Hump

Why do people get so upset when dogs hump each other in the dog park? Or when they play fight and end up rolling around on the ground.

Boo was playing with a Bernese Mountain Dog a few weeks ago, and she had Boo pinned on the ground, and ultimately sat on her. Boo was in no distress at all, and when she got tired of it, squirmed out of the way. Sure she was covered in dirt and drool, but I figure that's the price of taking your dog to play with other dogs at the dog park.

Similarly, she was wrestling with a Golden Retriever last weekend, and actually won the play fight! This time, the Golden was wriggling around on the ground. This rarely happens, and I exclaimed something to the effect that I was shocked that for once my dog hadn't "lost" the play fight. I felt this disapproving look from the Golden's parents like I was supposed to "do something" to prevent my dog from "mauling" the other dog. I'll point out that the Golden couldn't get enough of Boo and the two continued to run around the park happily for some time after that.

When she gets humped (she's a humpee, not a humper), she will typically stand there looking somewhat perturbed. Who knows what's really going through her (tiny) brain though. If she gets tired of it (which she rarely does), she will squrim away, or nip the air. I figure it's just the dogs working out their hierarchy amongst themselves.

Isn't the whole point of the dog park to let the dogs run around and play -- and roll around in the dirt -- so they can blow off some steam?

Video

Grumpity Grump Grump

I worked at home yesterday so as to sequester myself from the internet so that I could actually get s*hit done. As you all have gathered, I am a complete internet addict, and have a tendency to check my email, blog, and the news every 10 minutes unless I physically remove myself from internet access. Luca and I have avoided setting up the wireless internet in our house for that very reason.

Well anyway, I was successful at getting done what I needed to get done. But then I arrive back to my desk at school today and notice that it is completely immaculate.

?!?!?!?

Note: This is my PERSONAL workspace, with MY NAME WRITTEN ALL OVER IT. And my books sitting on top of it. It's the only place I have to call home at this m-f-ing university.

Someone had removed all of my papers from the workspace of my desk AND my large plastic cups and THROWN THEM AWAY. Bye bye password for the copiers! Bye bye locker combination! Bye bye being able to drink water without having to run to refill my cup every 15 minutes!

They had completely wiped down my workspace too. At least there was that. They shouldn't have been sitting there in the first place though.

But then there's the kicker. My right ear bud on my head phones is no longer functioning. So apparently, this douchey-douche is repulsed enough by my workspace to clean it off and THROW AWAY ALL MY STUFF, but not repulsed by the thought of using (and breaking) someone's ear buds. Ok, maybe they didn't actually use them. Still, the possibility of having someone else's ear giz in my ear for the few minutes it took to figure out -- yes my ear buds are busted for real -- totally grosses me out.

Grrrrr.......

An investigation will follow, I can assure you of that, dear readers.

On the positive side, at least I had a fantastic swim this morning. We had to go early since the pool just switched to summer hours, but the sun's coming up at 5:45 now so it wasn't a big deal to get up early at all!

New Trick

I was so aggravated by that lady (see previous post) that I almost forgot to mention that Boo has a new skill!

She will now do a down stay, and then wait as I tantalizingly roll treats across the floor in front of her. Then she will go get them (and eat them) when released.

I have to remember to tell her to wait, otherwise she chases after them directly.

And this skill only took 2-3 attempts to iron out!

She rules.

Toilet Paper

There was an article on the Well Blog today about how diet dog food often has more calories than it says it does. And that this contributes to doggie obesity.

I posted a comment saying something to the effect of, "My pit mix gets about 2 miles of walking a day, plus several trips to the dog park a week, and only needs 3 cups of food a day. According to the label on the dog food bag, it says she should get up to 4.5 cups. I can't imagine which dogs need that much! No wonder there are so many obese dogs."

This person responds with something along the lines of, "2 miles is nothing for a Pit mix. She is almost certainly under-exercised. I take MY precious animals for a 4 mile run daily plus a 3-4 hour hike plus a 9 mile run on the weekends plus the run in the yard plus they go to the dog park. Every single day because I am the best dog owner in the world."

I was really surprised at how angry the comment made me. I wanted to reach through the my monitor and wring her little exercise-bulimic-scrawny-ass neck. However, rather than rant on the NYT website, I will do it here.

Commence rant:

F you lady. Not all of us have 8 hours a day to devote to exercising our dogs. Don't you have a job? Even if I wanted to run that much -- which I don't -- I couldn't due to my bad feet. And point of fact: not all pits are distance runners. The last time I took Boo for a 2 mile run, I had to drag her exhausted ass home. Pits are generally speaking power sprinters, not endurance animals. I suppose you think she gets tired because I don't go running with her enough. What, you think I'm a bad dog owner or something? That my dog gets substandard care and not enough attention? That I have no business owning a dog that I can't exercise up to your psychotic standards? Don't be so smug. I'm sure you aren't perfect either. In fact I know you're not. You've already proven yourself to be holier than thou. I hope you trip on your dog's leash your next 9 mile run (when you're 4.5 miles out) and fall flat on your face.

End rant.

Ahhhhh... I feel so much better now.

And for the record, Boo is officially passed out on the couch following her 2 mile walk. She'll wake up for more fun when daddy gets home though, I'm sure.

Skilz

Of all the skills I anticipated learning during my PhD, writing my own reference letters was not one of them. I had no idea that people did this in academics, but it appears that after med school (and presumably residency, but maybe not? Don't know, haven't applied yet.) people expect you to write your own letters. I guess nobody really has time to do it for real once they get to the point where their word actually counts for something.

