Just as we feared

The neighbors whose parents laid down the 310K for the house for their annoying child and her friends? Suck just as much as we thought they would.

Last night they had a party. At about 6PM the guests arrived, and the giggling started. People kept rolling into the house with pillows and blankets until 1AM, and it got louder and louder, as the spoiled brats took it to the street outside my bedroom window.

On the positive side, they did move back inside when we told them to STFU the first time. The SECOND time we told them that (at 1:30 last night) they took it to the basement for the most part. I say, "For the most part," because every 10 minutes or so after that a couple of them would come upstairs to the living room and talk and giggle loudly (think "outside voice") for about 10 minutes or so before returning downstairs.

Then they woke up my in-laws at around 3AM engaging in some sort of drunken argument in the alley way in back of the house.

I HATE THEM. Luca especially hates them.

I said to him, "Just wait until we have a kid. I can't WAIT until it starts screaming at 3AM right outside their bedroom window and doesn't shut up until 7AM. Those little brats *totally* deserve it."

On the plus side, I have found no vomit on our property yet, and my garden seems not to have been destroyed. So I suppose it could have been worse - they could have been male spoiled brats.

(Actually, my husband now tells me that the males who were invited to the party were leaning on the hand rail drunkenly at 1AM chatting loudly, which could have very easily led to puking in my garden. Hopefully as few of them as possible will decide to live in the house.)

However, I may have won the battle of the air conditioner. See, Luca hates the air conditioner, and defers inserting it into the window until the last possible moment (read: when the temperature finally reaches 100 degrees for the 5th consecutive day). Last night he furiously ran down to the basement to retrieve the massive object, and attempted to insert it into the window in his impaired half awake state. Fortunately he gave up quickly, and we resorted to telling the brats to STFU repeatedly instead. But! This means I will get my A/C sooner rather than later, and I will no longer roast!

Every cloud has a silver lining, I suppose.


*STFU = Shut the F*** Up!!

Fouladelphia

When I lived in Chicago, street cleaning was a fairly regular occurrence. Every 2 months or so, the orange signs would go up in your neighborhood telling you to move your car lest you get a ticket. It was annoying, but predictable. And you WOULD get a ticket if you did not move your car. If enough cars remained on the street, it would not be cleaned and they would all get tickets.

Tickets = revenue for the city.

In Philadelphia, there is no street cleaning. Limited budget I guess? However recently, the city has received stimulus money to repave all of West Philadelphia. It's kind of nice, actually -- no more pot holes! Except when they do it, they put signs out about the days they will be paving about 24-48 hours in advance at most. Pity the poor soul who was out of town and didn't know this was going to happen!

But it gets even better. See, if you do not move your car, they will move it for you to another location in West Philadelphia. They are supposed to keep track of where they move your car, and there is supposed to be a number you can call so you can find your car. However this number - as far as I can tell - is not published anywhere, and I'm not sure it actually exists.

Therefore, if your car is moved, you will likely spend several hours of your time hoofing it all over West Philly trying to find it.

You know, there's a free municipal parking lot right down the street from where I live. You'd think that the city could just put the cars there, you know, since it OWNS the parking lot. But nooooooo.

Do they ticket people? Hells no! Why actually *increase* city revenue? They might have to pay someone to do that! That would be intelligent! They just hide move your car to somewhere within a 1 mile radius of where you left it, and leave it at that.

I won't go into the fact that often the city changes the dates posted on the signs telling you to move your car, sometimes the morning the construction crews arrive....

I suppose Philadelphia is quite charming in it's own incompetently run kind of way. It does make me grateful that we sprang for a house with a garage, though.

To Do List for Self

Want to see what the life of a grad student is like? See below:

1. Write research aims for Qualitative Study (assignment due Weds)
2. Do readings for Wed class
3. Get SAS (still)
4. Use STATA to calculate distribution of duration of time between ICU discharge and readmission
5. Rothman Ch 5 (finish)
6. Figure out what's in database so I can actually do some analyses
7. Continue combing through literature on ICU readmissions

Sounds scintillating, right? Well, actually it's not so bad *unless* it happens to be the Friday afternoon before Memorial Day weekend, and nobody except you decided to show up to work today. Which is to say, I'm getting the eff out of here for now and (hopefully) getting some of this done over the weekend. I simply can't sit here anymore today.

Now, I must go walk my doggy!

When is it ok to push your patient?

Yesterday's post made me think about times when I've pushed my patients to receive treatments that they don't want.

I know. Some of you are thinking that I'm a horrible person and that I am should respect patient autonomy 100% of the time. Pushing a course of therapy on a patient who doesn't want that is a deliberate breach of that.

Well I am going to tell you that things are not always that straightforward. Patients are sometimes in denial. Sometimes they are demented. And sometimes they just don't understand, even if you spend hours (and I mean hours) explaining why things are important.

To illustrate this, I will tell you about my patient from several years back, Mrs. Q.* I am using her example because what happened with her is something that I felt very conflicted about at the time, and resulted in part from the f-ed up nature of our medical system. Still, I think in the end she received the treatment that was in her best interests.

