.003-04:00

(but not as much as you, you see)

so we enjoyed the bounty of halloween this year with a trip to a fund-raiser haunted house on friday night followed by a drive through of the most decorated street in the area. almost all the houses on the street participate and they go all out. as in entire fabricated houses in front of the real houses and pirate ships and stuff. (i kept wondering if they warn new home buyers who are shopping in, say, july, just what is expected of them come october). and we went to see the halloween festivities at the zoo yesterday and then stayed home to welcome tricker treaters last night. we had a pretty good number of them. fun costumes included a young billy mays, several adorable captain jack sparrows, a geisha, and an apologetic hanna montana who, reportedly, had already lost her wig. and we noticed that kids are either more polite now than we used to be, or more afraid of stranger danger, because they were really quiet when approaching our house. i'd hear a light tap on the door or shuffling feet but very few "TRICK OR TREAT"s at the top of young lungs. i thought annoying all your neighbors was part of the fun.

anyway. we also just bought new iphones. the BHE has been wanting one for a while, and we finally broke down and did it. they're pretty cool. i have to say that the Apple company is doing things right. they're so hip, they appeal to every demographic. while we were at the Apple store there was a demo class on iphones for senior citizens ("but where does the answering machine tape plug in??"). and then a group of middle school age boys came in and knowing exactly how to use all the gadgets they touched- instead of causing mayhem they played quietly and respectfully. it was like a commercial. or a cult.

October is National Breast Cancer Awareness Month

2009-10-25T19:51:00.002-04:00

the shirt i wore during the half marathon last week says "SAVE THE BOOBS: Big or Small Support Them All" on the front and "Help Save Second Base" on the back. i didn't do the local breast cancer 3 day walk this year, but i plan to recruit as many people as i can and do it next year. there is power in what these women are doing. power and change. if you want to look into breast cancer prevention, screening or the movement in general- i would start here.

I Just Kept Running.

2009-10-18T15:38:00.003-04:00

so i learned a lot about seeing things from the patient's perspective when i was a patient in the hospital in august. i've been taking a ridiculous amount of time on the floors lately worrying over all the little things that might be causing my patients pain or annoyance. like, did you know that tape HURTS when yanked off arm hair? or that those flimsy little hospital blankets just don't cut it for warmth? or that, yes, the food is as bad as it smells from across the room. and i am doubly sure to follow up on patient's questions and to give them a hard and fast discharge plan, to communicate regularly, etc. these are important stuffs. their whole world is contained in that little room and they are afraid and unsure and it's my job to help them find their way out of it. that's how i'm looking at it.

and i'm feeling like i've officially moved on from the feeling of being out of control of my body, feeble, weak and needy. i ran a half marathon today. previous to my illness the most i'd ever done was 6 mls, and during the last 7 wks recovery from my illness, the most i'd done was 4mls. so trying to tackle 13 seemed kind of psychotic...but i did it. i ran the first 9 without stopping and then i ran/walked the last 4. i am sore and tired. but feeling accomplished, blessed, and healed.

I've Been Learnt

2009-10-10T10:50:00.002-04:00

the last couple days i was at a PA conference. it was nice to catch up with old PA school friends and professors and others. and the lectures were pretty good. everything from new hypertension treatments to vaccination recomendations to wilderness medicine rescue techniques (all the advice came down to- 'splint it, then pack it with snow.') was covered. pretty educational, if not a little boring. i have no attention span anymore.

and while i was sitting in those lectures, remembering all the things i'd forgotten, i got a little anxious about my body of knowledge and my career. i mean, other than the occasional day practicing "medicine" on the floor on post-op patients, i'm pretty specialized in a very hands-on discipline. i don't brain much while i'm at work. :) i'm afraid i'm forgetting all the medicine i learned in school. would i remember how to diagnose and treat diabetes? what about a heart attack, a rash, or head trauma? yikes. my friends in ER and internal/family medicine seem more plugged in to all this. hmmm...will have to contemplate this further. LOVE my job and always saw myself in some subspecialty (surgery, ob/gyn, etc) so maybe this is just my plight. and i'll have to study a little harder for my re-cert exams (every 6yrs) because they're on general medicine....hmmm....

Speak Spoke Write Wrote

2009-09-29T17:41:00.004-04:00

interesting day on the floor with patients today. i noticed all the cool ways i get to communicate. as much as i whine about rounding on patients the rare weeks that i have to do it, i do always learn a lot and in just a few days the relationships you establish with the patients and their families and the juicy human interactions you're part of make it not all so bad. (i guess).

firstly, i have a spanish-speaking family of a young patient who just went through major surgery. the child (the patient) translates on her parents' behalf. how helpless would you feel as a parent at the hospital when the staff is telling you important details of your kid's health and that same kid is the only one who can understand them? not to mention- this gives said kid big responsibility to not accidentally mismanage the truth in translation. ("the doctor says i will only get better if i get a pony for my birthday...yea, yea...and i should be allowed to eat chocolate cake for breakfast everyday when i get home"). i love speaking spanish and am piss-poor at it. but i feel like a total rockstar when i'm the only staff around who can do it at all. hooray for working in a whitebread hospital in the suburbs!

then, i had a patient who formerly had a trach (after they took his larynx among other neck area important parts in a series of surgeries to resect tumors -from years of smoking- just had to say it) and now has a gaping hole in the base of his neck with no ability to speak. except that he writes! beautifully! so we had a conversation like this for a good 20 mins about his time in the airforce and what it was like to be on huge ships like the one being shown on the discovery channel on TV when i came into his room. it was lovely.

amazing how you can get a feel for the personality of someone through such limited interaction. and i mused that- like the great "silent bob"- people with few words always seem so wise! the text written on the silent patient's note pads by his bedside seems so profound. even if it just says in shaky block letters "ham sandwich" or "make that damned PA girl go away and leave me alone" it carries a lot of weight.

and on that note.

Score 0.33 for Medical Science!!

2009-09-24T19:11:00.002-04:00

we're getting there!

together, the zany philanthropic mad scientists with all their smarts plus the "rent" cast and all their fund raising efforts have concocted a vaccine for HIV that is showing some efficacy!

how cool is that?

please read this and do a tiny anticipatory celebratory dance with me!

I Just Want to Work Already!

2009-09-22T00:15:00.002-04:00

this has been such a weird month. not only did i have 2 weeks off for my zombie bite illness, but last year, when i requested time off for this year, i crammed all my vacation time into the end of the summer/early fall.....so i had a week's vacation before my sick leave in mid august....then i had a 5 day weekend for labor day in which we went to austin to visit friends...then this weekend we went to nyc for a wedding and i took a 4 day weekend for that. and in just 2 weeks i have my annual 1 week off for continuing education when i'll do home study for a few days and also go to a local conference for a few.

crazy, right? and expensive.

anyone need a kidney? some eggs?

Celebrating my 1st Anniversary in a Shower of Poo

2009-09-16T21:11:00.002-04:00

so i've officially been working at MBH for 1 year as of yesterday. i can't believe i've been a real life PA for a year already! it seems like just yesterday that i was crying into text books and my classmates and i were feeling each other up under the guise of learning how to do physical exams.

i still have so much to learn, but i do recognize how far i've come. i feel mostly comfortable in almost every case i do (at least those i do fairly regularly) and i loath a little less being on the floor doing medicine the rare times i have to do that.

i have some goals for this next year. i want to learn to do some pretty invasive floor procedures that will raise my skills, knowledge, and stock. and i want to get back into learning and reading. i've read almost nothing clinical over the last year and it's time to get back into it. i'm forgetting a lot that i learned already and i need to review and update. (i might be woefully behind in my clinical skills and can't correctly diagnose heart failure, but this year i did read the ENTIRE sookie stackhouse vampire novel series and can chronical her sexploits with vampires, were wolves, were tigers....the list goes on. impressed?).

WHAT ABOUT THE POO you ask? that's another resolution i have for next year. don't inadvertently pull off a patient's VERY full colostomy bag onto myself, the floor, and everyone around me right before we're going to start a case. this happened today. and remember that show "you can't do that on television" where the liquidy slime stuff came out of the sky? that was sort of the consistency of the goo. and the smell- woo! the whole surgical area smelled like a slaughter house farted. so....i won't do that again. what i will continue to do is have spare socks in my locker just in case.

I Feel Very Much on the Outside of this Healthcare Coverage Debate

2009-09-04T16:10:00.004-04:00

we've been really fortunate as far as health insurance goes. our jobs have always been full time and included benefits and allowed us to pay in our few hundred bucks a month and they chipped in the rest for good private insurance. and we've had great jobs that for the most part haven't laid us off and even in the down times between jobs, one of us has always worked with benefits. and, of course, we've always found it important enough to pay in even when we were doing nothing but paying since we were healthy, healthy, healthy and never required any pay outs.

until now.

i was a little worried all week while in the hospital that we might have crazy high bills to deal with when we got home (since, once again, we've never actually USED our insurance so i've only always assumed it was good, but didn't really know). i actually almost stopped my dad from opening a second box of kleenex one day while i was still in the critical unit just in case they charged ($12 a pop, no doubt!!) per item.

so i got my bill from the MBH today and my total charges for 6 days in the hospital with all those specialists and all those tests (and all that kleenex!!) was some $42,000.00. (what the what??)

but guess how much i have to pay?

