How to study science

I think I've opined on this before.... but somewhere midway through med school I made the discovery that *in general* it took about 5 passes over the material before I felt I knew it well.

The first pass was usually cursory. I'd try to understand everything, but it would feel like it was going so slowly, and that I'd never be able to master everything.

The second pass was generally better. The meager base I'd built on the first pass would enable me to go a little faster. I'd feel a little more confident.

Then about a week before the test I'd go over the material again. I'd freak out because I'd realize that I didn't know as much as I thought I did.

A few days before the test would be pass #4. This would be more of the same, but the freak outs would happen less.

And right before the test would be pass #5. The quick overview, remind yourself run through of the material.

Maybe that's not how you study, but it worked pretty well for me. I've never been somebody who's able to sit down with brand new material and master it the first time just by reading through it slowly and carefully.

Since coming to grad school I've had to readjust to the feeling that I won't ever really master the material to the degree I did when I was taking science classes. But whatever. The focus is different in grad school and the work really never truly ends. At least in med school you'd get to hang loose the weekend after an exam....

I remember when I learned how to study sufficiently for my science classes. I was a freshman in college taking general chemistry -- stoichiometry -- and I was getting a B+. I was doing the problem sets every week and felt ok about them, but when I'd get a new problem I'd freeze up and not be able to do it. And I'd make stupid mistakes on tests that resulted from my lack of confidence and intimacy with the details of the material.

At the end of the quarter I realized what I was doing wrong. My friend E (who later became a Rhodes scholar) was getting an A, and she was doing EVERY. SINGLE. PROBLEM. at the back of the book before the test. Our chem text book had a companion study guide which made this easier. It would show you not just a number for the answer, but what the thought process was as well. Sure, E was also very smart and great at math, but she worked her little behind off as well.

So the next quarter I resolved to do the same. And I was moderately successful at it, getting an A-. The only problem I had then was that I didn't completely *understand* some of the concepts, and made a few stupid mistakes.

Finally spring quarter, I got the hang of it. Well, I got the hang of it after reverting to my original strategy (of not doing every problem) and failing the first exam. The second exam I got a 94. And the mean was a 50.

Things looked up after that. When I came back to school for my post-bac I tried to adopt similar study strategies, and they worked swimmingly. The only class I had problems in was Physics. The problem with Physics was that there was no companion study guide to teach you how to do the problems* and you had to rely on the homework problems to study for the tests. As I've said before, hw problems are never enough! Also, I hadn't taken calculus for 10 years.

Ochem? Not a problem. Sure, I spent probably 15 - 20 hours per week outside of class on this class, but the material was *definitely* masterable. You just have a lot to cram inside your head, kind of like you do in med school. My friend M suggested doing all the problems in the text for this class as well. And you know something? M is now a Rad Onc resident at a very prestigious program and one of the smartest and most talented scientists I know.

Why am I telling you (dear readers) all of this? Because there is this myth that you have to be "smart" to do well in hard science classes. The truth is that they just require more solid knowledge and practice than social science/humanities classes and leave very little room for BS. But in the end, I think hard science classes are easier in a way because you won't get a B+ if your professor disagrees with your interpretation of the text. You either know the material or you don't, and that is completely within your control.

You just have to put in the hours.




*I don't know why Math based classes are often like this. It's as though they're trying to make the subjects inaccessible to people who don't have "natural talent" and get everything the first time and with no effort so that the people who do can feel good about themselves.

**This post was inspired by AD2B.

Is it so wrong?

So, as I've mentioned before, I grew up in Manhattan and went to (gasp!) private school for grades K-6 with some kids who are.....

Let's just say that Ivan ka Trum p was a couple of grades behind me and leave it at that.

So I find myself perusing facebook, and I happen upon the new profile picture one of them has posted. It's her. Riding a polo pony. Her polo pony. And, for the record, she was the one who stated snottily when I got a horse in the 6th grade, "Your horse cost $4000? MY pony cost $48,000." (And it didn't even win.) She's moved on to hunters now, and still competes as an adult.

Is it so very wrong that when I happen upon her facebook status reading something like, "I am so mad about the tax increases Obama is levying on the wealthy. I can't wait until the November election season," I really really want an anonymous comment option on facebook -- like they have on blogs -- that enables me to post something like, "Don't worry princess, Obama isn't going to take away your precious polo ponies."