Mrs. Q was a pleasant 70s-ish lady with multiple cardiac risk factors and really bad peripheral vascular disease. She'd already had surgery to try to increase the circulation to her legs, and I *guess* it had been somewhat successful in that she still had them (her legs, I mean). She was admitted because she had developed another set of non-healing ulcers on one of her shins and feet. Vascular had attempted to treat her as an outpatient using an Unna boot, but when she had removed the boot at her house, she had peeled off layers of skin from her leg and foot. Some of the tendons and bones of her feet were exposed.

She was admitted for debridment of the wound, and when she came back from surgery, the culture grew MRSA, and her films were suggestive of osteomyelitis -- an infection of the bone that requires 6 weeks of IV antibiotics. Vascular surgery still felt that her leg was salvageable, and we agreed that this was the appropriate course of action.

Since she was an elderly lady with limited help at home, it was decided that she needed to go to SNF (a skilled nursing facility) for the remainder of her course of therapy. This would have been for about 4.5 weeks. She also needed a PICC line in which to receive the IV antibiotics. A PICC line is basically like a semi-permanent IV. It's *not* like a central line with all the infection risks that those portend. It is a peripheral line that would more or less obviate the need for someone to change her IV every 2-3 days.

Mrs. Q hated getting her IV changed. She also was terrified of losing her leg. A PICC line made a lot of sense for her. She also did not want to go to SNF, somewhat understandably, preferring to go home instead. Unfortunately, we could not allow that since she would have been unable to care for herself at home, and because there was nobody to help her.

Finally, she agreed to go to SNF. I guess she realized that she wasn't going to be able to make it home on her own if she left AMA. It was at that point that she decided to refuse the PICC line. The SNF we had gotten her into -- a feat in and of itself -- required that she had one so she could receive her IV antibiotics. If she didn't get a PICC, that meant she'd have to stay in the hospital for another MONTH, putting her at risk for all sorts of complications, and (to put it bluntly) costing the hospital an ass-load of money. Plus she hated getting her IVs put in and was not interested in amputation -- the only two other viable options. Refusing a PICC made no sense.

Anyhow, at the behest of my resident and the social worker who had gotten her the SNF placement, I cajoled, I begged, I pleaded, I listened to her concerns and attempted to address them, I tried to help her feel more comfortable and less worried. I did this over the course of several days. I spent a lot of time trying to work with Mrs. Q, to try to understand what her concerns were. Finally, I told her that I was going to put her on the list for interventional radiology to get the PICC, and she could think about whether she wanted the procedure while she waited down there. I told her that if she still really didn't want the PICC put in, she could tell the folks downstairs, and they would not do the procedure.

I felt HORRIBLE about pushing her so hard to do this, but I really felt that it was the best choice for her. Her best chance at keeping her leg and maintaining her independence at home. Her best chance for staying out of a nursing home and for her long term health and survival. I think she was in serious denial about the situation, and while it was completely understandable that she would be, and though I spent a lot of time talking to her about it, I don't think there was much I could have done to ease her burden. She was doing what she could to try to regain control of the shitty shitty situation. I know sometimes people just need a little time to process these things. Here there were time constraints -- albeit somewhat artificial ones -- and I couldn't wait any longer.

If she hated me for it, I completely understand why.

So what do you all think of this? Should I have stood up to my resident and attending and told them that I was not going to push her to get the PICC anymore since she had refused it? Have you tried to push treatments on your patients that you thought were in their best interests that they really didn't want?



*Details of this story have been changed to protect patient privacy.

In my Qual Methods Class this morning

Our non-clinician professor was talking about how she did a study in which she found that doctors and patients thought of different things when they heard the phrase, "patient centered care."

Patients heard that they would be able to make decisions about their care that was best for them.

Doctors heard that they would lay out all the treatment alternatives, and then "try to convince the patient of the best decision." (emphasis mine)

The last phrase was said with this sarcastic overlay that could only have come from a non-clinician social scientist.

Was she trying to say that doctors shouldn't try to persuade their patients to follow a particular course of therapy?

My thoughts? Who the heck goes to a doctor and DOESN'T want their opinion? Doctors are not just prescription dispensers where you press a button, and ka-jing! out pops a cure for what ails you! I mean, isn't the idea that you're supposed to have a *discussion* with your patient about the pros and cons of various options, and then offer your opinion? You don't go to a mechanic and then tell them what's wrong with your car and then how to fix it! Well, I don't anyway.

Oh, and then there was the social work student who commented that "doctors were trained to pass judgments about patients, whereas in social work, [they] are trained to keep an open mind about them."

In the back of my mind I was thinking, "I'm sure she just means that we're trained to collect all the pertinent facts and then arrive at an impression and plan. She's just using some unfortunate phrasing."

But seriously? Gah!!! I was tearing my hair out. I suppose if I said anything at all to them about this, she would tell me that I've been indoctrinated into the medical sub-culture. There's just no winning, so I kept my mouth shut. You all would have been proud.

