Wonderful and terrible

The thing about residency is that sometimes it's wonderful, and sometimes it's awful, and sometimes it's both at the same time.  Like today.

Today I made a bunch of split second decisions that saved a man's life.  The orders poured out of my mouth, and the nurse was right there, and she was fantastic, and he's alive. He's going to hug his grandkids again and kiss his wife and maybe make it out of this hospital.

Today no matter what I did, no matter how many drugs and tricks and interventions I threw at one patient, he passed away.

I'm not sure what emotions I'm supposed to have after a day like this.  So I just go home, take a long, hot shower, and tell myself that tomorrow will be a wonderful day. After all, it's really not anything that I did or didn't do.  I believe that God was ready for one man to come home and still had plans on earth for the other.  I have to believe that.

Post call

So it's September second, and I'm sitting on my couch post call, and I cannot think straight.

I know I have a long road ahead of me.  Most days I can face that pretty well because I love what I do.  Every day that I get to go in and operate is a good day.  Today, post call, is less of a good day.

Post call has its own set of rules that I will go over some time.  Suffice to say for now, that it is not the healthiest of times.  The only place I want to be is laying in my hammock sleeping the afternoon away.  Instead I have to study for chief conference and prepare for my O.R. cases tomorrow.

I need a shower.  I need to buy groceries.  I need to remember where I put my pager because the damn thing is going off again even though I left the hospital an hour and a half ago, and it's haunting me like a parole ankle bracelet that lets everyone know where I am at all times.

And I cannot think straight.

Breakfast

I know that breakfast is the most important meal of the day.

I think sleep is more important.

This is why my daily breakfast consists of whatever I put my hands upon at four in the morning.

Eggo's take too long.

Ice cream is too difficult to eat while driving.

Which is why my breakfast the past month has consisted of Gatorade, fudgesicles, and cheese grits.  This is not a diet I would recommend.  It does let me sleep me an extra five minutes, and those five minutes are essential to my well being.  They totally make up for my elevated cholesterol.

*Photo from A Taste of Home.  I'm sure they have it copyrighted.  It is not mine.  

Pre-op

I was presenting a patient to an attending a couple of days ago, and he interrupted me mid chief complaint.

"Q, what is this guy pre-op for?"

"Dr. M, he's not a surgical patient yet.  We're trying conservative medical management."

He looked at me sternly.

"We're born pre-op.  We just don't know what we're pre-op for until later."

God, I love surgeons.

Sleeves?

Today I was evaluating a patient who was post-op from a mastectomy with axillary lymph node dissection.  One of the complications we look for in these patients is lymphedema - swelling of the hand and arm from lymph back up after surgery.  This particular patient was having some occasional trouble with lymphedema when she traveled.

When I presented the patient to my attending, she asked if the patient was wearing a sleeve.

I looked at her, puzzled.

"No.  She wasn't wearing sleeves.  She was wearing a really cute sleeveless Lilly Pulitzer dress."

She looked at me, then started giggling.

"A sleeve - a medical sleeve to prevent swelling."

At least I know clothes....

Fashion or function?

I just switched from the hardest service at my program to the happiest service.  It was like the gates of heaven opened for me when I walked into the hospital on Monday.  One of my co-interns took over the service from Hades. 

One of my previous attendings looked her up and down on her first day on service in clinic. He noted her adorable driving loafers.

Then he said," I see that you and Q are polar opposites in the footwear department."

What can I say guys? 

I will pick fashion over function almost every time.

*Shoes are Christian Louboutin and completely drool worthy.

Auntie Q

I'm going to be an aunt.

This means my little brother is going to be a father.

That is so weird.

Clean or full..

DH has been incredibly supportive during this first month of my residency.  He makes me dinner when I forget to eat, makes sure I have tea to drink in the mornings, and sets out car keys for me every night.  He forgives my ridiculous work hours, tucks me in bed at ridiculously early times, and makes sure all the bills get paid.  I have no idea how people survive residency without someone like him in their corner.

Still he is sometimes left speechless by my ridiculousness.

A couple of nights ago I had just made it home at the end of my third eighteen hour day.  I knew I had to be up again at four the next morning.  I was exhausted and starving because I hadn't eaten yet that day.  I also smelled like the hospital.  I was faced with choosing food or showering.

Which is how DH came to find me in the shower.

Eating angel food cake.

Which, judging by his reaction, is not something normal people do.

Tone paging

There are two kinds of paging at my hospital: tone paging and text paging.  Text paging gives you a few minutes to finish what you are doing before you attend to whatever emergency is trying to get your attention on your hip.  Tone paging gives you approximately 27 seconds to get to the closest phone and call back before the person on the other end of the line hangs up.  Tone paging is supposed to only be used for very important calls, and we can get called onto the carpet for not answering tone pages immediately.

The moment I had been dreading since I started residency happened yesterday while I was on call.

I had drank three huge glasses of sweet tea in a valiant attempt to stay awake without drinking Coke.

And I was tone paged.

While in the restroom.

To let me know that my patient had managed to pee.

Calvin Klein

He was well over 80 years old.   He was five foot two.  Tweed pants, suspenders, button down shirt and tie.  Gold tipped cane. Blue eyes.  And a huge hernia right below his belly button.

We had discussed the risks and benefits of the operation - nerve injury, bleeding, failure.  I had answered easily twenty questions about the procedure.  He looked  me straight in the eye.

"Doctor, I have just one more question.  My wife wants to know..."

"Yes?"

"Can I go back to underwear modeling after the operation?"

Working 9 to 5

I am tired.

So very tired.

I got off work a couple of days ago and thought to  myself, 'Self, today was amazing!  It was such a short day!  You are so lucky to be going home while the sun is still up!'

Then I realized I had been at the hospital for 15 hours.

I apparently now consider a 15 hour day a short day.

This is an unexpected turn of events.

Pup, we're not in Kansas anymore

I am most definitely in the South again.

One might ask how I am so sure.

