the laws of supply and demand

For the past few weeks, Joe and I have been combing the rentals on craigslist.com and realtor.com for properties to check out during our trip to Atlanta in two and a half weeks. I think that despite the fact that neither of us have actually spent any prolonged period of time there, just from looking at hundreds and hundreds of listings, we are starting to get a reasonable grasp of the housing market in Atlanta, and what the going price is for homes is based on square footage, recent renovations, location and whatnot.

And then I passed by this poster on a lamp post in our neighborhood last weekend.




Wow. The housing market in New York is...different.

this american missed opportunity




I post this as a public service announcement to those who are fortunate enough to have the time to attend. Ira Glass is going to be making an appearance at the Borders bookstore in Columbus Circle tomorrow evening at 7pm, signing copies of the first season of the This American Life DVD. If I didn't have This American Job and This American Kid, I would surely be there, possibly slavering, but instead, I will have to listen to Season 3 of TAL that I downloaded off audible.com at during my uptown commute at 5:30am tomorrow morning, and dream of what might have been.

raising a tree hugger

no patients were harmed during the writing of this post

The problem with making a commitment to post on this site every day comes at 11:30pm when you're on call, and you realize that you have yet to post something. Patient care be damned, it's time to POST ON MY BLOG.

(Just kidding. I'm not in the OR. All the patients are fine.)

(So far.)

Anyway, let's make this a short one, and please ignore any grammatical or spelling errors. This is, like, FREE ASSOCIATION POST. On the fly. So spontaneous!

I am excited these days, because since I recently stepped up the intensity of my job search (read: actually mailing my CV out and calling people, as opposed to listlessly staring at a map of Atlanta and wishing that I could win the lottery), I have lined up not one, not two, but THREE job interviews! Interviews are just interviews, of course, but I am feeling more reassured that I might actually come through this thing with an actual job. Giving anesthesia, even, not just a job folding jeans at the Gap. (My other dream profession, you know. I would fold them so neatly. Plus, I could use that little board they have to fold shirts and sweaters that turns them all into perfect rectangles ready for display. Now tell me that's not gratifying.)

I realize that I am almost thirty years old and have never actually a real job. I mean, yes, I've had jobs, but they're all those academic-type volunteer/research/stipend jobs, not actual JOBS with salaries and benefits and the like. I guess residency is the closest I've come to having what people would classically think of as a "job," though I know few residents that think of their roles in the hospital in that way. We more consider residency a combination of school, slave labor, and a necessary means to an end.

But when you're starting to look to the future, there's something reassuring about residency, you know? It's so mapped out for us, we hardly have to think of what to do next. Looking beyond residency is not just a little bit scary, because there's something very comforting about having people telling you what to do all the time. Not that you always want to listen, but there are other people bearing the ultimate responsibility, and they are always there. Not that being a resident forever would be satisfying, and after five years of post-graduate training I'm more than ready to strike out on my own, but...man. That first step is a doozy.

OK, back to work.

now and forever




Every, oh, two years or so, I get it in my mind that we should get a cat. I am not, for the record, a cat person. I know some people love cats for the very reason I dislike them. The cat's aloof countenance and fey qualities leads some people to think, now there's an animal that needs me to WORK for its love, and accordingly, they fall into line. However, I am more drawn to the straightforward lack of pretension that dogs possess. Well, most dogs, certain toy breeds excluded.

But sometimes, I cross paths with a cat, and you know, cats can be cute occasionally, and I get this idea in my head that WE SHOULD GET A CAT. We could get a kitten, one who is still malleable, and bring him home to meet Cooper. They would become friends, Cooper channeling all her thwarted mothering instincts towards this tiny creature. Cal loves all animals, so he would be on board. And we would all live happily together, like on some damn hippie commune, people and animals together. Perhaps there would be a banjo.

Today, we went to visit our neighbors, who just adopted two kittens from the local animal shelter. The kittens are from the same litter, one is extremely shy, and the other a little more of a lap cat. Being very friendly people, our neighbors invited Cal over to visit the kittens, and spent much of the visit showing Joe how to play some rabbit-based shoot-em-up game on their Wii. While I was watching rabbits being pulverized and while Cal was busy rearranging their decor, the more social of the two kittens climbed into my lap and started snuggling with me. At which point I decided that CATS WERE ADORABLE and that WE SHOULD ADOPT ONE IMMEDIATELY.

And, as also happens every two years, I promptly started sneezing and broke out in hives. After which point I remembered why we don't have a cat in the first place.

(Photo credit from lolcats.com, OF COURSE.)

ten and two




The only thing worse than having to get up early on a Saturday morning to sit through a five hour class about driving safety is having to do it for the second time. Of course, it's my own fault, I never took my road test after the first five hour class and the certificate elapsed after a year. But still...damn.

However, having now attended more than one of these classes, I am free to make sweeping generalizations. My teacher this time around was an older man named Mr. Cohen, who introduced himself as such and said that we could feel free to call him by his first name, though he never actually elaborated what that first name was. My theory is that it was "Mister."

This city being (as I was told in second grade) a melting pot, my class this time around was largely composed of foreign nationals who for reasons of business have recently relocated to New York and require a New York State driver's license. As with last time, the actual amount of information conveyed in this class (which is universally called "the five hour class," its length apparently being the salient feature above all else) if condensed, would probably only take up about an hour, which further illustrated another requirement for those hoping to teach this course. You have to be able to talk a lot about nothing in particular, and you have to be able to go off on long, winding tangents. Well, you know, mission accomplished. Nothing against this guy, he was a sweet old man, and he meant well, but...

