Schedule

I finally have my schedule solidified for the fall. I think.

I'll be taking:
1) Biostatistics
2) Measurement
3) Empirical Bioethics
4) Practical Applications of Research Methods
5) Seminar: Health Care Cost Benefit Analysis

I'm told that the typical load is more like 3-4 courses, but that 5 should be ok. I really actually wanted to drop course #4 and take it next year, but the person who teaches it is my advisor, and I really didn't feel like I could request that at this point. And then I guess I'll also throw in some additional work with my now-pretty-much-selected mentor (though he doesn't know it yet), on top of all of this. It should be a pretty busy fall!

I've never taken classes on a semester schedule before. Quarters only. We shall see how it goes.

I also finally worked out what med school classes will be accepted for transfer credit. We finally decided that pharmacology and pathophysiology were reasonable for a credit apiece because the dept. head feels that all epi people should have a background in this sort of thing to even be qualified to do research. Supposedly med school has given me this background.... but then he used the word "calyx" and it actually took me a moment to realize he was talking about the kidney.

So yay! Beating my head against the wall has actually caused things to happen! I may not be the smartest person out there, but I do have a pretty hard head!

Little Sib #2

Last year, some of you may recall that my MD-PhD program instituted a "Big Brother/Big Sister" thing which was supposed to give the new students a person that they could ask questions of who had been doing this for a while.

With some reservations, I signed up to do it. And I ended up getting assigned the 2nd Epi MD-PhD student to come through (after me). He turned out to be a decent guy, and I was glad I did it. And I've actually been helpful to him at times. I think.

What were my reservations? Well.... I was worried that conversing with him would end up being me telling him about potential roadblocks -- ones that had happened to me -- and then having him pooh-pooh what had happened. I was worried that if I said, "I had problems with XYZ and here's what you can do to avoid this yourself," he would patronizingly nod and say, "That sounds really difficult," and think to himself, "God, SHE'S a total idiot."

Why was I worried about that? That sort of interaction happens all the time during med school! Sheesh people.

I think I was also worried that he would think that I was uncool/old/boring, well.... because I am these things. At least by the standards which most 22 year olds use to judge coolness.

Oh and finally? I was worried that the conversation would devolve into a let-me-tell-you-my resume, which it can sometimes do with some pre-med types.

But anyway, all these fears were for naught with my first little sib. He turned out to be awesome, and I'm really glad I've gotten to know him. He has his s*** together, and seems to be a nice person. And he laughs at my jokes. (Very important!)

So, it was with less trepidation this time that I signed up again to be a big sib. This time I got a guy who is not going to be in my department. He's not doing basic science, but his field is enough different than mine that I'm not sure how helpful I will be able to be.

And (I know this is petty), his email signature reads as follows:

Name
Very Important Award Winner
Famous University

People, come on. I'm sorry. But who signs their email: Old MD Girl, Rhodes Scholar* (haHA! I wish)? Really.

Well, maybe a lot of people do. Maybe I'm just jealous. Still, it seemed a little douchey to me.

TRYING VERY HARD TO SUSPEND JUDGMENT THOUGH. FYI. So please don't post a bunch of comments about what a complete bitch I am. Thanks.

We meet sometime next week. If he gets around to responding to my email.

Well, maybe it will be like last year and it will all go a lot better than I fear.

Let's hope!





*This wasn't the award he won (you know you just opened up google and started typing "Rhodes Scholar" you little stalker, you). I had actually never heard of the award he won.

Dog

Now that my husband and I have a house, the question has come up: Should we get a dog?

We would both love to have a dog. Some of my friends have told me that having a dog was part of what got them through their PhD. I guess I'm not the only one to feel isolated at times, sitting in my house reading about statistics and working on my paper for HOURS at a time. With no human contact. Basic science probably isn't that much better.

However dogs are a lot of work. They have to be walked, fed, paid attention to. I'm pretty sure that I'd be able to do most of this for the next few years while I'm in relatively flexible PhD-land, but what will I do when I start residency? We'd have to hire a dog walker for sure, and then the dog would be at home alone for hours a day. I know a lot of people leave their dogs at home all day and don't think twice about it, but I think we'd feel guilty. Especially since our house does not have a yard.

It would have to be a small/medium sized dog at biggest.

And when we went to Italy to visit the relatives, we'd have to pay for a kennel or dog sitter too. Though we only go together every two years or so. Not sure that this should keep us from getting one.

And then there's the hair. My husband is a little bit of a neat freak, and he is worried that there would be hair all over the house. And there probably would be. There's no question it wouldn't be as clean as it is now, at any rate, which I don't think would bother me, but I'm sure would bother him.

Anyhow, we're not getting a dog for now.

So we started thinking about a cat instead. A lot of the same issues come up, but! Tthe cat wouldn't have to be walked, which I think is the biggest downside to the dog. We like cats less than we like dogs, but they are lower maintenance. Also, I think I would end up loving pretty much any kind of animal we got.

There is the smell issue.... (a lot of people we know who have cats have very smelly houses -- is this because they don't clean out the litter box?), and the hair issue. However I think I might have made progress wearing Luca down last weekend when I suggested that it might catch mice. He hates mice, and so far the one I saw the other day has eluded the traps we set for it.

We'll have to see.

Any recommendations on this?

Did I have more energy in my 20s?

A lot of people say that you should plan on making your big career moves in your 20s and 30s. By your 40s you'll be too tired. In fact, a lot of them also say that they had less energy in their 30s as well.