Gah!

I feel a little hypocritical since it peeves me to no end when other people label me bougie, but come on. At least I'm not a walking republican princess stereotype. Stereotype of other things, sure. But republican princess?

Not in a million years.

Grant Support

Dear person who I emailed to ask for help on my grant, on which you would be a co-author:

I know you were at work yesterday because my friend said she saw you in your office. Now, can you please tell me why you couldn't be bothered to respond to my email? Either:

1) Yes I can help, let's set up a time.
2) No I cannot help.

Would be awesome.

Gah! It's BS like this that makes me worried about getting this project done in time! Why people at this GD institution consider themselves above replying to an email within 72 hours is beyond me.

All in a day's work

Luca went into work at 5AM this morning to supervise some experiments. That meant for the first time in ages he came home early! At 4:30PM or something. Seriously!

It was still a stressful day.

And then I made him prepare the taxes with me. And though we were able to complete the federal and the state in less than an hour (thank you Tur bo Tax), he was clearly vibrating with anxiety when we were done.

Anyway, then the dog proceeded to destroy her bed. Yes, this had been predicted well in advance by AD2B, and yes we knew this was coming.



Behold, the aftermath:



Poor Luca's OCD! I don't think he appreciates my blase attitude.

Biosketch

I have to submit a biosketch with my grant. I had no idea what one was supposed to look like, so I got a sample biosketch from a friend of mine who wrote one of these F30s last year. (I was going to tease her about her ONE non-A grade in Ochem -- it was an A-.... but decided against it.) After reading it I had been wondering:

Do they *really* want me to list out my entire transcript from undergrad? How exactly was that relevant (aside from the sociology major) to an application for a grant that I'm writing 11 years after college graduation.

So I looked it up.

Um, Yes. They really do want that.

For the love of God.

I think I have an old transcript lying around somewhere.....


*As a side note, I wonder if I'm the only applicant ever in the history of the NHLBI to have taken a class entitled: Intensive Study of a Culture: The Kayapo of Central Brazil.

Grant

Walking my dog.
Cooking dinner.
Going to the gym three days a week.
Taking care of my house.
Saying hello to Luca when he comes home at night.

I feel like I shouldn't be doing a single one of these things with this grant I'm trying to put together, but life just doesn't work that way.

I feel like my mentor is giving me a ton of his time, but no matter what it's not enough because I've never written a grant before. And he let's me know that he thinks he's giving me a ton of his time so that I feel bad about asking more questions.

I think he doesn't think I'm working hard. I think he can't understand why things take me so long. That I'm stupid.

I can't keep waking up at 2 in the morning worrying about whether this is going to get done, whether they'll be able to pull my funding out of their asses if it doesn't get done (or if it doesn't get funded), worrying that I'll piss my mentor off if I ask him one too many questions.

I worry that he thinks I'm more trouble than I'm worth.

I hate this. I hate this. I hate this.

Roses

Yesterday we gave Boo a bath. It had gotten to the point where when we open her crate we would be knocked backwards from the aroma that emanated forth. She disliked the bath very much, but smells much better now. Like roses, in fact. Yay deodorant doggie shampoos.

We sang this song to her as we toweled her off:

I know you like to think your s*** don't stink, but lean a little bit closer you'll see that roses really smell like Boo Boo-oo!*

It was as though they wrote that song just for her. Heh.

Dear Outkast group members, we apologize for perverting your song* however we could not resist.




*We're not normal.

Attention Single Ladies Who Live Near Me

My husband's cousin is SINGLE.

He is going to be a SURGEON (he's in residency).

He is also a MUSICIAN (guitar).

He is very HANDSOME.

He is 28.

He is STRAIGHT.

And he is going to be living in the U.S. for a YEAR (starting in May).

Hi mom is worried that her baby boy will be lonely all by himself in a new country. I said to Luca that I doubted he would be alone for long.

His mom is afraid that he will find an American girlfriend and will never move back to Italy. I said that I doubted it would be just *one* girlfriend.

He will be doing research for a year, so he's even going to have time to spend with a special someone (or two.... or three....).

Hahahahahahaha!!!!!!