$47.50.

priceless.

PLEASE STOP TELLING ME HOW SICK I WAS!

2009-09-03T16:01:00.004-04:00

i got the memo. you thought i was going to die. it's not really helping me now to hear it over and over again. this is just after coming from the cancer center at the "MBH" following up with my hematologist/oncologist. first of all, scary as hell to have to go there. i never want to have to go to a cancer center for anything they'd want to see me for. (before you get your knickers in a wad- everything is totally groovy. my labs are behaving just like they should in the event of a funky virus. no scary cancers or blood disorders and even after i pushed, pushed, pushed- frankly became the annoying pushy patient who seems to be begging for painful, invasive procedures- the MD reassured me that further testing will be limited and she has ZERO suspicions based on all the findings she's seen that there's a cancer lurking somewhere in my depths ). so that's a relief.

but this is also after two other docs i saw this week and last both looked at me from across the little exam room and shook their heads like, "i can't believe you look so much like a human now after you resembled a soggy puppet for so long" and said things like "do you know how sick you were?" and, when the aide couldn't get blood from my ruined veins at one of the appointments (don't they just have too many perforations in them after a certain number of needle sticks? wouldn't it be like a sprinkler head and just start sort of sprinkling out everywhere? must make note to ask poor, abused heme/onc on next visit), the MD referred to me as "the poor woman who's been through so much."

just stop.

i'm back at work and for the most part, feeling really strong. let's all just let my bruises heal and let me get back on my feet and be as strong as i know i am again. let's not see me as a tragic, broken doll, but as a horse. or ox. or bull. or some other labor animal.

Well, well, well.

2009-08-24T18:24:00.002-04:00

i spent the last week in the hospital. i have lots of lurid details for you and perhaps amusing/scary tales to regal you with. but give me a day to continue to heal and to collect my thoughts. here are the basics, which i wrote up for a friend earlier. i'll fill in the rest later-

i started a temp two wednesdays ago and went to the ER because it was up to 103 or something and i was worried. everything was well, they said it was a virus and they sent me home. so it persisted and i started getting a cough and stuff, but mostly just bad chills/sweats. fever went up to 105 on sunday night despite around the clock tylenol, cold baths, ice packs. so i was admitted last sunday and they had me in there until just 2 days ago, saturday. they ran every test in the book for everything from viruses to wacky bacterial infections to HIV and cancers and lupus and never found anything relevant. but my fevers lasted for days at that high temp despite all measures. and my blood counts got all wacky- pancytopenia- had to get 6 units of platelets over 2 days, etc. with all the fluid, i ended up in some CHF and had to be diuresed. eventually my counts improved and fever broke (after a few relapses) and i got to come home. it was taxing. exhausting. but my family, the BHE's family, and my friends and coworkers were extremely supportive. and now i'm home.

now more later. must rest.

Where Did I Go?

2009-08-13T11:57:00.002-04:00

sorry about the forever long delay between messages. i've been on a much needed vacation this last week. up in the woods with my family is just what the PA ordered.

last week i was on the floor following post-op patients but i'm with a new group of surgeons (we rotate every 6 months) so this was a veeeery laid back week compared to when i follow the other group. i got to see and do some interesting things and also was able to scrub in the OR at least once a day, since i had all luxurious afternoon time after i was done rounding. it was very tra-la!

i will be more diligent about blogging once i'm back from vaca. hope all is well out there...

Ah, Heck, Little Guy

2009-07-30T16:37:00.002-04:00

so we veeeeery rarely have pediatric patients (under age 21, actually) but today i did an appendectomy on an 11 year old. tiny little guy was all shaky with fear and pain and cold. i just wanted to scoop him up and take him away from the big mean people with knives. but then that wouldn't have fixed his problem, which was as he described, "my appendix really hurts."

all went well and he will be merrily on his way home to drive his parents crazy quite soon.

Boobs, Butts and Everything in Between

2009-07-22T16:07:00.003-04:00

have been doing a LOT of plastics lately. i think i tallied up all the hours i spent sewing last week and it was something like 15. that's a lot of work for the same pair of hands. i don't have a back up set or anything. of course the surgeons do a whole lot more, but as they are more skilled and efficient than yours truly, they cover a lot more ground.

i enjoy plastics immensely. generally speaking you're making someone more content with their image and you're not operating on critically ill people. (the main exception to this is burn victims, which i *thankfully* don't see much of). you're also doing a lot of breast reconstruction post cancer, so it feels valuable to help give back some of the identity and dignity lost.

plus...it's fun! the outcome looks great most of the time! they went from floppy to fabulous! that's very satisfying. and the bigger the better. it's like mowing the lawn when the grass is knee-high. just look how much better it looks!

You Wanna Get High?

2009-07-11T08:53:00.003-04:00

recent news has revealed how very weak we health professionals can be when it comes to money and drugs.

evidently if the king of pop asks you for a script for xanax you don't ask any pertinent questions like "hey, mike, you aren't already popping some 10-30 a night, are you?" and if he asks you to gank some propofol for him from the hospital, you happily comply. sad.

and if you yourself want some jollies and pills aren't enough for you, why not shoot up? a scrub tech in denver was recently discovered to be stealing syringes filled with fentanyl from the OR and injecting them in herself. so firstly, she was gaining access to something only anesthesia should be handling and was taking an extremely potent pain killer on a regular basis. and THEN she was refilling the syringes with saline and putting them back, so the patients, while paralyzed by other anesthesia drugs so they couldn't speak up, were getting no pain relief during surgery. and THEN, she knew all along that she had hepatitis C, but still gave back her dirty needle to be used on thousands of patients...and now 9 patients have been found to have hep C!! just atrocious.

when you sign on to practice health care you have all kinds of written and verbal ethics agreements and licensing boards you answer to, and always the threat of litigation. but that's not enough. deep down, you need to have some compassion for humans to get into it in the first place or you can be a major weapon. it's very scary. patients are so vulnerable to us, we cannot be this weak. we owe them more.

sigh.

What Do You Get When You Cross...

2009-07-05T14:15:00.003-04:00

a cheetah + a moose + sher khan from "the jungle book" + a horse + the 2009 international yodeling champion???

our new dog.

he's huge (94lbs) and loud. he definitely makes his presence known. i think some of it is just that he's adjusting to the new digs, the new schedule, new food, new roommates. we also get the impression that he was rather spoiled in his previous home (fat! so fat!). so with a little time and training, i think he'll quiet down. but he will not get much smaller, though. that's for sure. he's just a tank of a dog. he has to make a 3 point turn like a semi truck in our narrow hallways to change direction. we could easily saddle him and give pony rides to the neighborhood children.

good times. :)

Looooong Short Week

2009-07-03T12:39:00.003-04:00

my week started rough. i was on call monday night and was there scrubbed from 11 until 3 in the bloody morning, and so stayed over at the hospital in the call room so i could start my 7am regular shift "fresh." then, that day my case started at 8am and i was scrubbed all the way until 3pm doing an extensive plastics case wherein i sewed for a straight 2.5 hrs. aaaaahhhh!!! remember the game tetris and how if you played for enough hours in a row when you went to bed that night you'd still see little rows of squares lining up? that's how i was after that day. i could totally see the plane of dermis i was suturing to...back and forth, back and forth. into eternity in my sleep.

the rest of the week was better, but i'm still catching up on sleep. running a lot. did 5mls monday afternoon and another 6mls this morning. it's been easier since the weather seems more like october than july. we're officially off today but i'm on call during the day this holiday weekend. will be just kind of lying low. we are fostering a second dog from the rescue organization from which we adopted our first dog...so that adventure starts this afternoon.

happy drinking cheap beer and scaring each other with firecrackers to celebrate our nation's birthday! more soon.....

More Tasty

2009-06-28T22:22:00.003-04:00

one last fresh and tasty meal that the BHE made last week since we're on our healthy and delicious cooking kick. Bankok Drunken Noodles. amazing. fresh and bright and spicy- depending on how much thai chili sauce you use (he did that in place of the fresh red chilis). maybe a little time consuming, but definitely worth it. and it made enough for 4 meals!

What is The World Coming To?

2009-06-25T21:11:00.003-04:00

well, my day was better than that of the medical staff at UCLA Medical Center where some poor schmuck was doing chest compressions thinking to himself "I CANNOT LET THE KING OF POP DIE ON MY WATCH! OH SWEET SHIT, PLEASE WAKE UP/REBOOT!"

i was observing today what a weird place the hospital is. here we are doing various serious things like taking out bowel and thyroid cancers and fixing old ladies' fractured hips (and to maybe a lesser degree- making breastsesses perky and full). but what were we all talking about? Jacko and John +4 and Kate +4.

does that make us jaded and sick? nah. it's just survival i guess.

you know what IS sick? denise richards as a nuclear physicist in "The World is Not Enough" playing on TV right now. say what?