At first it felt kind of weird to me, you know, to talk about myself in hyperbolic terms. After the first couple I've begun to get the hang of it, though. Now I have a template of sorts that I can adapt to a variety of different audiences' and writers' desires.

Do any of you have any bizarre/unanticipated skills you learned during your training? Please share so that I may be forewarned!

Obligatory Boo Pic-o-the-day

She is so tolerant of me!

It's not nice to mock your students

Last week I presented a database I had designed in a class I am taking. It was my final project, but I still had some questions about how to do certain things, so I decided to ask while I was up there.

My main question was how to create a form with a password so that only certain people could view it. (No I don't want any of you to tell me, that is not the point of this post.) I would like to be able to blind myself to the exposure status of my subjects so I don't unintentionally bias my interviews, but I still want to be able to store exposure status in my database.

The professor -- who is also the PhD program director -- misunderstood and thought I was asking about how to *really* blind myself, rather than how to store the information in a hidden way in my database. And yes, this is a problem too, but not what I was asking about, and definitely not germane to this class on DATABASE DESIGN.

"Why don't you just get your project coordinator to collect the information for you?" He asked me.

I wondered for a minute if he was mocking me. My department can't even figure out how to pay ME, let alone get me a project coordinator. I mean, wouldn't it be nice if I could have a project coordinator to help me with my data collection! I might actually graduate on time then!

The sad part is, I think he was serious, because when I said, "Um, what project coordinator," he didn't seem to understand.

I thought about saying something, but decided it wasn't worth it and I let the issue slide. Shaking my head went back to my seat.

I can't wait to be done with that class.

This is how I felt this morning.....

After lying awake in bed for several hours last night from BUNION PAIN. (If that doesn't mean I am geriatric, I don't know what does.)



And also, I am an enabler.

Before:



After:



Heehee.



What a naughty doggie!

Pand ora

I think the most useful thing I learned during my surgery rotation (except how to cut sutures too long or too short) was about the existence of Pand ora. Before pand ora, for me new music officially stopped coming out approximately 10 years ago. Except Lily Allen. I love Lily Allen, but as my husband says, Lily Allen's godfather is Joe Strummer of The Clash, so she doesn't really count as "new" per se.

So (for the uninformed) pand ora allows you to create "stations" that compile music similar to an artist or song of your choosing. At the risk of showing my true age and revealing my truly embarrassing musical tastes, my favorite stations that I've created are the following:

1. Nothing Compares to You radio (plays Sarah McLaughlin, Madonna, Enya.... Whitney Houston) hangs head in shame
2. Lily Allen radio (this is how I discovered Regina Spektor and Kate Nash)
3. Bang Bang, My Baby Shot Me Down radio (sounds like the Kill Bill soundtrack)
4. Alicia Keys radio (taste developed during neurosurg rotation -- the attending and scrub nurse got into a fight over whether she was primarily a black or Irish artist)
5. Billy Bragg radio (carryover favorite from the mid-90s, plays Wilco!)

and (most mortifying)
6. Snoop Doggy Dogg radio

I already knew I liked Outkast and the Notorious BIG, but I've also found that I like 50 Cent.... is that ok? What can I say. It reminds me of my 3rd year of college.

I've even been considering *purchasing* some music in the form of MP3s. This caused quite a stir in the OMDG household as we are holdouts from the CD era. Something about having an object to hold in your hand when you buy an album.

I feel like an anachronism. :-P

Situs inversus

The prospies left this morning. Oh! I guess I forgot to mention that Luca and I hosted 2 prospies for the MD-PhD program these past few days. And really it wasn't so bad! They were nice young women, who seemed to have their acts together, and didn't even vomit all over my house after they went out last night!

Ah well, such are my expectations given that I know some of MY CLASSMATES did this during our own prospie weekend 4 years ago.

I didn't see much of them at all, since [my med school] kept them pretty well occupied with activities. I'm hoping they weren't horrified that I lived waaaaayyyyy out there in West Philly, instead of with the cool kids in Center City. All in all, it was a pleasant experience, and I'd do it again.

Now I have about 1,000,000 loads of laundry to do.

On the way out, one of the prospies said that they heard from the anatomy teachers about a cadaver that had its organs on the wrong side. She forgot what the term for that was..... AND so did I. I had to look it up. But! I did remember the Kartagener's syndrome triad:

1. Situs inversus
2. Chronic sinusitis and bronchiectasis
3. Infertility

What's the relationship between these three things? Ciliary dismotility. Though I can't remember if the infertility problem is from messed up flagellae on the spermies, or on messed up cilia in the male reproductive tract, leading the spermies to get sequestered in the testes.....

So sad that I couldn't remember the term "situs inversus" though.

Don't confuse Kartagener's syndrome with Kallmann syndrome which is caused by improper migration of neurons olfactory placode to the hypothalamus during development. They have no (or reduced) sense of smell and no LH of FSH.

And to answer your question, yes I had to look that up. All I remembered was that these patients have no sense of smell and that they suffer from hypogonadism.

Oh well.

Back to work on my T32 app.

The work never ends

Since I submitted my grant a few weeks back, I've been working on all my final projects for my classes, presentations, and then getting additional work from my mentor. I've also been having trouble motivating myself to do ANY of it. :-P

I'd really like to start on my project. Alas, there is a mountain of work to get through before that can happen. The good news is that at least much of it will be out of the way after May 3rd.