Qualitative Methods

I'm going to be taking a class in qualitative methods this summer. I am actually excited about the class! I've been doing the readings to prepare, and I've found that for the first time in ages, I'm reading about studies that are actually interesting to me. Ethnographies, studies using media as a data source, studies using in-person interviews. I guess what I find interesting about them is they seek to explore the meanings behind actions and words, motivations for behaviors, and how and why cultures function the way they do.

This, of course, is why I studied sociology as an undergrad. It was the ideology of sociology that ultimately turned me off, but perhaps if I study the use of these methods in the context of public health or epidemiology they will be of more interest to me.

I also also really like the instructors in the class. I had one of them for a class I took last Fall, and she was fantastic. None of the fellows in the class liked her because she called them out for conducting private discussions during her lectures, and leaving immediately after they had presented so they wouldn't have to listen to the other students go. One friend of mine went so far as to call her "unprofessional" which to me was the height of irony, since it was the fellows who were acting unprofessionally!

Anyway, she is an ass kicker, and I think she's amazing, and hopefully I will get some useful tips on how to design one the studies I'm planning.

Crossing my fingers!

Very productive

That's how my day has been so far....

NOT!!!

First I spent an hour or so trying to figure out how to work the fax machine so I could fax my data use agreement to Cerner. I never did get it to work, and am presently awaiting a response from the department secretary regarding an alternative fax machine I can use.

Then I spent another hour trying to figure out how to install SAS on my computer, only to figure out that the tech office had only given me RENEWAL documentation, and nothing on where I might find the actual software to install. Turns out the code they gave me won't allow me to access the online site that SAS operates.

I may just go ahead and purchase Stat Transfer so I can get started doing, you know, ACTUAL WORK.

And now I am going to go home to make sure my in-laws haven't burned down the house. Alas, this is a real concern. Yesterday my MIL "turned off" the stove by setting it to "low." The flame was still going when I found it an hour later.

Oh joy.

I can tell it's going to be a productive week already.

Addendum: I will say this though, the kind folks at Stat Transfer were very helpful to me this morning, and I have acquired software that will enable me to transfer my data from SAS to STATA. It's not a permanent fix, but it will enable me to get some work done while the tech people at my institution remove their heads from their asses get me what I need to install SAS on my computer. The PASS software people whom I got some really neat power calculation software from a few months back were also incredibly helpful.

Gotta love the private sector!

The bitch at the beach (both of us)

I'm not in a particularly literary mood this AM. Also, my in-laws are here making me unbelievably happy that we have three functional toilets in our house. but I promised pics of NC so here they are:

Here's a picture of the house we stayed in. It was very comfortable. Most importantly, it had CABLE, and as Luca and I have been living without TV for about three weeks (our newish tv died a few weeks ago -- apparently they now make disposable tvs as well as disposable cell phones and computers now -- what's next? Disposable refrigerators and hot water heaters?) and without cable for a year. It was like crack. On the day that it rained, I think we watched 8+ hours of HGTV, and got some surprisingly useful ideas for what to do with the kitchen.



Here is Boo on the beach with Luca.



And here she is running around in the waves.



And yes, she is peeing upstream of me there at the end. Fortunately urine is water soluble.

This is one of the houses that I was talking about earlier with the beach erosion underneath. You can see that the 12 feet I was referring to was 12 feet in addition to the fact that the house is on stilts. The water actually washes up underneath the house except at low tide now, where there was probably a 100 feet of beach in front of it before.



And here is Boo scoping out the crabs. We tried taking pictures of the crabs, but alas they are the same color as the sand and those pictures didn't turn out all that well.



And here she is looking cute. This is turning into a photo montage of the dog, isn't it?



Here is the view of the beach from the deck of our house. Boo and I sunned ourselves on Thursday. It was quite pleasant.



One of the nice things about being on the ocean is the fresh fish/seafood you can eat. The only problem is that much of it is fried (perhaps reflecting the tastes of the American public? And perhaps enabling restaurants to use frozen fish anyway?) Anyway, we ate a ton of soft shell crab. It was delicious.



We also took advantage of the fact that they sell beer and wine in the grocery stores. While we did not partake of it as malt liquor is revolting, below I have a photograph of King Cobra, beverage of choice during college (well parts of college, anyway). I include this for educational purposes for my pre-med to attending readership who does not know what a "forty" is, since many of you were too prissy busy to partake of such beverages during your pre-professional lives.



Note that this is a 40 oz beverage, and that it contains malt liquor, which is not the same as beer. It is about twice as strong as beer, in fact. So now you know that when your patient tells you that he/she drinks about a "forty" a day, that this is about 7 beers worth of alcohol. And we all know: that is a lot. Note also the price, at $1.49, makes it a relatively "good deal" in terms of the amount of booze you get for your money. It is also a good illustration of inflation, as King Cobra *used* to cost $1.09 (including tax) back when I was in college.

The beach where we were staying was in SOUTH Nags Head, and therefore only about a 1/2 mile or so away from the Hatteras National Seashore. This beach was almost totally deserted, and went on for faaaaarrrrr further than anyone could walk, which is just how Luca and I like it. We spent a great deal of time walking up and down the beach. And when we got tired of one stretch of beach, we'd drive down to the next access point and walk from there instead.



