aloha

We'll be leaving for Hawaii in the morning. We're packed. The dog is all set to be dropped off at the Spa for a week of tennis and Pilates. We have snacks and books picked out for our flight. (My books are fiction. Joe has unbelievably chosen to bring an ophthalmology textbook and a stack of journal articles. Who is this man?) Our boarding passes are printed out. As of the time this post is being written, ATA is bankrupt but still continues to fly. Ghetto-ass airline, next time we're flying Jet Blue. Hello, Direct TV. Does Jet Blue even fly to Hawaii?

This will be our first vacation together since we got married a year and a half ago. Gee, time flies when you're being a working drone. Full trip report and photos when we get back.

New on the photo project: Autumn in Central Park part 1 and part 2. I'm glad I had my camera because when February rolls around and the park is all grey and icy and inhospitable, I'm going to look at those pictures and not be able to believe that it was every so gorgeous out there. Until next fall, that is.

Currently reading: Nothing at the moment because I'm saving all of my books for the plane. But here's what I'm bringing with me:

• "The Corrections" (which I've hoarded and forced myself not to read up until now because you guys told me it was Tony the Tiger grrrr-eat! travel reading)

• "Memoirs of a Geisha" (purely a bookstore drive-by impulse buy, because I'd heard of the title, and I figured I should read it before they make the movie and ruin it for me)

• "The Stories of John Cheever" (because if I keep picking at this thing, story by story, I'll finally read the whole thing)

• "A Widow for One Year" (because I have to read one John Irving book every time I'm on vacation, even if it's the same one over and over again--"The Cider House Rules", I'm looking at you)

• "Magical Thinking" (because I have this strange thing with Augusten Burroughs, where I think he's an egomaniac and not even an especially brilliant writer--like, hello poor man's David Sedaris, I could totally write a book like yours, except for the whole psychotic-upbringing-homosexual-alcoholic thing--and yet I voraciously devour every single thing he's ever written. Dammit.)

autumn in new york

Our Tevas came! And lo, they are ugly, like giant rubber rafts. But comfortable. And on sale. So what are you going to do? Wear stilettos hiking up a cliff just for style points?

I had some administrative duties that to take care of up at the hospital that consumed most of my day, but afterwards, I got off the train early and took a little walk through Central Park. It was one of those amazing New York fall days, I felt like I was strolling through the set of a Woody Allen movie. Maybe even the one with all the singing and dancing. Or at the very least, I was walking through the set of "You've Got Mail." Either way, it was a gorgeous day out, if such things can be judged purely by the density of identical Chinese brides running about the park with their wedding photography crews in tow, shooting as many rolls of film as possible before the sun decided to pack it in for the day. I'm glad our wedding photographer didn't make us peek out coyly from behind a tree or some such nonsense.

But speaking of lame photography, not to be too fucking precious or anything like that, but thought you might enjoy pictures of Cooper playing with a ball of yarn. I know, I know. Because she is a cat. And because I am Jean Teasdale. (Click on the thumbnails to make the little pictures big.)

New on the photo project: First Avenue at night.

Currently reading: Re-reading "Box Office Poison" because it's good like that.

hello hawaii

Now that the Boards are over, I have to start getting ready for ur trip to Hawaii. Specifically, here are some issues that I'm thinking about.

• Packing. Seems like it would be easy enough, but since we're flying scary ghetto ATA, the company that notoriously fucked up our flight from LA, I don't really trust them all that much and, given that we have not one but two layovers en route to Honolulu, I would prefer to only bring a carry-on and handle the transfer of my own luggage, thanks. I think it can be done. Once I packed just a carry-on for a two week road trip. I never even had to wear the same shirt twice. (Well, it was summertime, so the clothing was less bulky.)

• Activities. We decided that we're going to do this day trip to Wailua Falls with a group, because, according to our book, it's notoriously difficult to be able to kayak up to these particular falls without a guide (though apparently more for reasons of lucre than safety). Which leads me to worries that I'm going to wimp out on the kayak ride and not be able to propel our vessel through the water, especially during the leg when we'll be paddling into the headwinds. But then again, maybe there'll be two-person kayaks and Joe can be the motor man, and I'll just supervise and yell at him to go faster like a coxswain.

• Shoes. When we made reservations for the trip to the falls, the person on the other end of the phone suggested that we bring Tevas or "water socks" or some other form of high-traction hydrophilic footwear. I do not have any Tevas. Honestly, I never wanted Tevas, because girlfriend, they ugly. And don't get me started on "water socks." I don't know what those are supposed to be--maybe those little footie things that surfers wear for traction?--but how durable can they be if they're called socks? What if I step on a nail? (Yes, we'll be out in the rainforest, but maybe someone was trying to build a little fort out there and left some pile of nails for me, like a booby trap.) Of course, the reservation lady said,the other option is that we could just rent a pair of Tevas or water socks for the day. Which is just--no. Tinea pedis, lady. So I caved and got us each a pair of cut-rate Tevas from some bargain basement shoe warehouse. What I saved on the sale price I made up for by requesting next day delivery, because we're leaving for Hawaii on Saturday morning, and I have no use for those ugly-ass shoes except on this trip.

• DVT prophylaxis. Due to the length of this flight, let's just say I'm concerned. But maybe I'm just paranoid because once I saw a woman visiting New York from London who developed a DVT on her way over and had to spend her whole vacation in the hospital. To understate rather hugely, that would be terrible. It would be like that commercial for Immodium AD, where the family goes to Hawaii but then they were sad because they were "all stuck in the room with diarrhea." Only worse.