This is my list (not like any of you care, but *I* care so I'm putting it here anyway):

- Finish Final Database for class
- Finish paper for Ethics, with feedback from today’s presentation (more like write the whole paper....)
- Cerner research proposal -- so I have permission to do my research project using the big database that my mentor uses
- Paper describing ICU bounceback epidemiology -- Yay! A paper. First I must go over the literature....
- Tell data person what variables to include for table.... so I can start analyzing my data for my project
- T32 application (research proposal, letters, cv, biosketch tailored for THIS grant, rather than what I'm actually going to do), because they still haven't figured out how to pay for me.
- JAMA review of paper
- data management assignment for class -- last BS assignment to turn in!
- IRB documents (lots and lots)

Joy!

Anyhow, it looks like it's going to be a busy week and a half. Or three.

Orchids

A friend of mine is getting ready to publish her next novel. She is thinking of calling it "The Orchid Affair."

I'm really sorry, but all I could think of when I heard that was that there's a strip club named "The Purple Orchid"** in Southwest Philly. We drive by it on our way to Ho me De pot on the weekends.

I don't think she appreciated it when I told her that.

:-P


** WARNING -- LINK NOT SAFE FOR WORK!!!! **

Not just one name

Boo has many names. Whose dog doesn't? Of course she is Boo, but she's also Miss. Boo, Boo-atrix Kiddo, Boo Doggy Dog, and Missy Moo.

And let's not forget Sweetie Pie, Chicken Thigh, Stinko, Miss. Stinko, Little Ho (while being humped at the dog park), My Ferocious Pit Bull. Miss. Ferocious.

Little Pig (because of the snoring)

Skinny Butt

Stinky stink

My Repulsive Stinky Stink

Fine Animal

Dog

I'll admit, they're not as creative as when I was 12 and started calling Polly (my mother's standard poodle) "Dildo," a moniker that was nipped in the bud as soon as my mother asked me if I knew what that was. (Um, no?)

What do you call your dogs? Do you stick with their given names, or do you get creative?

Do Tell.

Why'd you wake me up, Mommy?

So what you're saying is that I should just give up now, because it's so rare for women to succeed in academic medicine

On Sunday I was informed that I needed to apply to be on somebody's T32. It's a kind of training grant geared mostly towards post-doctoral students, which they're trying to squeeze me onto even though my project isn't really a good fit. My department still hasn't figured out how to pay for me, in case you hadn't noticed, and they're still trying to make it my problem.

Anyway, I met with a person today who was supposed to give me a sample of what the "research proposal" document was supposed to look like, since it's 2 pages long and not at all like the grant I just wrote.

So, said person started reading to me the contents of some 4 page document. It didn't sound at ALL like what I'm supposed to be doing, so my meeting wasn't especially helpful.

And then, more or less out of nowhere, he starts lecturing me on how despite the fact that 50% of their masters students are women, almost none of them go on to be academics. Most become clinicians or AT BEST clinician educators. Then he started trying to convince me that being a clinician would actually be a great career (It's a great job! You'd have time for your family and outside interests!) and that being an academic is like being "a project manager."*

To say I was stunned is an understatement.

Let me say something: I've never had a conversation with this man before in my life. He is not my mentor, nor was I meeting him for any reason other than to read a document that only he has access to. All I had said prior to that was that our surgery clerkship director -- an alumna of the masters program -- was an amazing individual for whom I had a lot of respect. And he launches into a spiel about how all women bomb out of academics?

W. T. F.

And you know? I know that someone is going to say that I am misconstruing what he meant. That he didn't mean that I would fail. Just that most women do. That I just need to realize what I'm up against.

Facts which really are not that helpful to someone who is trying to become MORE confident, not less.

The facts that were a topic of conversation that HE started, that was completely irrelevant to the reason for our meeting, not to mention a complete non-sequitur in our conversation.

The truth is, he probably thought he was doing me a favor. He even said that institutional prejudices kept a lot of women out of academics. Woohoo! Like I'm supposed to take his observation of flagrant sexism as a show of solidarity or something.

It was really depressing, and I'm feeling pretty bummed. It's like say.... I was black, and I walked into the pre-med office wanting to go to med school and the pre-med adviser suggested that I do something like basketball because people like me are good at that. You'd think people would have their heads less up their asses since it is 2010, but sadly that is not the case.



*Interestingly, the fact that being a researcher is like being a project manager is one of its great appeals to me. I've been a project manager before and absolutely loved it.

New (potential) neighbors

Our neighbors finally got an offer on their house! I'm sure they're very relieved. I guess Luca ran into one of the buyers on Friday and he did a good job selling the neighborhood and *apparently* told her that I was a grad student at [where I'm a grad student at]. She thought my husband was soooooo charming and fantastic and subsequently made a CASH OFFER on the house for her daughter who is going to be a grad student at the same institution this fall.

I told Luca that he should be happy that the prospective buyer took him for a 27 year old rather than the 36 year old ogre / curmudgeon that he really is. Heehee.

So we will (again) be living next to a bunch of 24 year olds, when one of the main appeals of the neighborhood was that there weren't any of those living here. No offense to my 24 year old readers..... but the mid-30s are just a different life stage. I mean, it's not like I purport to be especially mature or anything, but I just was happy to be surrounded by other people from my birth cohort for once. You know, people who had outgrown the whole "bar" thing. Who go to bed at 10PM rather than 1AM and are into things like gardening and knitting rather than partying and being cool.

Of course now our birth cohort neighbor friends have become attendings and are moving to an attending quality house in the burbs, making me feel hopelessly behind in my life again....

:-P

And what's up with the parents shelling out 300K for a house for their kid? Not that I begrudge them that or anything.... Must be nice, is all I have to say!

