vintage scutmonkey: surgery

So starting in 2000, and for more than a decade thereafter, I used to have part of my blog hosted on a platform called Homestead. (The fuck, you say? Shut up, it was the early 2000s, we didn't have nice things back then.) Homestead was clunky and hard to navigate and ugly as sin, and they also charged me upwards of $400 a year in annual hosting fees. As a resident I paid this. I mean, my God. Every July they would extort me remind me to cough up this renewal fee, and every July I would put off the payment as late as possible until they threatened to wipe all my data, at which point I'd pay and they'd keep my files online for another year. Anyway, one summer, many years ago, I just decided not to renew, they made good with their promise, and anyway, that's why the oldest strata of archives on this seventeen year-old blog have been fittingly lost in the ether. (That's an anesthesia joke for you. Not a good one, I admit, but...there really aren't that many great anesthesia jokes.)

Anyway, I do mourn the loss of those first three years of archives (as much for their Web 1.0-tackiness as for the content itself), but one thing that I didn't count on happening was that I would lose the scans of the first three long-form Scutmonkey comics I ever made, about three third-year clinical rotations I did in medical school: Psych, OB-Gyn, and Surgery. I am certain that the original hard copies remain somewhere in my possession, but I've moved 5 different times since then, and whatever logical location they once were stored is unclear. (I had also scanned them at some point, but, again, that was five hard drives and fifteen years ago--not every file has migrated intact.) So while I somewhat regret the archival loss of proto-me in medical school (only somewhat because let's be real--between the ages of 21 and 24, I was even stupider than I am now), what I really regret is the loss of the cached images of those first three long-form Scutmonkey comics.

I'm going to continue to look for the original hard copies, as I'm certain that they are merely displaced, though hopefully not irrevocably. But in my search, I did find something close--the two remaining copies of the handmade booklets I made and sold of the Scutmonkey comics, optimistically named "Issue #1" of the series. In truth it was the only issue I ever made. I wrote a dozen more comics in various forms for Scutmonkey, but that scan and Xerox, cardstock and staple zine-form of publication was on its way out, if it hadn't already become well extinct even before I cranked out "Issue #1." But in this form, the three original long-form Scutmonkey comics still exist.

Here's the last one of those, entitled (rather straightforwardly): Surgery. The images below are janky, because they are very "your mom texting you a photo of a photo," but I'm doing this quick and dirty, and it gets the point across. Forgive the slight image bleed-through, it was printed on cheap paper, both because I myself was cheap, but because the booklet had to be thin enough to be stapled through. (#thepast)

Mack, looking through this comic book earlier today, asked, a little puzzled: "Is this, like, supposed to be...for humor?" I don't know, son. I really don't know.

May all your dressings remain clean, dry, and intact. I'll post the Ob-Gyn comic once I summon the will to rotate and crop all those photos of photos too.

EDITED TO ADD: Thanks to Daisy Porter in the comments, I have found cached copies of the super old archives and extracted clean images from the Wayback Machine, thus enabling me to un-jank these images. Thanks, Daisy!

sartorius

Blogging has changed a lot in the almost 13 years (!) since I started writing online, and I often think--particularly during this most recent long hiatus, when I was too busy to perform anything but the most basic of life tasks (see: job, performance of; family, keeping alive of)--why do I still do it? What is it, aside from perhaps the compulsive need for me to document the minutiae of my life, that makes me continue to write online?

It's not a business decision, certainly. It probably speaks to the direction that online media is moving these days that this blog is such an aberration--a more than decade-old blog that is almost completely non-monetized. I have my "real" job to thank for that--although it's been the job that has been the biggest obstacle to me writing often and regularly, it also allows me to keep all my writing projects, even the bigger ones, completely recreational. I think about that sometimes, how something ceases to be fun when you have to do it, and I am thankful that I have been able to have some very modest success at a hobby that really, I expected nothing more from than enjoyment.

But there's a little more to it too. There's an element to writing, like any activity, that you have to work at. If you don't write regularly, your brain freezes up. You lose fluidity. Stringing together sentences and ideas become laborious, painful; the end-product wonky, full of holes.

Why do I still continue to write here? Because in its own low-investment, low-impact way, each time I post something online, it's like a little exercise. Let me tell you a story, and see if I can make the words work. Let me try to build this wall of words and see if it will hold water. Believe me, I understand that keeping a blog is not nearly as high-minded as some of the "real" writing people do both online and off. But dashed off and conversational or not, it still works, you know? It's 13 years of writing exercises, archived in chronological order.