Yesterday night I went out to practice some night-shots with my camera, what with the long exposure time and futzing with the aperture and whatnot. I figured it was as good a time as any, since the night was mild, and I don't want to be standing out in the freezing cold in the middle of the night later in the year trying to figure out how to use the damn tripod. So I walked around the neighborhood, and over to Bellevue, where there's a lot of glass and light and construction and fun stuff like that. The problem with shooting over at Bellevue is that there are a lot of borderline psych cases skulking around. Of the paranoid variety. I couldn't have shot pictures of people if I tried--with the longer exposure times, basically anything that moved at all would have been a giant blur--but there was this one woman (who I'll describe as a little bit "off") walking by as I was looking through my viewfinder at the building above, and she was convinced that I was taking her picture. And it was all scary, because she had a lot of plastic bags with her, and I didn't know if there was maybe something pointy in one of them, like a shiv with my name on it.

LADY
(Kind of menacing)
Why did you take my picture?

MICHELLE
(Flustered)
Oh, I didn't take--I was just looking through--I didn't take your picture.

LADY
(Louder)
Why are you taking my picture?

MICHELLE
I swear to you, I didn't take your picture. I'm just practicing with my camera, taking pictures of buildings at night. I promise you. No pictures of you.

LADY
Why did I see a light?

MICHELLE
The camera does that. There's a light that goes on when I focus. But I didn't take your picture. No pictures.

LADY
No pictures.

MICHELLE
Right.

LADY
(Suddenly cheerful)
OK, bye!

Note to self: stay away from Bellevue at night. Either that, or wear scrubs the next time so I blend a little more.

New on the photo project: Walking home from midtown, after the Boards yesterday.

Currently reading: A PICU handout about analgesia and sedation for my project.

step off

The second day of testing wasn't so bad, aside from the fact that my start time was delayed almost an hour because of some problems with the computer and "the files" that were supposed to be sent from "the main office." (That's just what they told me, I have no idea what it meant). So now I'm free to enjoy the rest of my elective time, and to actually put some work into this Web Based Curriculum thing that I said I was going to tweak. Right after I take a nap. And have a snack. And then take another nap.

New on the photo project: The Third Avenue street fair this Sunday. (Here's some more background on street fairs from ye olde archives, if you're interested.)

Currently watching: "Angels in America: Perestroika" I watched the first part, "Millenium Approaches," last night. I had read the play about a year ago, but there's something about seeing it acted out that makes it so much better. I don't know, maybe that means I don't have a very good imagination. Funny how it seems like Mary Louise Parker is always playing these sort of unhinged types, like in "Proof." She's like the Jennifer Jason Leigh of the theater. Or the Ally Sheedy, only, you know, successful. And who is that guy who plays Joe, the closeted Morman? He's dreamy. But what's with those weird undershirts with a seam down the front? Is that some sort of relic of the 80's that I don't know about? Maybe it's supposed to be a Morman thing.

one day down, one to go

I walked out of One Penn Plaza (my most hated of Plazas, by the way, tainted after two previous Boards sessions there during my formative years) at 1:30 this afternoon, having finished the first day of testing for Step 3. I chose to employ the Au Strategem for the USMLE, and that is to take the test as quickly as humanly possible. Seriously, just crank it. It's just too painful to linger over that many multiple choice questions, scrutinizing and pondering each one, thinking, "Well, are they asking this? Or are they asking this? Hmm, so many ways to interpret this question." Life's too short, sister. Don't know the answer? You're not gonna know it, no matter how long you sit and stare at that screen. Just click click click, and move on.

The good thing about taking the test quickly is you end up with a lot of time for breaks. So, also in keeping with the Au Strategem, I took a leisurely lunch break in repose with a cup of soup and a trashy magazine. For Step 2, I believe I had pasta and read "Jane Magazine." (This is before I started to boycott "Jane," because despite my former loyalties for "Sassy," I could not continue to turn a blind eye to the fact that Jane was suckola.) Today, it was "In Touch Magazine," who wants us all to know that MARY-KATE IS IN TROUBLE AGAIN!!!! Because of the anorexia, you know. Part of me is thinking, "Oh media vultures, you should just leave that poor girl alone." And yet another part of me is thinking, "Wait, what page was that article on?" Such a dilemma.

There were some technical hitches with my test-taking experience today that I'd like to mention. The first was my own neurosis. The test was scheduled to begin at 8:30am, but the testing center requested that you get in by 8:00am. Which, to me, says "Get in by 7:30am." Factor in an early exodus from the apartment, because Joe was giving me a ride on his way in to work, and I landed on the shores of One Penn Plaza at 7:00am. An hour and a half before the test was scheduled to begin. And therefore making me officially insane. Yar, whar's me Paxil? The testing center didn't even open it's doors until 7:30am. Luckily, there was a Duane Reade down the block, and I skulked around in there for a while, killing time and buying gum and water and all manner of test site contraband. Also, once the doors actually did open, they let me start my test early, even before 8:00am. So that worked out OK.

The second hitch was with the lockers. See, they give you these lockers at the testing site in which to stuff all of your crap for the day. The thing is that I'd never taken the Boards during cold weather before. I took Steps 1 and 2 in June of 2001 and 2002 respectively. It was 80 degrees out, so I didn't really have much of anything to put in my locker those times around. Today, though, I had my bag (stuffed with my camera and the aforementioned contraband) and my big winter jacket. The locker is roughly the size of a bowling ball. And no amount of jacket folding or bag-rearranging was going to make it all fit. (You think I would have learned this from premed physics by now, no-two-objects-can-exist-at-the-same-point-in-space and all that.) So I actually had to go back to the front desk and ask for a key to a bigger locker. Mister Front Desk Guy was very smiley and accomodating to my problems, but a little bit in a weird way, like a Stepford Wife. He's a Prometric Wife.

So anyway, that's done. The crappy thing is that, unlike Steps 1 and 2 of the Boards, I actually have to go back tomorrow and finish the job. Such tedium. I guess I'll need to find another magazine.

New on the photo project: Zabar's, Sunday morning. (And, for the uninitiated, what is Zabar's?)

