Pics de Boo

She's such a FEROCIOUS pit bull.



On her favorite perch.



Snuggling in the cuddler -- her new dog bed.



Her daily morning wallow on the new couch.



Hey boyfriend Marley likes the couch too.



Miss Boo is learning to use Stata. She is a very advanced ferocious pit bull.



Princess is cold.

Dog School

Dog School went well this week. Recall 2 weeks ago we had our first class, and it was all exercises that Boo knew practically before we even got her. And there was this doggy massage business.

Well, this week was substantially better. Boo will never be a calm motionless dog, however she was willing to lie down on her mat and let us rub her. For short periods of time. Then she would get up and look around until we told her to lie back down again. Feeding her hot dog seemed to help a lot. :-)

They've started introducing more distractions also, and so far she's been handling it well. The idea is that we'll have her do something, and then a strange person will walk by, and we click and treat when she reorients to us. In theory the level of distraction will increase until it's a dog running up to her. And in theory, she will then also simply reorient to us. Haha. We'll see. This may take a while.

But the best part of the class was the "off leash" part. They have us walk our dog to an enclosure made of plastic gates that the dog can see through. Again, you click and treat every time the dog reorients to you, but they're actually off leash, so the stakes are a bit higher.

Poor Miss Boo.

You may recall that we had agility class a few months back. Well, agility was in the same room. The focus on that agility class was on jumping, and getting the dogs to offer jumping for a reward the same way they might offer a sit or a down to us for a treat.

So, Miss Boo thought that we wanted her to jump out of the box. I know this because she jumped out 2-3 times, and each time she would reorient back to me to receive her treat.

Suffice to say, this was not the goal of the exercise, and it kind of freaked the instructors out.

And to be honest, I felt a little bad for the Boo who got hung up on her leash and came crashing down in the middle once because she didn't have enough slack. She was trying so hard!

I have to say though, I was really impressed with a) her athleticism, and b) her ability to generalize jumping to a variety of scenarios. The gates looked nothing like jumps, yet she inferred that's what we wanted anyway. Also, she took these 30" jumps from a complete standstill. I'm telling you, my dog is ripped.

I can't say that I'm terribly surprised though. We'd already noticed that she's generalized jumping to other contexts at home. For instance, she now jumps on our bed with ease, and also has been know to sail over the arm of the couch to reach her coveted spot in the cuddler. He favorite place to sit while I study is the back of my chair, which she leaps onto from halfway across the room.

We told the instructors to tell Alexa (our agility teacher) that Miss Boo had taken her agility class to heart and was now an expert jumper.

Anyway, we'll see how well she does next week.

Hotel

I finally got around to booking my hotel for the conference I'm going to in May. Uh, thank GOD I did because practically everything in the city was already booked!

I ultimately decided to stay for most of the conference. I'd initially fancied myself flying in on Sunday, presenting my poster, and then leaving later that night, thinking that I'm not so into lungs, and therefore wouldn't find much of interest there....

But! I looked at the program and found some sessions on palliative care, a couple of sessions of management of neuro-icu conditions, some sessions on autoimmune disease (LOVE!), some sessions that will be led by a committee member of mine, and another session led by a woman who would be me if I hadn't f-ed around in the business world for 7 years before coming to med school. (Yay my life!) So I decided to stay for the whole thing.

So I managed to get a room about 6 miles from the convention center. I had a choice between Doubletree, Red Inn, and some other hotel I'd never heard of. I chose Doubletree, even though it was the most expensive. My justification process went as follows:

1) If I'd managed to get a hotel near the convention center, it would have cost $219/night. At $179 a night, this was a bargain!
2) They have a 25 meter pool (allegedly)! Considering that I won't know many people at the conference and will probably spend much time by myself, I thought it might be nice to be able to keep up with my fledgling swimming regimen.
3) I remembered that Doubletree has really good cookies.*
4) The Doubletree had 4 stars and the other hotels had 3 stars.
5) My GRANT is paying (thank you NHLBI!!!). Somehow I have to spend $2700 on computers and travel/conference expenses this year. Since I already have ample computers (3 and counting), I decided I could live a little.
6) The other hotels were not that much cheaper.
7) Apparently dogs are allowed. Not that I would bring Miss. Ferocious to ATS anyway, but I appreciated the sentiment. (Can you imagine how awesome it would be if I COULD bring her????)

Anyhow, I haven't booked my flight yet because Luca and I are trying to decide whether we want to make a mini-vacay out of the trip.

We had thought initially of driving up to Boulder for the weekend after to hike, but then felt a bit meh about the whole thing.

Then we thought of flying to Chicago for a fun weekend there.... but then I remembered most of my friends who still live there that I'd want to see either I've seen recently or they have moved away. We thought about trying to take my old PI and his wife out to dinner to thank them for basically getting me into [my godforsaken MD-PhD program] but who knows if they will be in town and/or interested in seeing us. I don't know.

Any suggestions for what to do for a mini-vacay of about 4-5 days? We don't ski, so please don't suggest that. I think it would be great to have a small break before I start the quals study push over the summer. God knows I need the time off.





*This knowledge was gleaned by my year at the consulting firm where I learned (among other things) that there really is a difference between a nice hotel and a motel 6. Consulting ruined me forever, what can I say. My favorite hotel was the W in Atlanta (what with its bathroom stocked with Aveda products and 300 threadcount sheets and down comforters), but Doubletree was pretty good too. See, consulting wasn't a TOTAL waste of my time, right? Ha.

Never ending

I remember when I was doing my neurosurgery block many moons ago. We were standing around waiting for x-ray to come and do some films in the OR. The residents had all found chairs, and there was one chair that was located such that I didn't think I could get to it without contaminating myself.

So I just stood there in the middle of the room waiting.
Of COURSE nobody moved to help with the chair.... until the anesthesiology resident took pity on me after 45 minutes or so of standing and got it for me. For which I will be eternally grateful.