The local news I was watching a couple weeks ago is one sure sign that I have left the North far behind. Mixed in between news of robberies, murder, and kidnappings at the local mall was an interview with a man who called 911 because he saw Bigfoot in his backyard.

"He was just over there, and I saw him, and I got a big stick, and I shook it at him, and I said 'Get.  Get.'  And he get, went back down the path again."

This would never have made the news up North.  First off, if someone in the North saw Bigfoot they would never admit it to their friends and relatives, let alone to police and news crews.  Secondly, they are a stoic breed up there.  I've seen a farmer come in missing half of his arm and his only complaint was that it smarted a bit.  Bigfoot wouldn't be a blip in that guy's day.

The follow-up story was about a pie eating contest.

I most definitely missed living down here.

Seriously?

Mr. Re-pete:  I came in because I'm having an allergic reaction.  I have hives all over, I'm itchy, and I can't breathe good.

Me:  Do you know what you're allergic to?

Mr. Re-pete:  Yeah, it's something in a Taco Bell Burrito Supreme. I know because I had the same reaction the last two times I ate one.  I came in here and they gave me a shot, then they gave me a pen to use the next time I had a reaction.

Me: An epi pen?  For the reaction? 

Mr. Re-pete:  Yeah, that's it. I used it already.

Me:  Okay.  When was the last time you had a burrito supreme before today?

Mr. Re-pete:  Yesterday, and the day before that.

Me: You ate a burrito supreme every day the past three days AND had a severe allergic reaction that required shots of epinephrine all three days?

Mr. Re-pete:  Yeah.  I want to make sure that's what it is, so I keep going back and ordering the same thing to double check.

Stephan Pastis, I heart you

 I love my life in general.  Some days though, I feel a little more like Rat.

Mr. Pastis, you make my mornings better.  Thank you.

* Pearls Before Swine is copyrighted by Stephan Pastis, 2010.  It remains my favorite comic strip ever.

Working 9 to 5

There are restrictions on work hours in residency that have been in place for about five years.  We are allowed to work eighty hours a week with no more than thirty hours in a row. There are other restrictions, but those are the biggies. Going over the legal hours can get your program in quite a bit of trouble; they can even have their accreditation revoked.

Old timers grumble they worked far longer hours than that when they went through residency.  They are absolutely right.  They did work longer hours.  

However, the patient population has stayed the same or increased since then.  The surgeries and treatments have become far more complex.  Back in the day, we only had aspirin to treat a heart attack.  Now we have an entire protocol of medications and interventions and guidelines that require we have a door to catheterization time of less than 90 minutes.  In essence, the amount of work a resident does now has easily doubled and probably tripled since the 1950s while the amount of time we have available to get that work done in has shrank.

This puts current residents in a tricky position.  We have to get the work done.  It is difficult to darn near impossible to get the work done in 80 hours sometimes.  There are times when we might be quite a bit closer to 100 hours than to 80.  We are told that we have to be honest on the hour logs.  Then in the next breath we are told that we have to make sure we are under 80 hours on the log.  We don't want to get our program in trouble.  We don't want to break the rules. We are stuck in a situation where there is no clear solution that ends well for us.

So what is a resident to do?

Lying about hours is unethical.  Residents know it is wrong.  It reflects poorly on our profession and our integrity.  We don't feel good about it.  We don't want to do it, but no aegis is being offered.  Something must change in the culture of medicine, particularly in the culture of surgery.  We are under an obligation to our patients to provide them the safest care within our capabilities.  Operating with slowed reflexes and blunted decision making is unconscionable.  Getting a program suspended by refusing to lie about  hours is unacceptable to superiors.  The blame will immediately fall on the shoulders of the resident who was honest about their hours - not on the superiors who are responsible for getting the resident out on time and the culture that caused the resident to be stuck in the hospital long past the deadlines.  The resident takes the fall.  

Take for instance this cautionary tale told to me.  The person in the story has asked me not to identify him/her.  He or she is currently trying to find a program willing to accept damaged goods.

This resident in a surgical program in the west got tired of lying about his or her hours. He or she decided to truthfully record every hour he/she was working.  He/she turned in the Medicare time card to his/her superiors at the end of the month.  He/she was immediately called in and accused of lying about the hours.  The superiors insisted that he/she could not possibly be working that many hours since the other residents were reporting right at 80 hours.  He/she told the superiors that the other residents were lying, just like he/she had been before. He/she also explained to the superiors that they could look at the charts and records to verify that he/she was in the hospital writing orders, admitting patients, operating, and writing notes during the times he/she had reported. The superiors got blustery.  They got upset and told him/her that he/she was a danger to the program not being on probation.

Then they fired him/her for falsifying records.

So I ask you all - what's a resident to do?

I'll show you all right....

I started residency this week.  I'm on the minimally invasive service for the next month which means I will be doing a lot of camera driving.

Camera driving for an attending is my personal version of Dante's fifth circle of hell. Wrath and sullenness abound.   This is how it goes:

"All I want is for you to hold the camera straight and look where I'm operating."

Sounds easy enough.  Look at the tiny scissors and grabbers on the flat screen.


"Camera, move in."

Moving in.


"Why did you move the camera?  Don't move."  He grabs my hand and puts the camera back in the exact same spot it was.

You just told me to move in, but that's fine, I'll stay here.


"I can't see.  You're too far out. Look left.  That's too far left.  Dang* it."

"Look at where I'm going to be operating.  No, not where I am now, where I want to go. Look left."

 "Make sure you stay in line with my instruments.  Don't look at my instruments. Don't stay in a direct line with the instruments.  Son of a gun*.  I said to look at my instruments."

At this point, I am completely confused.  I'm supposed to look at the instruments, but not directly at them, read his mind to know where to look next, and know exactly how close or far away he wants the camera to be without asking.  Easy task since they teach basic ESP in medical school now - it's a combination class with tarot card reading.


 "Gosh darn it*.  Keep the tools in the bottom third of the screen.  Bottom third.  I want the tools in the center of the screen.  Have you ever held an camera before?  Are you even looking at the screen? Camera, move in.  Not so far.  No, farther."