Currently reading: "The Rule of Four." Also working through the election issue of "The New Yorker," but I'm getting all stressed out thinking about the election and what it could mean, especially with Rehnquist laid up in the hospital now.

memorial

Today was the memorial service for Dr. Miller. It took place in a synagogue on West End Avenue and it was absolutely packed, standing room only. I feel like everyone I'd ever met in my entire life was at this memorial, that's how many people came to pay their respect. The service was tremendously sad and hard for everyone, particularly tragic in that this was the loss of a young man, a husband and a father to young children, in the face of a horrible and unexpected death. How could we lose someone so loved, so needed? The senselessness and incredible waste of it all has me dull with shock. He was 46 years old, and he left us too soon.

In some ways, he was like a superhero. And I don't mean that in the ambiguous "that man was a hero" sense, because that word is so overused these days I'm not even really sure what it means anymore. I mean to say that he was like a larger than life character, a constant presence, a force. Say his name to any med student, and everyone can conjure up their own image of him, expressions, mannerisms and all. He even dressed the same way every day, it seemed. That same baggy blue denim shirt, those khaki pants, that maroon tie. It was like his uniform. I used to joke that he was like Charlie Brown, and that if you opened up his closet, you'd just see row after row of identical shirts and pants. Maybe it made it easier to get out the door in the morning, not to have to worry too much about what to wear.

His stories had a way of becoming our stories. It's like we adopted him into our family or something. He once told us a story from his med school days, when he was on call during his surgical rotation and looking a little worse for the wear. So much so that one of the patients that he'd been taking care of that week told him (this part of the story he relayed in an African accent), "Steve, you look like a bush man!" We laughed. And then, a week or two later, he told the story again. We laughed again. And then he told it again, exactly like the first time, with the same setup and punchline. And again. At this point, we were all looking at each other, like, "Did he forget that he told us this story already? Three times?" Yet, years later, I'm still using his story. So are other people. Just the other day, when I was looking a little rumpled, Joe looked and me and, without missing a beat, told me, "Steve, you look like a bush man!" And I laughed again.

As med students, we loved him because he was one of us. And we miss him now because we know how much he cared about us too. It's a tragic, senseless, inconceivable loss for all of us, and my heart goes out to his family and those who knew him best.

New on the photo project: Chinatown, part 2 of 2

Currently reading: An article in from last Thursday's New York Newsday about Dr. Miller.
Trying to finish "The Rule of Four" before Hawaii. Also going through the Clinical Case Simulations in preparation for the Boards. What would happen, I wonder, if you typed in something completely nonsensical, like "Stick monkeys up the patient's butt"? Would the computer explode?

four more years

It occurs to me that I've now been writing The Underwear Drawer for almost four years now. Four years. Sounds like a long time when you say it like that. Back when I started, I was a newly minted second-year medical student looking for a creative outlet and distraction from studying for her Immunology final. And look at me now. A second-year resident looking for a creative outlet and distraction for studying for her Boards. I'm so pleased at the lack of progress I've made.

When I started The Underwear Drawer (which I still refer to as an "online journal," though it seems that the term "blog" seems to have come into vogue in the intervening years), there really weren't that many medical blogs out there. I personally didn't know of any back then, but you know, it's not like I was out there combing every single corner of the internet or anything like that. The sites that inspired me were largely kept up by writers or artists of one type or another, like Nikol at "Disgruntled Housewife", Gwen at the formerly entitled "How to be a Trailer Trash Housewife" and Pam at the formerly entitled "Squishy". Keeping an online journal seemed like a fun thing to do, and I missed my college writing habit from the days that I had a weekly humor-ish column in the Wellesley News. I was taken with the idea of using a different part of my brain that I was using in med school--that being the part of the brain that memorizes at which levels various spinal tracts decussate--and I liked the idea of having some sort of public accountability to keep up with the site, so that I couldn't just get lazy and drop it without having people e-mailing and giving me a hard time.

I don't really think of The Underwear Drawer as a "medical blog" per se, rather the online journal of someone who happens to work in medicine. Certainly I talk about things outside of medicine just as often as I talk about the hospital or work stories or what have you. But I guess there's no way of getting around the fact that as a doctor, medicine is a central part of your existence, the echos of which reverberate through the other compartments of your life whether you want them to or not. People talk about keeping their home lives and work lives separate, but I don't think the boundaries are always that clear. Especially when you're married to another doctor. Why, that's twice the lawsuits! (Kidding. Haven't been sued. Yet.)

I didn't really realize it until less than a year ago, but medical blogs have become a huge phenomenon. Well, I guess the practice of blogging in general has really taken off, but the medical sector seems like a popular niche market. I have to play ignorant on this subject, because I'm really not all that up on internet communities in general (meaning I don't really actively promote my site, or network with others, or have little snippy gang wars or whatever it is that people do when internet rivalries form), but it seems to me like a good thing, both the demystification of the medical process for the layperson, and the camaraderie of people going through difficult things together. It's just kind of funny, because now I find myself in a community that sort of sprung up around me without my realizing it, like Willy Loman's little house in the shadow of all these huge buildings.

* * *

Went down to Chinatown today for a change of scene and to grab some lunch. I'm always amazed at how cheap the food is in Chinatown. You can get a sandwich (or the Chinese variant, a bun stuffed with meat and vegetables) for $1.50 down there. Good luck getting full on $1.50 in any other part of Manhattan. I had a bowl of noodles and walked around. It's not exactly the least stressful place to take a constitutional--the streets were packed with locals and tourists and fishmongers and knockoff bag/pirate DVD/baby turtle vendors--but I did take some pictures that are up on the photo project page.

Did I mention, by the way, that I got a new camera? I did. It was a present to myself, and I love it. Thanks, me! It's a low-end digital SLR, the Nikon D70, and I'm just starting to acquaint myself with it by basically carrying it everywhere and learning by trial and error. I'm used to using either a regular SLR or a regular digital point-and-shoot, so I have to get used to the settings and buttons and whatnot. Funny thing about having a big camera, everyone is instantly suspicious. Especially in Chinatown. Maybe they thought I was with INS or something.