My first book didn't exactly blaze its way to the top of The New York Times bestseller list (another reason I'm thankful to have gone to medical school and to have the luxury of writing on the side--the stress of having my professional success subject to the caprice of the literary marketplace makes any day in the OR look like a walk in the park), but I do think I have another book in me. I think I would like, someday, to write a book about the practice of anesthesia. It's probably one of the most misunderstood fields of modern medicine, and also one of the most fun.

In my mind (a place where everything always works out perfectly) this book would be a combination of medical history--the Ether Dome, "Gentlemen this is no humbug," sort of thing, I love that stuff--interspersed with first-hand stories of learning and practicing anesthesia. Shine some light on what the hell it is exactly that we're doing back there, at the head of the bed behind the blue drapes. Help people know more about anesthesia than the labor epidural and the notion that propofol "killed Michael Jackson." I'd like to tell some good stories, and I think I have more to tell.

Anyway, someday I'll do it. Until then, I guess I'll just stay warmed up, and keep writing here.

*          *          *

(And now for something completely different...in which I erase all the lofty musing from above and just talk mindlessly about clothes.)

Now that I actually spend some time out of the hospital and out of scrubs, I have noticed that I can't find any clothes to wear. Wait, let me clarify. I have clothes. But I have too many clothes. Because it seems that my attitude towards wardrobe curation leans towards the "survivalist hoarder" end of the spectrum, and I literally (LITERALLY) have clothes from high school still hanging back there because what if I need to attend a "Reality Bites" themed party and I don't have anything to wear? (This is all the more pathalogic when you consider how many times I've moved since high school.) So what actually have is a messy closet packed full of clothes, none of which I actually wear, and which are actually interfering with my ability to find the small percentage of clothes that I do wear. FIRST WORLD PROBLEMS Y'ALL.

Anyway, I'm going through a major closet purge right now (I was going to say "diuresis" but I'm not really sure if that's a real thing that people say or if that's just a thing that medical people say--either way it brings up unpleasant images of hollow viscera evacuating), the goal of which is to have a closet where I could walk in, pick any two pieces of clothing, and have them match. I know this is extreme--not everything is meant to match with everything, after all--but look, I'm a busy lady, I don't have time to plan my little outfits like Cher in "Clueless." I just want to be able to grab stuff, put it on me, and know that they go together.

These are the things I actually wear:

• Red, white, navy, and grey. Yellow occasionally as an accent.
• Cotton knit tops. Preferably boatneck, 3/4 length sleeves. Stripes are a plus.
• The occasional button down, as long as they are soft and don't need to be ironed too rigorously.
• Sweaters, cardigans preferred.
• Skirts, A-line, knee length or shorter, certainly not longer. (This is not a slutty thing, it's more of a short people thing. Long skirts make me look like Momma in "Throw Momma From the Train.")
• Jeans, straight leg, dark wash primarily, occasionally white against my better judgement. (And this is not a "my ass looks huge" thing, it's an "I have kids" thing, and any light colored pants end up with stains and footprints all over them.

So, basically: nautical private school student.

In Atlanta it's warm enough that this getup can get me through most of the Fall into the Spring, with the exception of a few frigid weeks after Christmas where you actually have to bundle up--I have an warm but also exquisitely ugly yellow parka from L.L. Bean that will get me through that stretch. My goal right now being that I want to streamline my closet enough that I will have to put in next to zero through into what I'm putting on my body in the morning. Which is probably only one step up from being Charlie Brown opening up his closet to a row of identical yellow shirts with a single black zig-zag stripe across each one, but hey, I'm sure it made his morning routine very efficient.

Oh, and by the way: those brown shoes above. Please tell me about them, because I want to find them and marry them and make little shoe babies with them. (Brownie, Flopsie and Lacey, natch.) What are they called, does anyone know? And where can I find them? The picture above was from an Etsy vintage shoe sale (only $35!) under the heading "Dexter desert boots" but they were not in my size, which for the record is a 6 or a 6.5 American. You guys, THE SHOES. I realize that in some sense they are hideous and orthotic but SO AM I. Please and thank you.

Furthermore, anyone looking for evidence that I am projecting my own fashion sense (or lack thereof) onto Nina need look no further, because: mea culpa. Likely in a year or two she'll be clamoring for only the tackiest taffeta/polyester/princess shit, so I'll inflict my questionable aesthetic while I can.

OK, back to work.

costume drama

He's my firstborn and so I say this with all possible love and bemusement, but Cal is a weird child when it comes to dressing up for Halloween. It's not so much like he has sensory issues--he doesn't have problems with the costumes being itchy or bulky or too hot, he just thinks they're dumb or something. I think in reality he just gets self-conscious. Like the act of wearing a costume garners too much attention, and he doesn't like the fuss. At all.