Gee, this is fun.  Please, pretty please, continue to yell.  I like that.  You have a nice voice when it's screaming at me.  And thanks for noticing that I have to stand on tiptoe on one foot to reach around you, hold the camera, and look at the screen since you are standing in front of me.  It's super easy to see the screen when your head is in front of it.  I spent four years in medical school just to give you the privilege of cursing at me for hours on end.  What I really want to do is take this camera and give you a nice view of your colon.....sir.


*Curse words have been toned down and reduced in number to ensure we remain family friendly.

Concealed weapons

During rounds this week:

Me:    Mr. A, is there anything else I can get for you today?

Mr. A:   A gun would be nice if you have one.

  

Making it to first base

On our trip South we decided to stop at my little brother's.  He's in flight school and stationed at a base on the way.  My grandparents had loaned us a GPS since the fiasco of a trip my brother had when he first headed to the base.  Apparently cell reception is a wee bit spotty in the Deep South and his iPhone lost Google Map capabilities.  It only added a couple hours to his trip, but wandering around in the backwoods of the Deep South can be a bit more intimidating than wandering around in the backwoods of the South.  My cousin, Lily, and I were not interested in random encounters with shotgun-toting, moonshine-chugging, gator-wrestling gentlemen so we were using the GPS.

Even with the GPS, we were a little leery of the surroundings.  The base was a ways out - far enough out that we were pretty sure that a serial killer had hacked into our system and was luring us to our premature death.

We evaded capture by our imaginary serial killer, made it to base, and pulled into the Korean Baptist Church outside the gates.

There are three things you need to make it onto a military base: identification, registration, and proof of current insurance. Normally I would have all three.  This time we had two of the three.  I had apparently tucked the registration somewhere in our file cabinet.  Which was safely in our packing truck.  Waiting for us at our new house.  Five hours away.

After he flat out denied us access to the base, the nice guard told us we could park our car in the guard lot overnight and ride in with my sister-in-law.  Our little car was packed with everything that was too important or too breakable to go in the moving truck so I was a little leery about leaving it out of eyesight. I thought I should double check the safety of our shoes and KitchenAid being left unsupervised.

"Mr. Guard, sir, will our car be safe here?  No one is going to steal our plants, are they?"

He peered at us over the beam of his flashlight.

"No ma'am.  We have Berettas.  Guns tend to deter thieves."

Shades of grey

I adore my brother. He’s a pilot in the military stationed a few states away and with a schedule as busy as mine, so I don’t get to see him very often.  I was able to spend about an hour with him last week before he had to go to flight class and I had to head east. I laughed more in that hour than I had in weeks. We don’t always agree, but I adore the man.  

Me: Do you know what I like about you?  

Little Brother:  That I’m so good looking?  

Me: Obviously, but I like how you see things in black and white.  You never see any grey areas.  

Little Brother:  Grey is for liberals. 

On the farm

I had an unexpected layover in the Midwest secondary to my encounter with the deer.  I am one of those very lucky people who have a set of in-laws they actually enjoy, so I didn’t mind.  A little farm work is excellent at taking one’s mind off unpleasant things like car accidents.

This weekend the guys were putting up a grain bin.  Before I met DH, I had no idea what a grain bin was.  I called every tall shiny round building on a farm a silo and left it at that.  They are not all silos.  Some are grain bins.  

This is a finished grain bin.  

This is a silo.  

If they look the same to you, don’t worry.  I still haven’t figured out the difference.  I just memorized which building is where on the farm so I didn’t make a total fool of myself when talking to the guys. 

The grain bin we were putting up that weekend was ten rings high.  It is supposed to hold 35,000 bushels or something, which is approximately a gazillion soybeans and a bazillion corn kernels.  Each ring is put on one at a time. Huge hydraulic jacks raise the installed rings and roof so the next ring can be attached.  

This is the central thing for the jacks.  

You should not mess with the hoses.  People get upset when you mess with the hoses.

If you are ever building a grain bin, I have some advice for you.  First, do not put one of the jacks where you plan on putting your door/platform/ladder.  If you do, then you will be installing the platform and ladder not on the ground level where it is nice and safe and not high, but in the air from a shaky ladder and loader bucket where it is windy and not terribly safe and very high. Then when you look down it will look like this.  This is scary.

Second, wear earplugs.  Four impact wrenches going at once will give you a heck of a headache. 

Third, do not take the jacks out, anchor the bin down, and then realize you left a stepladder inside the grain bin that doesn’t fit out the door.  Apparently, that will frustrate farmers.

Finally, hire my brother-in-law to run things. He’s a born leader, and he’s part Spiderman.

Buh-bye Mr. Jeep

I have had three car wrecks in my life.  Last week, I had my fourth.  

DH and I were headed to his family farm for Memorial Day.  The plan was for him to golf with his uncles in a scramble and for me to have a brief stopover on my way south.  We were late heading out because our house closing was delayed by a couple of hours, and thus we were passing through Iowa around midnight.  It was a full moon, and the deer were really excited about it.  One of them was so excited that it ran right in front of my Jeep which-was-going-seventy-miles-an-hour-and-no-faster-as-I-am-a-law-abiding-citizen.  

This did not go well for the deer.  

This did also not go well for the Jeep.  

Poor Jeep.  He lived a good life.  He saw a lot of riverbanks, a lot of lakeshores, and a lot of forests. He took me safely through a blizzard that closed all the major highways.  He carefully conveyed DH, our friends, and I  through a nasty storm up by Canada that turned the road to ice.  He survived the treacherous trip back North when we saw 106 cars in the ditch.  He was adventurous, that Jeep of ours, but he was no match for a corn-fed venison steak jaywalking across the interstate.  Now he’s in the big garage in the sky where wheels never rust and his oil will get changed every 3,000 miles.  I’ll miss the little guy.

One of those mornings...

We finished packing the moving truck on Tuesday with the help of some strong and handsome friends.  I'm lucky to be surrounded by such nice and good-looking people, particularly ones with excellent spatial reasoning skills.  You guys know who you are.