New on the photo project: Chinatown, part 1 of 2

Currently reading: Finishing up "The Secret Life of the Lonely Doll". This book is very Lifetime Television for Women. In fact, don't be surprised if Lifetime buys the rights, and then makes it into a two-part television movie starring Judith Light.

sorry, kids

My clinic official ran out of our last dose of flu vaccine today. It's only the middle of October, for chrissake. Oh, it's going to be a long winter. Bring on the Tamiflu. After I heard that our meager supply had already been tapped, I had to go out to the waiting room and tell my patients, two asthmatic brothers, that I was sorry but they wouldn't be getting the flu shot after all. The kids were psyched to hear it, high-fiving and the like, but the mom, not so much.

Whenever I tell people that I'm studying for Step 3 of the Boards, everyone who's already taken the test feigns disbelief. "You're actually studying for Step 3? Don't study! You'll totally pass! Don't worry about it! If I could pass, you'll definitely pass." Which defines the crucial difference between those who have taken the exam and those who have yet to. Those who already passed have the luxury of saying what a cakewalk it was in retrospect. Those who have yet to take the exam, like me, have to at least on some level assume that it's going to be hard, just out of humility or for self-presevation. And if for no other reason, I'm studying because I do not have another $600 to fork over to NBME in the event that I have to take that fucker again.

New on the photo project: To Inwood and back.

Currently reading: A little bit of "Blackwell," a little bit of "Q Bank." Hmm. Q Bank. Q fever. Coxiella burnetii. Do I really need to know all this stuff?

good grief

People grieve in different ways. You see this especially clearly in the wake of a tragedy. Some people grieve mightily, volcanically, with sadness and anger and regret issuing forth like a painful eruption. And some people grieve internally but visibly, like and explosion locked in plexi-glass. Some people find solace in the grieving process itself, the mourning process itself a catharsis. And other people don't even know that they're greving, but find little painful reminders of tragedy throughout the course of their normal day, like bleeding from a thousand little papercuts.

I many shades in the spectrum of grieving today, from the somewhat detached grief of someone feeling pain for a family without a father and an institution without a leader; to those who tried to get through their workday with a thin layer of normalcy overlying the constant tears just beneath the surface. I was probably somewhere in the middle. I like to choose the time and place and company of my grief, and so I was trying to get through my day as routinely as possible. And yet it was impossible to get away from it. It was like living in the tropics. Clear skies, but at any given moment, the threat of a storm.

I was in the hospital today, covering a shift in the NICU, and after work, I went to a medical student gathering in rememberance of Dr. Miller. It was a solemn affair, with a lot of silent reflection and private grief. Some students spoke briefly at the podium at the front of the lecture hall, most sat with their heads bowed and remembered. It was very quiet. I couldn't help but to envision how Dr. Miller would have run the grievance session had he been there. Knowing him, he probably would have asked us to break into small groups and talk to each other about how we were feeling, then to come together again in the end and share what we had discussed. He gave a lot of lectures to large audiences, but he was really a small group kind of guy. He liked the intimacy, the sharing that it allowed.

After work, there was an informal gathering of Peds residents at Jason's apartment in Chelsea. I think we all just wanted the company of people to whom we didn't have to explain too much. And it was a good time. We had wine and pizza and gelato, and talked about lots of things. Sometimes the conversation turned to Dr. Miller and the tragedy. And sometimes we talked about other things, like hospital gossip, or the upcoming election, or the latest rivalries on "America's Next Top Model." It was lovely and comforting to be together with people who were there and understood, even without you having to say very much at all.

Currently reading: "The Secret Life of the Lonely Doll." Maybe a little tawdry, but sort of gothic and spooky as biographies go.

dr. miller

I just got an e-mail from my Chiefs that Dr. Steve Miller is presumed dead, after the plane that he was taking en route to a medical conference crashed in Missouri this morning. I am beyond shock.

In fact, I don't even quite want to believe it. Right now, I'm reading over the news reports on CNN, kind of dazed, and see that there are still five passengers unaccounted for at the crash site. Five passengers. There were two survivors, after all. What if I write this, and we all start talking like he died, and he comes into Grand Rounds next week with a little bandage on his head like in the cartoons, smiling and telling us what a horrible misunderstanding it all was, and say in that that deadpan way of his, hey, I'm a pretty lucky guy, huh? That's the story I would like to believe. But I know it's not the truth.

Dr. Miller was the head of the Pediatric Emergency Room at our hospital, but more importantly for med students, he was the head of the third-year Pediatrics clerkship. He organized the curriculum, told us where to go and what to do, and above all, talked to us about a number of topics both Pediatric and professional. And oh, could that man talk. Sometimes, at 6:30pm on a Friday afternoon in that stiflingly hot lecture room with no windows, we really felt like he was earning his money.

When I first met Dr. Miller my first year of med school, he was the preceptor of my Clinical Practice small group, and I thought he was just about the greatest doctor I'd ever met. So sensitive, so patient, so funny. And so absolutely committed to med student education. We could just listen to him talk for hours. We did listen to him talk for hours. And we learned. He was one of my composite ideal doctors, one of the doctors like Dr. Garvey who I met early on in my medical career and idolized them all "Single White Female," biting their style. Even to this day, I find pieces of Dr. Miller falling out of me, in the way that I approach patients or talk to parents.

Dr. Miller had a way of teaching that was insidiously appropriate for his audience. He taught med students, so his method for teaching was repetition. I've known Dr. Miller for--what, five and a half years now?--and I must have heard him give the same handful of lecture at least seven or eight times. He would just go over it and go over it and go OVER it. I used to joke that it was like he popped a tape in. Initiate Miller Lecture 501B: "Professional Decorum" And then the tape would play. He would always say that he wanted certain approaches and behaviors ingrained in the very fiber of our being, like an automatism, and that's why he would repeat things so many times. So we would learn it good.