Above is, unfortunately, the only surviving photo of his first Halloween costume that I can find (there must be more out there, but I didn't use iPhoto during Cal's first year so many of those digital image files are archived somewhere unreachable). It also showcases Joe's unfortunate predilection for grafting cheesy beyond belief titles and borders onto photography--just be grateful we're spared a wreath of pumpkins around Cal's face or something similarly Printshop circa 1988. Anyway, I just show you this picture because this, taken at the time that Cal was about Nina's current age (they were both born in July), is the last time that we were able to cram Cal into a Halloween costume without him complaining.

Here the following year. You can't see most of the costume since he's you know, running away from Joe (I think I was actually on call that particular Halloween so I wasn't even there) but he's supposed to be a monkey. See how happy he looks? SEE THE LOOK OF CHILDLIKE WONDER WHILE TRAIPSING THROUGH THE MAGICAL WORLD OF MAKE-BELIEVE?

Above, the following year, when he was two years old. We, thinking ourselves terribly clever, dressed him as a medical resident. Cal quickly stripped himself of the accessorizing accoutrement (the scrub cap, the pager, the stethoscope which had been doused in alcohol and Clorox to eliminate all traces of Enterococcus fecalis--it's the small touches that really make the costume, after all) and just barely tolerated the rest of it, mostly once he realized there was candy involved. This was back when we still lived in New York by the way, so his exposure in costume was minimal--mostly we just walked down the hallway, trick-or-treated one apartment, and then walked back. (Some of the candy he got may have been from our own bowl.)

I had some high hopes the following year, as in September Cal specifically requested a pink butterfly costume. Yes, a pink butterfly. So I got the costume (OK, so maybe I got a red and orange butterfly costume--I am as open-minded as the next parent but maybe it's my own bias that led me to apply some well-meaning edits to his original intent), but by the time it came Cal decided that he didn't want to wear any costume, butterfly or otherwise. "I just want to wear regular clothes," he said, a refrain that would dog us again and again subsequent Halloweens. We went to his nursery school Halloween party that year wearing khakis and a grey cardigan (I begged him to let me put some baby powder in his hair so that we could at least pass his costume off as "old man," but he was not having it) and had no further costume planned as of October 30th.

Finally, we just ended up putting him in his beloved "regular clothes" (black long-sleeved t-shirt, long pants), gussied it all up with his rain boots and a two-tone bolt of electricity that I cut out from construction paper and taped on his chest. Enter "Captain Lightning Bolt."  He was OK with this for some time, but then had a little potty accident after hitting three or four houses (three year olds never feel like they have to go to the bathroom until all of a sudden OMG THEY TOTALLY DO) so trick-or-treating was cut short and the costume issue was put to rest for another year.

At age four, Cal finally acceded, after weeks of cajoling to think of a Halloween idea, any idea; to go as "a builder man." Again, a costume involving his everyday clothing and some accessories from the toy bin.  The hat, tool belt and goggles were, of course, instantly shed the second after the pictures were taken, and he ran around his school Halloween party somewhat incongruously dressed in jeans and a blue oxford shirt.

And then, the year he was five, Cal refused to wear anything even approximating a costume. In fact, we didn't even go trick-or-treating that year because he just flat-out refused to do anything and Mack was too young to know any better. At the 11th hour (that is to say: 6:00pm on Halloween night) we thought maybe we had convinced him to go as Steve from "Blues Clues" just by wearing stuff out of his closet (green striped rugby shirt, khakis, blue dog stuffed animal--boom, instant Steve) but then at 6:05 he decided with finality that costumes were BOGUS and trick-or-treating was DUMB and a horribly humiliating ordeal for LOSERS. Also maybe he whined and cried and acted like we were asking him to eat not but burning hot coals and drink not but burning hot cola.

"But if you go out and wear a costume, people will give you candy!" I told him, playing what I thought was my trump card.

"We have candy at home," he said, quite reasonably.

So after that debacle, we decided last year, when he was six, that he was going to find a costume that he would tolerate and we were going to go trick-or-treating whether he liked it or not. I don't think we're of the type necessarily to force our kids to do stuff that they hate, only it seemed like he was getting himself all worked up over nothing, and that if only he would stop being so rigid and just relax about "looking dumb" and allow himself have fun, that maybe he could actually have fun and we could be like a normal family going trick-or-treating. And then maybe I finally get some candy runoff at long last. IS IT SO MUCH TO ASK?