But until that point, I just stood there. I told myself that no matter what in 6 hours I would get to go home and that this too would pass. I could stand here for 6 hours motionless if need be. I wouldn't complain. What was there to complain about? Worst case, I would pass out and they would make fun of me, and then I would move on to a new rotation. With new fodder for my blog, at that. No matter what time would pass and in a little while I wouldn't be there anymore. It was that simple.

I thought this a lot on my rotations in the hospital. On EM it was, "Only 4 more hours to go on this shift," or, "Only 3 more shifts to go and then I'm done." On medicine it was, "This time tomorrow I will be post call and at home sleeping." And time literally flew. It was great.

That's part of the beauty of medical school. Yes, it is a lot of work. Yes people can be very unpleasant. But ultimately, if you jump through all the hoops they set up for you and simply bide your time, you WILL graduate, you WILL be a doctor, you WILL get to the next level. Annoying patients will get discharged. That attending who doesn't like you will rotate off your service. You will manage to improve almost in spite of yourself. There is this beautiful finite thing about medicine. You do it, and then it is done. If you work harder, you may actually finish sooner (if you don't get given more work as your reward for finishing early).

In PhD land, no such logic exists. You can work your tail off, and if your data doesn't corroborate your hypothesis, or at least tell some other interesting story, then you're back at square one. If you don't like who you're working with, guess what? You get to keep working with them for YEARS, and then they get to follow you around for the rest of your career. You only meet new people if you go out of your way to do so. It NEVER ENDS.

There is no standing around and waiting until 7PM until it's over and then you can go. You can kill yourself to finish faster, but it might not even matter. Fundamentally you have no control over your life. You'll graduate when your committee says you're done, and not one moment sooner. There truly is never a light at the end of the tunnel.

At least you get to make your own schedule and study what you (in theory) are passionate about. Thank god. Otherwise getting a PhD would be a hell that is totally not worth it.

As a side note, I haven't had a vacation since May of last year. It was one week long. I won't get the same this year. These next few months all I have to look forward to is finishing the semester so I can unload these three classes I can't stand and all the busy work they entail. Then I get to take MORE shitty class over the summer and study for my qualifying exams, all while trying to work on these papers that really, truly, will not die. Maybe in September I will get to take a real vacation. Right now all I want is for Spring to come so I can finally see my tulips, but then all I can think is that Summer, with its 6 months of 100 degree weather is right behind it, and it makes me want to puke. In sum, I have nothing to look forward to. I don't even get to go home at 7 if I successfully tough it out.

The End.

Wrong

I remember it clearly, the first time a resident told me something that was completely wrong. It my second day in the hospital as a clerkship student ever, and I had a patient whose chief complaint was abdominal pain, and he was asking for pain medicine.

The resident told me to give him toradol. When I asked whether that was ok, since he was here for abdominal pain, and I thought NSAIDs were contraindicated since we didn't know the cause yet, she said slowly, enunciating each word very slowly and clearly as though was mentally challenged, "Well that only applies to ORAL NSAIDs. Because the pill lands in the stomach and irritates the mucosa that way. It doesn't do that if you give it IV."

Which isn't actually true.

So what did I do? I nodded my head solemnly and said, "Ok, I get it now. Thanks for explaining that to me." I think I did a pretty convincing job since she smiled back and said, "You're welcome."

As for the patient, you're probably wondering whether he was harmed by this. The answer in this case is no. I don't think we actually ever figured out what was wrong with him. Who knows, maybe there really was something else about the case that I didn't understand at that time (and don't remember now) that actually made toradol ok to give under the circumstances. However the resident's explanation of the physiology is still completely wrong.

I just use this story as an example of the fact that I can and do respect the medical hierarchy when I'm in the hospital. I know it's hard to believe given what a whiny loud mouthed pain in the ass I probably sound like on this blog sometimes.

And that is probably to the detriment to patients everywhere. At least sometimes, anyway.

Grunge

I have never been a particularly feminine girl. I discovered the whole bra thing kind of late, and never have really learned how to apply makeup or do my hair. It was probably a good thing that I was a teenager during grunge, because that style was just my cup of tea! No makeup, no fancy hair, hiking boots, jeans with holes in them, flannel shirts, $1 t-shirts from goodwill.

Those were good times.

I had this purple Lakers baseball cap that I had snagged from one of my boyfriends. It was complete with cigarette burns (because don't you remember? smoking was cool in the early 90s)and athletic tape around the plastic adjustable piece. I loved that hat. Long after I'd forgotten the boy I used to wear it around campus after class was out for the day.* I had really long hair at the time which I used to wear in a ponytail underneath the hat, sometimes folded sometimes not.

However on occasion, this attire led to some confusion as to my gender.

Once in the library, a librarian came by to tell us boys to be quiet. I remarked that surely she couldn't be referring to me. This did not please her.

And one time, when I was 15, I was taking driver's ed and the instructor drove around with me for 10 hours on 4 separate occasions before asking whether I had a girlfriend. At first I wondered whether she was just incredibly open minded. Then I wondered whether she was hitting on me. And THEN I realized she thought I was a boy.

That was embarrassing.

I got over it pretty quickly. And actually, I didn't change my apparel because of it. At some point during my junior year of high school, I started wearing really short skirts with opaque tights and combat boots (I also had this adorable courderoy jumper that I wore with a green sweater and these wooden clogs), but that was about as feminine as I got until after I graduated from college. Plus, there was this new popular girl who was really pretty who we all idolized to a certain extent who dressed like that, and we copied her because she looked awesome.

I think I just didn't care all that much whether people thought I was a boy or a girl. And since I seemed to be able to attract boys I was interested in regardless, it didn't seem to matter at all. Maybe it was the, "I don't give a shit," vibe I exuded, or maybe it was because I spoke my mind boys thought I'd be easy. Meh. Who cares.

I wish I cared as little now as I did then.






*I was a day student at a boarding school, so I was typically on campus from 8AM until 10PM or so every day, including weekends.