These sorts of comments always irk me, for obvious reasons. What, you think I'm screwed because I started this second career as I was headed into my 30s? That my peak has come and gone (or is in the process of going)? That I'm always going to be hopelessly behind because I started too late?

I think back and try to remember: did I have more energy when I was in my 20s than I do now? I remember working full time and then going for 4:30 AM bike rides, and rock climbing trips over the weekends that left me with little sleep going into the week. But I also remember feeling tired all the time when I was at work. I guess it was easy to be up and awake while I was doing something fun, less so when I was at my desk.

I am really anal about my sleep now, and don't have the sleepiness at work problem that I used to have. I feel like I have more energy than ever. Granted, I'm only 32 and have a ways to go until 40, but I'm beginning to think this decline in energy thing is a whole bunch of BS.

Maybe I care a little bit less about becoming "successful" than I did in my 20s, but I'm pretty sure that I didn't know what that was then anyway. I wonder if it's that people get things in better perspective as they get older and can decide what's important to stress over and what isn't. Sometimes I wonder if I really care enough to make this work. Not the PhD part, I mean the whole launching my career part after. I mean, I'm pretty sure I can jump through the necessary hoops to get the degree and then to get a residency. But applying for that first K award? Getting my first faculty position? Realizing that I have to put out X number of papers in X years?

It seems a bit overwhelming to tell the truth. I hope that's because I have only a small idea of what these things take, and that I'll feel more confident when I get there.

Thoughts?

CRRRIIIIINNNNGGGGE!

Last night I was watching gymnastics on tv, and the following statement was uttered:

This gymnast has had the flu for the past two weeks, but she got some antibiotics and has been feeling much better.

Like nails on a chalkboard.

Granted, we all know that the intellect of your average tv commentator is..... not high. But come on people! Don't we all know by now that the flu is a VIRUS and as such not- responsive to antibiotics??

Way to spread misinformation, lady.

*Hits head with hand*

That other part of my brain

I think one of the nicest parts of starting my PhD is being able to use that part of my brain that thinks. I've been doing math again! Talking about ideas! Solving problems!

You just don't do these things as a medical student. I'm sorry, but calculating renal clearance or GFR* is just not the same. And in my experience, nobody on the wards cares one lick about the cool paper in JAMA you just read or the article in the NEJM that just came out on pay for performance (it's really interesting, you should check it out).

If you were to bring something like that up:

1- It would waste the time of everyone on your team who is trying to get "real work" done.

2- It is highly likely that it would be perceived as brown nosing by your colleagues and possibly by the attending.

The sad truth is that nobody cares about what's going on in the brain of the medical student. All people care about is that you're able to regurgitate facts. Opinions? You're better off keeping your mouth shut and any interesting thoughts to yourself in most cases because otherwise you'll just be seen as annoying and occasionally arrogant.*

After a while, the brain shuts down the analytic, creative, idea part to make room for the hypertrophy of the memorization and facts quadrant. Sometimes I'd wonder if I even had a right hemisphere any more. I'm glad I'm finally getting to use it again!


*And if your class is anything like mine, even learning to calculate renal clearance caused a total anxiety attack/meltdown from people in the class who had forgotten how to do division.
*I wonder whether doctors actually find these things annoying (I'm sure some do), and if rather it's that they're mad that they don't have the time or energy to read these things themselves and/or are mad that you may know more than they do about something and are making them feel stupid.

On gardening, and inappropriate thoughts

I really need to weed the garden this weekend. And one of the bushes seems to be taking over the entire back corner. It's totally growing over the begonias and the other plants in the area. I wish I knew whether it would ever produce pretty flowers, but sadly I still have no idea what kind of bush it is.

Perhaps by the end of the summer I will have figured it out.

******

On a related note, my default soon to be no longer epi advisor took it upon himself to inform me that his son now has a beard. Not a full beard, mind you, but one of those four days of not shaving beards that is intended to look scruffy/manly.

My advisor then went on to tell me that there are special beard trimmers that you can adjust to achieve Just! This! Look! And isn't that cool? Did you know did you know did you know?

Alas, dear readers. It was all I could do not to smirk. For the only thing that *I* could think of was the recently released ad for the Schick Quattro Trim Style:



And for your viewing pleasure (or in case you don't get it), this spoof the British version of the ad (Thanks G!:



Though in retrospect, I suspect this is more what he had in mind:



Call me infantile, call me whatever you want. We have to take amusement in the small things sometimes, right?

******

I think I will head out and do some bush trimming in the garden. Now where did my husband hide the clippers.....

Salary

A lot of doctors are really mad about Obama suggesting that patients might get better care and fewer unnecessary procedures if doctors were salaried rather than paid fee for service.

Why? For proceduralists especially, a salary - from the government or anywhere else - almost certainly means lower pay.*

But the president is right in a sense. I was trying to think the other day of whether you could use pay for performance to disincentivise neurosurgeons (for instance) from performing back surgeries that don't end up helping their patients. I concluded that the amount you'd have to pay to equal what they make doing these surgeries would be very very large. The easiest way to solve that is to pay a salary instead.

I'm sure that this thought makes a lot of doctors mad. "I already take the best possible care of my patients!" They scream, "No matter how much you try to incentivise me to do better, you won't be able to because I am already doing as well as I can."

Alas, friends, that is simply not true. Everybody can ALWAYS do a better job. Even when they think they can't. And ultimately doctors are people* and respond to incentives just like everyone else.

At any rate. I have no intention of being a proceduralist, so this is not likely to destroy my life. (I also will have no debt, so that will help too.) My first thought about all of this?