Well, let me just include an excerpt from the "don't drink and drive" portion of the talk. This seems to invite the greatest degree of elaboration from any driving instructor apparently, and turns even the most science-illiterate layman into an internal medicine consult. After being treated to an elaborate and long-winded theory on how alcohol gets "diluted by body fat" and how the liver "absorbs the alcohol from the stomach," Mr. Cohen then elaborated on some of the international laws surrounding DUI.


MR. COHEN
(Pacing in front of his desk)
But here in New York, I think we have it easy. In Bulgaria, I believe if you're caught driving under the influence, you're executed. (Pause) Anyone here from Bulgaria?

(Crickets)

MR. COHEN
Also, in France, or Paris, one of those places, if a man is caught DUI, not only is he thrown in jail,
his wife is also arrested and thrown in jail.

(The two French guys in the front row exchange glances.)

MR. COHEN
Or maybe it's in Japan.

(The Swede sitting by the window looks at MICHELLE.)

MICHELLE
(Whispering)
I'm pretty sure that's not true. But also, I'm not Japanese.


Anyway, it was fine, and everyone in the class, being adult, was exceedingly mature and polite about all of this. No one even complained that we had to watch two videos about The Dangers of Drag Racing and didn't get a chance to watch the video about Driving Tips for the Urban Environment, which, you know, may have been somewhat useful.

you should see the other guy




I think it's time to wash my sneakers. Having this many bloodstains on your shoes probably starts to undermine the confidence that your patients have in you after a while.

new lens!






The new lens came! I'm still sort of feeling it out, and I haven't taken it outdoors yet, but so far I am particularly liking it for portrait shots.

New toys. They are fun.

all in the name of science

For the past few months, Joe has been working on a project for measuring post-surgical outcomes of eyelid surgery.  There's probably a lot more to this that I don't understand, but the gist of it is that he is writing a computer program that measures the symmetry between the right and left eyelids, presuming that more symmetry is a better cosmetic outcome, and that less symmetry indicates a worse outcome.  I have no idea how he is able to create this computer program--he's actually writing all the code himself, having some background in programming prior to starting med school--but it looks exceedingly complicated and involves reading books like this:




...which indicates that the things I don't understand I will continue to not understand.

Anyway, someday this program will be applied to actual patients, but in the meantime, to amass a databank, Joe is measuring the eyelid symmetry of people with known aesthetically pleasing results, be they artificial or natural. Basically, Joe is combing through movie star pictures in People, US Weekly, and various fashion magazines, picking out good full-face head shots and measuring the eyelid symmetry for each of these people. He has separate files on each star: Lindsey Lohan, Cameron Diaz, Angelina Jolie, what have you. Each one is scanned and measured and becomes a filed series of data points. For this part of the study, Joe says, he is excluding males, as they will require their own separate data pool. So lately, now that the coding is done, this is what Joe is doing every night. Looking at pictures of ladies and doing eyelid measurement data entry for this project.

A few weeks ago, walking up behind Joe on his computer, I saw him assiduously working on a file he had named "Halle Berry Symmetry Study." And it occurred to me that I was probably the only wife in the universe who could see the name of that file, accompanied by all those pictures, and not assume that their spouse was using this all as a gigantic and elaborately constructed window-dressing for porn.

Frankly, despite all the Pascal and C++ computer mumbo jumbo, I'm still not totally convinced.

just as long as he doesn't pick up hackey sack

Yesterday Cal spent about half an hour sitting in this cardboard box in his underwear, playing guitar. Which shows, really, the extent to which rebellion against your parents will go, even at an early age. Have two parents that are crunchy long-haired performance artists, and their kid will grow up to be a right-wing AM radio talk show moderator.





Have two parents that are doctors, and here is a kid who aspires to be a musical street urchin.

more signs that the universe is conspiring against me




So despite all my God-given inclinations to stay out of those tin death-boxes forever, opting instead to walk or bike or scoot or whatever--I really do need to learn how to drive. I don't want to, but I have to. It's like the dentist. But without that plastic-y smell. Oh wait, cars have that smell too. Can someone explain to me why people spray that new car smell in their cars ON PURPOSE? Attention, people, that's the smell of mutagenic plastic polymers altering your DNA! Nor does it smell good! Carry on.

Anyway, I called this driving school this weekend to get a package and set up my first lesson for this morning. I told them to give me the earliest possible lesson (thus to be minimally disruptive to my busy and productive day), and they told me that someone could pick me up at 10:00am. I don't think that 10:00am is particularly early, but fine, whatever. Twenty minutes after I hang up with the driving school secretary, she calls me back.


DRIVING SCHOOL LADY
Michelle? Instead of the lesson from 10:00 to 11:00am, could you
take a lesson from 12:00 to 1:00pm? With Ray?

MICHELLE
Um...I could...but why?

DRIVING SCHOOL LADY
Since this is your first lesson, we thought it would be good for you
to be with Ray. He is our most requested instructor.

MICHELLE
Well...if you think that's best.

DRIVING SCHOOL LADY
(Fervently)
I do.

