Real Life Scrubs

I moved in with JW, who is a medicine resident in the same hospital. She is on-call tonight in the CCU (we worked together in the CCU in October) and I'm on night float, so it'll kind of me like Scrubs when Turk and JD.. 

 

I'm spending today, finally unpacking in the new room. Basically taking clothes out of trash bags, and separating out books and papers.

 

Wrapping up

 

I flew to Colorado on Saturday, and am flying home tomorrow. It's been a quick trip, that's for sure. Have kept it pretty quiet this time so that I can maximize time with family. It's hard to believe that I won't be seeing the family for a year. 8 weeks and counting.

 

I have some great pics, but they will have to wait until I get back to Massachusetts-I forgot to bring the cable to connect my camera to the computer.

 

 

The Flask

It's weird the things you pack when you're headed away.

I'm half way through packing up the kitchen. And I came across my flask.

Ironically, somebody had a flask at dinner last night. (I'll just let you use your imagination on that one). And I kind of wondered where my flask had migrated off to. I hadn't used it in a while. Oh wait, the last time I used it was backpacking... Whiskey (Jameson) on the Appalachian Trail with Johhny K. Ah yes...

So, there it was, hiding in the cupboard.

Before Johnny K, the last time I had used the flask had been in Ireland. It was in my suit pocket at a med school function. I am almost too embarrassed to admit that the flask was used to add whiskey to coke. Those were the poor years. Mixed drinks were expensive.

Why did it even make it to Ireland? Because it was a gift, from a very dear friend, whose wedding I participated in 2 days before moving to Ireland. I basically flew back from that wedding, spend a day in Denver and then flew to Ireland. The flask was just part of the luggage at that point.

Over the past few days of packing, I've been setting things that need to go to SA in a box. Books. Certain photos (most photos are now on the computer). My extra phone. Foreign money. My passport.

And tonight, I put that flask in the box. It seems silly to take the flask to SA...

I can only hope that at some point in the coming year, I find myself in the Drakensberg Mountains, sharing my flask with new friends, while remembering the great friends who have supported me for many years.

Running

I'm on the run.

I'm making a real effort to start running regularly again, and not to just codes in the hospital. I forced myself onto the treadmill, once, and on rare occasion twice a week during the winter. That's a total lie, I can think of one week where I was on the treadmill twice.

Anyway, this past Tuesday was beautiful. I was done at a decent time, and decided to escape away and go for a nice trail run. I picked a gentler path than normal, and ran for about an hour, covering just over 4 miles. And paid the price. Oye pain on Thursday. But, no pain, no gain.. right?

I'm hitting the wall today.

In my post-call-mental-slumber, concentration seems to be lacking. I only have 2 goals today. Get some packing done, and finish a presentation I'm giving tomorrow morning. Packing has been a minor failure. I can't quite part with some books that I haven't opened from med school. The books are all packed. The storage closet has been emptied. Basically all that remains is sorting through clothes. Moving day will be Friday.

I can't resist the pull of the beautiful sunny afternoon.

I'm going to have to give in and make a break for trail run #2. Surely it will hurt less than earlier in the week!

Wild Things

Yesterday was a tease. Offering what the summer will bring, but also what I will have to give up for a while.

Temperature in the 70s. Blue sky. Off of work by 4. As was KZ. So we met up, she picked up the kids and we went to the park. Got to hang out, playing on the swings, going down the slide. And then going for a stroll on dirt paths around the park, in a very cool wooded area. Darn, forgot the camera.

Bedtime rolls around, and the priceless moment was getting to read Ian and Emily their bedtime story. Emily was in my lap, Ian was propped up hanging off my side, and both were grabbing and turning pages. Growling. Showing fangs. Hoping that I get many more nights like this before I leave, and hoping that there is a day when I get to read bedtime stories to Ryan, Jordan and Haley too. Wishing that all the kids in my clinic had parents who would actually read to them at night...

Have Visa, Will Travel

Well, much to my delight and surprise, I got my passport back today. Have stamp allowing multiple entries as a temporary resident for the next year!

I am headed back to SA!

SHIT!

I have microwave popcorn..... AND NO MICROWAVE!

Let me think about this for a minute...

How did this happen. When I bought microwave popcorn, I had a microwave. Oh, that's right, I'm giving away what I can, and I freaking gave away my microwave! MORON! I don't use it all that much, but now, dammit, it's 1am I am wide awake (for reasons that are unclear to even me), I have the munchies (and a lack of food). I have no chocolate stash. I have no ice-cream stash. I don't want health food at 1am, that doesn't satisfy a craving for badness. Popcorn would have done it..

