It's been a long, slow process, spanning over a year, but I think I'll be ready to take Issue #1 of "Scutmonkey" to Kinko's tomorrow to be printed up. (When I say "Kinko's," I really mean "Office Depot," but I find that saying "Kinko's" is just universally understood to mean "Copy Store," just like people say "Kleenex" or "Band-Aid".) I have the covers assembled, I have the master printed and pasted, all that remains to be done is a little double-sided copying, folding, and long-necked stapling. It's a home-grown effort, but if I may say, it will be a handsome booklet when finished. More updates on Issue #1 and ordering information to come soon.
Laying out the comic, I was reminded of my high-school days working on my school paper. The nostalgia came from using Microsoft Publisher to lay out the pages, which, while not a terribly sophisticated program, is straightforward enough for even the computer novice, and the only publishing program with which I'm even remotely familiar. We used to spend entire "layout weekends" to get the school paper ready for press, oftentimes spending the entire weekend ingratiating ourselves on the hospitality of Phil and his family. Phil one of the tri-editors-in-chief, the only one who lived in Manhattan and conveniently had parents with a refreshingly laissez-faire attitude. At least more laissez-faire than my parents, which, I guess, isn't really saying all that much. We would stay up most of the night on these "layout weekends," taking shifts sleeping in Phil's hammock (which his parents had strung up in the living room), thinking up creative filler or pictures for the empty spaces between articles and ads, and generally acting as goofy and juvenile as any high-school students at what amounted to a two-day co-ed parent-approved sleepover. We would make deli-runs, take kung-fu movie breaks, and laugh at things that weren't really that funny because, at 3:00am and on your 28th page of copy, anything is funny. Especially when you're sixteen.
In retrospect, "layout weekends" were a little bit like being on call in the hospital, but for a key difference. We did "layout weekends" because we wanted to, we take call because we have to. And that may be the single and most marked downside of medical training--the loss of freedom. Where a day off becomes the most exciting thing in the world, because it means that you can use your time however you want.
I keep in touch with most of my good friends from high school, but my friends from the school paper somehow got lost. And I do hate losing people. There's something very special about keeping in touch with people who were close to you when you were young. So I'm going to harness the mighty power of Google and put the beacon out there. Phil Sphicas, Gillian Hodler, and Paul Nguyen, I'm thinking about you guys. If you ever do a search on your own names and find yourselves here, e-mail me and say hi. I would love to catch up on the last ten years.
Currently reading:"Running with Scissors." Still. But I may pop into Borders after my Kinko's (Office Depot) expedition tomorrow and browse for something new.
Got home last night at around 11pm after my shift in the ER, just in time to catch the tail-end of Kerry's acceptance speech. "Help is on the way." Catchy slogan. Reminds me of this elevator in one of the main administrative buildings in my med school. There was a little panel near the buttons with light-up letter reading just that same message. I guess it was supposed to light up in case the elevator got stuck, to let you know that the firemen were coming so you wouldn't start freaking out and cannibalizing your fellow passengers.
As I was signing out my patients to Allison yesterday night--I only had one left that I hadn't discharged, a boy who got hit in the eye by a line drive at a baseball game--she asked me if it was hard to go through this year (meaning this extra nine months of Pediatrics that I agreed to before switching to Anesthesia) knowing that I didn't have to. I told her that I tried not to think about it too much--working in Pediatrics is just my life as I know it right now, it's not the change that Anesthesia will be, so it's easier for me to put out of my mind the fact that I'm basically running in place for almost a year.
I finished what amounts to my prelim year last year. I was offered a place in Anesthesia to start this past July 1st. But I'm staying for an extra nine months essentially because my Peds program director asked--begged--me to. I'm staying on to do the work, to take the calls, to do the cross-cover, basically to help out. I didn't have to. Part of me didn't want to. But another, larger part of me feels obligated. This is my home, these are my friends. And I want to be good to them. Even if it means basically staying in a holding pattern until April.
But talk to me again about this in the dead of winter, after I'm NICU/PICU/Wards/Onc cross-cover, Q4 for six months straight, and see how much goodwill I feel then. Oy.
Currently reading:"Running With Scissors." I think one of the readers of this website had recommended this book to me a long while back, and I'm giving it a reread. It's David Sedaris meets John Irving.
The ER is such a tiring place. It's hard to say why, probably because the flow of work is so relentless, even during vacation season, that you're just go-go-going all day long. Even if it's not a bronchiolitis, flu-season ER, there's always something to do. There's always someone to look in on, something to check. And the day just goes on and on and on without a break, and by the time your shift ends, you're spent. You're useless for the rest of the evening. I know that our ER blocks count as call-free months, in that it's all just shift work, but try working that shift 13 days straight and see how "call-free" you feel. (Hint: not so much.)
This morning, as we were driving into work, Joe's consult pager went off. There was a patient in the adult ER that had been shot in the eye. Aside from her ruptured globe, the films showed a bullet lodged in the brain, herniation of said brain, and decerebrate posturing on patient exam. Afterwards, I said that while the eye is important, I sure hoped that Ophtho wasn't the first service the ER had contacted for this patient. Seems a little bit like calling a Derm consult for a decapitation.
Currently reading:"Dry." I'm going to need to figure out a new book soon, though, because I'm almost done.
So I'm through with Neurology, and these days am toiling back in the ER. Only not toiling. It's a lovely combination of summertime and school vacation, meaning that the critical mass of kids in the neighborhood has been cut by at least a half, and of those, fewer are sick. Therefore, the flow of patients into the Peds ER has been more of a slow trickle than the tsunami I channeled in November. Nothing better than a nice quiet emergency room. Summertime, and the living is easy.
(Cue schoolbus accident.)
This afternoon, for the first time ever, I got to call my own husband for a consult. I was working in the ER working up a kid for rule-out non-accidental trauma, and we needed ophtho to screen for retinal hemorrhages.
JOE
(over the phone)
Ophthalmology, returning a page.
MICHELLE
Hey, it's me.
JOE
Hey!
MICHELLE
I'm actually calling you for business reasons, though.