I'm a Total Pansy/Turning Over a New (Basil) Leaf

2009-06-22T18:46:00.008-04:00

so i didn't go to my reunion. i stayed home and hung out with my family watching our team win a baseball game instead. and i don't feel the least bit bad about it. i was hemming and hawing about whether i should bother driving the two hours to get there and then when we got on the road there was construction everywhere, so i just saw it as a sign and came back home. i also did not want to have to get dressed up and wear special underroos and nylons just to look slick in my pencil skirt. and i didn't want to have to make small talk with a bunch of people i barely knew then and certainly don't know now....like i said- total pansy. so i'll catch up w/ the few people i missed at a later date and will amuse myself with all the facebook pics that have been posted. it appears that everyone is as slim and pretty as they used to be, so that fact alone would have spoiled much of my evening's enjoyment. (evil).

and i'm taking control of my health. i decided this weekend that i am (oh geez) training for a half marathon in october. yikes. the BHE and i have also decded that we've been taking all kinds of shortcuts with our diet lately. not only are we not as balanced and low fat as we should be...but we're being poor vegetarians by eating tons of fake meat soy products (fake burgers, fake chicken, fake lunch meat, etc), eating out a lot, and making only super quick, simple meals. so now that our herbs in our herb garden are falling over they'e so huge- we're starting to cook healthy veggie food from scratch again. you should have seen the produce haul we got from the grocery store this weekend. like garden of eden.

Day #1 Vegetarian Stuffed Grape Leaves (Dolmades)- totally delicious. rather time consuming. 2 WW pts for 3 of them- recipe came from WW cook book. used lots of our fresh dill. hmmm....

Day #2 Bowtie pasta with Basil, Cilantro, Spinach, and Goat Cheese- mixed the basils i've been growing- fresh purple, spicy, and sweet basil, plus fresh cilantro (coriander). very tasty. made huge amount for lunches this week.

...and now i'm craving peanut butter ice cream. must fight impulse. eat an apricot. that'll be just as good...yea, that's it....

Hummus and Hematomas

2009-06-18T17:06:00.004-04:00

well, the good thing this week is that i've eaten spicy hummus for my last 3 meals. i like that.

the bad thing this week has been everything else.

it's been crazy busy on the floor as usual. seeing about 18 fairly complicated patients daily including writing notes and orders, providing wound care and preparing them for discharge. often not eating lunch until i'm about to leave for the day. pulling my hair out and running around in circles.

and, in case i'm not nervous enough about messing someone up good....earlier this week i did a very minor procedure at bedside that shouldn't be at all a big ordeal, but somehow this one caused the patient much bleeding and agony. in retrospect, it was sort of a fluke and nothing i could have prevented. but that hasn't stopped me from feeling a lot of guilt and angst about it. sometimes things happen that are unfortunate but unpreventable. i know this, logically. but i took little comfort in this while watching the patient writhe over something my hands had done. ya know?

but that patient is coming through the ordeal relatively unscathed and my week is almost over. this weekend is my (gulp) 10 year high school reunion. i couldn't be more excited (terrified) to go and am really looking forward to catching up with all my old school chums (drinking too much and exposing myself to the captain of the football team). i'll keep you posted about how everything goes (are the mean girls chubby now? will anyone recognize me without my goth makeup and smirk? will there be any pig's blood? it's an open bar, right?).

cheers!

Well...

2009-06-16T16:13:00.003-04:00

post bachelorette party. had a ball with all my girl cousins and the bride's friends. was a bit over served from our very own personal bartender from our fancy martini bar (ahem- we are VERY important)..but all in all, had a great time.

and almost fully recovered now and back to work and on the floor at work this week. running around like a headless chicken as usual. but surviving. taking care of a lot of really sick people...it's hard but not all miserable....it's also a good learning opportunity. yes. that is how i'll look at it.

and in those moments of stress i'm trying NOT to eat my weight in cookies since i'm going to my 10 yr high school reunion this weekend and trying to fit into wee little skirt. we'll see. might have to wear sweatpants/moo moo. i'll let you know.

Ay, Dios Mio

2009-06-09T18:19:00.002-04:00

so, back in the day i used to waitress at a mexican restaurant where we threw a big 'ol bash for cinco de mayo every year. no one knew what it represented to actual mexican people, but let me tell you, it was, like, THE HOLIDAY for drunken white people making asses out of themselves over melted cheese. and we would show up before lunch and slave away all day, winding our way through crowds of drunken a-holes with trays of hot beans and weak drinks. we were even blessed with wedding party after wedding party pouring in post-reception (i'm not joking- in their gowns and tuxes and everything) demanding silly girly drinks that didn't involve tequila. and we'd stay until 2 in the morning and leave with a few hundred dollars of really hard earned money. it wasn't as much fun as it sounds.

this is why i finished college.

so now that i make a billion dollars a year as a hot shot PA, mostly my days are peaceful and zen-like. but today was madness!! i followed an orthopedic surgeon as he jumped between 2 rooms doing a total of something like 10 cases. and since every other PA in the department was scrubbed in equally crazy situations, i was also running to pre-op and up to the floor and every which way every spare moment i got trying to get all the other chores done that needed doing.

as i left the last case and stumbled toward my locker in a blur, i swear i smelled cilantro and heard someone scream for another cerveza.

ay dios mio.

So Far So Good: Surviving the Economic Slump

2009-06-03T21:17:00.003-04:00

pretty much the longest day ever. this week has been busy, busy in the OR world. running from case to case, juggling rooms, fitting in emergencies. it's been nuts. which is good, mostly, as it was kinda quiet for a while and everyone was getting squirrelly, worrying about our jobs in this economy and all.

but, fortunately/depressingly, people still smoke and need wedges of their lungs removed to take out tumors. people still over eat and need the plaque scraped out of their vessels. people still do nothing wrong at all and require their gall bladders, appendixes, and thyroids excavated. shoot, some people still need bigger boobs and smaller noses, just cuz they do. so i guess we'll always have business. cheers!

What's Up in the World of Health/I am SoTired and Lame

2009-05-29T18:52:00.004-04:00

so i've been trying hard lately to prove that i'm still young (nope) and hip (not even close) by partying a bunch last weekend and then going to concerts 2 nights in a row this week on school nights. needless to say, if the hipster kids at the show giving me withering looks like i was somebody's buzz-kill mom wasn't enough to tell me i need to slow down and get back to my knitting circle , my paralyzing fatigue today is. i am drop-over-dead tired. and i'm running a 10k tomorrow morning and then going to a bachelorette party (for which i have to bake the dirty cake! don't ask). so tonight's my night to rest and relax.

so i'll be brief, if you don't mind. (good start, huh?). there have been a few allopathic medicine versus homeopathic medicine issues in the news lately. and i find them interesting and thought-provoking.

first- the boy with Hodgkin lymphoma and his mom trying to escape to mexico instead of finishing his chemo treatments. did you follow any of this? basically, this 13 y/o was diagnosed with hodgkin lymphoma and started on treatment, which include chemo (and, typically, low dose radiation). and his prognosis was good (in fact, according to the NCI, 90-95% of children w/ hodgkin lymphoma who receive this treatment modality are cured of the otherwise lethal disease) and the boy received initial doses of chemo. then he and his parents decided to stop doing chemo and instead use the Nemenhah native american naturopathic healing method, siting the miserable side effects of chemo as the reason. so they did that for a while and then a court got involved and while reviewing new xrays, physical exam, and labs, found that the cancer was spreading, so they mandated he get back on his treatment course, and mom and son ran away. they're back now...but it raises topics of parental rights and alternative treatments and all that good stuff. any thoughts on this?

-second- we know that there are new outbreaks of old diseases since people aren't vaccinating like they used to. here's some updates on the current situation with pertussis (whooping cough)- the gist is that it's a bacterial infection that can be harmful/deadly (10 in about 10,000 cases in 2007 died from it) and that the known cases are occurring in one in twenty unvaccinated kids and one in five-hundred vaccinated kids. so there's issues of not only leaving the unvaccinated kids vulnerable, but also then leaving susceptible children (immunocomprimised, too young to receive pertussis vaccine, etc) at risk.

-there are more....but i'll say more later when i'm more awake. but do please post any thoughts you have on this stuff.

Who Mopes Around on a 3 Day Weekend? I do! I do!