And finally, we have the requisite picture of OMDG and Luca on the beach with the dog. She is cooperating quite nicely here, don't you think!

Crabs

This week at the beach Boo has transformed into an almost water-dog. She doesn't go in to swim yet -- thank goodness! *I* wouldn't want to swim in those chilly waves! But she wades into the surf up to her tummy, and zooms around in the sand. She has even learned to ignore the seabirds for the most part. I think she realized that there was no way she was going to catch one.

Instead, she has decided to focus her attention on the crabs. There are crabs EVERYWHERE on the beach, and she has come close to amputating my arm not just a few times in her attempts to follow them into their burrows.

So this morning I decided to see what would happen if I let her actually chase one. I figured worst case she would get nipped, and then maybe she wouldn't be so interested anymore.

She um, caught one. In her mouth. Then she dropped it. I suppose she didn't expect it to wiggle. She was about to catch it again when I pulled her back.

I still wonder what would have happened if I'd let her finish her attack.

I have to admit I was pretty proud of her. My ferocious city pit bull caught a crab at the beach! They're not slow motherf***ers either!

Pictures of the bitch at the beach to follow.

Dear God

So, we were going to go for a walk around a nature preserve this morning, but God intervened. See, while it wasn't raining at the house we're staying it, it was a torrential downpour at the nature preserve. And when we arrived we saw that The Boo would not be welcome on the preserve, even with her gentle leader.

So we came back home and went for a 4 mile walk up the path that runs through Nag's Head. And now The Boo is passed out on the couch. We wore her out AND managed not to get a ticket from the dog police.

So God, although I was annoyed at you at the time for making it rain AGAIN, I have to say Thanks. Perhaps you could indulge us again with a brief respite from the rain so we can take a walk on the beach later too?

Thank you,

The Management

12 feet

When we first rolled up to our rental, Luca asked me, "How come none of the houses here are on foundation? How come they're all on stilts?"

"Because it floods here. A lot," I said.

No joke. Last year one of the hurricanes took out the row of houses that is on the beach in front of the house we're staying in. We have "new carpet" probably because this house was flooded too. If you head north along the beach, you can see houses in the sky, on stilts suspended 30 feet into the air. Row upon row, house after house, all condemned. The stairs into the houses hanging 12 feet or so in the air above our heads where the beach used to be. Waves crashing on the legs of the stilts.

The road where our rental sits used to be a loop that ran by the beach. You can see where it used to run on google maps. Now the street is a dead end, the loop part washed away into the ocean. There is a big dune at the end of the dead end where the bulldozers pushed the sand from the street that had washed up by the houses during the hurricane.



See the street called Seagull Drive that runs parallel to the ocean (where I marked it with an "A" on the map)? Yeah.... it's not there anymore, and all those houses on the beach in front of it are the condemned ones I was talking about.

The house we're staying in was advertised as being 150 feet from the beach. Maybe that was the case last year. Now it's about 25 feet. Interesting how we ended up with a beachfront house kind of by accident. :-P

Beach

So.... we can see the ocean from out deck and BR window. It's 75 feet from the house. We took a 90 minute walk down the beach this morning, and it was totally deserted save for a few people fishing. Boo seems to like the beach (especially the crabs though we warned her she might get pinched!). She was afraid of the water, but will go in if we do.

Also thanks to my reader who suggested Tortuga's Lie! We went last night and ate soft shell crab, which was very tasty. I will say, it is different than the soft shell crab (moeche) we had last fall in Italy, but good in a different way. The crabs here are much larger, and less sweet.

So dear readers who have told me that the soft shell crab is the same over here as there? You have no idea what you are talking about, which I suspected to begin with. Yet another reason to plan a trip to Italy, see!

:-)

We're off to the grocery store and to get some lunch now.

I got a grant!

Well, technically all I got was one of the pre-doctoral slots on one the Sleep-T32, so it isn't really *my* grant. And the truth is that I probably got it because nobody else applied..... But I did apply for it and receive it, so there's that anyway.

Most importantly, it means that I AM PAID FOR this coming year. And it means I get to do a sleep project, which frankly, I find pretty interesting.

I'll find out about my F30 in a couple of months.....

Time to celebrate by heading down to North Carolina.

:-)

Nothing

Last night at dinner, someone asked the speaker what his wife did.

In a long convoluted story, that involved a pregnancy and pre-term labor during a psychiatry residency, deciding she didn't want to be a doctor, followed by a job at a biotech, he finally mumbled something about, "She does volunteer work now."

Was he embarrassed? Did he think we would disapprove that he had a wife that had opted out (and did more or less nothing with herself now)? He's an incredibly famous researcher. Who the heck cares what his wife does!

Anyhow, it reminded me of my old mentor, who just gave me another reason to respect him. His wife had been a pediatric HIV social worker, and had gotten really burnt out by it. When they moved to Chicago, she hadn't gotten a new job, so when people would ask him what she did, he would say, "Oh, T? Nothing. She does nothing."

Awesome.