JOE
Yeah? What?
MICHELLE
Need you to come do a retinal exam. The name is [launches into patient spiel].
JOE
OK, got it. Just need to finish up this one guy in the adult ER and I'll be there.
MICHELLE
Great. I'll tell the parents. Thanks! Love you!
JOE
Love you too.
(hangs up)
Thereby marking the first time I've ever told a consult service that I loved them.
Currently reading:"Dry." Read it before, but it's good for the subway. I'm plus-minus on his writing, but he has some good stories to tell.
It's only three pages so far, but I figured if I just put something up, it might goad me to finish the rest. Click here to read the full strip (well, the full first part, anyway) or revisit the full Scutmonkey archive here, in all its bounty.
I don't work very well without deadlines.
Currently watching: A tape of "The Ali G Show" that Jack lent me. I can't believe all those people don't know it's fake. Also, I can't believe James Lipton wrote that rap.
found in translation We have exposition and translation of the German article! Thanks again, Kai B.
- - - - - - - - - - - - -
From: Kai B
To: Michelle Au
Re: Greetings from Germany
Hi! Thieme is one of the main publishers of medical books in Germany. I'll give a rough translation (please don't mind grammar or a strange use of vocabulary....)
Scutmonkey Comics about a physicians life
The start of a young physicians career in a NY hospital isn't easy. As always, the career starts at the very bottom and brings a lot of disappointments and she often drops a brick. The only way to survive seems to be humour - the first comics give certainly hope for more!
There's a lot to tell about the daily struggle, the dear colleges, and med students and the patients fads. On her internet homepage - there's also a diary! - she incorporates her experiences into absolutely funny comic strips.
Easy going she hits the mark, drawing and text add to a perfect result,so that no eye will stay dry (it means that everybody has to laugh so much, that tears will come). For sure, the strip "12 types of Med Students" will be a cult comic in the near future.
An interesting fact by the way: Med students across the pond (across the atlantic) are not so very different.... Kai B.
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Very cute. Gotta love the Germans. They're making me feel guilty, though, about being so behind on my new "Scutmonkey" installment. Maybe this will light the fire under my boots and get to me at least ink the first half of the new strip.
Currently reading:"Complications." So let me get this straight: this guy was a surgical resident at Harvard, a husband, a father, a regular contributer to the New Yorker and a National Book Award finalist? Some people are just amazing. Either that, or aliens.
I know that as a resident, my standards of "good" and "bad" have become bizarrely distorted when compared to the standards of normal people, but there's no better feeling than coming home post-call, taking a nice hot shower, and knowing that you are the master of the next eighteen hours of your life. You're not the boss of me, hospital! I can do whatever I want! I can take a nap. I can walk my dog. I can have lunch anywhere I want and take as long as I want to eat it. Or I can sit quietly by myself and do nothing at all. Sure, I'll be back the next day and you'll own me again, but for now, I belong to me.
Wow, that's a little depressing.
* * *
On the subway today, I was thinking about what would would constitute a real plum job. I realized that a great job would be one in which people are paying you to do what other people would do for free, or at their own expese, because it's fun. Here's a partial list of what I've come up with:
1.) Travel writer. Preferably for a publication with a lot of money and read by rich people, so they can afford to send you somewhere good. "The World's Top Ten Spas" or something like that. Not "Hoboken: Highlights and Attractions."
2.) Professional Movie Critic. Not of the Siskel & Ebert variety (I think having to be on TV would turn it into a whole other job) but of the A.O. Scott and Steven Holden variety. Also to clarify: Not Gene Shalit, not Rex Reed. If you were a movie reviewer for a classy rag (Times, New Yorkeror similar) you would get paid to watch movies, you could go to classy places with glamorous people (like the Cannes Film Festival, oh mais oui!) but still have steely journalistic integrity in case studio execs want to bribe into saying their stinker of a movie is "An Emotional Tour de Force" or some other such blurb that they can slap on their movie posters. Actually, maybe I wouldn't have integrity. Maybe it would be fun to be bribed. The only con that I can really think of is that sometimes, you'll have to review something like, "Garfield: The Movie," and be contractually obligated to sit through the whole thing. But then you could write a really bitchy review, and then it would be fun again.
3.) East Coast Socialite. Well, I guess that's not really a job.
4.) TV Doctor. Strangely enough, this is what my med school interviewer predicted that I would be doing in 20 years. A TV doctor on a news program I mean, not a TV doctor like Dr. Michael Mancini of "Melrose Place." I think my interviewer said it to mean that I had a good personality, but at the time I was paranoid that he was saying that I talked too much and should shut my pie hole. TV doctor would be a great part-time gig, though, mostly because it wouldn't be very hard. However, trying to convince a new mom why giving her newborn Strawberry Quik mixed into the formula is not such a great idea, even if "the baby likes it"? Surprisingly difficult.
I once had a friend who worked for an advertising company for the summer. He spent his summer in L.A., interviewing models by day and taking clients out to fancy dinner and clubs by night, all expense-free. Also, I believe they put him up in a suite at the Four Seasons his entire time out on the West Coast. How do people even find jobs like that? My only revenge is that I heard he's actually a second-year medical student now.
* * *
Hey look, they're talking about "Scutmonkey" in Germany! I only wish I could read German, so I could figure out what they're saying. Who knows, maybe they're saying I'm lame-ass. (Thanks again for the link, Kai B.)
Currently reading:"Complications." Back to the medical non-fiction for me. No offense, "House of Leaves," but you are making my brain hurt. I tread a fine line with these medical leisure books, alternating between feeling stressed-out thinking about medicine in my off-time, and feeling relieved in reading about other people's bumbling residency stories and knowing that I'm not alone in constantly feeling like an ass. And yes, I love run-on sentences.
I bumped into Noah when I was post-call the other day, and as we were chatting, waiting for the elevator, he asked me how I had the time to update my webpage so often. I gave him some sort of offhand answer, like, "Oh, it doesn't really take that long for me to update," but the real answer is that I type very fast, and don't think very hard about what I'm writing. I hope that wasn't too obvious already.