2009-05-22T21:12:00.006-04:00

i know it's been a while since i've blogged. (thank you, lindsay, for reading and for the friendly reminder!). i haven't had too many exciting things happen to me at work recently (thank you, GOD) and...well, the world seems like a very depressing place right now, so i'm struggling to come up with fun, happy material. there are a lot of things that make me sad right now.

i'll elaborate on the reasons for my angst....not necessarily in order of importance:

-the crappy economy. sweet baby (8 lb 6 oz) Jesus. all everyone is talking about is how desperate things are. if you believe the media, we'll all be homeless sleeping in cardboard boxes by the end of the summer and driving our pogo sticks to work every morning because they aren't manufactured by unions. but wait! we won't have jobs to go to because everyone is going out of business. starbucks will be forced to take the crack out of their coffee because the overhead is too high, strippers will have to use second hand pasties and find a way to accept small coins instead of dollar bills (maybe a fanny pack?), and hospitals will be forced to sell their MRI machines to the few remaining rich people who have been dying to see what the inside of their rich butts look like. and we'll only have our cardboard boxes if we can continue mining paper from the middle east. and we'll only have a place to put them if the stimulus package doesn't use all the good squatting street corners and overpasses for subsidized lemonade stands for kids.

-swine flu.

-news this week is full of stories about parents killing their children. sad, desperate, awful stories. kids found buried in fields and sandboxes...just ick. . and then there's the mom who took off w/ her kid with cancer mid treatment (more on this later). yikes.

-Tasmanian devils are now endangered because they're dying out from a contagious facial cancer. (i am not making this up).

-i just went to cnn.com (my favorite source for news that makes me want to jump off a bridge) and one of the headlines is "man sucker-punches blind woman on bus." seriously. is the world ending? is this the sign of the apocolypse?

-bea arthur is dead.

-people are being tortured in the name of peace.

-and lastly, they're remaking "footloose" and "drop dead fred." NEED I SAY MORE??!!!?? no, but i will. DDF won the Academy Award for the Best Movie Ever Made. there is NOTHING that can be improved upon from the original phoebe cates/rik mayall/carrie fisher version by adding russell brand (as fred). and &a^#@ ZAC EFRON DOES NOT MAKE KEVIN BACON!!! even with your little upturned bacon-y nose- you are nothing but an impostor! oh, my word. i'm going to go rock and cry under a table now.

good talk.

*giving credit where it's due- i slipped in a few "talledega nights" quotes into the text. will ferrell does not make me sad.

Call on Me, Brother, When You Need a Hand...

2009-05-15T21:22:00.003-04:00

been taking a lot of call this week. a few night ago i was snoring and drooling on the couch at home at about 10:30pm when the BHE woke me up with "i think your beepie thing is going off." it had, in fact, gone off twice...so i made haste to get to the hospital. was there for a few hrs and got back home and to bed about 2am...only to wake up to my regular alarm to go to regular work at 5:30. then i was supposed to be on call all this weekend, but people in my department more driven then myself picked up about 2/3 of it. even so, it's 9pm on a friday and i'm just getting home from the hospital.

but i don't mind. this might change as the novelty of being on call wears off, but i so much love being in the hospital, that i sort of enjoy even these odd hours. being there in the middle of the night means getting out of my warm bed/off warm couch and having to drive and park and get dressed in scrubs and be functional at the OR table....but it also means i get to be part of the heartbeat of the hospital, which is infectious. (not literally, usually). in my past career in the hospital i had the same feeling. just walking through the door, smelling that comfortable blend of disinfectant, human stink, and cafeteria peas and carrots is simply....irresistable. :)

this might make me officially sick in the head, huh? forget it, i'm going to bed.

Pop Music In One Ear, City Pounding Under My Feet

2009-05-10T17:45:00.004-04:00

well, i ran my first 5k run this weekend. and it didn't kill me. at all. i actually had a lot of fun. i've been training for about a month and the last 2 wks i've realized that it's all mind over matter and that i can, in fact, run 3 mls straight without stopping. so for the race day, i just relaxed and enjoyed it. got to run on highways and over bridges and on city streets...places you never get to see except through a car window, so it was cool. plus i was running along side my wonderful little sister. she and i shared an ipod, actually, w/ an ear bud apiece. so that was fun (and a little hazardous). we ran pretty slowly, but we finished. and we avoided the rain. not so much for my coworkers and the BHE- they ran through a downpour. but also survived.

things have been good and busy at work. struggling to overcome insecurities as always. i did find my surgical assistant skills helpful outside of the OR recently. the BHE was fixing the engine on his car (i know, right?) and when i went out to check on him at about 9pm, i found he was working with a flashlight in his mouth and struggling to uncoil tape with his bare hands. i know less-than-nothing about cars (don't tell my mechanics- i think i have them fooled!)but i DO know that you need proper lighting and instruments to perform surgery. so i brought him a giant floor lamp with extendable arms to light the garage and i found surgical scissors and a hemostat i'd ganked from when i was a student, to help him get the job done. i felt useful. i charge by the hour.

i also find that i'm a lot cleaner and more precise when cooking than i used to be before i worked in surgery. but i had to laugh at myself the other day as i was carefully peeling and cutting a pepper when i had a thought that i wanted to raise the counter top to my height so it was more comfortable on my back and eyes like you can when you're operating on a surgical bed. i wish i had a foot pedal for that in my kitchen. will work on that.

It's Been....a Week

2009-04-30T19:48:00.004-04:00

and it's almost over, gracias a Dios. i do not think i could have survived another few days of this. and i might have sat on the toilet in the locker room in the middle of the day yesterday, weeping silently while texting the BHE that i'm going to pay off my loans and then quit and become a rodeo clown or bank robber. and i might have accidentally on purpose almost dropped my pager into the toilet so that it would stop going off and people would stop asking me questions and expecting me to KNOW stuff and give them CORRECT and reasonable answers.

and i was such a stressy anxious spaz yesterday after work that i went right home and ran over 3 miles. (i bet you thought i was going to say a puppy, right? ran over a puppy? you're sick). which is a personal best and i would be really proud that that was my healthy means to blow off steam, except that i took a few drags of whiskey straight from the bottle and ate half a bag of chocolate chips before i went. in retrospect, drinking and running is kind of maniacal and may be a sign of some deep neuroses.

perhaps there are some things that i should not confess and should instead keep to myself.

nah.

now if you'll excuse me, i'm off to make a cognac whey protein smoothie.

(i'm joking, but seriously- why do i have so much old man booze in my house? what are the kids drinking these days? are they still on pomegranate martinis? hypnotiq? zima?).

Geek Drama

2009-04-28T16:47:00.005-04:00

so, being on the floor this week again means that i'm in a near constant state of panic, because i'm still so afraid to make decisions regarding the health and well-being of real live people. i mean, seriously, heart palpitations, head ache, and i think i'm developing a tick. (which i'm sure is really reassuring to the poor patients).

and, i guess, somehow in our little sterile OR world, i can separate myself from the reality of the pain and fear of the hospital. when i'm holding a tumor, i don't have to think about the terror the patient and family felt as they were told it was cancer or the upcoming chemo treatments they'll face that will take them to the brink of death to save them from going over. or even the complications and challenges in recovery- nausea, pain, confusion, weakness....every little thing is scary and hard. even just having to wear the flimsy hospital gown and losing all modicum of privacy and dignity.

on the floor, all this is apparent. patients are crying and throwing up and yelling. families are either repeating the one hopeful phrase someone tossed their way or they just look...lost.

i can understand why medical shows are so popular. there's no better stage than a hospital to demonstrate human tragedy. and comedy.

i walked past the surgical waiting area on my way out this afternoon. this is where families wait while their loved ones are in the OR. it's just a big area with chairs, a TV, and a reception desk in a hallway with a little room to the side where surgeons take the family when the surgery is over, to tell them how things went and what they can expect. the faces of those waiting vary in this room. there's everyone from the husband of the woman getting breast augmentation who's beaming in the corner in his own private triumph to the little old lady whose husband is in the middle of a coronary bypass graft sitting wondering if she could survive as a widow. occasionally you'll see families holding hands and praying. some do suduku or sleep. some pace clinging to a venti starbucks drink.

today as i passed, i saw a huge group of the waiters huddled around the one TV. i was certain another national bank had bit the dust or some other big news, but when i got closer, i saw that they were all watching a high speed car chase and that the police were just apprehending the crazy driver out from the driver's side of a truck.

i couldn't help but be amused. here i was, observing the drama unfolding in the waiting room while they were finding apparent distraction and possible comfort in watching the mess on the screen- the tiny self-destructive driver on the small screen being manhandled by the angry miniature police in their own tragi-drama. and i assume that the driver then, in turn, spotted a bully picking on a little nerd in a school yard from the back of the paddy wagon on his way to the big house...full circle. like a sad bastard Russian nesting doll.