In truth, his wife is a really wonderful, funny, intelligent person. I really liked her. Who cares what she does with herself, it's none of my business anyway. If she was burnt out and needed a break, more power to them that my mentor and she were able to work that out. I loved that my old mentor refused a) to be embarrassed by his wife's choices, and b) refused to make up some BS activity to make it seem more important than it was.

....

Jetta

My husband and I bought a new car two years ago. This was to replace the Jetta that I bought at the beginning of 2001, after I ran my 1987 Volvo 240DL into a concrete support, skidding on some ice heading into Lower Wacker Drive.

Don't ask.

Anyhow, the Jetta was an *ok* car. Well, not really even. I started having problems with the catalytic converter almost immediately, and needed my transmission replaced at 12,000 miles. Sure, it was under warranty. But you still shouldn't need to have your transmission replaced after 12,000 miles. I guess we got lucky in some ways. Warranty repair notice after notice came in before we developed problems most of the time.

We decided it was time to get rid of it when the transmission started having problems again. The car only had 70,000 miles on it.

*****

Last night I went out to dinner with some MD-PhD students and a guy who does genomics research. He asked me what I did, and told him epidemiology, and a little about the project I am doing. He said, "It seems like you wouldn't be able to control for things like differences between ICUs in your project. That it would be hopelessly confounded."

I thought, "Dude, my project may be confounded, but not by the variables you suggest, which we can control for using a clustering analysis."

I said, "Well, that's why we're modeling ICU as a fixed effect. In fact we'll be using hierarchical linear models to create a nested model of ICU within hospital to control for ICU AND hospital related factors. That way, we'll be able to control for known and unknown confounders at the hospital and ICU level, and account for the fact that patients may have similar outcomes just because they're at the same ICU."

I didn't know how far to go with this. I was pretty sure I was speaking Greek to these people, and I really wanted the conversation to go someplace else. In the back of my mind I was thinking, "You do genomics, dude. Don't you know ANYTHING about statistics?"

And the answer was..... No.

In fact in his lab? His biology grad students do all of his "statistics" and "programming" with little to no formal training in the subject.

People, he does GENOMICS. That IS statistics.

It's a little horrifying actually, but so totally the basic scientist mentality.

*****

I got a ride back from the dinner from the MD-PhD person at my med school who invited this speaker. In HIS 2002 Jetta, which made a funny noise every time he stepped on the accelerator. The check engine light was on. He commented that he was concerned.

"Oh that," I said, "Yeah, that's a problem with the catalytic converter, but unless it starts flashing you're fine. It could just be the gas cap is loose. If you take it in, they'll charge you $100 to do diagnostics, and probably won't find anything."

He agreed. He then told me a series of stories detailing all the problems he had with his car over the years. It was an even more extensive list than mine was.

I said, "It's a shame really. The VWs sold really well after the New Beetle came out, and were decently made for a time. Then it's like VW decided to capitalize on this, and they cheapened their cars. There's a whole generation of unreliable VWs as a result. Get rid of it while it's still worth something!"

He said, "This car is WELL MADE. You can tell it is. They didn't cheapen anything."

Ok dude, whatever. It's your car.

Can someone answer a question for me

A few months ago, I noticed that a profile picture I used about 6 months ago on my facebook account started appearing with comments I posted on blogs using typepad.

I found this perplexing. On my privacy settings, all of my photos on facebook are "friends only" as are my profile pics. I use a different email address for my facebook account than my blogger account, and I really have no idea how typepad learned that this facebook photo belonged to Old MD Girl the blogger.

Does anybody have an answer to this? It shows my face, and while I don't *really* care, I don't like that my privacy settings seem to have failed to keep my photos private, and worse, have substituted the profile photo that I have on blogger with this facebook photo.

Does anyone know how I can keep this from happening?

I am sad

I think the hardest thing about being a young adult is when people you become close to move away to pursue their dreams. You're happy for them, of course. But sometimes it's really sad and you miss them a lot! Of course you make new friends, but it's never really the same. And then they move away too. Or you do. And then you start all over once again.

My swim buddy is moving away today, and this morning was our last swim! We did a 100 free all out to mark our progress from when we started 5 months ago. Untapered and with a push start she did a 1:07, and I did a 1:08. Considering we were struggling with 1:30 5 months ago, this is such an improvement, and I am so proud of her! We did this together, and have come such a long way with our swimming.

But it's not just the swimming. She has been a great friend and source of support for me these past few months. We would always talk before we got in the water in the mornings, and it really brightened my days. She was such a good listener, always understood me, and let me gripe when I needed to. She is a positive person and she made me want to be better myself. To be less of a grumpy curmudgeon. Now when I feel like being that way, I think to myself, "A wouldn't act that way, she would be nice anyway." It's so rare to find people who make me want to be better. She is one of those rare people.

When I think about going back to the pool to swim without her this summer, it makes me a little teary, and I feel a little empty inside. :-(

Her friendship has meant so much to me, and I'm really going to miss her!

Thank you A, for being such a good friend! And good luck!

BOOOOORRRRRIIIIINNNNGGGGG!!!!