I just hope our new neighbors aren't very social. It would suck to be woken up by a house party every other weekend. Maybe they'll be extra special mature.

Lesson in anatomy at the dog park

The classic peroneal nerve injury vignette is where you see a football player with a foot drop who acquired this problem after receiving a helmet to the side of the knee during a tackle. See, the peroneal nerve courses close beneath the skin here around the head of the fibula, and is susceptible to injury from the above mechanism.

Sometimes the problem resolves over time. Sometimes not. Sometimes surgery helps (according to the peripheral nerve specialist on my neurosurg rotation), sometimes not.

Like at the dog park today! When a herd of racing dogs came barreling into me from the side, clipping me in the knee.

Hello paresthesias down the lateral aspect of my leg and shin! Fortunately, the foot was still functional and the tingling went away after about 10 minutes.

Fortunately I still remember what the peroneal nerve is 1 year out of the clinics.

:-P

Gnaw

Just like the cat in the hat (comes back)!

Our neighbor's cherry tree has been in full bloom this past week. It just started shedding its petals, and it's like there is pink snow swirling outside our window every time the wind blows. Hopefully we won't need some Voom to clean it all up.

(Don't ask me what Voom is, I never will know....)

Here is a picture of the petals on our front steps.


And the cherry tree in front of the house.


I love spring in Philadelphia.



Boo likes getting her tummy rubbed. Why'd you stop, Mommy!

How old is too old

I remember during the MD-PhD retreat my second year of my program, one student who was a year ahead of me was talking to me in line.

"OMG, thank GOD I got my surgery rotation out of the way BEFORE I did my PhD! I just can't imagine having to do such a demanding rotation at the age of THIRTY," she said.

I thought she had to be pulling my leg. I was already 30 and hadn't done a single rotation yet. She had to know that, right?

"You know, 30 is not that old," I said.

She looked at me like I was nuts, and then continued her rant, going on and on about how old 30 was, etc. etc. etc.

I was 31 when I did my surgery rotation, and it was two of the most fun months I had during my core clerkship year. I joked with one of the attendings, as I told him that at the rate I was going, if I went into surgery, I'd be pushing my walker into the OR by the time I became an attending.

His response? "Dump the PhD and become a neurosurgeon. You'll be done in roughly the same time."

He did have a point.... but I'm in school to become a researcher, not to become a brain-cutter, as cool and awesome as that rotation was. And I need sleep.

But how old IS too old to become a surgeon? If you go to med school as a non-trad, should you restrict yourself to shorter residencies?

The problem is, once you add in fellowship after residency, you're looking at 5-7 years post med school training anyway for any specialty -- not just for surgical specialties. If your passion is surgery, you might as well just do it. It ends up being roughly the same in the end. My reasons for not wanting to do surgery have more to do with lifestyle issues and what turns me on about practicing than anything having to do with my age. I don't know how I would feel about it if I was already 40 and just starting down this path, but that's how I feel now at 32.

One thing I will say, when I started this business, I think I was only distally aware of the fact that even once I started my MD-PhD program, I was still looking at a minimum of 10 years until I could be a PI/attending. More like 13 years. That's a long damn time. If you're going to do medicine at all, you HAVE to pick something you love. For your sanity if nothing else. And if that means becoming a surgeon, you should just do it, even if everyone tells you that you're old.

Confidence

My mentor has this ability to say something, and even if he is dead wrong, sound completely and utterly confident that he is right.

I won't get into what happens if you question these assertions of his (it isn't pretty), but it got me wondering how he is able to project complete and total command over anything and everything he discusses, regardless of whether he really knows what he is talking about.

Why? Because the farther along I get in this MD-PhD process, the LESS I feel I know. The LESS confident I feel. I know I'm not the only one who feels this way.

The problem is that I get the sense that part of the reason he's been so successful in his career thus far is because he's able to project this confidence. And it's not just the confidence, it's confidence with a hint of, "Don't even THINK about messing with me," thrown in. The subtle put downs of fields that he doesn't have expertise in.

I wonder: Do I need to learn to be like that in order to have a successful career? I don't really want to be like him, but there are a lot of things he does that I wish I could do. Like command a room. Make people want to listen to me and my ideas. Articulate myself more clearly and succinctly. Be respected. How is this ever going to happen if I continue to feel stupider and stupider as I go through this process?

Is it all an act?

Is this a "man" thing?

Can I be successful if I do things my way?

And fundamentally:*
Do you think it is necessary to be an asshole to be a successful academic? My old mentor (notably NOT an asshole) asked me this once. My response then, as it is now was, "You don't have to be an asshole, but it probably helps."

Anyone have any thoughts on this?


*Not saying my mentor's an asshole, just asking in general.

(And now, for the obligatory Boo pic of the day.)

How Al and Yo chased away the unwanted house guests

My old riding coach used to breed Bull Mastiffs. They were these huge smelly slobbery dogs who just loved everybody, and she had at least two of them as I recall. They were named Al and Yo.

I remember on one trip we took to do an event in PA, she told us a story about these house guests she had had. These weren't ordinary house guests who try to be neat an unobtrusive, and leave after a short period of time. No. These house guests were loud and messy. And they had been there a week, and showed no signs of leaving any time soon.

To make matters worse, they would all eat a big dinner every night, and then while the hosts were doing the dishes, they would pop open a few beers and kick back in front of the tv. "What's for dessert?" they would holler from the tv room.

My coach and her husband would bristle.

