On the surgeon's music playlist in the OR today:

he's getting a box of tampons for father's day

Joe got me a box of Red Vines for Mother's Day. He then ate the whole package while I was on call last night.

I suspect this is only marginally better than getting me a bowling ball monogrammed "Homer."

Also: For those not yet inculcated, I am updating on Twitter even on days that I am not updating here. You can follow along if you're interested in reading extremely short messages several times a day about nothing in particular. (I know, I'm making it sound so AWESOME, aren't I? Clearly, I was born to do sales.)

because there may come a time when I might need that physics 101 textbook

I can think of several reasons why being a packrat could actually be adaptive--if you ever needed a shrink-wrapped Matisse calendar from 2004, for example, or an old Halloween costume last worn during your sophomore year in college. (The occasion could arise. Time travel, for instance.) However, there are two instances in which packrat-ism is disadvantageous. One is when you die, and they have to dig through the mounds of newspapers and clothes and old volumes of Encyclopedia Brittanicas from 1982 to find you. Two, when you actually have to move out of your house. The plus side is I'm sure that we'll find many things that we presumed were lost along the years. The downside is that we probably never missed most of these things in the first place.

Joe is the best at diuresing our posessions, and mercifully for everyone, he picked a time when I was actually sleeping to do something that was long overdue, which was to finally chuck all my notes from the second year of medical school. There was really no rational reason to keep them aside from sentimentality--given that they weren't indexed, anything that I really need to look up about nephrology or endocrinology or infectious disease I would first turn to one of my textbooks or Dr. Google anyway. But I just never had the heart to throw them out, if only for the reason that it was the only tangible proof I had left that I ever studied that hard. That, and the corpses of at least five different colors of highlighters that I'm sure I will get around to throwing out before the move as well. Memories, like the corners of my mind.




Anyway, we had a nice Mother's Day here. We met up with my family and went to the park, where we blew giant bubbles and flew some rocket balloons. In other words, it was more of a Children's Day than a Mother's Day, but that's what it's about anyway, isn't it?

the graduate




So the graduation ceremony was nice, though as with all graduations, somewhat overlong. I didn't get to stay for the whole thing, since part of my task that afternoon was running home to get Cal so that we could make it back up to the graduation dinner. ("Why didn't you just bring him along to the graduation ceremony?" one might ask. Well, because I am an anesthesiologist by training, and my goal is to MINIMIZE pain. The idea of forcing a not-quite three year-old to sit through a three hour ceremony in which the defining characteristic, even for adults, is EXTREME BOREDOM...that would not have been a good idea.) There were some nice moments--I particularly liked the speaker they invited, who though he was the New York Health Commissioner (doctor, check; important, check) was only their second choice, invited hastily after they rescinded the invitation to their first choice speaker earlier this Spring. Who was the first choice? Eliot Spitzer. Nice.

My dad (who is a doctor too, as is my mom...I know most of you know that, but for those who don't it's sort of salient to the observation that follows), watching the processional of the soon-to-be-new-M.D.s filing in, noted that he had been to the White Coat Ceremony for this group of med students four years ago as well. The White Coat Ceremony, by the way, is this little induction-type event they have just prior to starting med school where all the new baby med students get crowded into an auditorium, lectured grandly about the glories of medicine, and are finally "cloaked" with their first white coats, which is, no matter how cynical and jaded you are, a very exciting event. "That was their happiest moment, I think," my dad observed. "They look a little more cautious now. They're not quite as idealistic. The reality has set in."

"Yeah," I chimed in not quite as eloquently, like some asshole frat big brother hazing the new pledges. "Now the PAIN begins!"

Fresh graduates, if I may be presumptuous, let me pass on some advice that my surgery preceptor gave me back in med school with respect to residency. "First there is pain. Then there is more pain. Then you learn to love the pain." Oh, Dr. Edwards, you were exactly right.

Congratulations, new doctors! You're going to be great. Now roll up your sleeves and get in here.

like some kind of metaphor or something




They grow up so fast. Time to get a bigger pot.

they'll probably want time off for their menses, too

I don't want to start a shitstorm, but what do people think about this article that my sister e-mailed to me? (My sister, by the way, is graduating from medical school tomorrow. Celebrate good times, come on!)

BUSINESS WEEK, April 17, 2008, 5:00PM EST

Are There Too Many Women Doctors?

As an MD shortage looms, female physicians and their flexible hours are taking some of the blame

by Catherine Arnst

Finding a doctor could soon be even harder than paying for one. Various studies have projected a shortfall of anywhere from 50,000 to 100,000 physicians in the U.S. relative to demand by 2020, and the Institute of Medicine, a federal advisory body, just reported that in a mere three years senior citizens will be facing a health-care workforce that is "too small and woefully unprepared."

This looming shortage is forcing into the open a controversy that has been cautiously debated in hospitals and medical practices for some time: Are women doctors part of the problem? It's not the abilities of female doctors that are in question. It's that study after study has found women doctors tend to work 20% to 25% fewer hours than their male counterparts.