FU

Today when I went in for my follow-up appointment at student health, I asked the nurse practitioner why she had given me no refills on the script for my pre-natal vitamins* she had written for me the month before.

She said she was in the habit of doing that with things like birth control when her patients had a follow up visit to make them come back for their follow-up.

As a 33 year old woman who has never missed a doctor's appointment in her entire life (I feel guilty when I go 8 months before I see the dentist for christ's sake), I really love being treated like a child by the nurse practitioner at student health. Particularly about something like pre-natal vitamins. It just makes me feel all warm and fuzzy inside.

And also? I'm sure as hell never going back to that fucking place ever again.




*No I am not pregnant

It's all in how you look at things

The upside to having been to medical school when you go to see the nurse practitioner at student health is that you probably already know something about the problem that brought you there.

The downside is that you might know more than they do. That can make things awkward.

The upside is that when they get all "patient-centered" on you, you can actually make an informed choice.

The downside is that they tend to get patient-centered about everything, and ask you what you want to do, when all you want to do is run screaming from the room.

The upside is when they throw some out of date non-evidence based bullshit at you, you know that it's bullshit. (This is also an upside of being an epidemiologist.)

The downside is that you can't really call them on it because they tend to get defensive and obstructionist when you *gasp* request services rather than wait for them to be offered.

The upside is that you probably know the literature better than they do.

The downside is that you realize how much they are making shit up.

It's all in how you look at things I suppose.

And thank god I have access to Up To Date and have the knowledge base to understand it. Otherwise being a patient would be really really scary. At least this way, I can wave an article under their noses and get the referrals I'm supposed to get, even if they don't like it.

(I hate student health.)

Did I get linked on SDN again or something?

I noticed my traffic is way up these past few days. Anyone have any idea why?

Anonymous blog stalkers -- reveal thyselves!

GIANT FAUX PAS!!!

This morning I got an email forward from one of the MS4s who is graduating this year. It was sent to the list serv and was a video of medical students in Chicago at their match day ceremony.

The video was from Loyola University of Chicago.

He thought it was from THE University of Chicago. Even though the video was labeled "Loyola." He even said, "If the students from the university where fun comes to die can have this much fun, we should too."

GAH!!

Now, I love my alma mater, even though and perhaps BECAUSE it is the place where fun comes to die, where hell does freeze over, where the squirrels are prettier than the girls, and where the only thing that will go down on you is your GPA. However, and no offense intended to Loyola students -- I'm sure Loyola students are 1000% more cool that we were down in Hyde Park -- but The University of Chicago is just not the same university as Loyola University of Chicago.

I cringed inside just a little when I read that email.

This is so stupid, but I really don't get it

I had a meeting with my PI today. I was running late, since my class across campus ran over, and then I had to print out a document that I was presenting and the computers were all taken, and I rush rush rushed to get there.

And my PI was also running late, so it was ok. One of the fellows was there waiting for the meeting as well, and made a comment about my breathlessness.

Ok.

Well anyway, the meeting is about to start and we're all sitting down, and for some reason my bag keeps getting caught on the mini blinds on the inside of the door as I try to place it by my chair. I jiggle my bag to get it uncaught but it doesn't work. And it makes a lot of noise rattling the mini-blinds against the door.

And the fellow makes a comment about how, Gee, *now* I'm fighting with my PIs mini-blinds. Do I have a vendetta against them? So I said, "Well, stop opening the door into me, then."

So the meeting goes well, and is about to wrap up, and everyone stands up to leave. But I wait by the door until people leave so as not to repeat the mini-blinds debacle. And the fellow stands there watching me. So I ask, "Are you leaving?" No, she's waiting for my PI. And I said, "Well, I don't want to get into a fight with the mini-blinds again."

"Oh, haha you're referring to my little joke," she said.

And really? I had no idea what to make of the situation. She hadn't sounded like she was joking before at all. In the hospital, your superiors will often make comments in the way she did when they want you to stop doing something, or when they find you annoying. Out of the hospital, there might not be the same connotation.... but since she's a fellow it seems pretty safe to assume that it was there, and that she wasn't actually joking.

And none of this is a particularly big deal except that my mentor is not fond of my personality, and has in the past used occasions like this one to highlight my poor social skills.

This has made me neurotic; I feel anxious when we meet as a result.

Also, I didn't really think she was being funny before the meeting started. I don't get why she called it a "joke."

Then I think, am I just completely humorless? Am I committing some grotesque social faux pas and I don't even realize it? Am I just crazy, and there was nothing going on here at all? Why oh why is it so hard to understand these people that I am being forced to work with?

Anyway, I really wish I could find a group of collaborators I meshed well with. I do like my biostatistician, but it's really not sufficient.

Yes, I am an adolescent boy

Sensitive to Sensitivity Analyses

I'm doing some sensitivity analyses for these two papers I've been working on, and it's the most nerve-wracking thing ever!

You may be wondering, what is a sensitivity analysis?

Answer: When you do a statistical analysis, you make assumptions about your data. For instance, we have made the assumption that ICUs entering and leaving our study population over our study period are generally the same as one another. This may or may not be valid. To test this assumption, you could do a sensitivity analysis, performing the same analysis on a restricted sample of your data. In my case, on ICUs that were in the study for a minimum of a particular amount of time. If you get the same or similar results, you can have confidence that your assumptions are ok.

The issue is, I have significant results, cool results, interesting results. And I am worried. What if they're no longer significant in my sensitivity analysis! Ack! That would suck. I mean, I think we could still publish, but probably not in as good a journal. And it might render my cool result null. And we don't want that now, do we?

So I'm sitting here, biting my nails as I run my sensitivity analyses. Please please stay significant, results! Please!

Positive Thought of the Day

This may be the last semester where I have to take a full time course load in my ENTIRE LIFE!! In the fall I plan to take Survival Analysis and Doctoral Seminar for a grand total of -- you heard it here first -- 1 credit. The rest will be dissertation credits.