One evening, they had finally had it. Now, my coach and her husband were in the habit of allowing their dogs to lick the plates clean before putting them in the dishwasher. However, the house guests had no knowledge of this since, as shitty house guests, they only ever ventured into the kitchen to take more (of my coach's) beer out of her fridge. So this night, when the house guests started demanding dessert, my coach simply ignored them.

After a few ignored requests, the house guests I guess must have decided they were going to get more dessert for themselves, so they wandered into the kitchen. And what did they see? Plates on the floor covered in bull mastiff drool. Al and Yo barely took the time to glance at the intruders as they were intently focused on their job of pre-washing the plates.

My coach nodded at the shitty house guests, who were standing in the doorway observing the spectacle. And then, rather than load the dishwasher with the licked dishes, my coach and her husband silently started replacing the dishes directly into the cabinets as the shitty house guests watched in horror.

The next morning, the house guests got up early for breakfast, their packed bags sitting awkwardly by the door. They really had to get back to where ever they came from, you see. Their plants needed to be watered, and they didn't want to overstay their welcome.

And that, dear readers, is how Al and Yo got rid of the shitty house guests.

Stabbing in my backyard

We seriously considered buying a house on that very street last year. I walk Boo there literally every day, and it's less than 1/2 a mile from my house.

Ah, joy.

Queen Boo

Apparently the *seat* was not good enough for her.

Choice

Fizzy had this great post on how to choose a medical specialty. All you have to do to find out what you're meant to do with your life is click here.


*She forgot Rad Onc though. Fizzy, where would that go?

Bringing Epi to the Masses

Every year our MD-PhD program has a retreat where we all get together, and we non-basic science people are forced to listen to the basic science people talk about their research. There are only 10-15 of us at most out of 150 students in the program overall, and therefore most of the activities are geared towards them.

It's a pity really.

See, probably 1/2 of the basic science people will end up doing clinical research. Probably bad clinical research (since most of them think it only takes a stats class or two to be proficient at designing clinical research projects.... don't get me started), but clinical research nonetheless. It would be undoubtedly useful to them to see what clinical research people do, so they know what's in store for them.

So this year I'm on the planning committee for the retreat, and I decided to be on the panel who decides which faculty to invite to eat lunch with us to discuss their careers. I am really hoping to get a few Epi faculty members to come. There are a few that I have in mind who a) love students, b) did basic science PhDs and then later became Epidemiologists, and c) women.

(I know, it's pathetic that I have to lump "women" into a "special" category, but it is what it is.)

We'll see how it's all received. After sitting through many a painful lunch with a basic science person saying to me, "What is it that you do? I don't know ANYONE who does anything like that, except these failed researcher clinician educator track individuals who are beneath me," I will hopefully be able to find someone who gets what I do.

And I guess if I don't, at least this year it will be my fault.

Edit: Just looked at the faculty who came to last year's lunch. Not. One. Single. Non. Basic. Science. Person. No wonder these lunches always suck for me. And also? This may end up being an uphill battle.... and I worry if I invite a clinical research person, they will get ignored.

Perhaps we should have named her Duloxetine instead

I was talking to my dad this morning about my fur-princess, and he commented on how much happier and sane I've been this semester since Luca and I obtained Boo.

Perhaps Duloxetine would have been a more apropos name for her than Boo.

Ah, my four legged SNRI. With fur. How ever did I manage without you?

Too tired for breakfast

Today we took Boo to the Schuylkill River Dog Park. She was very well behaved and got along well with all of the other dogs. She ran continuously for 60 minutes or so, and is now passed out on the couch, ignoring the food in her bowl. She may need another bath today, however, sine she is covered in dirt and doggy drool.

She was the only non-pure-bred dog at the park. I guess having a Pitty-mix isn't as common in center city as it is in West Philly (or maybe they just don't get taken to the dog park)? That's right, my ferocious feral pit bull mix was playing with all the beautiful Vizslas, Labs, Bernese Mountain Dogs, Poodles, Brittany Spaniels, Boxers, and Great Danes. She had a BIG time.

I think we will have to make this a regular event for her on the weekends.

Sausage Hands

As I sit and work on my project, in the background on occasion I will turn on the tv on mute. Sometimes I find the flickering light in the background comforting. What can I say.

So apparently, there is this idea floating around that having hands with VEINS and TENDONS is ugly. Now they're trying to sell products that make your veins and tendons appear smaller.

WTF??

I once had a friend who was very insecure, constantly worried about how fat she was, point out to me in college that my hands were very veiny -- unlike hers -- and that this was supposed to be unattractive.

OMG!!! She had prettier hands than I did! NOT THAT!

So I raised my hands above my head for 5 seconds and Presto! No more veins!

She didn't like that very much.

Anyhow.

How stupid are we? Do people really get collagen fillers in their hands or buy these ridiculous infomercial products to reduce the appearance of veins in their hands? Do people really pay attention to other people's hands?

How incredibly bizarre.

Thus

When I was a freshman in college, I had a phenomenal English teacher who more or less ironed out all of the terrible writing habits I had, and made me capable of expressing myself in a coherent way. I think she thought I was an idiot.

The problem is though, whenever I read something written by another person that breaks one of her rules, I cringe internally.

For instance, I was taught never ever ever to start a sentence with the word "Thus." My teacher argued that if you found that you needed to use that word to make your point, then you probably hadn't done a good enough job of laying out your argument before you got to that sentence.

I'm sure this stylistic point is up for debate, but to this day, it makes me cringe whenever I see a sentence in academic writing beginning with that word. What's worse is when your mentor has a veritable love affair with that word, and peppers his manuscripts and grants with it.