Note, Luca's parents think that this is hilarious. And Luca and I are excited to have him here, though I doubt he'll want to spend much time with us. Hehe.

On journalism

I went to MICU rounds again yesterday. Teaching rounds were on managing grief, and a pastor and two attendings who are into this sort of thing precepted. Residents went around the room talking about their emotional responses to patients who had died in the past month, as well as their general coping methods for dealing with grief as a doctor.

There was a journalist there who is making a movie about this. He told me that he wants to use his film to prove to the public that doctors care about their patients. That they are sad when patients die. That doctors aren't jerks after all.

I thought it was kind of callous. And ignorant. How exactly do grief rounds prove any of this? I told him he should talk to the trauma surgeons. They don't do grief rounds (or at least they didn't when I was on service), and they see plenty of tragedies also.

The journalist said, "Oh you mean they don't have grief rounds because of their God COmplexes?"

I was annoyed.

No. That's not what I meant, I told him.

I told him that the trauma surgeons were some of the most caring and compassionate physicians I had met during med school. And that this was despite not having formalized communal grieving sessions. Clearly they have found some way to cope with the tragedies they see that doesn't involve sitting in a circle, holding hands, and crying together (not that there's anything wrong with that.... I actually go in for the touchy feely stuff from time to time as you may know....).

I suggested that a compare and contrast might be interesting. MICU vs. SICU.

But gah! He was totally milking the stereotypes of medicine vs. surgery. Caring vs. uncaring. Humble vs. God Complex. Good, well adjusted human being vs. maladjusted jerk.

It really bothered me.

There are nice doctors and jerk doctors just like there are nice plumbers and jerk plumbers. And not everyone deals with grief in the same way, and nor should they have to. To judge a category physicians positively or negatively based on whether they have grieving rounds on their service struck me as "arrogantly liberal." It's just not the right measuring stick. I don't know how else to say it. Like you're an insensitive jerk with repressed emotions because you don't want to cry with your colleagues.

Media stereotypes abound.

Surgery

I just found out my husband's cousin, who is a surgery resident in Italy, is coming to [very famous university hospital in adjacent city] in the US to do some sort of fellowship!

We found out via facebook. A friend of his posted a congratulations. Apparently he hadn't even had the chance to tell his parents the news.

Of course Luca and I *immediately* called Luca's parents and demanded to know more details. So then (of course) his parents called the cousin and demanded to know more details. The cousin demurred until he could tell his own parents first.

"How the heck did Luca and OMDG find out??" he wanted to know.

Luca and I are very excited, and eagerly awaiting the arrival of more information.

And we promised him we wouldn't break the news to his parents before he had a chance to tell them himself.*

Hopefully the fall out won't be too bad. Italian parents never like to see their babies go overseas for such a long period of time, even if their babies are almost 30 years old. Sometimes they never come back! My husband didn't after all.

;-)



*Don't worry, they don't read this blog.

Sometimes there is nothing you can say that will make the patient happy

Except maybe, "My mistake! You don't actually have cancer, and you're going to live in perfect health for another 30 years."

On my rad onc roation, I recall the attending being yelled at by a patient who had just been diagnosed with cancer.

The patient was accusing the doctor of, "trying to scare her into getting radiation therapy" by describing what would happen if the tumor that was encasing [insert large and very important vascularized structure here] continued to grow around/into said blood vessel.

In truth, the doctor was very worried about the location of the tumor, and was trying to convey the need for urgent treatment to the patient.

I was there. The doctor addressed the patient professionally. Urgently, but in a kind and compassionate way.

Patients can be very naive about these things. I think this patient's issue was that she didn't even want to believe that she had cancer, let alone that it might kill her. And soon. Therefore, everything was the doctor's fault. He was mean. And she wanted someone to yell at.

How would you like to exsanguinate because your tumor grew into a major blood vessel?

It happens.

MICU rounds

Yesterday morning I went to MICU rounds again. I arrived in time for teaching rounds, and lo, it was ACLS protocol refresher with my favorite pulmonary attending. Who remembered my name(!). I always get a little star struck and weak in the knees when that happens.

