Are blog posts/comments admissable as evidence in a lawsuit?

Regular readers may recall that about 2.5 weeks ago on October 10th, I complained to the dog park membership director that one of the members was bringing her two foster dogs to the park. Two foster dogs that she'd had for 3 days and that hadn't been screened for aggression by the membership committee, and who did not have the proper documentation (Philly license and rabies certificate) required to be members.

He did nothing. Said nothing to the woman who was bringing them.*

Those two dogs, over the next two weeks, went on to attack 3 other dogs while at the dog park (that I know of), resulting in a bitten human, and a doggy torn up enough to require stitches at the VHUP.

AWESOME.

(Can you say "lawsuit" boys and girls? Because if my dog had gotten ripped to shreds by a non-member dog, and I knew they weren't members, and that the membership committee knew about the problem and had done nothing, that's kind of sort of exactly what would have happened. And SHOULD have happened.)

But I digress.

*****

In other news, the website has gone live. Finally. After 3 months. I had signed up to work on it, hoping I'd learn a little html.... but no. They wanted to use this really cumbersome and annoying software instead. So whatever. I wrote content. Which someone changed. And then I started a helpful links page, with vet info, dog walker info, boarding info. That sort of thing.

So the first time I hear about it from a member, she's talking about the website and how stupid it is that there is a helpful links page. That everybody already knows all this stuff, so why would anyone ever bother to put it on a website.

Awesome. :-)

And then yesterday someone else was telling me how stupid the person was who did the links page because it was missing some absolutely critical link, and how on earth could the web designer not know about it.

Double awesome. :-) :-)

*****

And they still have no procedures in place for accepting new members. And it's still on a case by case basis, like if you're friends with one of the committee chairs, or something else completely asinine.

And then they complain that people in the neighborhood think they are exclusive snobs.

Poor babies!

HAHAHAHAHAHAHA!!!!!!!

Anyway, there's a dog park meeting next week, which of course conflicts with my schedule (my EM shift is that evening). But I will send my husband so that they can't say I don't care. It's probably a good thing I can't go though, because I might get irrationally pissed off when I express a concern (for example: see above) that gets blown off. Which will happen.

Anyway.

AWESOME!!!



*Yes, he does have contact information for her as her other dog is a member.

EM shift

So, I signed up to do my first EM shift in November. So exciting!

I do feel a little lame postponing it for two weeks, but there are a few reasons why:

1) Only 2 attendings know my deal (i.e. the fact that I am a "fake" sub-i and haven't seen a patient for 18 months), and I wanted to start out working with one of them. I'll work with other people later on when I'm feeling like less of a moron.
2) They are on for a bunch of nights next week, but only when I have class all day the day after. That would suck, and while I'll have to be awake for 36 hours in a row in a future life, I see no reason to do this to myself now.
3) Other shifts conflicted with class, so that was out.

And at least this way (theoretically) I will have time to do a little reading to brush up on my sh*t in advance.

I'm still nervous. I kind of wish I could fit in a shift sooner, but it is what it is.

I hope I like it!

Last night

Last night was Miss. Boo's last class in Basic Agility Skills 1. We practiced doing front crosses in a figure eight pattern. Since I had to be in the ED for orientation yesterday at 8 yesterday, the morning run did not occur, and she was CRAZY. She sprinted at full speed across the length of the entire warehouse at least 10 times before she settled down enough to do the course.

But after she settled down, she was by far the fastest dog there. I had to seriously run to keep ahead of her. Her focus was fantastic.

But still, there were those zoomies.

At one point Luca was taking her around the course, and she zoomed over to me, where I was standing behind the fence, and she jumped up and down trying to get to me. Finally Luca got her to follow him, but she kept wanting to come back to me. It was really cute.... though I'm not sure the instructor was so pleased with her.

Next class recommendation: Control Unleashed.

They said that she didn't HAVE to take it, since she's not aggressive to other dogs, but that it would really help her, to um, remain under control while off the leash.

Haha.

And I do not disagree. The only problem is that the class will be at 6PM on Wednesdays. And it's out in the burbs. And Luca doesn't even leave work until then most days. AND I don't have my own car.

I suppose I *could* do Philly Car Share once a week for the duration of the class, but that would end up being kind of expensive multiplied over 7 weeks. On the other hand, I think the class would be really helpful for the Boo. It would be SO NICE if I could only get her to relax around other dogs so that she could pay attention to me. And not just run away as soon as she sees something moving in the distance. It's almost a safety thing, really. I'm just not sure if it's worth it.

We could try waiting until the next cycle of classes comes out in January, but there's no guarantee that the schedule would be any better for us then than it would be now.

*Sigh!*

What's a girl to do?

Ugh.

Yo. Why can't I get my a$$ in gear this morning? I'm just asking....

EM

Regular readers might remember that in an anti-internal medicine furor, I signed up to do a clinical connections activity in Emergency Medicine a few weeks back.

Because I've already completed all my core rotations AND I've done a medicine sub-i, the course director decided that it would be appropriate for me to see patients on my own and report directly to an attending during this experience.

(Normally they shield the attendings from the incompetent medical students by making them report to a resident.)

Pro: No shadowing! I will actually probably figure out if I like this field.