When he edits my documents, he sprinkles that word all over them, too.

Reading the edits makes me feel like I have ants crawling all over my body.* My English teacher really had an impact on me, you might say.

Do you have any writing pet peeves that drive you crazy when you see them, dear readers?


*Yes, I know that is formication. And no, I do not use cocaine.

Question

Say you run into a friend on the street. This friend is a frequent status updater on facebook. When they say, "I just got back from XYZ," is it weird to say, "Oh yeah, I saw that. How was it?"

Just wondering. I kind of figure if they don't want people a) knowing, or b) commenting, then they should reconsider status updating these things....

Drug

Maybe one of the pharmacists can answer this one:

Why does my new medication* have the following instructions on the label:

"Please take on empty stomach."

followed by:

"If medication upsets stomach, take with a small meal."

They seem to be contradicting themselves, no?


*No, I am not telling you what medication.

Click!

Someone (I think it was Outrider) suggested way back that we clicker train Boo.

For those who don't know, it works like this:

1. Dog performs good behavior voluntarily.
2. Click click!
3. Treat
4. Dog learns to associate the good behavior with the clicker with the treat. Continues to perform good behavior.

I don't know about that, but I CAN tell you that Boo has DEFINITELY learned to associate the clicker with the treat. As soon as I click (provided she's not distracted by a squirrel or a blowing leaf) she starts licking her lips and looks at me expectantly. If I had a little bell, you could call me Pavlov.

Then I give her the treat, and she will zoom off again. Well, sometimes she stays by my side for 5 more seconds.

Maybe she's learning?


(As a side note, and apropos of absolutely nothing, we have a new nickname for Boo following watching Chad Ochocinco on Dancing with the Stars last night -- Boo Ocho-stinko. Pertaining to her aroma, not her dancing ability, of course. Hahahaha!!!! Ok, only I find this funny. Sorry for torturing you all with my lame-ass sense of humor!)

What's not to like about Emergency Medicine?

Ok, so now that you all think I'm going to be a Psychiatrist, I thought I would FINALLY get to posting, "What's not to like about Emergency Medicine?"

Though, I've been in a Neurology kind of mood lately, so this may be a challenge.

So here goes.

First, the pros:

1. Procedures. Hate standing around for hours in the OR? Hate *watching* someone else do that procedure? Think the hours on surgery are insane? Well, EM might just be the specialty for you. I&D, Lines, intubations, lacerations, setting fractures, you get to do a whole range of procedures in this specialty. I know a good number of people who went into EM because they wanted to be surgeons, but didn't want that lifestyle. Procedures can be really fun as long as a) the patient isn't simultaneously screaming at you, and b) you don't have 10 other patients to see 5 minutes ago.

2. Variety. You see every. single. type. of patient. in the Emergency room. You do a ton of primary care, you see critically ill patients. Adults. Kids. Geriatric patients. Patients with a lot of chronic illnesses. Psychiatry patients. Ladies giving birth. Ladies with routine Gyn complaints. (Note I left out Neurology... That's because I've not seen a single EM person who is good at it.) Seriously. You see everything. The only problem with that is that it's hard to become really good at managing all those different problems. But you're job is mainly to stabilize until the patient can be admitted, so it's sort of all right.

3. You get to see completely undifferentiated patients. Patients who nobody else has seen. YOU get to be the one to make the first diagnosis and decide what they need. Of course, my medicine residents told me never to go off of the Emergency Medicine resident's note when admitting my patients, so the same probably applies for any admitting specialty too, but still. IN EM, you are *officially* the first to see the patients.

4. The pace. EM can be incredibly fast paced. And most of the people I've met who go into it are a little ADD. The downside is that their manner is cultivated in order to extract only the relevant information from as many patients as possible in a short period of time, and this can spill over into their interactions with non-patients as well. The social hierarchy in the ED can be a little bit military as a result, but once you're "in" there's a lot more joking around than there is in other specialties. Though this may be hospital dependent. I remember having to be completely silent during the first few weeks there. After that, people started warming up to me, and it was ok. I probably didn't mind because at that point it was one of my last core rotations and I had gotten used to the hierarchy.

5. Sometimes the ICUs are so full that you end up admitting only patients who are on death's doorstep and who probably won't survive. The patients who are a curable end up boarding in the ED until a bed is available, so as an ED doc at a busy hospital, you'll probably end up treating a lot of curable (or at least stabilizable) conditions, and you get the satisfaction of having made the patient better.

6. Trauma!! These are really exciting. Doing the primary survey is fun, and once a few of your patients die, you begin to get used to it (is that bad to say?) and it's not quite as heart wrenching. Things move really fast. Decisions are made quickly. If you know what you're doing, you may get to help out. If you don't, stay the hell out of the way.

7. Ortho. You get to stabilize fractures. This can be very satisfying.

8. Primary care. Poor people who can't afford to see a doctor, as well as people who don't want to wait to see a primary care doctor, come to the ED for their care. You have the (not often taken advantage of) opportunity to really make a difference in the lives of these patients, since you are the only doctor they see.

9. Shift work. You do five(?) 12 hour shifts per week as an ED resident, and during your last year, these go to 8 hour shifts. Of course, often they'll end up being 13 or 14 hours, depending on how much extra work you need to tie up before you can go home, but my impression is that this is totally manageable. No Q4 call. No 30 hours in the hospital at a time. Of course, this also means that you will become a slave to your sleep schedule, and your circadian rhythms might get pretty out of whack, but if you're the kind of person who can sleep anywhere and any time, it may not bother you that much. Also, I like being in the hospital overnight. It's much more relaxed than during the day. Don't know how much I'd love it at age 50.... but that's another issue entirely.