Rain on My Home Improvements

2009-04-26T18:15:00.003-04:00

definitely spring weather we're having, huh? pouring rain for days at a time and now the GREENEST grass ever! i love it. and it's been in the 80's....like when i went running with coworkers on friday. heat stroke + being kidnapped and forced to run= good times. but, begrudgingly, i do have to admit that running is getting easier every time i do it. maybe i will survive the 5k after all. (don't they have a 2k or maybe a 1/3k?).

anyway...the BHE and i are trying to figure out how to make our tiny house into a tiny house w/ some useful space. and it's already a bit frustrating and overwhelming before we even start it. the itty bitty kitchen has been the bane of my existence since we moved in (so little counter space that i once caught my sister rolling dough up the side of the microwave). but of course, with every project comes a lot of unknowns and unexpected costs, so we're weighing all our options.

and i feel a bit like i just woke from a long slumber. the cold, dark winter coupled with my obsessive reading of serial vampire books and watching countless hours of movies has made me a bit negligent on things like my house and finances and health and cleaning. so ENOUGH! i'm going to be a lean, mean, organized and productive machine. and i might even put away the chocolate chip bag that i've been dipping directly into while i type this. also, my new leaf includes NOT putting chocolaty finger prints on my keyboard. anymore.

New Policy: Only Run if I'm Being Chased

2009-04-18T16:16:00.006-04:00

...and then only if i'm over 90% sure that the thing chasing me is for sure going to eat me. and only then if it will only be a short run.

have i mentioned before that my stupid stinkin' coworkers are all health nuts? they all run long distance and eat healthy and even though they've had a few kids each, you'd never know it looking at them. so...in the spirit of shared health consciousness and against all better judgment, i signed up to run a 5k in a few wks. it's only 3 lousy miles, but for me, it's pretty much a death sentence. and apparently signing up for it and getting the cute little race t-shirt isn't enough, you have to actually train for it. so one of my coworkers (who's running the 10k-6 whole miles of insanity!) asked me if i wanted to run for a few miles this morning. much to my dismay, when i showed up at 10am at the assigned trail head, i found out that she actually meant we'd go for a run and that wasn't code for "going to the local grill for pancakes." so i ran. and whined. i probably spent more calories on the latter. i ran a total of about 2 mls and walked another 2 1/2 or so. and now i want to not move ever again. which will make it hard for me to kill my coworker. i'll find a way.

And...it's Friday and the Sun is Shining. Tra-la!

2009-04-17T13:51:00.008-04:00

have had a pretty quiet work week. was on late this week and we've stayed steady-ish. i love being at the hospital late at night- there's something so quiet and sleepy about it. and i've gotten a chance to work w/ some docs and other staff i rarely see, so that's always fun. and i ended up doing a good bit of plastics this week, which i love. a few breast cases that turned out quite lovely. nothing too crazy- ended up not so much like this, maybe more like this. with maybe a little less...less.

now the weather is turning around and the BHE and i are home for a relaxing weekend. thinking about making some long-time-coming changes to our house, so we're gearing up for that. i might get out voted on my idea of hanging our bed from the ceiling and my stairs-to-nowhere as art in the backyard like in "beetlejuice" but i'm gonna try.

might go to a movie or something, too. i've been slacking on movies lately as i have been reading a terrible/totally awesome vampire romance trash novel series w/ the heroine "sookie stackhouse." anyone know of them? evidently they're a big thing on the trashy book market, but are new to me. i've become a total addict. in place of cleaning my house or exercising i've been glued to this series. between this and the "twilight" movie, i might have to find a creature of the night-crush support group.

A Manifesto on Baby Mammals

2009-04-12T20:19:00.005-04:00

had a great Easter sunday with some coworkers and their families. ate way too much delicious food and gorged myself on chocolate. there's even a small chance that i was caught by the BHE eating a chocolate cupcake in the shower this morning. i can neither confirm nor deny this claim.

i'm addicted to one of my coworker's 9 month old baby boy. he's got the cutest, fattest little...everything. face, feet, thighs, eyelashes. all of it. he's like a blond, blue-eyed little cherub. a tiny bit "children of the damned," but in a totally cute way. he's the absolute picture of rosy glowing baby health.

i really love spending time with kids. they're so loving and warm and funny. but i must say, the young of our species are exceptionally dumb. i am by no means referring to my coworkers' children specifically-i gather they're all at or above average intelligence for their age. but...in general, babies and young kids have very little problem-solving skills and zero survival instincts. i mean, for pete's sake, it is many, many years into their existence before they can even use doorknobs! and it would be utterly impossible for them to survive in the wild. in fact, they seem to be deliberately trying to off themselves. they toddle out into traffic, they fall into open manholes and wells, they stick fingers in electrical sockets, they drink poisonous substances, they play with knives...i suppose all the while assuming SOMEONE will come to their rescue. (after all, someone already opens doors for them). i'm just saying. if a lion cub or an eaglet was born as slow and awkward as a baby human, they would surely be eaten and/or fall from a tree. baby humans are more like baby cows and horses- clumsy and sort of wandering the world, lost and stupefied. i suppose that's why we eat veal and not lion cub, huh?

anyway. i'm just sayin'.

Back in a Good Groove (Not the Pit of Despair)

2009-04-09T21:55:00.004-04:00

so trip was awesome. perfect weather, great company. awesome food (best restaurant was an old church/monastery where we had lobster and "sexy coffee" which is a flaming boozy coffee drink w/ ice cream). lots of reading mindless books on the beach while sipping banana daiquiris and other such delicacies. also visited mayan ruins, shopped, snorkeled and watched college basketball at a local "irish pub" that served pastrami sandwiches and guacamole, dos equis and guinness.

and we scuba dived...dove...dev(?). diving was sort of the whole point of the trip- we stayed at a dive/snorkel resort. we were slated to do 2 boat dives a day for 3 days. i was dragging my feet going into it because the two days of training last summer (in a cold, murky inland lake and a peed-in high school swimming pool) were not as fun as they sound. i had a mask malfunction on me during the training and so between nerves about losing my equipment/drowning and worry that my motion sickness issues would make me miserable, i was very afraid. but after we got on the boat the first day and it was a beautiful morning and i wasn't feeling nauseous (thank you, dramamine, my BFF), i started to relax. and even on the first dive, i felt surprisingly natural, comfortable, and in control. we dove through some coral tunnels and saw many amazing animals of all shapes and sizes. good times were being had. until i gave myself brain damage and third degree burns.

see, the thing was....since i was so paranoid about my mask falling off, i harnessed it down around my head...emphatically. it squeezed a lot and when i was down at about 80ft the pressure was rather uncomfortable (think cartoon wolf w/ eyes popping out on a slinky when he sees his wolfy heart throb). but again, i was afraid to mess with it, plus, i didn't know what it was SUPPOSED to feel like, so i just endured. evidently that is NOT what it is supposed to feel like. i ended up with 2 pretty nasty, puffy, red/black eyes that lingered like that for a few days. i also kneeled in some fire coral which left some burn patches on one calf...which apparently can fester and boil and linger for weeks or more. but i got lucky and there was a knowledgeable crew on board who could understand my poor spanish (i think i said the equivalent of "there's a red menace ate my foot leg shoe and hurt it me ouch bad"). enough to fix it by pouring vinegar on it. the pain and redness went away immediately. gracias a dios.

so, that was the end of my diving adventures. i will dive again, but for the rest of this trip, i let the BHE and my dad do all the diving while my mum and i sat on the beach and snorkeled and generally avoided further trauma.

so despite all my whining, trust me when i say it was a perfect trip. and soooo relaxing. sigh.

i'm still relaxed from my toes up through my hair. coming back to work this week was great. you'd think i'd be all growly about having to come off vacation, but i'm actually feeling so excited about my job, thrilled by the friends i'm making there...it's so comfortable for me (most days) that it feels like home. ask me again next week. this weekend i'm working/on call both saturday and sunday and then on monday i'm doing 2 cases w/ a tricky doc followed by a difficult vascular case. and then i'm on afternoons all next week. welcome back!

Sleepy and Suntanned. More soon.

2009-04-08T22:41:00.005-04:00

Did not get eaten, stolen, drowned-ed, or shivved

2009-04-07T23:27:00.002-04:00

Adios, Suckers!

2009-04-01T13:23:00.003-04:00

leaving for mexico tonight through texas. all tanned up and pedicured with new sandals and sundress, a 300 pack of Dramamine (my elixir of choice- i wonder if they have support groups for people like me) and ready to go. ate the last fresh food in my fridge and attempted to put my house in some semblance of order so that we will come back to what looks like a house that grown-ups live in. wonderful friend taking us to/fro airport with only promises of eternal devotion and tequila.

glad for the get away and the adventure, but also glad for a break from U.S news. hopefully i'll find that in a land of drug smuggling and kidnapping, our dire, dooms day economic prospects and our infernal insistence on "going green" (i've seen it on everything from cooking magazines- "re-use your oil" to women's magazines -what the HELL is "green sex"??? i don't even want to consider what can be recycled and reused) won't seem so exhausting and annoying. PLUS, i'll get to practicar mi español a bit.

and i had a great last day of work yesterday. did a total abdominal hysterectomy w/ an Ob/Gyn i did a rotation with last year and it was awesome! interesting case and i was very involved- she did 1/2 and i did the other. i was high all day from that. :)

i won't have 'puter access in mexico, but we'll be taking lots of pics and i'll post on it when i get back. assuming i don't get kidnapped, eaten, or drowned. if one of these fates befalls me, please eat some chocolate and take a shot (pudding shot?) for your fallen homie.

hasta luego!