WOOHOO!!!! I'll be able to have a fixed schedule and STILL make my [insert dollar amount here] salary. I won't have to worry about kissing the assess of patients who want unreasonable things done, because I won't have to cater to their whims in order to feed myself!! I'll get paid anyway!

(Kind of how the VA currently operates - the staff are typically out-'o-there by, oh... 4:30?)

No doubt salaries will cause longer queues to see the doctor, and perhaps over time fewer smart people* will decide to go to med school, but that's a separate issue. Only time will tell how that will impact upon quality of care.

Now, how about some tuition relief and tort reform.

Am I warming up to this socialized medicine thing? Mm.... probably not. But at least I see that the president understands incentives.


*Probably a lot less pay.
*As much as they would like you to think otherwise.
*Not sure how this will matter for things like primary care since the medical students who are at the top of their class currently tend to gravitate towards derm and rads now.....

You know what I wish?

That Biostats met every day instead of twice weekly. And that we had daily assignments.

I feel like by the time I get to class 3 days after the last one, that I've already forgotten what I just so recently learned!

Case in point: When I took Physics and class was every day it was actually easier for me than when it was twice a week, even though we moved much more quickly through the material. It was more of an immersion. Less time to forget stuff.

I wonder why more classes aren't taught like that?

I suppose that I could solve this problem by studying more in between, but that just seems inefficient.

Too bad the rest of the world can't just conform to *my* learning style, right?

The Saga

Before I came to med school, I did research -- generally speaking -- in the areas of health policy and economics. When I was admitted to my program in Epidemiology, I chose to come here because it gave me the flexibility to continue doing health policy, but also had a strong curriculum in classic Epi and genetic epi if my interests changed during med school.

I.e. You could still do health policy and be in the Epi department.

In fact, when I was accepted into the program, it was assumed that I would continue to do health policy. If you look at my CV, this was a reasonable assumption. And everybody was ok with the fact that I would be in the Epi department, and that I would do the health econ/decision making track. At the time that existed, and there were plenty of potential mentors.

Then sometime during my first year of medical school -- we're talking 2 years ago -- the health policy people split off from the Epi department. Now they have their own department in their own building and are affiliated with the business school.

Oh, also? Nobody told me that this had happened until Wednesday of this week. I was aware that there was a "new group" of researchers who did health policy, but it had not been made explicit to me that these people were no longer in my department, or that they were now "off limits" as potential mentors.

*******

I had been wondering what was going on. Back in February of this year, I had been told that (all of a sudden) I needed to decide NOW what I wanted to do with my life. All this so that I could be paid from the appropriate source of funding.

I dug my heels in HARD. I had been told repeatedly up until that point that I wouldn't have to make a decision until oh a year from NOW. I had been talking to faculty members, but was nowhere near making a choice.

They ultimately told me I had no choice but to be assigned to the Pharmacoepi pot of money. "It's going to be ok!" They told me. "You can still do research in whatever you want (as long as it has to do with drugs)."

I told them no, this was too restrictive. That I didn't want my funding to determine what my dissertation topic would be. That it was way too early to make a decision like this. What if I did policy or something, and I wanted to do something completely unrelated to drugs?

"Oh, it will be fine. (And also you have no choice.)" was what I was told. Maybe not in so many words, but that was the reality.

******

Fast forward to now, and I'm talking to potential mentors. I noticed this not-so-subtle shift in the message I was getting.

Previously, it was: "You should pick something you're passionate about, and do that. You should do this because from this program, you should be able to apply directly to faculty positions right out of residency without doing an additional fellowship. Of COURSE you can do health policy, I think that would be a great fit given your background."

Now it's: "Well, I think you should just be doing this program to get a handle on the methodology. Your interests are going to change anyway, so it doesn't really matter what your PhD topic is. You can always do policy as a fellowship after residency. No, that isn't really an option now, why would you want a career in that anyway? You'll never be able to get funded."

WHAT??????

I had this sensation that pharmacoepi was being crammed down my throat, and that I was not-so-subtly being steered away from policy.

But more to the point: Why the F*** would I do a PhD in something I "don't care about" only to have to do an additional fellowship in order to get the training I really need to do health policy after residency? Sure, I'd be really good at statistics. But so what? If that is really how it's going to be, I should just drop out now, go onto a medicine residency, and plan to apply for an RWJ fellowship (hoping to get it) three years from now.

In other words, if that were really the case, doing a PhD now would be an utter waste of time.

Now at least I know where this new message is coming from. The question is, now that I've decided (pretty much) that I want to do health policy afterall, what do I need to do in order to get what I want.

*******

I feel like I've been lied to. I am very angry about this.

And I WILL get what I want.

You'll see.

Exercise Log

One of the nice things about being on PhD time is that I now have time to exercise. Pretty much every day actually. I've been getting up early three days a week to swim with a friend (at 5:45 -- medical school has trained me well), and then going as soon as I get up at 6:30 or 7 on the other days.

It's been amazing.

I was talking with the swimming friend about exercise and med school. We figured that during rotations exercise took place about half as much as we wanted. One crazy person managed to do 40 miles per week of running during his medicine rotation. Bear in mind that normally he does 90-100 miles. (We are not ALL crazy, just some of us.)

By which I mean to say it's so much better during PhD time.

******

In other news, I had an absolutely fantastic, earth-shatteringly helpful meeting with a health policy person today and the former admin/coordinator of the Epi department. OMG, thank GOD I met with these people.

I just say this because sometimes I meet with so many people in a row who do research that I'm just.... meh about, and then I meet with people who are just so incredibly helpful it's not even funny.