It was an extremely frustrating day at work today, capped off by an exchange coincidentally very much like the one I detailed in yesterday's entry. Only in this scenario, we actually got as far as getting the patient on the schedule and wheeling her down to the OR, only to watch her get sent back up less than an hour later because the attending coverage had just changed that same morning and the new attending had some bright ideas about what shiny new workup he wanted. So no dice. The patient was physically in the OR, for chrissake. We were so close! Damn, just give me the endoscope and a spork, I'll put in the PEG myself. The funniest part (though I was not laughing at the time) was when this new attending was basically dressing me down for what he felt like was the faulty patient management plan. "You guys were wrong, OK? Your plan was just wrong," he spit out, before turing on his heel and walking off into the sunset of A Good Doctor Practicing Tough Love. Unfortunately, he didn't realize that the aforementioned "wrong" plan was not one dictated by us fools on Neurology, rather by his colleague, the GI attending who had been covering his service immediately before. Oh well. Right-wrong, tomato-tomahto.
As I signed out the service this evening, with patient stacked up on the wards like firewood and at least four more already in the ER waiting to be admitted, I was so, so glad to not be on call tonight. My only regret is that I felt bad for Jack, who was. I'll have to buy him something tasty for breakfast tomorrow morning. Only the best for my my co-resident, so long as it can be purchased off the coffee cart for a total of $3.00 or less.
Currently reading:"House of Leaves." At this point, I just really want to find out what happens at the end of the story. But I guess I'll have to read it again anyway.
The air conditioner in our bedroom finally gave out last night. It had been making these pained groaning sounds for a week or so now, but seemed to be responding to the well-placed kicks and turn-it-off-then-turn-it-on-again fixit method that I apply to all electronics. But now it's really dead. The maintenance man from the building says the motor needs to be replaced.
Damn, it's hot in there. Maybe we should sleep in the living room tonight.
* * *
The medical hierarchy is such a ridiculous thing, and so counterproductive to getting things done sometimes. The chain of command and communication from nurse to intern to resident to fellow to attending and back (though not always ranked in that order) is like this ridiculous game of telephone. It ensures that the delay from the moment a decision is made to the actualization of that decision is at least two or three hours, if not more. Sometimes even answering the simplest questions can take the entire day.
PEDS RESIDENT
(On the phone)
Hi, I'm just calling to see if the decision was finally made to put [patient] on the surgery add-on schedule. Do you know if she's going to go down today?
SURGERY INTERN
Um, I don't really know. I have to ask my fellow. Can I call you back?
PEDS RESIDENT
Sure, just be sure you do, though, because I'll need to make the patient NPO and start her on fluids if she is going down.
(Three hours later)
PEDS RESIDENT
Did you hear back from your fellow yet? Is [patient] on the list?
SURGERY INTERN
Uh, I still don't know, we didn't get a chance to round on her yet. Can I call you after we've rounded?
PEDS RESIDENT
Can you just ask your fellow now? I mean, he's standing right there. It's just a quick thing. Is she going down for surgery today or not?
SURGERY INTERN
I'll tell you after we round.
(Two hours later)
SURGERY INTERN
So I asked, and the fellow has to discuss it with the attending before the decision can be made.
PEDS RESIDENT
OK, so when's the attending going to make the decision?
SURGERY INTERN
He's giving a talk today at [Upper East Side Affiliate Hospital]. So he won't be back here until 5pm. But he's going to round with the fellow then and they'll decide.
PEDS RESIDENT
Five o'clock?
(Four hours later)
PEDS RESIDENT
So, what's the good news?
SURGERY INTERN
My fellow said it was too late to put her on the add-on schedule for today. They're going to rediscuss tomorrow.
PEDS RESIDENT
What's there to discuss? Can we just put her on the list for tomorrow morning?
SURGERY INTERN
The attending coverage is switching tomorrow, so we need to re-evaluate and the senior resident needs to discuss with the fellow who needs to discuss with the attending whether or not she's a suitable operative candidate.
PEDS RESIDENT
But we already decided that she was suitable! You guys already decided she was suitable! She was just waiting for a spot on the schedule!
SURGERY INTERN
Yeah, but...we need to decide again.
PEDS RESIDENT
Excuse me, I have to kill myself now.
(Does.)
I know that the layers of hierarchy serves as a sort of a screening mechanism to ensure that the more important you are, the less you have to deal with the piddling bullshit. That's why the attendings are making decisions from on high and the interns are running around faxing things to the Medicaid office. But just you wait. One of these days, I, a puny Peds resident, am going to directly page one of the Neurosurgery attendings for a consult in the ER, and the whole universe will implode with the impossiblity of it all.
Currently reading:"House of Leaves." I admire the amount of work that was put into creating this book, but it does take an aggressive reader to get through it.
I know it's a children's hospital. I know they play music in the lobby to make it a happy place. But the last thing I want to hear when I'm walking to the ER for a consult at 10pm on a Sunday night is the a chorus of small children's voices piped in through the overhead speakers singing, "Old Grey Mare She Ain't What She Used to Be." Currently reading: About the appearance of new MS plaques on T1-weighted MRI images with gado. I'm trying to teach myself how to read brain scans, because while all the neuroradiologists went home, the patient and I are still here.
I have Sunday call this weekend, and Saturday call next weekend, which means that today is my only day off for the next two weeks. So the pressure was on to have a good time, dammit. Therefore, we went to see "Anchorman," and lo, it was funny. Go see it. Unless you don't like funny movies, in which case, don't see it.
* * *
So my sister is due to start med school orientation in about three weeks. Who knew school started so early? How much orienting do they need, anyway? There's the bookstore, there's the lecture hall, thank you and good night. I tend to get nostalgic easily for things, but there's really not that much that I miss about the first two years of medical school. Basic science? Anatomy? Eight final exams in five days? Never again. Actually, the only thing I really miss is the freedom to wake up in the morning, decide that eh, I'm pretty tired, maybe I'll skip lecture today and sleep in. Can't do that anymore. As a resident, you can't even really do that when you're sick, because you know that they're just going to have to pull some other resident to cover for you, and not only are adding to their workload, chances are you'll probably have to pay them back at some point when maximally inconvenient for you. Do you know how sick I would have to be to actually call in sick on a day that I'm on call? So very sick. Actually, I'd probably have to be dead.