Con: My incompetence will be revealed.

Let's consider the facts.

Fact: I haven't spoken to a patient in the past 18 months.
Fact: I haven't thought about the workup for a gyn complaint in the past 2 years.
Fact: I think my Medview password expired about a year ago. But I don't really know since I haven't tried to use it in even longer than that.
Fact: I'm not sure I even know where my stethoscope is.

I am terrified.

It's going to be awesome.

Fortunately, tomorrow is only orientation. So hopefully I won't actually have to remember anything by then. Eeek!

And for those of you who are thinking, "Wait, I thought OMDG wanted to be a neurologist?" Never fear. I will be doing a clinical connections activity in the Neuro-ICU after this one is over in 4-6 months. At that point, I will have to refresh my memory on the joys of the neuro exam. And buy a new reflex hammer.

Yippee!

Nice

Did you know I've done 13 triathlons, including a half-ironman? Of course, I haven't even been on my bike since 2004. Not once. I just got tired of them. Of everything about them.

This article in the NYT pretty neatly sums up why I don't do triathlons anymore.

Because it is just sooooooo awesome to be yelled at by some pathetic middle age crisis man who is angry at you for being faster.

(It's also, incidentally, what drove both me and Luca away from Masters Swimming.)

Questions about post-bac programs

I recently received a comment on my post about my post-bac program that I completed before doing med school with a bunch of questions. A lot of them are pretty general, so I thought I'd post my response here.

(Also, I don't have a blog specific email, so I didn't really want to email my response to her personally. You know, faux-anonymity and all.)

Question #1 -- Did I find the pre-med advising resources adequate at the University of Chicago?
Answer: Not really. But then again their job is a) to tell you that you will never get into med school unless you improve your CV, and b) to process your recommendation letters. Their job is not to provide meaningful advice. If you know this going in, then your experience will be much more satisfying.

To be more specific, my pre-med advising office was unable to tell me what med schools would let me do MD-PhD in Epi. They just didn't know -- and why should they? So I had to find out for myself. If I had to do it all over again, I would have applied to a different selection of schools. That being said, I couldn't have known that in advance, and everything turned out well in the end anyway.

Point being: Do your OWN research. Learn about programs on your OWN. Make your OWN contacts. Do your OWN networking. It will only help you in the end.

Question #2 -- Would I recommend a formal post-bac program for someone who needs to complete ALL their requirements, or would I recommend the a la carte option that I chose for myself?
Answer: I don't know enough about your situation to tell you what to do. I did a la carte for several reasons:
- First, I wasn't sure about med school when I started it, so I wasn't willing to invest in a full time program.
- Second, I had this awesome full time research job that I wouldn't have been able to do at the same time as a full time post-bac. That research job gave me a bunch of publications and the experience I needed to know that I wanted to do a PhD in Epi also. I wouldn't have gotten any of that with a formal post-bac program.
- The third reason was financial. I got to do my post-bac for around $10,000 in total at an excellent university. I was able to pay for this myself because I had a job, and also support myself at the same time. I didn't have to ask my parents for money, or borrow any money to do it. Some places will pay 100% of your tuition if you're working full time for the university, so you can get an even better deal than I had.
- Fourth, my grades from undergrad were comparable to my post-bac grades since they were all from the same institution. Also, my grades from my post-bac were comparable to all the undergrads who were applying, since I was taking the exact same classes as they were.
- The main disadvantage was that my plan took 1 year longer. This was something that I was willing to live with. I have NO regrets about the path I chose to complete it.

Question #3 -- Why Epi and not Biostats?
Answer: There are a couple of reasons for this too. Epi is not the same as biostats. People are often confused by this.

Epi is primarily interested in answering research questions using Epi methods, which include sampling methods, measurement, reducing bias and confounding, and all things related to study design. An epidemiologist is like the general contractor of a research project. Biostatistics are an important part of this, but only a part. We need to learn biostats so that we don't design stupid research projects and perform the wrong analyses on our data, but we don't need to know then the way a biostatistician would.

A biostats PhD involves doing math proofs. Ultimately then end goal of the PhD is that you will invent your own new biostatistic. It's very heavy on the math and computer programming. I'm more into math and computer programming-lite.

My main goal for my PhD was to be able to design and run clinical research projects. Epi was the best way for me to do that, though I could have done public policy also. Biostats was too theoretical for my interests.

I hope that helps!

Target

One of the skills Boo has learned in agility class is to touch a target with her nose. She's gotten really good at it.

She will race down the stairs and put her nose on the target.

She will race across the room and put her nose on the target.

She has even gotten so that when there are targets on the floor (basically anything round and 4" in diameter), she will run over and repeatedly touch the target with her nose and then look expectantly at us for a treat.

It's totally adorable.

It's what I've been thinking about lately when I really need to make myself smile inside.

Fool that I am

Tomorrow I am presenting some of the work I've been doing lately in the doctoral seminar. I had originally planned to ask for suggestions on what data I should include in an abstract I will be submitting, but since I already have the abstract written, I no longer need that input.

So I was instead going to talk about my project, and the various steps I've gone through to get to this point. We don't really learn how to analyze large datasets as part of our curriculum, so I thought I'd talk about that also.