I Said "Knish."

2009-03-29T14:26:00.004-04:00

back from new york and had a crazy work week. our last day in nyc was nice. on our way to get breakfast, we stopped by a street vendor coffee and donut shop and shared a glazed huge donut. then we had authentic new york bagels for breakfast (awesome) and then caught up w/ some of the BHE's online musician friends so they could shop at the famous music stores...which happened to be near times square, so i went to roxy's with my cousin's hubby and we had their famous cheesecake (dear Barbara) and a knish- which for all you gentiles out there, is a flaky pastry filled with mashed potatoes or brocolli or other such things. i had never had a knish, and i must say, i am a fan of the knish. and i like saying "knish." then we had thai for lunch. then we went for ice cream for dessert.

so for anyone counting, that was cheesecake, ice cream, donut and real food all before our flight left at 6pm. needless to say, my skinny jeans are now creaking like an old house when i try to squeeze into them. sigh.

we flew in pretty late monday night and so the next day getting up for work was tough. then the whole week was kind of busy and on friday, i worked the floor on a long list of fairly complicated patients. i still get overwhelmed pretty easily when having to do medicine on the floor. there's just so much i'm not comfortable or familiar with. lots to learn. and the list is never comprehensive- there are always add-on patients to see or favors for nurses, etc, etc. so it makes for a long day. but i had some help from my coworkers, and i got through it. and then on saturday i worked for a few hrs admitting new surgical patients and getting acquainted w/ a surgeon who's new to me and can be kind of scary when you're on your own w/ him. so it was a long week.

and then we had some of my coworkers over last night for a wine & cheese party and had a great time. we had joked when putting together the plans for the party that we'd prefer donuts and jello shots to wine and cheese, so i actually made a donut bread putting recipe (but without the fruit cocktail and raisins- sounded too healthy) and pudding shots (amazing!) along with some dips and salads and stuff. it was great. did sleep pretty hard last night, though and am taking it easy today watching college basketball and catching up w/ stuff around the house.

we leave for mexico on wednesday. cannot wait!

Meat Me in New York

2009-03-23T00:29:00.003-04:00

so...new york is known for its food, of course. any ethnicity you could possibly want, at any price, at any hour, practically in any neighborhood. but when you're craving a certain culture's fare, you go to the source.

and so, we went to get dim sum in china town this morning. and i've been to china town before, so i knew to expect the chickens and other slain beasts hanging in windows (one "chicken" had 8 legs- we couldn't quite figure that one out), so i was a little worried that the BHE's strict vegetarian diet would be hard to accomodate. (since i eat seafood, i knew i'd be square). but when we got to our chosen destination, the menu was filled with bok choy, green beans, eggplant, and tofu options and when we quietly mentioned to one server that he didn't eat meat, all the wait staff seemed to shout to each other around the restaurant that he wanted only vegetarian food. so we thought we were safe.

we were wrong.

"i don't eat meat" apparently means i don't eat any blatant beef/pork products but i'm totally cool with pork-laced eggplant, shrimp-encrusted tofu, and sausage-stuffed sticky rice. it became a joke. everything he tried had a little golden ticket of carne tucked in it somewhere. he somehow eventually got full, but it was an amusing ordeal for him. i loved it. i enjoyed all the known and mysterious seafood(?) options and thought the whole experience was pretty cool. we shopped around china town for a while afterwards and i got knock-off sunglasses for dirt cheap and my cousin got a wallet. there were fake hand bags all over the place and allegedly there are real bags out of the back of cars and in apartments in the area if you're willing to risk following one of the eager salesmen off the beaten path. i'm too cheap and easily spooked for all that. i'd rather just make do with a "squishy couture" or "harold vuitton" bag, thank you very much.

then we went to battery park and spent the day on the boat tour admiring lady liberty and ellis island.

by the time we were done with that, it was getting late and we were starving...so we took a cab to one of nyc's most famous pizza places, lombardi's. because at this point we all felt a bit bad for my poor veggie husband and because it's the house special, we shared their original (thin crust, tomato sauce, mozzarella in thin slices (not shredded), basil and romano). it was good. the crust was perfect but i thought the sauce/cheese were a big tasteless. i got laughed at for adding a bunch of red pepper and salt and black pepper, but it helped. if i went again i would try their specialty clam pizza, which i hear is delicious.

so then we went to an improv comedy show by the group the "upright citizens brigade," which has apparently been around forever and is pretty well known, but is only $10/ticket for the early show and free for the later show and is really informal and totally fun. it rotates people like amy poehler (SNL) and horatio sanz (SNL) and kate walsh (grey's anatomy/private practice- who knew she was funny?) and other local comediens. it was amazing. the stuff they came up with on the spot was funnier than most scripted television. their creativity, timing, mastery of language, formatting....all incredible. and it was fun to see a few famous people- john lutz (30 rock) and bobby moynihan (SNL) perform with the troupe.

then we went for dessert at a crazy hip place owned by the "it" chef david chang (momofuku). it was muy tasty and really fun. they have weird things like fruity cereal milk flavored soft serve ice cream and green tea bread, etc, etc.

we've been escorted and guided around by my wonderful cousin and her husband. it has made such a difference having locals to show us the non-touristy sights and tastes of the city. plus, they're a ball, so we've had a great time eating and laughing and eating some more with them.

Day 1 in NYC

2009-03-21T23:33:00.003-04:00

glorious day. beautiful, sunny, if a bit cold. we woke up early and wandered from our hotel (awesome location, only a few blocks from grand central station) up 5th avenue and over to park avenue window shopping and people watching. we went through the waldorf astoria's opulent lobby and the nbc store and checked out rockefeller center.

when we went to fao shwartz, we happened to get there just as it opened at 10am. and it was awesome! the soldier guys came out to open the doors and welcome us in and then when we walked in, the whole staff was lined up clapping for us! it was joyful. made us feel like 5 year olds as we raced toward the yodo bobbleheads and lifesize lego statues.

then we went to central park where we took a carriage ride from a scottish guy named something like "decron" and his horse named "joey.' we cuddled under the heavy soft blanket and enjoyed the views...so many movies have been filmed there- we saw the "home alone" and "ghostbuster" sites (oh, i forgot to mention above and am too lazy to go back to edit- when we were walking along park ave we saw a bunch of press, police, and film trucks for the angelina jolie movie "salt"...so we're practically famous now). after our ride around, we walked into the park and made our way past the carousal, ice skating rink, dairy store, and enjoyed the views of crazy people running in short shorts in the frigid cold, crazy people selling ice cream sandwiches in the frigid cold, and crazy people making the whoopee on the big rocks in the frigid cold. then we had a lovely and leisurely lunch at 'tavern on the green,' a restaurant i've always walked past but never dined in.

we then made our way to times square and saw the usual mass hysteria there. then we wandered to the museum of modern art and spent a few nice hours there with my cousin.

then we went to catch up w/ her hubby and hung out at their apartment for a while and then ate delicious indian food for dinner followed by nummy cupcakes for dessert.

so it was a long and fantastic day. lots of walking- we estimate about 10 miles, since we got a wee bit misguided through central park at one point when trying to find MOMA (which is no where near central park for anyone keeping score). we'll sleep hard tonight. tomorrow is dim sum in china town and then off to more awesomeness all over the city. tra-la.

Long Weekend in NYC- Does It Get Any Better Than This? Answer: No.

2009-03-20T22:07:00.002-04:00

Traveling is an interesting thing. Being this close to so many strangers makes one first notice them, then, if you’re me, make snap judgments (is that not the BLONDEST mullet you’ve ever seen? It’s a force of nature! Take a picture!), then, if you’re still me, chastise yourself for judging. Then you get annoyed because all their bodies together make a crowd and this crowd is in your way and slowing you down. And then you notice the pretty Asian girl 3 rows ahead of your seat who’s wearing a surgical mask like I do when in the OR, but not like me, because when I’m in the OR, I’m wearing the mask to try to prevent dropping innocent germies into open wounds…NOT from spreading SARS to 300 people! Oh God! Stop judging. Stop being a jerk. Maybe she has the king of pop disease and it’s not SARS at all. Hold your breath the whole flight just in case. And the beautiful little Indian baby girl in the stroller making big eyes at you in the security line. How do you know this tiny baby is a girl? Well, there’s the pierced ears and the bracelet. No such ornamentation for her big brother. And I notice how, when the BHE and I travel, we usually check a bag (WHAT A RIPOFF! 15 bucks!) and then each carry a backpack and can maneuver around the terminal with the greatest of ease. Not so much for families with children. Kids are worse than celebrities. They require trunks and fancy transportation and provisions and an entourage. And they’re usually grouching at their keepers. Just like celebrities.