Anyway, we had a pretend scenario where I was the med student who finds a patient unresponsive. I call for help and my "senior resident" shows up. In this case my "senior resident" was a very awesome classmate of mine on her MICU rotation. I might add her FINAL ROTATION IN MEDICAL SCHOOL BEFORE SHE MATCHES IN FOUR WEEKS. Go her.

For a moment I pondered the irony that the next time my classmate and I will work together, she will likely be an *fellow* or *attending* and I will still be a med student.

It's sort of horrifying to ponder, really. I try not to think about these things too often though. And honestly? My research project is completely awesome, and I would never have gotten to work on something like this had I gone straight through med school.

This is what I keep telling myself as I watch my clinical skills and classmates fade away into the distance.

Those "BS Social Questions" on the USMLE

I have a friend from China who is studying for Step 1. We were talking about some of the questions last night, when she said she wanted to ask me about a specific question:

You are a pediatrician, and a 15 year old patient tells you he smokes 10 cigarettes a week. He tells you he doesn't feel like this is a problem and that "it's not like he's addicted or anything." You:

a) Remind him about the future health consequences of smoking.
b) Say, "A what point do you feel it *would* be a problem for you?"
c) Tell him to quit right now.
d) Tell him that you will tell his parents if he doesn't quit.

If you answered "b" then congratulations, you have been indoctrinated into the culture surrounding Western medicine, where we ask patients what THEY think, avoid authoritarianism, and put patient autonomy above all other things. I guess this is not something that they do in China, because when I told her the answer was "b" she was completely shocked. Nobody she had ever worked with in China would ever talk to a patient like that, she said.

It thought her perspective was pretty fascinating actually.

And God help me if I ever have to take the medical boards in another country. I can't imagine how difficult it must be to even learn the language, let along pick up on all the social mores underlying the questions.

MICU

Today I went up to the MICU for board rounds. My mentor is on service and we figured it was as good a time as any to meet the nurses and see how the bump list* was created.

When I walked into the hospital, the first thing that struck me was the smell. I never really noticed it when I was a rotation student, but it really was quite distinctive.

And then I rounded on two patients with my mentor and his team. Fortunately, not the whole list.

Now granted, I've never done a unit rotation, so I am pretty ignorant of the world of ventilators and pressors. However I was pleased that I still understood everything that was going on. I wasn't as good at coming up with a plan -- in my head of course.... but I was ok. And realistically, as a 4th year med student, we don't really do much of that anyway.

Though I will say, I didn't know the answers to far too many of the pimping questions. And oh yeah, I've almost completely forgotten how to interpret an ABG. Gah. Fortunately, none of the questions were directed at me, so I could just use the opportunity to listen and learn.

Overall, it was really awesome. It turns out I really miss clinical medicine. Go figure. Back again tomorrow morning for rounds again. We'll see how I like the real marathon MICU rounding experience. As long as I have something to lean against, though, I should be ok.



*Bump list = List of patients who can go to the floor if the ICU suddenly needs to admit a lot of new acutely ill patients.

If you like primary care

Think about oncology.

When I did my heme-onc rotation last winter, I discovered (to MY dismay -- not necessarily yours) that heme-onc is at least 50% primary care for cancer patients in remission.

You get all the benefits of long term relationship with the patient and the families, without the blame that the primary care doctor receives for blowing off their initial presenting symptoms that turned out to be cancer. You get to be the one who "saved the patient's life," not, "that a**hole doctor who told me my GI symptoms were all in my head."

Sure there's a lot of death, but they cure about 50% of their patients. That can't be said for most other specialties. And you can really help families and patients feel better during the dying process if palliative care is your thing.

You also make a lot more money than most primary care doctors....

And while most/many primary care doctors don't see their patients while they are in the hospital, the doctors where I did my elective saw all their own inpatients. Of course, this resulted in their days being 6AM-7PM..... but for me, the inpatient issues were the most interesting part (I diganosed a case of TTP -- it was so cool....). And the continuity of care was fantastic.

They also got to work on a multidisciplinary team that included surgeons, radiation oncologists, radiologists, and pathologists.

Of course, I liked talking to the surgeons and pathologists more than the team I was on.... and doing the inpatient consults more than any not-sick-anymore breast cancer patient follow-up visit. I did really like the palliative care and family conference angle though. Probably heme-onc is not going to be the specialty for me, but if you want primary care with a twist, it might be for you.