PhD life is like this:

You run run run run run to try to get your work done before a deadline. And then..... you wait.

Right now I'm waiting for someone to figure out how I can get SAS installed on my computer, and paid for by someone other than me. This last part is the real kicker. Sadly, my project is essentially stalled until I get that done. You'd think this would be straightforward. After all, all I need are the cds and a license #. But no.

I'm not even sure what I can do to expedite this at the moment. Every time I ask the admins what the status is, I get an irritated reply. I worry that the touchy one will complain about me to the PhD director again. I've never had this problem before. At least when I bugged people back in Chicago to get things done for me, it was understood that it was part of the game. Here it's all personal and s***.

In the meantime, there's only so much reading out of Rothman (the giant epi text book that is our Bible) that one can do in a day. Yesterday I fell asleep three times while reading it. It was that dry.

I know all you people who have taken an Epi course are shocked and surprised to hear that. Haha!

So life's kinda boring lately. Today I picked up my friend's cap and gown for graduation, since she's out of town. It was a little bittersweet as I stood in line with some friends who are graduating now. That's going to be me in oh..... 4 years.

Dear lord, that's a long time.

People, can I please get SAS on my computer NOW!

So, sorry to bore you, dear readers. I just don't have much that's interesting going on right now!

Visualization

A few weeks ago at a particularly stressful meeting (the one where they told me I absolutely *had* to group study, lest I fail out), during the lulls in conversation that had nothing to do with me, I started practicing visualization in order to prevent myself from throttling the instructor relax.

I know you're dying to know what I visualized.

Well, I thought about coming home, and letting Boo out of her crate, and feeling her soft wet nose on my hand, and watching her stretch as she steps out of her crate, and then WAG WAG WAG WAG WAG, sniff sniff sniff sniff sniff, WAG WAG WAG WAG WAG, she beats my leg with her tail, waiting for me to stroke her soft fur.

It made me smile. It still does when I think about it.

A moment later, the instructor goes, "Old MD Girl! Old MD Girl! I was asking you a question!"

What an irritating disruption, I have to say.

"I'm sorry, can you please repeat the question?"

WAG WAG WAG WAG WAG

There's nothing quite like a handful of shit to start off your day

Dearest Husband,

While I wholeheartedly endorse recycling the plastic bags we use to carry food home from the supermarket into poo bags for the Boo, next time could you please make sure that said bags are without holes?

Thank you,

The Management

Rain

And.... so far the weather forecast is 5/5 for rain/thunderstorms for the first 5 days of our vacation. I see I get my way with a freaking CAVEAT. Thanks God. Thanks a lot.

Bad mommy

Oh. My. God. Boo's snoring is driving me absolutely INSANE today. It's nice that's she's napping instead of constantly harassing me to play with her, but I can HEAR HER THROUGH MY HEADPHONES.

I wish I had a microphone so I could play it back for you. But it's kind of like this.



ACK!!

Update: I have given her one of the marrow bones we were keeping in the freezer to make her be quiet. I am so totally going to be one of those bad parents who silences her children with granola bars. Heh.

Women in medicine

Among the members of the woman MD-PhD group at my school, there is a rift:

There are those who want to hear talks from woman physician scientists about work-life balance and having a family along with a professional career.

And then there are those who are tired of hearing these talks. Who feel that such topics are not relevant to them because a) they don't plan to have children themselves, and b) they feel that work-life balance isn't a WOMAN issue per se, but a PERSON issue, and that perpetuating these talks furthers the stereotype that ONLY woman physicians need to concern themselves with thinking about planning to have a family around their career.

How do I feel about this? Well, as someone who is interested in at least the idea of having a child someday, hearing about how other women have done it is at least somewhat interesting to me. On the other hand, I'm older than most of the other women students in my program, and such topics are more necessarily imminent for me....

At the same time, I remember when I was 26, I was so, so tired of hearing about how to plan my family with my career. Marriage and babies were a distant concern, and all I wanted at that point was to get into med school and focus on my professional life. Weren't there issues relevant to women in medicine OUTSIDE of reproduction? I wanted to hear about those things, not about how important it was to hire a good nanny and to find a husband willing to do his share of the housework.

We never do hear about these issues - discrimination, cut downs and slights that don't occur to men, assumptions about us and out commitment to our careers based on our lack of penises. Talking about them seems to be out of vogue. I guess women don't want to be labeled as castrating feminists or whiners?

It annoys me that these talks for women in medicine always revolve around family too, fundamentally because I firmly think these concerns should be relevant to fathers as well as mothers. I am tired of being told -- by women, men, EVERYONE -- how HARD it is to have a family and be a professional woman. Such statements strike me as counterproductive, not unlike telling a group of girls in a gifted math class that girls are traditionally bad at math, that math is hard, and that it's ok if they fail at it. Unfortunately, this is what these talks ultimately often devolve into.

And then there are the talks where the female attendings take a collective crap on women who have done things differently. Like the one who insulted her friend the surgery resident who had a baby and went back to work a few days later. Of course SHE would never be a bad mother like that. As if the surgery resident was given much of a choice....