I am totally dreading this.

I know one of two things will happen:

A) The course director will decide to treat this as a dissertation proposal, and will grill me on things that I don't understand very well yet in front of my peers.

B) My classmates will ask me questions that I can't answer, except not in a questioning tone of voice. It will be in a, "You should have done it this other way," tone of voice (even though they are a year behind me and don't really know anything themselves.)

To all of you who are going to tell me it will be good practice, I will now tell you where you can shove it. It will be good practice at not acting annoyed when I really am, but not much else.

(I fully expect a lecture on my lack of professionalism if the tone of my voice ever betrays just a teeeeeeeeny tiny bit of annoyance, even if only for a millisecond.)

Can somebody please remind me why I signed up to do this, again?

Fading Away

This morning I woke up at 5:30 with a minor freak out.* I'm about to start doing clinical activities again, and I couldn't remember how to calculate an anion gap.

I think this happened because a couple of my commenters tried to convince me the other day that acid base physiology was "math." And for the record, sorry guys, Winter's formula is basic arithmetic, not math. Real math involves proofs. Or at least calculus.

To my credit, I could remember that a normal gap was about 10, and that there was this thing called MUDPILES. I could even remember what most of the letters stood for. I still pulled out my renal physiology book and took a look at it over breakfast though.

It was almost as bad as last week when a friend of mine used the word "cecum" and I thought to myself..... now, that's in the SMALL INTESTINE.... near the appendix.

Haha. It's really not as bad as it sounds. Sometimes I need to have my brain jiggled a little bit, but a lot of medicine is still in there. I swear.



*And promptly went back to sleep -- for a total of 8.5 hours last night.

Mike

Recall about 6 weeks ago, the lead pan for our shower in the master bath failed, causing water to drip into the living room. Since then, I've been using the other shower in our 2nd bathroom. We also got a quote to have the bathroom retiled, as well as a quote for the tile itself.

As you may remember, the quote was astronomical, so we are continuing to look.

Of course the sales person at the tile store hasn't been able to come to terms with the fact that we are not going to be buying the tile we got quoted out RIGHT NOW. So he's been calling us. Repeatedly.

Gah.

On Friday it went something like this:

Phone: Ring ring!
Me: Hello?
Tile dude: Hello may I speak to Luca please?
Me: Who's calling?
Tile dude: May I speak to Luca please?
Me: Who is this?
Tile dude: It's Mike. Can I speak to Luca please?
Me: Mike who?
Tile dude: It's Mike. Is this Old MD Girl?
Me: Uh.... Mike who?
Tile dude: Old MD Girl?
Me: MIKE WHO?
Tile dude: Mike..... From (says so fast I can barely pick out the words "tile" and "store.")
Me: Oh for Christ's sake.

Then I hang up.

Was he seriously trying to trick me into thinking it was Luca's buddy Mike on the phone so he could try the hard sell on him instead of me?

Sales people are so annoying!

(He'd have had more luck if he'd said his name was Fabio.)

Know it all

I told a friend the other day about "Boo at the Zoo" and how cute it was.

She said?

"Um, I think that's for kids, not dogs."

THANKS!!!

Silly me. I forgot that they amputate your sense of humor at the start of medical school.

Should I go to med school?

Last week I fielded a question via a classmate about the offspring of one of her parents' friends. Their son was in college. He loved math and engineering, but also thought he wanted to be a doctor. However, he'd heard that medical school had very little math, and was mostly memorization. He found this to be a turn off.

His questions?

1) Is there any math in medical school?
2) Should he go to medical school anyway?
3) If he went to med school anyway, is there any way he could utilize his math skills.

Here are my answers:

1) There is virtually no math in med school. Seriously. I suppose if you get all crazy and go into Radiology or Radiation Oncology, they make you take "Physics Boards." But really? I am not at all certain that these would constitute difficult math for somebody with any aptitude at it at all.

The sad truth is that most doctors (not you, Fizzy) suck at math. I remember when we started Renal block, and the professor threw an equation up on the board, 80% of the students started having a panic attack. The noises in the room were a cacophony of hyperventilation and, "OMG do I really need to memorize this equation????" They did not cease until renal block was over. Seriously. My internist once tried to convince me that 12x4=52. I'm telling you. DOCTORS ARE BAD AT MATH. That's part of why they became doctors. That's part of why pre-meds are so insufferable as they struggle through Physics and Chemistry.

If they were good at math, many of them would have gone on to become investment bankers.

2) Which brings me to #2 -- Should he go to medical school anyway? My answer: HELL NO. Medical school is all about memorization, and if you aren't good/don't enjoy doing that sort of work, then you will hate med school. It won't get better when you become a doctor either. The sorts of problems most doctors solve just don't involve the math part of your brain.

Plus, you can enjoy a wonderful career as an engineer, investment banker, financial planner, economist, etc. all of which require less work, and less martyrdom, all while making you better money at the same time.

Still feeling the urge to go into medicine because you want to help people? Become a medical physicist, not a doctor. You can get an MS and do a ton of math and still help people. What could be better than that?