Wednesday morning I packed up the Jeep with the essentials that I would be taking South.  A suitcase of clothes, my KitchenAid mixer of which I am overly protective, my jasmines and lavenders, Pup and her accoutrement, and my backpack stuffed with the laptops, my stats book, surgery reference books, and cell phone charger.  I was prepared.

Except  DH had forgotten to pack a few things.

Thus I added two coolers, a Rubbermaid container, a pair of antlers, a set of downhill skis, a broom, and a tree stand to the interior.  I strapped the kayak to the roof.   I tossed the cable box we had to return, the non-functioning laptop we had to recycle, and the library books we had to donate into the passenger seat. I was prepared.

Except Pup and I had nowhere to sit.

So I rearranged the plants, tucked her bed on top of the pile of electronics in the passenger seat, and put my lavender in my lap. She could barely fit, but we were just going 30 minutes away. I knew I would be able to move things into the Jetta for the trip to DH's parents.   We would be fine.

Except we got stuck in construction on the interstate.

I was hot, I was sore, and I was wearing the same grimy clothes I had been the day before because of a packing error on my part.  I had just scrubbed the entire apartment. I hadn't eaten yet. I was gross and cranky, y'all.  I just wanted to get to our friends' house, shower, and change.

One of the boxes kept shifting when we went around corners causing it to bang into the window switches.  This meant that at various times the windows would roll down, and I couldn't get my hand under the box to roll them back up immediately.  Annoying, but not that big of a deal.  I had one last glass of sweet tea that I had squished into the cup holder.    It was the only thing holding me together - the thought of how wonderful that cold sweet liquid was going to be when we got to K. and J.'s house.

Except someone had fed Pup pizza and ribs the night before.

She chose the moment when we were stuck in construction and the back window was rolling down on its own to stand up on her little bed, look at me, and throw up.

Everywhere.  In the cable box.  On my plants.  On her bed.  On the gear shift.  And in my last glass of tea.

Another paper for the wall

Today I finished my last assignment in my last class.

Someone get me a hammer and nail.  It's time to add another piece of paper to our wall.

I never was a poet...

I was going through and recycling papers today in an effort to minimize the piles of stuff that we will be moving with us to the South, and I came across a poem written, I think, by my old college roommate.  It immediately took me back to the campus lawn at dusk, sitting cross-legged in the grass listening to her practice her beat poetry.  I had no idea what beat poetry was, but the coffee house crowd was dark and mysterious and seemed oh-so-cool.  I never figured out how to snap in rhythm, and I never figured out exactly what the poems were talking about. Surrounded by that hipster crowd, sipping my hot chocolate and pretending it was coffee, I felt all artsy for a couple of hours.  Then I would go back to my straightforward pre-med courses.  I appreciated her for that.  I can't say I agree with everything she wrote, but this is the poem I found, edited slightly for space:

I seek and search.

Down red brick avenues,

dusty winding roads.

Like Ponce De Leon

in pursuit of that nirvanic utopian place.

See, I want to live in a perfect world. 

Is it too much to ask? 

A perfect world where the three stooges would be Chris Farley, John Candy,

and of course Curly. 

Because Larry was destined for punk rock

Not Moe

Because he was a mean little bastard anyway.

Where we all speak in French.

No fat grams or health clubs.

Where Keanu Reeves can act.

Like the Scarecrow in the Wizard of Oz,

George Bush would get a brain.

Mike Tyson would get --- help.

In the perfect world you wouldn’t have to be bright or cool or on.

You could just be.

No stereotypes

Of being skinny or fat or pretty or ugly or old.

No Self magazine,

Vogue, or GQ.

Where all the angels

Are Downs Syndrome children

Because aren’t they the sweetest angels already?

The seraphim is Joni Mitchell

Singing songs from the Blue album.

On a cloud veranda, there’s Bob Dylan

Singing anything he wants.  He’s Bob Dylan.

And every song in a perfect world

Would be sung with the pain and the passion

Of how Ben Harper sings “Oppression”

Or how Richie Havens sang “Freedom” at Woodstock.

Where God would look like Frank Zappa

With legs like Giselle

And would play two guitars

One like Hendrix

And the other like BB King

And He’d belt out truth like Martin Luther King

In sweet lyrics like Carol King

Have hair like Don King

Because He is the King of Kings

His throne would be a metal chair

In a tree shaded yard

Surrounded by a perpetual drum circle

And He’d have time to talk and listen

We’d all have time to listen and talk.

Yeah, no hate or war or hunger –

Those are givens,

But what about loneliness

Or failure – NADA!

It would be what all dreamers dream

What the beat poets wrote about

What the songwriters of the 60’s sang

Where even Satan

Would find his mantra

Or get saved

Or at least commit to rehab

But this isn’t a perfect world

And when I think I’ve found it,

It pixilates and fragments into its fallen sometimes horrific reality

And I’m just a little weary.

But we have this,

You and I.

Maybe, if we can be real

And honest

Have a little understanding and love

We can capture a perfect moment.

And for now,

Perhaps that will have to be enough.

Mulch Bandit

Why is it that you run into people you haven't seen in ten years on the one day you forget to dress like a non-slob or put on makeup because you're gardening and just dashing into Lowe's to pick up two bags of mulch for your grandparent's roses?

So, hypothetically,  you're wearing yoga pants and a rugby shirt with your hair in a ponytail so high it would be more appropriate on a two year old (but who cares because it's keeping it out of your face).  You probably have dirt smeared across your forehead and cheeks.  It's a good likelihood that you have on flip flops that have seen better days - and those better days were two years ago.

There you are, a huge bag of cedar mulch propped on each shoulder, sweaty and dirty, waiting on the cashier who is possibly the slowest person to count money in the history of the world.  There he and she are.  A former football player and a former cheerleader.  Granted, they have both put on their fair share of weight. But they are clean, they are wearing clothes that Goodwill would not give back, and they have spotted you.