Flight was 1 ½ hrs late to leave our city’s aeropuerto, so we’re getting to NYC late….meaning that instead of walking around a little and getting dinner @ a fun local place, it’s straight to the hotel for us to lie around and watch college basketball! It’s cool. We couldn’t have done that at home, so I’m glad we’re in the most awesome city on the planet where they have TV’s. Neat. I’m not actually bitter. We’ll order in something (pizza pie!) and relax and settle in and then hit the city tomorrow. It’s good to be away from the hospital for a few days. I was starting to feel claustrophobic. You know how it is when you have an impending vacation. You just want to GET THERE! And as I’ve mentioned already, this is the best month ever. This weekend in Manhattan. Two weeks from now in Mexico. I’ve been fake baking in preparation and I’m getting dark enough that people are asking questions. I’m trying to convince them it’s liver failure (jaundice) and not tan vanity. Kind of morbid, I guess. Don’t judge me.

I Feel Like Skinny Oprah

2009-03-16T19:38:00.004-04:00

we weighed in today and i lost 14.5 lbs over the last 10 weeks! very excited. weight watchers diet and working out 3-4 days/week does the job. my team won. for 5 people, we lost something like 87 cumulative lbs. very proud indeed.

so, to congratulate myself and to officially let myself off the hook from being so darn good...i partook of the potluck at work most heartily. i took a whiskey cake with green frosting (i used this recipe, but did it w/ real butter and actual eggs and a wee bit of khalua w/ the coffee- woo hoo!) and everyone seemed to like it. in addition to several shots of my cake, i ate 2 pieces of costco cake (w/ their signature crack cocaine frosting) and mac n' cheese, artichoke dip, and a myriad of other fatty delicacies. and THEN. oh, and THEN, folks....for dinner the BHE took me to my new most favorite restaurants which is a, wait for it, all you can eat japanese/sushi buffet! so much goodness. rows after rows of lovely little things i'm pretty sure but can't confirm contain shrimp. yum. serious yum.

but now i feel absolutely disgustingly sick. i will get back on the wagon tomorrow and work out and stop eating frosting out of the tube.

Good Week and Soon Good Eats

2009-03-14T17:57:00.002-04:00

strutting around like some sort of a rock star this week as my cases went well and it's all sunny outside and i've been running in it and soaking it up. i did a few more vascular cases early in the week and i love them! and they went well!

but then we got really slow toward the end of the week and were scraping for stuff to do (ie- i was super excited friday to get to do a hemmroidectomy. which is just as yummy as it sounds)...and when business is down job security is rocky, so that's been a little nerve racking. but so far so good.

plus the weight contest is OVER ON MONDAY!!!! aha! then i get to eat. so we'll see how i do over the weekend and what my final weight loss is. i've been up a bit the last few wks, so we'll see. plus, we went out for mexican (so good but SO bad) last night. we're having a huge fatty pile of food potluck for lunch at work on monday to celebrate being done. i'm making an irish whiskey cake. (2 tablespoons for you, cake, 3 for me, two for you....)

plus, i'm really excited as the BHE and i are going to nyc next weekend to visit family and see the city sites. and then in a few weeks we're going to mexico! super excited about that. beach and margaritas and scuba diving and margaritas and good food and good company and tequila with lime juice and salt....

so this dreary winter is winding up and things are good.

I Don't Understand Women, Even Though I Am a Women.

2009-03-08T12:51:00.004-04:00

this was said by my littlest sister back when she was about 7 yrs old and we were watching some movie where the woman was storming around and yelling at her man and the man was pulling his hair out exclaiming that he didn't understand women. it was adorable then...claiming in her little squeaky voice that she was "a women."

but i find the sentiment to hold up now. i am feeling very sorry for and angry toward women kind right now. firstly, i did some plastic surgery last week on a woman who had had about 6 previous operations to fix her body. and it was just never going to be good enough for her. she had an image in her mind's eye of a body that wasn't hers. and no matter how much she tried to change it, there was just no way. but she'd keep risking infection, going through painful recovery, and spending the money to try, try, try to be someone else. argh.

THEN one of my coworkers gave me a few back issues of a certain women's magazine (i won't name- you know who you are) that i've always accused of secretly being written by men/for men through women. ie: here are some of the article titles- "what sex feels like for guys," "8 things in your closet that make you look chunky," "new guy? our classic seduction trick will keep him hooked," "how to deal when your man gets moody," etc, etc. and they've got man trap tricks in there (although they don't word them that way- they call the section something like "finding mr. right in new and creative ways" or some crap)...giving helpful examples such as when you're at the grocery store and you spot a cutie behind you in line, drop your earing discretely in your bag and then grab your ear and frantically say you lost your earring and that you need his help to find it. he's supposed to swoop in and save the day and start a conversation that will bloom into love in no time. in reality, you'd slow down the cashier as you foibled around and probably get dirty looks from both the object of your obsession and all the other customers in line for being an idiot and talking to strangers who are just there trying to shop.

THEN i'm reading a book called "wideacre" by philippa gregory (author of "the other boleyn girl") and it's all about how back in the day women had no right to land or inheritence just because they had ovaries instead of testicles. and this particular lead female character is so stunted and frustrated by this injustice that she kills both her parents, shtups her brother and bears his children, mames her lover, and frames her husband. not that her motives can entirely be blamed- but what a wicked, awful depiction of a woman! i think i'm done reading this one. no mas.

THEN, of course, there's the recent celebrity news story- that you will have heard about unless you're living comfortably under a news-free rock- about two beautiful young r & b stars so madly in love that when he very publicly kicks the shit out of her and leaves her for dead on the side of the road, she takes him back. there are lots of rumors circling that she has since married him and/or is having his child. at the very least, it is verified that she is open to contact from him and is not pressing charges. dear God. when are women going to evolve to be bigger than men? when is it our turn to take out all our rage on 'the weaker sex?' obviously humans still resolve conflict with violence, so how do we fix that women always get the raw end of this?(i'm of course generalizing and don't endorse violence from/to anyone...but i'm uber frustrated by the whole thing).

so i'm just disenchanted with what it means to be a woman right now. both past and present, our situations and our selves have caused us to be less than confident, less than respectable, less than admirable. i guess i can just try to define what being my woman means, and hope to help those women around me achieve their most bestest, too...and try to steer them away from paternicide. that doesn't seem the way to go.

but all you men out there- if some lady in front of you at the store "loses her earring" don't buy it! she's out to get you! hide your children!

LAY OFF ME, I'M STARVING!!

2009-03-04T21:17:00.003-05:00

i was thinking about pain this week as i continue to gripe about my discomfort on this diet...pain tolerance is an interesting thing. i had a patient the other day who was weeping like a baby after a minor procedure and while on a ridiculous lot of narcotics and then we'll have patients who undergo huge surgeries who basically tide themselves over with a mentos (the freshmaker).

and pain scales are SO subjective. if you've ever been on the patient end of things, you get asked "on a scale from 1 to 10 how bad is the pain?" i try to qualify it with "10 is like pain of child birth" but even then, that only gets so far. like with dudes. and i don't know how you determine your own pain tolerance unless you do crazy shite like this at the eskimo olympics. then you might know where you stand. and how to conquer the pain. RAAAAR!

i've been kind of a crab this week. i was less than awesome in the OR today and i hate that. and the weather is looking like it might get nice soon, but for now is still kind of blah. and my weight is going the wrong direction and all i want to do is eat! i have a constant menu in my head of what i'd like to be eating at any given moment. for example, right now i would like huge portions of the following: broiled eel nigiri, corn on the cob, coleslaw, double stacked mcdonald's fish sandwich, peanut butter chocolate pie, and wine. lots of wine. i didn't say it was reasonable.

don't you judge me.

Thank God February is Almost Dead, Paczki's, and Undies

2009-02-23T17:34:00.004-05:00

alright. seriously. longest (well, longest shortest) month of the year. snowy. still. cold. still. dark. still. boring. still. when, oh when will you end?

and to top it all off, i'm still doing this stupid diet thing (down 9.5 lbs total, but no change from last week so i'm bitter) AND i'm giving up chocolate for lent starting wednesday AND it's mardi gras tomorrow and all i want is a *&#%* paczki!!! but the stalin-esque spies on my weight loss team watch me like a hawk, so even if someone brings paczki's to work tomorrow, i can't have any unless i first kill the other 4 members of my team.

i could do that.

i did have a rather funny thing happen today. it's in a sort of warped context, so try to bear with me. i was doing a surgery this morning and things got a bit bloody. not a problem, patient was fine, no emergencies at all, just a bit...oozy. so oozy, in fact, that it oozed through my gown, through my scrubs, and right INTO MY UNDERWEAR. so after the case, i'm in my skivvies in the locker room faced with the dilemma- do i wear underwear soaked with someone else's life juice or do i permit flimsy scrubs to be the only thing standing between my most holies and the rest of the world? i took the commando option but later mentioned my conundrum to a coworker and she very wisely suggested i get a pair of mesh panties, usually reserved for patients post delivery or post-op who need roomy, comfortable, light weight diapers, basically.

and i have to say, they were very comfortable. i might never go back.

february is "responsible pet owner month"

Happy VD!!