We decided, after brief discussion, that he would be Harry Potter, which was cool because he already had a Harry Potter wand, and anyway, Harry Potter wears regular clothes, he could even skip the glasses, all he'd have to do is let me draw on the forehead scar and wear this Gryffindor scarf that he got just so it looked like he was trying a little.

After a lot of discussion (and more whining, and more crying), he finally let us tie the scarf on him. But he was not real happy about it. "You know, Cal," I told him, "most kids actually really like Halloween. They think it's fun to dress up, and go around, and they like going door to door to get candy. It's kind of a really big holiday for kids, you know?  Some kids look forward to this all year!"

He just grunted.

(Though eventually he did get into it.)

This year, we didn't even have a discussion. We were going to do this thing. After polling Cal to see if he had any costume ideas (to which he responded, "I don't know. I have to consider it.") I just decided, boy, you're going to dress up as a Star Wars character, and I don't want to hear any more about it. Originally I bought a whole pile of cream and brown fleece and was going to sew all the kids matching Jedi costumes (pause for laughter), but reality testing eventually intervened and I ended up buying the chintziest of chintzy drugstore Jedi outfits for both boys, coupled with these foam colored light up rods that I highly recommend to anyone who has kids that are into Star Wars.

And when we went to the third grade Halloween party this Friday, he put it on without any discussion.

Cal!

Put on an actual non-regular clothing costume!

WITHOUT DISCUSSION!

(High fiving a million angels)

I know it's not a big deal (and believe me, I'm trying not to make it into one, especially in front of him), but it's been seven years and eight Halloweens to get to this point so...yeah, it is kind of a majorly big deal.

Both of the boys, by the way, decided to be Obi-Wan Kenobi for Halloween.  Originally Cal wanted to be Obi-Wan and Mack was going to be Anakin Skywalker (which I found actually quite fitting), but then Mack decided that he wanted to be Obi-Wan too, and Cal got mad because what are you nuts, there can't be two Obi-Wans, haven't you even seen the movie?  Like, a couple hundred times? And there was much squabbling, and I came in and decided, perhaps at a slightly higher volume than strictly necessary, YOU KIDS SHUT UP EVERYONE'S GOING TO BE OBI-WAN.

Ah, Mack.  Mack, on the other hand...

The only problem we have with Mack is getting him out of costume.


* * *


I'm kind of hustling to write this while the kids are asleep so I don't really have time to reflect on this fact or get overly introspective/profound/lachrymose about this fact, but: this weekend marks the twelfth anniversary of this blog.

Twelve years. That's a lot of years, boy. Twelve years ago I was starting my second year of medical school and decided, on a whim, to start an online journal in lieu of memorizing the complement pathway to have even a faint hope of passing my immunology midterm. And now I am an attending anesthesiologist, married to my med school classmate (who, not to knock my own clinical skills, but I often think is a better doctor than me, or at least good at different things), a mother of three, living in the South.

Aside from the part where I now have a medical degree, at the moment I started this blog I had no idea where I would end up ten-plus years down the line.  I can't say that everything that has happened to me since has been expected. But as much as we Type A personalities like to control things, the unexpected can be exciting, and what's more, the unexpected can be quite good. And really, I don't think that this blog anniversary requires much more reflection than that, only to say that life now is busy and full and, most importantly, fun. I think I've reached a point in balancing my life and obligations where I feel that if something extracurricular ceases to be fun, it's probably not worth doing anymore. But keeping this blog, even after twelve years, continues to be fun, and that's why I keep writing. So thank you for sticking around with me.

And yes, if the finer details of the CXCR4 signaling pathway are indeed important to my clinical practice, I am pretty much screwed, because I don't think I ever really learned it in the first place.

break Joe's website

So as you all know, Joe recently switched jobs, so for the past week or so I've been trying to help him build a professional website (professional meaning for work, not as in designed by a professional) because how else are patients ever going to find him and know how awesome he is?  My proposal went like this.

MICHELLE

You need a professional website.

JOE

I do?

MICHELLE

It has to have your credentials on it, and all the information about the surgeries you do,
with, like, "Before" and "After" photos and contact information and post-op instructions
and such, because blah blah blah online presence marketing Internet searches social media blah.

JOE

What is an "Internet"?

MICHELLE

Let me...just do it for you.

So we made this:

I designed and built the site, while Joe provided the content.  It's still a work in progress, but I think it's starting to look...pretty decent.  I personally have a bias when it comes to doctors' work sites--many many of the plastic surgeon websites I've seen I think come off a little too glitzy (and I realize that this is somewhat dictated by the nature of the work and clientele, but there comes a point where patients may have a hard time telling if they're researching a doctor or reading US Weekly).  For Joe's site, though, I wanted a simple, clean interface with all the medical information and professional credentials easily available. Joe does such good surgery and his professional pedigree speaks for itself, I thought it would only be distracting at best and cheapening at worst to gild the lily with, like, animated lens flare effects and an Enya soundtrack.