And hot damn, it worked. Just a month ago, I had to call a parent at home because their sick child was very unstable, to the point that we thought she might die sooner rather than later, and we wanted those parents to get in now. It was not a comfortable conversation to have over the phone, honestly not an exchange that I'd ever had to have before, so I wasn't quite sure how to approach it. The funny thing is, the second I started talking, it was like I popped in Miller Lecture 423G: "Delivering Bad News" and suddenly I was calm as could be. I told the parents that their child was very ill ("Set them up for the news."). I told them that right now, her blood pressure was dropping despite the medicines we were giving her ("Try to avoid jargon"), that this was a life or death situation ("Don't be afraid to use the 'D' word, they need to hear it to understand") and that and despite all our best efforts, their child might die ("Say the 'D' word again, in case they didn't hear it the first time"). It was so strange in that moment, like having a little Dr. Miller on my shoulder, feeding me my lines. Strange, and comforting.

Many of us, students and residents both, felt that he worked too hard. He was like some mysterious holdover from the workaholic 1980's, just completely overextended. There wasn't a med school committee he wasn't some way involved in, not a single residency meeting about the medical student education he didn't run or help organize. Sometimes we got impatient with him because he was so busy--he was always off to his next meeting, it seemed. You could catch him for five minutes here or three minutes there, but there was always more to do, always somewhere to be. Why couldn't he just slow down? Do a little less? Now I understand. The man had a lot of life works to accomplish. He just didn't, in the end, have a lot of time.

Thank you, Dr. Miller. We'll miss you.

tick tick tick

The problem with being the sick-call resident is that you feel constantly on edge, as though you're sitting on a time bomb. You want to make plans for your day, or for your week, but there's always that threat of being called in. I don't mind being on call in general, I just need to be mentally prepared for it. I like to see it on my calendar weeks in advance, so that I can see the call approaching, like a train, or a charging bull. Subbing in on short notice fills me with dread and anxiety. There's something indecent about being called at home and told to come into work when you're not really scheduled to be there. It's like having the long arm of the hospital sneakily infiltrating my home and dragging me to work in my pajamas.

On a separate topic, I have decided to keep a separate page for random photo projects that fall outside the narrative of the daily entries. That way, people can look at the pictures if they want, but won't have to suffer through them if they don't. Because the last thing I want to become is one of those people who are all, oh my word, I'm ever so artistic, look at me, I took a picture of a LEAF. Hey, I took that high school photography class too, so I know the pain of demonstrative self-indulgence. But at the same time, hey, photography is fun, and I'm starting to pick it up again, so if you want to take a look at what I'm shooting, by all means. There's a link to the photo project page on the sidebar, and I will let you know when I post anything new up there.

Yeah.

Currently reading: OK, I have to admit, despite the adage of "2 months, 2 weeks, number 2 pencil" (the conventional wisdom for how much you should study for Steps 1, 2 and 3 of the Boards, respectively--obviously, the pencil reference was a remnant of the bubble sheet days of the Boards; can you imagine the horror of a two day bubble sheet exam?) I have caved and gone back to the method that worked best for me on Steps 1 and 2. Thanks right, good old Q Bank. I know, I know. But in a staring contest with the NBME, I blinked. I just need something more active to engage me in my studying than just reading alone. And I need to build up my stamina. Eye of the tiger!

behold, i have a camera

I took some photos walking through my neighborhood the other day. Not to glamourize my ability to point and shoot or anything like that. The even more unglamorous part of this story is that I was walking to Teriyaki Boy for lunch. It's the Wendy's of Japanese food. But it's still Japanese food.

The other reason for my posting the photos, pseudo-artistry aside, is that I wanted to try this new photo-posting service that I found online. See how nice, you can click on the thumbnails to see the big version pop up. So clever, and so handy. Thanks, technocrats!

Today I had a meeting with my advisor for the elective I'm working on this month. In brief, I'm going to be tuning up a didactic on pain-management and sedation for the program's "Web-Based Curriculum." Read: I'm going to be doing some advance-reading for anesthesia. So anyway, I was supposed to meet with this attending to go over my project. So I packed myself up and went all the way uptown to his office. The hospital is an hour away by public transportation. Did I mention it was raining? Well it was. And when I finally got to his office, the attending wasn't there. So I paged him.

MICHELLE
(Over the phone)
Hi, [attending]? I'm here. We were supposed to meet?

ATTENDING
Oh yeah! I forgot that I loaned out my office for some other meeting. I'm actually not even in the hospital right now.

MICHELLE
Yeah, but...I am.

ATTENDING
Well, do you know what you want to work on for your elective?

MICHELLE
Yeah, I thought I might tune up the Pain Management didactic. I have some ideas about adding a section about sedation...

ATTENDING
Great! E-mail me your work when you're done, and I'll look it over! Gotta go!
(Hangs up)

And then the one hour commute back home. In the rain. With no umbrella. Well, that was a pointless trip uptown. If I had know that would be the extent of the "meeting," I would have just called him from home. I do have a phone here. (Incidentally, I also have an umbrella, but I seem to have some pathalogic inability to bring it out with me, even when I know it's raining.)

Adding to my growing list of Old People Medical Terms I Haven't Heard Since Med School (OPMTIHHSMS): Polymyalgia rheumatica. Waldenstroms hypergammaglobulinemia. Plain-old prostate cancer. Ah, the amazing ability of the human brain to forget.

Currently reading: "Blackwell's Underground Clinical Vignettes, Clinical Science Color Atlas." Mmm, gory.

this one's for the geezers

In studying for Step 3, I'm encountering a lot of phrases that I haven't heard in a long time. Phrases like, "unstable angina," "temporal arteritis," and "87 year-old man." What, there are 87 year-old men now? Who knew? I guess aside from doing a Family Medicine internship or some sort of transitional year, everyone is going to have their knowledge gap when going into Step 3. Medicine people are going to have a hard time remembering Peds. OB-Gyn residents are going to have a hard time remembering men. And Surgery residents are going to have a hard time remembering patients. (Ha! I kid. I kid because I love.)