And if my department doesn't know how to sign me up for dissertation credits (which they won't since I'm the first student going through this), they're just gonna have to figure it out.

This makes me happy beyond words.

Swim

I haven't been swimming much these past several months. After my swim buddy moved away last summer, it just wasn't as much fun and I got burnt out. Recently, I started swimming again, but with much much lower expectations. God, I'm about 15 seconds slower on 100y than I was this time last year. It's pretty depressing how fast I got out of shape.

I recently started going to the pool again this block since I have class about 100 feet away twice a week and really, there is no excuse at this point. I keep telling myself that all I have to do is get in, and so far it's been working.

And I really needed it today after sitting in class and finding out that I got (at least) 30% of the HW questions wrong because I didn't know how to incorporate cost of capital into overage costs. Not that I give two craps about this, or that it will ever be useful to me in life, but it annoyed me. I think the most annoying part is that there is no partial credit given in this class. I got every other bit of the f-ing problems right, but then get zero points anyway because I do not get the right answer out to 2 decimal places.

Also, I was cold and damp and cranky because it was raining on the walk in, and I sat shivering through class since they've turned the heat off for the spring.

Given my mood, I expected my swim to be shitty But you know what? It was the best swim I've had in months. I'm still slower than a sea turtle, but I managed to do 2000y, including 1 set that was 1000y long. Then I sat in the sauna.

I got a few comments yesterday about enjoying the ride through the tunnel, and I really feel like I haven't been doing enough of that lately. Sometimes I think that if I just put my head down and work like a dog, I will get through things and everything will be great. All my work will be done, and my mentor will (finally) be happy with me. Unfortunately that strategy hasn't been cutting it these past few weeks, and let's face it, my mentor will never be happy with me. It seems that no matter how hard I work or how much I get done, there's always something that needs to be tweaked on the model. Some other analysis to do. And I feel like all I do is sit in front of my computer fighting with STATA and the grid and my data, feeling frustrated that I'm not getting anywhere.

While I still can, I think I just need to take the opportunity to start doing things that make me happy again. It used to be that finishing work and feeling accomplished would do that for me, but since I'm doing work that will never be finished, it's time to find something else to get satisfaction from.

Maybe it will be swimming again. Maybe it will be something else. Whatever it is, I hope I figure it out soon, for my sanity's sake.

Sunday

I'm looking forward to having these two papers behind me. I've worked on them every single weekend for I think the past 6 months. I think I am beginning to see the light at the end of the tunnel.... but I'm not sure.

Sigh.

Random Dog Park Convos

Looking at the match list this year, and noticing that practically as many people went into rads as into internal medicine, made me recall a conversation I had at the dog park last summer.

I was talking with one of the new members, a med student who was a year behind me.

One of the other members, a middle aged woman with a yappy little dog, overheard us talking.

"Are you in medical school?" she asked us.

"Yes," we both replied.

Then she asked what specialties we were planning on going into.

"Neurology," I said.

"Family Medicine," the other girl said.

She asked me why I didn't want to go into Family Medicine too.

I said that outpatient general medicine wasn't really my thing. That I found the clinical problems in Neurology to be more interesting.

Then she turned to the other girl and told her what a wonderful, selfless human being she was for going into primary care, and how other people who chose "high paying specialties" (gesturing towards me) were all selfish and in medicine for all the wrong reasons. I want to say that the tirade -- because that's what it was -- lasted only a minute or two. But it went on and on. And that lady has never made eye contact with me again once in the 9 months that have elapsed since that lovely interaction.

Man, I WISH neurology was a high paying specialty! That would be totally awesome!

It's probably for the best that I didn't tell her that I want to do primarily research, seeing patients at most 1 day per week, and hopefully less. I hate to think what she would have thought of that. Haha.

File this under What the Public Thinks of Doctors, I guess!

Oh yeah

Yesterday was The Match.

I suppose as a medical blogger I am obligated to give it some sort of hat tip, even though at this point in my life I could (almost) care less about it. So, hear it is.

I ran into one of my classmates who'd taken a year out at the gym a few days back and he asked me if I was going to go to watch the match.

"Why would I do that?" I asked.

"So you can see what it's like," he said.

"I can see in three years. I'm totally ok with that."

"Did you go last year?" he asked.

"No."

"Why not?"

"Why????"

"There's champagne...."

I guess some people go just to show support to their friends? I wasn't that close with most people in my class, and the ones I was close with never expressed any desire for me to attend. Thus I did not.

It was much more interesting to read the match list in my house later on.

I have to say though, it wasn't as interesting as I thought it would be. Most of my friends "knew" where they were going to be already, albeit informally, and the rest either matched in internal medicine (BORING!) or at my institution (BORING!). Most people at my school tend to get what they want, so it's not nearly as riveting to watch as it might be. And this is probably a good thing.

I hope when I match, someday, my parents are not so infirm yet that they won't be able to come, and that my husband doesn't have a work emergency that pulls him away. I think that would really suck actually, since by the time I graduate, I doubt I'll know anyone else in the auditorium matching with me.




**UPDATE: I just took a look. This year we had*:
Derm = 10
Rad Onc = 7
Anesth = 8
Neurosurg = 4
Ophtho = 8
ENT = 2
Radiology = 13
Ortho = 5
Urology = 2

*Not so many in primary care fields.

Is your PI upset about a reviewer's comments on your manuscript?

A friend sent me this. Unfortunately, I can't embed it, but it's pretty funny. Follow the link.

http://www.youtube.com/watch?v=-VRBWLpYCPY

The good new is....

I finally figured out how to use the grid! I can now run 7 time consuming jobs at once: 1 on my school laptop, 1 on my crappy laptop, 1 on my desktop at school, and 4 on the grid. Before I could only run 3-4 at once, and if I did 4 I essentially could not use my computer at school because running 2 jobs at once would use up all my RAM. Now I just run one on that computer so I can work on the grid at the same time.