But anyway, do me a favor and look at the site. Look around on all the pages and see if they read well, click on the links to make sure they all work. I know some of this is a matter of personal taste, but does the website flow well for you?  Is there anything not on the page that, as a patient, you would want to see? Click around a lot, roll around, try to break it, think of it as a couch at Ikea that you're trying to decide to buy for your family room, then e-mail me or leave a comment to let me know what needs to be fixed.  Remember, this is still a work in progress (in particular, I have an "FAQ" section and a "Patient Testimonial" section that we're still working on) but in general, how does it look?

As for the subject of trying to build a website with your spouse looking over your shoulder, I will add this conversation from this morning.

MICHELLE

(Painstakingly editing HTML to adjust photo alignment and spacing, because the Blogger 

"compose" interface is a piece of doo and has already taken years off my life.)

JOE

Hey, you should try to use HTML!  Or something!  For the website!

MICHELLE

(Pause)

Have you ever seen that site, "Clients from Hell"?

JOE

Yeah, you showed me that once.  Hey...why are you bringing that up now?

MICHELLE

No reason.

Thanks guys!

(By the way, I've test-driven the site on Google Chrome, Safari and Firefox and it renders decently on all of them so far as I can tell--however, if you're using some kind of antiquated browser, NO PROMISES.)

a more perfect union

I was working on my Grand Rounds (about the ever-scintillating topic of perioperative antibiosis--a topic that I personally find engaging and endlessly fascinating, mostly due to the influence of Drs. Garvey, Prince, Lowy et al., but I understand most people find...uh, pretty dry) when a couple of colleagues steered me instead towards the admittedly sexier topic of the role of social media in medicine.  It's a topic that other people have covered much more extensively, and I daresay with much more eloquence and expertise than I; though I've personally been writing online for coming up on eleven years, in some ways I feel like Willy Loman, who built his little house in the middle of a field and later found himself surrounded by skyscrapers.  I'm not an expert by any means, and I'm not a pundit, nor do I aim to be.  But do I have any opinions about the interface of social media with medicine?

Why yes, yes I do.

Let me say first that medicine, above all fields, is slow to adopt change.  Sure, medical technology is evolving rapidly, but the culture of medicine, the technological change within our own ranks, moves at a glacial speed compared with other industries.  See, for example, the excruciating pace with which we have moved to adopt electronic medical records.  No other field in which the essential importance of recorded orders or observations, and the critical nature of interpretation error would be so inextricably tied to the the ability (or, as I see every day, the utter inability) to legibly hand-write notes with paper and pen.  And don't even get me started on dictation.  Or pagers.  Who else in this day and age still carries a pager?  I could go on, but at this moment I am chained to my dictaphone, hand-writing a patient note with quill on parchment while working the butter churn with my feet.  Fresh butter in an hour, guys!

But the fact that medicine is slow to change does not mean that the rest of the world will follow suit.  As we all have seen, the evolution of technology and how we use it has progressed at a blistering pace since I started writing this online journal as a med student in 2000.  The year 2000 was before Friendster and MySpace--remember those?  It was before Facebook and Twitter.  It was before YouTube, Flickr, LinkedIn, and whatever other incorrectly punctuated, problematic vowel/consonant ratio site has evolved in the last decade.  It was before blogs.  Really, it wasn't that long ago, but the Internet was a very different place since then, and as both the Internet and the way we interface with it has evolved, the learning curve has been steep, particularly when it comes to the world's oldest profession (no, not prostitution) dealing with the world's newest media.

In many ways, medicine is like the military.  It is a combination of a hugely public and yet extremely private field, and both are intensely scrutinized and regulated.  So it is not surprising that medicine has been slow to adopt (or to even acknowledge) the Internet.  Sure, the medical world has long viewed the Internet as an incredible repository for information--even the most steadfast of medical Luddites will use PubMed and be the better for it--but when it comes to social media in medicine, I think I'm safe in saying that at best, most established doctors think: why bother? and at worst, think that the personal and professional risk of engaging in social media is well beyond whatever marginal benefit can derived from it.

Do doctors have to have a web presence in order to do their jobs?  No, of course not.  Having a blog does not help me take care of my patient with the ruptured abdominal aortic aneurysm.  Having a Twitter account does not help me intubate my patient with the critical airway.  In some ways, interaction over the Internet is utterly peripheral to my everyday life of taking care of patients and my family, and possibly a distraction from those essential tasks.  Medicine is about triage, and over the course of a busy day, with a lot of other pressing obligations, it's easy to look at something as seemingly frivolous as social media and think: it's not important.