* * *
I had an encounter with a drug rep the other day. I don't really see many drug reps, because they don't actually let them into our hospital for ethical reasons, but I guess some of them breach the defenses through some of the specialty outpatient clinics. The one I met was actually attempting to network through the Ophtho department, and once she heard that I was a Peds resident, she was all over me like flies on dung. I couldn't really deflect her attempts to infiltrate the Pediatrics department without being outright mean, but I really didn't want to end up as a drug-rep go-between.
Maybe it's because it was drilled into my head from med school, but some of her promotional ploys were just painfully blatant. At one point, she told some of the residents that while she thought it was great that they were prescribing [pharmeceutical company ophthalmic solution] twice a week, she would be "so grateful" if they could prescribe it four or five times a week. And by the way, these drug companies absolutely know what they're doing when they hire these reps. The one I met is this cute-as-a-button little cheerleader-type who was impossible to say no to, especially after she picked up the tab for the resident's Happy Hour. I mean, no offense to her personally, she's just doing her job, and I'm sure she's a nice girl. But it's just all a very shady business, this buying of doctors.
* * *
In clinic yesterday, I diagnosed a kid with hand-foot-and-mouth disease, probably from coxsackie virus. Heh. "Coxsackie." Currently reading:"House of Leaves." OK, it's starting to get kinda good. But I'm still a little "???" on the footnotes.
I came home today with a bottle of white wine, a gift from my Neurology fellow for the champagne tap the other day. She said that she knew the rules stipulated champagne, but who really drinks champagne anyway? I agreed that wine was the populist choice. Do I look like the Puff Dad? She brought a bottle for Jack too (Jack is one of the Neurology residents rotating through Peds this month, and an old med school friend), who also pulled off a champagne tap the day after I did--but while my bottle of wine was a Chardonnay, his was a Shiraz. Does it defeat the intent of the prize if the wine is red?
Anyway, it was nice of the Neuro fellow to get us gifts. She's the opposite of what a bad scary Neuro fellow would be; worst case scenario they could be these manically intense nerds weilding both a fund of obscure yet useless knowledge, as well as the power to make your life a living hell. Our current fellow is none of these things. And besides, she has this lovely Australian accent that I could just listen to for hours. Foreign accents--love them. The other day, one of the anesthesiology residents I was talking with had a Dutch accent, and I was transfixed.
I wore this v-necked t-shirt to work today. It was fairly proper, I thought, not super low-cut or anything--not like I really have much in the mammary department to showcase--but still, I don't think that I should wear it in the hospital anymore. I noticed that parents were telling their kid's seizure history to my chest. I don't see anything particularly captivating about clavicles and a bony sternum overlain by what may be the world's puniest pair of pectorals, but maybe the skin itself was distracting. And that in turn started to distract me--I spent most of the day pulling the v-neck narrower and higher. I guess it's crewnecks and button-downs from now on.
Currently reading:"House of Leaves." Has anyone else read this book? Does it start to make sense later?
Another decent call-night on Neurology. So far my luck has really been holding out on this service.
Earlier in the day, I had to take an in-service exam for Pediatrics. The in-service is kind of a mock Pediatrics Boards that residents have to take annually. I'm not really sure what they use the data for (in some vague way, I think it's used to accredit the program, or to make sure that our academics are up to snuff) but the results of the test don't really directly affect us. For example, I don't think I'd get fired if I didn't do well on the in-service. Or I don't know, maybe I would. There are different bell curves, anyway, for how the average resident does as a PGY-1, 2 and 3, and one of the purposes of the in-service is to see that we're actually progressing in our learning from year to year. Therefore, interns are not really supposed to do well on their in-service. Aside from the fact that they've only been doing Peds for two weeks, doing really well wouldn't give them any room to get better. And then the program couldn't take credit for teaching them all that stuff. I definitely knew more on the exam than I did when taking it a year ago, but here was still some element of wild guessing. There were some genetic syndromes on there that I feel like I'd never even heard of.
My general strategy on taking standardized tests (I don't know if it's too lofty to call it a "strategy," really) is basically to take the exam as fast as humanly possible. Read the question quickly, scan the answers, and if there's a knee-jerk reaction to any of the choices, I bubble that sucker in and move on. I don't overthink, and I don't go back and check my answers. I know this sounds like horrible test-taking strategy, like some haphazard kamikaze blitzkrieg operation (yes, I like war-related vocabulary from other languages), but I've been doing this test thing for a long time, and it has yet to bite me in the ass. For example, when I took Step 2 of the Boards, I finished something like three hours early (including a 45 minute lunch break during which I langorously read something mindless, like Jane magazine), and Joe and I ended up getting the exact same score. (I guess it's also relevent to insert here that Joe is a smart guy, and something of a hyper-acheiver.) So there you go.
Sometimes I feel that this strategy works because I get into this Zen-like state while taking tests, where I can kind of feel out the answers with some sort of medical intuition radar, and the less I overthink things, the more answers I get right. This is how I can rationalize taking tests in such a reckless manner. But the real reason that I take tests so quickly, I think, is that I really don't care how well I do on them, so long as I pass. I hope that doesn't sounds like I'm being artificially laid back, in that Hansel from "Zoolander" way, because it's true.
And anyway, there's only so much I care about the Pediatrics in-service exam when I know I'm going to be switching to Anesthesia in the spring. I mean, not like I don't want to be smart in Peds, or know the material for my own sake, but as for my actual exam score: whatever.