3) If you still really want to go to med school and put your math skills to use, you could consider doing a combined degree, like an MD-PhD for instance in bioengineering, computational neuroscience or biology, genetics, genomics, biostatistics, or something like that. Your math skills would be highly valued in any of those fields. The only downside is that you'd still have to do the medical school part.... and then you might start thinking to yourself that you could have just gotten a PhD and avoided the med school shenanigans altogether. Those are the most depressing thoughts one can have when one is 6 years into an MD-PhD program.

*****
In sum, being a doctor is a great career. I love what I'm doing now. I especially love the research that I'm doing. I guess my advice is this: if you can see yourself doing something else besides becoming a doctor, then you owe it to yourself to explore those options before committing to go to medical school. This is particularly true if you are really good and love math -- one of the most valued skill sets on the planet. It's not that doctors don't appreciate math, they just don't do very much of it. If you love math and want to do math as part of your career, then for the love of God don't be a doctor -- do something else where your talents will be appreciated!!!!

Paradox

Ever since I started going to the "members only" dog park, I've noticed that there are a greater number of dogs that.... have problems with other dogs than at the public park. I've tried to think of why this might be the case, since really the whole point of membership -- I THOUGHT -- was to keep the park safe.

In reality, it's turned out that the membership cap was invoked to prevent new people from infiltrating and disrupting the clique of West Philly dog owners who had been around for a long time. However, I digress.

I came up with a couple of reasons:

1. Once you've paid your membership dues, you feel it's your right to come to the park no matter how your dog behaves.

2. Since people know each other, there is less self-policing of bad dog behavior. Also, people chat with one another rather than watching their dogs closely.

3. People feel that since their dog has been "approved" a wider range of behavior subsequently falls into the "acceptable" category. I.e. My dog was approved, therefore its behavior must be fine.

And then of course, there are the OTHER reasons:

1. The guy who is responsible for screening dogs has an aggressive dog himself. And by "aggressive," I mean scary, unpredictable aggressive. I've seen her provoke at least 2 fights in the last 4 months, and she has been in several others in addition to those. The owner I'm sure feels that it would be hypocritical to tell any potential member that their dog is not an appropriate dog park dog because that would mean he could no longer bring his own dog. He's also very conflict avoidant, so probably couldn't tell anyone "no" even if his dog was incredibly gentle.

2. More former strays and street dogs than in center city. Not that pure-bred dogs are all wonderful, or that all adopted dogs cause fights, but when you adopt a dog it's more likely to have behavior problems due to its history. In fact, it may have been given up by its previous owners because of behavior problems. It's just a fact.

Anyway, who's to say whether this is all conjecture, and that if I'd kept going to the public dog park we wouldn't have had problems there too. I'll just say though, I noticed this difference almost immediately at this park, so I really don't think it's in my head.

Thoughts?

The path is back

Drum roll please.....

The growth on the ear of the Boo was:

A Viral Papilloma

Yep, Miss Boo had a wart in her ear. A really really big rapidly growing wart.

Who knew?

Congratulations to Luca who said off-hand about a week ago, "It looks like something a papilloma virus would do." Happy now, Mr. Smartypants virologist?

On Having it All

When I got into med school 5 years ago and had my last visit with my doctor in Chicago before I moved to Philly, I decided to tell her that I was going to med school.

She was all happy for me until she heard I was doing MD-PhD.

"Those MD-PhDs are the WORST doctors that I work with," she sneered.

(Ah, internal medicine....)

In a way, it's true though. My name is OMDG and I am in training to be a shitty doctor.

Why do I say this?

I am training to be a researcher, and as a physician scientist I will have (I hope) a job where I do 80% research and 20% clinical. That amounts to 4-8 weeks of in hospital time, or 1 day a week in clinic. There is just no way you can be as good a doctor with that amount of clinical time as someone who does it 7 days a week.

But then there's the other stuff.

When I started working with my mentor, I casually let it slip that I was planning on having kid(s) during my PhD. I'm 33 now, and if I wait until after residency, I will be in my 40s, which would obviously not work and be a stupid thing to do. Plus, my time is more flexible now than it will ever be again in my life. So, now it is.*

Bearing in mind that he is a junior investigator with 2 small children, would you like to know his response?

"Wow. You're going to try to be a good doctor, a good researcher, AND a good Mom? Do you think that's such a good idea?"

I held back the temptation of saying that I had no plans to try to be a good doctor... he doesn't have much of a sense of humor.

Putting the good doctor part aside though, did he really mean that a woman, or maybe just I, could not actually be a good researcher and a good mom at the same time? Because we all know he wasn't talking about himself here.

I gave it some thought and concluded that his idea of what a "good mom" was and my idea were probably not one in the same. Also that, despite his protestations to the contrary,* his wife probably does the majority of the baby-work in their household.

I hear all the time from the frat boys in my department about how various women "threw their careers away" to have babies, and are now "just" doctors not doing any research at all. It was just "too hard" for them to do keep the research going, they say shaking their heads.

Will that happen to me? Am I going to try to "have it all," and then "fail" like so many other women before me? Who knows? Who cares? I've learned this past year that no matter what, people will always want more from you than you can give. This is on the career side and on the family side. My mentor will always tell me I am not working hard enough and there will always be more work to do at home that I can accomplish. So I don't try to do everything anymore, since I know that I'll never be able to. I just do what I can, and it just has to be enough. Isn't that all anyone can do?