But it is important.  Certainly it's important to patients, who by overwhelming majority, and for better or worse, look to the internet as a source of medical advice before seeing any of us.  It's important to hospitals and medical schools, who are finding out more and more how indispensable a strong web presence is from a business and marketing point of view.  And I'm willing to bet that young doctors-in-training, most of who are in that key 18 to 34 year-old demographic, think that social media is very, very important.  Look at this infographic from Mashable about how we interact with Facebook and tell me what you think.  You can decry it, you can shake your head in rue, but you have to at least acknowledge that this is the direction in which society is moving.  And then either bury your head in the sand and wish it away; or, as our training in medicine has taught us to do, you can observe and adapt your treatment plan.

Some medical institutions around the country have taken the stance that they will not allow their trainees to partake in social media at all.  And forgive me for being blunt, but: that's dumb.  First of all, most of our future doctors are already engaged in Facebook or Twitter probably both.  Most of them read blogs, some of them may write them.  So you can either ignore that, and place a blanket edict stating NO SOCIAL NETWORKING EVER, YOU KIDS DON'T KNOW WHAT'S GOOD FOR YOU AND WE DON'T TRUST YOU ANYWAY SO SIT DOWN AND SHUT UP AND READ YOUR DAMN SYLLABUS.  Or we could start talking about it.  We could start educating our medical students and residents about what is appropriate interaction with social media, and what could be construed as unprofessional.  Instead of closing our eyes and wishing it away, we could start to be proactive and do what we were trained to do.  Educate.  React.  Adapt.  Here's a start.  So is this.  And this.

Let me just say right here that if there is ever anyone who was in the position to make mistakes with respect to social media in medicine, it's me.  Having come of age writing a blog way before there were conversations about this topic (let alone newspaper articles, lectures, or studies) I just had one thing, and really it's all that each of us are left with and the end of the day when the noise dies down and the dust settles.  That thing, quite simply, is common sense.  You can't tell doctors to stay off social media entirely, and many would argue (myself for instance) that you shouldn't.  Because social media has tremendous power for good.  Dissemination of quality information.  Access.  Building community.  Breaking down barriers between practitioner and patient.  Humanizing the practice of medicine, and humanizing the experience of those in our care.  But with the incredible power of social media comes great responsibility, particularly for those who see the human condition at its most vulnerable.  And we need to start teaching our young medical trainees, from an earlier age, about common sense when it comes to its use.

Because common sense is not obvious.  Sometimes it needs to be learned.  Now, as an attending, if I have a patient in the OR now who is desaturating, I instinctively go through a series of "common sense" steps to troubleshoot the problem.  At this point, it is ingrained.  But would it have been as obvious to me as a medical student, or even a resident?  Of course not.  I had to learn it.  Someone had to teach me.  It feels like common sense now, sure, but only through experience did it become instinct.

The world outside of medical school is changing, and it will continue to change over the next few decades in ways that we can't imagine.  The Internet isn't going away, and the way we interact with it as individuals is only going to get more fraught and more inescapable.  This is progression.  This is fact.  So  sure, we can hide or dismiss or disdainfully pretend we're above it all.  Or, we can do what we do best, which is to roll up our sleeves, learn for ourselves how to deal with this brave new world, and then teach a new generation of doctors to do the same.

grand canal

I went to bed last night with the start of an ache in one of my upper right molars.  Nothing terrible, but it got worse overnight, occasionally waking me up from sleep, to the point that I realized that I might need to go in to the dentist post-call on Thursday in order to get it looked at.

By early this afternoon, the pain was, shall we say, exquisite.  It was like a ball of flaming nails inside my head.  It hurt so much I couldn't even think straight.  And I knew I was to be on call all day tomorrow, in a job that requires above all that I can think critically and pay attention and be able to make big decisions in a split second without being distracted by the fact that my mouth felt like it was going to freaking explode.  It could not wait another two days.  So after work, I made an emergency appointment with my dentist, and soaked a gauze pad with lidocaine to mash on my gum over the tooth.  (Pathetic topical attempt though it was, it kind of worked, enough for me to drive to the dentist's office anyway.)   My dentist, who very nicely carved out a spot for me in his schedule, took one look at my tooth, took one look at me, and promptly did a root canal.