MICHELLE
Well, fine then. 12:00 to 1:00pm with Ray.

DRIVING SCHOOL LADY
Wait for him outside your building at 12:00pm on the dot. And bring your learner's permit!

MICHELLE
Will do.


You know I am very obedient, right? Well, I am. I am very obedient and law-obeying and I always finish my full course of antibiotics, even if I'm feeling better. So this morning, I was waiting in the lobby of my building ten minutes early for my driving lesson. I waited. I waited for a long time. Yet in that half hour of waiting, not one car with flashing lights and neon yellow signs blaring STUDENT DRIVER pulled up in front of my building. Finally, I called the driving school demanding to know where the hell was this popular, requested "Ray."


DRIVING SCHOOL LADY
Did you buy your driving lesson package yesterday?

MICHELLE
No, two days ago.

DRIVING SCHOOL LADY
On Saturday? What time?

MICHELLE
What time? I don't know. In the afternoon sometime.

DRIVING SCHOOL LADY
(Dismayed.)
Oh.

MICHELLE
Is there a problem with that?

DRIVING SCHOOL LADY
Well, you see...Ray is out of town right now.

MICHELLE
Ray is...what?

DRIVING SCHOOL LADY
Ray is not in the city. They must not have logged your lesson with him until late, and he doesn't check his Google [I think she meant his e-mail - ed.] after 6:00pm. So he left town. I'm sorry.

MICHELLE
(Reflexively)
It's OK.

MICHELLE'S INNER MONOLOGUE
What do you mean "it's OK," you idiot? She just wrecked your whole day off!
DRIVING SCHOOL LADY
He must not have gotten the notice about your lesson. He was leaving the city.

MICHELLE
Well, the thing that kills me about this is that you guys specifically wanted to schedule me for a lesson with this guy! I had a lesson for someone else, and you guys called me back to put me with Ray! Who isn't even here!

DRIVING SCHOOL LADY
Would you like to reschedule for tomorrow?

MICHELLE
I have to go to work tomorrow. I can only take driving lessons on the weekends.
During the very little spare time that I have off.

DRIVING SCHOOL LADY
Why don't we schedule your next lesson. How's next Sunday, at 8:00am?

MICHELLE
Fine. Whatever. Schedule it. 
DRIVING SCHOOL LADY8:00am is not too early for you on a Sunday?  Ah ha ha ha!
MICHELLE'S INNER MONOLOGUEI wake up at 4:55am every morning, Lady, so don't talk to me about "too early."
MICHELLENo.
DRIVING SCHOOL LADYOK, next Sunday, 8:00 to 9:00am.
MICHELLEWill this be with Ray again?

DRIVING SCHOOL LADY
(Flipping through schedule)
No, this lesson will be with...Jay.

MICHELLE
You're kidding, right?



So anyway, now I have Driver's Ed scheduled for the next four weekends. It is as though I have four consecutive weeks of dental surgery coming up, that's how excited I am about this. I have better things to do with my time than sit in my lobby waiting to be stood up by a driving instructor. And if I ever meet this guy Ray, I'm going to kick him in the nuts.

table for one

In the afternoon, during these weekend days that I manage to get out the house to do some writing, I've been developing a little ritual.  After a couple of hours at Starbucks after which I can't look at my keyboard anymore because I'm tired and I have to pee and I'm GOING BLIND, I pack up my stuff and head on over to Rice, where I have a late lunch.  I always have the same thing off their weekend brunch menu, which is the congee--very tasty with grilled shrimp and lots of garlic and scallions.  

It is a rare moment when I get to eat lunch by myself, and am not in such a rush that I am shoveling in my food as fast as humanly (or inhumanly) possible before having to run back to the ORs.  It is a nice half hour on my own.  I like it.

a present for me

When we got our first offer for "Scutmonkey" from one of the publishers this fall (not the publisher we ended up going with, but still, exciting because it was the first offer), I told Joe that there was one thing I wanted to treat us to when and if I actually got a book deal. I wanted us to take a nice vacation this Spring. Not a long vacation obviously, since we don't get that much time off, and not to a far off exotic location either, as the thought of trying to contain Cal on a flight to South Africa or similar makes me just want to sit on the floor in the corner, rocking back and forth and harrowing my face with my fingernails. But just a nice family vacation somewhere warm. This would be our treat, our small self-indulgence from the book money, and the rest we would squirrel away. Like squirrels.

Well, turns out we won't really get a chance to take vacation this year anyway. I had to rearrange one week of vacation to February to fly down to Atlanta for the necessary schooling/housing/employment arrangements, and I'm planning to give back my other week of vacation this Spring, so that I can finish residency, if not on time, then at least one week closer to on time. (I have four weeks of maternity leave to make up--giving back that week of vacation should cut it down to three.) So there's that. I know we can take vacation later, or even next year, but with Joe's fellowship starting up, I don't really know when and if he'll be able to take off. So that's kind of a bummer.

Also, we have a lot of new things that we're going to need to capital for now, like moving costs, housing, possibly needing to lease a second car. Whatever is left over will need to be our "cushion" money, in case I need a few weeks after we land in Atlanta before I start my theoretical job. Since we don't have any childcare in Atlanta yet, it's not realistic to think I can start work right away before getting some household things settled. And so it goes.