Just saying.

Shovel

Now that it's been a few days since our last 2 feet of snow, life is beginning to go back to normal. The dog has finally realized that she *can* poo in the snow, and the sidewalks are actually clear enough for us to go on a real walk.

Well, I should say *most* of the sidewalks are clear enough.

On our street, there is this one house -- the most expensive one on the street, in fact -- that does not shovel the sidewalk in front of his house. And before you get all up in my grill about, "Maybe he's a frail elderly gentleman and you should help him," let me set you straight:

He is a 35 year old economics professor at the annoying but famous business school affiliated with my university. He goes for regular runs and lifts weights at the gym. In fact Luca and I saw him go for a run in the ice and snow yesterday.

As he was walking out of his house, I yelled, "Hey Asshat,* are you planning on shoveling your sidewalk at any time in the near future? You're the ONLY ONE on the block who hasn't yet."

My husband, being far more diplomatic than I am, said, "You really need to shovel it, Asshat. The city will give you a ticket if you don't."

Asshat replied, "I paid some kids to shovel it since I don't have a shovel myself. You mean they didn't shovel the sidewalk?"

No Asshat, no they did not.

I love the way he plead ignorance. As if he hadn't left his house in 3 DAYS. Please.

Asshat.

My husband is far too diplomatic. This spring, I am totally training Boo to pee in his garden. It's not like he tends it anyway.



*Not his real name.

Children

Today I was walking the dog, and we ran across a man and his three young daughters.

"Can they pet the dog? They love dogs!" he said. I guess Boo was looking especially cute and sweet today.

So I let them pet her. She was good.

"So, what kind of dog is she?" he asked.

Somehow I suspected that this was not the time to respond, "Ferocious attack pit bull," so I said, "Oh I don't know. She's one of the vet school spay dogs," and hoped he didn't make the connection.

He didn't.

Phew!

7A to 7P (at best)

A friend of mine relayed a comment made by a neurosurgery attending she knows:

"My life is pretty good now! I'm in every day by 7AM, and two days a week I am able to get home by 7PM."

I am assuming he takes weekend call too....

Sounds pretty horrendous to me. It's not like I want a 9-5 job. But.... a little more flexibility than an endless string of 12+ hours days from here until eternity might be nice.

I could even take worse hours for a short period of time, as long as that period of time was followed by a break period. It's that break that's critical for me.

Everybody -- even a neurosurgeon -- needs a break sometime.

On meaning

On outpatient peds I had a mom who brought her teenage daughter in with sinus pain with discharge x2 months and pain to palpation. I explained to her that she probably had sinusitis, and that she might need antibiotics given how long she'd had the infection, but that we'd discuss it with the doctor together in a few minutes.

"Sinu... what?" she asked.

"Sinusitis," I said. Then I explained that the word meant "inflammation of the sinuses," and that a person could have an "itis" of any body part, and gave her a few examples, and that some itises required treatment, and that others did not. But that this case probably did.

Then I left the exam room to present the case to the doctor. Then we went in together.

When we entered, the mom started yelling, "I didn't come here with my daughter to get some BULLSH*T diagnosis!!" she screamed at us. She grabbed her daughter's arm and was pulling her out the door. "My daughter is just lazy and complains too much and just doesn't want to go to school. If there's nothing really wrong with her just tell me and I'll teach her a lesson."

Uh ok.

So, the moral of the story is? I'm not sure. Except that sometimes, despite your best efforts to communicate effectively and do right by the patient, you're going to fail sometimes no matter what.

On saying no

I hate it when people reschedule or cancel appointments at the last minute. Especially when they do it every. single. week. And every single week, they knew about the conflict ahead of time, they just didn't bother to tell you.

It's just disrespectful.

This is the fundamental reason I hated consulting. When I was in consulting, you'd get a call from your boss at 5PM on a Friday (after you'd done nothing all day), telling you that you had to do a project by Monday. And sometimes you'd find out that your boss had known about the project by say.... noon, and hadn't bothered to tell you.

Similarly, when I worked at the Industrial Supply Company From Hell, not allowing people to mess with your schedule ad infinitum was called "being inflexible," or, "not being a team player." Even when your flexibility was required so that your co-supervisor (whom your manager liked more than you) could go to a concert that night.*

Somehow to me, medical school is different. I came into this already knowing that all of my free time would be subsumed by work. Maybe I'll feel differently when I'm a resident or fellow.... but generally I feel like things are a little different with this career path from the ones I've been on before.