I'm going to go experiment in the kitchen.. certainly the kernels don't know they are suppose to only pop in a microwave, I'm going to try and pop them in a skillet with oil...

Wish me luck.

My Rorschach Inkblot Test

"An Iraqi army soldier looks on as a woman picks up rice at a checkpoint in Sadr City, Baghdad. The Shia suburb is suffering food shortages as troops clash with the Mehdi Army militia."

-BBC-

What's your reaction???

My Verdict on Pike Place Roast

I understand why they did it. Getting back to the purity of coffee. Getting back to the fundamentals of what makes a good coffee, or coffee good.

Fresh roasted is best. Blue Bottle knows this. That guy built a coffee company with fresh being the core concept. Coffee older than 48 hours is not fresh, and he gives it away. Starbucks started out small, with fresh roasted coffee, then exploded into a coffee empire, offering pure roasts, exotic blends, and a confusing array of lingo and ordering styles. You're average Joe gets his cuppa and likely ruins the taste with splenda and soy. Wait, I mean the average Joe uses milk and white sugar, carbo queens go for the splenda and soy..

Joe likes the whoosh of a can, not the whirl of a grinder. Joe doesn't care if the coffee is from Latin America, or if it's a Yemen. (Yemen, being my all-time favorite coffee).

Starbucks proved that they can master blends and roasts. They are good, but mass production of blends can't be best, because by the time you get those coffees to a consumer, they are no long have freshness. Local coffee roasters offer freshness.

The idea is great. Mass roast one blend, and bring back freshness. The Starbucks I visited yesterday had coffee roasted on 3/29. That's pretty decent.

That one blend is Pike Place Roast. I think it is very mediocre. But that's what they needed to do. Find one blend that east coast coffee wimps would drink, but not too dilute that hardened west coasts fanatics would avoid. I think Pike Place Roast accomplishes this...

That's my opinion.

Random Thoughts

1) This morning, I packed up my book shelf, and dismantled the kitchen table. I have to be out of the apartment in 2 weeks. Reality bit me in the ass. 3 boxes of books. Sadly, there are about 5 books to be read still, and I kept those ones out. I'm not sure these boxes will be unpacked. When I moved to Ireland (almost 8 years ago), I packed up 4 or 5 (maybe more) boxes of books, thinking someday I would be back and unpack those books and display them in my home. I'm not sure when I'll ever really settle down long enough to unpack all these books. And maybe I should just learn how to part with books...Or *gasp* use the library.. Maybe I should just ship these boxes to Colorado to join the other boxes of books.

2) VISA. Applying for my South African Visa tomorrow. To me, this is the real final step. There are some small things like getting an international drivers license, applying for medical indemnity coverage etc, but this makes it real.

3) I would drink Animal Dung Coffee.

4) My hair. I am growing it out. And right now it is in that frizzy annoying short-long phase. If I hear one more person tell me that the grey makes me look "distinguished," I am going to develop even more of a complex and may consider getting my hair darkened, which is a total waste of money, but I don't want to look distinguished. Actually, if I want to look distinguished, I'll wear my glasses. Shit, maybe I am more vain than I realize.

I am going to bed now.

Sundays

Heather, my old flatmate from Dublin came for a visit this weekend. It's been over 2 years since we've hung out (when I went to see her in Pittsburgh). It was like old times. We reminisced about the simplicity of life in Dublin, and the things we took for granted there. We had dinner at The Blue Heron (one of my favorite places) Friday night, and then a drink at the Montague Book Mill, and then made our way home and watched episodes of Sex and the City. Saturday we went to Brattleboro and Shelburne Falls, the two places here I would move to in a heart beat, except they are too far from the hospital. This morning we went to Karin's for brunch, and had a great time hanging with her and the kids. And like that, the weekend is mostly over. Weekends are going fast these days...

JR

Last week the ER resident called me to admit a patient. "I have an eight-year-old boy with pyelonephritis. And he has rash." Interesting, I remember thinking, you don't really get a rash with pyelonephritis.

I made my way down to see JR. As I knew I was already going to get out of work late, I decided to take my time and make some small talk with JR and his mom before I asked them all the medical questions.

So, I asked him about what he liked to do. And he told me he liked to knit. I was taken aback. What 8 year-old boy likes to knit?? He told me how he has knitted scarves and also a hat. This was no normal 8 year-old boy. We talked a bit more, and the more we talked, the more inferior I felt.

"So, JR, can you drive a car?"

"No, I can't reach the pedals." Well, I was glad to know that there was one thing I could do that JR couldn't!

Even before asking him or his mom any questions, it was very obvious that he did not have pyelonephritis. As we talked, I was looking at the rash on his hands, looking at the injection of his conjunctiva, and looking at his red cracked lips. It was time to stop the chitchat and get down to figuring out what was going on...