10. Did I mention the hours? They're not as bad as a lot of the other specialties. And the pay is still pretty good (will be interesting to see how much this gets eroded over time -- I worry that it will be a lot).

11. The ED nurses, paramedics, ancillary staff, are all pretty awesome to be around and are incredibly helpful. More so than on most of my other rotations.

12. No SNF, rehab, nursing home placements. Minimum social work.

13. Extremely limited rounding. Minimal paperwork. Minimal note writing.

And now the cons:

1. The military style of interaction in the ED. Abruptness. Poor doctor-patient communication skills.

2. The shotgun approach to medical diagnosis. Testing everybody for everything to avoid a lawsuit. No art in diagnosis.

3. Procedures on screaming patients (at you), when you don't have any time.

4. You don't learn in depth medicine, you just learn how to stabilize people and get them out of your ED.

5. Overnights are fun now, but probably suck when you're 50.

6. Patients are at their worst in the ED. Some of them scream at you a lot.

7. Frequent fliers, drug seekers, patients who are only in there so you can write them a note to get off of work and give them some Percocet. The tendency to mistake legitimate patients for the above.

8. You often never really learn what the diagnosis was.

9. I kind of like rounding. Just not for 5 hours.

10. Gyn gyn gyn. If you don't enjoy pelvic exams, this is not the specialty for you. Hygiene is often an issue in the ED (not just for gyn either), and though it might make for good stories, it's always a bad sign when you can diagnose the BV as soon as you walk into the room.

11. ROMI ROMI ROMI*. All for patients with panic attacks.

12. The endless sea of patients with very little actually wrong with them before you get to the truly sick people.

13. Demanding people who don't need to be there who want to be seen 15 minutes ago.


I'd love to hear your thoughts on the pros and cons. I know a lot of my readers think that this is THE specialty for them, and there definitely are a lot of interesting things about it, and it's a very popular specialty these days, in particular because of the pay and the shift work aspects.

Thoughts?



*Rule out MI

Even more tulips!

Ok, I am a bit obsessed. But even more are blooming today! And it's so beautiful outside. You can even see some of the hyacinths, which smell really nice!

Food

Fizzy at MiM had a great post this morning about quick go-to meals for doctors/families. I hate to say it, but it reminded me of that time in my life when I was 22 and working as a consultant. I would work all day, have an enormous lunch, go to the gym, and come home by about 10PM.

Then I'd have ice cream for dinner.

I don't really ever do that anymore (see, I've matured!). And while these recipes aren't really all that helpful for when I was a) on nightfloat or b) during any surgical rotation, they are helpful to me NOW. I.e. now that I have more than 30 minutes of time between when I arrive home and when I hit the hay.

1. Pasta
- toss with red sauce (raw tomato sauce in a bottle), 1 tablespoon of butter, Parmesan cheese
- sautee some mushrooms in butter, add cream, reduce, pour over pasta (works best with wide egg noodles), add more cream and lots of cheese
- Pesto: if you're pressed for time, just get the stuff in a jar at the food store
- Zucchini sauce -- sautee sliced zucchini (6) in olive oil while the pasta is cooking with diced garlic cloves. When soft and beginning to brown, add juice from whole lemon, some basil and serve over pasta.

2. Asparagus
- sautee in olive oil until tender (less than 10 min), sprinkle with Parmesan cheese, or dip in mayonnaise

3. Chicken cutlets
- my husband and I keep our freezer stocked with these. Buy the thin boneless skinless chicken cutlets, dip in flour, then egg, then bread crumbs. Then you can freeze them pretty much indefinitely in freezer bags. When you're ready to eat them, thaw in the microwave (5 min) and then sautee in olive oil (5 more min), and serve with mayonnaise and/or lemon.

4. Mashed beans
- cut up garlic clove, wash some canned canellini beans, put some olive oil in a sauce pan, mash all ingredients together with a potato masher, serve when warm

5. Roasted red peppers and goat cheese on toast
- Cut peppers and roast in oven at 450 for 22 minutes. Toast bread (sourdough from TJs tastes best). Spread toast with goat cheese, serve peppers on top.

6. Couscous
- You can put anything in this. My favorite is sauteed spinach/chard with raisins and pin nuts. You can also add sliced tomatoes and Parmesan cheese. Leftovers keep forever in the fridge.

7. Broccoli
- BORING, but you can steam a head in about 3 minutes. Sprinkle with salt + pepper + cheese.

8. Re-fried bean burrito
- Heat burrito shell in skillet, open can of re-fried beans, put 1/2 can on burrito shell (now removed from heat). Add however much cheese you want. Wrap. Nuke 2 minutes. Eat with salsa and/or sour cream.

9. Canned beets
- open can, drain, sautee in butter with salt + pepper for 10 minutes

10. Frozen peas.
- Cook covered in microwave as specified (add a tiny bit of water) with butter, salt, and pepper. If you have time, they taste better with sauteed onions, but it's really not necessary.

11. Sandwiches
- Tuna salad, egg salad, cheese. Buy a really big sandwich at the hospital, eat half, and bring the rest home for dinner.

12. Hummus/baba ganoush and vegetables

There's also gnocchi and manicotti (in the frozen food aisle), pierogies, cottage cheese (with canned fruit -- or fresh), yogurt with pretty much everything (esp. raisin bran), Stouffer's french bread pizzas and mac & cheese, and of course the old standby: ice cream on those nights when you get really desperate.

