dinner at chinatown




Figure we might as well get it while we can.

perhaps not unlike the birth of reeses peanut butter cups

There was a patient today for which I was planning to do a saddle block, and in preparation, I took out a small ampule of hyperbaric bupivacaine (a kind of local anesthetic, like lidocaine) to use for the case.  The ampule is a glass cylinder, just about an inch long and as thin as a toddler's pinkie finger, with a hollow glass stem that can be snapped off before the drug is drawn up and administered.  They didn't stock hyperbaric bupivacaine in the OR where I was working today, so I actually walked all the way over to the cystoscopy suite, hunting through the drawers in three separate rooms until I found what I was looking for.  This is called MAKING AND STICKING TO YOUR ANESTHETIC PLAN.  

Well, turns out that despite my planning and despite my hunt for The Perfect Anesthetic, in the end that the case was cancelled--the procedure was listed as RECTAL EXAM UNDER ANESTHESIA and I guess he decided that was just as unappealing to him as it sounded, and never showed up.  So I put the hard-won ampule of bupivacaine in the back pocket of my scrub pants, along with my iPod and a partially eaten Power Bar, figuring I would keep it handy, just in case the opportunity might present itself for use later on.

The rest of the day went as planned, and as I was walking down the hallway at the end of the day, it occurred to me that I could sure go for the rest of that Power Bar.  It was all warm and melty from being pressed next to my butt all day (SO GRAPHIC) but I figured that would just make it easier to eat, because if you've ever tried to eat a cold Power Bar, you know that it turns to cement and you'll be working on that thing for hours.  For those of you who are just disgusted at this point, please note that the Power Bar was simply next to my butt, but at no point during the day did it ever touch my butt.  Got it?  There was no Power Bar to butt contact.  Therefore, still good!  So I extricated the bar from my pocket, peeled back a little more of the foil, and without really looking, took a bite.

The first thing I thought when I felt the crunch was that this was just an unusually potent flavor crumble, the likes of which are seen in certain flavors of Power Bar--for example, Vanilla Crisp.  However, the texture of the crunch was different from that of a Rice Krispie embedded in some sort of gluey carbohydrate matrix--much more crisp, much more bite, almost like a chip.  The next thing I noticed (and this was probably just a fraction of a second later) was that this Power Bar tasted awful, kind of watery and bitter, like chemicals.  What had just happened?  Had I just shattered a tooth?  How could I break my tooth on a Power Bar?  And what was all this foul liquid leaking out?  Some sort of mercury filling amalgam?  Some sort of frightening nerve pulp liquified by years of subpar dental care on that crappy resident health insurance plan?  What the hell was going on here?

I looked at the Power Bar in my hands.  And what I saw was this: the vial of bupivacaine had, over the course of the day, worked its way into the bar itself, with heat and time pressing and molding itself directly into the goo.  And when I bit into the Power Bar, I had actually bitten into the vial.  I bit through glass.  I WAS EATING GLASS.

Needless to say, I spent the next minute assiduously pooling my saliva and spitting into a sink, for fear (perhaps after one too many Tales of Intrigue) that I would swallow microscopic glass shards and cut myself internally and DIE.  I do, however, think that the Power Bar saved me to some degree--it was so gluey and sticky that most of the glass shards just kind of got pressed into it, where they stayed in place, like bug in amber.  (Aside: does anyone think that bugs in amber make creepy jewelery?  I mean, I get it, amber is a pretty color, and nature is beautiful, whatever.  BUT THEY ARE DEAD BUGS.  I do not want to wear dead bugs as earrings, sorry.)

I thought that hazards of the workplace in anesthesia mostly consisted of environmental exposures, like standing next to the fluoro beam for hours at a time, or of biohazards like getting blood sprayed in your eye after someone dings the renal artery or some such thing.  However, I now have to expand my scope of workplace hazards, those being the improbable hazards facilitated by my own ridiculousness.  If anyone has a story worse than this, I would like to hear it.

(And for those thinking one step beyond: yes, my tongue and lower lip were quite numb for about half an hour afterwards.)

i like to pretend that it's some sort of eco-statement, not just procrastination

If you follow my Twitter stream, you already know that I just found out today that I passed muster and got approved for a Georgia State medical license! Licensed to THRILL, baby! And to treat hookworm!

Woo!

Now for that pesky driver's license.

and who is this steve irwin everyone keeps talking about?

I was working with an attending today who is Australian, recently returned to New York from a two year stint back in Australia as a matter of fact, and who I know has three very young kids at home.  So of course when the chance arose, I asked him the most obvious question I could think of, one that I had in fact been mulling over since I realized we would be working together last Friday.

"So, you're from Australia, right?  Do your kids watch 'The Wiggles'?"

He smiled politely.  "Um, we don't, actually."  And then, he added this next sentence which just made my mind explode.  "Who are 'The Wiggles'?"

WHO ARE THE WIGGLES?  Is he serious?  Could there be another Australia that I'm not aware of, and could he be from this alternate Australia?  Doesn't everyone in Australia know "The Wiggles" personally, just like how everyone in California lives next door to a movie star?  TREAD LIGHTLY, FOR YOU TREAD ON MY DREAMS.

the mix tape

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

• "Up Where We Belong" by Joe Cocker and Jennifer Warnes

• That song that goes "Sometimes when we touch, the honesty's too much."
  