We are so lucky, though, and I keep calling this book advance our deus ex machina. Since we really don't have anything in the way of savings (well, we did, but after two and a half years of paying for nanny care, this nest egg has gradually been eroded down to the equivalent of an eight year-old's weekly allowance), getting a little extra cash flow at this point prior to the big move is a saving grace.

However, I did think that we should at least get a small treat after signing the contract. You know, something just a little bit fun, just so if anyone asked me what we did with the book advance, I could have something to say other than, "a downpayment on some shack in Georgia." (It is a very nice tarpaper shack!) So I got this:


A new lens! I just ordered it yesterday, and I am really excited about it. I have been wanting for a long time a lens more suited for low-light photography--something with a bigger aperture and blah blah blah. So I guess it's really more a treat for me than for the entire family, but hey, they get to be in the photos and with more flattering ambient lighting, so everyone wins.

sadly, this is the "after" picture




I came home today and finally got fed up with my desk being such a mess. Really, it was a disaster. You might not believe it, and this is something that I am a little embarrassed to share because in the OR, I am literally someone who could spend an hour lining up my syringes to be at perfect right angles with the tabletop, and bundling up loose cables with paper tape for MAXIMAL ORGANIZATION--yet in my home, I am well on my way to becoming those ladies with 50 years of back newspapers in ceiling-high piles all around the house. Only scratch newspapers, and envision medical journals instead, some still in their original mail wrapping. Anesthesia and Analgesia, I love you, and yet, I have no time to read you. So stay warm for now in your plastic jacket.

The center of this pack-rattery is my desk. It is cluttered with a number of things that, for one reason or another, I cannot easily throw away. Prime among these are mailings which require shredding (so as to avoid IDENTITY THEFT) and so cannot be easily tossed. We do have a shredder, but it is a cheap one that can only shred, like, one piece of tissue paper at a time, and therefore is too annoying to use, especially with envelopes (of the "You have been pre-approved for a Discovery Platinum card!" variety) which I would like to shred whole. Also mixed in are a number of medical forms which have outlived their usefulness (patient preops from many months ago, OR schedules from the turn of the century) and old Christmas cards, invitations and whatnot, which I don't feel right just chucking in the trash, although I really can't think of any rational reason not to.

I got my book contract in the mail today. It came in a big envelope, printed on legal paper. News flash! Legal documents may come printed on actual LEGAL paper. I have always just used legal paper when I wanted to save money on Xeroxing and was trying to squeeze in two pages per sheet. Anyway. So I was trying to find the other contract that I signed this summer with my agent, which was at the bottom of some precarious paper tower on my desk, when I realized how truly out of control my home office situation was becoming. There are many things that I can't for the life of me even begin to locate, and am just praying I will find as we start to pack up for the move. THIS IS NO WAY TO LIVE.

I was trying to get organized, trying at the very least to get all of my book stuff filed away in an actual file cabinet, but damned if I didn't have papers strewn around everywhere like some damn newspaper morgue explosion. So this evening I finally got fed up and did what I should have done a long time ago. I took all my shredder-requiring garbage and put it into a big plastic bag. On Monday (oh wait, Tuesday--one of the few MLKs in my residency career that I am not working) and toss it all into our departmental paper disposal box the contents of which get dumped into some industrial-sized paper shredder and chopped into dust-particles. There. Now my identity won't be stolen, and my desk, while not by any means clean, is at least slightly debulked. Now all I have to do is clean off the handfuls of change, dead batteries, iPod accessories, encampments of old Christmas presents, and bundles of miscellaneous IV catheters and lidocaine ampules that mysteriously hitchhike home from the hospital in my pockets, and then I might actually be able to do some work at this desk.

name that OR equipment




A new contest. Will be easier for some people than others, obviously, but fun for the ENTIRE FAMILY. This first one in particular may be a dead giveaway, mostly because I already mentioned them before.

how many residents does it take to to screw in a light bulb?*

Young doctors on the whole are extremely egocentric. Not in the way you think--I don't mean that we all think that we're God's gift to humanity (even there are though some of those among us clearly do think just that), but what I mean is that we tend to think that many things that happen somehow reflect personally on us, though they often do not.

One example I can think of is with patient outcomes. If a patient I have taken care of has a bad outcome even days out from the surgery, I immediately think that it must be because of something I did to them. Never mind that they were sick as shit before I got to them, that the fact that they crashed and burned had more to do with florid sepsis or a crappy heart or a liquefied liver or evil humours, and less to do with, say, the expertise of, say, my fiberoptic intubation. Not to generalize, but I think more senior physicians tend to take bad outcomes a little bit better, just because, having been around the block, the know that sometimes despite best efforts, Bad Things Just Happen. For a junior physician however, we develop a little tunnel vision sometimes, and figure that anything bad that happens must be because we did something wrong. I should have done this. If only I had done that, then maybe it would have turned out differently. It's conceit, in some ways, but mostly, it's just inexperience.

Another example is Resident Paranoia. I will apply it specifically to anesthesia, since that's what I know, but I'm pretty sure that you can apply it to other fields as well. Each afternoon, the OR schedule for the following day is released, and the room assignments are issued as well, where residents are assigned to each OR, depending on what service they're rotating through that month, what year resident they are, and the difficulty level of the case. For example, first year residents will often get assigned to rooms with healthy patients having, like, hemorrhoid surgery, whereas a more senior resident might get assigned to bigger cases, like liver transplants or major vascular surgery. The same probably applies for surgical residents, and obviously, it makes sense. The more experience you have, the bigger cases you're able to handle, and with more independence.