Anyway. All will be revealed when I finally decide what I want to do. I swear.

On helping people

"I should hope," she emoted at a lecture on community service during our Family Med block, "that anyone who got into a med school like OURS, did because they wanted to help people and had extensive experience with community service before applying."

She was looking right at me. I had just said that I *hadn't* done really any meaningful community service before coming to med school, but that the project we had just done piqued my interest in perhaps doing more. Not sure why she decided to publicly lash out at me right then in front of faculty and everything, but she did.

You wonder why people sometimes think medical students are tough to take....

Oh horrors, you might be thinking. How DID OMDG get into med school without community service? Isn't she interested in helping people?

I got in because I had three years of full time research experience. My med school is interested in producing clinician scientists as well as pure clinicians.

As for helping people? It turns out I DO like helping people. But hands on grassroots community service was never my goal (though studying it is completely fascinating). I am interested in learning to do better research, and making a research career for myself, and that is why I ultimately chose this program. Do I like research *because* it ultimately helps people? Maaaaaybe. Mostly I just like the process, and I'm happy it helps people as a byproduct. Does that make me a selfish person?

In my opinion, people go to medical school for a variety of reasons, all of which have an ultimate goal of helping people, but which might not be so direct has opening a public health clinic in an impoverished area. To see helping only as working in a soup kitchen or building a house for habitat for humanity seems pretty narrow to me.

The extent to which you sacrifice your own life for the sake of helping others is another issue entirely. I guess it depends on what makes you want to get up in the morning. Ultimately, I think the people who work 100 hours a week in a 3rd world country do so because their feeling of fulfillment exceeds their frustration and exhaustion. If that stopped being the case, they would stop doing the work. If you can only manage 50 hours a week for 3 months a year before you get burned out and exhausted, you're not less of a good person than the one who works 90 for 10 years (though they make think that and/or tell you that -- it helps keep them going, you understand). You just have a different threshold and different priorities.

A different demand function for helping people, if you will. (Ohs no! Not more economics!)

Ultimately you have to have a balance in order to be a sane and well adjusted person.

Are there professions/activities that are less valuable to society than others? Of course there are! I'm not sure that line between valuable and not-valuable lies between 100 hours a week of community service and 50 for three months a year. Or between doctor at a public health clinic and research in molecular biology.

And ultimately, different kinds of people with different interests and priorities help make the world go around.

Thoughts?

Mentor

Today, I had positively atrocious swim this morning, and then I sat around killing time waiting for other various appointments to happen. One appointment got canceled at the last minute, and another one? Well he's an amazing researcher, but I just knew 5 minutes into it that it wasn't meant to be with us. I mean with him as my mentor.

And so it was that I found myself in the office of one of the admins trying to reschedule with the guy who canceled, and she told me, "You didn't hear this from me, but you seem like a very organized person, and working with this guy would make you crazy."

Pure. Gold. Is what I thought of her advice.

Then we started talking about who WOULD be a good mentor. Based on sign.

Zodiac sign.

Well why not? At this point sometimes I feel like I'm going to have to ultimately flip a coin to make the mentor decision. Astrology seems like a reasonable alternative.

:-)

I am addicted to work

As I was weeding my garden this morning and (probably unsuccessfully) transplanting one of the dying roses from the full shade part of my garden to the full sun part, I had a moment to talk to my neighbor as he was unloading his car.

He asked me what I was up to these days. And in fact, I've not been up to much. I've been taking biostatistics, which I've actually been enjoying, working on a paper that is LONG LONG overdue, and occasionally meeting with prospective mentors for my PhD. Oh yeah, and I've been planning my curriculum for the next two years which has been surprisingly time consuming.

It's been really relaxing. I've had time to work out almost every day, as well as get 9 hours of sleep a night. I've also watched my fair share of Judge Judy and surfed the internet a little too much.

So on Friday when I walked into my advisor's office to make sure that he was going to read the paper that we're working on before our meeting on Tuesday, and he asked me what was going on with me, I said, "Well, not much actually. Have any extra projects I can work on?"

Because I am just that crazy.

And there are only so many episodes of Judge Judy a girl can watch before going completely bonkers.

So anyway, we'll see if he comes up with anything by our Tuesday meeting.

******

In other news Luca and I booked our tickets to Italy for the end of August/beginning of September. That should be a nice break before the work of actually having a full course load starts up again.

Tickets were super cheap. Yay recession!

Hilarious Moment of the Week

This came when one of the admins who was scheduling me for an appointment with one of the epi people said to me:

You look like someone who knits.

HAHAHAHAHAHAHAHAHA!!!!!!!!!

I guess I *can* knit, but I honestly can't stand it. I usually get frustrated within a few rows and wind up wanting to throw the whole wad across the room.

In sum: Knitting + me, not a happy combination.

I wondered out loud what made her think that. That I was definitely not a patient person, and that all knitters I know are wonderfully patient and relaxed people.

She told me that I seemed patient and relaxed to her.

Hm. Well, I have been a bit more relaxed than usual since I started doing little to no work on a daily basis. Perhaps this is what she was referring to.

Truthfully? I've been starting to think that something like knitting or sewing might be something I'd enjoy doing. Well, perhaps after I got past the initial frustration of sucking at it. Maybe it WOULD make me more zen. It would probably be better than tv (though that episode of Judge Judy was highly entertaining yesterday....).

I wonder what will happen when I have to start working hard again. :-/

******

In other news, I finished "Mountains Beyond Mountains" last night.