• "(I Just) Died in Your Arms" by Cutting Crew
  

• "Lady in Red" by Chris De Burgh
  

• The theme from "Rocky" (not "Eye of the Tiger" proper with the trumpets, but the sad, ruminative piano riff on the same that they play during quiet moments, like when Rocky visits Adrian in the hospital when she's in a coma after she has a placental abruption secondary to working to hard at the pet store and it's sad and Rocky doesn't want to be a fighter anymore until Adrian wakes up due to the POWER OF HIS LOVE and tells him to WIN)
  

And then we all put our hair up in scrunchies, rolled up the sleeves of our jean jackets, and flattened out a cardboard box so we could breakdance on it.

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

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

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

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

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

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

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




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

the graduate




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

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

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

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

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

like some kind of metaphor or something




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

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

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

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

Are There Too Many Women Doctors?

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

by Catherine Arnst

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

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

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

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

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

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

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

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

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

My initial reaction is twofold:

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

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

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

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




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

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

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

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

cue the gershwin

We headed down to DUMBO today to have brunch with friends.  (DUMBO, by the way, being an acronym for the neighborhood in Brooklyn located Down Under the Manhattan Bridge Overpass, and not any judgement on the I.Q. of its locals.)  It was nice to have an excuse to visit the area, and overall, I think we made a nice day of it.




I'm excited about moving to Atlanta, don't get me wrong.  It's going to be fun, an adventure, yay for new experiences and all that.  But there are some days, like today, that I just can't believe we're willingly leaving this city.

he blinded me with science

For the last month or so, I've been wanting to take Cal to the New York Hall of Science, which is this really cool science museum in Queens. I went a couple of times when I was a kid, and being a young nerd, I really enjoyed myself. I mean, come on now. SCIENCE. What's more fun than that?

Anyway, one thing I especially appreciate about this museum is that though it is clearly geared towards kids (almost every single exhibit is hands-on, if not climb-on), the concepts and explanations are surprisingly high-level. The exhibits about optics and mathematics were particularly interesting for adults, I thought, and I think there's no kid alive that can resist the allure of gigantic soap bubbles or a hall of mirrors.  If you live or are visiting anywhere near Queens, this is little side trip is worth it.  (Full photo set here.)

Also, on that note, thanks all for your suggestion of kid-friends activities in or near Atlanta.  Very awesome recommendations, we'll definitely be trying many if not all of them at some point.

secure in his manhood

So there's this attending on the OB anesthesia service who has gotten everyone into doing beadwork.  Well, perhaps "everyone" is overstating things somewhat.  She has gotten all the women on the labor and delivery floor into doing beadwork, I guess as sort of a stress-reduction thing.  There's this big box under the counter in the OB Anesthesia workroom with twine, fasteners, and styrofoam cups filled with all these different kinds of beads, and during random moments during the day or night, whenever there is some down time, you will find someone rustling through that box to go through the supplies.  As a result, almost every OB resident and all of the nurses have these beaded ID holders around their necks, and you can tell which of the (female) anesthesia residents has recently been through OB by whether or not they are sporting the same.  It's like the Anesthesia version of a Boy Scout merit badge.  (Curiously has not caught on among the actual boys in our department, however.)

This last month was my third rotation on OB in as many years, and up until last week, I had not jumped on the bead bandwagon.  Firstly, I never really had time to get all Martha (there was always this pressing guilt that every single second on OB not spent in the throes of patient care should be spent studying for this oral exam we all have at the end of each four week OB rotation), and secondly, there was this feeling in my gut that making a beaded ID holder was just a touch too girly for me. And I am not so girly. No sir, this plain polyester corded ID holder from the security office does just fine by me, thanks.

And then last week, my attending (the bead one) mentioned that she had just gotten a new shipment for the craft box. "They're crystals!" she said, shaking the little plastic baggies in front of my face, like they were cocaine or some such thing. And when I saw those multifaceted beads, I knew that the era of restraint was over. Like a bird, I am apparently unable to resist anything sparkly.




So I caved and I made a beaded ID holder. And it is possibly the girliest thing I have ever touched. Not only is it sparkly, it is rainbow. And based on how many nurses squealed that their daughters would love a necklace just like it, I apparently have the design aesthetic of a second grader.

The idea of using my bead thing as an actual ID holder was quickly ruled out when I realized just how many things I carried around on my current ID holder. Aside from my hospital badge, I currently have looped on my neck cord two pens, a Sharpie, a plastic holder stuffed with singles, a ring with five or six keys, and a calculator. It's like Revenge of the Nerds, Medical Edition. And I didn't think that one thin loop of twine could sufficiently support that mass of hardware. So instead, I brought my creation home, and gave them to possibly the only other person who could appreciate it as much as I did.




In the words of Cal, who held out his hands almost reverently when I presented him with his newest accessory, "Mama, it's so beautiful!" I figure he might as well wear it now, before he starts school and some preschool thug inevitably gives him the idea that wearing a rainbow-beaded sparkle necklace is not something that boys are supposed to do.