Aside from reminding myself about statins and such, I've been enjoying my time semi-off. After consuming more food than the human stomach can possibly hold at Curry in a Hurry Saturday night, we ended up going with the economical option of renting from Blockbusters rather than going to see "Friday Night Lights." So we rented "The Bourne Identity," mostly to fill in the gaps outstanding in our understanding of "The Bourne Supremacy." I guess we watched them backwards. But it didn't really matter anyway. The movie was appropriately Euro-travelogue and exciting, and Matt Damon was handsome and emotionally wounded. I think that he has effectively put to rest the issue of "Who wins? Matt Damon or Ben Affleck?" I think we can sum this up by just looking at each entrant's Christmas 2005 selection. "Ocean's Twelve" vs. (cough) "Surviving Christmas." Thank you, and good night.

Since I'm on sick-call as well as being on elective, I actually got pulled this afternoon to cover for a short-staffed cardiology team while one of the first-years was in clinic. So I played intern for the day. Which blew, because being an intern kind of sucks, even if you're just filling in. But there was something very liberating about knowing that I was just there for one day. Liberating, yet at the same time unsatisfying, to follow patients for one day only. It's kind of like working in the ER--after you do all that work, you're curious about what happens next.

Currently reading: My old med school pharmacology notes. Ah, it's all coming back to me. Kind of.

studying, kind of

Man, when was the last time I had to really study for something? Probably two and a half years ago, when I crammed for a week before taking Step 2 of the Boards. I just don't think I have that kind of discipline anymore, to sit down for long stretches of time and just study. I'm looking back over some of my med school notes and I just can't believe I ever knew so much stuff. I wonder if, had I taken Step 3 two years ago, I would do better than I'm going to do now. Sure, I didn't have the practical knowledge base that I have now, but I knew pathophysiology and pharmacology and obscure syndromes up the yin-yang.

Well, the countdown is on. I take Step 3 next Monday, which means I have one week to whip this old brain into shape. (Cue "Rocky" theme. Yes, there's my brain jumping up and down on the steps of the Philadelphia Museum of Art.)

Currently reading: "Blackwell's Underground Clinical Vignettes, Internal Medicine, Vol. 1." My study philosophy is simple, and that is remind myself that there are adult patients in this world.

lips together, teeth apart

Now that I'm finished with my month in the PICU, I'm on two weeks of elective, and as such, I'm electing to not do much of anything. That said, I already know that as sick call resident, I'm getting pulled to cover the cardiology and NICU services two days next week, and of course there's that little matter of Step 3 of the Boards to attend to. But I still have a whole week to study for that. A whole week to study and realize that I'm stupid and get panicky and perhaps impulsively defer my Boards date for a later date. I hope not, though.

When I got home from call this morning, I saw a stack of photos on my desk, taken at my cousin's wedding last month. I guess my dad finally got around to sending them to us. Looking at the photos, I was reminded of one thing. I mean, aside from the fact that the wedding was beautiful and all that. I realized that I don't know how to smile with teeth.




Look at everyone else with their toothy photo-smiles. And then look at me. I can't do it. I don't know how. The only photos of me with teeth are ones taken while I'm actually laughing or talking to someone. But smiling with teeth without an inciting stimulus, I cannot do. Neither, apparently, can my dad, which only further substatiates the theory that WE ARE CLONES.




Look at me in these photos. I barely even look happy. It's like I'm trying to pull my face into the rictus of a smile, but all I can accomplish really is stretching out my cheeks and adopting a generally benign, pleasant expression. But how does one smile naturally for the camera? I just don't know. I've tried (embarrassingly) practicing in front of the mirror, and all I do is scare myself. The closest I can manage is the look of a scary clown, with a toothy not-quite-right mouth and non-smiling eyes. I don't think I could have been a cheerleader. I mean, due to the inability to smile spontaneously and the general lack of athleticism.

I read a review for "Friday Night Lights," and I guess it looks more interesting than I had assumed at first glance. I thought it was going to be like "Miracle," except without Aerosmith on the soundtrack. So maybe we'll grab some Indian food and catch a late show tonight. At least it's better than "Ladder 49" or some such drivel.

Currently reading: OK, I have to admit that I put "The Fortress of Solitude" on hold for now, but mainly because it's a paperback and therefore appropriate for airplane reading. No, I did not give up, shut up. So I'm currently working through "The Rule of Four," which is both on loan from my dad, and in hardcover.

post-clinic call

Thanks to Jenn for translating my shirt! Now I know that it is not about child molestation, rather about martial arts and kicking ass. And now I can actually wear it out of the house without an obscuring pullover.

I have clinic all day today but am on call tonight. My last PICU call. Kids, just stay alive for twelve more hours, that's all I'm asking you.

That "Inconsiderate Cell Phone Man" jingle keeps running through my head. You know the one they play at the movies before the previews? "Marty, you're a joker!" I love that commercial. I must have seen it 20 times by now, and I still laugh every time at that line. I may actually be seeing the commercial for the 21st time this weekend, because Joe really wants to see this new movie "Friday Night Lights," which I'm not overly enthused about because 1.) Um...football, and 2.) creepy Billy Bob Thorton, but I am willing to make a spousal concession.

Currently reading: "The Fortress of Solitude." Is this book supposed to get good at some point? This book irks me a little in that I get this feeling that the author is one of those nouveau Brooklyn bohemes that think they're too cool for school. But I will keep reading and give it some more time to take.

read my shirt

At reader request, my Japanese t-shirt:




I bought it during a trip to Japan in 2001 because it looked like a spoof of a soft drink with which I was obsessed. Hooray for Qoo!