However, there are only so many "big" cases each day to go around, and they (you know, the attendings in charge) try to split these up among the seniors throughout the week to be fair. What this means is that every day, there are at least a few senior residents doing "smaller" cases (in quotes because we all know that there are NO SMALL CASES, only small doctors, right?), and there is always internally some speculation about who got assigned to the "bigger" cases and why. "I got stuck in the hernia room today? What did I do wrong? Maybe they think I can't hack it in the Whipple. Why didn't they put me in the reop-hepatectomy? Maybe they think I'm dumb." Like I said, we are a paranoid bunch.

And we have short memories too. Monday, I did a huge case, but the two days since then I've been doing anesthesia for thyroid surgeries and hernia repairs. So of course I think that I'm being PUNISHED and I'm worried that they're not putting me in the BIG LEAGUE ROOMS because they somehow don't think I can HANDLE it or something. Maybe because they know that I'm not taking the Boards on time and now they don't TRUST me or something. Put me in, coach! Just put me in the game!

Not until I talked to two other residents in my class, who respectively have been stuck in the Gyn rooms and in the cystoscopy suite for the past two days that I am more reassured that it's not necessarily that they think I'm an idiot only capable of handling the anesthetic challenges presented by a varicose vein stripping--and more that they have a lot of senior residents on the roster, and just need someone, anyone, to staff the OR.

Anyway, it's good to do bread and butter anesthesia once in while, right? And anyway, if they put me in huge cases day after day, I'd be totally burned out by the end of the month. It's kind of nice sometimes to do a nice, calm little case. You know, to have a relaxing day for once. So it's good. The attendings in charge know what they're doing.

Doesn't stop us from being paranoid, though.

(* One. She holds the light bulb, and the world revolves around her.)

something's gotta give




I got an urgent page yesterday from the Education Office because they got word from the ABA (The American Board of Anesthesiology, that is) that I hadn't yet applied to take the Written Boards for this summer. The final deadline, apparently, was today. There had been an earlier deadline in mid-December which I missed on purpose, because Joe's match was right around the same time, and I didn't want to register to take the Boards in New York before knowing whether or not we would be moving to Atlanta. Afterwards, figuring I'd have to pay a late fee now anyway, I'd been kind of dragging my heels, with the idea that I would register eventually, when I had things more sorted out. What I didn't know, probably because I didn't really check, was that the late deadline for registering for the Written Boards was only one month later, on January 15th.

"I'll take care of it," I told the people at the education office, but since I was on call last night until fairly late, I didn't really get a chance to sit down and look the registration info until late this morning. Turns out the Boards are in August this year--August 4th, to be precise, which will be basically a few days after I move me and Cal and all our stuff to Atlanta. I thought about what else was going to be happening in the few weeks prior to the Boards, and felt suddenly like I was looking down the barrel of a gun.

Joe will most probably be moving to Atlanta several weeks ahead of me and Cal, as his fellowship (like most things in academic medicine) begins on July 1st, and I will still have three weeks of maternity leave to make up, to fulfill my requirements for graduation. During these three weeks, I will no doubt be taking a good deal of call, as I will be the most senior resident in the department, and besides, none of the new first-year residents are allowed to take call the first month, since they don't know enough to be left alone for any period of time. Most likely what will happen is that we will pack all our stuff up in a moving van and send it off around the time that Joe leaves for Atlanta--Joe will drive down with a carload of stuff and Cooper, and Cal and I will shack up at my parent's house for a few weeks. In the weeks preceding, I imagine there will be a good deal of packing, of planning, of living in chaos and partially filled cardboard boxes purloined from the supermarket. A real low-stress environment, you know. In addition, the final manuscript of "Scutmonkey" will be due to my editor by the beginning of July, so there's that hanging over my head around the same time too. And you know, that's all fine, I can do that, I plan to do all of that. But when I started thinking about having to study for the Boards at the same time--and I mean really studying, final month studying, med school level studying--I just didn't see how I could do all of those things and expect to do them all well.

So.

I thought about it. I had been tossing this idea around for a while, but having that deadline right in my face really forced my hand. I went to talk it over with my residency director, and in the end, I made a decision. 

I'm not going to take my Boards this August. I'm going to take them next year, in August of 2009. It will not affect my Board eligibility, and it will not adversely affect the residency program ("I mean, unless you fail," my residency director found it necessary to point out, to which I replied that the whole point was that I wanted to minimize my chances of failing by actually giving myself a fighting chance to study for the damn thing), and it won't really make a difference in finding a short-term anesthesia job, or even in the long run, provided that I eventually take and pass the exam. I know that for my own ease, it's ideal to take the Boards straight out of residency, and that I might have to study extra hard just to keep on top of my academics and skills if I take that extra year, but in the end, the decision was easy, and a pop-off valve of sorts. I have many things happening that summer that I need to do. This is the one thing that could wait.