So I guess that despite my interest in how other women are doing the baby + career thing, I too am tired of the talks for women in medicine that focus almost exclusively on work-life balance. What do you think, dear readers? Is work-life balance the only -- or most -- important issue for women in medicine? Do you find these talks redundant and somewhat counter-productive? What kinds of talks and gatherings might be more productive?

Dog park was slow today

We took Boo to the dog park this AM. It was pretty quiet, and there weren't many dogs to play with, which was a little disappointing. A post-call resident showed up for about 10 minutes to let her dog run around before she (presumably) went back home to pass out for the day. Dog didn't want to go home.

We also took Boo to the new vet yesterday. She seemed nice, and we got loaded up with Interceptor and anti-emetic for the year. Miss. Pukey-breath made it all the way to the parking lot at the vet's before she vomited all over the back seat. Luca - whose job it is to supply the plastic bag for Boo to puke in when we drive her anywhere - missed. I think he thought we were home free since we were stopped in the lot and ready to take her out of the car.

Oops.

She was diagnosed with (surprise!) hormone responsive incontinence and given a script for phenylpropanolamine for it. Urine was unremarkable. We need to go back for a BP check a few weeks after we start her on it. We'll probably try it when we get back from NC in a few weeks, and see how it goes.

Thanks for all the advice, guys.



*Chemistry kind similar to sudaphed, I think. You can totally make speed out of it, anyway.

I do get my way sometimes

My birthday was really quite lovely yesterday. Thanks for all the happy birthdays. And the new hot water heater DOES provide much hotter water than the old one did. I am very happy about that too.

We found out that my in-laws AREN'T coming tomorrow after all. As it turned out, some health problems cropped up, and they're delaying their visit by 2 weeks. Everyone is going to be fine though, thankfully, and we are looking forward to their visit two weeks from now instead.

So, Luca and I decided to go to North Carolina for a week before they arrive. The outer banks to be precise. He is in desperate need of a vacation, and it's a good time for me to go as well. I'm so excited! It's still low season down there, so prices were pretty good, and we got a house on the beach all to ourselves in South Nags Head.

Most importantly, we get to bring Boo. It will be interesting to see how she likes the beach. $5 says she's afraid of the waves. Any suggestions from my veterinarian readers on precautions I need to take with her down there?

And also, apropos of nothing: Has anyone else read the well blog recently? There was this post on estranged children and something 700 people commented. So much vitriol from both parents AND children. It made me sad to read it. On the other side though, it made me grateful that I have as great a family as I do (in-laws included), even though they drive me nuts sometimes.

Today is my birthday

To celebrate, we are getting our hot water heater replaced.

Yeah baby, me and the plumber gonna have us a grand ole time.

Haha.

My birthday twin from 6th grade pointed out to me this morning that we are 33 on 5/5/77 today. See the thing with the odd numbers? Cool, eh. Heh.

I just realized that another girl I knew from hs and also share my birthday with defriended me on facebook. Well, fine then. No happy birthday from me, b*tch!

I love mayonnaise

Luca and I finally went in to see the doctor for our primary care appointments. I hadn't been in 4 years or so for anything but a pap smear. He hadn't been at all in 2 years, and hadn't bothered to get his blood work done that time.

Bad husband! Bad, non-compliant husband.

Anyway, we got our cholesterol results back. His total cholesterol was 150. Mine was 170.

But here's the kicker, my HDL was 77 and my triglycerides were 61. LDL was normal.

I guess all this walking and swimming we do has been paying off.

So we celebrated last night with deviled eggs and potato salad.

:-)

Hm.

I've noticed a trend recently among my new facebook friends. It seems that almost every. single. female. friend I have who is my age (or older) has removed the YEAR of birth from their facebook profile.

Ladies, there is no shame in being over 30. You're not fooling anyone with those photos of your kids either. We know that you're turning into an old hag. Just like I am. Embrace it ladies, and you will be much happier, I can assure you.

I didn't realize I'd reached the age at which I'm not supposed to talk about how old I was. How completely fascinating.

I'm grouchy

Top 10 reasons I'm grouchy today:

1) I have to write this stupid paper for this stupid class, and I don't wanna.

2) My in-laws are coming at the end of the week, and it is going to be stressful. All I can say is that my MIL BETTER not bitch about the food or how much things cost.

3) After I finish this stupid stupid paper, I have to write a document describing my research to Cerner, so that I can use their database.

4) Then I have to write the IRB documents.

5) Did I mention it's hot and humid today, and utterly nasty out?

6) My husband's cousin has arrived in Baltimore, and proceeded to jerk us around all weekend about whether he needed us to drive down there to help set him up in his apartment ("only come if you *want* to," and "if you want to come and *socialize* with me on Sunday, of *course* you can drive 2 hours each direction and waste your entire weekend visiting me" figured prominently in this discussion.)

7) The dog wouldn't pee when I took her out 20 minutes ago, and I'm sure this must be because she peed in the house. Only, I can't figure out where.

8) As of the end of this week, I will officially be in my MID-30s.