Of course, they spotted you.  You couldn't heft those bags of mulch any higher to cover your head.  They head your way, but since you haven't yet made eye contact you are using all of your Jedi mind powers to try to force the cashier to count the money faster.  Why didn't you just use your credit card?  Finally, she's done.  You clutch the three dollar bills in your hand and bolt for the doors.

They call your name with a hint of question in their voices.  They think it might be you, but they haven't seen you in ages, and they think you are supposed to be living in another state.

Don't pause.  If you give even the slightest indication that you are indeed who they think you are, you're stuck. Run, my friends!

Just make sure not to accidently set off the security alarm on your way out, or that really slow cashier will prove that she is just storing up energy waiting to catch would-be mulch thieves.   Which means the people you were avoiding will catch up with you too, and you will have to stand there, sweaty, dirty, and holding a leaking bag of mulch while they prattle on about their kids.

So you plot while they babble on.... 'next time, I'll wear sunglasses.  No one recognizes me in sunglasses.....' 

Mr. Banker Man

I appreciate the fact that lending practices have become much more strict since the huge housing/crazy mortgage crisis we went through the last couple of years.  I agree that people should be held to higher standards and should only buy houses that they can afford. That being said...

I am still frustrated as bear with his nose stuck in a beehive that it is apparently darn near impossible to get a traditional mortgage after graduating from medical school.  Now, I know very well that I have a huge amount of student loan debt.  It's part and parcel of going to medical school and then getting a master's degree after that.  Oddly enough, those things cost money.  Money that I will be paying back.  Over the next thirty years.  So Mr. Banker Man, yes, I do already have a monthly payment on my brain that is just slightly lower than my proposed mortgage payment.

Also, Mr. Banker Man, we decided to be very conservative in the size of house that we would buy.  So yes, we carefully budgeted and applied for the loan only on my tiny little resident salary. We figured if we could get by on my salary for monthly expenses, Mr. Banker Man, that we could use DH's salary to do other things.  Like pay off those rascally student loans. Or plan for retirement. Or get haircuts.

I understand that these may be foreign concepts to you Mr. Banker Man. I understand that no matter how many times I offer, you won't let me use my brain as collateral.   I understand that you see things in black and white now, not all those delightful shades of grey that allowed you to hand out sub-prime mortgages for the past few years like the money would revolt and perform a military coup if it stayed in your bank too long.  I know that if I had walked into your bank two years ago, you would have been throwing dollar bills at me and I wouldn't even have to take off my clothes.  It's not that era anymore.

It's a shame.

I think we could have been friends.

Reunions

I've taken pretty good care of myself since high school.  I eat right, except for those occasional lapses in judgement I have when faced with homemade ice cream or really dark chocolate.  I'm active; heck, I even gave in and joined DH's kickball league this spring.  I don't smoke, I avoid abusing my liver, and I am one of those people who never tried any drugs because I was pretty sure I would become instantly addicted and be forced to live in a gutter somewhere selling my blood to get money.

So when my ten year high school reunion rolled around, I was pretty pumped.  I have a bunch of fancy papers hanging on my wall, I feel like I look good, I'm thrilled with my life, and I have a charming husband.  This is a far cry from the oh-so-painfully nerdy chickadee I was in high school. I was going.

Of course, I was also looking forward to seeing everyone.  

The picnic they planned for lunchtime was rained out.  DH and I drove to the park in the downpour just to make sure that there weren't drenched children playing on the swing set with dry parents tucked under the pavilion.  There were not.

Reunion part two was a dinner at my least favorite restaurant in the whole town.  However, as I wasn't planning the reunion, I felt I had very little room to complain.  Around sixty people graduated from my class.  Not a huge class, but most of them live within a twenty minute drive of our hometown.  The majority of them live within a three hour drive of our hometown.  I live twelve hours away.   One would think that those who could walk to the restaurant without breaking a sweat might show up.

Counting myself, six people from our class showed up (plus spouses). Two of them are married to each other, so I think they should count as one person.

Six.

Now don't get me wrong - I was very happy to see those people again (plus spouses).  However, one of them hadn't even known there was a reunion happening until I called him two days before.  Which means the one organizing the reunion had a turn out of five counting herself and her husband (a fellow classmate).  So that brings her total down to three. I think I saw that many classmates when I was wandering through the Wal-Mart the day before.  It is a tiny, itsy bitsy possibility that this was poorly planned. 

None of that fazed me overly much, because of the most important part: I cleaned up pretty well. 

Wait up!

I had a lunch date with a dear friend of mine a week or so ago.  We had agreed to meet at Punch's Pizza, a Neapolitan pizza place that always convinces me I need to eat an entire pizza by myself and not share with anyone.  I have fork tines sharpened and poised to attack anyone who gets any ideas about sampling my Margherita without advanced notice.  All that gooey buffalo mozzarella and that heavenly basil and those juicy fresh tomatoes.....yum.  But I digress. 


I arrived shockingly early by an entire five minutes.  I was very proud of this.  The line was pretty long and getting longer, so I decided to go ahead and get in line while waiting for Linda.  Every few minutes I would let a couple of people go ahead of me so we wouldn't be throttled when she came in and slipped ahead of the growing crowd.  After about twenty minutes the door swung open to let in a new gaggle of co-eds, and through the downpour I saw Linda searching the crowd.  I waved and called her name.  Still she scanned the crowd. I waved again and hopped up and down a little bit.  She turned and headed up the sidewalk.  The heavy wooden door slammed behind her.  


Shoot.  I excused myself from the line and headed after her.  That woman walks fast.  She was about half a block ahead of me, and I was trotting after her in heels sans umbrella in the rain. 


"Linda!"  She must have thought I came and left when she was late.  Gosh the traffic is loud here.  Are there noise ordinances on these buses?  My eardrums hurt.  


"Linda!"   I'm gaining on her.  Just a few more steps.  Oh, come on!  Seriously Mr. Traffic Light?  You just had to change right before I got there?


"Linda!"  


I dashed across the intersection as soon as the little man turned white.  I grabbed her shoulder and stuck my head under her umbrella.  