Now I have to start out by saying that usually I am not into memoirs, or actually non-fiction of any kind, with a few exceptions. It was inspirational in a way, you know, look at this person totally throwing himself into his passion, and actually succeeding in making a difference in the world. It did make me want to help people.... but then I remembered that I *already have* a passion: DATA. Does it make me a less good person if my passion isn't saving dying babies, and his is?

Well, Paul Farmer would probably argue yes. Which was my big gripe about the book. I actually found him to be a total ass. Self centered. Bombastic. Self righteous. And I didn't agree with his view of how economics works that is so in fashion among the intelligentsia these days. What can I say. I learned econ at the University of Chicago and you will never get me to buy into Marxism as a legitimate way of running an economy that grows, the idea that "maximizing utility" = "earning as much money as possible," or that money is intrinsically evil. Money is a unit of measure, people. That is all.

Anyway, I thought I would mention it, because one reader (I forget who) suggested this book to me a year ago, and now I have read it.

*****

Ok, I'm going to do some work for real now.

Because of/In spite of

I remember when I was interviewing for my MD-PhD program. When I actually was on campus, only three people from my department were available to talk to me, while 5 actually needed to. Because of this I was forced to have 2 phone interviews when I returned back to Chicago.

I'll just say this. I really hated the program when I interviewed here. Everyone (including most of the other interview candidates, though I did like the students I met) seemed really pompous and full of themselves. One faculty member I spoke with didn't even know what program I was interviewing for. The basic science people who run the MD-PhD program told me that my (non-basic science research in health economics) was bullshit. That actual word may have even been used. I don't remember.

At least they didn't accuse me of lying about my involvement on projects, which is what one guy at Harvard did.

Anyway.

I had already decided that there was no way that I would ever go to my med school, and felt rather put out by the idea that I now had to waste two more hours of my time being interviewed over the phone with additional people I was probably going to dislike. Nonetheless (and I guess obviously because I am here), I set up a time to talk with each of the other two people.

I think one was scheduled for 2:30 PM Central Time one afternoon while I was at work. I waited and waited, tethered to my desk for an hour or so until the faculty member -- to this day I don't recall who it was -- bothered calling me at 3:30 PM Central Time.

I told them firmly that they were an hour late and they would have to reschedule because I had work to do.

Eventually we conducted the interview, and I guess it went well because I was accepted.

To this day I don't know if I got accepted because of or in spite of that interaction.

I bring this up now because "being late" seems to be how people operate in my department. In contrast to medical school, where if you are 30 seconds late to a class or an appointment someone jots something down and it is noted how unprofessional you are in your next evaluation, in the Epi department people will actually yell at you if you are three minutes early.

Yesterday I arrived thusly, and the person practically dropped their coffee into their lap and hastily told me to come back 15 minutes later. I thought to myself that maybe I had probably caught him looking at porn, but when it happened again with another person today (I was 2 minutes early this time), it occurred to me that perhaps this was a cultural thing in my department.

I wonder what would happen if I started routinely arriving 15 minutes late to all my appointments in the Epi department. Would I somehow signal to everyone around me how important I am?

Thus:

Medical student = one extreme. Important Epi faculty member = other extreme.

Ridiculous.

Database

I love Microsoft Access. I learned to use it as an alignment consultant right out of college 10 years ago. Later I created databases that identified billing and shipping errors in our accounts payable department while I was working at the industrial supply company from hell.

Finally I applied my already existing skills, acquired in the business world, to design databases used in various data collection projects at my research job before I came to medical school.

My biggest frustration? I didn't know anyone who could teach me how to incorporate visual basic code into my Access queries to create randomized question sets, or how to program in SQL to allow for multiple users at the same time.

I love Access. It loves me.

Anyway.

I recently found out that we have a required course entitled "Database" this Spring in the Epi department. Curious as to what this course would entail (and also fearing the worst since enduring a class last Friday that was like, "Here, this is how you open Stata. This is how you log your data. No No. The 'View' icon is here.") I ventured to find out what the Database course was like.

What is it like? I know you, dear readers, are simply burning to know.

Apparently, it is a course in how to use Microsoft Access.

Surprise!

Anyway.

So I casually inquired the PhD-master today who happens to teach the course: Is this a course that teaches Microsoft Access.

He was offended. In fact, *he* considers it to be a course that, "Delineates best practices in data management that can be transferable to any other data storage medium."

I pointed out that I had essentially used my skills in Microsoft Access in order to feed myself in the 7 years prior to my application to medical school.

"What do you MEAN by that? Do you know how to normalize a database?"

Fair question, actually. So I told him that I didn't know what "normalize" meant, but that I had built several databases for a number of research projects over the years. That I had in fact been paid as an independent consultant to do this.

He concurred that the class might be redundant, and that I could take a placement test to see if I could place out of it. But I'll have to take something else to replace the credit.

Ah credits. Of course.

Anyway, we'll see what this placement test is like, and whether I actually still know any of this Access stuff after 3 years.

Part of me wonders whether I should have just bitten my lip and taken the class. Maybe I'll wind up doing that anyway.

Is that what you would have done, dear readers?

The forest for the trees

Americans are completely obsessed with eating disorders. Just today the NYT published a piece on (where else) the toilet paper blog about 40 year olds with anorexia. I guess news must be slow these days, so what better way to fill space and generate thousands of comments from your completely food-crazy readership?*

This weekend I read an editorial in a magazine this weekend while waiting in the check-out line at the grocery store. They showed a photo of an emaciated model walking down the catwalk alongside a starving African child. Ironic on many levels, no?