9) My swim buddy is moving away a week from now. :-(

And finally, the last reason I am grouchy today:

10) I want a REAL vacation, but instead I get my in-laws living in my house for 30 days.

This is what I think about when I don't want to do my work

So..... Boo seems to have developed this problem where when she's really sleepy and lying with us on the couch late at night, she occasionally leaks urine.

The damp spots on the couch have been occurring for about a month now, and at first I thought that they were where she'd been licking something. But now that I saw where the dribble is coming from, I know that it's pee.

Interesting how I've been lying in dog pee for the entire last month, and didn't even notice it. Makes me understand how LIVS could potentially sleep in it. Haha.

Anyhow, I was wondering what the incontinence could be from, and if there was a solution to it, so I googled it. My mom's dog Polly had submissive urination incontinence, but I didn't think this could be the same thing. Of course I found things like ureterovaginal fistulas and the like, which I really doubt she has since she only dribbles when she's really really sleepy and relaxed. I decided that she probably has hormone responsive incontinence secondary to her spay surgery.

But reading about ureterovaginal fistulas reminded me of medical school where we studied the tampon test as a way of differentiating between a fistula between the bladder and the vagina and the urethra and the vagina. For this test, the patient takes phenazopyridine (Pyridium), and indigo carmine or methylene blue is filled in to the empty urinary bladder via a urethral catheter. Pyridium turns urine orange in the kidneys, and methylene blue (or indigo carmine) turns urine blue in the bladder. And the rest is all anatomy! You figure out where the fistula is by the color the tampon turns.

I got to thinking whether they ever did the tampon test in dogs to diagnose these things, or if there was some more technologically advanced (i.e. expensive) test they perform instead. And also, if you just want to rule out a fistula, why not just feed the animal beets instead of going through all that rigamarole with the pyridium and the methylene blue. I'm pretty sure my dog would like beets. She likes broccoli stalks for goodness sakes, and she'll eat anything that's covered in peanut butter.

Anyway, the long and the short of it is that a) my dog probably doesn't need this test at all, b) I really don't want to go back to that asshole vet (we haven't gone to a new one yet since Luca has the car during the week), and c) I don't especially mind pee pee on the couch. My understanding is that this problem can be fixed with some estrogen, but it's not urgent or anything, unless she develops a UTI, which hasn't been the case thus far.

Anyway. These are the things that I think about when I don't want to study. Beets and the tampon test. Good thing I went to medical school, huh.

Now, back to bioethics.....

Group Study

Do you study in a group? I don't. In general I've found it to be a waste of time for me. Either we end up socializing too much, or we get hung up on something small because one person doesn't understand. Solo studying has always just worked better for me.

For instance:

If I don't know the material well, I'm usually better off spending my time figuring things out on my own. When other people try to explain and I don't understand, it often frustrates me, and my frustration then makes it more difficult for me to learn, and the other person usually a) takes it personally, or b) decides I'm stupid. Neither of these are positive outcomes.

If I do know the material well, then the reverse happens, and I end up spending my time teaching the other person when I should be reviewing the areas that I am weaker in. Then, a) the other person gets frustrated with me because I can't make her understand, and b) decides that I am a poor explainer/bitch. Again, not positive outcomes.

I have found group studying to be useful in a few rare circumstances when there are gaping holes in my notes that I need help filling. But generally speaking these sessions end up being useful only for ME, and not the other person, and I feel like I am imposing myself upon them. Generally it works better for me to just do a good job up front so I don't have to do this!

The other case is in going over your problem sets with someone else before turning them in. Of course, this is only necessary in classes where the problem sets are worth 50% of your grade and the posted solution sets suck.... otherwise I prefer to use those since that IS WHAT THE TEACHER WANTS US TO LEARN.... But yeah, in cases where the course is poorly run group problem set review can be very helpful.

This strategy of self-studying has been highly successful for me. And I have to say this: the brief period of time when I did do group study before exams for about 6 months of med school was probably a mistake. I performed well, but I'm pretty sure I'd have done even better had I just done the studying on my own.

Why do I bring this up now? Well, on Thursday during our PhD seminar, I was told by the PhD director in a very animated and flamboyant manner that I "absolutely must" do group study, "that I would be seriously missing out" if I did not do it, and, "didn't I use this technique in med school, and how could I have survived NOT using it." He was shocked, SHOCKED, not to mention horrified that I wasn't presently doing study groups with all of my PhD comrades.

Since the people he wanted me to group study with were sitting right there, it felt kind of awkward to say, "Hell no," so I halfheartedly said that perhaps this circumstance was different, and group study could be helpful.

But you know what? HELL NO. I am not doing this. It is going to be a giant waste of my time. Group study doesn't work for me, it won't work with this group of people (it will turn into a giant bitch session) and frankly it kind of irritates me that this man is insinuating that failure is imminent if I don't adopt his personal study strategy. Hasn't he noticed that I have kicked ass academically in the past?

I just don't understand why he flipped out when I told him that I never study in groups. Why does he care? It's not like it's any of his business how I study anyway, as long as I get good grades. Dear PhD director, please MYOB. Now.

Do you guys like group study? Why or why not? Discuss.