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.