2009-02-14T16:35:00.001-05:00

Salty.

2009-02-13T22:53:00.003-05:00

just finished a four hour case wheren i stuffed wads of toilet paper up each nostril and STILL had cascades of snot running down my face into my mouth behind my mask. the (hot) ortho surgeon looked up to make eye contact w/ me at one point and totally paused. i'm pretty sure he could see the slick wet snot soaking through my mask. sexy AND hygenic. :)

still feeling kinda crummy, but i'll survive. wasn't called in this week when i was on overnight call. just thought i'd give you an update since i promised i would. i like getting a few bucks an hour to sleep. pretty awesome. and tonight wasn't too bad, working the afternoon shift. it was nice to scrub in again. i'd missed it. back on all normal shifts next week.

by the way...did anyone see "30 rock" last week? i dvr'd it and have watched it twice, i thought it was so funny. tina fey is a hero of mine. for reals.

Bastard Patients Gave Me the Consumption

2009-02-12T17:05:00.003-05:00

seriously. violent hacking cough. headache. subjective fever (meaning i'm making it up to make myself feel more legit). lazy, slow head. generally achy and groggy.

but my week on the floor is over. i'm taking one of my coworker's afternoon shift's tomorrow, so i'll be back in the OR and he'll be on the floor for me. which is a relief. it's different/stressful doing medicine. and i've missed surgery. and spending actual quality time with actual sick patients has made me sick. argh.

Hurts. Hurts So Much.

2009-02-10T17:00:00.004-05:00

both my brain and my butt muscles hurt. mostly unrelated.

brain hurts because i'm on 'the floor' this week. meaning that i'm not scheduled to scrub any cases. but instead i'm following all the patients of about 8 doctors. which isn't as bad as it sounds- only had about 10 on my list today. but i'm making ACTUAL MEDICAL DECISIONS for them about fluids and antibiotics and pain control and what home meds they can safely take and when they're ready for discharge and dressing changes, etc, etc. plus i'm dictating discharge summaries (scariest thing ever- think seeing a typed transcription of the most idiotic answering machine message you've ever left then multiply that by medical terminology and pagers going off and interrupting your flow and trying to paw through a 10 inch high chart as well as find stuff on the new computer system all while supposedly forming and communicating complete thoughts on a patient's hospital stay into a phone. the first time i did it i asked someone "will they transcribe all my "uh....ummm's...." fortunately, they do not). and i'm on call tonight and have already gotten 3 pages. but not to come in for surgery...but rather about floor stuff. but my little heart stops every time the thing goes off. i've been on call overnight a few times now and it hasn't been bad at all. i'm waiting for the 2am 6 hour case shoe to drop. i'm volunteering for all this call because i heart MONEY. we're going on a few trips in the next few months and for those i want some MONEY. so it's my own fault if i get called in and have a rough night. but please cross your interweb fingers that i won't. i'll keep you posted.

and my butt hurts because when i weighed in monday i was 2 lbs up!!! so i've been busting ass (literally, at the seams) all week working out. did squats and lunges and all kinds of brutal things yesterday and now today all this running up and down the stairs to put out fires with patients hurt a lot. but i will not allow my weight to crawl back up. i will be strong. i will be dilligent. i will be...is that chocolate? can i have a piece? it's low fat if i only have a small corner, right? and it's dark chocolate, so really it's good for my heart and high in anti-oxidants, so technically it's diet food, so i should have a few pieces....

sigh.

(i would seriously cut a bitch for this right now. no joke).

Have Your Butts Checked, People. Seriously.

2009-02-04T21:14:00.009-05:00

i helped take a colon tumor out yesterday that was the size of a brain. it was amazing. it had many different surfaces and lymph nodes poking out in all directions and really looked like some sort of extraterrestrial being. and you KNOW it didn't just pop it's ugly little alien head up yesterday. had the patient been having her routine colon cancer screens, maybe it would have been found a long time ago when it wasn't unholy huge and totally adhered to her small intestine and interfering w/ the blood supply to all the rest of her gut. maybe she wouldn't have needed a 4 hour surgery with likely chemo/radiation to follow and still be facing a horrible prognosis.

what IS a routine colon cancer screen you ask? good question. you should be getting colonoscopies/sigmoidoscopies starting at age 50 and then every 5-10 yrs...(unless your MD sees something concerning...then maybe more often. or if you have a first degree relative with colon cancer- then start at least 10 yrs before the age that they were diagnosed). PLUS get annual physicals including rectal exams (yippee!) and fecal occult blood tests. see this site if you have more questions or message me with questions and i'll find you an answer. it's imperative that you follow your MD's guidelines on screening. there are only a select few types of cancers that we can detect early by simple(ish) means. take advantage and don't miss this one. it's pretty common- colon cancer is the 2nd most common type of cancer en los estados unidos. and there's nothing pretty about tumors or having to carry your poo in a bag coming out through your side.

alright. enough lecturing and bumming you out. cancer is bad. we get it.

it's been a busy week. on call some and working late some and did a cool vascular case today and blah blah blah.

weight loss efforts are going great. i'm down 7.5lbs following weight watchers and working out at least 3 times a week. it's fun. i'm fitting into skinny jeans again. we still have (DRAG) another 6 wks left in the weight loss competition, so hopefully i'll keep rolling like i am now.

toodles.

Bleh!

2009-01-31T12:11:00.003-05:00

good week. i cracked down on myself a bit at work and am working on some of the ways my sewing isn't perfect in the OR. i've also been trying to do a bit more floor stuff- consults for the docs, ordering more meds, etc. i'm on the floor for a full week in 2 wks and am nervous. evaluating labs and making decisions, writing my own orders and scripts...still makes me a bit nervous. what if i miss something? miss-diagnose or dose something? in this way i'm jealous of my friends who went directly into family/internal medicine. although i'm sure their palms sweat all day every day for the first few months, they're probably used to it by now and know their shtuff. not so much for me. i've had so little of it still, that i'm feeling pretty green. so i'm working through that. and trying to become mo' betta' in surgery, too.

having a lazy weekend now. kind of green in another way, too. not feeling so hot. there's a stomach bug going around at work- vomiting, diarrhea, etc. i'm just kind of naus and dizzy so far. hopefully it will stop with that.

but the BHE and i went out for a magic date last night anyway. we got crepes in a downtown crepe stand that were amazing and then went to our local art museum. we became members in august and this is the first time we've been...it was really cool being there on a friday night. i felt like a bruce wayne dame out in gotham city for a function. they had a little string quartet playing near a big sparkly wintry exhibit and it was enchanting. we also wandered through some exhibits we haven't seen before. it was pretty vacant in the rest of the museum away from the music, so it was really exciting to be there. i can't believe some of the 16th century items that made their way from europe here. incredible. we contemplated trying to steal one for my sister's upcoming birthday and thought better of it. she'd probably prefer money to a sarcophagus anyway.

what else is new? let's see...i had an awesome/funny experience the other day at a dermatologist's office. cold winter= dry, dry skin and it's not getting any better despite my best efforts. and i've been putting off going to a dermatologist for several years because all of my previous experiences have been that it takes 3 months to get in and then they see you for a very dissatisfying 5 minutes. so against my better judgement, i tried a new derm. and it was great! not only did he see me 2 days after i called for an appt (unheard of!) but he spoke to me for about 20 minutes (insane!) and wrote me for an adequate amount of steroid ointment instead of the little piddly 4 oz that lasts only 2 days . he was really helpful. but he was also sort of goofy. he advised me that i should not be a surgical PA since scrubbing in is harmful to my hand skin. and then when i kind of scoffed at that, he showed me how to fake wash my hands. :) very helpful.

End of the Afternoons

2009-01-23T21:55:00.004-05:00

well, i'm finishing up my week of afternoons. it's been really quiet...i have only had 1-2 cases per night. and the night staff is great, so it's been a lot of fun. a little too much down time where i'm sitting in the office snacking- so my weight is crawling back up. i'll just have to be really dilligent this weekend for my monday weigh-in.

it has messed up my sleep schedule a bit. i get home at midnight and then am up to 1:30am catching up on TV and other critical things, and then sleep in until 10am...leaving me only a few hrs to get stuff done at home before returning to work at 3pm. a dilligent person would go right to bed when getting home, wake up at 7am, go work out and have all morning/afternoon to be productive before going back to work. not so much with me.

and i haven't seen my husband in a week. nor this weekend, since he's off to frollick with his brother...so i'm going to visit friends and family back home. sigh. we'll see each other some day. hopefully we'll recognize each other.

in the thick of the winter blahs, but so far so good. keeping my mind on work and watching movies and planning a few vacations this spring. that seems to help.

hope everyone is staying warm...i wish i had more thrilling things to discuss. but i guess in the surgical world, you kind of want routine and boring and not excitement, so this means that things are going well. and since i always vent to you when i'm really mucking it up good, the fact that i have little to say must be a good sign, right?

if you're curious about the upcoming oscars- here are the nominations. again, i plan to see all the best picture nominees this year.