So anyway, after getting some sleep on call, I kind of wanted to watch a matinee of "The Door in the Floor," but not really enough to want to pay $10.50, even if the New York Times did call it the best John Irving film adaptation ever. So instead I got my Irving fix and rented "The Cider House Rules" instead. I mean, not like I love John Irving or anything, usually it takes me a few false starts to get into his books because they're so long and kinda weird, but he's accompanied me on a plane ride or two in paperback form. It's actually amazing what a good job they (he) did of adapting the novel, paring it down to the essentials. Sure, a lot more stuff happened in the book--the whole Melony thing, all the stuff that happens after Wally gets back from the war--but the essence of the story is preserved in the film adaptation. And I don't particularly feel like watching an 8-hour movie anyway.
Currently reading:"House of Leaves." This book is making me feel stupid, because I can't figure out what the hell is going on.
On call again for Neuro tonight. There's this Cup o' Noodles thing that's been sitting in the call room for weeks. Actually, it's more like a high-class Cup o' Noodles, a Thai Kitchen Ginger Rice Noodle Bowl. I don't know whose it is, but if I'm fairly sure that it's been abandoned, and I really want to eat it. This is what my life has come to. Eating cast-off dehydrated foods. If only someone had abandoned some Astronaut Ice Cream too.
Currently reading:McSweeney's online. I didn't know they had some many pieces posted. They even have a column by my imaginary boyfriend, Michael Ian Black.
I tapped a kid today, and it was straight up bubbly, baby! (And I don't mean pus.) Champagne tap! And not in that fake champagne tap way, like it just looked clear to the naked eye. It actually was blood free. ZERO reds on the cell count, as per the lab. I just about lost my shit as I checked the results in the computer, and had to stop myself from running a lap around the ward, draped in the American flag. I knew it was a good tap when I saw the fluid in the manometer, but I was trying to play it off like "ho hum, just in a day's work" because the Neuro fellow and attending were both standing nearby and it probably was no big deal to them. But I think I may have been smiling behind my surgical mask.
It's a good feeling to do something well.
Strangely enough, this is actually my second champagne tap. But the first one I don't even count, because it must have been a complete fluke. It was done on an ER gurney in a curtained-off corner of an inner city hospital when I was a third-year med student on Neurology, and I'm lucky I even knew where to point the damn needle. When I started getting fluid out, I was so surprised I almost dropped the manometer. It reminds me of the first time I went fishing as a little kid, and caught this gigantic flounder on my first cast. (I think I acidentally snagged it on the back as the lure went into the water. The hook was nowhere near it's mouth.) I felt pretty awesome draining the Cristal that first time, but as mirrored by my subsequent luck fishing, almost every tap I've done after that point has been traumatic to some degree. Mostly just a teeny leak of blood that clears quickly, but the worst tap I ever did actually had a big clot in it by the time it got to the lab. Yes, I was intending to send a blood culture in that CSF tube, thanks for asking.
Currently reading:"The Spirit Catches You and You Fall Down." Again. Because I'm on Peds Neuro now, and the case deserves review. Also, I've actually had patients with Lennox-Gastaut syndrome now, so it's interesting to compare them to Lia and see if I think that's what she had.
Not to jump on the bandwagon of "Spiderman 2 was awesome," but...Spiderman 2 was awesome! For a summer popcorn flick, it was meaty and had a good story and the action sequences weren't tedious. Though completely fictionalized (the imaginary subway line running above ground through midtown Manhattan), I thought the much-touted subway scene was thrilling, and I loved the depiction of New Yorkers as people who band together and champion their heroes, not just as pushy, ornery, over-caffeinated, over-nicotined lunatics in a big rush, as is the standard movie convention. Tobey Macguire is of course adorable and excellent as Peter Parker (he has this uncanny method of acting scenes entirely with his eyes), and the screenwriters had the good sense to have the story focus on Peter and his struggles rather than on Spiderman fighting the bad guys. The standard superhero element of the story was as expected (scenery-chewing villain, acrobatic hero saves the day and gets the girl), but it's the angst of the protagonist out of costume that really gives the story it's driving force and resonance. Good stuff.
It's a lazy kind of Sunday, and I'm occupying myself alternately reviewing some basic pharmacology and applying for my New York State medical license. I'm aiming to take Step 3 of the Boards sometime this fall, and there's an amazing amount of paperwork and bureaucracy to wade through up until that point. The licensing application even wants to know where I went to high school, and whether or not I graduated. At this point, after college, med school and residency, shouldn't they be able to assume that I'm at least a high school graduate?
I got home by 11am this morning and had a tasty lunch with Joe at this new (to us) Japanese restaurant over by Gramercy Park, sharing a big fresh tuna salad, with a bowl of miso for me. Joe kept saying how he wasn't that hungry, wasn't that hungry, but then of course the second we finished lunch he had to chase the lunch with a cream chese bagel. Hi, we were just at a nice lunch place, why didn't you just order some more food? Never believe it when guys say they aren't hungry.
So we're finally going to see "Spiderman 2" tonight. For a change, it's been me agitating to see the superhero fare instead of Joe (although he must have watched the trailer about 500 times on his computer in the months leading up to its release), and I think that it's because it's been so lauded for having a decent and compelling plot. Also, Toby Maguire in nerd glasses is always good. Maybe he will shed tears in this movie as he did in the first Spiderman, and I will be captivated by his sensitive-guy persona and limpid ocularies.
Currently reading:"Basics of Anesthesia, 4th Ed." Makes me realize that there are so many topics I haven't even thought about since second year of medical school that I really need to revisit. Pharmacology? Anatomy? Biochemistry? Did I ever know this stuff?
MICHELLE
(Calling back) Hi, this is Neurology, returning a page.
MARIAH
Hi, this is Mariah, one of the Peds residents.
MICHELLE
Oh, hey Mariah, it's me, Michelle.
MARIAH
Oh, hey Michelle! You're on Neuro now?
MICHELLE
Yeah, that's me. Neuro "consult" at your service, bringing expert advice to your door.
MARIAH
Oh! Well, I guess that answers my question.
MICHELLE
What was the question?
MARIAH
Well, we were just trying to tap this kid down in the ER and having kind of a rough time of it, so we were calling Neuro to see if there was anyone on call who was really good at doing LPs.
MICHELLE
Well then...I guess the answer is no. I mean, I can do them, but...