The bad news is.....

I realized that I need to be specifying an unstructured covariance matrix for my code. Before I'd not been specifying this, and STATA defaults to an independent covariance matrix, which is not correct and not conservative enough. Thus, I must start my time consuming runs COMPLETELY FROM SCRATCH!!!!

AHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!
(rips hair out, rends snot and dog hair covered sweatshirt in frustration)

Also, unstructured correlation matrices take even longer to run -- even on the grid, so WHO KNOWS when these jobs will be finished running. A week? 2 weeks? My PI is going to have (another) heart attack. He's going to ask me, "I thought we solved this problem?"

And we did, but we just made the model even more complex. And now we can run 7 jobs at once instead of 4 so we can go marginally quicker. "Aren't you glad we solved this problem?" I will say.

Haha.

The nice thing is, when I have my jobs running on the grid, it frees me up to work on my other projects which I've been neglecting due to lack of CPU space.

Yay?

Face palm

In class yesterday, our professor brought up how terrible he felt about Japan, and how terrifying it must be to be told to close your windows and stay inside in order to (hopefully) avoid radiation.

And it is terrible.

One of the students in my class then piped up and went on this tirade about how HE KNEW that the nuclear reactor damage was going to be a problem, and how they should have just evacuated everyone in a 12 mile radius on the day the damage happened.

I kind of wanted to say, "Gosh, why don't you just go have a chat with Gaddafi too and let him know you think he should step down. Then you can go ahead and pick a new government for Libya while you're at it."

I don't know, it's one thing to Monday morning quarterback Bush and Katrina -- which was a colossal f-up on behalf of the US government -- but I look at the footage of that tsunami, and see the earthquake, and I think it's a freaking MIRACLE that (so far) only 10,000-12,000 people are reported to be dead. A testament to how well prepared Japan is compared to the US.

Also, it's incredibly difficult to evacuate an area of that size in a short amount of time under the best of circumstances. And right after a major earthquake and tsunami hardly qualify as "the best" of circumstances.

I was kind of embarrassed for him.

I really hope this class gets better

Because last night, we had our first Control Unleashed class, and we spent our time teaching our dog to go in and out of her crate on our signal, and sending her to her mat. Which was lame. She had mastered "crate" before we got her (thanks Lisa!!), and we got "square" down months ago by only feeding her from the table while we eat dinner when she lies on her mat (which is across the room from the table). It has worked like a charm in preventing begging.

Oh, and they made us do like 15 minutes of doggy massage, which the Boo and I are totally not into. She spent her time repeatedly getting up and going to her square to request a treat. What can I say, we have a ferocious pit bull, not a foofy new age dog. We gave it a try for 15 minutes, and really, no progress was made on the relaxation front whatsoever. WORKING seems to relax the Boo. Lying on a mat being petted does not.

Boo seemed a little disappointed that we didn't get to run around and play on the agility equipment. However, perhaps I am just projecting.

Hopefully it will be better next week. If only the class didn't incorporate so much of this fru-fru dog massage then I think I might feel a little less irritated and that I was wasting my money and time. Maybe -- hopefully -- they were just using the first class to assess where everyone is, and it will be better next class.




*I noted I lost a follower after this post. I hope I didn't offend anyone by calling massage "fru-fru"! LOL!!!

Daylight savings

I'm glad I looked yesterday to see when it was. But damn! 4:30 already? Where did the weekend go?

We found a stray pit bull today and had to take her to the PSPCA. She was really sweet and seemed scared. Luca and I felt pretty sad about about having to take her. She smelled bad, like she'd been peed on by some person.

I want to take a nap.

Spring Semester

I am sad that spring "break" is almost over. I made a lot of progress this week. It was fantastic not having to go to class and do readings, and I got to focus on my projects.

Several good things happened:

1. I found out that as a PhD student, I get free access to The Grid. This will enable me to a) run 4 models at once, and b) run them in about 1/6th the time it currently takes. Now, all I have to do is figure out how to use it. It's on a Unix platform, and I've never used anything like that, so there's definitely going to be a learning curve.

2. I got a bunch of models run for my project. 3 in total (out of 24). But one of them was my most important set of results. And the results were still significant when I added the second layer of clustering!! Woohoo!!

3. My project that was put on hold got re-started. I was really unhappy and bored with how the paper was shaping up previously, and I think I needed some time away from it to think more clearly. I think I know what I want to do with this project, now. Of course this will *also* entail running a number of (even more) time consuming models. However, once I figure out how to use the grid, my hope is that this too will progress more rapidly.

4. I started studying for my quals! I don't know yet if I'm going to take them in July or August, but I can tell you that I am very rusty on many of the basic epi stuff that I'm supposed to know. I haven't taken a basic epi course since 2007 for goodness sakes! I'm glad I had a chance to go over some basic things, like how to calculate a kappa statistic, and what happens to sensitivity and specificity when you run tests in parallel or in sequence. I so totally had forgotten about that stuff!

So, on Monday I go back to the old grind. On my plate will be:

1. Operations Research II -- I think this one is about supply chain management. It's theoretically going to be very helpful to me at some point in my career. All I know right now, though, is you only get points on HW and tests for the right answer -- to two decimal places!! -- and I received a gift from my instructor in the form of an A- last block. Gah! Stressful! And such a silly thing to be worrying about right now!

2. Outcomes Research -- Really helpful class. But this block I need to write a paper and prepare for a final. It really shouldn't be TOO onerous, I just don't want to do it.

3. Doctoral Seminar -- 2-3 hour time suck ever week. But, I get to see my classmates which is really nice.

4. Advanced Database -- The bane of my existence. I totally shouldn't be taking this class, but I needed 0.5 more credits than I had. I will be learning Sequel, which I am not going to use AT ALL in the immediate future, and as such is will probably be kind of a waste of my time. Also, it's not technically required for me, since I've been grandfathered in under the old requirements (which changed in 2009), but we all know that it will come up if I don't take it. It's also taught by the PhD director, and he has this problem with being personally offended by these things. So, I decided that this was a sword worth falling on.

