dinner at chinatown




Figure we might as well get it while we can.

perhaps not unlike the birth of reeses peanut butter cups

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.

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.

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

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

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

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

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

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

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

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




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

the graduate




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

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

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

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

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

like some kind of metaphor or something




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

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

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

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

Are There Too Many Women Doctors?

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

by Catherine Arnst

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

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

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

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

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

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

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

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

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

My initial reaction is twofold:

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

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

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

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




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

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

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

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

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

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.