I guess my definition of "having it all" is not feeling stressed out all the time at home and at work, and feeling like I am doing something I enjoy. Being at peace with the amount I'm able to accomplish regardless of how inadequate other people tell me I am. I don't think that's too much for anyone to ask for. So I guess anyone can have "it all," it just depends on what your definition of "it all" is.

What's your definition of "having it all?" Why is this a term that people use? It seems so weird to me.







*No, I do not have a special "announcement" to make, if that's what you're wondering.
*Once he told me that having an infant was easier than fellowship.

Just in time for Halloween

I was REALLY impressed with the shaving job the vet student did on Boo's ear for surgery today. She totally looks like a punk doggy.

Luca bought Boo a Halloween costume today too.





The t-shirt even glows in the dark (her eyes are like that all the time).

Poor sweetie is still high from the anesthesia and methadone they gave her from the surgery today. Hopefully she'll start feeling a little better soon, though.

Ear

Miss Boo is having her ear mass removed today at VHUP. I took her in this morning. Of course she wouldn't poo this morning since the grass was wet. Miss Princess LOVES jumping into water, but go near a little bit of wet grass?

Never.

I'm hoping they don't have to remove her ear, and that the tumor is benign. She has the cutest ears! But if they do, she will totally look like a fighting pit bull.

When the vet student took her away this morning, she didn't even look back at me to see if I was coming. I didn't say good bye to her since she was pulling the student to the back behind the double doors, and she didn't look anxious at all. A part of me wishes she'd been at least a little distraught that I couldn't go with her though. :-(

She's so popular

The Philadelphia Zoo is throwing a party for Miss. Boo this Halloween! It's called "Boo at the Zoo."

We are so excited.

Imagine, a party at the CITY ZOO thrown on behalf of the Boo! I could never be that cool. I'm lucky Miss. Boo deigns to associate with me.

I'm trying to decide whether she should go to her party as a) a ferocious pit bull, or b) a ghost (more true to her name, but not as scary).

Either way, we're going to have fun!

You all are right

I shouldn't have renewed at the dog park. But, it's only $60, so I figured we'd pay and then just go less.

I know you all love my righteously indignant crazy dog park stories though, so OF COURSE I had to post this one too!

I was there on Friday morning by myself and Boo practicing on the agility equipment, and this woman comes in whom I've never seen before. She had a key, so she was a member. But then she started telling me that these were her two foster dogs that she'd had for THREE DAYS.

As I watched the female foster ram her body repeatedly into the Boo and put her paws all over her, despite Boo trying to walk away, which then escalated to the female growling and lunging at Boo and putting her paws on her while the male repeatedly tried to hump her, I listened to the woman expound on how wonderful the dog park was as a way to socialize these strays. The female continued to come after the Boo after the foster mom had pulled her off and I had the Boo between my legs by the collar. I was a little nervous that I was going to get bitten.

No good was going to come of this. Which is what I said, and started to leave. The foster mom then blamed the Boo for her dogs' behavior. "Boo must not like to play rough," she said. (Actually that it Boo's favorite game -- but this was bully behavior, not rough play. Is it really that hard for some people to tell the difference?)

It seemed like incredibly poor judgment to me to bring these so recently stray dogs that you don't even know to the park, and expect everything to all work out. Not that I'm this big expert or anything, I'm just saying.

And anyway, in order to be members of the dog park, dogs must have a certificate for rabies vaccination and a Philadelphia dog license. As a foster of these dogs for 3 days, there was no way they had a dog license at least. Isn't the whole point of membership to keep dogs who haven't been screened (not like this helps much) out of the park?

Alert Alert!! Rule Breaker!! Haha.

Ah, whatever. File this under: People are idiots. I've decided to not let it bother me. If she shows up again, we'll just leave.

Connecting, Clinically

Don't know if this is unique to my MD-PhD program, but the program I'm in encourages us to sprinkle our PhD time with occasional clinical experiences. The purpose of these experiences is to a) keep our brains at least a *little* in the clinical mix as we slave away work very hard at our PhDs, and b) enable us to decide which specialty we plan to pursue so that we can be more focused when we return to the clinics in X years.

If anybody follows my career preferences du jour, you'll have noticed that there's been quite a bit of flux over there for the past couple of years. Even though I got through three full years of med school, I still didn't know which clinical specialty I wanted to pursue. This caused no small amount of consternation on the part of my program administrators, since the whole point of letting me do three years was to help with this. (And actually, it did help, just not the way they wanted it to.)

The problem stems from the following:
- My research is classic internal med research.
But I don't think I want to do internal med for a variety of reasons.

Which leaves in primary contention: Emergency Medicine and Neurology

So, I finally bit the bullet and signed up to do Clinical Connections in Emergency Medicine. Because I've finished all my clinical rotations AND done a sub-i (in internal med), the clerkship director had arranged for me to function as a sub-sub-i in Emergency Medicine in that I will be able to see patients myself and report directly to a particular attending (him or another one I already know). I'll do 1 shift per month for the next 4-6 months.

I am so excited!!! I am also a little terrified since I haven't seen an actual patient in almost a year and a half, but mostly excited.