5. I'd really like to have paper #2 finished and submitted by the beginning of April. I'd really like to have paper #1 finished and submitted by the MIDDLE of April (but it ain't gonna happen), so I'm shooting for the beginning of May. Cross your fingers for me, guys!

6. Because, I'm presenting paper #1 at a conference in Denver in May. And perhaps I will also try to do a poster for paper #2 for a department research day at my institution that would need to be done by June (abstract in May).

7. And of course there's that pesky quals studying I need to do.

So, it's going to be a busy 8 weeks. I was really hoping to get a chance to spend some time in the Neuro ICU, but I just don't see that happening for the next couple of months, maybe not until August?

Wah wah wah.

Ready set go.

Here I come.

Bilateral Carpal Tunnel

Many doctors develop indicators they use to tell if a patient is "crazy." For example, one doctor I know counts the number of rings a patient is wearing. More than 3 rings (on separate fingers) is good indication of craziness in his opinion.

Others use diagnoses such as fibromyalgia, chronic lyme disease, and bilateral carpal tunnel syndrome as their indicators. I'm not saying it's right, I'm just saying it happens.

But I will say, I think what ultimately turned me off of Emergency Medicine was the cavalier way in which the attending I was following threw his theories about these diseases around in front of a group of impressionable medical students.

In fact, the patient was there for a completely different reason which I won't get into due to HIPAA. The problem was relatively minor, only, instead of being triaged to fast track, she had been triaged to the main ED through no fault of her own. And she had wrist braces on both hands.

Now, while we were talking with her and examining her, she was completely reasonable. Answered all of our questions non-evasively. She seemed very pleasant and agreeable. But then there was the bilateral carpal tunnel surgery that she'd had 5 years prior.

As soon as we left the room, the attending started talking about how she was obviously crazy, because there is no such thing as bilateral carpal tunnel syndrome. How she was likely a drug seeker, or lawsuit happy, or something else nefarious must be going on. How unless you type 8 hours a day 365 days per year, there is no way you can develop this affliction.

Then he gathered the other medical students around and shared his opinion about this disease and also the others I mentioned above.

I'm sure you all are wondering: Did I say anything?

Um, Hells no!!! I am NOT falling on that sword, guys.

I kind of wanted to say, "Dude! She wasn't even a difficult patient!! Why are you so upset that she came to the ED? She was EASY! You should be happy!"

Also, as someone who has experienced bilateral hand pain before (ulnar rather than median nerve), I can tell you it is not imaginary. It is debilitating. It hurt. It kept me from working. It kept me awake at night. NSAIDS did nothing. I can see why someone might seek out surgery as a last resort, even if it's not been shown to be helpful. And yes, it did go away over time on its own -- when I stopped using my computer so gd much.

Anyway, the whole experience was kind of a turn off. I guess all of emergency medicine isn't like that, but the attitude is pervasive enough. Maybe I'm just too touchy feely or suffer too much from overidentification syndrome to really like working in that kind of environment? I don't know. I just imagine going to the doctor and having them decide I'm difficult because of something written in my chart, and ever after treating me dismissively. It is looking more and more like either internal medicine or neurology is going to be a better choice for me.

Control Unleashed Begins Monday

And today we received a confirmation email:

Hi! You are confirmed to begin Control Unleashed at Y2K9s this Monday at 7:15pm.

We have crates for use at the building, but if you can you may want to bring one. Please also bring a mat for your dog to lie on, a variety of treats, and a kong or stuffed bone your dog can chew while they're crated.

Dogs must be able to crate quietly when it's not their turn.

I would like to direct your attention to the last sentence:

Dogs must be able to crate quietly when it's not their turn.

In particular, this word:

QUIETLY.

I have only one response to this.

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!!!!!!!!!!!!!!!!

I wonder what happens if Boo isn't quiet? Do they kick us out of the class? Or do the instructors and fellow classmates cast dirty looks in my direction as if I should *do something* to get my dog to stop barking, and that I am clearly a bad doggy mommy for having a dog that barks when you put her in the crate?

I am guessing it will be the latter.

I'm sure I will receive some well meaning but completely unhelpful comments such as, "If only you brought a stuffed Kong, I'm sure she wouldn't bark."

Hi, the dog won't touch a Kong when she's crated. Never has never will. Ditto for the rawhides. She might consider touching a raw and bloody marrow bone, but you'd probably frown upon giving her that now, wouldn't you.

Dog people.

*shakes head*

Sigh.

Notice to people recruiting volunteers

Guilt and sarcasm are not good ways to go.

Twice in the last two weeks have I found myself at community meetings about what to do about the developers who want to buy the parking lot at the end of my block. And twice I have ended up in unpleasant conversations about the park that is also at the end of my block.

The first conversation was with this guy who claimed that HE had PERSONALLY cleaned up Clark park, and that this was what had ultimately made Clark park a nice park. That picking up the trash and the dog shit got rid of the drug dealers. That *I* should do the same for the park on my corner. And that fundamentally it was my fault that there were drug dealers in the park because I had not personally taken a sufficient interest in keeping it clean.

The second conversation happened when I asked a guy who is involved with the cleanup of the park on my corner how we might get lids for the trashcans. You see, every time the wind blows, the garbage bags invert and trash blows all over the neighborhood. Lids would help alleviate this problem, and reduce the trash pickup burden.

But despite this interest, I STILL got a lecture on how HE cleans that park even though he lives two whole blocks away, and that NOBODY on my street took ANY interest in the park, and that it was OUR responsibility, not his. That *I* personally should clean up all the dog shit, and that this would cause the drug dealers to go elsewhere.