The caption read:

"Our definition of beauty is unrealistic and unattainable. This is why we need to change the way in which society objectifies women."

Or something along those lines.

I chuckled because the exact opposite is true.

In fact, being starving and emaciated is not only attainable, it occurs deplorably often all around the world.

Sometimes the most pressing issue is NOT the problem afflicting thousands of (mostly) bourgeois overachieving white women across the globe, but the poverty which afflicts 1000s of times more people.

I'll bet if toilet paper did a post on world hunger her comments wouldn't surpass 25.


*Not to poo-poo your eating disorder, dear reader. I'm just saying.

I try not to judge, but....

It frustrates me to no end when you see that NYHA class 4 heart failure patient who is being aggressively diuresed in the hospital -- who in fact has acute renal failure because her pump function is so poor --

MUNCHING ON AN ITALIAN SUB AS SHE LIES IN HER HOSPITAL BED.**

Gah!

This, only hours before you have to put her on a milrinone drip because despite the 120mg of IV Lasix she has received in the last day, she is still waaaaaaaaay volume overloaded and her creatinine keeps creeping higher and higher.

"The food here tastes so bland," she says, "So my husband /son /sister /etc. brought me in some REAL food."

What I want to know: Do you think if she poured salt directly down her throat, her outcome would actually be worse?

It's times like these that you have to remind yourself that you can't save everybody, and you have to just let the ill feelings go.


** Before you all get up in my grill for failing to educate the patient, YES the patient knew she was salt restricted, and YES she knew that Italian subs have salt in them. Lots.

Argument for marrying a foreigner?

As I was procrastinating, I read today that:

"An Italian study, for instance, done by the National Statistics Institute, found that the odds that a marriage will last increase with every hundred yards that couples put between themselves and their in-laws. Italian courts found this evidence so compelling that they have ruled that a wife has the right to a legal separation if her husband is not effective in preventing his mother from "invading" their home, Apter says."

At the distance of thousands of miles, Luca and I totally have it made.

Yet another reason housewifery is not for me

I really dislike the kitchen in our new house. It just.... has major issues. Allow me to delineate them:

1) There are probably 6 total square feet of available counter space in the entire kitchen.
2) The refrigerator door only stays closed if you push on it after you close it.
3) If you try to cook with the window open, the breeze will blow out the flame on your stove, causing you to leak gas into the house. Thus, you can not ever leave a pot unattended if the window is open.
4) The door to the back is old and rotten and must be closed just so.
5) The screen door only opens if you fight with it. And it is metal and falling apart and I worry that I will cut my leg open one day if the top of the door opens, but the bottom sticks as I walk through it.
6) The sink SUCKS.

I became acutely aware of this final problem this past week. You see, I despise doing dishes. Thus, I vow only to do them once a day. However we have only one non-stick skillet which gets used virtually every meal, so it has to get washed two, sometimes three times per day.

The problem is, our sink is so small and shallow that you can't actually wash something as large as a skillet if there is even one dish in it already. God help you if you had pasta the previous evening and something as large as a strainer is in the sink. This means that in order to make lunch or dinner, you actually have to do ALL of the dishes before you even start.

This just totally throws off my qi. I like to wash AS I cook so that I don't have to stand there for the 3-5 minutes in between steps doing nothing. Can I do that with this kitchen? Of course not.

I'll also point out that because the sink is so small, we will leave the dirty skillet on the stove after we cook because it will not fit in the sink. Thus if HE does the dishes he won't do forgets to do the skillet as well.

Leaving me with the problem mentioned above.

At least it has good storage space.

Oh no he didn't!

Ok, I don't even know who said this since I was in the back row....

But someone asked -- I'm pretty sure it was one of the fellows -- as we were learning how to do union and intersection and all those conditional probability things we learned about in 11th grade but have now forgotten (hopefully):

Can you tell us whether this is going to be on the test?

Sigh!

Once a pre-med, always a pre-med.

Finding a second soulmate

I remember the first time I ever saw my husband. I was walking over to the end of the new pool at the U of C, when I spotted him stretching his long arms above his head, getting ready to dive into the crisp blue water. He laughed as someone made a joke, and looked completely at ease on the pool deck.

I remember how sexy he was, and I assumed that he must have a girlfriend. For weeks I tried to find an opportunity to talk to him, but it didn't finally happen until months later when the pool was closed, and a group of us gathered to swim at UIC for an early morning workout.

When we spoke, we immediately clicked, understanding each others jokes and feeling at ease. I couldn't wait to see him again. It was one of those things. I just knew things were right with Luca.

I'm told that when I find my PhD mentor, I will "just know" kind of like one just knows about anything else, like for instance that one has met one's future spouse. That if I think too hard about it, I will end up choosing the wrong person. That I'll end up with a mentor-divorce, I guess.

Since I'm going to be spending a lot of time with my mentor these next 4 years, we had better be compatible. I've met a lot of different prospective candidates, some better, some worse. Some downright nightmarish to imagine. None who gave me that "soulmate" feeling. Not yet. Not really, anyway.

I've been given a deadline of September 1st to make my decision. Hopefully I'll have found someone by then. If not, then maybe I'll pick the some names of the remaining candidates out of a hat.

God.

What happens if you never get that special feeling about any of your potential mentors? Are you ultimately screwed?

I really doubt it, but it's annoying to have yet another person putting pressure on me. DECIDE DECIDE DECIDE.

Leave me alone and perhaps I'll be able to.

Yesterday

I spent my day outlining my plan for my PhD program.