Luca and I recently purchased "The Moosewood Restaurant Cooks at Home,"* which has a ton of recipes that are reasonably healthy THAT ACTUALLY ALSO TASTE GOOD that can be prepared in 30 minutes or less. Most of them require a few fresh ingredients, but also a lot of canned stuff (beans, fruit, etc.) and dry ingredients (pasta, couscous, rice) that you can buy in bulk. Also, the recipes are usually 4 generous servings, which means I have leftovers during the week. I would never have had time to make any of these when I was, say.... on a surgery rotation, but I do now.

On my surgery rotations, Luca would cook for me, which was really nice. I'd highly recommend it if that's an option for you!



*I swear to god, I do not work for them. And they are completely AMAZING!!

Swimming

I'm in the midst of submitting my [obscenity] grant this weekend (bye bye Sunday!) so it's only natural that I procrastinate a bit by watching some swimming on Universal Sports.

There was an absolutely classic interview done by Markus Rogan, after he won the 200 IM (I think) who is 27 and therefore about 10 years older than most of his competition.

It went something like this:

Rowdy Gaines: Marcus, how is it that at the age of 27 you're able to stay motivated with your swimming?
Markus: Well, I quit swimming a few years back and did private banking. And it was really boring. Working sucks! So I decided to get back into the pool.

Amen brother. Amen.

Tulips!

My tulips are blooming! I'm so excited! They look really really pretty. Though, you can see that I still need to work on the shade part of my garden....

The hierarchy

Last night we had our "You're halfway done with the MD-PhD!" dinner that they hold to make us feel less bad about not becoming residents this July. Not that any of us are exactly yearning to be interns at the moment, but still, it kind of sucks to be left behind.

I and a friend started talking about how much being a clerkship student sucks. How you're under the microscope at all times, expected to do and say everything perfectly, with an imaginary "good" vs. "bad" checklist being kept in your resident's head at all times.

As in:

"Med student asked annoying question" = bad
"Med student stayed out of my way" = good
"Med student didn't know the answer to my SIMPLE question today" = bad
"Med student knew all of the answers to my questions today" = also bad (read: annoying, above)

You get my point.

And then there's the hierarchy. Because a 3rd year clerkship student is lower than dog shit. I really wish I were exaggerating.

I remember on my Ob/Gyn rotation being given a task (finally!) on a patient I hadn't been following to call radiology for a preliminary read on a sprial CT they'd done on a patient with hypoxia and shortness of breath. They'd been slow on the read, the NP on the floor told me. Please help out.

So I called them up, and got a resident, who immediately was like, "WHY are you calling? Who are you? Oh, they didn't tell you anything about the patient? God, so typical." They were annoyed with me, and perhaps also my team. Then they went to get the attending.

Now I know that means that the CT? Is seriously messed up. As in, hello, major finding here. At the time I didn't understand what the problem was. And I'm beginning to sweat because the team had wanted this information before rounds, and rounds were about to start, and I didn't want to get yelled at for being late.

The radiology resident and the attending finally came back on the line. And the lady had a massive PE. Like, 3 out of 5 lobes were affected. I mean, no shit she was hypoxic and short of breath. So I diligently scribbled down the information and scurried off to the room where the residents were rounding so I could tell them.

When they got to my patient I tried to interject, really I did. Several times, but I got THE LOOK, and kept my mouth shut until rounds was over.

Everybody started to get up and leave, so (since I needed to convey important information) said in my smallest voice, "Does anyone want to hear about Mrs. Anderson's* Spiral CT?"

"Sure," they said. So I pulled out my piece of paper and read my diligently scribbled notes to them verbatim.

"What!!! Why didn't you tell us this before? You should ALWAYS interrupt for something important like that!"

Sigh.

Sometimes, a lowly clerkship student just can't win.

Who says the hierarchy never compromises patient care?



*Not her real name.

Suoceri

The in-laws are arriving in a little over a month. And they are staying for a month.

"Wow, that's a really long time," I hear someone saying, "You must really love your husband."

Well in fact, I was the one who suggested the month long stay. Why? Because the original plan was one week, and they seemed to kind of expect that we take that week off of work, and spend that time staring lovingly into each others eyes from across the living room. And for one, I don't have a week to take off (pardon me for wanting a real vacation at some point in the year), and two I was hoping that if they were here for a month, they'd kind of get used to things here, develop a routine, and chill out a bit.

I mean, I do like having them around and talking with them, but since my Italian ranges from poor to very poor, talking with them for more than, oh say 60 minutes at a time is really stressful for me.

So, dear readers. I have to figure out how to occupy them for the time that they are here. Bearing in mind that no matter what we do, they will complain that they are not seeing enough of us Luca.

I've come up with some options:

-Long walks around West Philadelphia (which is beautiful in May)
-Art museum
-Baseball game
-Franklin Institute
-Penn Archaeology Museum
-Eating out at various places

And now I am stuck. They are not going to want to do idiotic touristy things like see the Liberty Bell and Independence Hall (because quite frankly, they are intelligent people, and seeing these things is B.O.R.I.N.G.). I guess we could take a weekend and see my parents in CT.... or perhaps we could see Luca's cousin who will have just moved to Baltimore for his fellowship.... but beyond those things, I'm kind of at a loss. Valley Forge maybe? I don't know.

Note to in-laws, in case you are reading this: I really am excited about your visit, but I am worried that you will freak out about the cost of things and the small amount of time you see us. Please don't do these things. It will make things go so much more smoothly.