For instance, at least now I am allowed to say no. Sometimes.

Still, I feel like I can't or shouldn't most of the time. Even though these last minute schedule changes completely derail my entire day. I worry that the person I said no to will hold it against me in some way. That I will be told I'm being difficult or selfish -- even though that's what they're being. Is this another case of classical conditioning from my previous jobs? Perhaps.

If you don't say no, people will make you bend until you break trying to accommodate them. They will plow right over all your plans and your life and your other work commitments if you let them in an effort to make their own lives easier. If you don't set up some boundaries, you will never get anything done in your efforts to accommodate others.

So dear readers, do you have problems saying "no" too? How do you do it? How do you know when you really need to bend? How do you set boundaries without pissing people off?


*Not that this ever actually happened to me....

Public Service Announcement

To the professor of mine who I saw at the pool today:

Drag suits are meant to be worn with a speedo underneath. That way we all don't have to be privy to what religion you practice.

That is all.

Great Snow 2010 (part deux)

My street.



My house.



My dog.



My (second) snowday!

DFC*

I have some friends who are 4th years who are going into surgery. They are all nice people, just a little more masochistic than I am. Also, I like talking to my patients and all the touchy-feely social BS that comes with it. Them? Not so much.

What's interesting is seeing how the divide is already starting to form. The divide being that medical residents think that surgical residents don't use their brains, and surgical residents justifying that they shouldn't have to.

Case in point: Last year when I was doing Heme-Onc elective, I received a consult for a patient who had just thrombosed a graft that vascular had done to help her peripheral vascular disease. Also, she was a smoker. The consult was: why did she thrombose her graft???

Answer: She had a florid psych history, was known to be non-compliant with her meds, and had stopped taking her warfarin. Note the INR of 1.0. And her mild polycythemia (Hgb = 16)? Most likely due to her 3 ppd smoking habit.

Why did she thrombose her graft?? Why the F do you think she thrombosed her graft? Seriously. It was a DFC.*

I actually wasted way more time on that stupid consult than I should have because I kept thinking, "Surely there must be something I am missing here in the notes, since even a stupid 3rd year med student can tell why this happened, otherwise they wouldn't have consulted us."

Anyway, I was relaying this story to one of my soon-to-be surgery friends, and what did she say?

"Well, I think the consult was justified because, you know, you want to make sure with these patients, that there's not some *other* reason. And anyway, surgeons have better things to do with their time than to think about things like this."

Let the hair ripping begin, folks. Let the hair ripping begin.


*Dumb F***ing Consult

Rehab

We have a snow day today, so NO CLASSES!!! Woohoo!!

I only had one class today -- one that I actually enjoy. But still, it's nice to have 4 hours of my life back.

So what did I do with my time? Well, last night instead of doing work from 7-9, I watched the next disc of The Wire that I had received in the mail earlier that day. It was only two episodes....

Anyway, my conclusion after watching this particular set of episodes was: No wonder none of my patients who are addicts want to go to rehab when they're discharged! The rehab place looked so seedy and nasty! Full of unsavory looking people.

So you see, watching The Wire last night was really *actually* educational, right?

I said, RIGHT?

:-P

The gentrifiers

On my stroll with Boo around the neighborhood this afternoon, I had the opportunity to talk with one of my neighbors about the changes in the neighborhood over the past few years.

It turns out that the house that was just remodeled and sold right next door to his, not two years ago was home to a middle aged woman and her eleven foster children. Who used to sell drugs in the alley behind the house, and in the park on the corner where I take Boo to shit three times a day.

I guess one day 3-4 years ago, there was an altercation between one of the residents of that house and someone else, leading the resident's car to get shot up "with a small caliber weapon." When my neighbor talked to the cops after calling 911 to report the event, they recommended to him that should an altercation ever arise between him and one of the aforementioned juvenile delinquent neighbors, he should lure the neighbor into his house and *then* shoot him.

Lovely. I am hoping this guy was trying to impress me with his large and impressive knowledge of firearms.