After taking a history, examining JR, and looking over the labs, I suspected that he had something more serious than just pyelonephritis.

I talked to JR's mom and told her that I was concerned about what was going on. She asked me to call her partner, who worked in health care, and discuss what I thought was going on. And I told them I suspected that this was Kawasaki's. But it was too early to make a diagnosis.

I explained to mom #1 that they would have a new residents taking care of them in the morning.

"But, we like you. Will you please be our resident?"

Our team size was alread a little unruly, but how could I turn down taking care of this cool kid, with two moms, and an interesting/complex medical condition.

JR had a rough course. There was disagreement about whether he had Kawasaki's or some infectious cause. He failed initial treatments. And on day three, he was looking worse. We had multiple family meetings daily discussing his care, and what more we could/should do. We called the Kawasaki specialists in Boston, and were on the verge of transferring him. Thankfully though, he responded to the second course of treatment, and went home a week after coming into the hospital.

When I went back to work on Monday, they have left me a card with their number, and an invitation to come over for knitting lessons...

They were the coolest family that I have taking care of, and if I ever have a family, they would be one of my role models.

Reunited

Here are a few clips from this past weekend. Kevin is a great pal who is now a Specialist Reg (Senior Resident) in ER in Edinburgh. The summer I stayed in Dublin he was one of the residents on the team I was on. Anyway, we had a great weekend. Had to do loads of shopping on Sunday, because his was one of the 20,000 bags stranded at Heathrow Airport. WANKERS!

Photos from Satuday.. hanging out with friends from work.

19 & 3

19-the number of days I have worked in a row.

3-the number of months until I am on an airplane moving to South Africa

Haunted Halls

"So, you're leaving for a year, you're not getting paid, and it's not going to count-so you'll still have a year left when you come back. Why would you do that?"

90 days to go. I don't want to be asked again.

I know exactly where I was 2 years ago on this night. I was on-call on the pediatric ward as an intern.

Today, when I walked past the ICU, I was very aware that it was 2 years ago last night that Gabby died in our ICU. And the next day, the only thing I could think to do was go to work and know that being on call would keep me busy and keep my mind occupied so I wouldn't think about the horrible loss at that moment.

And today, when my co-residents ask me the why I'm leaving for a year, I'm reminded that I am on outlier in my residency program. There use to be two of us, who had convictions about using medicine as a tool to bring about change, to improve the quality of life for those who lack access to fundamental care. There use to be two of us who just didn't seem to fit in as well with our peers. Somehow we aligned early in residency, and Gabby was the one person I could call at midnight in utter disgust at what I saw going on, and I could vent to her before going to bed. Gabby was the one who called me from Florida to ask what I was doing for one of her patients that I covered when she went on Christmas break. And that seemed normal. Last weekend I called the pedi intern to remind her about an order that needed to be done, and was chastised for doing work when I had physically left the building.

As I walk past the ICU doors on the way to the adolescent ward today, I feel a twinge of pain at knowing that the one person who would have never asked me the above question is no longer alive. I see a family huddled in the waiting room, and remember that 2 years ago we were in that room, hoping for a miracle, which never came.

But... I also see how much I've changed and learned in those two years. And somehow I know that her spirit is still very much alive.

And from now on, when people ask, I'm not going to justify or defend my plans. Instead, I'm going to smile and say "because I can."

At Risk

I am at Risk.

I am at risk of fucking away a perfectly good post-call Sunday afternoon...

It is now 1036 am, and I can't decide what to do. Paralyzed by guilt of the multitude of tasks that are piling up (emails, bill, phone calls, clinic notes, taxes, laundry-almost out of clothes, groceries-down to oatmeal ) that I could care less about completing, and the competing desire to get out a live a bit (go for a drive, a hike, find a new coffee place).

14 days of work in a row.. I haven't been out of a 5 mile range and I am going stir-crazy.

Trying to fall asleep last night in the call room I just kept envisioning going home to a nice mountain cabin, reading the NY Times on a wooden patio and drinking damn good coffee.

sleep, run, gym, play, work.
what to do
what to do

where have my fun friends gone?

Dr House

It doesn't matter that I got home 4 hours late from work today.

It was a great day. It was a bit of a mad house. Lots going on and I just kind of flew solo for a most of the day. Rounding on kids. Discharging kids.

I've learned a few lessons in the past few days.
-don't ignore my nagging gut feeling
-ask smart people when you're stuck

I've had 2 teens lately with unusual medical problems. While they have both been on my team, I haven't been rounding on them directly. For reasons that are not worth mentioning.

One of them went home, better.

One of them is still in the hospital, getting worse.

And it has just been pissing me off.