"Linda!  Thank goodness!  I've been chasing you for three blocks!"




Her name was Stacey.  

Bubble wrap

I know that I may come across as more of a Rat than a Pig at times, but I like people in general.  It's people in specific that get to me sometimes.  Our first mortgage guy is an excellent example.

We'll call him Timmy.  It suits him.  We were referred to Timmy by a friend.  I have now vowed never to take mortgage advice from friends or family.

Timmy was aware that we were going to The South for two days to choose and make an offer on a house.  Because of the short time frame we had to choose the house, we needed to get pre-approval before we left.  He assured us this wouldn't be a problem since we had three weeks until we flew out.

He didn't call us for a week.

After we repeatedly called, he made an appointment for us to meet two weeks before we had to leave. He apologized briefly and explained he had been in training all week, but assured us we had plenty of time to get pre-approved.  He then explained that even though DH will be employed past the time I will start my job, he wanted to only use my salary for the pre-approval.  This seemed odd to me, but I'm not a mortgage broker. 

I handed over my five year contract and salary to Timmy the Wonder Broker. 

He read it.

Timmy reads really slow.

"So, you're sure you're going to be working there for five years."

Well, it is a contract that has dates equaling five years written on the front page, so yeah, Timmy, I'm pretty sure.  

"Yes, that is correct."

"This salary says that it's correct starting July 25, 2009.  What will you be getting paid?"

Since it's correct starting in 2009, and we are now in 2010, odds are that I'll be getting paid that amount Timmy. 

"That's the listed salary for my position."

"But what will you do for income after five years?"

Maybe he doesn't understand medicine.  I'll give him the benefit of the doubt. 

"I'll probably do a fellowship for three years.  I get paid for that too."

"But then what will you do for income?"

Nope, he's just a doofus.  

 "Then I'll be a surgeon.  I get paid for that too."

"But are you guaranteed a job then?"

You have to be joking. I have a five year contract, and he's worried about what I will be doing for work eight years from now.  Does everyone applying for a mortgage have to prove they will have work for the next ten years?  My job is more secure than his job right now.  I'm willing to bet you don't have a five year contract Timmy-boy.

"I'm not guaranteed a job, but the odds are very good that I will be working somewhere.

"You guys are great on everything else, but this is highly unusual.  I'll have to talk to my manager about this.  It shouldn't be a problem."

That's the last we heard from Tim-Tim-Cheree.  We called.  We emailed.  No response.

We found a house I loved.  The only problem was another couple loved it too. We had our bid in first, but we needed one more thing.

A pre-approval letter.

We called Timmy-poo.  He said he was working on it, but that it was unusual and no one he worked with had ever seen a salary like mine. I found this hard to believe as thousands of people graduate medical school every year,  a large portion of them get mortgages during their residency, and he worked for a large bank.  Niche market, maybe. Unusual, no.

So I gave his number to our real estate agent.  She is a Southern woman through and through.  Sweet as sugar with a backbone of steel.  She talked to him for about five minutes.  He told her he was trying but that it was a very unusual case, and that he would have the letter to her in 30 minutes.  Three hours later, we had the approval letter and Timmy had really ticked me off.

We were easy money. He hadn't been forced to expend any effort to find us.  We came to him.  We gave him all the documentation before he even met with us.  We had a 20% down payment.  We were both employed. We had rock star credit scores.  All he had to do to get his commission was put the paperwork into the system.    He just blew us off.  I guess I'm just used to people thinking doctors make too much money instead of worrying that they won't make any money.

When we made it back to The North we switched to another broker at the same bank. Let's call him Tommy.  He entered a new request and had everything ready to go in two days. Tommy also used part of DH's income because 'we assume you will be working somewhere when you move since you have had stable employment for the past five years.' Tommy is awesome.

Timmy....well Timmy makes me feel a bit more like Rat.

*Pearls Before Swine is copyrighted by Stephan Pastis and is my absolute favorite comic strip.

Bless his heart

DH and I were taking pup for training this weekend, and the conversation turned to aprons as it rarely does.

I had found some adorable aprons on sale, but resisted buying one.  DH has a thing for women in aprons. I think it's the whole "Susy Homemaker" thing.  Barefoot, not pregnant, and cooking.  That's me lately. Anyway, DH was all excited because he thought  I meant manly aprons - the kind with bottle openers and barbed wire built in.  I did not.  I meant frilly feminine aprons that made me feel all 50's housewife.

DH sighed.  "At least I still have the apron from my mom."

Oh dear lord.  Have I told you guys about this apron?

From the front, normal apron.  Nice pattern, big pockets.  Then you look at it a little closer.  Something seems.... amiss.  Something seems.... different.  Something seems... bulging.  So you look a little closer.  The apron flaps up in the brisk breeze from the kitchen fan.

And you see them.  Twigs and berries.  Mr. Goodwrench and the Michelin Brothers.  The family jewels.  This apron has a fake set of male genitalia made from pantyhose and pillow stuffing attached.

My husband and brother-in-law love this apron.  Which brings us to the next point:

"Matthew and I are going to be be fighting over that apron. It's the best apron in the world."

I peered at this adorable man I married over the top of my sunglasses.  "Matthew can have it.  If it makes it into our house, Mr. Apron will be singing soprano post surgical removal of his business."

DH glared at me.  "You wouldn't dare.  Q, that apron is a work of art.  Would you go hacking away at a Monet with a scalpel?  No.  It takes real genius to create something like that."

Wait.

Hold the phone.

Did my husband just equate Monet to a pantyhose penis apron?

I made the right decision on procreation.

Matched

"Congratulations, you have matched."

I had been waiting to read that sentence since my rank list was certified in February. I hadn't slept well for weeks. I had been nursing a darling little stomach ulcer. I had been superstitiously afraid to jinx the process in any way, and so had forbidden anyone to say "when you match" in my presence. I had resigned myself to moving to Antarctica and working with a group recovering lost whiskey for the next year.