The British Medical Journal went public with the debate on Apr. 5 when it published a commentary by Dr. Brian McKinstry, a general practitioner at Scotland's University of Edinburgh, titled "Are There Too Many Female Medical Graduates? Yes." McKinstry argues that "society still expects women rather than men to reduce work commitments to look after children and not to return to full-time work until the children are older." He laments the unfairness of it all but concludes that "in the absence of a profound change in our society in terms of responsibility for childcare, we need to take a balanced approach to recruitment."

Plenty of medical staffing experts reject the notion that women should shoulder the blame. Even McKinstry does not want to set the clock back to the 1970s, when only 10% of U.S. doctors were women. Today women account for one-third of the physician workforce. In U.S. medical schools, they make up half the class.

But even those who disagree with McKinstry's position acknowledge that women doctors in the U.S. work less—47 hours per week on average, versus 53 for men. They also see about 10% fewer patients and tend to take more time off early in their careers. "It's pretty much an even bet that within a year or two of entering practice they will go on maternity leave," says Phillip Miller, a vice-president of the medical recruiting firm Merritt, Hawkins & Associates. "Then they are going to want more flexible hours."

Such demands tend to irritate older doctors. "The young women in our practice are always looking to get out of being on-call," says a male internist at a large New York-area medical group who asked not to be named. "The rest of us have to pick up the slack. That really stirs up a lot of resentment."

On the plus side, women are willing to take on lower-paying specialties that male doctors are moving away from, such as primary care, pediatrics, and obstetrics. Since 1996 there has been a 40% jump in the number of women choosing primary care, offsetting the 16% decline in men entering the field.

A lighter workload also has its advantages. "Lots of studies show that doctors who work fewer hours have less burnout," says Dr. Joseph Flaherty, dean of University of Illinois College of Medicine. "There is a strong association between long hours and medical errors."

The issue of shorter work weeks may in fact be as much generational as gender-based. Newly minted male doctors are also rejecting the heroic 80-hour weeks put in by physicians of yesteryear. Ultimately, medicine will have to accommodate the lifestyle demands of a younger generation if it is to address the physician shortage, says Dr. Nancy Oriol, dean of students for Harvard Medical School. "If there is a problem with retention, it might serve us well to investigate details of the career paths themselves."

My initial reaction is twofold:

1.) I think this "looming physician shortage" may be a larger than the issue of women needing to take maternity leave. Why aren't people going into medicine? I have some notions. And also, how can the answer to a "looming physican shortage" be that we have too many women doctors? Too many? Maybe we need some more!

2.) I think it's time to evolve past the golden age where we expected our doctors to be somehow above the everyday concerns of regular people. The fact of people looking for flexible job hours and balanced time between work and family is many decades old, but in medicine, people are treating it like, OH MY GOD, where do these young doctors get off, thinking they're allowed to have lives? Obviously, I think everything should be fair, some people should not be repeatedly allowed to shirk work and others repeatedly expected to pick up their slack (at least without some sort of compensation), but juggling two things rather than one should not, to me, be interpreted as a sign of laziness or weakness, so long as good faith is shown and an effort made to continue to do your job well.

But obviously, I am a woman doctor with a child, so I am coming at it with bias. Your thoughts?

the end is near...but not in that way




A couple of people in the comments section asked me in the last entry about my May 1st word count deadline, and whether or not I have met my goal yet. And the answer is...no. I actually had done some writing this past month, though failing to update the sidebar as I did...but I have not cracked 70,000 words yet nonetheless. But before anyone starts freaking out that I have NOT MET MY CONTRACTED DEADLINE, let me tell you this: my real deadline is July 1st. The May 1st deadline is a decoy deadline that I set for myself to give myself a margin of error, just so I wouldn't stray too close to the actual deadline without being reasonably close or at the point of completion. And I guess I'm living in that margin now. I think there's a reasonable chance I will be done with the writing portion of things this week, with enough time for polish and finishing the illustrations by July 1st.

I realize that this whole "fake deadline" thing is some kind of neurosis on my part, and that perhaps it was slightly unrealistic to think that I would be done with the whole thing two whole months before it was actually due to my editor. But this is the same neurosis that leads me to arrive at the airport four hours before my flight. Because that way, even if I forgot my passport and have to return home to get it, and then the cab breaks down on the highway on the way back to the airport from home, followed by a hold-up in security for a full stripped down body-cavity search because someone has maliciously impregnanted my luggage with explosives while my back was turned briefly at the check-in e-ticket kiosk...I'll still hopefully be able to make it on the plane.

Anyone else find themselves catastrophizing as an adaptive strategy? Hoping for the best but preparing for the worst just seems to make the normal course of events seem miraculous.

In addition: I am also doing micro updates on Twitter now. What is Twitter? Are mini updates stupid? I have no idea, I just joined yesterday. But I am willing to try things. I am only quasi-old. Like remember when I joined Facebook? That was interesting. Though I rapidly became terrified of it and people started inviting me to join The Zombies Club and El Vampiro League and all sorts of crazy things and then I was just getting freaked out by getting updates every time someone was going to the bathroom. But anyway, Twitter. Subscribe if you like, maybe it will be fun. Or not.