He also regaled me of tales of the high-rise across the street before it was turned into condos. I found out that the car with the fogged up windows that bounces up and down on my street at 5AM? Is likely being used by one of the hookers who used to live in said high-rise. Apparently they still like to use our street as a place to "park" with their clientele.

I found it much less unsavory when I imagined that it was probably teenagers in that car. Ew.

Well, that explains the used condoms.

Oh well, it's not like they've ever bothered me. And the lady with the eleven foster children is gone now, and the house completely renovated. I guess the annual block party started as soon as they moved out.

Gotta love gentrification.

And now for the mandatory pics de Boo

Because of the snow storm this weekend, we did a lot of lying on the couch.



As you can see, Boo is an incredibly dominant dog. Not! So ferocious! My little Black Mamba!



My slippers from T get are very warm and cozy. And check out that plant! It was almost dead this time last year! It only had one leaf left! It think it likes it here.



Can't you see I'm trying to sleep here!



Can you tell she's put on 8 pounds since we got her? Check out those jowls!



Hey, today is Luca's 36th birthday. One of us is now officially closer to 40 than 30! Ah! How did this happen????

Anyway, wish him happy birthday.

Young on the outside

I got a comment from an egg donation site the other day. It was an ad. I thought it was pretty savvy for them to target a medical student's blog. Why? Because my readers are largely smart, broke, and 20 years old.

Because let's face it: it ain't MY eggs they want. That's for sure.

You see, while I may get mistaken for a 25 year old on the outside, I am in fact 32 on the inside. Which isn't really "old" per se, and I certainly don't feel old.

But the fact is: advanced maternal age is approaching a little too quickly for my taste. If Luca and I have kids, I'd really prefer to do it before intern year. Why? Because I'll be 37 then! And also, I actually have time now, as opposed to then when I will not.

But.

But the thing is, I really like my life the way it is now. With Luca and the dog. I have enough to do without a screaming infant to contend with. I like being able to go to the pool. Make friends. I like feeling fit again for the first time in two years. I like being able to get enough sleep. I like feeling at least marginally in control of the amount of work I'm able to get done in a day. And I don't want to ruin all of that.

And if I have a kid, I will be able to do none of those things. Ever. Again. Well, at least until I'm 45 or so. I just don't know if I want to abandon all the things I've started to enjoy about my life, now that I've finally stopped hating being in grad school.

Also, dear in-laws. You need to stop nagging my husband about when are you going to get grandchildren. Don't think I don't hear about it, because I do. And if I *did* have a baby, rest assured it would be for ME, not for you. Please don't ever mention it again.

Thank you.

I just want a few months without some grating reminder that really all I am is a vessel for potential children. To have a nice life. To enjoy just being with my husband without having to take care of someone else. Without being forced to think, "Better hurry up! Those eggs are shriveling as we speak!"

At this rate, by the time I decide I want a kid, I'll be in need of those egg donor services myself. Perhaps I should reconsider posting their ad, for the sake of karma.

Classical Conditioning

When I was on trauma I had my regular pager, and I also had a trauma pager. The trauma pager was to alert the trauma team that there was a trauma about to arrive in the bay. When it went off, you'd drop everything and run as fast as you could across the hospital to the bay to help.

I had mine set to one of the less oft used ring tones so that I wouldn't get confused between my pager and everyone else's. Or between my trauma pager and my other pager.

Well, on The Wire, D'Angelo's pager makes the *exact* same noise that mine did. Every time I hear his pager go off I jump like I've just been shocked and feel my heart racing in my chest. And not just a little.

Every. Single. Time.

Who says classical conditioning is just for dogs.

The semester

I've been having a bit of writers block lately. It's just.... PhD life yields much less juicy gossip than does life on the wards with actual patients and misanthropic residents and attendings. It kind of just goes.

My second semester.... well actually my third semester.... is underway, and seems to be going decently well. I feel more under control of my coursework, and though my grant is due in T-9 weeks, it feels like it might actually be possible to complete, and NOT suck.

Well, we'll have to see about that.

My mentor and I had a conversation with the NHLBI this week to talk about whether the topic fit with the aims of the organization. And the answer was: Well, we got lots of really useful feedback. It wasn't a "no" anyway. So we incorporating the feedback and revising, and then sending it to some more people next week.