But one Monday, I got The Email.

Congratulations, you have matched. 

I wish I could appropriately convey the relief and elation that slammed into me at reading that one sentence.

I can't.

I spent the rest of the week wandering in a complete daze wondering where I would be moving in May. I forgot to eat. I forgot to return my library books. I remembered to brush my teeth. Thursday morning DH and I sat in our living room trying to ignore the fact our future would be set (for the next five years) in just a few hours. DH was doing a great job; I was failing miserably.

About 9 a.m. I checked my email for the eighty-sixth time that morning, and noticed a new message :

Congratulations! We are so excited that you matched with us here at World Famous Medical Center. (WFMC from here out.) We look forward to working with you in June. Let us know if we can be of any assistance in your upcoming move to The South.

I read it five times.

"We're moving to The South......oh my goodness, we're moving to The South!!"

Medicine can taste a little bitter...

If you aren't a medical student, a physician,  a friend or relative of a doctor, or sleeping with someone who is, the whole becoming a doctor process can a little bewildering.   The conversation I have with an uninitiated usually goes a little something like this:

“So you’re in medical school.  What are you going to be, a nurse?”

“No.  I’m going to medical school.  To be a doctor.  Of medicine.”

“Oh, that’s great.  How long does that take?”

“Eight years, usually.  Four years of undergraduate, and then four years of medical school.”

“Then you start practicing?  Eight years isn’t too bad.”

"No, but almost.  After medical school we go to residency – it’s like an apprenticeship.”

“Oh.  How long is that?”

“Three years for some specialties, up to six years for others.”

“Oh.  Then you start practicing?”

“Some people do.  Some others go onto special training called fellowships.  That’s how you become a heart doctor, a lung doctor, a heart surgeon…”

"So you get to pick where you do this residency then?  Where are you going?"

"You don't get to pick a place.  You pick the specialty you want to go into.  Then you spend a whole lot of money applying to programs across the United States.  Then you wait for some of them to give you interviews."

"That's great!  They fly you all over the U.S. to interview ~ how fun!"

"Well, not exactly.  You have to pay to fly there.  And for your hotel.  And for your rental car or taxi. A lot of people have to take out more student loans to pay for it."

"Huh.  Do you get to pick where to go then?"

"No, then you make a list of all the programs you interviewed at in order of how much you liked them.  And all the programs make a list of the people they interviewed in order of how much they liked them.  Then the lists go into a magic computer, and they match you with a program."

"So you find out right away?"

"Not exactly.  The lists go into the computer in February, and we find out in March."

"But everyone goes somewhere, right?"

"No, some people don't get matched and don't go anywhere."

"So let me get this straight.  You go to eight years of school.  You pay a lot of money to apply to residency.  You have to take out loans to go to places to interview.  You make a list and then wait a month to find out IF you have a job, and you don't get to pick where you will be moving for the next three to six years. Sheesh.  At least you'll be making a lot of money during residency."

"Around 40,000 a year for 80 hour weeks and three weeks of vacation.  It averages out to a little more than $10 an hour before taxes.  Plus we have to start paying back our school loans."

"Remind me not to let my kids be doctors."

Japan and Thailand

After C. picked us up and another obligatory round of hugging and laughing was taken care of, we went to the Japanese garden.  It closed at 5.  We arrived around 4:50.  So we peeked over the wall instead.

It was pretty.








Very Japan-esque.


We went to  Pok Pok for dinner.  Dear Lord above, was that good Thai food!  Imagine the best pad thai you've ever had. Take everything you know about Thai food in the U.S. Now forget all of it.

We had sil krohng muu yang - ribs marinated in whiskey, ginger, and Thai spices. Kai yaang - a roasted game hen with dipping sauces.  (I liked the vinegary one.)  The curry (kaeng om neua) was light and spicy, not heavy and milky. It was so good that we started dipping the other meats in the curry so we didn't wasted any. The papaya pok pok was cool yet very spicy.  We actually ordered to cool our mouths from the other dishes.  Poor planning on our part.  It was definitely the hottest dish we had.


Full bellies, delighted to be back together, we fell asleep scattered across C's apartment - a lovely start to a lovely week.

Staying Behind

Moving away is difficult.  Remaining behind seems like it may be even worse at times.

Because of a little snafu with a branch of the military last year, I ended up staying in The North for an extra year getting my master's degree instead of starting residency.  Most days I have a pretty cheerful outlook on it.  It may have taken me a month or so to get the outlook, but it's there now.  There have been many challenging things about this situation.  A medium sized one is the huge chunk of my friends who moved up, up, and away to start their residencies.  

Two of my best friends, J. and C., are in Chicago and Portland, respectively.  J and I promised to make a valiant attempt to get away together once a year.  She is infinitely more valiant than I, and so gave up a week of her vacation to meet me in Portland.  I gave up a week of studying and classes.  It was quite a sacrifice, but it had to be done.

I think when you haven't seen someone in awhile, they freeze in your mind. You maintain a snapshot of the way they were the last time you saw them.  That's why high school friends stay 18 and your great-aunt squeezes your cheek and tells you how much you've grown.  It's also why I really dislike funerals, but I digress.

The last time I saw J was at her wedding last fall.  My mental J was glowing and happy and beautiful.  The J I saw in the airport was tired and happy and beautiful.  Plus her hair was about six inches longer.  We squealed and hugged and laughed as women are wont to do when they reunite.

It took me two days to place what it was that was different about her.

She's a doctor now.

She has developed that lovely confidence in her abilities and decisions that make patients believe that you know best.  She's brilliant, of course, and that hasn't changed, and patients have always liked her.  (It's rather difficult to dislike the girl.)  But this...this is new.  I love it and am horrifyingly proud of her.  I am at the same time sad that I am missing out on a year of growing and developing as a physician.  It's a strange place to be.

Billy beer

My brother in law came up to visit DH and I a couple of weekends ago.  I really like that guy.  He's such a solid man.  Hard working, loyal, funny, resistant to change.  Everything my potential sister-in-law will love if he ever gets around to finding her.