MARIAH
But you're not a Neuro resident.
MICHELLE
Right-o. Sorry.
MARIAH
That's OK.
MICHELLE
I have failed you.
MARIAH
That's OK, we managed to get some CSF. Just not a lot.
MICHELLE
OK. The kid's being admitted?
MARIAH
Yeah, to the medicine team.
MICHELLE
OK then. Sorry again for not being the expert.
MARIAH
Don't worry about it.
I'm useless as Neuro consult. I couldn't help but to think, though, that maybe when I switch to Anesthesia, I'll actually start developing a skill set that's useful to call upon. I mean, not like I can't tap a kid, or that I haven't in the past, but the idea of me going down to the ER as the "expert consult" to tap a kid after the ER attendings were having trouble getting fluid is a little silly.
Currently reading: Nursing notes for a consult in the PICU.
Depending on how much you either loved or hated your classmates, the great/terrible thing about staying on for residency at the same institution where you went to med school is that you end up seeing a lot of the same faces throughout your career. (I lean towards the "great thing" side of the picture--even if I didn't love every single personality I encountered in med school, I thought most of my classmates were pretty cool, and moreover, the more people you know in different departments, the more it greases the wheels when you need them to consult on your patients and such.) Today alone I bumped into eight of my former classmates; four in Anesthesia case conference, three in Neurology grand rounds, and one in the hospital lobby. Oh, wait, make that nine former classmates--I forgot that Joe also counts. It's funny, us all being residents now, all responsible and whatnot, when not so long ago we would scheme about creative ways to avoid going to clinic, or how we would sneak out of some boring case or lecture to get frozen yogurt and catch a nap in the student lounge. I wish I could still get away with some of that shit I pulled my last two years of med school.
Has anyone else had any trouble loading this page? I notice I usually have to press reload a couple of times before it shows up. Weird.
My last neuro call was gloriously frontloaded, with a moderate amount of action during the day but a quiet night. Got called a couple of times for kid seizing, but since they were in the hospital for EEG monitoring of their seizure activity, we didn't really do anything about it. Seize away, little children. Just make sure that you stop after a few minutes.
Since I was able to get some sleep overnight, I set my pager to wake me up the following morning at 6:15, even though attending rounds didn't start until 8:00. After a brief peek in on my kids first thing, I went downstairs, walked through the building from the Children's Hospital to the main hospital administrative building, and went upstairs to the offices of the Anesthesia Department. There was a 6:25am lecture on airway management for the new Anesthesiology residents, and I didn't want to miss it. Now what the hell was I doing sitting in on an Anesthesiology lecture at 6:30 in the morning?
Here's where it gets crazy. Don't get too excited, but I have something important to tell you.
I'm switching residencies.
Starting this Spring, I'll be a first-year Anesthesia resident at [University Hospital]. Starting April 1st, to be exact. This is not something totally out of the clear blue sky, I'd been considering it for a few months now, but I have to admit, once I made the final decision to switch and spoke with the necessary administrators, it all happened very, very fast.
And now, becuase I'm a mindreader, here are the answers to some FAQ about my switch:
Why are you switching? What, you hate kids now? Not at all. I still want to work with kids, and I still want to be involved with Pediatrics. I just came to the realization that I didn't exactly want to be a Pediatrician. Let me emphasize this one more time in case it isn't clear: I'm not switching because I had a bad intern year, or because I don't like Peds. My decision has nothing to do with my life in its immediacy, I'm not that short sighted that I extrapolate that all life in Pediatrics is as grueling as intern life. However, after my intern year, I realized several things. The first thing I realized is that my interests tended towards acute care. I like the ICU setting, I like critical care. I also realized that I wanted to do something moderately procedure based, not necessarily cath or endoscopy (read: cards or GI fellowships), but a field where I could be a little more hands on than a generalist. I wanted something with a good amount of flexibility, meaning that I wouldn't have to be pigeonholed into too specific of a field (NICU, for example). I wanted a career where I could have time to reasonably accomodate a family life, where the job prospects were good, and where I could have a comfortable lifestyle while still managing to keep my fingers in academic medicine. I was really struggling to find a fellowship or career path within Pediatrics that could accomodate all these things I was looking for, and having a really hard time with it. Then I realized that things weren't as rigid as they seemed. The field of medicine is dynamic, and so is the development of a medical career. I realized that switching fields was possible, and, after wrestling with my decision for a good long time, I decided to go for it.
What, so you can just leave your residency? Weren't they pissed? Not really. I mean, I think they were surprised, certainly, but once I told them what I was planning to do and why I was doing it, they were actually great about it. My fellow residents were nothing but supportive, and my program director was invaluable in helping me call the Anesthesia program and set everything up. The late switch date is out of deference to Pediatrics, since I wanted to pitch in and help them out with their call staffing (I feel guilty, all right?) but the Peds Department really went to bat for me, and I don't think my cross-over could have been accomplished as quickly or as smoothly without them.
So, now what? So for now, I'm a Pediatrics resident, same as ever. I'll keep on working, on Neurology, in the ER, in the NICU, PICU and wards for the next few months. I'll take call, I'll pitch in where I can, and come April, I'll switch over to Anesthesia, and be a clueless first-year all over again. Anesthesia is a four-year residency, of which one year is a preliminary year, usually Internal Medicine, but sometimes Peds or even Surgery. I already completed what amounts to my prelim year, and I'll be doing a little more on top of that before I begin (the nine Peds PGY-2 months that I'll be doing before the switch), so basically, I'm looking at at least 4 more years of training from this point in time. Which sounds like a long time, five years of residency training total, but even if I decide to chase my Anesthesia residency with a one-year fellowship, I'd be finishing at the same point in time as if I decided to complete three years of Peds followed by a Peds fellowship, which invariably runs an additional three years.