So, that was my afternoon.  Well, that, and the fact that I found out, while I was in the dentist chair waiting for the calcium hydroxide (or whatever that stuff is that they use) to exercise its bacteriocidal action on the inner workings of my molar, that my response to Dr. Sibert's Op-Ed in the Times this Saturday was quoted in The Wall Street Journal online.  So I guess this day wasn't all bad.

psychology today

You may have already seen this, but I have a new writing gig on Psychology Today, and as my first post, I put up a piece that I've been noodling around for a while, about work-life balance during residency.  If you haven't seen it yet, take a look.

It doesn't totally surprise me, though I guess I'd be lying if I didn't admit that it surprised me just a little, the reactions I got to the piece after I posted it.  There are some measured responses, some balanced responses, but also some responses that make me realize: wow, some people really feel a lot of generalized antipathy towards doctors.  And that makes me kind of sad, I guess.  I don't deny that it's a privilege to go to medical school, or that it's a privilege to take care of patients, but I wish...I don't know what I wish.  Maybe I just wish that criticisms lobbed towards doctors didn't automatically lead with the assumption that we are all terrible people with icy, cold hearts made of cash registers and human tears.  Or that we all drive Lexuses.

(And, for the record, though I feel partially like I'm losing ground by even bringing this up--neither Joe or I drive a Lexus.  I myself drive a Toyota Camary that we got from a used car dealer, whose cosmetic imperfections compel perfect strangers to stop me on the road in order to harangue me about body work.)

I put the piece up to talk about the fact that a profession born out of humanism sometimes fails to use humanistic principles in dealing with its own trainees--trainees who are largely idealistic and hardworking and wanting more than anything else to do good.  And yet many of the comments I got sort of went in another direction, almost like an airing of grievances about the whole of medical profession itself.  So.  Three things.

One: I'm really glad I wrote the book I did.  If for no other reason to humanize the practice of medicine to the outside, and to let people see what it's like, really like, to be a young medical trainee who, like all young medical trainees, got into this profession not for fame or fortune or the promise of a champagne fountain in their two-story foyer, but simply in the interest of trying to do her very best, for her patients and for her family.  Many, many of the people who have read my book already are involved in medicine in some way, but now, more than ever, I'm determined to bring it more to a non-medical audience.

Two: I have no problem with getting comments opposite to my own viewpoint (so long as they are not gratuitously vitriolic), because that's the value of having a system which encourages open discussion.  So I really hope that, for this piece and future pieces, that I get even more discussion, on all sides, and that the culture of those discussions is as well-conducted as the ones we've been able to have on this page.  Do you have any thoughts about the piece?  Why not weigh in?

Three: I'm delighted to have started writing online for Psychology Today, because I'm excited to bring the topics that I care about to a wider audience.  The focus of my column on PT is the human side of the medical profession, and I can already see that we're going to have a lot to talk about.  So what should I talk about next?  I have some ideas, but you guys tell me: what do you want to read about?

from here to eternity

Hi all! Sorry no posts for a few days (though I have been posting to my Tumblr mini-blog, if you haven't checked that out yet). The conference at the University of Iowa went really well. As an ISTJ I am an introvert by nature, which is not to say that I'm not friendly (I am!) or not a nice person (I am, I am!) or that I don't like to meet new people (I can say without reservation that finally meeting some of my blog readers at the conference was the highlight of the trip), only that all that plus the travel tends to makes me a little tired. So! Now it is Monday! And I woke up extra-super early to try and get some work done before going to actual work at the hospital. So let's get to it, shall we?

IOWA! I WAS INSIDE OF YOU!

Let me say first that I have never been as unprepared for a trip as I was for this one.  It went literally like this.  I packed half an hour before the cab came to pick me up.  I got into the cab, which took me to a train, which took me to another train, which took me to a plane, which took me to another plane.  Which I almost missed because after we landed in O'Hare (early, mind you) we were parked on the runway, unable to taxi into the gate for, like, half an hour.  Once we finally pulled in, I had nine minutes to get to my connecting flight, which was at the opposite end of another terminal, across the length of the entire airport.  Feets, don't fail me now!

Luckily there was a series of moving walkway connecting the two terminals, all lit up with crazy '80s roller derby neon, which you could probably see better above if I wasn't running all crazy holding two bags.  Action!

The good thing is I made it to the gate with exactly 30 seconds to spare.  The bad thing is the flight was then delayed for another hour and a half.  So...yay?

Anyway, I made it to Iowa City, took an $80 cab from the airport (YES, I KNOW, I should have called ahead for a cab with a flat fare instead of just letting the meter run, but at that point I was just like GET ME TO WHERE THE BED IS) and checked into the Hotel Vetro, which was recommended to me by blog reader Susan and which I now also highly recommend.  Because of its bed and its bed-affiliated paraphernalia, mainly.  Also: BED.  (I was tired.)