Could I have taken the Boards this August? Sure. People do. People have kids and move and have all sorts of outside responsibilities and still take their Boards the summer after residency. And really, I could take it this August. And, you know, I could probably pass it too. But I just think that I'd be stretching myself much, much too thin. I think it wouldn't be healthy, and I'd really be killing myself and sacrificing other things for no good reason at all. So I made a decision. Occasionally one reaches a branch point in life where something's gotta give, and this time around, it's this exam. Next time, it'll be something else.

I've made this decision, and after talking it over with The Powers That Be and realizing that it's not going to RUIN my career, it's really kind of a relief. And I hope that it continues to be, because as I mentioned, the final deadline for registration is today, so I can't really change my mind after this. Oh well.

"why, there's no basement at the alamo!"




I did a case today wherein the patient lost 11 liters of blood, and we ended up transfusing, in addition to assorted exogenous (read: donated by other people) products, 16 units of Cell Saver. The concept of Cell Saver, for those unfamiliar with the technology, is this. The patient is bleeding. The surgeons suck up the blood from the field into a special machine. When the blood in the container reaches a certain level, the perfusionists wash the blood in the bowl and spin it down. Then the anesthesiologist gives the blood back to the patient. Hence, cells are saved. Cell Saver. Ah, one of the few names in medicine that makes sense.

Aside from certain circumstances when Cell Saver cannot be used (soiled bloodstuffs, certain cancers that might get disseminated), Cell Saver can be a great thing. However, in a case like this where there is just so much bleeding, the practice starts to border on the absurd. Imagine this: We give the patient blood. They bleed it all out. We suck it all up and give it back to them. They bleed it all out. We suck it up and give it back to them. They...oh, you get the idea.

It actually reminds me of this quote from "Pee Wee's Big Adventure," a movie that I loved as a kid, and now appreciate as an adult as the first truly avant-garde art film of my (ill-spent) youth. "It's like you're unravelling a cable knit sweater that someone keeps knitting, and knitting, and knitting, and knitting, and knitting, and knitting, and knitting."

a table of one's own




I snuck out of the house early this morning and shacked up at Starbucks for a good six hours where I wrote. And wrote. And wrote. It was good. I was getting worried because I really haven't had a lot of time to work on the book since the holidays, and getting a look at my contract last week, while it made things all the more real and exciting, also got me feeling a little nervous because damn, I actually have to get this thing finished by July. IT WAS IN BOLD PRINT. But after putting in a good day today and falling back into the project, I'm feeling a little less worried. It'll get finished on time, and it might not even be half bad. (I hope. Oh please let it not be half bad. Or worse yet, all bad.)

However, after all that typing, I'm all typed out. So please excuse the insubstantial update. Above, by the way, is a picture of my writing camp at Starbucks. (The orange backpack is mine. It is huge because that's what I used to lug my breast pump to work in, and I just kept using it though it's probably much too bulky for everyday purposes.) I got there so early I even beat out the med students, who usually descend on the place and create little forts and tribal societies, buried amongst their syllabuses and Netters and whatnot. I even beat out the Work From Home Laptop set, who I was pretty convinced up until this morning lived under the condiment table when Starbucks closed for the night. That's right, Work From Home Laptop People, I beat you to one of the coveted big tables! Booya! For once, I did not have to sit next to the toilets! And I got a plug all to myself! MY VERY OWN OUTLET!

Oh lord, I am pathetic.

giving me the finger

(I usually don't tell stories like this, because as someone who deals in foul bodily succus all day long at work, I don't really find anything particularly disgusting about the excretia of young children. But this one was kind of gross, even for me.)




One of the many charming things about two year-olds is how few problems they seem to have, and how easy it is to fix them. For instance, I think I can break down Cal's daily tribulations into three main categories:

1. I Want Something (cookie, toy, dangerous pointy item) But My Evil Controlling Overlords Won't Let Me Have It.
2. Lo, I Have Hurt Myself.
3. I Am Overtired, And Therefore Must Waste More Of My Meager Remaining Energy Stores By Screaming.

The solutions to these problems are fairly apparent, even if they are illogical. For example, if Cal hurts himself, he requires (as many children do, I imagine) a kissing of the hurt body part to set things right. He firmly believes that this kissing really makes things better, and takes great pains to manipulate his face or hand or whatever injured part so that is aimed directly at my lips, therefore centering the healing vibes towards whatever invisible wound lies beneath. So of course Joe and I find this adorable, and I particularly relish it, because I know it won't be long before we as his parents will be viewed as USELESS and our kisses the equivalent of some cruel and humiliating punishment.

Anyway. So today Cal comes running up to me with his hand extended, saying, "My finger." He had been playing in the living room, so I assumed that he had banged his hand on something, sustained some sort of mortal crayon wound or similar. So of course, I bent over and kissed his extended index finger. Which I noted only afterwards was slightly brownish, and smelled like poop.

"Mama need to change the diaper," Cal added nonchalantly, about two seconds too late.

extortion

I got my New York State medical license in 2004.  Since that time, I've already had to renew my license twice, at $600 a pop.  I don't have to take a test to renew my license, or prove anything about my clinical acumen or outcomes, or really do anything related to medicine.  It seems that all I have to do is fill out a short questionnaire detailing the breakup of my time in practice, confirm that I have not been convicted of any felonies, and of course, send in a check to New York State for $600.  