I just thought to myself that a) I'm sorry, did you not notice that I was trying to get involved?, and b) now I don't want to because then I would have to work with you. Oh, and c) since when do people think drug dealers care about whether a park has dog shit in it?

A few tips to people who are trying to recruit volunteers:
1. Lecturing people who are interested in helping about how awful they are for not previously helping is not an effective recruiting strategy.
2. What works better is, "I'm so pleased you're interested in helping out! Those are interesting ideas that we should think about addressing. We meet every X months, so why don't I take your name, and the next time we have a clean-up day I'll send you an email and perhaps you can join us."
3. Lying to them about how immediately fruitful their efforts will be in ridding the park of drug dealers is pretty transparent.

Sealed the deal....

There was this article on the well blog about how psychiatry has morphed from a specialty where most patients received talk therapy to one where patients have 15 minute visits for medication changes.

This has happened because insurance companies reimburse relatively poorly for talk therapy (~$90/hr) compared with the shorter appointments ($150/hr).

The psychiatrist lamented that he had to teach himself not to therapize his patients. That he directed them to see a psychologist or social worker instead if they wanted talk therapy. He also said that often he had to turn patients in crisis away because there were no open appointments.

Predictably, the readership called him a greedy pig, a whore, a charlatan, a pill pusher. Some said that they would LOVE to be making $300,000/year. Where they got this number, I do not know.

I did a little number crunching myself.

If he did exclusively talk therapy, his revenue would be:
$90/hr x 7hr/day x 5days/week x 50weeks/year = $157,500

If he does exclusively short visits, his revenue would be:
$50/hr x 21hr/day x 5days/week x 50weeks/year = $262,500

Now, he has to pay for rent and office staff (he uses his wife). He has to pay for malpractice insurance. He outsources his phone and billing services, and therefore has to pay for that.

These things are expensive. On top of that he has children in school. He lost a lot of money from his retirement fund (as did we all) when the market dipped in 2008. He likely has to pay for his own health insurance as well.

After all of these expenses, I'd be surprised if he had enough left over to pay the mortgage or feed himself under plan #1.



As a side note, I am really tired of having people tell me what "enough" money to live on is. This problem is especially prevalent among my twenty-something friends who have no expenses like a house or a car and who don't have any children. Who haven't realized that daycare costs $1500/month per child in our city, and this doesn't include feeding, housing, or clothing them, and that it only gets worse as the kids get older. Whose parents purchased them a house or who paid for them to go to grad school. Who label anyone with a desire to do better than the median income in the US ($48K for a family of four) as greedy and selfish.


Anyway, end tangent. What concerned me about this practice style was how it had affected patient care. But, on seeing what the albeit small sample of patients thought of all this, it interested me to see that many of them a) did not desire therapy, and b) the ones that did seemed happy to see a therapist for the talk therapy, and the psychiatrist for the medications. They way that the insurance companies have forced people to practice seems to work for many people. Maybe not all, but nothing works for everyone. Perhaps a more thorough study is needed to measure how people feel for sure. But then, I don't know that psychiatric patients are going to end up being any more dissatisfied than any other type of patient whose care is managed by insurance companies.

I think what made me saddest about this article was that he went into psychiatry with one idea of how he was going to help people, and in order to stay afloat he has to practice another way. He has gone the way of the primary care specialist. He seemed dissatisfied and burned out. I suppose this can happen with any career. Why is it that if it happens to a union protected machinist, people beat their breasts and demand government protection of the working man Michael Moore style, but when it happens to a doctor, everyone says that as a greedy pig he deserves it?

High

The last time I was officially measured, I was 14 years old, and I was 5'5 and a half inches. The "and a half" part was important to me. So important that when I got my driver's license when I was 16, I rounded up to 5'6". Everyone else in my family -- women included -- is 5'8" or taller. I was the shrimp with the short genes.

Ever after, I'd always assumed that I was 5'6". I'd even gotten into arguments with male friends of mine who claimed to be 5'8, but who were my height. I just figured the male ego was a fragile thing, and they just couldn't bear the thought of being 5'6".

While I was waiting for the gyn on Friday I got bored, so I decided to measure myself using the contraption they had on the wall.

It turns out I'm 5'7 and a half.

Oops.

I must have kept growing through high school. Who knows when I stopped! Perhaps all of those pants I had to discard because they became too short for me hadn't actually shrunk in the wash, but I actually grew.

I guess we'll never know.

Most importantly, I am now tall enough to be a midget.* Because who needs brains when you can be hot instead.



Kidding.




*A model who is between 5'7" and 5'9".

Maybe this will be a good week?

- I'm on "Spring Break" which means I get to catch up on all the crap I couldn't get done while I was in the midst of exams.

- I finished model building for my newly defined post-ICU discharge death variable and I started the multi-level modeling with it last night. Hopefully round one of that model will be done in two more days or so.

- I found variables for day and night staffing for nurse practitioners AND physician assistants in my dataset, which means I can see whether staffing changed over the course of my study for either type of provider, or both.

- There appear to be temporal changes in the use of these staff members by ICU. This is kind of exciting, given my hypothesis.*

- My data person can get me these variables by 1PM today.

Also,
- My model only took 2.25 days to run this time (rather than 3 days). However I f-ed up and accidentally ran another piece of code while the model was running yesterday. This means that instead of stopping when it was done so I could run Wald and linear combination stats, the next set of models IMMEDIATELY started running, wiping the memory of the model that had just finished. Hence, I must start over AGAIN. The good news is that it should only take 2.25 days to run instead of 3.

- The tile guys were supposed to come and finish the shower today, but are sick. So they are coming tomorrow instead. Pro: they are coming tomorrow. Con: They are not coming today. Pro: Because they are not coming today, I can get errands done on campus and swim in the pool when it is set up long course today.

And,
- I'm going to a community meeting tonight to discuss the possibility of getting the city to convert their abandoned parking lot to parks and recreation rather than sell it to a developer who wants to put a methadone clinic in it (I'm speculating).

- My tulips are coming up ALL OVER my garden.