How long have you been thinking about this? Didn't this all happen really fast? Yes, it does feel like it happened really fast, once the machinery was in motion. But I'd been contemplating the switch for a couple of months now, at least since this past winter. And whereas I dismissed a lot of those early thoughts as the winter blues, or the halfway-through-intern-year-disenchantment, the fact still remained that I knew what I liked and I knew what I didn't like, and that I was struggling to carve out a career path for myself that could accomodate all the things I envisioned for my future, both professionally and personally. Am I 100% sure that this move is the absolute answer for me, and that I can guarantee perfect Nirvana-like happiness forever and ever into infinity because of my decision? Well, I don't think you can say that about any decision you ever make, unless you're delusional. But do I feel with confidence and faith that this is a good choice for me, a well-thought out mature move, both for my life now and for the long-term? Yes, absolutely. I'm glad I'm doing this, and I'm grateful that I was given this chance.
Wait, hold on here. Your name is Dr. Ow and you're going into anesthesia? Don't you think that's funny? Oh, don't think that didn't occur to me. Wait until I do a fellowship in Pain Management, then I'll really have you rolling in the aisles.
Currently reading:"Basics of Anesthesia, 4th Ed." I'm not switching for months yet, but I might as well start doing some reading now.
When I'm on call for Neurology, I carry three pagers. One is my personal pager, which I always have. The other two are Neurology pagers, one for consults, and one for the wards. The fact that there are two Neurology pagers seems like a little bit of a waste, but it must be for during the week, where there are enough residents to disperse the consult and ward responsibilities between two or more people. Either way, it's irrelevant, because there's a digital phone that they can reach me on too. Anyway, just to make my life a little easier, I have reprogrammed each pager to a different ring, just so I can tell quickly which one is going off without frantically unclipping them from my pants and holding them to my ears. My personal pager is just of the standard "beep beep, beep beep beep" variety. The Ward pager plays the theme from "Love Story." And the consult pager plays "Starry Starry Night." (Because that's when the ER loves to page me.) And before you mock me for picking such lame-ass pager tones, why not blame Arch Wireless for not selling the hospital pagers a system with more ring-tone choices.
So far, all quiet on the Western Front. Hopefully, things will stay calm. Nothing worse on Neuro call than being woken up to a strident electronic version of "Starry Starry Night."
Currently watching:"Capturing the Friedmans." I wonder if David Friedman's birthday clown business gig took a big hit after this movie came out. My guess would be yes.
Volumes 3 through 9 of "Iron Wok Jan!" arrived in the mail for me yesterday. So exciting. That was some speedy delivery, especially since it was shipped for free. Oh man, how did I get so nerdy? Soon I'll be going to Taco Bell to get a hundred tacos in a wheelbarrow, which will provide adequate susenance for the "Dr. Who" marathon.
Nothing much going on here. Just sitting at home, eating burritos, having a beer, and waiting for the fireworks to begin. Which is, of course, what our founding fathers intended Fourth of July to be all about.
Currently reading:"Iron Wok Jan! Volume 5." I tried to use some of the cooking tips for making dinner tonight, but I don't think that the cooking techniques carries over to refried beans and ground pork.
Now that Joe finished his prelim year at [Upper East Side Hospital] and has joined me at [Upper West Side University Hospital], it actually helps out with my commute a lot. That's because unlike his ADL-delayed wife, Joe can drive. He drives to work every day, and if our schedules are in sync, I hop in the car with him. Since we live all the way downtown and on the East Side (I maintain that the trip between our apartment and our hospital is the most inconvenient inter-Manhattan commute you could possible make, public transportation-wise), getting a ride into work cuts my commute time from an hour or more to a mere fifteen-minute jaunt. And this is all good by me. Shorter commute time equals longer sleep time.
The car is also important because now that he's an ophtho resident, Joe takes home call. Which means that his call is what the layman thinks of when he hears about a doctor being "on call"--namely that Joe is at home with his pager on, and if they need him for some kind of eyeball emergency, they call him and he comes in. Ophtho residents don't spend the night in the hospital, and once they finish their first year, they only have to be on call once every three weeks (as a second year) or even less frequently than that (as a third year). This is awesome, and I am psyched for him. Since he's a first year, he (like me) is still on call every fourth night, but at least he gets to spend at least part of the night in his own bed.
Last night was Joe's first ophtho call, and he got called in around 11:30pm or so for some kind of trauma case. So he was gone, and there I was. Unlike when he took overnight call, I didn't really make any definite plans for a night by myself because I wasn't 100% sure that I would be by myself--but when he called in, I decided to go see a movie. So I headed on down to the Angelika and caught the midnight showing of "Before Sunrise."
I know probably no one has seen this movie yet, since it just opened yesterday (and only in very few cities at that), but here are some thoughts anyway.
1.) Ethan Hawke is one haggard looking guy now. I don't mind him not being so pretty anymore, because it gives his face character, but he just looks really thin and drawn these days. He lives in my neighborhood, so maybe the next time I see him walking his dog, I'll give him an Entenmann's All Butter Loaf.
2.) I love movies where the plot is just driven on dialogue, so this movie indulged me. But hot damn, these two can talk. I think some people in the theater were getting annoyed (one couple actually walked out grumbling halfway through), but I think that the frantic dialogue just fueled the sense of urgency in the story. How to catch up on the past nine years, say everything that you need to say in the span of 70 minutes? There's definitely an acute sense in the movie of time ticking by, time running out, and I think all the dialogue that danced around but was afraid to touch upon the central issue only heightened that feeling. Could I have done without all the yakking about the environment and politics? Sure. But the really true, important things are hard to say, and they need some sort of a cushion, some kind of a prelude. That's how it is in real life too.
3.) The ending. I can't quite tell if I'm annoyed with it, or if it was just as enigmatic and ambiguous as it needed to be. I hate movies where everything is spelled out for you, but after all that talking and tension, it might have been nice to see a little more acted out. I read an article that the original script was one in which the two characters spent a madcap weekend traipsing around Europe and end up getting married in the end. That would have been bad. But a little less restraint than the final version would have been OK.
4.) I need to travel more. Damn.
We have friends staying over with us tonight, so we're going out to dinner with them later. Then, tomorrow, we'll probably have a little cookout for the fourth and watch the fireworks from the balcony. Wait, are the fireworks on the Hudson this year, or the East River? If they're on the Hudson, we may have to watch them on TV. Or maybe not at all. What's the fun in watching fireworks on TV?