You would think that they'd already know what the required courses are, when these are offered, and how many credits each class was worth, but sadly....

THEY. DO. NOT.

Grrrrr.....

I spent the morning drafting a spreadsheet of the coursework, feeling pleasantly relieved when I noted that actually it seemed I'd be more than half done with it by the end of my first year.

That's when I had my meeting with the new program director.

"Oh no, THAT class is only 0.5 credits. It's definitely not a full credit."

"Oh, THAT class isn't offered anymore. It's this three course sequence instead."

"Oh yes, you are required to take 'Survival Analysis' even though it is not listed as a required class for you in the master list of required classes."

"I'd love to design another required class that teaches The Cannons of Epidemiology. I suspect I'll be done designing that in a year. You should take that."

"After people take their qualifying exams at the end of 2nd year they take 6-12 months to write a defensible proposal. After that it takes between 6-18 months to finish."

"You mean you didn't take a class called 'Pharmacology' during med school? I don't see how we could possibly give you credit for that even though you took Pharm as part of each of your organ blocks."

So guys? According to this plan, unless I'm able to actually get a large portion of my research done while I'm also taking a full course load (don't ask me how) the program will take me between 4 and 5 years. There are no concessions given to MD-PhDs in the coursework.

What happened to this idea that MD-PhDs could conceivably finish in 3? I actually don't see how that is possible at all.

What is frustrating is that everyone says that all the information should be readily available on the web.... AND IT'S NOT. Then they say they will update it.... AND THEY DON'T. Then I go by what the updates say.... and they say, "Oh, actually it's supposed to be [insert smaller amount of credit/more courses here]. You will have to take that instead. I'll make sure this gets fixed."

It's this bullshit moving target, and I'm pretty sure that nobody has taken the opportunity to figure out the nuts and bolts of this new program. People have all these great ideas of how things can be improved, but nobody has actually tried to figure out what those changes might mean pragmatically for a student.

I'm giving this thing one more week, and then I'm going to have a shit fit. It's insane that I'm having to write out the plan for the PhD program! Don't they have people who are paid to do that? I find it incomprehensible that despite the fact that they have PhD students going through the program all of the time, that they don't know what people are required to take! It's amazing to me.

Independent

I had a somewhat productive day today, my first day to make myself do actual work status post sub-i.

I went for a swim at 8.

Read some of my text book until 11.

Attended class. 2 classes actually.

Read some more.

In total, it was about 5.5 hours of work. Not terrible, but definitely not where I'd like to be on most days.

I'm going to have to become a bit more productive if this PhD thingy is going to be completed in a reasonable amount of time. More productive without the proverbial slave driving machine that is medical school flogging me from behind.

:-/


It's weird.

I'm used to these marathon 12 hour days, coming home, and flopping on the couch completely spent and unable to prepare a more elaborate dinner than some ice cream or mac & cheese (the microwavable kind -- I usually don't even bother to do the Kraft variety -- too much work), and possibly a piece of fruit on a good day.

Today I came home and was able to make dinner and read the newspaper. It was really amazing.

And I got to see a robin pluck a nice juicy worm from my garden and then fly away, worm wriggling in its beak.

I suppose all this will be balanced by my fare share of evenings when I come home and read, but I think I'll enjoy this respite while I can. For now.

Date

For those who don't know already, I went to a prep school in CT for high school. I was not exactly the most popular person there, to say the least. I could just say that this was because I was a day student and didn't get to hang out with the other girls overnight as they sneaked outside to the dorm to the boy's dorm across the way. Or I could say that is was because I didn't play varsity field hockey or lacrosse.

But I would be lying to myself.

I wasn't popular because I was a dork. Have been and always will be.

Back in the early 90s, before cell phones were invented, the dorms all had a single pay phone per floor. We didn't even have email back in those days (I KNOW! Hard to believe.) So if you had a friend (or boyfriend) who wasn't at school with you, they had to call the payphone and hope somebody picked it up.

This system worked remarkably well.

Anyway, it was almost the end of my freshman year. It was warm outside and the girls were all sitting on the lawn in between Buehler and Memorial hall sunning themselves in their bikinis watching the boys toss the lacrosse ball around without their shirts on, generally acting like the adolescent idiots we all were at one time.

I came inside to pee, and the phone was ringing so I answered it.

It was a boy, and he was calling KH, one of the most popular (field hockey and lacrosse playing) girls at my school.

KH and I were not friends (obviously). However, KH was also a day student also and had many friends in the area who were friends of friends of mine (if that makes any sense at all). I ascertained that this boy happened to be friends with another friend of mine who had gone to elementary school with KH, and we ended up talking on the phone for an hour or so.

Now, before you get your panties in a bunch about me stealing KH's boyfriend, let me just tell you that this was no bf of KH's. Just a friend who lived in the area who was about to come home for the summer from prep school himself who wanted to tell her about a party he was having or some such. And eventually I DID get KH to come to the phone.

But anyway, this boy and I hit it off via telephone. We talked each of the next 5 successive nights and arranged to have a date two weeks from then when school was finally out.

It was my first date ever. I had just turned 15.

Well, anyway. After much anticipation, the date finally happened.

It was a total flop.

We went to see Lethal Weapon 3 at a movie theater in Torrington. He said a total of three sentences to me the entire evening.

(I counted).

I suppose I could have been more conversant myself, but I didn't really know what to say. I didn't know what had happened to change him the guy who was so great to talk to on the phone to this asshole who wouldn't even look me in the eye when I came up the driveway to meet him.