The next day I attended a book fair, gave a talk about work-life balance in medicine, did a short reading of my book at Prairie Lights, and then attended a meet-up at the very excellent Sanctuary Pub and Restaurant in downtown Iowa City.  It was a very busy day, and I enjoyed every minute of it.

See how I have lollipops set up at my book fair stall, like some kind of cartoon witch, to lure children into my shiny book trap?  Also, see to the left: BOOKMARKS.  (Aside to everyone who pre-ordered and gave me their addresses for the bookmarks: thank you!  There are, like, hundreds of you, so sorry that I can't e-mail you all back individually, but rest assured that I will be putting your bookmarks in the mail on Wednesday, May 11th.  The bookmark promotion is a limited-time offer just for pre-orders, of course, else I would bankrupt myself with postage, so if you want one, and you should, please pre-order and then e-mail me!  I don't need a receipt or anything, just don't be a lie-face.  Also, yes, if you pre-order more than one, I will send you multiples.  SO GET ON THAT.)

Like I said, meeting my blog readers was definitely the highlight of the trip.  Since I don't run this site like a business, I don't have a great sense of who is reading or how many people read, but meeting so many readers, in Iowa City no less (not to say that Iowa is, like, the North Pole, but it's a little far-flung for lots of people) was amazing.  Please especially note above my new Super-Friend Amy, who drove four hours just to hang out with us at Sanctuary.  Such nice people in the Midwest!

The reading at Prairie Lights was also a blast.  My first reading!  It would have been a bad time for me to reveal at this moment that I NEVER LEARNED TO READ, like Jordan Catalano, or Marlon Brando in "Viva Zapata!" but luckily, I can read a little bit.  This is also the first time I ever done anything remotely artsy like this, so I wasn't sure what to expect (perhaps an audience full of berets, macrame-ed vests and bongo drums incanting, "How now, brown bureaucrat."  Yes, a truly arcane Simpsons reference, how typical of me.)  But it went really well, I thought, and I think people were amused and piqued and all that.  Plus, now at least I have a crowd-tried excerpt to read for future events, speaking of which:

BOSTONIANS AND PERI-BOSTONIANS! You guys helped me make this book event happen!  Join me at the Harvard Coop on Monday, May 16th at 7:00pm.  I know it's not at Wellesley itself, but I do happen to know a certain shuttle bus that runs straight into Cambridge and will drop you off in front of the Coop basically the second that finals period ends.  What could be finer or more convenient?  NOTHING. As always, check the EVENTS page for more information and updates about after-event meet-ups.  Will there be more vaguely booze-laced events to make me feel slightly queasy the following morning?  ONLY TIME WILL TELL.  (But come on--it's Boston.  What else are we going to do?  Walk the Freedom Trail?)

Despite the revels the night before, we had a nice turnout for our panel talk early Saturday morning, which was about blogging and medicine.  Above is Rob, aka Dr. Rob, holding the crowd in the palm of his hand, and the crowd not looking the least bit hung over.  (Full disclosure: I was a tiny bit hung over, but that's probably because I wasn't sure that the Iowa City tap water was potable.  Turns out it is!  Good to know for next time!)

And then it was time to go home.

Mainly, I needed to get home so I could hide sixteen frillion plastic eggs with Snickers in them in our yard the following morning, in order that my kids could find them and demand that I hide them again.  So we did that for a while, which was OK, because I missed them like stink when I was gone. Which begs the question: what is stink? And do we say in the OR that something "bleeds like stink"? I don't know, but such are the enduring mysteries of language, and at any rate, I missed my kids a lot.

Cal looks like he belongs in a "Twilight" movie in this next one, because for some reason the light that morning made our back yard look like the Pacific Northwest, and him vampiric:





As a wonderful capper to our weekend we had guests over for dinner, which brings me to my first brush with Internet Super Fame.



Holy shit, guys, KEVIN MD was at my house!  And he is the nicest!  And I, apparently, am very short!  The best part, though, is that Kevin brought his lovely wife and kids, who are the exact same age as Cal and Mack, and they all had so much fun together that when they had to go back to their hotel, Cal cried.  And then he pretended not to be crying, which is extra-adorable.  In fact, I'd say nothing is cuter than that, except maybe two bunnies sitting in a teacup together.  And also the bunnies are hugging.

Then everyone slept for many hours and now it's Monday.  Again.  Which is somewhat less cute.

Anyway, hope you had a good weekend too. and thanks again to everyone in Iowa for making me feel so welcome. You guys were the best, and I hope to see you again soon.