I do not know what this $600 is for, or really even where the money goes when I send it in.  I do not know why my license expires every two years, when even my learner's permit is good for five years at a time.  All I know is that if I don't send it in, my license to practice medicine in this state expires.  So I have to pay up.  I have no choice.  This latest renewal also unfortunately coincides with my application for a Georgia state medical license, so, you know, there goes another $400.

This is the biggest racket of all time.   

i am talking about this again because i am clearly a glutton for punishment

Cal started his twice a week pre-preschool playgroup this Tuesday, and so far, he seems to be liking it. I mean, you know, he talks about "school" at home, and these stories aren't punctuated by tears or tales of midday throttlings by Thuggo the Abnormally Large Two Year-Old. So that's good.




I think what we mainly need to work on before he's actually ready for real preschool is the separation portion of the program, which is really why we enrolled him in this class in the first place. They try to allow the kids to do it gradually, and there's no absolute mandate that there must be no caretakers in the classroom by X point in the semester, so we're just sort of going with the flow and feeling out what Cal is ready for. For instance, Joe brought him the first day, and Cal was so instantly absorbed in all the toys and activities that when Joe got a page from the hospital 20 minutes into the class, he felt that he would probably be safe to step outside the room for a moment just to return the call.

Well, you know, I wasn't there, but I am told that what happened when Cal looked up and realized Daddy was gone was what we euphemistically call "a meltdown." Well, I guess that's not much of a euphemism. Luckily, the incident didn't seem to do too much harm--he was still excited about going in today, and our nanny says that he had a good time. So, you know, we'll work on the separation bit.

Though our prime intent for sending Cal to the pre-preschool is so that he will eventually crush the USMLEs (um, kidding and whatnot), they seem to be a good job of accomplishing our other prime intent, which was to get him used to a more structured classroom environment, with a teacher, set activities, and rules. You know, because usually we let him run wild in a lawless environment like we're on HBO: NO LIMITS. Not really. But it's nice for him to have these little activities and tasks, like hand-washing and group snack time, and he has enjoyed showing off his new skills at home. Like today, the kids learned about drinking from a regular cup, not a sippy cup or a covered cup with a straw. I myself have rarely allowed him free reign over an open cup, because hey, I have enough stuff to clean, but as Cal told me at dinner, all it requires is "two hands" and for one to "do it slowly" and "be careful."




He is taking to outside instruction so well I am going to suggest to the teachers that the next addition to their curriculum should be how to use the Swiffer.

the underwear drawer

It does not count as age-inappropriate browbeating if I tell you that we're trying to toilet-train Cal, does it? I figure it's either that, or I'll start getting notes from people cavilling, I CAN'T BELIEVE YOUR TWO AND A HALF YEAR-OLD ISN'T TOILET TRAINED YET, GOOD LORD WOMAN, WHAT ARE YOU THINKING, MY TEN MONTH OLD HAS SUCH EXCEPTIONAL BLADDER CONTROL THAT HE CAN PEE IN A VERY SMALL SHOT GLASS FROM ACROSS THE ROOM! So anyway, between the two extremes, let's just call it even.

So yeah, we're trying to toilet train Cal.





So far, he has been pretty good about keeping himself dry for an hour or so in underwear before bathtime in the evening--the timing of such extended diaperless tightrope acts being timed to minimize the fallout from an errant urine stream or two. He can hold his pee for a while, and he can pee on the potty when the mood seizes him. But to say that he's anywhere close to being toilet trained is a vast overstatement at this point.




He does seem to like his new underwear, however.

i owe you one book




After my day on Monday, it was kind of a nice respite to be in a room doing anesthesia for eye surgery today. As I tell my patients, nothing in medicine is free of risk, but at least compared with yesterday, I was slightly less concerned about my patients trying to die on me.  Which is good.

In other news, I got a look today at a near-final draft of the book contract that I'll be signing with my publisher.   Ah yes, the book.  I know I haven't talked about it much, since Joe's fellowship match in Atlanta got me all stressed about having to move to a place where I have NO HOME and NO JOB and NO CHILDCARE and NO GOOD PUBLIC TRANSPORTATION, but yes, I am still making good progress on writing this book.  This is probably not much of a surprise to anyone, so I'm not afraid to tell you that...I don't really know much about the finer details of literary contract-speak. For instance, who even knew it would take so long to cobble together a contract? Who knew it wasn't just a single piece of paper reading "I owe you one book" that I would sign with an X? My understanding prior to this was: I write a book proposal. Some publisher decides they like the book proposal. I write the book. The book gets published. The end. Nowhere in this (admittedly simplistic) understanding of the process did I ever conceive of terminology like "foreign language rights" or "mass market editions." Also, there are stipulations in the contract with respect to audio versions of the book, and some part in there about large print and Braille editions. Ah so.

So anyway, I am reading through this contract, but I find that I am having to Google, like, every fifth word. It reminds me of that part in "Ramona the Brave" (I'm not sure if this is the exact "Ramona" book that I'm remembering, but whatever, the one I'm talking about is the one where she's scared of the gorilla in the nature book. And where there's a hole in the side of her house that she and Howie jump through. Remember? Yes.) where she's trying to show off to her babysitter that she can read, but she doesn't know all the words, so she just kind of makes a buzzing sound in her head and skips over those parts. "The Publisher shall be entitled to BZZZZZZZZZZ and BZZZZZZZZZZ the rights granted in this BZZZZZZZZZZ, in whole or in part, upon such terms as BZZZZZZZZZZ, and the Author shall earn a share of BZZZZZZZZZZ as set forth below (see section B subsection (ii)." Dammit, Jim, I'm a doctor, not a...contract...parsing...type-person.