We'll see how it goes. Optimally, I'd like to do this experience, and then do some time in the Neuro ICU as a clinical connections experience so I can try that on for size as well.

Can't remember if I ever wrote a post on What's not to like about Emergency Medicine, but I'll probably write one in the coming months if I haven't already.

Bliss

Bliss:

Is when the med school server goes down over the weekend and you can't view, or even receive, anxiety inducing emails from your PI (or anybody else).

Don't think for one minute that this enables me to take the weekend off, haha. It just means that I can stick to the plan I've created for myself and not be thrown off by demands for other data.

Yay for the server crashing!!

Chic-lit

Is chic-lit still popular? I remember reading it before I went to med school and being struck with a common plot line. I call it the normalization of working mommy failure.

Lawyer/Businesswoman +/- Mommy has high powered career that is grinding her into the ground. She works so hard that she doesn't even realize how unhappy she is. Then something bad happens to her. Usually this "something" is related to her inability to maintain the veneer of perfection to the degree she is expected to. She then has a breakdown of sorts, during which she realizes that her true calling is to have a less high powered/masculine career. She softens and starts acting more maternal. If the protagonist is unmarried, her new self is FINALLY able to find the man of her dreams. If she is married, her husband starts loving her again. And she and her newer, softer, caring and maternal career go galloping off into the sunset with the new man (and babies) by her side.

-First gripe: Why don't people ever write about doctor-ladies?
-Second gripe: Why don't we ever see the woman kicking ass and taking names and finding a balance while remaining true to her original-ass-kicking nature.
-Third gripe: Why does this alternative career have to be softer/maternal/nurturing?
-Fourth gripe: Why is the protagonist always written as pathetic and unappealing to men until she starts acting more maternal?

I'd love to write a novel about a doctor who rises above these stereotypes and succeeds in being likable -- to men AND to potential readers -- despite/BECAUSE she has an ass-kicker career.

Probably this would never sell. Haha. Maybe an idea for a future NaNoWriMo?*




*Thanks Fizzy for telling me about this a few years back!
*As a side note, I heard that Sarah Gruen started Water For Elephants during a Nanowrimo month. Does anyone know if there is any truth to this?

VA

I remember having a brief freak-out moment during the early part of my clerkship year when I found out from a friend that some of the residents at my institution were reading my blog. I toyed with the idea of making my blog private because I figured that there was NO WAY my blog could possibly reflect positively on me, and could only hurt my career.

But then, probably out of a mixture of obstinence and stupidity, I decided to keep it up anyway.

It helped that the resident that my friend had been talking to actually emailed me following my freak out, telling me not to freak out.

And so it happened that I was on my internal medicine rotation over on the geriatric care unit and I had a patient with dementia who had also been a VA patient. My resident asked me to "call over to a friend" rotating at the VA to "get them to give me his medical records."

Hello. Daunting task. Who the heck did I know at the VA? Friends? Ha. But as I was scrolling through the names of residents who were rotating there that month I came across the name of the resident who had been following my blog.

So I paged him.

When he called me back, I introduced myself, "Hello John*? It's OMDG.... from the blog? I have a patient over here who is also a VA patient, and..... he has a little dementia and can't tell us about this very-common-but-important-condition he has. I was wondering if you could take a peek at his records and let me know what it says about this condition in your records. And also, can you tell me if he is service connected?*"

And so, my blog friend gave me the information I needed about this patient. He was very nice and so helpful!

(Of course when I delivered this information to my resident, he barely even noticed. What can I say, he was a medicine resident. Heehee.)*

It turned out that I got to work with my blog reading resident on a later rotation, and he was just as awesome in person as he was on the phone. Though I have to say it was a little weird when we met, he came up to me in the hall acting all friendly like he knew me, and I had no idea who he was. We're still friends now. He's great. I wish I could be as zen as he is.

Why do I tell this story? Because bloggers often write anonymously out of fear that someone might read their blog and decide they are unprofessional or dislikeable in some way. I guess I just wanted to put it out there that there can be benefits to blogging non-anonymously as well. And also, sometimes the blog friends you make can turn into real friends too.





*Not his real name, duh.
*If you are injured in the military and are injured while serving, you can become "service-connected." The extent of your injuries determines the "percent" service-connected you become. If you are above a threshold percent, all of your medical care delivered through the VA will be free.
*This is a JOKE, people.

How's that for uncontrollably goal directed

Just looking at facebook, and saw this video that my friend had posted. I thought my basic science peeps might appreciate it.

Pain

I remember on a surgical rotation I did 2 years ago, I and a sub-i from another school were sent to pre-round on a post-op patient.

"She's really whiny," the resident told us before we went down to her room.

As it turned out, she was refusing to press her PCA* button because it caused her to go to sleep, and then she'd wake up 30 minutes later in pain. She had started crying, which hurt even more. And she'd been pressing her call button all night, complaining to her nurse about her pain, which had irritated the nurse.

It turned out that she took Percocet at home for her chronic pain, and this was raising her pain med requirement above the minimum dose she'd been prescribed.