Plus (and maybe best yet),
- I just found out that my grant gives me $2,700 a year to put towards conferences, travel, and computers. Maybe I can get some of that expensive server time for my models after all?



*Actual hypothesis with citation and all to be provided when paper comes out.

Taxes Done!

Federal and State anyway. All that's left is city.

Yay TurboTax!

I'm grumpy

I'm cranky because I have to work all weekend.

Because I only got an A- in one of my classes. I know this is stupid, and in fact it would be a waste of my time if I'd gotten an A. That said, I BARELY got an A-. I only got one because he was being nice to me. I think this should make me happy. It doesn't. What can I say, I'm a med student at heart.

Because I got into an argument with a guy at the dog park this morning.

Because I am beating my head against a wall re: my dataset.

Because I have to go BACK to the dr in 3 weeks to follow up on something she was concerned about. Mostly this just annoys me because going in for my yearly gyn visit was something I wanted to be able to cross off my to do list, and now I can't for a few more weeks.

Because no matter what I do, my mentor will never be satisfied.

Because I have this hideous crick in my neck that is only getting worse and makes it so I can't even watch tv without pain.

Because I have to do my taxes this weekend.

Because some developers want to build a veteran's "shelter" in the parking lot on my block complete with a Chinese restaurant that sells cocaine through a bulletproof glass window and a methadone clinic (I am speculating).

Because it is cold again.

Wah.

Meeting

Had a meeting with my PI today. He practically had a heart attack when I told him that the extra analyses that he requested are probably going to take an additional month to do.

We then discussed computing options that could be faster. Like paying $3000 for me to be able to use the biostats servers to run my programs instead of the wimpy-ass desktop (which has been a total lifesaver) he got me 6 months ago. Or perhaps purchasing a Linux machine to run stata on exclusively.

The thing is, I worry that if I DO get access to all these other computing resources, that he'll expect my analyses to be done with a snap of the fingers. The reality is that it will take a 3 day run and do it in 12 hours, which is much better, but is NOT going to solve everything.

Upshot: He's still not going to be able to get things as fast as he wants, he will continue to be dissatisfied with me, and nothing will actually be any better.

Oh, and guess what, I get to work all of THIS weekend too.

Awesome.

So I'm taking this class

With a bunch of undergrads. It's the same class that's taught in my department in the Fall, only it wasn't taught last fall, and I need it to do my dissertation research.

And it's a great class! Really.

But a lot of the undergrads are struggling with some of the basic statistical concepts, like dummy variables. And the professor isn't so fantastic at teaching these concepts because, well, he's not a statistician. He really ought to require some stats as a pre-req, but he doesn't so there we are.

I like this class. It's completely fascinating, to me, and also incredibly useful to my research. So I ask and answer questions. Ergo, most of the students seem to know who I am, and that I (at least seem to) know what I'm doing.

Anyway, last class, one of the students asked me if he could copy my notes. Of course I said yes. Then this turned into, do I want to study with him for the midterm, the answer of which was, "I don't have time." And then he wanted to know if I could meet with him to go over the practice problems, and I said, "We'll see. I doubt I will have time given my schedule next week." Which was true.

Today after class, he asked me AGAIN. And I said, "Sorry, I haven't gotten to the practice problems yet," which was sort of true, and sort of not. And then he wanted to know if he could email me his answers so we could compare answers. And I said, "I really don't think I'm going to have time to go over this material with you. I have a final exam on Thursday in another class that I need to prepare for, and I don't plan on spending too much time on this midterm, since it's only worth 15%. I'd hate to say yes, and then not get to it, when you were relying on me."

And that finally got him off my back.

I guess on one hand I should be flattered to have been identified as A Person Who Knows Something. But really? Studying with him would have been for his benefit, and not mine, most likely. And he's not my friend -- I've literally only spoken to him twice. And he was hella persistent! Man.

So I felt like a bitch for saying I wouldn't help him, even though it would have been a bad use of my time.

This whole Saying No thing is hard.

But I feel so relieved, and I am really glad I did it.

Saw this

And thought it was pretty spot on.

Comments

I would NEVER recommend the Well Blog as anything approaching credible science. However it is excellent for getting a (probably -- HOPEFULLY -- biased) view of the way in which Drs are seen by the non-medical population.

I.e. The public hates doctors.

There's a weekly column that started a week ago in which a doctor talks about what it's been like for him to go through a breast cancer diagnosis with his wife.

The first week, many of the comments fixated on the "special treatment" his wife received because he is a doctor, how unfair that was, and how he should be ashamed of himself.

This week, there were several comments on how selfish he was for writing this column about his own feelings, since his wife had the cancer diagnosis, not him. Oh, and how this selfishness typified the arrogance that all doctors are guilty of. Apparently all feelings experienced by family members of a cancer patient are completely irrelevant. Especially if those family members happen to be medical professionals.

It's really sobering as a medical student to know that you are entering a profession in which a significant (hopefully) minority of patients will express nothing but vitriol towards you for having the effrontery to try and help them with traditional western medicine.

Do you want to know why I hate hierarchical models?

Because each model takes 3 days to run.

Therefore, every mistake you make, every typo, every minute change to the model, is a three day mistake.

And also I love that stata auto-resets the "set more off" option to off every time you start running things again after the models stops for some reason. So you don't get auto-scrolling. Instead the model pauses and waits for you to hit the space bar.

So things take EVEN LONGER because the model pauses at 2AM, and just sits there doing nothing while you sleep when it should be processing.

I love stata sometimes.

None of this would be a big deal if my mentor actually understood that things take so long. For a while I don't think he believed me when I told him that it took 3 days for the model to run every single time I ran it. Now I think he does, but he still harbors these fantasies that things will be done far more quickly than they will be.

And the pressure goes straight onto my shoulders.

Oh how I wish I were a person who could be like, "Not my fault! His problem! I don't care what he thinks!"

But I'm not.