Part of it has been the pedi mentality, taking time, not being aggressive in work up and treatment. And I just wasn't going to be able to leave work until I felt like we were finally getting a clue as to what the hell is going on with this person. There are specialist on the team already, but things just weren't moving along. I decided this morning that I was going to cross a fine line and go to some of my adult medicine attendings for ideas. It's taboo to consult adult docs for pedi patients. But I'd reached my limit of being passive and waiting for badness to happen and decided I'd deal with the consequences later. My plan had been to pop into the Chair Of Medicine's office (who is likely smarter than Dr House) and bow my head in disgust that we'd done a sub-par work-up thus far. Her health is worth a lot more than my pride.

But at the last minute I decided to ask another adult specialist his opinion, and he had some ideas. We talked for a while. He was a bit concerned about our lack of progress, and asked if he could see the patient, as a formal consult. That's pretty unusual. Nobody looks for more work.

He saw the patient, and likely has figured out what's going on, and gave treatment plans as well. All of this starting at what should have been the end of his day.

I feel good tonight. I don't feel good because I think we finally have a clue. I feel good because this patient is finally getting the care they should have been getting.

And I'm a bit embarrassed. This medicine attending stay late today to help. Why haven't we-the resident taking care of her-worked as hard the past few days to figure out what's going on???

Updating..

yeah, lots going on.

Work: Love and Hate.
Love working in pedi land. Taking care of kids is great. Seeing kids getting better is great. Working with some great attendings.
Hate: Not going to mention it here.

I am taking care of some beautiful babies right now. Two who have infections and are going to turn out gorgeous after finishing IV antibiotics/antivirals. I also have one adorable infant who was abused beyond belief but amazing may still develop normally and who has an awesome foster mom lined up to care for her. I offered to take this kiddo home! (Well, not really, but I'd love to be a foster uncle).

Just got over food poisoning. It's a great way to drop 3 pounds really quick. Though sleeping for 18 hours on my only day off was not great. Being positively orthostatic and dizzy on standing was a fun cheap high though.

Have heard rumor that I'm getting a medical license for SA.

Bought a ticket to fly to South Africa-leaving June 21st.

Just really working a lot right now. Am trying to figure out what I like best about my job, and what I like least. I like my autonomy. I like that the attendings who know me and respect my opinion. I like that I usually have a good idea of what to do. I like that my skills have improved over the years. I don't like realizing how much I still don't know. I don't like supervising interns and medical students. I'm not really sure I'll seek an academic post after residency.

Time to go read up a bit..

Contra Dance & Pedi Wards

Well, I will confess that last night was... FUN!

Who knew that Contra Dancing could be fun. It's basically line-dancing, with live musicians and somebody calling out the moves. Thank god, there is a walk through of the moves and then the dance happens. Though, for the last dance there wasn't a practice session, and lets just say we didn't go out with a bang.

We probably did a dozen or so dances. And the other cool thing was that you change partners after each dance. Being the newbie last night, I got to dance with most of the guys. So, the dance part itself was fun (requiring constant concentration). It was also a really cool group. It was a GLBT-Gender Free group. I was the second-youngest guy! It was like a mini-pride.

I judged people based on how they did the twirl portion of the dance. Some were gentle and slow, and some liked to whip around. When you do the twirl portion (I forget the real dance term for it), if you don't watch your dance partner's eyes, you get wicked dizzy!

I may have to go again to the next one.

I'm call tomorrow on the Pedi Ward. It has been 18 months since I was last on the pediatric ward. EIGHTEEN months... I have floated in a day or two to round on kids, but 18 months is a bit of time to be away. Though, I am looking forward to it.

Anyway, going to try and make this a productive day.

Trouble #2

I can't even remember the last time I was up until sunrise. Well, at least the last time being up until sunrise when I wasn't in the hospital working...

DT and I had planned an early night. We were going to meet up after work (damn, I still have charts to finish from clinic), grab a bite and call it an early night since he's on call today. Well, we invited a few others, a bite turned into a lavish meal, then ES and I went to the sad gay bar and ended up chatting to this guy who I saw last time I was there (back in September? October?), and we swapped numbers so that he could come to Contra Dancing (more on that in a minute) tonight.

I *finally* got home. And then the bartender from the night before called so we met up and hung out-until sunrise. He's much younger, and so much fun. Really a breath of fresh air around here. I don't think many others would have even considered intentionally staying up until sunrise.

So, I am suppose to go to a Contra Dancing event tonight. I get visions of being back in elementary school, when it must have been gym or music class where they tried to make us square-dance. It didn't go so well. I wonder if I have one of those plaid shirts with the snap buttons... Looking for Trouble #3.

Time to get busy.