In my humble med student opinion, she probably could have used a basal dose of pain medications in addition to her PCA. However, having worked in this hospital for almost a year, I knew that surgical patients never - EVER - got one. Teams were very concerned about "over-narcing" patients, causing them to aspirate.

The sub-i from the other school was very distressed to see the patient like this (as I was I). He urged me to tell the team to give her basal pain meds. I told him they didn't do that here, and that my asking wouldn't change anything, it would just irritate the team. He could ask if he wanted.

The sub-i from the other school then launched into a diatribe directed at me about compassion in medicine, how I lacked it, and how horrible I was.

I shrugged.

We got to rounds, and here's what I DID say: Hey guys, patient X in room 384 seems to be in a lot of pain. We got her to start pressing her button, and it's helped a bit. Is there anything else we can do for her?

They told me they'd called anesthesia to come fiddle with her PCA. They'd be there sometime that morning. In 6 hours or so.

Sub-i then interjected something about basal pain meds.

"We don't do that here," the resident said, then (visibly irritated) gave a lecture on over-narcing patients.

It sucks to be a med student (and probably a resident too) impotent to help your patients in any real way, and then be forced to watch them suffer as it takes hours for the wheels of the hospital machine to turn to help them. Part of me wishes I could have argued more passionately for the basal pain meds, and feels bad that I didn't, even if nothing more would have come of it.

But in the end, it wouldn't have done any good to argue anyway, and my team would have been annoyed at me. If there's one thing that med school has taught me, it's that advocating for the patient against hospital policy at your own expense almost never works out for you. And it doesn't help the patient either.

Isn't it awesome* how med school teaches you to sacrifice advocating on behalf of your patients for team harmony?




*Patient controlled analgesia
*By awesome, I mean "sh*tty"

Dark

I do like Fall. I like that it's not 90 degrees out every day. I like that the weather is cool and crisp. I like that I don't lose a pound of water as I sweat my way into school every day.

What I don't like is having it still be dark when I wake up in the AM. It's cramping my style, you know? I was getting in the habit of waking up at 6:15, running my dog to the park, and then coming home, showering, and being out the door by 8:30.

But when the sun doesn't come up until 7, it throws a bit of a wrench into those plans. I don't particularly want to run in the dark and get hit by a car. And also, when I get to the park in my running gear and then have to stand there while Miss Boo runs around like a maniac, it's freaking cold!! Even if I bring an extra sweat shirt it's cold!

Perhaps I should try running later in the day when I come home from school? The Boo would probably like that better too. She's not really a morning doggy. Of course soon the sun will be setting earlier....

I need to figure out a way to make this work. Suggestions, folks?

Bat

When I was a baby, my dad worked for a fine gentleman who wasn't particularly fond of him. He's not sure why, and it really doesn't matter.

One day, my dad's boss, in the middle of reaming him out for something that he wasn't responsible for, threatened to beat him up with a baseball bat.

Sometimes I feel like this (minus the bat) when I've worked with certain people in the past. I felt like this for about a year at the industrial supply company from hell. I felt like this for the four weeks I worked with two very unpleasant attendings during my internal medicine rotation, and pretty much the entire time I was on OB/Gyn.*

I felt completely helpless to please the person who was doing this, no matter what I tried.

Every so often I read something about people choosing the wrong specialty in medicine because they chose a field based on the rotation where nobody yelled at them. I've been warned about this multiple times with respect to my aversion to Internal Medicine, but it's easy to see how this can happen. I'd rather live in a cardboard box than go into Ob/Gyn for instance, and I *almost* feel that way about Internal Medicine as well (one of my attendings was really good, which helped make up for the other two). Whenever I see those particular doctors, I start to shake with anger and feel waves of nausea. Can you imagine working with people like that for the duration of residency if not your entire career?

Anyhow, does anyone else work with people who are impossible to please? How do you make a level headed choice about medical specialty when there are such strong personality factors pushing you or pulling you in a particular direction? And finally, how important is it that you like the people (in general) in the specialty you decide to go into?




*Certainly not everyone was like this on OB/Gyn, but as a rough estimate ~50% were, and 80% of my "bitchy resident" stories come from that block.

On a lighter note

After growing up with cassettes and then moving along to cds, I finally broke down and purchased my first MP3 albums from Amazon last week. Here's a song off of one of them.


Trix -- It kind of reminds me of you. I thought you might enjoy the song too.

;-)

List of Bullshit

This is how life goes, you know? But lately it's been worse than usual. Below is the list of bullshit Luca and I have had the pleasure of dealing with this weekend:

1) Fender-bender on Friday (Luca is fine, albeit very pissed off) --> of course this means trips to the body shop, being without a car for 1-2 weeks, dealing with the insurance company, paying a ticket, learning how to do Philly Car Share, etc.
2) Since we're without a car, I'm going to have to walk to the post office (1.2 miles away) to....
3) Return a package of stuff I ordered that arrived on Friday opened and damaged.
4) While my mentor has begged off our weekly meetings for a while since he is too busy, he just so happened to choose THIS weekend to badger/micromanage me for several hours by email on Saturday.* And to apply pressure to work more. For some reason he thinks that this paper I'm working on should have been done months ago, which is completely insane.
5) The dog needs surgery on her ear to remove a melanocytoma that is growing bigger by the day. That will be at least 2 vet appointments. Did I mention that VHUP is only open 9-12 M-W for this? Yeah, so Luca has to take time off work to get this done since this directly conflicts with appointments that I cannot move.
6) Luca's US citizenship interview has been scheduled for 10/20, which is great news! Except for all the documents that he has to assemble and the meeting with the lawyer he has to attend before that date.
7) My credit card was stolen in June to the tune of $8000, and everything was supposed to have been taken care of. Except now a few of the merchants are disputing the charge-backs, so I have to (repeatedly) fax documentation that I did not purchase said items.
8) Did I mention that Citibank keeps losing the faxes I send? I have kept documentation of their receipt, but it is still irritating to have to go through this with them every couple of days-weeks.
9) Did I mention that merchants can continue to dispute every single charge on an individual basis for as long as they want?
10) My bathroom still needs to be re-tiled
11) We're supposed to start interviewing contractors to re-do the kitchen this month, and hopefully buy our cabinets.
12) The ceiling started leaking under a place we patched a year ago, so we need to finally call the roofer again.
13) We also need to get the sidewalk in front of our house redone.
14) And get the chimney repointed so that it doesn't fall on someone's head.
15) We haven't had time to vacuum for 2 weeks and the floor looks like shit, and has a layer of visible dirt all over it.
16) We've been intending to hire a house cleaner, but haven't had time to schedule the interview with the service and the initial "deep clean" that they do.
17) My parents' new retort when I complain about any of this or that I am overwhelmed is that I am a bad selfish wife and that my husband is going to divorce me.
18) My yahoo account was hacked today.
19) I worked most of yesterday and all of today, just on a problem set that's due this week and on general stats housekeeping that I had to do before running more models. I didn't even get to starting the presentation I'm supposed to prepare for this coming Friday (sprung on me two days ago).

And we don't even have any kids yet. God help us if that ever happens.

What can I say folks. When it rains it pours.

Maybe November will bring better luck.



*And also, apparently, to criticize my people skills.

Dear Miss Boo

Dear Miss Boo,

When you insist upon lying practically ON me when I am trying to do work (even though the rest of the couch is completely empty), and when you rest your head on my mouse-arm, you are undeniably the cutest doggy on the planet.

However, I can't get any work done.

I promise I will take you for a run in a few hours or so. But first I really need to get this done!

Signed,

Your (overworked) human mommy

Intense

This week I met with a neuro-ICU doctor who does non-basic science research. My issue is that I really like neurology clinically, but every time I speak with a person in the department about what I do, they totally do not get it.

And when I say they "don't get it," they don't get it to the point that either, a) the description of my research prompts them to shake their heads and walk away, or b) some advice that I really need to learn more basic science in order to make my research "better." I do health services research looking at ICU bouncebacks. Molecular biology is completely irrelevant.

Suffice to say, I want to make sure I'll be able to find a job doing the kind of research *I* want to do if I go into neurology.

It turns out for this doctor, it's not really been an issue.

Why, you say?

Well, as she put it, neurosurgery is the 2nd or 3rd highest grossing specialty in the hospital. And there are very few people who specialize in neuro-intensive care. Because the hospital is desperate to find people with the expertise to keep the neurosurgery patients alive so that the hospital can make money by having neurosurgeons perform surgery on them, they let her do pretty much anything she wants as long as she continues to work there.

That her research has to do directly with keeping neurosurgery patients alive better doesn't hurt matters at all.

What's the caveat? Her department still doesn't really see what she does as "research." They see it as QI (quality improvement) instead.

The upside to this is that it means that even if she doesn't get a K-award, or R-awards in the future, she will still be permitted to do her work by her department. The results of her research will also be used to help lots of patients in the immediate future, and she will be able to see that happen.

The downside is that her position is not tenure track, she doesn't get the respect of other researchers. Actually the real downside is that her position has the potential to morph into an administrative job. She actually suggested that I consider doing hospital administration to which I didn't actually respond, "Huh, I haven't thought about jumping off a bridge in a couple of years, but thanks for the suggestion!" but rather thought it to myself instead.

She had some good points though, mainly:

a) Don't let the basic science people define what "success" is for you.

b) Basic science people will never understand what you do / think it is important or research, so don't even bother trying to explain. Making a direct impact on the lives of patients through your findings is important even if some people don't call it "research."

c) There are a lot of different types of positions in health care that will enable you to do the kind of work you're interested in, but not all are strictly "research" positions.

d) Doing HSR research is easier as a neuro-intensivist than as an outpatient neurologist because of the way that neuro-intensivists are paid by the hospital.

e) Become a hospitalist (haha she didn't actually say that, but I kind of thought it after talking to her).

f) Doing good work in general requires that you have good people skills and form relationships with those who can help you accomplish what you want. You have to figure out how other people will benefit from what you do and bring that to their attention in order to get their support.

And finally, g) If you are good at what you do and sell yourself well, you will be able to find a job doing what you want in any specialty.

And finally, I really liked her. She was INTENSE. Very goal directed, like if you got in her way she would mow you down (or at least would persuade you to be on her side after all). She was an ass-kicker. I was a little afraid. I wonder if when people call me intense, they mean that I come off like her?

That would be awesome.