I highly suspect that my t-shirt says dirty things on it, however, because the guy on it looks like a child molester, and they symbol on it is a clenched fist that looks suspiciously like some obscene gesture. Also, what is that guy saying? "One two three something something something"? Counting the number of CHILDREN HE MOLESTED maybe? I don't know. I know the text is a little blurry, but help me out people. Tell me what my shirt says.

Currently watching: The last of the three presidential debates. Did anyone else see that they were wearing the same tie?

parental guidance

After a couple of back-to-back months in the ER, NICU and PICU, I think that there should be a level of processing in the core lab above what is currently accepted as "stat." Because to be frank, "stat" is not really "stat." Call it "pseudo-stat." You send your labs to the stat lab from the ICU, and two hours later, maybe, you get the results back. What kind of stat is that? The problem is that if you don't send your labs "stat," they take even longer, up to 6 hours to come back. So then everyone abuses the stat system, sending labs stat that don't need to be stat, and then the stat lab gets all backed up, and all the real stat bloods get lost in the mix. So we need a priority system above stat. Call it "super stat" or "mega stat" or (more accurately) "real stat." Then maybe I can finally get the coags and CBC back on my patient whose ENTIRE MATTRESS IS SOAKED IN BLOOD.

I was on call last night.

But anyway...

We had a good time when Joe's parents were in town, and were surprisingly not really all that worn out at the end of the weekend as we feared we'd be. It was one of those low-key tourist weekends. Except I ate so much that I think the staples from my gastric bypass surgery are ripping out.






I think that Joe's parents were very good sports about going out for Dim Sum, though they are occasionally wary about new foods. I even think they kind of liked it in the end, though you can't tell from Joe's dad's face as he eyes this bowl of steaming tripe and turnips.






Afterwards, we set off down to Little Italy to get some sausage for dinner. Everyone said the butcher shop smelled good, but I was kind of skeeved by the cured meats and cheese hanging from the ceiling. But who am I to talk? I ate the dim sum tripe.




Joe's dad collects baseball hats. Here he is minimizing his chance of getting beat up at the border of two neighborhoods, wearing one hat from the Chinatown Ice Cream Factory and one hat that says "Little Italy NYC." Or maybe that's maximizing his chance of getting beat up.






Here are the two families enjoying a big Italian dinner courtesy of Joe's parents. My dad was helping out Joe's dad in the kitchen. People say I look like my dad. If by "look like" you mean "am a total clone of".






The next morning at brunch. We went to a nice restaurant in Greenwich village managed by a neighbor from down the block. He was actually working that day, and the ultimate in New York hospitality, giving us special attention and free desserts. I was really hot sitting in that patch of sun but didn't want to take off my sweater, because underneath I was wearing this T-shirt that I got in Japan that I highly suspect has some obscene writing on it. Suspect, but cannot confirm, because I can't read Japanese. So I sweated it out.


Three more days in the PICU, and one more call. It's been a good time, but I think I'm ready for my month of elective and vacation. I want to take a little break from the hospital to live my life. I want to work on my comics, organize the house, maybe pick up photography again, even though I'm not quite sure it's a hobby that I can afford. Of course, getting a digital SLR means saving on film costs, but oh, the startup costs are high. And do I really want to be another faux-artsy girl, wandering the streets with my camera and taking "profound" pictures of trash in the gutter or pretty pretty flowers?

Currently reading: "The Fortress of Solitude." I'm having kind of a hard time getting into this book.

out-of-towners

Joe's parents are arriving tonight for a weekend visit to New York. I have a great relationship with "the in-laws," even though it sounds funny to call them that, like something out of some middle-class sitcom starring Ray Romano or some such thing. We have some tentative plans for the weekend, including such touristy activities as going to the top of the Empire State Building tomorrow night, and a walking tour through Chinatown and Little Italy on Saturday. Saturday evening, Joe's parents (who are Italian) are making some sort of gigantic pasta dinner, and my parents are coming over to partake in the goodness. Chinese and Italian people living in harmony. How very Marco Polo.

In other out-of-towner news, there's a new medical student doing a PICU Sub-I, visiting New York from the midwest. This medical student took his first call in tandem with me last night. Now, I'm a sympathetic person, and was a medical student myself just a year and a half ago. I know it's hard to strike that balance between being engaged and interested and being a total stalker. I've precepted my share of med students and enjoyed working with most of them. But sometimes, sometimes, it's just really annoying to have a med student on your tail.

I just need a little space, man. I mean, you're a 4th year med student, one less than a year away from internship, I think it's time to learn to work independently. Fly out of the nest, little bird! Do you really have to be right at my shoulder as I'm checking patient labs? As I scroll through vitals? As I write my notes? Don't you have your own things to do for your patients? Are you going to follow me into the bathroom too? I mean, honestly, it can't be that interesting to just follow me around for 24 hours straight. I was so relieved when he finally went to lay down on call overnight, I was afraid that his next move would be to physically crawl into my clothing so that we could be that much closer.

Currently reading: "The Ultimate Kauai Guidebook," planning the itinerary for our trip. There's this one hike that I really want to do, but I'm nervous about committing to it, because I'm not exactly the world's most outdoorsy person, and the hike is 11 miles long (if you count walking back to your car at the end of the trail). What if I wimp out or crack my damn head open and we have to get airlifted out? On the plus side, that's a free helicopter ride.

praise cheeses

I have become rather enamored of government cheese. I'm talking about that single serving shrink-wrapped cheese that comes on hospital trays, about the size and shape of two pats of butter side by side, and containing roughly the same fat content. They have a little pyre of them in the refrigerator on the PICU, runoff from the pantry, and I have been dipping into this stash every day after rounds. Slap a little government cheese on a Saltine, with another Saltine on top, and that's some good eating.

I don't steal the cheese from the trays of patients themselves, of course. Then again, maybe I just haven't been hungry enough yet.