M. and I had wasted a good hour of our lives one day watching VH1's "Best of I love the 70's".  It was our first introduction to Jimmy Carter's brother Billy and thus to "Billy Beer".  The slogan was (I may be wrong here), "I think it's the best I've ever tasted.  And I've tasted a lot."

The three of us were on our way to a micro brew party later that day and started talking about favorite beers we've had.  I'm not really a beer fan since I think most of it tastes like water that didn't make it through a properly functioning Brita system, but in Czech M. and I discovered something in common.  We loved Velkopopovický Kozel Cerny.  (It helped immensely that it was half the price of properly filtered water.)  DH prefers lighter beers and thus does not share our infatuation with this heavenly creation. (DH just informed me that he does NOT prefer light beers.  He prefers lagers.  I don't drink enough beer to know why this distinction is important, but the record has been set straight.) 

Talk naturally turned to our trip to Czech and the absurd amounts of alcohol that the locals consumed.

Which brings us back to M. who proclaimed, "People in America think they can drink.  They are wrong. Even if you took Billy Carter over to Prague - he'd never be able to hang.  And that guy looked like he was a serious alcoholic."

Unknown future sister-in-law, I'm glad you appreciate this guy as much as we do.


*Kozel picture is the property of Kozel's brewing company.  I did not take that picture.  I do love that beer though.  Sadly, it is unavailable in the U.S. as far as I know. 

Get off the plane

I thought there was an established etiquette about how to disembark from an airplane. These are the rules I thought were understood:  

Rule 1: We unload from the front of the plane to the back. Each row empties before the next row starts.  

This is slightly unfair as the people in the very front also got to board first. However, as they paid an additional couple hundred dollars to sit in plane seats with slightly more leg room and get free cheap alcohol, I can overlook this class seperation. This rule can be bent for the following subsets:

a) People who are in actual danger of missing their connecting flight. Few things are worse than dashing to your gate to watch your plane taxi away in front of you. These people can get off first. Pretending to have a close connection just to get off sooner is evil. I have faith these people will be punished at some point by actually having a close connection and missing it.  

b) People with screaming children. For goodness sake, let them off the blipping plane. They aren't making it more pleasant for anyone by staying on the plane, and if you had a bladder that small you would scream to go potty too.  

c) Medical emergencies and women who have decided to go into labor on the plane. They win. Always. It cannot be bent because you are in the back of the plane, impatient, and want to scurry off the plane in a sad attempt to 'win' by starting your three hour layover ahead of everyone else. 

Rule 2: Help old people, small people, and people carrying small people with getting luggage down.  

Don't look blankly at the four foot eleven eighty year old woman who is struggling to open the overhead compartment. Help her. Or else you deserve to have items that may have shifted during takeoff and landing fall on your head. Karma, my friend. Enjoy the reverse Samsonite logo tattoo on your forehead.  

Rule 3: If you have luggage stored more than two or three (although three is pushing it) overhead bins behind your seat, you have to wait to get it. You cannot elbow your way back through the crowds. This is only acceptable if you may miss your connection. See Rule 1. I understand it may not be your fault it is so far back. Maybe some other doofuses filled up the bins around you with their winter coats so you had to use one farther away. I understand, but I don't care. Wait.  

Rule 4: When it is your turn, get off the plane.  

This one sounds easy. It is apparently not. Please look for your keys/makeup/cellphone/flask, fix your hair/makeup/nails, and text/email your spouse/lover/friend/archnemesis after your feet have hit the actual airport carpet. Not in the plane aisle and, for heavens sake, not in the jetway as soon as you get off the plane. This makes me (and most everyone behind you) think thoughts that involve bodily harm to your person. I have to then repent of those thoughts. Which makes me angrier at you.  

Those are the main ones. Four rules. Teach your children, your friends, your sister. I'm pleading with you.

Curses

My last interview of the season was this week. I am suspicious that this interview was cursed.  

Courtesy of another two inches of snow and a flight that left ages before snowplows ventured out again, I had to drive on rather slick roads. Courtesy of the woman in the red Suburu who felt the need to drive recklessly in both of our lanes at 4:30 this morning, I missed my exit. Courtesy of my abysmal sense of direction, I got hopelessly lost immediately after this. All of this added up to having to park in the airport at the exhorbiant rate of twenty American dollars a day. I like to say it like that... American dollars. As opposed to un-American dollars. They only accept patriotic cash at my airport.  

(On a side note, I just found a bay leaf in my pocket. No idea why it's there.)  

Back to my disasterous trip. I made it to the airport a little too close to the check in deadline and had a lovely discussion with the counter man about the advisability of printing my boarding pass in spite of that. I dashed to my favorite security checkpoint and slipped past the brimming Casual Traveler aisle down the empty Expert Traveler aisle. A middle age couple in Hawaiian shirts proceeded to berate me for cutting in line. I tried to explain to them that it wasn't cutting - there were two lines. Like at the grocery store - just because my line is moving faster doesn't mean I cut. It means you picked the wrong line. And that you probably have a huge carry-on, a laptop in a separate bag still zipped up, shoes that don't slip off, none of your liquids out in a bag yet, a winter coat and a fleece still on, a huge purse, and a backpack that you are planning on stuffing your purse into to qualify for the "one carry-on, one personal item" rule. You earned the slow line. I said it in a much nicer way though.


Boarded the plane on time (hooray!), and then sat on the tarmac for 45 minutes waiting on deicer. Deicer is an important part of the flying experience when one lives in The North. Except someone must have forgotten to place a refill order. They ran out of deicer. I would understand this if I were flying out of Hawaii; I imagine they have little to no need for deicer. Running out during a freak snow storm is acceptable.


However, I live in The North. We haven't seen grass in my neighborhood since November. There is a solid two feet of snow on my yard. My side road has been covered in snow and ice since December. I don't know if the pavement underneath even exists anymore. When we live in a place like this, there is no excuse for running out of deicer. We should have deicer stockpiled somewhere.


The only explanation: Cursed.