Later I found out (through that friend of a friend of KHs) that KH had told him that I was ugly and unpopular and that he shouldn't have anything to do with me.

Ah, the wonders of the teenage bitch.

I'd like to say that this was the only mean thing KH did during high school, but it wasn't. We all know someone like this. If you don't, you probably WERE her.

And so it was that when I joined facebook two years ago I faced a dilemma. Do I friend KH? Would she friend me back? Was I a fool to put myself out there? None of my other friends that I had left from high school thought it was a good idea. Yet at the same time, we all wanted to know what had become of her.

Well, mostly I think my friends wanted to see if she'd reject my friend request. And (let's be honest here) we all wanted to know whether she'd gotten fat. We all already knew what she had done with her life via the alumni bulletin.

I finally gave in and friended her. And she friended me back! I got to see pictures of her husband and son, and was now privy to all the updates she and the other members of the Wolph Pack (the name given to the field hockey-lacrosse clique at my high school) were saying to one another. Not that it mattered, but the comments were all completely..... benign.

Strangely, I found that I wasn't angry with her any more. That the goings on of that clique no longer had the power to make me upset. Her power was gone.

(And she was fat.)

As much as I hate to admit it, I probably hated her as much because other people liked her when they didn't like me as much as because of anything she ever did to me. Yep, I was jealous. Aside from this one incident, I can't remember anything else specifically mean she did to me. My own friends were meaner than she was. Maybe I was too.

I can't say that things would be any different now if I ever saw her in person. But I'll bet she'd be more polite than some of my other "once-were-friends" would be.

You know who you are.

At very least, I feel that that chapter of my life is closed now. Thank goodness. Because that grudge was awfully heavy to carry.

Derm

I found out the other day that 10 of my classmates were planning on applying to Derm residencies. Oh, I guess some of them were doing Peds Derm, and 8/10 were planning on taking a year off to improve their chances at getting a residency.

But 10? Really? My class only has 150 students in it!

And if you really want to do Derm in order to have a cushy lifestyle and make a lot of money, then why is it that a year of research actually helps you match into Derm? It's not as though a most of these students plan to be researchers when they grow up, afterall.

It's kind of like requiring Firefighters to take a written test.

Many of these people had previously wanted to be surgeons. It's interesting to see how things change. One of my first thoughts was, "Wow, everybody must be more burnt out than they're admitting."

Or maybe they're selling out, as one of my prospective mentors (whose wife is a dermatologist) suggested the other day. Not that Derm isn't cool. But you can't honestly tell me that all 10 of them are planning on doing Immunology, Rheum-Derm, or Med-Derm, which to me are the most interesting branches from a research perspective.

Then there are others who had planned on Neurosurgery now deciding that Rads is really the field for them. Glad they figured THAT out before starting the most hellish residency possible.

And then there are my friends who thought that they were going to be medicine docs or pediatricians now going into General Surgery. I have to say that I feel very proud of them and a little bit jealous. I loved my surgery rotation, and miss the environment of the OR, and it makes me feel a little misty-eyed to think that I will probably never get to scrub in on a case again (unless I become an interventional pulmonologist or something else like that).

But the truth is, I love research more than I'd love doing the same surgeries over and over again, and doing the kind of research I want to do just wouldn't be possible if I became a surgeon.

And plus, as bad-ass as surgeons are, as a future medicine/neuro person I am embarrassed by some of the consults various surgery teams have called while I was on the consulting service. Like that one for a hypercoagulability work-up on a patient who had occuluded her peripheral arterial stent because she had stopped taking her coumadin (did I mention that her INR was 1.0?).

I think in the end I'm going to be better off as a specialist who uses her mental dexterity for a living rather than her manual dexterity. That's just me though. Different strokes for different folks.

Casa nostra

Finally, I bring to you pictures of our house.

Welcome.


Here is the view of the house from the street.



Hydrangea.



Basement



Garage. For 2 cars (currently underutilized)!



LR from front door. Notice presence of clutter (already).



Literature belonging to previous owner. Can you spot the confederate flag?



View of house from front to rear.



View of self in large mirror on LR wall. (At least it's not on the ceiling.)



Dining Room from breakfast room.



Breakfast Room.



Wall between breakfast room and kitchen that we would like to demolish (see: plans for next summer).



Lovely built-in cabinets in kitchen. We would like to keep this. Further pictures of kitchen forthcoming. Possibly.



Tenant (occupies basement bathroom). 5 points for anyone who could name the species. No I will not get a close-up picture!! This one was already way too close for comfort!



Upstairs Hallway.



Master bedroom.



Green bathroom (shutters closed to avoid flashing neighbors).



Bedroom #2/Office.



Bedroom #3/Luca's luxuriously large walk in closet.



Bedroom #4. Chez guest (hint hint). Futon will be assembled this weekend.



Blue Bathroom. Behold: skylight.

Outside my window

This morning, I was admiring my plants as I ate my raisin bran and yogurt, when outside my window I spotted a woman walking her dog.

Well, actually she was talking to a neighbor. And as she stood there chatting, she allowed her dog to wander into the garden of the house next door to mine.

Now I KNOW that ain't her garden. That house has just been put on the market, and that garden is freshly planted. It's about, oh.... 2 weeks old. Plants just taking root. You know.

VIRGIN.

Ha. Not so much anymore.

I watched as she allowed encouraged her dog to urinate in the garden that wasn't hers. At least the dog didn't crap. I'm sure she wouldn't have picked it up if he had.

DEATH. That's what awaits her little mutt if I ever catch her letting him into my garden.

Grrrrrr......