My classes? Are going well. Only 4 more weeks of biostats this semester, and then I will have a good 20 hours more time per week to do other work. Praise the Lord.

The house is getting its 2nd floor windows done next week, and we're going to get a new hot water heater. I can't wait until Spring comes and I get to see what became of all those bulbs I planted last fall. I am also thinking of planting a peony bush where a bunch of the ugly annuals were last year.

And of course there is the dog. Who is awesome, and who makes my life so much better than it was last year. Even Luca agrees that she has been a great addition to the family.

Even my swimming is coming along. I've been going 4 times a week or so with a group of friends, and have actually been improving. This is somewhat miraculous given how woefully out of shape I was this time last year. Seriously.

So tonight, I'll probably do another hour of work and watch an episode of The Wire with Luca. And throw the ball for the dog. And hunker down for this damn snowstorm we're about to get. 12 inches or so at least, they're expecting. Blegh. Good thing I have some brownies and milk in the fridge.

I have become such a wuss since leaving Chicago's all I have to say about that.

And tomorrow will be a big study day. Again.

Lather, rinse, repeat. But in a good way.

Dog Walker

Our dog walker has started taking Boo out with one or two other dogs she walks (whom she knows to be good with other dogs) and letting them romp around. We LOVE this. Boo gets socialized a little, and also gets worn out. She's been so nice and calm when we've come home most days this week. So far it's been a really great arrangement.

Of course, there was yesterday, where the dog walker wrote on her daily note: No dogs to play with today, so we cuddled on the couch at the end of our walk.

Cuddled?? No!!!

As I opened the crate, the furry brown tornado burst forth from it. She raced around the house like her tail was on fire for 45 minutes. AT LEAST. And then Luca came home and she did it again.

Did I mention she totally shredded one of her crate blankets too? Well, she did. :-P

Dear dog walker, if it were possible to engage the dog in a full gallop for 45 minutes, we would LOVE that. Since this is not possible, please WALK (not cuddle) our dog.

Sincerely,

The Management.

Slack

Have you ever taken a class where you feel like you could try and try and try and work your butt off, but you will never be able to really get it? Or at least get everything they want you to get.

That if you completely slacked off and did the bare minimum, you'd do about as well, AND be more relaxed.

I have.

Heck, I've even had classes where I did better once I stopped trying so hard. Maybe the increased level of relaxation helped get me into the groove....

Here's hoping that this stat block is like that. It certainly seems to be so far.

And yay! I only have 4 weeks of it left! Thank goodness because THAT puppy takes up 15-20 hours of my life every week. Useful info, I gotta say. But it definitely takes a toll on my schedule.

My little furry blood pressure lowerer

Of course I'm talking about Boo!

I look forward to taking her for a walk when I get home from school every day. Hearing her tail beat against the bottom of the crate as I open up the gate to let her out. Seeing her BIIIIIGGGG stretch as she staggers into the dining room all groggy in the mornings. And when I'm sitting on the couch doing lit review (which seems like it's 150% of the time now), she curls up on the couch and goes to sleep, putting her head in my lap. Snoring. Of course.

She has a new trick. Every night before we put her in the crate for bed, we have a routine we go through. Usually, I gather up her favorite toys and a bone, and put them in the crate. Then I straighten out her crate blanket. Then I go to the kitchen to get her a treat.

Well, last week I came out of the kitchen and she wasn't in the living room any more lying on the couch where I'd left her. She was waiting for me in the crate to give her a treat. It was so cute, I almost died.

And this wasn't just a one time thing either. Now she goes to the crate and waits in it for me EVERY night, so I can give her her treat.

You would think I don't ever feed this dog. She's put on 7 pounds since we got her, and she's still a skinny-mini.

Her other new favorite thing to do is steal Brutus, my stuffed dog that I sleep with at night. When I go upstairs to use the bathroom (I guess she knows I am temporarily incapacitated) she will sneak into my room and steal him off the bed. And then RACE downstairs with him. She looks so guilty when I find him with her. Naughty doggy!

The gentle leader is working too. She even heels better with the regular collar.

I'm so happy we got her! She makes me so much more of a relaxed person. Even though she takes up some of my time.

She's my little furry blood pressure lowerer!