Currently watching: The vice presidential debate. This debate is much more down and dirty than the first presidential debate. But I guess that's what happens when you have the campaign attack dogs going at each other. What kind of dogs would they be, I wonder? I think John Edwards is a Jack Russell Terrier, and Dick Cheney is a bulldog.

top shelf

Last night, for the first time, I slept on the top bunk in the resident call room. So now I know better. Always pick the bottom bunk. Here, a crude schematic:

Yes, the call rooms have bunk beds. It's Kamp Krusty. The call room is obviously small, but the niche into which the bunk bed is wedged is really small, barely larger than the bed itself. And as you can see, this creates some logistical difficulties for actually getting into the bed. Bottom bunk, fine. Just sit down and swing your legs in. Top bunk, you're crawling through a foxhole and wiggling your torso in between the bedpost ladder and the ceiling. And are you thinking of sitting up in the top bunk? Bad idea. Maybe we should put some padding up there.

Anyway, I chose of my own free will to go for the top bunk out of good old-fashioned med school guilt, feeling that if I was lucky enough to get to lie down during my night on, it should at least be as painful as possible. So I slithered into the top bunk and shut my eyes for a moment. Which brings me to my first theory about the hospital paging system, that there must be some kind of a weight-sensor on the mattresses in the resident call rooms, such that one's pager is guaranteed to go off the second one lies down to rest. (My second theory is that there is a similar pager-activating weight-sensor on the toilet seats of the staff bathrooms. But never you mind about that.) So of course, the second I lie down, the sensor is triggered, and my pager starts going off. The patient's K is 2.1. Do you want to write for a run? Do I ever. Awkwardly lower myself to the ground, check the patient, write for potassium, re-ascend the ladder, slither into bed, with much jangling of keys and ID tags and rustling of signout sheets. Another page. This kid's blood gas is going down the toilet. What do you want me to do? Suction that ETT but good and I'll be there in a minute. Another perilous descent, socked feet slipping on metal rungs, and another precarious ascent, coins and pens dropping from my being. I lie down again and one second later...This kid is starting to look a little mottled and his chest tube is putting out green mucous. Oh lord, why bother?

I did manage to get some sleep in the end, however. That's the good part. The bad part is somewhere between climbing up and slithering down for the five millionth time, I seem to have lost my stethescope. I looked everywhere for it, but it just got sucked into the void somehow. I'm sure it will turn up, but I hope sooner rather than later, as I switch sides to the cardiac ICU tomorrow, and if I need any one thing, it's probably going to be my stethescope. Well that and, like, my brain.

Currently reading: I just got some new books at Borders, ostensibly for Hawaii plane reading, but I can't resist just breaking into one. I'm deciding between "The Fortress of Solitude" and "The Corrections."

twin peaks

Yesterday in clinic played out like an avant-garde French film, or maybe like a David Lynch short. Aside from the general strangeness and chaos and circular dialogue...

MICHELLE
How often are you breastfeeding the baby?

MOM
I'm breastfeeding.

MICHELLE
Yes, but how often? How many times a day?

MOM
I breastfeed.

MICHELLE
Yes, but how many times in one day? In the morning? In the nighttime? Every two hours?

MOM
(Blankly)
Breastfeeding.

...there was just a weirdness permeating the fabric of the day. For instance, just before lunchtime, a new patient showed up unannounced, an eight year-old newly immigrated from the Dominican Republic, and our attending was asking if one of us could squeeze her into our schedule. "I don't think it's anything," our attending said, "Mom says just a school physical and some forms to be filled out. I'll even help you fill out the school form after you examine the patient." Mariah gamely agreed, and walked into the exam room where the patient and her mom were waiting.

Several minutes later, she walked back out and came up to me. In a low voice, she said, "She's a dwarf."

MICHELLE

What?

MARIAH

She's a dwarf. The patient's a dwarf.

MICHELLE

Aargh! The classic last-patient-before-lunch dupe! I knew there had to be something more! "Only a school form" my ass!

MARIAH

She's a fricking achondroplastic dwarf.

(Starts frantically flipping through Smith's)

MICHELLE

This is such a French film.

Later, I had another patient, a six year-old also fresh from the Dominican Republic, also here for "Just a school physical and shots." She was not a dwarf, my crack diagnostic skills told me right off. She just looked pretty normal. I was talking with the mom, asking her about the kid's past medical history, any prior hospitalizations, problems during pregnancy and birth. All no, no, no, nothing, nothing, nothing. So I had the kid hop up on the table and start examining her. Only when I reached over to take her wrist for pulses, I noticed that there was no wrist. Nor was there a hand or an arm. Just a gigantic plastic prosthesis.

MICHELLE
Um...what's this?

MOM
(Blithely)
Oh, she has no arm.

MICHELLE
I see that.

MOM
(Taking off the prosthesis to reveal a hypotrophic limb stump)
It was like this when she was born.

MICHELLE
Ah. You might want to mention that next time.

I suppose that's nice, that the mom was so nonplussed by her child's missing limb that she even forgot to mention it to her doctor. But Christ, a little advance warning would have been nice. I set her up with her lab tests and shots, and referred her over to our Rehabilitation department so that they could help with her prosthesis and fit her for a new one when she outgrew the current.

So between the dwarf and the girl with no arm, it was a surreal end to the week. Leaving the clinic, I half expected to see mimes playing tennis on the sidewalk or some other such thing. But instead, I saw my patient and her mom walking down the street to the subway station. They were holding hands, the little girl with her elbow bent upwards and the mom holding on to the flesh-colored prosthesis. It was cute.

Currently watching: "Seabiscuit." Not to give away the ending, but...he wins! And triumphs over adversity! Actually, I did enjoy the movie, especially the PBS-like Ken Burns narration, even if it did give the story a sense of pseudo-gravity that I'm not sure it necessarily warranted.