Currently reading:"1984." Also trying to start "House of Leaves," which my sister gave me for my birthday. She says it's supposed to be creepy, in that "Griffin and Sabine" kind of way.
First of all, good news from the homefront. My sister was just accepted to an excellent New York City medical school! She was already set to attend another med school, but had been holding out for her first choice, where she was waitlisted. I'm glad she held out. She's psyched to start this fall, and despite the fact that I would never, ever want to go back in time to the first two years of medical school, we are psyched for her. (I don't really want to give the name of the school, obviously, but let's just say she may be bumping into our friends from "Push Fluids" in ye olde hospital cafeteria.)
Today was my first clinic day as a second-year. Interns only have half-day clinic once a week, but once you hit the big-time, your clinic is upgraded to a full day. Depending on how you feel about clinic, you could view this as either a perk or a pain in the ass, but at least it's something different than being in the hospital.
I had a little visit in the afternoon with one of my overweight patients. Let me clarify first that almost all of my clinic patients are technically overweight, to the point where I kind of stop noticing, and start thinking that normal kids are malnourished. After working in inner city Pediatrics, my whole perception is skewed. But anyway, even by my inflated standards, this kid was overweight. Like, six years old, 85 pounds kind of overweight. So during the visit we were talking about the usual things--cutting out all juices and sodas, portion size, snacking habits, what have you, and I asked the kid about fast food.
MICHELLE
How often do you eat fast food? Like McDonald's or Wendy's?
KID
I don't eat Wendy's!
MICHELLE
OK, McDonald's, then.
KID
I don't eat Wendy's!
MOM
(Dominican accent) Fass food? He dun et fass food. Neber.
KID
One time a week!
MOM
OK, so maybe one time a week. Perro no too much.
[Note: As soon as they're old enough to talk, ask the kids what they eat. Parents will try to make a good impression at the doctor's office, but kids will always give you the real dirt.]
MICHELLE
OK. Well, still, that's better than last time. Last time you were eating at McDonald's four times a week.
KID
Yeah! McDonald's!
MICHELLE
(Noticing little plastic thing on the kid's belt) What's that thing?
MOM
Oh, thass wha dey give ah McDonald's when you order the ensalada. Ess por exercise.
MICHELLE
Oh, the pedometer! Great! And I'm glad to hear that you're ordering the salads. Show me how it works.
KID
It's a toy! Look! (Shakes the pedometer) When you shake it, the numbers go up!
MICHELLE
Right. Actually, that's supposed to be counting how many steps you're taking. Like when you're walking on the street, or jogging, or running. It counts how much exercise you're doing.
KID
(Maniacally shaking the pedometer up and down to increase the step count)
MICHELLE
Right...
MOM
Es por walking, perro he can' walk now.
MICHELLE
Why can't he walk?
MOM
He have rash on his legs here (gesturing to inner thighs). So when he walk, it hurt him.
MICHELLE
Wait, let's take a look at that.
Turns out the kid has a contact dermatitis from where his thighs are rubbing together. Which makes him exercise less. Which makes his thighs bigger and rub together more. Sometimes working with kids is like building a sand castle. You get one wall built up real good and a tower on the other side crumbles.
I gave him a script for a topical steroid and told him to try swimming for now.
Currently reading: The New York Times review for "Before Sunset." I feel cheesy saying this, but I really want to see this movie.
So for my birthday, my dad gave me these two comic books. He's been telling me for years about these Japanese comic books about the culinary arts, often translated into Chinese and which he is able to find around the city at various specialty comic book stores. We are alike that way, in our nerdy comic love. Anyway, I've always been interested to read these cooking comic books, but my interest has been foiled by the fact that there haven't really been any English translations. That is, with the exception of this one series, "Iron Wok Jan!"
The reasons that I love "Iron Wok Jan!" are as follows:
1.) It's called "Iron Wok Jan!" (The main character's name is Jan, by the way. I thought at first that it was a monthly comic, and was confused why there was no mention of "Iron Wok Feb!" or "Iron Wok Mar!")
2.) It's so melodramatic. For example, when the titular "Iron Wok Jan!" is cooking a banquet dish and accidentally uses the wrong proportion of vegetables to beef for a stir-fry, he dissolves into angry tears and starts punching the wall until his fists are bloodied into meaty pulp. Dude, chill. This is all very Japanese ("I have disgraced my family name with my poor stir-fry recipie!") and therefore hilarious. Cooking is very serious business in "Iron Wok Jan!"
3.) The teen girl chef (Kiriko) has the biggest boobs ever. She's always shown with either her bosom straining against the front of her chef's outfit, or in various stages of chaste nudity, as in the scene in "Iron Wok Jan! Vol. 2" where she's trying to figure out how to make the flower out of turnips and flings herself back on the bed in frustration, her pajama tops flying open yet not showing any of her naughty bits.
4.) It's bizarrely scientific. Sample panel from the scene where Jan and Kiriko face off in an intestines cooking competition:
Dig the little micelles surrounding the "odor" particles, reminiscent of my AP Bio textbook. This is a comic book that takes itself very seriously.
5.) IT'S A COMIC BOOK ABOUT COOKING. Ha!
It just goes to show you that there's nothing as funny as that which is unintentionally funny. My dad only got me Volumes 1 and 2 for my birthday, because he wasn't sure if I was going to like it or not. I hope that the fact that I just ordered Volumes 3 through 9 will show him that his was a very fine birthday present indeed.
Currently reading: On a completely different note, "1984."Again. I was just reminded of it when I watched "Fahrenheit 9/11" last weekend (catching the midnight showing on Saturday because every other show was sold out), and thought the Orwell version deserved a re-read. Or, in my case, a re-re-re-re-re-re-re-read. Also, I think that I've been spelling the word "Fahrenheit" wrong my entire life, up until right this moment, when I looked it up. Who knew there was that extra "H" in there? FaHrenheit. Huh.
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