Luckily, my agent seems quite expert and appears to know exactly what she's doing in these negotiations, so I will continue to let her do just that. And I will give anesthesia and continue to Google things, and hopefully, pretty soon, we will have a finished contract, which I will sign with an X. Huzzah.

you take the good you take the bad

I knew today was going to be a challenge (see: two Peds open heart cases back-to-back), but what I didn't know was that I was supposed to be carrying the Peds Trauma and Peds Arrest pagers today too. You want to know an wholly unpleasant way to find out that fact? Be working in the OR, getting your patient settled before going on bypass, when a nurse wanders in, thrusting the pagers towards you. "Dr. Au, one of the anesthesia secretaries said you're supposed to be holding these pagers today, and that one of them just went off." Whee!

I don't know why someone who is actually working in the OR is somehow also supposed to be available to field the arrest and trauma pages (this just builds in a critical delay--I had to page my attending to handle my patient on the table while I grabbed the arrest bag and went running down to the ER to attend to a patient who, for the sake of anonymity, I will call Stabby McKnife) but hey, things can't always make sense, can they? That would make things too easy.

Anyway, so there was Stabby McKnife, and there were the two open heart cases, and then, at the end of the day, there was an arrest in the ICU, which--hell, anytime you have an arrest in a critically ill child, things just aren't pretty. I left work two and a half hours late and when I got home, Joe tells me that he absolutely MUST watch football tonight because Ohio State is in the playoffs (or whatever) so could I please take care of Cal's emotional, bodily and hygiene needs for the rest of the night, because blah blah blah football. FOOT. BALL.

Anyway, enough with the computer, I have to give Cal his bath. And then I have to DIE.

but what i really love about you is your mind




The problem with taking Saturday call is not so much the call itself, as the aftermath. I got home this morning at 8:00am, slept for three hours, and then went with Joe and Cal to the playground so that I could at least spend some with my family this weekend. Now it's 7:00pm, and I am back in the ORs early tomorrow morning, doing two back-to-back Pediatric open heart cases. Next weekend I am off, but that seems very far away right now.

Starting the work week at a deficit makes me feel not unlike a zombie, lurching from one task to another in search of tasty delicious human brains upon which to feast. Brains! BRAINS!

So I am a little tired is what I'm saying.

saturday on call




There's nothing like having your name pasted over the paper towel dispenser in the PACU to make you drunk with power.

deconstructed turkey

Cal brought home a folder of stuff yesterday, culled from the past few months of his art class. The below I suspect was some sort of "assemble a turkey" project from Thanksgiving, involving felt cutouts, feathers, googly-eyes and the like.




Either that, or this is a much more avant-garde class than advertised, and they took the kids out to the highways to create studies in roadkill.

yes, it's january 3rd, what of it?

Christmas was so nice that I'm having a hard time thinking about taking the tree down.




Anyway, why can't we just keep it up year-round without being labeled eccentric cranks? You know, as sort of an alternative decorative light source? Some people have chandeliers, others have Tap Lights, we have this Christmas tree.

neither desperate, nor a housewife




Is it some sort of a rule, or just a stereotype come to life, for mothers-in-law to feel that daughters-in-law don't do enough around the house?

As a medical resident with a two year-old child, who leaves the house at 5:15am every morning and gets home anywhere between 5:30pm that evening and 9:00am the following day, I have to say that most of my time is pretty much booked with raising my offspring and, you know, being a doctor. In the hospital. Where I work when I am not at home. Also, sometimes I try to write this book that I'm working on. Just a few small activities to occupy my day, you know. Unfortunately, this leaves me relatively little time to sew my own drapes, or turn old drapes into clothes, or whatever paragon of wifely virtue it is that I may be held up to.

I think this impression that I don't do enough housewifery is innocent, a holdover from another generation and another set of duties and expectations, but I would be flat-out lying if I said it didn't bother me a little. There are the larger feminist implications of it first of all. And then there is the knee-jerk reaction wherein I rail (quietly), "What, do I have to be good at everything?" Anyway, it's 2008 already, isn't this supposed to be The Future? When can I get me one of those robot maids and a self-cleaning home? Not to mention a car that folds into a briefcase?

Really, I think what clinched it is that Joe did the laundry yesterday when I was post-call, you know, having worked for TWENTY-FOUR HOURS STRAIGHT the night before, and the fact that I wasn't on hand to pair my own socks make me look kind of bad. Damn you, dutiful new-age husband!

And therein ends my obligatory holiday season family psychodrama. Feel free to share your own. Otherwise, as you were.

(Obligatory addendum: May it go without saying that I love my in-laws, they are the best, so helpful, so supportive, will be staying with us for a month helping us with our transition to Atlanta, super-duper people. Yes! The best! I didn't need to say that did I? Well, yes, I probably did. I! LOVE! THEM! But I do not love dusting.)

happy new year

On the whole, I can think of a lot worse things I could be doing at 11:58pm on New Year's Eve.






But I can think of a lot of better things, too.

Happy New Year. May 2008 be all that you wish for it to be and more, and may your nights on-call be less busy than this one.